Uncertainty looms for 41,547 Kenyans employed under the President’s Emergency Plan for AIDS Relief (Pepfar) programme following the U.S government’s decision to freeze foreign aid, despite a waiver granted by President Donald Trump for emergency services.
These employees collectively earn an annual salary of Sh17.4 billion through Pepfar’s HIV programme. They provide essential HIV services including clinical services, community support and programme management across the 47 counties, from health facilities at Level 3, 4, 5 and 6.
A brief on the impact of the U.S government’s re-evaluation and realignment of foreign aid was prepared by the National Syndemic Disease Control Council (NSDCC), the National Aids and STI Programme (Nascop), and the Kenya Medical Supplies Authority (Kemsa).
Dated 30 January, 2025, the report analyses the implications of the U.S executive order to assess and restructure foreign aid on Kenya’s HIV response and offers recommendations to mitigate the effects
“During the Financial Year 2024/25, Pepfar’s support for the HIV programme is allocated to the following areas—human resources for health at a total annual cost of Sh17,376,505,147 (October 1, 2024, to September 30, 2025),” reads a section of the document.
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The uncertainty surrounding thousands of jobs comes as Trump’s attempt to dismantle USAid faces a setback. A federal judge blocked his administration from placing 2,200 agency workers on paid leave.
However, in his ruling, Judge Carl Nichols declined to grant petitioners’ requests to restore grants, reinstate contracts, or reopen USAID offices.
USAid provides support to more than 100 countries globally, including Kenya.
For smooth service delivery amid shaky funding move, the Kenyan government is expected to allocate an emergency kitty of Sh4 billion to maintain health workers handling HIV services across the country.
“At the time of writing the brief, data availed by county governments through Council of Governors, showed a total of 9,501 frontline staff at the cost of Sh380,618,320 annually were supported under the U.S Government grants,” reads a section of the report.
The report proposes support of human resources audit to ascertain in the current U.S Government supported staff and align with Kenya Human Resources for Health approved structures. It further proposes audit of the vertical service delivery systems model and identify areas that require integration of HIV services into mainstream service delivery systems without losing the gains and mitigating stigma and discrimination.
People living with HIV under the umbrella body of National Empowerment Network of People Living with HIV/Aids (Nephak) in Kenya welcomes the integration of HIV services into the broader health programme, but cautions that this may lead to stigma.
“Integration of HIV into other health programmes should be handled with care to ensure that HIV related stigma does not lead to treatment interruption,” says Nephak executive director Nelson Otwoma.
Presidential Health Advisor Dr Daniel Mwai describes the suspension of foreign aid as a radical shift at a time when the Kenyan government was preparing for a gradual transition from foreign to domestic health financing.
He regrets that the government shall not be in a position to transition all employees serving under USAID to the health system, but rather adopt an integration model.