Premium
What Trump’s edicts portends for our healthcare
US President Donald Trump speaks during a disaster briefing at a hanger, as he visits to assess recovery efforts and tour areas devastated by Hurricane Helene, at Asheville Regional Airport in Asheville, North Carolina on January 24, 2025.
What you need to know:
- The American President drew the first pint of blood by signing an executive order for withdrawal of the US from the World Health Organization.
- With Trump’s triumphant entry into power and his threat to cut funding to global health organizations, Kenya will not be spared.
On his first day in office, a resurgent Donald Trump signed a raft of executive orders that will dramatically alter the global landscape, from the Atlantic to Latin America, from Africa to Asia.
In his seminal poem, “The Second Coming,” WB Yeats describes a situation where the falcon cannot hear the falconer even as they turn and turn into a widening vortex. “Mere anarchy is loosed upon the world…. The ceremony of innocence is drowned. The best lack all conviction, while the worst brim are full of passionate intensity.”
Just as the Irish concludes that some revelation is at hand, and that the Second Coming is at hand, the world witnesses with fear and expectation at Trump’s second coming.
Global health, which for decades has depended on funding from rich countries in the global north through governmental and philanthropic organizations, must brace for impact. Already, the American President drew the first pint of blood by signing an executive order for withdrawal of the US from the World Health Organization.
These events, though taking place in Washington, will affect lives deep in the villages of Africa.
Slightly over a decade ago, when I served as a medical officer intern in lower Eastern Province, I came face to face with the meaning of global health. The hospital ran a comprehensive care clinic for thousands of HIV patients.
So well organized was the clinic that patients were served porridge and meals, and follow-up calls were done by the clinic staff. Those who got lost to follow-up were traced physically and brought back to care. Medical staff caring for HIV patients attended regular trainings to keep abreast of current advances in treatment.
Cut funding to global health organizations
This was at the height of the PEPFAR program, birthed by the administration of President George W Bush in mid 2000s. Hospitals all over Kenya became centres of excellence in HIV care. Within 10 years, the battle against HIV, previously thought to be a death sentence, had largely been won.
In the same hospital, there was the chronic disease clinic, which consisted mostly of diabetes and hypertension patients. The difference between this clinic and the HIV clinic couldn’t be starker. In this clinic, only a handful of drugs, most of them outdated, could be provided. Patients had to pay for expensive tests out of pocket.
Complications such as stroke, kidney failure, heart failure and sudden deaths were rampant among those who could not afford tests and modern medication. I heard one patient complain that it was better to suffer HIV than diabetes. He was partly right because at the time, the odds of dying of diabetes were considerably higher than HIV.
With Trump’s triumphant entry into power, his transactional approach to politics and global issues, his mantra of America First, and his threat to cut funding to global health organizations, Kenya will not be spared.
Up to 20 per cent of healthcare budget is donor funded. This includes immunization, HIV care and treatment, tuberculosis treatment, reproductive health, malaria and health research. The US government and donor organizations affiliated to US institutions provides the lion’s share of this fund.
During Trump’s first administration, there was a sharp decline in donor funding from 35 per cent of the health budget to below 20 per cent. While HIV statistics have not shown a rebound to the pre-PEPFAR era, a casual look at hospitals will tell a story of undoing of the gains made over the first decade of the millennium.
Emerging challenges in healthcare
Today, getting a HIV test in a government hospital is not easy. In the past, provider-initiated counselling and testing (PITC) ensured that almost every patient who came into contact with healthcare was tested. Healthcare workers today have to contend with patients with advanced AIDS disease due to missed opportunities for testing.
Can this change be a blessing in disguise?
The country should take Trump’s shock therapy as an opportunity to get rid the nation of donor dependency.
This is the time to prepare proactively for the coming change. One, the government needs to lead from the front in planning for the change, and instituting necessary adjustments to make do in the worst case scenario.
Allocation of more resources for health is an urgent priority. The Lagos declaration that recommended an allocation of 15 per cent of the GDP for health in African countries should be revised upwards, and implemented, taking into account the emerging challenges in healthcare.
It is the opportune time to encourage cheaper, local manufacturing of pharmaceutical and non-pharmaceutical products. Strengthening of supply chains and human resource for health is an immediate priority.
Finally, this Trumpian therapy affords a chance to fight the dragon of corruption with renewed vigour, and eventually slay it. Without corruption, it is possible to avail enough resources for health, just like other sectors of the economy. Profiteering cartels who benefit from overblown tenders for medications and medical supplies should be dismantled.
And as WB Yeats concludes, “Surely Surely some revelation is at hand; Surely the Second Coming is at hand,” this change in Washington, well handled, will herald a new birth of self-dependence in Kenya and Africa.
Dr Bundi Karau (MD, PhD) is a senior lecturer in Internal Medicine at Kenya Methodist University, and is currently a fellow in Neurology at St John’s Medical College, Bangalore, India.