Donor funding declines as Kenya shifts toward health self-reliance

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As African countries brace for a future with less external health financing, a new question is beginning to shape policy conversations: what happens when the funding that has long sustained health systems starts to fade?

Across Kenya and much of Africa, donor support has historically underpinned critical health programmes, from infectious disease control to emergency response and workforce training.

Shifting geopolitical priorities and economic pressures are now redrawing that landscape, forcing governments to confront a more urgent reality of self-reliance.

Health experts say the system is under strain but also in transition, with innovation, collaboration, and local capacity increasingly positioned as part of the solution.

“Development funding for global public health has dropped by more than 10 billion US dollars in 2025 alone,” said Dr. Caroline Kisia, Africa Director at Project ECHO (Extension for Community Healthcare Outcomes).

“External health aid to Africa has also significantly declined, which means countries must rethink how they finance and deliver healthcare.”

Yet even as financing gaps widen, the burden of disease continues to rise. Africa is facing a growing number of outbreaks, alongside persistent challenges such as antimicrobial resistance, workforce shortages, and the impacts of climate change on health.

In this shifting landscape, attention is turning to how existing systems can be made more efficient, particularly at the frontline where most patients first seek care.

One approach gaining traction focuses on strengthening the capacity of healthcare workers through virtual, case-based learning networks that connect specialists with providers in lower-level facilities.

Rather than replacing funding, experts say such models are helping stretch limited resources by improving diagnosis, treatment, and referral systems.

“At the core, it’s about leveraging technology to ensure that the limited number of specialists we have can mentor frontline healthcare workers on an ongoing basis,” said Jennifer Njuhigu, Tele-ECHO National Coordinator.

“That way, patients can get the best possible care even in primary healthcare settings.”

Dr Teresa Lotodo, Consultant Pathologist and Senior Lecturer at Moi Teaching and Referral Hospital and the Academic Model Providing Access to Healthcare (AMPATH), said the approach has helped bridge long-standing gaps between urban referral hospitals and rural facilities.

“It has made it possible for knowledge to be transferred from referral facilities to lower-level facilities,” she said.

“Healthcare workers are now more confident in making diagnoses, and we are seeing earlier diagnosis and treatment, which leads to better outcomes.”

Dr Lotodo added that improved referral pathways have allowed patients to be escalated more efficiently when needed, while also enabling follow-up care to continue closer to home.

Experts, however, were quick to caution against overstating the role of knowledge alone.

“If you have knowledge and skill, you will not use those skills if you don’t have the tools,” said Professor Gunturu Revathi, Head of Clinical Microbiology at Aga Khan University Hospital.

“If you have the tools but no knowledge, they will not be used effectively. The two must go hand in hand.”

That balance is at the centre of ongoing debates around health system reform. While digital learning and collaboration can expand expertise and reduce inefficiencies, gaps in infrastructure, equipment, and staffing remain a significant constraint, particularly in underserved areas.

Still, there is growing evidence that targeted capacity building can influence outcomes across a range of health priorities.

In Kenya, virtual learning networks have been used to strengthen antimicrobial stewardship, helping clinicians improve how antibiotics are prescribed and reducing the risk of drug resistance. Facilities are also reporting better infection prevention practices and stronger teamwork across disciplines.

In other cases, improved knowledge sharing has supported earlier detection of diseases such as cancer, where late diagnosis has long been a challenge.

“Raising the index of suspicion among frontline providers can significantly improve survival rates,” Njuhigu said.

The approach has also shown promise in outbreak response. By enabling faster dissemination of information and real-time collaboration, health workers are better equipped to identify and contain emerging threats before they escalate.

“If outbreaks can be identified early, that gives us the best chance of containing them cost-effectively,” Dr. Kisia said.

This comes as Kenya prepares to host global and regional leaders at the World Health Summit Regional Meeting 2026, where discussions are expected to focus on health workforce development, financing, and strengthening health systems across the continent.