Kenya and Rwanda Agreements: A Shift in US Global Health Funding
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On december 4th, Kenya and the United States signed a Memorandum of Understanding (MOU) for $1.6 billion in American funding for Kenyan health programs over the next five years. Rwanda followed suit with their agreement the next day. While details remain limited – I have preliminary budget facts for Kenya and analysis revealing a discrepancy of approximately 12,000 unaccounted-for frontline health workers based on these agreements – these MOUs are notable as they foreshadow “dozens” more to come. This necessitates a critical examination, particularly for African civil society and stakeholders directly involved.
The core takeaway from these initial agreements is a clear indication of US priorities: market access, economic and military cooperation. Together, there appears to be a disregard for a factual accounting of the impact of programs like the President’s Emergency Plan for AIDS Relief (PEPFAR), and, crucially, a lack of demonstrable concern for whether the funding actually saves lives.
However,the ample financial commitment demands attention.Real money is at stake, and positive impact is still possible, but only if communities, elected officials, and health providers in recipient countries take ownership and are held accountable for meaningful results.
This isn’t simply about “country ownership” as a feel-good phrase. It’s about recognizing that the US is funding healthcare as a means to achieve broader economic, political, and military objectives. The current “America First Global Health Strategy” offers no evidence of prioritizing evidence-based,data-driven solutions for improving health outcomes.
This is reflected in the challenges facing organizations like the US Centers for Disease Control and Prevention, burdened by political appointments, and a reluctance to fully embrace vaccines. Furthermore, those working on the ground in recipient countries are currently facing confusion regarding implementation plans and guidance for these new funds.
Therefore, it’s time to shift focus away from questions about US strategy – there’s little evidence one will be forthcoming – and away from speculation about a post-US global health landscape. Despite withdrawing from organizations like the World Health Organization, the US remains a significant donor. The critical question is not if the US will fund global health, but how that funding will be utilized.
Ultimately, the success of these agreements hinges on prioritizing country-led initiatives and demanding accountability for results that genuinely improve health outcomes, rather than serving solely as a vehicle for American interests.
The Quiet Power of “Good Enough”
We live in a culture obsessed with optimization. From biohacking our bodies to meticulously planning our days, the pressure to maximize everything is relentless. we’re told to strive for perfection, to relentlessly pursue self-improvement, and to never settle for anything less than our full potential.
But what if I told you that “good enough” is not only okay, but actually powerful?
I’ve been thinking a lot about this lately, particularly as it relates to creative work. As a writer, I often fall into the trap of endlessly revising, tweaking, and polishing until I’m fully exhausted and, ironically, the work feels…stale. I’m chasing an elusive ideal,a perfect version that exists only in my head.
This pursuit of perfection isn’t just draining; it’s often counterproductive. It can lead to procrastination, creative block, and a general sense of dissatisfaction. We get so caught up in making something perfect that we never actually finish it.
The concept of “good enough” isn’t about lowering your standards or accepting mediocrity. It’s about recognizing that diminishing returns set in. At a certain point, the effort you put in yields increasingly smaller improvements. It’s about understanding that done is better than perfect.
This idea isn’t new. It’s rooted in the 80/20 rule (also known as the Pareto Principle), which states that roughly 80% of effects come from 20% of causes. In practical terms, this means that you can often achieve 80% of the desired result with 20% of the effort. The remaining 20% of the result requires 80% of the effort.
Think about writing a blog post. The first draft might be messy and imperfect, but it gets the core ideas down. Revising it once or twice will likely improve it significantly. But spending hours agonizing over every single word, sentence structure, and comma? That might only yield marginal improvements.
Embracing “good enough” allows you to:
* Ship more work: Rather of getting stuck in endless refinement, you can actually put your creations out into the world.
* Learn faster: Feedback from real-world audiences is invaluable. You can’t get feedback on something that never sees the light of day.
* Conserve energy: perfectionism is exhausting. “Good enough” frees up mental and emotional energy for other things.
* Reduce anxiety: Letting go of the need for perfection can be incredibly liberating.
Of course, there are times when striving for excellence is crucial – surgery, engineering, anything where lives are at stake. But for most of us, in most areas of our lives, “good enough” is a perfectly reasonable and often superior goal.
So, the next time you find yourself spiraling into the vortex of perfectionism, remember the quiet power of “good enough.” Finish the draft. Ship the product. Release the work. You might be surprised at how much more you accomplish, and how much more joy you find in the process.
Kenya’s New Health Security Agreement with the US: A Cause for Concern?
The recent Memorandum of understanding (MoU) between the United States and Kenya regarding health security has sparked debate, largely due to a lack of clarity surrounding its growth and potential implications. While framed as a collaborative effort to strengthen pandemic preparedness, the process leading to the agreement raises serious questions about inclusivity and accountability.
The core issue lies in the limited engagement with kenyan civil society. Throughout the year-long negotiation process, participation was largely restricted to faith-based organizations, effectively excluding a broad spectrum of voices crucial for a truly representative agreement. This exclusion is particularly concerning given the potential for the MoU to impact various aspects of Kenya’s health systems and data governance. The agreements themselves, and those pertaining to specimens and data, are subject to change, adding another layer of uncertainty.
A notable, and perhaps telling, development occurred just before the signing. A member of a Kenyan civil society group received a direct email from the US Embassy requesting a conversation to “clarify statements” made about the agreements. This proactive outreach, after a year of limited information sharing, suggests potential pressure from Washington D.C. and highlights the importance of continued engagement with civil society to ensure their safety and that their concerns are valued.
The financial commitments outlined in the MoU are substantial. kenya’s agreement totals $1.6 billion over five years, comparable to Zambia’s $1.5 billion. However, it’s crucial to remember that funding for FY27-FY30 has not yet been appropriated by Congress.
A meaningful assessment of this funding requires a detailed breakdown of planned expenditures, a comparison with existing US and domestic investments, and a clear accounting of program changes over the past year. This information remains unavailable. However, a pre-signing budget table, focusing on disease-specific allocations, has surfaced. It’s important to note that funding for future years is marked with asterisks, indicating a lack of guaranteed commitment.
Without full transparency and a comprehensive understanding of the financial details, it’s challenging to assess the true impact of this MoU. A rational conversation about the agreement’s value hinges on access to this critical information, and a willingness from Washington D.C.to clarify any ambiguities.
## The Problem with comparing Apples and Oranges: A Look at Global Health Budget Trends
Below I’ve listed some of the things I notice in the budget breakdown and/or learned as I looked back at previous years’ information and talked to folks working on similar processes in other countries. the top-line takeaway for me is: this process looks different in every country. This table is different in every country. The funding trends in terms of rates of decline are different in every country. Kenya’s table doesn’t say anything about what is happening in any other country, but it dose suggest some questions to ask, including:
> What categories of HIV funding is a given planning process using, and what activities fall under each category?
The version of Kenya’s table that I’ve retyped splits HIV funding into “core life saving HIV” and “strategic investment.” The “core” column largely covers frontline health workers and commodities. When I asked several people what went into the “strategic investment” column, I received many answers, including “I have no idea, we didn’t do it that way.” It appears to be a budget line that can hold everything from innovation to the-other-stuff-that-matters-that-isn’t-in-core. (Kenya’s column reportedly includes an on-line health workforce training platform.)
Having tailored country plans is a good thing. It might even be called “country ownership.” except that if every country is using different budget headings, or even different definitions of what goes into a given category, then it’s hard to compare notes and learn from each other. In this situation, country ownership should include steps that ensure cross-border comparability of core elements of the budgets.
Here’s another question:
> How do the disease area budgets in the table compare with past-year investments?
* The sum total of HIV funding in this table for FY2026-$370,000,000-is higher than the FY2025 budget for PEPFAR funding-both the new FY2025 allocation and the FY2025 budget total that included new money and “pipeline” carried over from the year before.
* Both malaria and tuberculosis have only four years of funding and take substantial cuts.If we compare this four-year total to four years of steady funding from the most recent years, that’s a 55 percent reduction in funding for malaria, and roughly a 30 percent reduction for TB spending.
* HIV funding doesn’t reduce gradually over time. year 4 is 80 percent of Year 1, and then there’s a cliff in 2030. It also doesn’t go to zero.
Comparisons like these should be used as the beginning, not the end, of a conversation about what’s possible and likely to happen. Programs can be maintained and even strengthened with reduced budgets. They can also be destroyed. The difference lies in the detailed plans for every step of the transition to reduced funding and in the answer to this question:
> What used to be funded that isn’t funded at all anymore-and what is the signing-country government doing about those services?
It’s ill-ad
Questions Remain About US Health Security Agreements with African Nations
The recent memoranda of Understanding (MoU) between the US and several African nations regarding health security raise critically important questions beyond the initial headlines. While the agreements aim to bolster disease surveillance and outbreak response, critical details remain unclear.
One key concern revolves around data management. The US stipulations grant it 25 years of access to these systems, but the question of who will be responsible for data input, cleaning, analysis, and subsequent action based on the findings remains unanswered. This is a crucial point that warrants further investigation.
Another vital question to consider is whether any government entities named as potential beneficiaries have a history of defrauding the US government or the populations they serve. Dismissing concerns about corruption with broad generalizations about “Africa” is both racist and colonialist. Accountability should be universally applied, particularly when country ownership is central to these agreements.In the case of Kenya, the Kenya Medical Supplies Authority (KEMSA), a named recipient of funds, has been previously implicated in corruption scandals and faced scrutiny regarding its efficiency and procurement processes.
Regarding the US-Rwandan agreement specifically,the total value is USD$228 million,with Rwanda contributing USD$70 million and the US pledging up to USD$158 million over five years to combat infectious diseases and strengthen disease surveillance. However, this five-year funding level appears to be less than the US has historically provided for just malaria and HIV funding alone. The specifics of funding allocation – whether it’s consistent across all five years, gradual reductions, or uneven distribution – remain unknown, as does how Rwanda might address potential funding gaps.
The Department of State has announced plans to sign similar agreements with “dozens” more countries in the coming weeks. As these agreements proliferate, continued scrutiny and a demand for transparency will be essential.
## The enduring Ambiguity of *Thelma & Louise*: A Reflection on Choice and Freedom
The final scene of Ridley Scott’s 1991 film *Thelma & Louise* remains one of cinema’s most discussed and debated moments. As Louise accelerates their 1966 ford Thunderbird towards the edge of the Grand Canyon, holding Thelma’s hand, the film freezes, leaving the audience to grapple with the implications of their choice. Was it an act of defiance, a tragic surrender, or a liberation? This ambiguity is precisely what continues to resonate with viewers decades later, and it’s a key reason why the film remains a cultural touchstone.
Worth a look