Kenya has had to redirect its aid programmes to fill the gap after the United States’ withdrawal of its foreign aid funding. President Trump rode into office on a “Make America Great Again” (MAGA) clarion call, championing the interests of the American people over those of other countries. To this end, he issued Executive Order No. 1,4169 on January 20, 2025, freezing US donor funding worldwide. Major health initiatives in Kenya supported by PEPFAR, USAID, and CDC were crippled, endangering millions who rely on these services. 

The US contributes Sh24.9 billion out of Sh80.5 billion, which is approximately one-third of Kenya’s national health programme budget. This has led to a halt to key programmes in critical illnesses such as HIV, tuberculosis, malaria, and maternal health, nutrition and immunisation. Organisations such as the Mission for Essential Drugs and Supplies (MEDS), Intercontinental Medical Statistics (IMS), UNICEF, and the World Food Programme (WFP), which rely on US support for the procurement and distribution of life-saving medicines, have also been impacted. 

The halt has affected 41,547 PEPFAR-supported staff who now face uncertainty, while another 10,982 employees have already lost their jobs. Critical health data systems, such as Kenya EMR, Chanjo KE, Damu KE, and KHIS2, are now facing breakdowns due to a lack of maintenance, cybersecurity vulnerabilities that expose sensitive health data, and weak disease surveillance, all of which delay responses to public health emergencies.

There is also a growing backlog of unpaid obligations which threatens the financial stability of health facilities.

The gaping hole left by the withdrawal of funding has exposed the heavy reliance on foreign aid in a critical sector, such as the health sector, highlighting the need for swift action to address the shortfall and prevent the collapse of existing health infrastructure. 

Immediate alternative funding sources are required, combined with policy action, to ensure that critical sectors, such as health, are financed through domestic mechanisms to ensure long-term sustainability. 

For a more resilient health system, the country needs to initiate structural reforms that will make it more self-reliant in matters of health. Local pharmaceutical production, innovative financing, and decentralised health governance are a good starting point, given that Kenya has a robust pharmaceutical sector that has the potential to scale up the manufacturing of essential medicines, reducing dependency on foreign aid while stabilising the shaky supply chains.

Kenya is the largest producer of pharmaceutical products in the Common Market for Eastern and Southern Africa (COMESA) region, accounting for approximately 50% of the region’s market share. Furthermore, Kenya serves as a central hub for pharmaceutical manufacturing in the East African region, benefiting from various initiatives aimed at pharmaceutical development. By leveraging this power, the country can turn its current health crisis around. 

Other policy reforms are key to addressing the gaps in procurement, financing, and contract execution. Strengthening local financing mechanisms, such as health insurance schemes and public-private partnerships, is also crucial for sustainability.

As a short-term measure, engaging the US government diplomatically may help restore some level of funding or technical assistance during the transition.

The government has issued an advisory on the impact of the USAID withdrawal on the health sector, demonstrating awareness of the current crisis. What is now required is the political will to implement the necessary reforms.