On the 15th to the 19th of March, health workers, government officials, county health teams, and researchers gathered in Nairobi for the Health Integration Summit 2026. The theme was Health Without Barriers for Holistic HIV Response, and the conversation was frank. Kenya has been running its HIV programmes largely separately from the rest of its health system for decades. As donor funding pulls back and the country moves toward Universal Health Coverage, that model is no longer sustainable. The question the Summit tried to answer is: what does it actually take to bring HIV care into the everyday work of every health facility, every nurse, every community health worker in the country?

Our team at KHHRAC and Strathmore University came to the Summit with early findings from an ongoing national survey of health workers across Kenya. What we are hearing from the frontline is important, and we think the public deserves to know.

The workforce was already stretched before integration became the plan

Before we can talk about integrating HIV services, we must be honest about the foundation we are building on. Kenya does not have enough health workers. The shortage is not evenly distributed either. Some counties have many times more health workers per person than others, and the gaps are most severe in marginalised areas and at the primary health care level, exactly where integration is supposed to happen.

Nurses carry a disproportionate share of HIV service delivery already. If integration means adding HIV care to the routine work of nurses without also adding nurses, something will give. Either HIV services will suffer, or the broader care nurses provide will suffer, or the nurses themselves will. Preliminary findings from our survey suggest that in many places, all three are already happening.

What health workers are experiencing right now

The withdrawal of donor funding has not been a quiet or gradual process for the people working in Kenya’s health facilities. Early findings from our survey point to a workforce that has experienced significant disruption in a short period of time. Many health workers report colleagues being laid off, contracts being cut, or roles being reassigned, frequently without preparation, consultation, or support.

Those who remain are picking up the slack. Workloads have risen. Supplies and equipment have become harder to come by. And morale, by the accounts of workers themselves, has taken a serious hit. This is not a minor adjustment period. It is a system under acute stress, and the people feeling it most are the ones on whom integration will depend.

“We didn’t even know what drugs are being used nowadays for HIV. It was total confusion and the patients are still having a hard time trusting us because we seem unsure.”

That quote came from a health worker in our survey. It stayed with us. Because integration, at its heart, is a promise to patients that the care they receive will be seamless and competent. Right now, in too many places, that promise is not being kept.

The integration that was supposed to happen has largely not happened

Here is perhaps the most uncomfortable finding we brought to the Summit. When we asked health workers whether donor-funded staff had been successfully absorbed into the regular government workforce, the response was, to put it plainly, not encouraging. Early data suggests this has been the weakest outcome we have measured across the entire survey. More than anything else, this single finding points to the gap between what integration is supposed to mean on paper and what it looks like on the ground.

The reasons are structural. There are no formal absorption policies. Transition planning has been inadequate. And a significant number of partner-funded staff have never appeared on government payroll systems, which means they are effectively invisible to the planners who should be finding them a place in the system. The result is that experienced, community-trusted, HIV-trained staff are leaving the health system entirely, and they are taking years of institutional knowledge with them.

But there are counties showing what is possible

The Summit was not only a space for difficult findings. It was also a chance to hear from counties where integration is genuinely working, and those stories matter just as much.

In several counties, mentor mothers have been formally brought into the community health system. These are women living with HIV who have been supporting other mothers through prevention of mother-to-child transmission for years, often informally and without recognition. Formalising their role within the community health structure means their work is supported, their knowledge is valued, and their reach extends to households that a health facility simply cannot serve on its own.

In other counties, nurses have been trained to provide voluntary HIV testing and counselling as a standard part of their primary care duties. This might sound straightforward, but it represents a meaningful shift. It removes the need for a separate HIV testing clinic, which many people associate with stigma. It means a patient coming in for any reason can be offered a test as part of normal care. And it means that nurses, who are often the most trusted health worker in a community, become the face of HIV prevention rather than a specialist service that some people go out of their way to avoid.

These examples do not require a new system. They require investment in the system that already exists: training, supervision, clear roles, and the confidence that comes from being genuinely supported.

So what needs to happen?

Our preliminary findings, alongside the discussions at the Summit, point to a set of priorities that are clear even at this early stage of our research.

Workforce planning needs to be driven by real data, not assumptions. Kenya has the tools to do this well, including systems that can calculate how many workers of which type are needed where based on actual workload. The challenge is using them consistently across all counties and making sure the results actually shape budgets and hiring decisions.

Task shifting needs to be made official, and it needs to come with proper support. A substantial share of health workers are already doing tasks beyond their original roles, informally and without recognition. Making this formal means writing it into guidelines, providing the training to go with it, maintaining supervision, and paying people fairly for the expanded work they do.

Retraining needs to be treated as an investment, not an afterthought. Workers are asking for it. They want to be equipped for the world of integrated care. Pre-service training in medical and nursing schools and in-service programmes for existing staff both need to be redesigned with integration in mind.

The wellbeing of health workers has to be part of the plan. A demoralised, burned out, under-resourced workforce cannot deliver the quality of integrated care that patients deserve. Psychosocial support, workload management, and reliable supply chains are not luxuries. They are the conditions under which good care happens.

And the financing has to follow. The Government of Kenya, through the Ministry of Health and the National Treasury, needs to prioritise absorbing critical HIV cadres onto the government payroll. HIV services need to be fully included in the SHA benefit package. And the budget for health workers needs to be protected and grown, not quietly eroded.

Why this moment matters

Kenya is at a fork in the road. One path leads to a genuinely integrated health system, where HIV care is part of what every primary health facility does, where community health workers and nurses and mentor mothers work together as a team, and where no patient has to seek out a special clinic to access the care they need. The other path leads to a fragmented, under-resourced system that loses the gains of decades of HIV work as donor funding retreats.

The early evidence from our survey suggests Kenya is currently closer to the second path than the first. But the county examples at the Summit show that the first path is real and reachable. The question is whether the policy decisions, the investment, and the political will are there to take it.

We will continue sharing findings from our national health worker survey as the research develops. Because the people on the frontline of Kenya’s health system deserve to have their experiences inform the decisions being made about their work.

About the authors

This post was written by the KHHRAC and Strathmore University research team following the Health Integration Summit 2026. It draws on preliminary findings from an ongoing national survey of health workers in Kenya. While you are here, please help us collect us critical evidence by filling our national survey here