In March 2011, the Kenyan National AIDS Control Council prepared a Cabinet memorandum that outlines ways to raise funds for HIV programming. Through innovative solutions, Kenya is looking for sustainable ways to combat the AIDS epidemic in country.
The memo is based on a recommendation from the USAID-funded Health Systems 20/20’s HIV/AIDS Program Sustainability Tool (HAPSAT) assessment.
Two government staff who helped prepare the memo tell us how it will help Kenya’s 1.5 million citizens living with HIV.
Regina Ombam, head of strategy for Kenya National AIDS Control Council (NACC), leads planning, implementation and evaluation of HIV programs. As part of the Cabinet memo initiative, she managed the process of gathering relevant health financing data on behalf of the director of NACC. Ms. Ombam holds master’s degrees in economics and public administration.
Irene Mukui is the antiretroviral therapy (ART) program manager for the National AIDS and STI Control Programme. She oversees the provision of ART and other associated care (i.e., nutrition, TB/HIV integration, etc.) for both children and adults in Kenya. Dr. Mukiu was a member of the technical working group that developed the Cabinet memo. She is a licensed medical doctor.
HS20/20: What does the Cabinet memorandum propose to raise funds for HIV programming?
RO: The Cabinet memo proposes that the Ministry of Finance create a HIV/AIDS Trust Fund that would support scaling up prevention, treatment, care and support in Kenya. If approved, the government would contribute 1% of its annual revenue to the fund. In addition, the fund would receive contributions from partners and the private sector through initiatives such as airtime and airline levies, levies on remittances from abroad, corporate and NGO donations, the national lottery system, and leveraging unclaimed financial assets (i.e., monies that are dormant or abandoned often as a result of death, name change, or relocation). The Ministry of State for Special Programmes, the Ministry of Public Health and Sanitation, and the Ministry for Medical Services would implement HIV programming supported by the fund.
IM: The Cabinet memo aims to establish long-term, sustainable financing through the existing National Health Insurance Fund and increase government funding to meet the Abuja target of allocating 15% of the annual budget to health.
HS20/20: What is the process and timeline for passing this Cabinet memo?
RO: The Minister for Special Programmes has to first present the memo to the Cabinet for approval before it is tabled in Parliament. We’re currently waiting for this to happen.
HS20/20: In Kenya, one-fifth of HIV spending comes from out-of-pocket payments. If passed, what effect would this Cabinet memo have on Kenya’s 1.5 million people living with HIV and how HIV-related costs are to be covered?
IM: The Cabinet memo proposes not only increased local resources for HIV, and hence less reliance on external funding, but also offers sustainable solutions such as expanding the National Health Insurance Fund to finance antiretroviral therapy and treatment for opportunistic infections. A 25% increase in premium payments would provide $122 million in funding over five years, which would be enough to cover roughly 25% of the population in need during that time period, or approximately 174,000 Kenyans by 2015.
RO: Given Kenya’s HIV prevalence, the financial resources available are insufficient to establish and operate an accessible quality health system for HIV services. The first step to universal coverage is to ensure that the country has funds and that funding increases consistently over the coming years to enable the necessary scale-up. If the Cabinet memo passes, we estimate the trust fund will generate Ksh 1 billion (US$10.7 million) annually from government contributions, enough to provide ARV treatment to meet the current need for adults and children, and provide all ARV drugs required to prevent mother-to-child transmission (PMTCT) for HIV-positive mothers throughout Kenya.
In the long term, we foresee an investment strategy for the growth of the HIV/AIDS Trust Fund as capital for the National Health Insurance Fund with the government adopting an approach of health insurance for all and implementing resource pooling mechanisms that will lead to universal coverage.
Why are you personally passionate about HIV/AIDS work in Kenya?
IM: I got engaged with HIV work not long after graduating from medical school. When HIV care and treatment was being introduced into the public sector around 2004, my colleagues and I started clinics what we at the time called “PMTCT plus clinics” targeting mainly mothers who had been diagnosed HIV positive. The experience was sobering. We met young mothers with HIV, dealing with social-cultural issues and stigma. We had little resources at the time, and ARVs were being rolled out and not widely available. It was sad.
Since then things have changed for the better and systems are better, but many challenges remain including stigma. Systems to ensure that people living with HIV are cared for are still not optimum and new infections still remain unacceptably high.
I still see HIV as one of the most challenging issues to deal with. Not only does it affect the individual, it affects the family, society, and the development of the country. No other disease, in my opinion, carries as much stigma and social-cultural bearing as HIV. This is why I work to see that life becomes better for those infected and affected. My motto is to always do my best and leave as minimal human suffering as I can wherever I work.
RO: The epidemic has caused far reaching social, economic, health and population effects to the people of Kenya, including myself. Universal access to HIV services continues to be a mirage. HIV spending has increased with the bulk of the funding coming from development partners (87 percent). With global economic crises putting aid budgets for many developed countries under stress, the future for HIV needs to be seen as a chronic condition. This requires Kenya to make a rapid shift towards building systems and processes for an HIV response that is country owned, country led, and consistent with our planning and budgeting cycles and the country‘s Vision 2030. As an economist working in the HIV field, I’m most excited to work to improve policies and country ownership.
