How US envoy Robert Godec promoted ‘America First’ policy in Nairobi

By Gatonye Gathura

The US embassy in Nairobi says the outgoing envoy Robert Godec was a roaring success especially in improving the health of Kenyans.

A recent statement from the US embassy listed health as a top achievement of Godec in his six-year tenure in Nairobi.

“Every day we help keep a million HIV-positive Kenyans healthy with anti-retroviral treatment,” said the statement.

With roughly $1,767 million US aid to Kenya in 2012-2016 with 83 per cent going to health and mainly to HIV, Godec wielded huge influence on local health policy.

Godec came to Nairobi when the US was overseeing a major policy shift on HIV in its aid recipient countries.

In the new USaid policy, Dollars to Results, HIV activities were classified as core, near-core and non-core, with funding reducing as you move from the centre.

The core includes commodities such as ARVs, condoms, testing kits and other relevant biomedical which receive priority in funding.

Near-core covered healthcare workers and medical infrastructure while the outer most layer, the non-core, included awareness creation, behavior change, advocacy and capacity building.

By de-emphasizing on behavior change programmes tens of local NGO’s lost funding with some closing down with hundreds of Kenyans losing their jobs.

On the other hand while it had taken Kenya more than a decade to cover half a million HIV patients with ARVs, with the new US policy it has taken only about five years to reach over one  million people.

A health expenditure analysis for 2013 -2018 by the US funded Health Policy Plus group, shows of the estimated Sh1, 103 billion spend. the bulk is for buying  drugs.

The investment plan shows Sh 384 billion earmarked for medicines and commodities with Sh103 billion going into ARVs.

During the same period, the report shows only Sh16 billion was allocated to drugs for non-communicable diseases such as cancer, diabetes, heart and kidney diseases.

In his World Aids Day, speech in December former Cabinet Secretary for Health Cleopa Mailu, had put the number of Kenyans on ARVs at 1.1 million with the government putting Sh26.4 billion in HIV last year.

In line with US emphasis on biomedical HIV control, last year the Americans helped Kenya launch a daily HIV prevention pill called Truvada.

Data from the US funded NGO, Avac shows currently 40,000 Kenyans are on Truvada.

The US President’s Plan for Aids Relief (PEPFAR) plans to recruit 4,496 for Truvada this year.

The Ministry of Health targets at recruiting 500,000 Kenyans for the daily HIV prevention pill within five years.

Truvada is manufactured by Gilead Sciences of the US which reported global sale revenues in excess of $10.2 billion from the drug for the period 2014 to 2016.

The 2016 total sale revenue for Gilead, from all products, was reported at $30.39 billion.

Data from the Statista Inc, a global research company list the top three HIV medicines by sales in 2016 as Truvada and Atripla from Gilead and Triumeq from the UK giant GlaxoSmithKline.

Truvada contains the compound tenofovir, which is present in other antiretroviral drugs such as Atripla used in most countries including Kenya.

In a move that surprised local pharmaceutical companies last year, two Tuvada generics were fast tracked for registration in Kenya.

These were registered by Aurobindo Pharma and Mylan both of India, the later a subsidiary of Mylan NV, an American global generic manufacturer registered in the Netherlands.

While the importation of ARVs may have increased dramatically during Godec’s mission in Nairobi, HIV prevalence in Kenya  remained around six per cent since 2003.

“We are very worried about the persisting high rates of new HIV infections, despite our big spend in treatment and medicines,” said Dr Nduku Kilonzo, head of the National Aids Control Council at an earlier meeting in Nairobi.

A similar pattern has also played out in malaria control during the period, which has culminated to Kenya turning to Cuba for assistance in controlling the top killer disease.

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US aid to Kenya 2012-16

Total $1,767 million

Allocation by sector    %

Health                         83

Agriculture                  9

Education                    4

Democracy                  2

Environment               2

Source: USAID: REPORT TO THE KENYAN PEOPLE | 2016