What Form will the US-Kenyan Partnership on Health Take in the Coming Years?
August 15, 2009
What form will the US-Kenyan partnership on health take in the coming years? Will it be one in which the U.S. stays very deeply engaged over many years, while the Kenyan government takes on greater ownership of health programs, ensuring long-term sustainability? That is a macro question we will be pondering during and after this trip. There is no immediate answer, and much hope, but there are several important issues to consider, including the state of the overall bilateral relationship.
The United States has made a very big play the past several years in regard to health in Kenya. The major driver is the President's Emergency Plan for AIDS Relief (PEPFAR). Of the 300,000 people on life-sustaining therapy today in Kenya, the U.S. supports 190,000 of them. Expenditure this year on HIV/AIDS programs is vast, $534 million. Kenya joins with South Africa and Nigeria as among the three top countries for U.S. health investments in the past five years. It is a global priority where much is at stake for the United States and Kenya.
The next phase of U.S. engagement in health in Kenya involves concluding a negotiated Partnership Framework with the Kenyan government that lays out reciprocal commitments – for both the U.S. and Kenya -- over the coming years. That process is under way but has not yet been concluded; it is expected that Kenya will be among the first countries where such a framework does come into force in 2009.
There is no doubt the U.S.-Kenyan partnership has had substantial impacts. Mention has already been made of the significant numbers of Kenyans now on ARVs. Cooperation in joint planning has improved a great deal. HIV prevention efforts have moved ahead through a high level task force, and prevention investments have contributed to significant reductions in new HIV cases and the lowering of national HIV prevalence. A new Demographic and Health Survey (expected to be released at the end of September) reportedly documents recent major health gains. Kenyan-U.S. technical cooperation is strong, and the younger generation of nurses, doctors, lab technicians and outreach workers have demonstrated great skill and commitment.
Kenya has seen 700 ARV sites established; much innovation in counseling and testing; big gains in male circumcision (especially in the Nyanza province), and the nearly universal prevention of mother-to-child transmission of HIV.
The Kenyan government’s performance has however been very mixed. Official budget levels for health remain modest and 35-40 percent of annual budget allotments typically go unspent. We heard during our visit many observers repeatedly claim the government commitment on health is "anemic." We heard also repeatedly that the official procurement system remains highly problematic, prone to disruptions ("stockouts") and mismanagement.
The broader political environment has intruded negatively. The unsteady unity government cobbled together in spring 2008 (following the violent internal crisis after the December 2007 elections) resulted in the health ministry getting cleaved into two entities. This unnatural and costly partitioning carries from the national to the provincial to the district levels. The Ministry of Medical Services is now a separate entity from the Ministry of Public Health and Sanitation, the former led by a personality identified with Prime Minister Raila Odinga's Orange Democratic Movement (ODM), the latter by someone identified with President Kibaki's Party of National Unity.
In this same period, the number of districts in the country has multiplied, creating further administrative fragmentation.
One final important point: Our bilateral relations are shifting towards confrontation over highly sensitive political and human rights issues and this could potentially impact the future partnership on health, should the bilateral relationship deteriorate. Last week Secretary Clinton visited Kenya and delivered an exceptionally tough message. She communicated that President Obama is deeply concerned that there be concrete progress on several fronts: an independent tribunal to investigate the extreme violence that killed 1500 and displaced 350,000 following the December 2007 elections; police reform; constitutional reform; and strengthening of anti-corruption institutions. This marks the opening of a delicate, uncertain new phase in U.S.-Kenyan bilateral relations.
