Kenya: Charting a Course toward Sustainability

In this interview, John Ochero, Fund Portfolio Manager for Kenya at the Global Fund, discusses how Kenya is working toward sustainable financing for HIV/AIDS.

Friends: Can you provide a brief history of the HIV/AIDS epidemic in Kenya?

John: The first case of AIDS in Kenya was reported in 1984, and the disease spread rapidly after that. The Kenyan government initially tried to stem the spread by educating the public with articles in newspapers and poster campaigns, but the epidemic continued to grow.[1] The prevalence rate reached its peak of 10.5 percent in the mid-1990s.[2]

In 1999, then-President Daniel Arap Moi declared the epidemic a national disaster and a public health emergency. In response, he announced the launch of Kenya’s National AIDS Control Council.[3] Since then, the government has continued its commitment to fighting the epidemic, including through the passage of legislation in recent years aimed at reducing AIDS prevalence.

Friends: What is the state of the epidemic in Kenya today?

John: While the HIV epidemic still places a burden on Kenya’s economy and health systems, there has been major progress in recent years.[4] Since its peak of 10.5 percent prevalence in the mid-1990s, the HIV prevalence rate dropped to 6 percent in 2013 (among ages 15-49) as a result of increased voluntary counseling, testing and a scale-up of preventive and treatment services. Additionally, legislation was passed in 2006 to formally protect the rights of Kenyans living with HIV. While prevalence among women is higher than among men (7.6 percent vs. 5.6 percent for ages 15-49),[5] preventive services such as condom use and voluntary medical male circumcision have helped reduce the rate of HIV transmission.[6]

Friends: How is the fight against HIV/AIDS in Kenya funded?

John: International funding accounts for about 70 percent of HIV/AIDS expenditures in Kenya. Since 2003, the Global Fund has committed $542 million for HIV.[7] The Global Fund has had 13 grants in the country to date, six of which focused on HIV/AIDS. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest external donor for HIV in Kenya.[8] PEPFAR’s involvement has been critical to HIV prevention and treatment services and to the improvement of the supply chain management systems of the Kenya Medical Supplies Agency (KEMSA), helping to strengthen the health system.[9] Over 800,000 Kenyans are currently on antiretroviral therapy (ART) as a result of the joint efforts of the Global Fund and PEPFAR.[10]

The Government of Kenya accounts for about 16 percent of HIV/AIDS expenditures, with domestic private sources providing another 14 percent. Domestic resource investments are continuing to grow, with each stakeholder playing a critical role. As a result of collaboration among the various stakeholders, the country has been able to achieve goals such as providing HIV testing systems in nearly all hospitals and health centers.

Friends: What steps is Kenya taking to ensure that the fight against HIV/AIDS is sustainable?

John: The Kenyan government is taking steps to ensure continuous control over the HIV/AIDS epidemic, including by identifying domestic resources to contribute to the fight. The Ministry of Finance and the Ministry of Health have shown a commitment to increasing the percentage of Kenya’s Gross Domestic Product spent on health in recent years.[11] For example, as part of the PEPFAR Partnership Framework agreement, the government agreed to increase its budget for ARVs 10 percent annually between 2009 and 2013, enabling it to contribute more toward covering the costs of medication procurement.[12] The Government, in its 2030 vision strategy, has also committed to increasing its expenditure on health from 4.5 percent (2013) to 12 percent by 2018. In addition, Kenya has surpassed its Global Fund counterpart financing requirements, committing 17 percent to the country’s national HIV/AIDS program versus the required 5 percent for the current round of funding.[13]

To further mobilize resources, the government is investing in public-private partnerships. One example of these efforts is the Beyond Zero Campaign, which was launched by the First Lady of Kenya in January 2014. The Ministry of Health is coordinating this campaign, through which other domestic donors, including Equity Bank in Kenya, have already pledged $580,000.[14]

Friends: What are some of the innovative financing mechanisms and approaches Kenya is currently evaluating?

John: One of the ways the Kenyan government is looking to grow its investments in health is with an AIDS and Non-Communicable Diseases Trust Fund. Discussions on the setup of the fund and innovative ways to raise funding are ongoing and could include tax levies and debt swaps. The proposal for the Trust Fund has been endorsed by the Cabinet and awaits enactment/operationalization.[15]

Another option currently being explored is for the National Hospital Insurance Fund (NHIF), the primary provider of health insurance in Kenya, to help cover the cost of antiretroviral (ARV) drug coverage. Since the NHIF is already well established in Kenya, it could substantially increase ARV treatment coverage for HIV/AIDS patients.

Friends: What do you believe that the future holds for Kenya’s response for HIV and AIDS?

John: Amid a great deal of change in the country – including a new Constitution in 2010 and the responsibility for healthcare service delivery and resource allocation shifting to the local level in 2013 – Kenya’s commitment to fighting the AIDS epidemic has remained consistent.

Kenya was recently reclassified as a middle-income country and has one of the highest GDP growth rates in Africa. Therefore, it is well-positioned to make a larger investment of resources in health.[16] It has demonstrated a commitment to improving the quality of life for its citizens and growing its own contributions to their health. As the country’s economic transition continues, Kenyans will need to focus on ensuring that the impact of its investments in health are maximized in order to achieve long-term sustainability in the fight against AIDS.

 

Footnotes

[1] HIV & AIDS in Kenya, AVERT, 2012. http://www.avert.org/hiv-aids-kenya.htm (accessed September 3, 2014).
[2]National AIDS Control Council. Kenya AIDS Response Progress Report, March 2014. http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/KEN_narrative_report_2014.pdf.
[3]HIV & AIDS in Kenya, AVERT, 2012. http://www.avert.org/hiv-aids-kenya.htm (accessed September 3, 2014).
[4] National AIDS Control Council. Kenya AIDS Response Progress Report, March 2014. http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/KEN_narrative_report_2014.pdf.
[5]Ministry of Health. Kenya HIV Estimates, June 2014. Accessed April 9, 2015. http://www.nacc.or.ke/attachments/article/428/HIV%20estimates%20report%20Kenya%202014_print.pdf.
[6]Kenya Service Provision Assessment Survey 2010. http://dhsprogram.com/pubs/pdf/SR182/SR182.pdf (accessed September 8, 2014).
[7] http://portfolio.theglobalfund.org/en/Country/Index/KEN.
[8] http://data.pepfar.net/country/funding?country=Kenya&year=2013.
[9] Ochero, John. (Fund Portfolio Manager for Kenya), interview with author, July 22, 2014.
[10] Ochero, John. (Fund Portfolio Manager for Kenya), email from author, March 27, 2015.
[11] Kenya, World Health Organization. http://www.who.int/countries/ken/en/ (accessed December 10, 2014).
[12] Partnership Framework Between the Government of the Republic of Kenya and the Government of the United States of America to Support the Implementation of the Kenya National AIDS Response as Articulated in the Kenya National AIDS Strategic Plan III 2009/10-2012/13. The President’s Emergency Plan for AIDS Relief. http://www.pepfar.gov/documents/organization/135213.pdf (accessed September 9, 2014), p. 8.
[13] Ochero, John. (Fund Portfolio Manager for Kenya), email from author, April 9, 2015.
[14] “New ‘Beyond Zero Campaign’ to improve maternal and child health outcomes in Kenya,” January 30, 2014, UNAIDS. http://www.unaids.org/en/resources/presscentre/featurestories/2014/january/20140130beyondzerocampaign/ (accessed September 11, 2014).
[15] The Global Fund to Fight AIDS, Tuberculosis and Malaria (2013). Sustainability Review of Global Fund Supported HIV, Tuberculosis and Malaria Programmes, Final Report. Geneva, p.63.
[16] The World Bank. “Kenya: A Bigger Better Economy.” News, September 30, 2014. http://www.worldbank.org/en/news/feature/2014/09/30/kenya-a-bigger-better-economy.