Kenya should invest own HIV funds, ensure accountability
Evelyn Samba and Mercy Onsando
Recently, reports that the government through Kenya Medical Supplies Authority (Kemsa) distributed phased out antiretroviral (ARV) therapy drugs shocked and angered Kenyans and stakeholders.
The drugs in question were phased out in 2019 due to adverse effects on patients.
This came on the heels of a dispute between the government and the US over the management of the distribution of a large batch of ARV drugs and other donated health supplies that had stuck at the Port of Mombasa since mid-January.
A report published on Devex, a media platform for the global development community, provides perhaps the best documented description of the problem.
That the issue under dispute is which entity will distribute the drugs: Kemsa or US-based private company Chemonics?
The US through USAid and Kemsa had a five-year contract that ended in 2020. USAid then asked the Global Health Supply Chain - Procurement and Supply Management — implemented by Chemonics and a consortium of partners — to procure HIV, malaria and family planning commodities for Kenya instead of Kemsa.
Last year, Kemsa faced allegations of corruption and mismanagement of Covid-19 funds.
Health Cabinet Secretary Mutahi Kagwe said USAid decided to not use the State corporation for distribution of HIV drugs because it did not trust Kemsa.
In response, the government demanded Sh90 million in importation taxes on the drugs, saying it wasn’t a tax-exempt government-to-government donation, but has since withdrawn this demand.
According to civil society groups, though, the government is still insisting the drugs be delivered through its own system and not USAid’s private partner, creating the ongoing impasse.
When the story of stuck ARVs at the port broke, Kagwe said the issue had been resolved and the consignment had been released, a position USAid disputed.
However, the development that the phased out ARVs had been flagged off for distribution to the counties speaks loudly about the crisis at hand — the supply of ARVs is not secure.
At the root of the crisis are two facts: One, Kenya, a lower middle-income country, largely depends on external sources for treatment and care for its more than 1.5 million people living with HIV; and two, corruption and mismanagement of resources is putting the lives of the millions at risk.
Experts have for the past five years expressed concern about of the challenge of funding HIV response.
According to a policy brief published by the National Aids Control Council in 2018, Kenya spends approximately Sh86.37 billion on HIV response with ARVs being allocated more than half of that amount.
Only 17 per cent of this HIV expenditure is from the government sources — 63 per cent is funded through international aid, 10 per cent through household contributions while the other 10 per cent is funded by ‘other sources’.
Kenya’s reclassification to lower middle-income status in 2015 may see it miss out on aid as donors will likely prioritise low-income nations.
Efforts to increase domestic funding to HIV response need to be accelerated. The Kenya Aids Strategic Framework II (2020/21-2024/25) targets to increase domestic financing for the HIV response to 50 per cent by 2025.
Question is: where will the rest of the funds come from if international aid sources continue to dwindle as it has been projected? Precisely the reason why disputes with donors are not helpful.
The concerns by the US about integrity issues at Kemsa are valid. A majority of Kenyans also share same feelings after Kemsa botched the management of Covid-19 supplies and funds last year.
To ensure people living with HIV are guaranteed the care and treatment they need, the government should increase domestic funding to HIV response and ensure funds and supplies are handled accountably. — Samba is the country director at Deutsche Stiftung Weltbevoelkerung (DSW) while Onsando is chief executive of the Health NGOs Network