Kenya, US deal will strengthen healthcare systems, says Duale

Kenya has for long relied heavily on donor support to run its healthcare system, particularly programmes targeting HIV, TB and malaria that were funded through United States Agency for the International Development (USAID), that has since exited. In the wake of the transition, a Government-to-Government (G2G) funding model was introduced through the signing of a five-year cooperation framework. Health Cabinet Secretary Aden Duale explains how the new model will work.

Is Kenya experiencing stalled programmes following the exit of USAID? Are there service delivery or commodity disruptions?

Our health programmes have not stalled and services across the country remain operational. What we experienced was a temporary shock in certain programme areas, which we anticipated as part of the transition. However, Kenya’s health system has shown strong resilience, and together with our partners we moved quickly to stabilise services.

A few services targeting key and vulnerable populations experienced adjustments, including some drop-in centres and methadone-assisted therapy services for people who inject drugs. These issues were addressed through coordinated action between the government and our health partners.

Essential services such as HIV treatment, TB care, and maternal and reproductive health services continue uninterrupted.

How will the G2G funding model with the United States work?

Under the Government-to-Government funding model, resources from the United States Government will flow directly to the Government of Kenya, rather than through external implementing partners.

The funds will be managed through Kenya’s public financial management systems, channeled through the National Treasury, and implemented based on agreed work plans, budgets, and performance milestones.

This approach reflects important lessons we have learned. It is designed to strengthen government systems so they can sustainably deliver services to Kenyans, while ensuring transparency, accountability, and alignment with Kenya’s national health priorities.

What are the implementation timelines under the G2G framework?

Implementation will begin once both governments sign the agreement, and the framework is expected to run for an initial period of five years. At the end of that period, both sides will review progress and may agree to extend the partnership.

We are currently in a transition phase focused on strengthening oversight systems, reviewing programme portfolios, and preparing implementation structures. This process is expected to be completed by July 2026, after which the programme will progressively scale up with performance-linked disbursements.

How will accountability and expenditure tracking be ensured under the new arrangement?

Kenya already has strong public financial management systems, and these will be the backbone of accountability under the Government-to-Government arrangement. Funds will be tracked through IFMIS, overseen by the National Treasury, audited by the Office of the Auditor-General, and subject to scrutiny by Parliamentary oversight committees, alongside joint reviews with the United States Government.

In addition, the framework provides for audit mechanisms, including performance audits, supply chain audits, co-investment audits, and statutory compliance reviews.

Kenya is expected to secure Sh850 million in co-financing. Is it annual or one-off?

The Sh850 million is expected to be an annual commitment, and it will be progressively incorporated into Kenya’s Medium-Term Expenditure Framework. The resources will come from a combination of Ministry of Health allocations, county health budgets, ongoing health financing reforms under the Social Health Authority, and efficiency gains within existing health spending.

The lesson we have taken from past financing arrangements is clear: Kenya must progressively increase domestic investment in health to safeguard long-term stability and national ownership of these programmes.

Will the government allocate additional domestic resources to complement G2G funding?

Yes. A key principle of the G2G framework is progressive domestic resource mobilization. The Government is committed to increasing allocations for essential health commodities, strengthening primary healthcare financing, supporting county contributions, and integrating vertical programmes into broader health financing reforms.

Is there a strategy to reduce donor dependency over time?

Yes. Kenya has a clear sustainability strategy that focuses on health financing reforms under the Social Health Authority, integration of HIV and other vertical programmes into primary healthcare, strengthening national procurement and supply chains, digital efficiency improvements, and partnerships with the private sector.

What key performance indicators will be used under the new model?

Performance monitoring will focus on health outcomes and system performance. On the disease control side, we will track indicators such as ART coverage, viral load suppression, maternal mortality, and malaria deaths among children under five.

At the health systems level, we will monitor budget absorption, commodity stock-out rates, and timely disbursement of funds, while financial accountability will be assessed through audit compliance, fulfilment of co-financing commitments, and efficient use of resources.

Are there structures to guarantee transparency and accountability under G2G?

Yes. Kenya already operates under a robust public accountability framework, including the Public Finance Management Act 2012, Public Audit Act 201 5 and oversight by the Controller of Budget, Parliamentary Public Accounts Committees, County Assembly oversight mechanisms, and multi-stakeholder health sector coordination forums.

The G2G model builds on and strengthens these existing systems rather than replacing them.