Kenya to shoulder health funding burden as donors exit in 5 years

Kenya is facing a rapid transition away from its biggest health donors.

Under current plans, Kenya’s Gavi support will end by 2032, while the new US health agreement commits Kenya to fully self-fund US-backed programmes by 2031.

Gavi has been supporting Kenya's national vaccination programme since 2001, providing vaccines and related supplies worth more than $950 million (Sh122.5 billion), according to the Ministry of Health.

The new US-Kenya health agreement also requires Kenya to take over US-funded programmes and absorb thousands of health workers by 2030.

The US will put in about $1.6 billion (Sh206.4 billion) over five years while Kenya must raise roughly $850 million (Sh109.65 billion) over that period, after which US funding will phase out.

These timelines put Kenya on track to lose most external health financing within five years.

“The framework is intended to continue for five years, after which the participants plan to review implementation of the activities under this framework and may extend the duration by mutual decision,” the US-Kenya deal says.

Under Gavi’s rules Kenya entered an “accelerated transition” in 2022 and was on track to fully fund its vaccines by 2029.

However, in May this year, Health Cabinet Secretary Aden Duale pleaded with Gavi for more time, proposing to revert to a slower “Preparatory Transition” phase.

Gavi did extend Kenya’s exit schedule: its five-year financing phase was stretched to eight years, giving Kenya until about 2032 to fully assume costs.

“This partnership has been truly transformative,” said Treasury PS Dr Chris Kiptoo. “Thanks to Gavi’s support, Kenya’s immunisation programme has been significantly strengthened, ensuring that millions of children across the country are protected from vaccine-preventable diseases.”

These donor exit dates come just as Kenya continues to lean heavily on aid. Health experts note that Kenya’s health system is dangerously dependent on a handful of donors.

A World Bank health economist points out that four donors — the US, the Global Fund, the UK and Gavi — supply 89 per cent of Kenya’s external health aid.

“Donor dependency is also high in key health sub-sectors in Kenya, particularly TB, HIV and immunisation. Kenya’s health sector has a high donor concentration, with just four donors (the United States, the Global Fund to Fight Aids, Tuberculosis and Malaria, the United Kingdom and Gavi, the Vaccine Alliance) making up 89 per cent of health ODA (official development assistance),” Dr Kenneth Munge, a health economist with World Bank, said in a study.

He noted that this extreme concentration means Kenya is vulnerable to any one donor pulling back.

Kenya’s domestic health budget has remained stagnant, and actually shrank in some years. For example, the 2023-24 allocation to the Health Ministry was Sh141.2 billion, only 11 per cent of the total budget, down from Sh146.8 billion (about 12 per cent) in the prior year.

That means even without adding new services, the share of government spending on health remains well below Africa’s Abuja target (15 per cent of total budget).

Analysts warn that this flat or falling trend — despite Kenya’s rising middle-income status — leaves little breathing room for new obligations. Once donors step away, the government would have to make urgent budget shifts.

Last year, a survey in 15 counties indicated Kenya was not ready to foot the bill for childhood vaccines when donor funding ends by 2032.

At least 77 senior county officials from 15 counties were interviewed and all agreed that neither the national nor county governments show any readiness to handle the costs of immunisation independently once Gavi exits.

These vaccines cost about Sh36 billion every year but the government only provides Sh4 billion, being cost of freight and distribution. Treasury has previously failed to timely disburse co-financing payments to Gavi.

Earlier last year, the country experienced stockouts, which former Health Cabinet Secretary, Susan Nakhumicha attributed it to outstanding claims of unpaid funds for distribution. The government owed the supplier between Sh1.5 billion and Sh2 billion. “Vaccines should be accommodated in the national annual budget. I think they should factor it in the national budget because it needs a huge sum of money,” said one county official.

The study, “Are we ready to transition from the Global Alliance for Vaccines and Immunization support? Perceptions from 15 Kenyan counties”, was published in the Pan African Medical Journal.