Health funding falls 7pc amid America's WHO withdrawal

Finance and policy expert Dr Julius Muia (left) with the Institute of Public Finance Chief Executive James Muraguri during the launch of the IPF 2025 Macro-Fiscal Analytical Report in Nairobi. [Wilberforce Okwiri, Standard] Many Kenyans are one hospital bill away from poverty, according to a new report, and this may get worse in the coming days in the wake of funding gaps following the US withdrawal from the World Health Organisation (WHO). The withdrawal is expected to affect some of the Kenyan government's health programmes, including the provision of antiretroviral (ARVs). According to the latest Institute of Public Finance (IPF) Macro-Fiscal Analytic Report, between the 2018-19 and 2022-23 financial years, Kenya's consolidated health budget declined by seven per cent in real terms. This constituted a reduction in the health budget as a share of GDP from 2.1 per cent to 1.6 per cent and a fall in real per capita terms from Sh5,597 to Sh4,791 in 2023. This is despite additional allocations of up to 0.2 per cent of GDP in the 2019-20 through 2021-22 financial years for Covid-19 mitigation measures such as the vaccine roll-out and access to affordable medical care. While allocations for 2023-24 increased slightly in real terms, the national budget for 2024-25 was cut back again. According to the report, the decline in budgetary allocation in real per capita terms in recent years falls well short of international benchmarks, putting Kenya's dream of attaining Universal Health Coverage (UHC) in question. Also, donor on-budget financing for health has gone down and accounts for a majority of the overall decline in government spending. IPF Chief Executive James Muraguri said the situation is further complicated by the new policy direction of newly sworn-in US President Donald Trump's administration. The US, formerly WHO's largest donor, had played a key role in funding global health initiatives. This, Muraguri said, underscores the urgency of mobilising domestic revenue. "Additionally, Kenya's poverty rate remains high for its level of income perpetuated by a dual labour market that generates a small number of well-paying jobs in the formal sector and leaves most in the informal sector on much lower wages," he said during the report's launch in Nairobi yesterday. The immediate impact of the US withdrawal from WHO on Kenya's health sector funding is unclear. Trump's move drew criticism from public health experts on his first day back in the White House. Trump has long been critical of the United Nations' health agency, and his administration formally began a withdrawal from the WHO in July 2020 as the Covid-19 pandemic continued to spread. IPF hinted at a rising concern over the implication the withdrawal might have on Kenya's health sector. "External on-budget support declined from 22 per cent of the total national health budget in FY 2021-22 to just nine per cent in FY 2023-24. This is lower than the pre-pandemic level of around 15 per cent," The report read in part. According to the think tank, off-budget Official Development Assistance (ODA) for health is believed to be higher than on-budget support. The think tank questioned the lack of published data to verify the claims. The report says there e is a greater focus on secondary and tertiary care at the national level, partly due to the sector's structure, with the national government overseeing higher levels of care and policy development, while primary health care services are largely under the purview of county governments.

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