Kenyans’ access to a range of health products – including HIV treatment, maternal medicine, and contraceptives – plunged in three counties last year, largely as a result of the closure of the US Agency for International Development (USAID).

In contrast, Zambia showed “modest improvements” in certain areas, particularly maternal health – largely thanks to a 30% increase in domestic financing for medicines and medical supplies.

This is according to new research from the Solutions for Supporting Healthy Adolescents and Rights Protection (SHARP) Project, which compared the availability, affordability, and frequency of stockouts for 50 commodities in Kenya’s Mandera, Isiolo, and Marsabit counties and Zambia between 2022 and 2025.

In Kenya, there was a “significant deterioration” in access, including “chronic stockouts of potentially life-saving medicines, in some cases lasting several months”, according to the researchers.

‘Near collapse’ of HIV treatment

In Kenya’s largely rural Mandera County, HIV treatment availability is at a “near-collapse”, with the average for all HIV treatment at 1,5%. Three of the seven antiretroviral (ARV) medicines available in 2022 were completely unavailable in 2025, in both public and private sector health facilities. However, ARV access in 2022 was also very low in the county, averaging at around 4.5%.

People on ARV treatment run a high risk of drug resistance if they stop their medication.

In Mandera, which borders Somalia and Ethiopia, only 1.8% of women use modern contraceptions, and the fertility rate (7.7%) is double the country’s average.

While the availability of all family planning commodities was “critically low”, there had been an improvement over 2022. Availability of the most common oral contraceptive pill had increased from 17% to 25.7% of facilities, while male condoms were found in 31.4% of facilities – a substantial increase from 13.3% in 2022. 

Dire shortage of maternal medicine

In Isiolo County, a dry region in the east, the availability of magnesium sulphate for the management of pre-eclampsia in pregnancy fell from 35.7% in 2022 to 15.4% in 2025.

The availability of male condoms and some oral contraceptives dropped sharply from over 80% to just 38.5%. 

There were also prolonged stockouts of two medicines to treat sexually transmitted infections (STI), namely benzathine benzylpenicillin and ceftriaxone  – lasting up to 218 days.

In Marsabit County, in the north bordering Ethiopia, there was a “dramatic decline” in the availability of life-saving maternal health commodities. For example, the availability of oxytocin, the gold standard for preventing haemorrhaging, dropped from 51.9% 2022 to just 14.3% in 2025. 

Kenya has a relatively high maternal mortality rate of 355 deaths per 100,000 births.

‘Post-USAID crisis’

To compile the report, data collectors from Health Action International (HAI) and Access to Medicines Platform Kenya (AMPK) visited 86 health facilities in 2022 and 91 health facilities in 2025 from the public, private and faith-based sectors in the three counties.

They surveyed the availability, stockouts and patient prices of 50 medicines and other products. These included family planning products, maternal health medicines, STI treatment, ARVs, HIV tests, and menstrual health products. 

Aside from county variations, researchers report that adolescents’ unmet need for family planning is as high as 34%: “Without access to condoms and self-test kits, we are facing a ‘triple threat’ of unintended pregnancy, STIs, and HIV.”

AMPK executive director Dorothy Okemo said that the results “suggest that Kenya experienced a post-USAID transition crisis.” 

“USAID had previously bridged the gap for high-cost sexual and reproductive health (SRH) commodities [and] their absence created a vacuum that the public sector has failed to fill,” said Okemo.

She added that the “lack of a robust, state-funded contingency plan following the devastating cuts has effectively privatised SRH access, with the public sector left unable to serve the vulnerable communities that traditionally rely on it.”

Zambia mitigates effects with investment

In contrast, similar research by HAI with Medicines Access and Research Platform (MedRAP) across public, private, and faith-based facilities in Zambia showed “modest improvements” in certain areas, particularly maternal health. 

Teams of data collectors visited 133 Zambian health facilities in 2022 and 105 in 2025 from the public, private and faith-based sectors. 

While there were fewer stockouts in 2025 than 2022, shortages of STI treatments and “the vast majority of HIV/AIDS commodities fell between 2022 and 2025.” 

“While changes in donor funding have also affected Zambia, a 30% increase in domestic financing for medicines and medical supplies has helped cushion the impact of reduced external support, particularly from the United States,” the research notes.

Sustainable domestic finance

“The findings of these reports highlight the fragility of access to essential SRH commodities and underscore the urgent need for sustainable domestic financing in the long term,” the report notes. 

“But without the support of donor countries and other stakeholders, vulnerable communities, especially women and adolescents, risk losing access to potentially life-saving health services.”

The European Union funded the research. Many EU members have also cut their aid budgets, including for HIV.

Image Credits: Brian Otieno /Global Fund.