The abrupt reduction of US funding for HIV / AIDS , TB, malaria and other essential health programs creates an immediate public health crisis in Kenya and other African, Asian and Latin American countries heavily reliant on external support. This report, based on the “Kenya Health Sector Transition Roadmap, 2022-2032” offers urgent guidance on prioritizing funding transitions and determining the appropriate pace for a successful and sustainable shift in this emergency setting, while considering other disease burdens and priorities.
While the roadmap finalized in 2022 focused on the need for Kenyan Ministry of Health to gradually (over 10 years between 2022 and 2032) transition away 90% of essential health funding from donor programs towards a domestically funded health system, in the era of US government budget cuts during the first quarter of 2025, it serves as an emergency financing guide since funding cuts may cost the lives and livelihoods of hundreds of millions of individuals around the world. The report provides a roadmap for this transition, focusing on key areas such as essential commodities, service delivery, human resources, information systems, and infrastructure. The report also analyzes the current funding landscape, identifying opportunities and challenges in sustainable financing. Key recommendations include increasing health sector budgets, prioritizing commodity funding, strengthening local manufacturing, and reforming the Social Health Insurance. The report also proposes a monitoring and evaluation framework to track progress in the transition.
Prioritizing Funding Transitions
The following areas should be prioritized for immediate funding transitions to mitigate the impact of the funding cuts:
- Life-Saving Commodities: Prioritize life-saving commodities for the prevention and treatment of high-burden diseases, such as HIV, TB, malaria, and neglected tropical diseases. This includes:
- Antiretroviral (ARV) medications for adults and children
- Essential medicines for opportunistic infections
- Vaccines for preventable diseases
- Essential medicines and supplies for maternal and child health care
- Therapeutic foods and micronutrient supplements for the treatment of malnutrition
- Essential Services: Focus on transitioning funding for essential health services, such as:
- HIV testing and counseling (HTC)
- Elimination of mother-to-child transmission (PMTCT)
- Community health services, including those provided by community health workers and volunteers
- Immunization programs
- Maternal and child health care
- Malaria prevention and treatment
- Tuberculosis diagnosis and treatment
- Health Information Systems: Maintain funding for data collection and analysis to monitor the impact of the funding cuts and inform response strategies.
Determining the Pace of Transition
The pace of transition should be accelerated to address the immediate funding gap and prevent disruptions in service delivery. The following factors should guide the pace:
- Severity of Funding Cuts: The extent of the funding reduction and its impact on essential programs.
- Domestic Resource Availability: The ability of the government and other domestic sources to fill the funding gap.
- Health System Capacity: The ability of the health system to absorb and manage the transition process.
- Disease Burden: The prevalence of HIV and AIDS and the urgency of maintaining treatment and prevention programs, alongside other high-burden diseases.
Recommendations for Developing Countries
- Emergency Budget Allocation: Immediately allocate emergency funds to cover the projected shortfall in external financing for essential commodities and services.
- Prioritize Life-Saving Commodities: Focus on securing an uninterrupted supply of life-saving commodities, such as ARV medications, essential medicines for opportunistic infections, and vaccines.
- Strengthen Local Manufacturing: Accelerate efforts to establish local manufacturing of essential commodities to reduce reliance on imports and improve cost-effectiveness.
- Reform Health Financing Mechanisms: Fast-track reforms to health financing mechanisms, such as public health insurance, to mobilize additional resources. Increase coverage for essential services that are facing cuts into the budget.
- Optimize Service Delivery: Implement strategies to improve efficiency and reduce costs in service delivery, including task-shifting and integration of services.
- Mobilize Additional Resources: Explore all avenues to mobilize additional resources, including partnerships with the private sector, civil society, and other donor countries.
- Increase advocacy for the replenishment of international organizations funding substantial portions of essential services including the Global Fund to fight AIDS, TB and malaria, GAVI, United Nations agencies, the World Bank and IMF, large foundations, private sector funds and initiatives such as Product (RED), debt-to-health and others.
- Monitor and Evaluate Impact: Establish a robust monitoring and evaluation framework to track the impact of the funding cuts and the effectiveness of response strategies.
In the immediate term, where should the money come from?
In an emergency setting where urgent funding is necessary, governments can consider the following sectors and budgets to redirect resources towards health:
1. Non-essential Expenditures:
- Defense and Military: In emergency situations, a temporary reduction in defense spending can free up significant resources for immediate healthcare needs.
- Large-scale Infrastructure Projects: Delaying or scaling down non-critical infrastructure projects can release funds for urgent health priorities.
- Administrative and Operational Costs: Streamlining government operations and reducing non-essential administrative expenses can create savings for health investments.
2. Contingency Funds and Reserves:
- Emergency Funds: Governments typically maintain contingency funds for unforeseen crises. These funds can be readily deployed to address urgent health needs.
- National Reserves: In exceptional circumstances, governments may consider drawing on national reserves to finance critical health expenditure.
3. Re-prioritization within Existing Budgets:
- Social Sector Programs: While maintaining essential social services, governments can explore re-allocating funds from less critical social programs to health priorities.
- Education and Research: While education and research are vital, a temporary shift in funding priorities towards health may be necessary in an emergency.
- Debt-Relief, Suspension or Restructuring: Developing countries should collectively negotiate for a temporary suspension of debt repayments and restructure payment of at least 40% of it to be extended another 5 to 10 years.
- 4. Innovative Financing Mechanisms:
- Tax Reforms: Implementing temporary tax measures, such as increased taxes on non-essential goods or services, can generate additional revenue for health.
- Public-Private Partnerships: Partnering with the private sector can leverage additional resources and expertise for health investments.
- Tax and duty incentives including part-waivers for companies verifiably covering substantial portions of essential services as part of CSR either nationally, internationally or around communities.
5. External Assistance:
Multilateral Organizations: Seeking emergency funding from multilateral organizations, such as the World Bank or the International Monetary Fund, can provide immediate financial support.
Donor Countries: Engaging with donor countries and appealing for increased aid can help fill funding gaps for health priorities.
Countries with budget surpluses or balancing budgets such as Norway, China, Taiwan, Saudi Arabia and other Middle Eastern oil exporters.
Conclusion
The abrupt reduction of US funding for HIV/ AIDS and other essential health programs necessitates an immediate and decisive response from developing countries. By prioritizing essential services, accelerating the pace of transition, and implementing the recommendations outlined in this report, countries can mitigate the impact of the funding cuts and ensure the continued provision of life-saving treatment and prevention programs to their populations, while addressing other health priorities and disease burdens.
Click or scan to read a copy of the Health Sector Transition Roadmap for Kenya.
The principal author, Chris Alando, is the CEO of Globesolute Corporation and a Health Financing advisor for African Union RECS and SADC Member States.