“We cannot rely on foreign entities to take care of our health… we need to change our mindset”: immediate impacts of the 2025 U.S. government funding cuts on health in Kenya

Abstract

In 2024, the United States Government (USG) distributed $730 million of development assistance for health to Kenya, much of which supported HIV care; in early 2025, almost all USG funding was abruptly halted. This study explores the impacts of the funding cuts on uptake of health services and on physical and mental health in Kenya. This study adopted a socioecological framework, hypothesizing that funding changes would create ripple effects from macro to micro levels, ultimately shaping individuals’ health and wellbeing. Routinely collected data on service uptake from the Kenyan Health Information System were analyzed for temporal trends, with attention to changes following the funding cuts. We interviewed 14 key informants representing government, civil society and multilateral agencies to explore perceptions and experiences of the impacts of these funding cuts. Striking declines are visible in recorded uptake of HIV testing, pre- and post-exposure prophylaxis for HIV, antiretroviral therapy, co-trimoxazole among people living with HIV, and tuberculosis screening among people living with HIV. While these indicators cannot determine whether declines reflect reduced service availability, changes in care-seeking behavior, or other factors, interview participants described layoffs of technical personnel, collapse of logistics systems and failures in the health information system as undermining the pipeline of data and services, with disproportionate impacts on HIV and TB services, particularly for key populations. Loss of employment and/or access to care led to deteriorations in mental health and in some cases, forced relocation. Long-term concerns included rising drug resistance, increasing HIV and TB incidence, greater morbidity and early mortality. The withdrawal of USG health financing in Kenya constituted a system-level shock. Routine government health data paints an alarming picture, whether reflecting true declines or breakdowns in the data system itself. As global health financing contracts, Kenya’s experience illustrates challenges increasingly faced by donor-dependent health systems globally. As more countries negotiate bilateral aid agreements, it is critical to understand the differential impacts of the initial funding cuts, what priorities communities and front-line workers have for re-building better, and what compromises are (and are not) acceptable in negotiations with external funders of critical services.