The question many have asked me — is the Kenya-U.S. health deal good or bad? My answer is that it’s neither good nor bad — it’s pragmatic at best; more complex than black or white, and this is why.
At face value, a U.S. commitment of $1.6 billion over five years looks like an unequivocal win for Kenya’s health system: cutting-edge laboratories, digital health systems, better-trained health workers. To put this in context, a contribution of $320 million annually in a country where total general government expenditure on health is just slightly above $2 billion means America’s “gift” is almost 15% of Kenya’s total general public expenditure. Simply put, America is “gifting” Kenya about $5 per capita in a country where the government spends $43 per capita.
It is understandable why many see this as a generosity that Kenya should simply accept. But should Kenya look a gift horse in the mouth? If Kenya did look the gift horse in the proverbial mouth, the teeth would reveal a fundamental decay in how wealthy nations now conduct global health partnerships and Kenya’s constrained position in negotiating them.