Why the Proposed U.S. – Kenya Healthcare Deal is a Trap

While Kenyan mothers are currently being detained in hospitals because the new Social Health Authority (SHA) claims system is “still stabilizing,” government officials are in high-level talks with the U.S. government to sign a new Global Health Memorandum of Understanding (MoU). On the surface, this “Global Health Security” partnership promises millions of dollars to modernize our laboratories and digital health systems. But a closer look at the fine print, patterned after a similar deal recently drafted for Zambia, reveals that this deal is a Trojan horse that threatens to mortgage our health sovereignty, criminalize our reproductive choices, and bankrupt our future health budget.

As an advocate for reproductive justice who has spent an extensive amount of time interacting with these documents and negotiations, I see five red flags in this agreement that every Kenyan taxpayer, doctor, and patient should be losing sleep over.

Prioritising future biosecurity over present safe births

The core philosophy of this US strategy (America First Global Health Strategy) is “Global Health Security.” In plain English, this means the priority is not the health of Kenyans, but the safety of Americans. The bulk of the funding is earmarked for “surveillance,” “pathogen detection,” and “biosecurity.” The US wants to ensure that the next COVID-19 or Ebola variant is detected in a Kenyan village before it can reach an American city.

While pandemic preparedness is important, it cannot come at the expense of primary care. We are currently witnessing the chaotic transition from NHIF to SHA, where the “Linda Mama” free maternity scheme has been subsumed into a system that is rejecting claims and leaving mothers stranded. Why are we signing a treaty that prioritizes hunting for rare viruses over purchasing oxytocin to stop women from bleeding to death during childbirth? This MoU risks creating a two-tier system: a high-tech, well-funded surveillance network for American interests, sitting atop a collapsing, underfunded public hospital system for Kenyan citizens.

A violation of Kenya’s data sovereignty

Perhaps the most chilling aspect of this proposed partnership is the demand for data access. The MoU drafts require the partner government to grant US agencies direct “log-in” access to national health data systems for “auditing” and “surveillance.”

This creates a direct conflict with our own laws. Just this year, the Kenya Medical Practitioners and Dentists Council (KMPDC) issued a directive requiring all health facilities to comply with the Data Protection Act (2019) by March 2025. We have a Data Commissioner, Immaculate Kassait, whose job is to protect our genetic and medical data from misuse. Yet, this MoU effectively demands a backdoor key for a foreign power.

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For women, this is dangerous. In a digital age, health data is the new oil. Handing over the “keys” to our national health database to foreign contractors undermines the doctor-patient trust that is the bedrock of our healthcare system. If a woman in a rural clinic suspects that her intimate medical history (her HIV status, her pregnancies, her genetic markers) is being scrutinized by foreign auditors, she will stop coming.

Policing the womb

The threat to privacy is also political. The MoU explicitly includes a clause mandating audits to ensure compliance with the Helms Amendment, a US law that prohibits American funds from being used for abortion services.

In Kenya, abortion is permitted under the Constitution (Article 24(4)) when the life or health of the mother is at risk. However, the Helms Amendment is frequently interpreted by US auditors as a total ban, creating a chilling effect. If this MoU allows US auditors to inspect patient files in Kenyan facilities to “verify compliance,” it will terrorize our health workers. Doctors may hesitate to provide legal, life-saving Post-Abortion Care (PAC) for fear of being flagged in a US audit and losing funding for their entire facility. In fact, our own Ministry of Health (MoH) will be enforcing such bans albeit clandestinely. This is a direct assault on the constitutional rights of Kenyan women and the professional autonomy of our doctors.

The fiscal cliff at the end of the deal

The financial structure of this deal is a ticking time bomb. The MoU operates on a “transition” model: the US pays for salaries and commodities now, but rigidly scales down this support to zero by 2030, requiring the Kenyan government to absorb the costs.

Let’s be realistic. The Ministry of Health is currently in a standoff with the medical union (KMPDU) because it claims it cannot afford to post medical interns or pay existing arrears. The Treasury is warning of a “wage bill crisis.” If we cannot afford to pay our current doctors, where will the money come from to absorb thousands of new “partner-supported” epidemiologists and lab technicians in five years? By signing this, the Ministry is committing future taxpayers to a massive wage bill that Parliament has not approved. When 2030 comes and the US money dries up, we will be left with a bloated payroll and no funds, forcing yet another collapse of essential services.

Institutionalizing “theft”

Lastly, there is the matter of dignity. The text of these agreements often cites “historic systematic theft” of health commodities as a justification for punitive clauses, including cutting funding if “leakage” is detected. While we must be honest about corruption at KEMSA, formalizing our reputation as thieves in a bilateral treaty is a humiliation. It gives the donor the right to act as both judge and jury, cutting off life-saving ARVs or maternal supplements effectively as a form of collective punishment for the corruption of a few elites.

We are not beggars. Kenya has a robust constitution, a skilled workforce, and a clear vision for Universal Health Coverage. We welcome partnership, but not subservience.

We demand that the Ministry of Health must publish the full text of the proposed MoU before it is signed. Kenyans need to see the “transition plan” and the financial commitments. The Office of the Data Protection Commissioner must also review and publicly approve any data-sharing clauses to ensure they comply with Kenyan law.

Finally, any new funding must align with our burden of disease (maternal mortality, malaria, and NCDs) and not just the biosecurity fears of the Global North.

Our womb is not a surveillance site. Our data is not an export commodity. And our healthcare system is not a project to be managed from Washington. Kenyans, let’s keep our eyes peeled before our government signs our rights away for a few million dollars that will largely end up in the pockets of politicians.

Mr Kariuki is a sexual and reproductive health advocate. He is the founder of Alien Citizen Media.