VOCAL-KE led the development of this report on Harm Reduction Financing in Kenya: Advocacy for Local Resource Allocation

Kenya is transitioning from a low-income country to a low middle-income country (LMIC); which has meant that donor support towards healthcare and HIV programming is decreasing at an alarming rate. The transition has already seen dwindling resources available for HIV programming as resources were not increased, though the country adopted the global 90-90-90 targets. Between 2014-15 and 2017-18 HIV programming expenditures subsequently increased from KES 59.37 billion to KES 96.52 billion, and although the government’s contribution to HIV financing increased from 24% in 2014-15 to 28% in 2016-17, HIV programming still has a resource gap estimated at USD 173 million in 2016-17 and only has a coverage of 51% in 2018.

Healthcare in Kenya is provided through public, private-for-profit and private not-for-profit facilities. Healthcare services are arranged in tiers running from level 1 (dispensary, the lowest level of care) to level 6 (referral hospitals, the highest level of care). Public health facilities are found in the lower levels of care while private-for-profit facilities are concentrated in the higher levels of care. Currently, health care in Kenya is financed from three main sources: out of pocket expenditure (households), government expenditure and donors.

Kenya introduced needle and syringe programmes in 2012 delivered through civil society organizations (CSOs) as part of targeted interventions among people who inject drugs. The needle and syringe programme is a huge complement to existing HIV prevention and care efforts, and also provided an opportunity for a specific focus on people who inject drugs. Over a period of nine years, Kenya has managed to provide healthcare services to over 21,000 injecting drug users who access needles and syringes and over 9,500 opioid agonist therapy (OAT) clients in 8 healthcare facilities. The centres struggle to provide 50% of the complete set of World Health Organization (WHO) recommended interventions which include: 1. needle and syringe programs 2. opioid agonist therapy 3. HIV testing services 4. antiretroviral therapy 5. prevention and treatment of sexually transmitted infections 6. condom programmes for people who inject drugs and their sexual partners 7. targeted information, education and communication 8. prevention, vaccination, diagnosis and treatment of viral hepatitis B and C 9. prevention, diagnosis and treatment of tuberculosis and 10. community distribution of  naloxone. Some of the interventions like community distribution of naloxone, and vaccination of viral hepatitis are still not implemented.

This report analyses harm reduction funding and expenditure in Kenya, specifically HIV and harm reduction for the period 2015-2018. It outlines all the CSOs implementing harm reduction in Kenya, where they get their funding and what services they offer. The report analyses the progress and gaps domestically since 2013, donor inputs, different donors, and their area of priority. Finally, it presents a discussion on what the future looks like for harm reduction in Kenya, and the challenges encountered during the COVID-19 pandemic.