Kenya will have to dig deeper into its own pockets to keep essential health programmes running as international donors retreat, with billions of shillings in external support disappearing from the sector.
The shift is already being felt in programmes dealing with HIV, tuberculosis, malaria, maternal health and the supply of essential medicines, forcing the government to prepare for a future in which it carries a much larger share of the health bill.
State Department for Medical Services PS Dr Ouma Oluga said the change in donor priorities has left Kenya with little choice but to strengthen domestic financing of healthcare.
Speaking during a Radio Generation interview on Wednesday, Oluga said international support had for years helped Kenya fund a wide range of health programmes through bilateral and multilateral partnerships.
However, he said the support began becoming uncertain about a decade ago as development partners started focusing more on problems within their own countries.
“For the last 10 years, this has been shaky because the world is reorganizing itself. People are becoming more nationalistic, including those friends of Kenya. Nationalistic means they are now looking more inward,” Oluga said.
The impact of the changing funding environment is reflected in figures from the University of Nairobi Centre for Epidemiological Modelling and Analysis (CEMA).
External financing for health fell from Sh126 billion in 2024/25 to Sh54 billion in 2025/26, leaving a Sh72 billion shortfall.
The United States has traditionally been the biggest contributor, accounting for more than 60 per cent of Kenya's external health funding in 2018/19.
But American support was disrupted in January 2025 after President Donald Trump ordered a freeze on foreign assistance as part of his administration's “America First” policy.
USAID implementing partners in Kenya were issued with stop-work directives, affecting programmes dealing with HIV, malaria, tuberculosis, maternal health and other services.
USAID had been giving Kenya about Sh60.63 billion each year, with approximately 80 per cent of the funding going to health programmes, according to a recent analysis of the sector.
The disruption raised concerns over the availability of medicines and other supplies. UNAIDS warned that a prolonged suspension of funding could result in shortages of antiretroviral drugs and other HIV commodities.
Kenya was also left facing the task of mobilising more domestic resources for programmes that had relied heavily on support from the US President's Emergency Plan for AIDS Relief (PEPFAR).
To manage the transition, Kenya negotiated a new five-year financing arrangement with the US.
The agreement, signed in December 2025, provides for up to Sh206.4 billion in American support over five years, while Kenya committed approximately Sh109.65 billion in domestic health financing.
The arrangement is expected to progressively shift more of the responsibility for funding and implementing health programmes to the Kenyan government.
Oluga said the agreement was designed with an eventual end to American support in mind.
“We said, let’s do five years. These five years, we are giving you money, but progressively you increase your money until five years. Then we exit,” he said.
The US is not the only partner scaling down its involvement.
Oluga said Germany was among the first countries to withdraw, while Denmark's remaining support through the Danish International Development Agency (DANIDA) will run for only about six months.
He said he signed the final letter concerning the Danish support two weeks before the interview.
“GIZ, the Germans were the first ones to withdraw. Danish International Development Agency (DANIDA) is only six months. I signed the last letter two weeks ago. It’s only six months, Danida done,” he said.
DANIDA's exit is likely to affect health centres that have benefited from its support.
“We will have no more money in DANIDA, and it’s the one that has been supporting health centers,” he maintained.
Britain has also been cutting back on traditional development assistance. The Independent Commission for Aid Impact estimates that UK aid will decline by about 42 per cent, equivalent to Sh838.5 billion, over four years.
Kenya is among longstanding partners expected to feel the impact as Britain reduces traditional bilateral programmes.
Oluga said the UK's Foreign, Commonwealth and Development Office (FCDO), previously known as DFID, had already reduced its health commitments to Kenya.
“DFID, or now what was called FCDO, Foreign Commonwealth Development Organization, basically the British, they deprioritized. They said two years, no more, and that two years is remaining nine months,” he said.
The squeeze in donor funding has also hit specific disease programmes.
CEMA found that Global Fund support for tuberculosis dropped from Sh4 billion in 2024/25 to Sh1.74 billion in 2025/26.
Funding for malaria fell from Sh4.25 billion to Sh1.53 billion during the same period, while the shortfall in financing for health commodities reached Sh34.655 billion.
For Oluga, the funding changes signal a fundamental shift in how Kenya must approach healthcare financing.
“Basically, the error of using somebody else’s money to finance your healthcare system is gone.”
The government is therefore under growing pressure to build a reliable domestic funding base that can keep essential services running and protect progress made in fighting HIV, tuberculosis, malaria and other diseases.
The challenge will be to replace the shrinking external support without leaving critical health programmes and supplies exposed to funding gaps.