Kenya and the United States have signed a historic KES 325 billion ($2.5 billion) health agreement that fundamentally overhauls how American aid is delivered, moving funds directly to the Kenyan government instead of through international NGOs.

This five-year pact is the first of its kind under the new “America First Global Health Strategy” and represents a high-stakes pivot for Kenya’s health sector. The deal follows a tumultuous year that saw the abrupt dismantling of USAID and sweeping funding freezes that severely disrupted essential health services across the country.

A New Funding Philosophy

Under the agreement, the U.S. will contribute approximately KES 220 billion ($1.7 billion), while Kenya will co-invest KES 110 billion ($850 million). The funds are earmarked to combat HIV/AIDS, malaria, and tuberculosis, as well as to bolster the country's emergency preparedness and national surveillance systems.

The new model intends to cut out intermediary NGOs, a move the U.S. State Department argues will reduce waste, end a “culture of dependency,” and build sustainable, self-reliant national health systems. Proponents suggest that by funding Kenyan institutions like KEMSA and the Ministry of Health directly, the money will more efficiently reach frontline clinics and healthcare workers.

This strategic shift is a core tenet of the America First strategy, which prioritizes bilateral agreements and co-investment from recipient nations. The goal is to have countries take over key functions and reduce long-term reliance on foreign assistance.

High Stakes After a Year of Disruption

The deal comes after a period of intense uncertainty for Kenya's health system. An executive order in January 2025 paused most U.S. foreign assistance, leading to the eventual dismantling of USAID. This triggered what one report described as a system “folding in on itself,” with devastating consequences.

NGOs and health workers reported severe disruptions earlier in the year:

• Tens of thousands of Kenyan health workers faced layoffs.
• HIV prevention programs, ART clinics, and maternal health services were suspended or reduced.
• Patients arrived at clinics fearing they would die, asking for longer prescription refills as services disappeared.
• The collection of critical health data was halted, hampering the country's ability to track disease outbreaks.

While the new agreement promises stability, it also places immense pressure on Kenya’s public financial management systems. Concerns about corruption and weak accounting procedures have historically been a challenge, with some donors withdrawing funds in the past. Success will depend on robust accountability to ensure the direct funding translates into better health outcomes for Kenyans.

As part of the deal, Kenya has committed to progressively increasing its own health budget and absorbing thousands of U.S.-funded health workers by 2028, a significant step toward the self-reliance envisioned by the new American strategy.