The assessment, jointly convened by Harm Reduction International (HRI) and The Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) aimed to document the impact of funding cuts on harm reduction services in Kenya and identify opportunities for advocacy and domestic resource mobilisation to safeguard existing harm reduction achievements amid shifting donor priorities. The research employed a mixed-method approach.

“We lost clients to overdose because there was no administration of naloxone since peer educators could not report or offer [it]. We are scared it might happen again.” – community representative, Mombasa

The assessment made seven key findings that define the current harm reduction landscape in Kenya:

1. Service disruptions: Methadone services have been interrupted due to a loss of human resources and reduced outreach, forcing some people to ration or share medication, and also transfers of MAT services to government facilities, which were affected by low integration.
2. Notable increase in lost to follow-up clients: This is largely attributed to service interruptions, stock-outs, and reduced outreach activities due to funding cuts. This is affecting both OAT clients and people supported by harm reduction programmes and follow-ups run by the Harm Reduction community service organisations.
3. Workforce attrition: Funding uncertainty has caused staff layoffs, low morale, weakened supervision, reduced service delivery, and uncertainty on harm reduction programming.
4. Donor reprioritisation risks: The Global Fund’s reprogramming process under GC7 has reduced the harm reduction allocations by USD 2.4 m.
5. Limited domestic financing: Despite political commitment from the government, national and county budgets allocate minimal funding for harm reduction, mainly due to legal and policy barriers. However, the government does purchase the methadone used in the Global Fund-supported harm reduction program. The government also supports staff recruitment for some OAT clinics and allocates space for harm reduction facilities within existing public buildings.
6. Fragmented coordination: The absence of a solid national harm reduction coordination mechanism across stakeholders has led to duplication, weak accountability, and poor integration of harm reduction into public health systems.
7. Community resilience: Networks of people who inject drugs displayed strong self-organisation and advocacy potential, demonstrating the community’s readiness to lead responses if adequately supported and resourced, importantly by strengthening domestic funding for communities and civil society through social contracting.

Our analysis revealed a strong correlation between funding volatility and service instability. Disruptions to OAT are directly linked to people stopping or interrupting both OAT and ART, as clients are not attending or accessing services as they did before.

The assessment identified six strategic advocacy entry points to navigate the crisis and rebuild resilience in Kenya’s evolving health and fiscal context.

1. Domestic resource mobilisation: Advocate for the inclusion of harm reduction programming in national and county recurrent budgets and Social Health Insurance (SHI) to reduce donor dependency and ensure sustainability.
2. Global Fund and the Country Coordinating Mechanism (CCM) engagement: Influence the Global Fund Grant Cycle 8 (GC8) funding request to protect harm reduction funding and enhance key population representation in decision-making.
3. Legal and policy reform: Advocate for the redrafting and passage of the Harm Reduction Bill (the aspect of serious validation fora was mentioned so that all critical partners can have a buy in) and review the Narcotic Drugs and Psychotropic Substances (Control) Act to decriminalise personal drug use, promote a health-based response to drug use and enable government investment in harm reduction.
4. Integration into universal health coverage (UHC) and primary healthcare: Position harm reduction as a core part of Kenya’s UHC agenda and integrate into primary healthcare points.
5. Improve coordination across sectors: Establish a national harm reduction coordination platform to align donor, government, community, and civil society efforts.
6. Empower communities: Strengthen the advocacy capacity of networks of people who use and inject drugs so community members can better influence budgets, policies, and accountability processes.