HIV gets lion’s share of Kenya-US health deal

HIV testing.

HIV services have received the highest allocation in Kenya’s new health cooperation framework with the US.

The Sh208 billion agreement over five years also suggests that HIV services may be absorbed into the national Social Health Authority (SHA) through reimbursements to facilities.

A Kenyan court, however, on Thursday temporarily halted implementation of the ‘landmark’ health aid deal over data privacy concerns. It follows a case filed by a consumer rights lobby seeking to stop the alleged transfer and sharing of Kenyans' personal data under the agreement.

Many Kenyans have raised concerns the deal could allow the US to view personal medical records such as their HIV status, TB treatment history and vaccination data. The next hearing will be on February 12 next year.

The agreement shows the US will spend $14.2 million (Sh1.84 billion) on HIV laboratory commodities and $57.2 million (Sh7.44 billion) on HIV treatment and related commodities next year.

The next biggest allocation is Global Health Security (GHS) to support Kenya in preventing, detecting and responding to infectious disease threats (Sh64.3 million) and tuberculosis Sh24.9 million).

For treatments, the next biggest allocations go to malaria ($16,866,693), maternal and child health (Sh64.8 million), and TB (Sh22.1 million).

This is not new funding but replaces the money Kenya used to receive every year through the US President’s Emergency Plan for Aids Relief (Pepfar).

From next year, Kenya is expected to gradually increase its domestic funding to eventually take over these commodities by the end of the framework period in 2031.

The framework also outlines how HIV services could shift into Kenya’s national insurance system as part of a wider plan to make the country more self-reliant.

The agreement states: “[Kenya-US] may seek to update the Social Health Authority (SHA) benefits package to include HIV, TB and other donor-funded services in standardised reimbursement rates for public, faith-based and private providers.”

If implemented, this would mark one of the biggest shifts in HIV financing in two decades, as health facilities would receive reimbursements for attending to HIV patients instead of depending primarily on external funds.

The agreement also details the transition of US-funded healthcare workers, many of whom support HIV, to the Kenyan government by 2028.

Next year the US will fund 28,668 frontline healthcare workers, many attached to HIV and related services. Kenya begins absorbing 13,293 of them from 2028.

Kenya and the US signed the five-year agreement that will replace the health funding previously channeled through the defunct Pepfar and USAID last week.

The deal, signed by US Secretary of State Marco Rubio and Prime Cabinet Secretary Musalia Mudavadi, commits the US to provide as much as $1.6 billion (Sh207 billion) over five years.

In return, Kenya must raise about $850 million in domestic resources over the same period.

Kenya will receive a large portion of the Sh207 billion grant first, but the amount will decline each year until 2031, when Kenya should fully finance its HIV treatment, prevention and other health services.

President Ruto promised “every shilling and every dollar will be spent efficiently, effectively and accountably.”

“The framework we sign today adds momentum to my administration’s universal health coverage that is focused on supply of modern equipment to our hospitals, efficient and timely delivery of health commodities to our facilities, enhancement of our health workforce and health insurance for all, leaving no Kenyan behind,” Ruto said during the signing ceremony.

“This facility will also boost disease surveillance and emergency preparedness.”

The agreement is part of the America First Global Health Strategy (AFGHS) and Kenya was only the first of 50 countries expected to sign by the end of December.

The US is slowly reducing its health funding through AFGHS and wants countries like Kenya to take over most of the costs. The US will still help, but with smaller and more targeted support.

Rubio said the US will help countries build their own health systems over the next five years and stop being too reliant on donations.

“That money is not just going to be spent to provide medicine and care; it’s going to be spent to improve the domestic infrastructure, health care infrastructure, so that in five or six or seven or eight years, countries will say we no longer need this much assistance,” he said.

The funding will be spread over five years from April next year.

UNAids welcomed the agreement, calling it a major shift in global health cooperation.

The agency said, “It builds on decades of shared commitment between the US and Kenya through the US President's Emergency Plan for Aids Relief (Pepfar) and represents a renewed demonstration of shared solidarity, co-investment, self-reliant systems and resolve to save lives, reduce new HIV infections and advance progress towards ending Aids in Kenya.

The US deal marks the end of Pepfar as the main external funder of the national HIV programme. Pepfar has been the backbone of Kenya’s response for two decades, supporting antiretroviral treatment for more than 1.3 million people and financing critical health workers, commodities and community programmes.

In the most recent cycle, Pepfar provided around Sh43 billion, roughly US$322 million, in a single year. It also supported tens of thousands of health workers across all 47 counties and financed large segments of the supply chain, laboratory systems, prevention programmes and data infrastructure.

Those funds traditionally flowed through USAID and partner organisations, rather than directly through Kenya’s own systems.

The new agreement ends that model. Funding will now move more directly through government systems under a government-to-government framework.

UNAIDS described the pact as “a milestone in the future of global health cooperation, bringing renewed momentum to advance Kenya’s outstanding response to HIV and US leadership in the global HIV response.” It highlighted that the agreement with Kenya is the first in a series of 50 similar bilateral arrangements the US intends to sign with other countries.