According to the World Health Organisation (WHO), the health workforce is fundamentally the backbone of any thriving health system. In Kenya, four donors account for nearly 90% of health aid, with key vertical programs including HIV/AIDS, maternal and child health, malaria, and TB.
Following the recent shifts in donor funding, the stakes have never been higher. The health system is at risk of collapse if we do not protect the very key to our health system, the health workforce. The scale of workforce disruption is staggering. The 2025 US funding freeze affected 41,547 health workers supported by PEPFAR across all 47 Kenyan counties.
Within months, counties reported losing 10,982 staff members, with Nairobi experiencing the highest impact at 8,803 workers. For the remaining health workforce, increased workload has led to burnout and attrition. This has resulted in poor service delivery in health facilities, thereby compromising our journey toward universal health coverage. The isolation was the genesis of all problems.
Donors in LMICs were crucial in funding the health workforce, commodities, and health management information systems, thereby exposing donor dependency and explaining why most LMICs have been hit hard by the recent donor transition. However, this also created parallel systems that operated independently of government structures.
The isolation created several interrelated vulnerabilities. Donor hiring of health workforce led to workforce fragmentation as they hired specialized cadres such as the HTS. Additionally, the hired health workforce was trained exclusively within disease-specific silos, rendering them incompatible with integrated primary healthcare.
Beyond personnel, donors supplied the invisible infrastructure, medical commodities, diagnostic equipment, and digital systems, such as IRIS, a workforce information tool. Gaps in institutional ownership resurfaced when the transition happened because data sovereignty and management capacity existed outside government structures.
Eventually, the patient pays the price when the quality of service delivery collapses. Reports reveal how donor withdrawal has reversed years of progress in stigma-sensitive HIV care. In Uganda’s Rwenzori region, similar patterns emerged. The patient waiting times increased from 45 minutes to over two hours, patient loads per remaining provider jumped from 18 to 32 patients per day (a 78% increase), and observational data confirmed worsened conditions with patients sitting on floors.
Beyond job losses, the donor transitions have created profound motivational crises. The health workforce has reported intense frustration over the loss of crucial allowances and training opportunities, which severely undermined morale and led to increased attrition rates. As Principal Agent Theory predicts, when the external oversight and incentive structures that motivated performance disappear, the health systems are left struggling with accountability and the health workforce resource.
Perhaps the most indirect impact is the failure of capacity transfer. When donor-funded specialists left, they took with them years of experience in managing complex treatments that kept Kenya’s viral suppression rate at 94%. Yet, amid the crisis, health workers have become innovative. The emergent responses, such as workforce strategies and integration of services, and alternative sources of funding, have demonstrated resilience.
Recent research identifies critical factors for successful donor transitions. These include effective leadership, mobilization of domestic resources to close financing gaps, and realignment of country systems to new funding sources. Kenya’s response has included a record KSh 138.1 billion health budget allocation for 2025/26, an 8.74% increase. However, budgeting alone is not enough. Kenya’s lived experience shows that successful transitions require true system integration before exit, workforce absorption strategies, capacity transfer, building internal technical expertise by transferring data systems to government control, and continuous training of the health workforce.
Donor transition forces a fundamental question for Kenya’s Health System: can the country sustain quality health services when external funding disappears? This is not a question with an easy answer. It requires rethinking how health workers are employed, supported, and valued. It demands serious investment in domestic financing and workforce planning. The real test lies ahead. As more donors transition out and external funding becomes scarcer, understanding how to navigate this transition is essential for building a sustainable health system.
