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November 22, 2018

Why Kenya must address sustainability in the funding of HIV, TB and Malaria

Kenya relies heavily on the Global Fund and the United States government to finance HIV programmes.
Kenya relies heavily on the Global Fund and the United States government to finance HIV programmes.

The level of health financing in Kenya remains low. This is despite the high burden of disease that continues to ail the country. Data shows that between 2013/14 and 2017/18 financial years, the total budgetary allocation to health has ranged between 3.7 per cent and 4.1 per cent of total budget.

In 2014/15 financial year, the health allocation was 3.17 per cent rising to 3.8 per cent in 2014/15 and 4.1 per cent in both 2015/16 and 2016/17.

In 2017/18, the allocation fell to 3.9 per cent. 

Health experts and practitioners as well as leading health-financing players have decried the low of investment.

A report commissioned by the Global Fund on tuberculosis, HIV and Malaria in 2017 identified three critical challenges in health financing.

These include continued over-reliance on external funding in the past and in future, imbalance in funding areas from the government from specific disease perspective and areas of investment focus.

Kenya relies on external funding to finance HIV, TB and malaria. An estimated Sh77 billion (USD 770million) is accounted for by donors, mainly the Global Fund, the US government and other donors, which amounts to 92 per cent of the total need estimated at Sh84 billion.

At the end, the donors invest 1.3 times the total amount of the Ministry of Health budget. This constitutes 3.9 per cent of the total national budget for the FY 2017/18.

Secondly, the future projections in funding do not indicate significant shift from the current and past state of financing.

The report estimated that during 2018-20, the Global Fund will account for 18 per cent of the total external funding for HIV, TB and malaria while the US government with contribute a massive 81 per cent. Overall, 8 per cent of the budgetary need is not met in HIV and a 26 per cent in TB.

Overall, HIV response attracts 80 per cent of the external funding for the three diseases, with most of this coming from the US government. Global Fund is the leading partner for TB, which is the smallest of the three programmes.

The two donors play a balanced role for malaria. Notably, malaria is the only programme in which the government invests more than the donors and where the budgetary need is met.

The third challenge revolves around the specific areas of investments by the donors.

Donors largely invest in the areas of treatment and prevention activities, which include commodities. Donors also invest in programmes that are geared towards priority and vulnerable populations.

In terms of HIV, finances are largely in the anti-retroviral therapy (ART) and a number of general and targeted prevention activities.

These include Voluntary Medical Male Circumcision (VMMC), HIV counselling and testing, Elimination of Mother to Child Transmission, (EMCT), Pre-exposure prophylaxis (PrEP), and condom provision.

Other efforts include harm reduction work in key populations like Needles and Syringe Prevention (NSP) programme, Methadone Assisted Therapy (MAT), and adolescent targeted interventions.

The funding on TB focuses on care and prevention as well as investments in TB/HIV co-infection and addressing multi-drug resistance TB. Priority areas in malaria, facility based treatment services and preventive efforts that involve insecticide treated bed nets and indoor residual spraying. 

Donor partners like The Global Fund will continue to play role in financing through leveraging efforts that will ensure the sustainability of their investments by anchoring transition planning for the three diseases to Kenya’s forthcoming Health Financing Strategy through 2030. 

This strategy articulates an ambitious agenda for achieving universal health coverage through a social health insurance scheme.

 

 

 

 

 

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