Funding cuts threaten HIV/Aids treatment efforts  

What you need to know:

Donor spending on HIV programmes was more than double that of the government as at 2017.

Overall, external financing makes up at least half of public health spending.

HIV positive people fear losing access to free treatment services as Kenya coasts towards a crisis while donor funding declines amid insufficient domestic funds, reveals a NationNewsplex review of HIV financing.

Misuse of available resources has worsened the situation in a subsector that is heavily reliant on donor funding. Donor spending on HIV programmes was more than double that of the government as at 2017, according to a study by experts from Strathmore University, World Bank Kenya country office and Duke University in the US.  

The study that was released recently finds that the US President’s Emergency Plan for AIDS Relief (Pepfar) is the primary funder of Kenya’s HIV response, having contributed over half of total HIV/AIDS funds and over 80 per cent of funding from external sources since 2012.

But Pepfar reduced its disbursement to Kenya by nearly three-quarters in four years, from Sh17.3 billion in 2016 to Sh4.9 billion in 2019. The US Government’s overall spending for HIV/Aids programmes in Kenya also declined by six per cent from Sh42.1 billion in 2016 to Sh39.7 billion in 2019, indicates figures from the United States Agency for International Development (USAID).

Overall, external financing makes up at least half of public health spending.

Free treatment

The declining donor support for HIV programmes has alarmed HIV positive people like Nancy Mwashigadi. The 49-year-old has been living with HIV for the past 17 years. “Last year, we were hit with a shortage of Septrin, a drug that helps to prevent opportunistic infections. Many of us also lost jobs and we relied on well-wishers for food donations,” says Ms Mwashigadi.

Even though the situation has improved this year, the community health worker is worried about the declining funds. “At the moment, we are given ARVs for one month compared to previous years where we could get medications for three months. Before, HIV positive people used to get free treatment for other illnesses but now when you go to the hospital, you are told you can only get ARVs and Septrin,” she says.

Dr Catherine Ngugi, Head of Program at National AIDS and STI Control Programme, says a client on first line ARV drugs uses about Sh7,000 but if they move to second line medications it would cost about Sh19,000 and Sh16,000 for a child. A patient may develop resistance to first line drugs if they do not adhere to prescribed therapy.

“This is just the commodities and not operational costs. Around 85 per cent of the spending on HIV and Aids programmes are from donors. With the government now providing money, we are going to be self-reliant soon,” she says.

Dr Ngugi says the government is engaging local manufacturers to produce the drugs in the country to help reduce costs, so that the external funding can be used for programmatic activities and not for buying drugs and other products.

Uganda is already manufacturing ARVs and is exporting them to other African countries.

However, the Kenya Private Sector Alliance Chairman, Patrick Obath, says that for this to happen, there is a need to address the cost of electricity and transport.

“The intellectual capacity is there but all these impediments are making it impossible to manufacture these drugs. Uganda is already manufacturing ARVs and is exporting them to other African countries but they had to go through many hurdles to get where they are now,” he says.

A report released by Health Policy Plus, an organisation that advances health policy priorities, shows that nominal public allocation for health has increased overtime but not enough to compensate for reduced donor spending. Additionally, the proportion of the total government budget (national and county) allocated to health is still below national commitments while key national strategic programmes, such as HIV and malaria, heavily rely on donor support.

An analysis of the national and county budgets by the Ministry of Health for fiscal years between 2013/14 and 2019/20, shows that the share of public budget allocated to health dipped from 7.8 per cent in the fiscal year 2012/13 to 5.5 per cent in the devolution transition year. The proportion then increased gradually to peak at 9.5 per cent in the 2018/19 fiscal year before decreasing marginally to 9.1 per cent the following year.

During the reviewed period, the share of the public budget allocated to health remained lower than the 15 per cent recommended in the Abuja Declaration. 

Speaking during the 2021/2022 Budget reading at the Parliament, Treasury Cabinet Secretary Ukur Yatani said Kenya allocated Sh5.8 billion to fund HIV/AIDS programmes, an amount that experts and activists say is insufficient.

 “We need about Sh25 billion to provide lifesaving ARV drugs and other commodities to Kenyans who need them, so it’s a drop in the ocean, '' says Dr Vernon Mochache, Deputy Director Research National AIDS Control Council.

However, he says, it is encouraging that the government has set aside money for HIV/AIDS for the first time.

According to Dr Adel Ottoman, Director for Preventive and Promotive Health Services in Homa Bay County, delays in the disbursement of the funds by the national government is a problem.

“They send the money when the time is almost over so we don’t have enough time to implement our plans. The budget is read in June but the first disbursement arrives in October,” says Dr Ottoman.

A statement released on June 14 this year by the Chairman of the Council of Governors Martin Wambora revealed that Treasury was yet to disburse money to county governments amounting to Sh102.6 billion two weeks to the end of the 2020/2021 financial year. The shortfall has affected public service delivering, including healthcare, by county governments.

Treasury released Sh43.5 billion, 42 per cent of the money owed, on June 23, just a day before a deadline issued by governors for a shutdown of operations.

Among the about 1.5 million people living with HIV in Kenya is Ms Mary Waceke, 58, a widow who is hopeful that she will not miss the lifesaving drugs that have kept her alive since 2007.

“Every time I watch the news about reduced money for HIV projects I worry that one day I will go to the clinic and be told there are no drugs. I am hopeful that the government will sort this problem out. I have no choice but to trust in God,” she says.