Dr Githinji Gitahi Group CEO of Amref Health Africa, Dr Rose Oronje Director at Afidep Ann Mawathe Editor in Chief Defrontera during the forum .jpg
As donor funding for health decreases across Africa, a bold conversation is taking shape in Kenya one that moves beyond lamenting the loss of aid and instead focuses on self-reliance, efficiency, and systemic reform.
At a high-level Thought Leadership Series convened in Nairobi by the Kenya Editors’ Guild (KEG), journalists, policymakers, and public health leaders gathered to dissect the implications of falling Official Development Assistance (ODA) and propose new models for sustainable healthcare in the region.
“This isn’t just about donor cuts; it’s about how we redefine our approach to health,” said Rosalia Omungo, CEO of the Kenya Editors’ Guild, as she opened the forum.
“We’re here to spark a shift in narrative, and in how we hold power to account.”
The session sought to confront one of the continent’s most urgent realities: foreign funding, particularly for programs like HIV, TB, malaria, and maternal health is shrinking, leaving governments with hard choices and vulnerable populations at risk.
Reframing the Crisis: The Money Is There
Dr. Githinji Gitahi, Group CEO of Amref Health Africa, challenged prevailing assumptions about Africa’s dependence on aid.
“Kenya spends about $5 billion annually on health. Donors contribute only $1 billion. The remaining $4 billion comes from public funds and out-of-pocket spending,” Gitahi noted.
The problem, he said, is not simply about missing dollars—it’s about reorganizing and reprioritizing existing resources.
While donor-funded vertical programs have played a critical role, including the provision of ARVs for 1.4 million people, the current moment presents an opportunity to move away from fragmented interventions and toward an integrated, domestically driven system.
Gitahi emphasized a shift from a “healthcare” focus to a broader “health production” model, investing in preventive interventions like clean water, sanitation, nutrition, and urban planning.
He also called for increased public trust and investment in public health facilities.
“The best doctors and labs are often in public hospitals, but people don’t want to go there. Why? Not because of poor clinical care, but because of poor customer service. We need to fix that,” he said.
Health Promotion Through Regulation
Gitahi called on policymakers to introduce bold regulations that support healthier lifestyles.
“We must pass laws and regulations to help people live healthier lives,” he urged.
“For example, we need front-of-pack food labeling to help people identify unhealthy foods, just like we did with cigarettes.”
He also highlighted the growing burden of non-communicable diseases (NCDs)—conditions driven by processed foods, sedentary lifestyles, and poor urban design.
“Obesity, hypertension, and diabetes are now responsible for over 50% of hospital admissions in Kenya—not HIV, TB, or malaria,” he said.
Gitahi recommended regulatory action such as sugar and fast-food control, as well as investment in walkable infrastructure, street lighting, and safety to encourage physical activity.
“Walking 7,000 steps a day can reduce your risk of death by 50%. We need to start producing health, not just treating disease.”
Use Data to Drive Decisions
Finally, he emphasized the importance of localized, data-informed decision-making to ensure that health interventions meet real, on-the-ground needs.
“Different regions have different disease burdens. Some areas need more malaria medication. Others need more hypertension drugs. Centralized, supply-driven systems often result in wastage and missed priorities,” he explained.
To address this, Gitahi advocated for community-level, demand-driven procurement, powered by robust data systems.
“Let demand drive supply. Invest in local data. That’s the only way to make smart, life-saving decisions.”
The Hidden Costs of ODA Decline
Dr. Willis Akhwale, Special Advisor at the End Malaria Council, described the cascading impact of donor withdrawal.
From job losses in the health workforce to the disruption of data systems critical for patient care, the ripple effects are already visible.
“When we lose funding, we also lose the systems that track who’s taking medication, who is defaulting, and where new outbreaks might emerge,” Akhwale warned. “Without data, we are flying blind.”
He emphasized that the downturn has also hurt adjacent sectors, such as travel and hospitality, which previously benefited from health-related conferences and capacity-building events.
Still, Akhwale urged optimism. The Global Fund’s latest commitments, while reduced, have retained key support for malaria response and emergency preparedness.
But long-term resilience, he said, requires local innovation including domestic production of bed nets and medicines, community-led spraying programs, and stronger private sector partnerships.
The Real Emergency: Mismanagement and Missed Priorities
For Dr. Rose Oronje, Director at the African Institute for Development Policy (AFIDEP), the issue is less about shrinking aid and more about poor domestic accountability.
“We’ve focused too much on what we lack and too little on how we use what we have,” she stated.
“ODA cuts are just a symptom. The real crisis is inefficiency, corruption, and a fragmented view of health.”
Oronje advocated for health to be treated as a cross-cutting issue—one that touches infrastructure, education, water, and agriculture.
She urged stronger political will, tighter procurement processes, and a reorientation toward community-level care, where early screening and lifestyle education can drastically cut long-term costs.
She also called out misplaced spending driven by politics.
“Sometimes we procure items we don’t even need because someone benefits from the transaction. That must change,” she said.
Journalists as Watchdogs and Change Agents
The event also reinforced the critical role of journalists in this transition.
Omungo urged editors and reporters to look beyond headlines, ask tough questions, verify health data, and embrace complexity in their storytelling.
“We must stop chasing speed and start chasing accuracy,” she said. “Journalists are the second line of defense against misinformation, and they must be equipped to tell these stories right.”
KEG pledged to continue building the capacity of its members, working with development partners to ensure that reporting remains ethical, evidence-based, and impactful.
The Road Ahead: From Aid to Agency
The consensus at the end of the session was clear: Africa must own its health systems.
The retreat of donor funding is not the end—it is an invitation to reform. The panelists agreed on five clear action points:
- Reorganize domestic health financing to reduce out-of-pocket burdens and serve the most vulnerable.
- Prioritize prevention through regulation, urban design, clean water, and food systems.
- Strengthen public health infrastructure by improving service delivery and restoring trust in public facilities.
- Leverage data to guide procurement and treatment decisions at the community level.
- Engage the media to sustain accountability and promote a more informed public dialogue.
“We cannot fix a broken system with the same tools that broke it,” Dr. Oronje reminded the audience.
“It’s time to do things differently—and it starts now.”
