Cash crunch hits Kenya’s war on HIV in counties

Activists march during a past international Aids conference. PHOTO | AFP
Activists march during a past international Aids conference. PHOTO | AFP 

Kenya requires a hefty $597.6 million (Sh62 billion) to combat the burden of HIV and Aids in the country’s 47 counties, an official report shows, signalling the hard task ahead of raising funds to fight the disease.

The report titled “Kenya Aids Response Progress Report 2016” published by the National Aids Control Council (NACC) shows that Nairobi leads among the counties with the widest gap between resources available against the need.

Nairobi, for instance, has a Sh3.3 billion ($32 million) deficit of the monies intended for key HIV programmes aimed at managing patients and curbing new infections.

“The total resource gap based on five programme areas namely: key population, HIV testing, counselling, voluntary medical male circumcision, elimination of mother-to-child transmission of HIV and antiretroviral (ARV) therapy is $246 million [Sh25 billion],” read the report.

Following Nairobi, which has the largest (11.3 per cent) number of people living with HIV is Homa Bay county with a $22 million resource gap while Kisumu at $21 million with Siaya and Migori having $18.3 million and $13 million deficit respectively.

As at 2015, at least 897,644 adults were on the national ARV treatment programme, an increase from 656,359 people living with HIV in 2013, according to Kenya Aids Response Progress Report 2016. Children living with HIV are about 36,000.

The uncertainty comes at a worrying time when the US government, Kenya’s largest foreign donor has partly suspended its funding to the Ministry of Health following corruption scandals at the State Department.

In a statement, US Ambassador to Kenya Robert Godec said that America had suspended about $21 million (Sh2.2 billion) in aid to the Health ministry.

This represents “only a small portion of the overall US health investment in Kenya, which exceeds $650 million (Sh67 billion) annually”.

“We took this step because of ongoing concern about reports of corruption and weak accounting procedures at the ministry,” said Mr Godec.
“The action is intended to ensure that healthcare spending reaches those in need, and to protect US taxpayer money.”

The envoy said they were working with the ministry on ways to improve accounting and internal controls with the hope of restoring the funding when appropriate progress is made.

Mr Godec said, however, that the US support for life-saving and essential health services, such as providing anti-retroviral therapy for a million Kenyans, was not affected by the suspension.

“We will continue to provide funding for health services and medications going directly to Kenyans,” he said.

Local funding for HIV response remains a significant challenge that needs to be addressed in order to provide scalable integrated health services for the vulnerable.

The report shows that only six counties have cash shortage of less than $1 million including Isiolo, Lamu, Tana River, Wajir, Marsabit and Samburu.

In February, this paper reported that HIV programmes were facing lukewarm support from foreign donors due to corruption.

Development partners on HIV financing like the Clinton Healthcare Access Initiative (Clinton Foundation), Japan International Co-operation Agency, and DfID have stopped funding HIV programmes in Kenya.

“These partners have partially stopped financing the components of HIV that they used to cover in the health sector,” said an NACC official.

The Network of People Living with HIV and Aids in Kenya (Nephak) had last November reported that a sizeable number of Kenyans have had to stop taking ARVs due to a lack of food supplements usually provided by the government.

This came to light after an interim audit report, which highlighted a suspected Sh5.3 billion loss at the Health ministry showed that Sh515 million was lost through an NACC programme meant to buy food and rations for HIV-infected people.

The Ethics and Anti-Corruption Commission 2016 Report on the Afya House, ministry’s headquarters’ investigation is yet to be released.

“This (lack of food supplements) has been the situation since 2012 and the response from the Ministry of Health has been that there is no funding for such and that HIV treatment services are devolved to counties,” said Nephak executive director Nelson Otuoma.

Last fiscal year, donors contributed 62 per cent (Sh19.1 billion) of the Health ministry’s development budget of Sh30.6 billion in the same period, a figure expected to drop this year.

Much of this donor funding was allocated to HIV, reproductive health, immunisation, and health systems support, according to national and county health budget Analysis for the financial year 2015/2016).

The government is identifying options for long-term financing of these costs through the creation of a fund that will complement resources from the Exchequer, according to the Kenya Aids Response Report 2016.

In the year ending June 2016, Sh73 billion was spent on HIV programmes, 55 per cent of these funds came from the US government.

The 2016 health budget analysis showed that although the donor contributions specifically to HIV and malaria increased over the period, over-reliance on foreign aid for the programmes of national priority raises concerns about the predictability and sustainability of these initiatives.

Donor funding went up by about Sh7 billion the year ending 2016, up from Sh12.2 billion in 2014/2015.

The number of new HIV cases is, however, likely to go up in the next three years, posing a threat to about 40 per cent of the job market while increasing the cost of productivity and insurance.

The more than 1.5 million people living with HIV are also likely to die in the next three years, according to the report, dealing a blow to the gross domestic product.

“The mpango wa kando (infidelity) upward trend is worrying and we are likely to see an increase in the number of new infections in the next three to four years from now,” said the NACC official.

“This threatens the job market and the economy since once you are infected with the HIV virus you become a government property.”

It costs the government at least Sh20,000 per year to place one person living with HIV on ARV treatment alone.

The government would need to spend Sh17.2billion on ARVs annually to cater for the 897,644 adults living with the disease.

If other costs for opportunistic diseases that come with HIV were factored in, for instance, the government would be forced to channel at least Sh35 billion yearly for the HIV treatment programme. Roughly 600,000 Kenyans living with HIV are not on treatment.

“The current Sh17 billion used yearly only caters for ARVs, without factoring in the CD4 count tests, pneumonia treatment, diabetes, and other diseases that come with HIV,” said the official.

The ideal long-standing plan for Kenya is to have a national resource envelope that provides resources annually for funding HIV treatment and related health conditions.