Shaken Foundations: The Impact of U.S. Aid Withdrawal on Kenya’s Health and Development

Alice Okwirry, a 50-year-old Kenyan mother living with HIV, now fears for her life. The Nairobi clinic that supplies her antiretroviral medicines has cut her refills from six months to just one month at a time since the United States froze its foreign aid. Mere miles away, a warehouse is stacked with millions of donated pills that cannot be delivered because funds to distribute them have dried up and also they await word form the donor on weather to distribute or not. This sudden aid halt has upended Kenya’s health services overnight – and its ripples are being felt from rural dispensaries to national programs that once kept millions alive.

Introduction: A Partnership Upended

For two decades, Kenya’s health progress has been intertwined with U.S. support. The U.S. government – through agencies like USAID, PEPFAR, and the CDC – has poured billions into HIV treatment, malaria control, maternal health, food security, and education programs across Kenya and sub-Saharan Africa.

In 2023 alone, the U.S. contributed roughly $12.9 billion to global health efforts, about 42% of all international health aid. In Kenya, that generosity translated into life-saving medicines for over 1.3 million HIV patients, widespread vaccination campaigns, and a robust health workforce largely funded from abroad. U.S. initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR) have saved millions of lives globally (over 25 million by one estimate) and dramatically expanded health services in low-income countries.

This partnership, while transformational, created deep dependencies. By 2020, just four donors – the U.S., Global Fund, UK, and Gavi – accounted for nearly 90% of Kenya’s external health funding. PEPFAR alone has financed about 60% of Kenya’s HIV programs in recent years, enabling the country to achieve an HIV treatment coverage of over 98% of adults by 2023. But that dependency meant Kenya’s health system became structurally vulnerable to any donor retreat.

In January 2025, those vulnerabilities were laid bare. A new shift in U.S. foreign policy – embodied in an Executive Order that imposed a 90-day freeze on foreign aid – abruptly shut off funding streams mid-flow. American grant government issued “stop-work” orders to projects overnight, halting disbursements even for ongoing contracts. Few exceptions were made, and even critical health programs were caught in the paralysis. This was one of the fastest and largest donor exits in modern history. The geopolitical context for this dramatic step was a mix of donor fatigue, domestic political realignment, and a desire to “reevaluate and realign” U.S. foreign assistance priorities. Regardless of motive, the immediate consequences for Kenya and other aid-dependent countries have been devastating.

This report uses Kenya as a case study to examine the real gaps left by the cessation or reduction of U.S. funding – in health commodities, systems, human resources, infrastructure, data systems, and governance. It then compares Kenya’s experience with that of other African countries like South Africa and Malawi, highlighting how donor withdrawal has affected their programs. This will be in subsequent article. Finally, it analyzes the structural weaknesses born of donor dependency and offers actionable recommendations for Kenya and similar nations to build more resilient systems in an era of donor uncertainty.

Kenya’s Health Sector at Risk: Gaps Left by U.S. Funding Withdrawal

Health Commodities and Supply Chains

Kenya’s health programs have been heavily subsidized by U.S. funding for essential medicines, diagnostics, and supplies. Out of an estimated KES 80 billion (≈$570 million) needed annually to stock the country’s health facilities, roughly KES 24.9 billion (≈$180 million), or about one-third, was provided by U.S. programs. Through initiatives like PEPFAR, the President’s Malaria Initiative (PMI), and others, the U.S. funded a vast pipeline of drugs: antiretrovirals (ARVs) for HIV, anti-malarial treatments and bed nets, tuberculosis medications, family planning commodities, vaccines, and nutritional supplements. This support was often indispensable. For example, U.S.-funded supplies were the sole source of routine mosquito nets and malaria prophylaxis for pregnant women in Kenya; their interruption “risks leaving a critical gap” in malaria prevention.

When the funding freeze hit, these commodity supply lines ground to a halt. Distribution of stocked medicines stopped due to lack of operating funds, causing pile-ups in central warehouses while clinics began rationing what little stock they had left. In the HIV program, Kenya suddenly lost the funding that comprised 60% of its resources a program that had also relied on donors for 75% of all ARVs and 67% of HIV test kits as of 2020. Thus, even though ARV shipments had already arrived in-country, the mechanism (and money) to move them to patients collapsed. In early 2025, distribution of life-saving HIV medicines was effectively “blocked”, leaving clinics like Ms. Okwirry’s with dwindling supplies. Health facilities began reporting stock-outs of everything from antiretrovirals to basic antibiotics. A former USAID official in Kenya noted that about $10 million was urgently needed just to distribute the HIV drugs sitting in warehouses, but those funds were frozen. As one Kenyan patient put it, “I was just seeing death now coming,” when she heard that the drugs might run out.

Human Resources for Health

Perhaps the most immediate shock has been to the health workforce. Years of donor support had helped Kenya hire and train tens of thousands of health workers – doctors, nurses, clinical officers, community health workers, lab technicians, data clerks, and program staff – to expand service delivery. PEPFAR alone was supporting over 41,500 health workers in Kenya, providing their salaries or stipends through donor grants. This represented a significant portion of the frontline staff in HIV, TB, and maternal-child health programs. When funding stopped, those jobs were suddenly on the line. Within weeks, counties reported laying off about 10,982 PEPFAR-funded staff due to budget shortfalls. The Ministry of Health warned that without quick intervention, the loss of nearly 11,000 health personnel would cripple services for HIV, tuberculosis, malaria, maternal health, immunizations, and more.

Every remaining health worker was suddenly stretched thinner. Clinics faced acute staff shortages as donor-paid nurses and counselors vanished. Those who remained shouldered double duty, raising the risk of burnout and undermining quality of care. Crucial outreach programs began to falter – for example, community health workers (CHWs), who deliver care in remote villages, largely depended on donor funding for their minimal stipends and training. With these funds in limbo, CHW programs were scaled back or suspended, “leading to reduced outreach and lower coverage of essential services” in rural areas. The vacuum left by departing health workers was felt most in HIV clinics (where lay counselors and peer educators suddenly disappeared) and in preventative services like family planning and immunization campaigns that rely on outreach teams. Kenya’s ability to absorb health shocks was already strained; now the human resource backbone of its system was shaken just as needs continue to grow.

Health Information and Systems Infrastructure

Behind the scenes, Kenya’s health sector relied on donor-funded technology and systems that often go unnoticed by the public – until they fail. The freeze exposed critical vulnerabilities in health data systems and supply chain infrastructure that had been maintained with U.S. support. Key national platforms like the Kenya Health Information System (KHIS2, a DHIS2-based data warehouse), the electronic medical records for HIV (KenyaEMR), the logistics management system for medicines (KEMSA’s LMIS), and specialized registries (for vaccines – “Chanjo” system, or blood services – “Damu KE”) all faced maintenance and funding gaps once U.S. technical assistance was withdrawn. Almost immediately, users reported glitches and downtime. Data reporting from the field slowed as software updates and server costs went unfunded. This impaired disease surveillance – real-time tracking of HIV, TB, and malaria trends weakened without the donor-supported systems and staff to manage data. Kenya’s capacity to detect outbreaks or monitor program performance in a timely fashion has been hamstrung by this digital disruption.

Moreover, routine supervision, training, and mentorship systems – often coordinated by donor projects – were interrupted. The Ministry of Health’s ability to coordinate hundreds of off-budget donor initiatives was already complex; with the sudden stop, it was left scrambling to even identify where gaps existed. Many contractual arrangements for public-private partnerships in health service delivery (such as faith-based hospitals supported by USAID grants) fell into limbo, revealing weaknesses in the policy and contractual framework for managing such transitions. In short, the health system’s “software” – its human and technical systems – suffered an abrupt jolt that has undermined day-to-day operations and strategic planning alike.

Service Delivery and Disease Programs

The ultimate cost of these disruptions is borne out in health outcomes. In the weeks following the funding cessation, vital services were interrupted across Kenya. HIV treatment centers scaled back patient appointments or temporarily closed some satellite clinics. Community-based HIV testing and prevention programs (including those providing pre-exposure prophylaxis and condoms) were largely paused, as their NGO implementers lost funding. Prevention of mother-to-child HIV transmission efforts and voluntary medical male circumcision campaigns also suffered cuts. This raised immediate alarm: a modeling analysis by UNAIDS projected that a prolonged aid cut could lead to 2,000 new HIV infections every day worldwide and a surge in HIV-related deaths, as treatment interruptions cause viral rebound. In Kenya – home to the world’s seventh-largest population of people living with HIV – even a few weeks of ARV supply disruption for thousands of patients risks a spike in HIV transmission and drug resistance. Winnie Byanyima, head of UNAIDS, warned that “shutting down clinics and laying off thousands of health workers” means new infections will rise and many lives are at stake.

Tuberculosis and malaria programs likewise teetered. TB clinics reported difficulties in transporting lab samples and providing nutritional support to patients as donor-backed programs stalled. Malaria bed net distribution for the upcoming rainy season was thrown into uncertainty – the U.S. had been financing 100% of Kenya’s routine net replacements, so without immediate alternative funding, rural communities might miss their net allocations. The President’s Malaria Initiative had to fire about two-thirds of its staff globally due to the budget freeze, meaning expertise and support for Kenya’s malaria control were sharply reduced. If the situation persists, experts fear a resurgence of malaria cases in endemic regions that had achieved control in recent years. Even basic childhood immunization efforts felt the pinch: while vaccine procurement in Kenya is co-financed with Gavi, the data systems and outreach operations (fuel for motorcycles, per diems for health workers) that ensure vaccines reach every child were disrupted by the loss of donor operating funds.

Community Health and Nutrition

The shockwaves extend beyond the formal health sector. U.S. development aid also supported many programs targeting the social determinants of health – nutrition, water and sanitation, and community development. One immediate casualty was food and nutrition support. The U.S. is a major funder of the World Food Programme and UNICEF’s nutrition efforts in Kenya, which provide therapeutic food for malnourished children and pregnant mothers. Those pipelines have been jolted. Field reports indicated that deliveries of “children’s food” and nutrition supplements screeched to a halt in many areas once USAID funding was frozen. In arid counties of northern Kenya, where chronic drought already leaves communities on the brink, any lapse in food aid can rapidly worsen malnutrition and even famine conditions.

Education programs have not been spared either. While Kenya’s education system is largely government-funded, U.S. aid has played a supporting role – from building classrooms and training teachers, to providing scholarships and school feeding programs in vulnerable regions. The freeze immediately put some U.S.-funded scholarship students in limbo, as university students on U.S. bursaries were suddenly told to seek alternative support or drop out. Planned construction of new school facilities under donor grants was suspended, straining an already over-capacity system. All told, the cascading effects of the U.S. funding withdrawal are touching nearly every aspect of community wellbeing. What began as a crisis in health financing is evolving into a broader development crisis: one that imperils gains in disease control, threatens to push vulnerable families deeper into poverty, and tests the resilience of Kenya’s public services.

Cascading Effects Beyond Health: The Development Spillover

The abrupt withdrawal of U.S. development support has revealed how interconnected the health sector is with wider development outcomes. In Kenya’s case, health gains of the last decades were tightly linked with improvements in other sectors often backed by donors. Now, the loss of funding in health programs is producing spillover effects: HIV, TB, and Malaria Resurgence: As discussed, cuts to disease programs risk a resurgence of epidemics. The World Health Organization warned that the disruption to HIV services could “undo 20 years of progress,” potentially leading to over 10 million additional HIV infections and 3 million more deaths” if not reversed Strain on Food & Nutrition Security: The U.S. Feed the Future initiative and Food for Peace program have long supported Kenyan agriculture and emergency food relief. With U.S. agricultural aid on pause, initiatives that provided drought-resistant seeds, farming training, or school meals have diminished. In Malawi (a comparable aid-dependent country), over 80% of all new school building projects and a significant portion of the education budget were funded by foreign donors Economic and Fiscal Shock: Beyond service delivery, the aid cutoff is causing a macro-economic ripple. Donor funds have effectively functioned as an infusion of foreign exchange and budgetary support. In Malawi, for instance, the U.S. provided about $350 million annually – over 13% of the national budget Governance and Planning Disruptions: Perhaps one of the most subtle yet important effects is how this situation has exposed weaknesses in national planning and governance mechanisms. In Kenya, a flagship health financing reform – the new Social Health Insurance Fund (SHIF) aimed at achieving universal health coverage – has been rooled and need some support in insights and that might not be forthcoming. Any technical support that could be supported using donor funds might never and that will have an impact.

In summary, the U.S. aid withdrawal is not just a funding issue – it is a stress test for Kenya’s entire development model. Health outcomes are threatened directly, and indirectly through shocks to nutrition, education, and economic stability. Community health delivery has been left scrambling: volunteer health workers lack support, medicines aren’t reaching villages, and preventive services are scaled back. Disease-specific gains (in HIV, TB, malaria) hang in the balance, with experts openly worrying about resurgences of diseases that had been in decline. What is happening in Kenya is a cautionary tale, one that is also playing out in other countries across Africa that have long relied on U.S. support.