PROF. ALLAN RAGI: KENYA MUST ACT NOW TO SECURE SUSTAINABLE FINANCING FOR HIV RESPONSE

For more than three decades, Prof. Allan Ragi has been at the centre of Kenya’s fight against HIV and AIDS, working at the intersection of public health advocacy, policy development, community mobilisation and civil society engagement.

Now, as Kenya confronts a major shift in international health financing, the veteran public health advocate is warning that the country must move with urgency to secure alternative and sustainable sources of funding for HIV and other related interventions.

Ragi, the Executive Director and Board Secretary of the Kenya AIDS NGOs Consortium (KANCO), has argued that the reduction and disruption of United States support for HIV/AIDS programmes has created an urgent financing challenge that cannot be wished away.

His message is particularly significant because it comes from a leader who has witnessed the evolution of Kenya’s HIV response from the early years of the epidemic to the era of large-scale international financing, treatment expansion and community-led interventions.

Ragi has more than 35 years of experience as a public health specialist, policy advocate and community networks leader, with much of his career devoted to strengthening Kenya’s response to HIV, tuberculosis and other public health challenges.

His warning comes at a critical moment.

The United States has historically been one of the most important sources of external financing for HIV programmes in Kenya, with support delivered through initiatives including the President’s Emergency Plan for AIDS Relief, commonly known as PEPFAR.

The funding disruption that began in 2025 has already had consequences across Kenya’s health system. A 2026 study published in BMC Public Health found declines in recorded uptake of HIV testing, pre- and post-exposure prophylaxis, antiretroviral therapy and tuberculosis screening following the US funding cuts. Researchers also reported disruptions to logistics, health information systems and the health workforce. 

These developments underscore why Ragi believes Kenya needs to look beyond traditional donor support.

## A financing model that must change

For years, international development partners have played a critical role in supporting Kenya’s HIV response. Their contributions have helped finance treatment, prevention, testing, community programmes, commodities, health workers and systems that have enabled millions of people to access essential services.

But the latest funding crisis has exposed the vulnerability of relying heavily on external resources.

According to a report from the Center for Epidemiological Modelling and Analysis at the University of Nairobi, external health funding in Kenya fell from Sh126 billion in the 2024/25 financial year to Sh54 billion in 2025/26. The reduction affected programmes including HIV and tuberculosis. 

For Ragi and other health-sector stakeholders, the lesson is clear: Kenya must accelerate the transition towards domestic and diversified financing.

That does not necessarily mean abandoning international partnerships.

Rather, it means creating a health financing system in which international assistance complements, rather than substitutes for, domestic investment.

Kenya’s HIV response requires predictable financing because HIV is not a short-term emergency that can be addressed through temporary interventions. People living with HIV require continuous access to treatment and monitoring. Prevention programmes require sustained investment. Community organisations need resources to reach vulnerable populations. Testing and early diagnosis must continue even when external funding declines.

A sudden interruption can therefore undo gains accumulated over decades.

## Protecting the gains made

Kenya has made significant progress in its HIV response. The expansion of antiretroviral therapy has transformed HIV from what was once widely regarded as a devastating and often fatal disease into a manageable chronic condition for people who have sustained access to treatment.

But those gains cannot be taken for granted.

The evidence emerging from Kenya following the funding disruption demonstrates how quickly weaknesses can emerge when financing, commodities, personnel and community systems are affected.

A study of HIV clinics in Kenya, Uganda and Tanzania found that, during the first five weeks following the US funding withdrawal, new patient enrolment fell by 59 per cent compared with the same period in 2024, while viral-load testing fell by 33 per cent. 

Such figures demonstrate why Ragi’s call for alternative financing is not simply a question for economists or government budget planners.

It is ultimately a question of lives.

Every missed test, interrupted treatment, unavailable commodity or disengaged patient creates a potential gap in the HIV response.

## The role of government

One of the most important responses will therefore have to come from the Kenyan Government.

Domestic health financing must increasingly reflect the reality that Kenya cannot build a resilient health system while depending excessively on external assistance.

This requires stronger budgetary commitments to HIV, TB and other essential health programmes, while ensuring that resources are efficiently utilised and reach communities.

It also requires better integration of HIV services into the wider health system without undermining the specialised and confidential services that many people living with HIV depend upon.

A 2026 qualitative study conducted in Thika found that the rapid integration of HIV services into general primary care following the funding shock raised concerns about confidentiality and stigma among some patients. The study also documented reports of antiretroviral therapy rationing, missed visits and interrupted monitoring. 

The transition to domestic financing must therefore be carefully planned.

## Diversifying the funding base

Alternative financing will also require Kenya to think beyond the traditional government budget.

Private-sector partnerships, innovative financing mechanisms, philanthropic support, community contributions and carefully structured partnerships with development institutions could all form part of a broader financing architecture.

But diversification must be accompanied by accountability.

Every shilling committed to the HIV response must generate measurable impact. Governments, donors, civil society organisations and implementing partners must strengthen transparency, monitoring and evaluation so that limited resources achieve maximum results.

This is an area where organisations such as KANCO have an important role to play.

KANCO brings together civil society organisations working on HIV, TB and other public health challenges, providing a platform through which community voices can influence policy.

Ragi’s long experience gives him a unique perspective on the importance of ensuring that communities are not left out of financing decisions.

## Civil society cannot be sidelined

As Kenya seeks alternative funding, the role of civil society must remain central.

Community organisations have historically been among the most effective links between health systems and populations that may otherwise struggle to access services.

They reach people living with HIV, young people, vulnerable households and communities in difficult-to-reach areas.

They also play a critical role in fighting stigma, encouraging testing, supporting treatment adherence and holding institutions accountable.

Any transition from donor financing to domestic financing must therefore protect these community structures rather than weaken them.

The challenge is particularly urgent because international HIV financing itself is under pressure globally.

A 2026 analysis by KFF and UNAIDS found that donor government funding for HIV programmes in low- and middle-income countries fell by $2.1 billion in 2025, representing a 25 per cent decline from the previous year. It was the largest single-year decline since the global HIV financing scale-up began.

Kenya cannot therefore assume that international funding will return to previous levels.

Indeed, the Global Fund has also reduced its HIV allocation to Kenya for the 2026–2028 period by 18.2 per cent, further underscoring the need for a more sustainable financing model.

This makes Ragi’s call for alternative financing particularly timely.

## A moment for strategic leadership

The current crisis could ultimately become an opportunity for Kenya to build a stronger and more sustainable health financing model.

Instead of responding to each donor withdrawal as an emergency, the country can use the moment to develop a long-term strategy for financing HIV and other essential health interventions.

That strategy should include increased domestic investment, stronger health insurance mechanisms, efficient procurement, private-sector partnerships, continued engagement with international partners and protection of community-based organisations.

It should also recognise that prevention is often cheaper than dealing with the consequences of new infections and advanced disease.

For Prof. Ragi, whose career has been closely associated with Kenya’s HIV response, the issue is therefore bigger than replacing one donor with another.

It is about changing the architecture of health financing.

The United States funding cuts have delivered a difficult lesson: external assistance can be enormously valuable, but it cannot be the only pillar supporting a country’s essential health services.

Kenya must now build a system capable of sustaining its HIV response regardless of changes in the political or economic priorities of foreign governments.

That will require leadership, innovation and political commitment.

Above all, it will require placing the needs of people living with HIV and communities at the centre of the conversation.

Ragi’s intervention is consequently a call for action at a pivotal moment.

After decades of progress, Kenya cannot afford to allow financing challenges to reverse the gains made against HIV and AIDS.

The country has the institutions, expertise and experience to chart a new path.

What is required now is the determination to finance it.

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