•Family planning in Kenya is financed largely by donors from the UK, United States and Germany., and they have set a deadline.
•The United States President's Emergency Plan for Aids Relief (Pepfar) is also reducing its financing to Kenya.
The incoming government faces deep cuts in donor funding to health programmes.
Most affected will be financing for family planning, HIV, malaria and TB programmes, which are heavily donor reliant.
This is because donors have been forcing Kenya to foot its health bill by gradually reducing aid. After all, it is now a middle-income country.
President Uhuru Kenyatta’s administration had already negotiated short extensions and some will expire in 2025.
Most affected is family planning which the government was expected to almost fully finance from 2022.
However, the Health Ministry last year negotiated with USAID and Bill and Melinda Gates to continue buying contraceptives for Kenya until 2025.
The agreement will see Kenya access FP commodities valued at Sh2.5 billion annually.
“In the initial plan we were to have 100 per cent funding from the government for our family planning commodities but because of the Covid-19 pandemic’s economic impact we have requested to push this to 2025/26, two years forward,” Issak Bashir, the head of Department Family Health at the Ministry said.
Family planning in Kenya is financed largely by donors from the UK, United States and Germany.
Three donors—the UK's Department for International Development, the USAID and the Bill and Melinda Gates Foundation had said the cutbacks will be gradual, until 2025 when the government should fully take over the bill.
According to a breakdown given in 2019, the government was to spend at least Sh870 million on contraceptives 2019, while the donors spend Sh1.3 billion.
The government's share would rise to Sh1.1 billion in 2021, Sh1.3 billion in 2022, and Sh1.7 billion in 2023. By 2024, the government should fully take over. However, Kenya was unable to pay its share since the Covid pandemic struck.
Kenya had been buying all its FP commodities until Devolution in 2013 when that money was redirected to the 47 newly created counties, leaving the national budget without a dedicated line item for the purchase of FP commodities.
Because there was no guidance to any of the county governments to make provisions, this reform resulted in an erratic FP commodity funding landscape, forcing donors to come in.
Studies show Kenya faces serious donor dependency in its health system.
External financing makes up more than half of all funding for immunizations, tuberculosis and HIV, where for every dollar spent by the Kenyan government on immunizations, TB, and HIV, donors spend 3.3, 2.8, and 1.7 additional dollars respectively.
The United States President's Emergency Plan for Aids Relief (Pepfar) is also reducing its financing to Kenya.
These cuts will be felt strongly by the incoming administration.
Since 2015, Pepfar has been cutting HIV/Aids funding in low-burden areas.
By 2020, it had already stopped funding HIV activities in Garissa, Isiolo, Lamu, Mandera, Marsabit, Tana River, and Wajir because they account for only one per cent of Kenya’s HIV burden.
Pepfar said it expected the Kenyan government to fill in the gap.
Pepfar said Kenya has become one of its biggest beneficiaries since 2003 but is doing too little to increase domestic funding to fight HIV.
“Pepfar Kenya has one of the largest programmes and budgets, but falls in the bottom third when it comes to hosting country government co-financing,” former Pepfar boss Dr Angeli Achrekar in February said in a planning letter in February this year.
Overall, Pepfar's budget for Kenya was cut from Sh68 billion in 2017 to Sh40.7 billion in 2022.
The US government contributes more than 50 per cent of total HIV/Aids funds in Kenya every year.
Kenya’s problem is also that it relies on only a few donors.
Four donors make up nearly 90 per cent of all health official development assistance.
These are the United States (62 per cent), the Global Fund to Fight Aids, Tuberculosis and Malaria (18 per cent), the United Kingdom (five per cent), and Gavi (four per cent).
This is according to the Brookings Institution, a think-tank based in Washington that researches health financing.
“A concentrated donor environment creates vulnerabilities,” it says in a study titled, Reducing Kenya’s health system dependence on donors.
“If very few stakeholders contribute the majority of funds to a pool of external resources, then any change in an individual donor’s funding level or behaviour could have a large impact on external resources available for a particular sector or sub-sector.”
Edited by Kiilu Damaris