In my previous articles on the Kenya-US health deal, I wrote as a Kenyan. I raised concerns about data colonialism, about counties being bypassed, about who benefits when our health data fuels foreign drug development. Many of you wrote back agreeing. Those concerns remain valid.
But I hold a dual perspective. I am Kenyan. I am also a United States citizen. And from that second vantage point, I have different questions. Uncomfortable questions that we as Kenyans need to sit with.
Let me take you to the other side of the table. Since 2003, the US has invested over $8 billion in Kenya’s health system through the President’s Emergency Plan for AIDS Relief (PEPFAR).
That is not foreign aid in the abstract. That is money collected from American workers, families, and small businesses. People who will never set foot in a Kenyan clinic, but whose taxes built our laboratories, paid for our drugs and covered the salaries of over 40,000 health workers.
Globally, Americans have contributed $110 billion to PEPFAR. The largest commitment any nation has ever made to a single disease in history. Twenty years. $110 billion. And yet, Malaria remains a major public health problem in Kenya, with 75 percent of the population at risk of the disease. HIV treatment in Kenya is still not self-sustaining.
When PEPFAR funding was frozen for a few weeks in January, our health system nearly collapsed. After two decades and $8 billion, the dependency is deeper.
As an American citizen, I have questions. What worked? What did not? Where did the money go? Why are we still funding the same programmes 20 years later with no exit in sight? We Kenyans have embraced the shamba metaphor in this debate. Foreign powers coming to harvest our land. Taking the crops and leaving us with nothing. It resonates because it speaks to a painful history.
But let me offer how it looks from Washington. Your shamba was fallow. Your family could not afford seeds, fertiliser or workers.
People were dying. We came in, cleared the land, planted and kept the farm running for 20 years. We didn’t take the harvest. We gave it to you. The medicine. The treatment. The lives saved.
Now we want to study the harvest patterns. Which seeds grew best in which soil. Which seasons failed. Which investments paid off. Not to steal your land. But to decide whether to keep planting, and where to invest next.
That is not colonialism. That is a funder asking what they paid for. Follow the logic. The laboratories that process samples: American-funded. The digital health systems that capture patient records: American-funded.
The health workers who enter data into those systems: over 40,000 of them on the American payroll. The supply chains, the training programmes, the surveillance infrastructure: all built with American money.
When you fund the system that generates the data, pay the workers who collect it, build the infrastructure that stores it, at what point does that data become yours?
This is a practical argument. If an investor funds your company, they expect equity. The US has invested $8 billion in Kenya’s health infrastructure. From their perspective, asking to see what that investment produced is not exploitation. It is due diligence.
This is why the US wants access to health data. Not to exploit. Not to extract. But to understand. Pattern analysis across millions of health records can reveal what interventions actually reduce disease. It can identify where money is being wasted and where it is saving lives.
Secretary of State Marco Rubio said it plainly when signing the Kenya deal: “That money is not just going to be spent to provide medicine and care. It is going to improve domestic infrastructure, so that in five or six or seven or eight years, countries will say we no longer need this much assistance”.
The goal, he said, is to “eliminate dependency, inefficiency and waste”. That is not the language of extraction. That is the language of a funder who wants to see results, and an exit.
To be clear: this is not new money. American funds have flowed to Kenya’s health system for over two decades. What is new is the leverage. The dependency was always there. Now the US is making it explicit. They are naming the terms. And Kenyans are uncomfortable. Not because the terms are new, but because we are finally being forced to see them.
Here is the question we Kenyans do not want to ask: how much of “our” health system is actually ours?
When PEPFAR funding was frozen in January, we scrambled to find Sh200 billion in emergency funds. Counties suddenly faced losing thousands of health workers they assumed were permanent staff, but who had always been paid by American money.
Clinics discovered their entire ARV supply came through a parallel American-funded channel. More than two decades later, Kenya has never consistently met that target. We relied on donors to fill the gap, then expressed outrage when those donors asked questions about outcomes.
Data sovereignty has a price tag. The question is whether we are ready to pay it.
As a Kenyan, I want fair partnership and control over our national inheritance. As an American citizen, I want accountability and an end to perpetual dependency. Both of these require the same thing: a Kenya that can stand on its own, and an America that can demand accountability to end dependency.
We have demanded data sovereignty. Perhaps it is time we talked about data responsibility. He who pays the piper calls the tune. If Kenya wants to choose its own music, Kenya must pay its own musicians.
Compare this to South Africa, which funds 74 percent of its HIV response domestically. When American funding fluctuates, South Africa’s HIV programme continues. When PEPFAR was frozen, South Africa adjusted. Kenya panicked.
That is the difference between sovereignty as slogan and sovereignty as practice. None of this means Kenya should accept unfair terms. The imbalance between five years of funding and twenty-five years of data access is real. The lack of county consultation is real.
The absence of intellectual property protections is real. I have written about all of this, and I stand by it.
But sovereignty is not just a legal argument to win in court. It is a budget line. If we want to own our health data, truly own it, with the power to set terms and walk away from bad deals, we must fund our own health system.
That means meeting the Abuja target. It means counties prioritising health over other spending. It means building domestic pharmaceutical manufacturing so we are not hostage to foreign suppliers. It means training and retaining our own health workers instead of depending on donor-funded positions. It means investing in digital health infrastructure on Kenyan soil, under Kenyan control.
The court will rule on whether this agreement violated Kenyan law. Civil society will continue to push for better terms. These efforts matter.
But the deeper conversation is not about this deal. It is about dependency itself. For 20 years, Americans have invested in Kenya’s health. Millions of lives have been saved. That is real, and it matters. But benefit and dependency are two sides of the same coin.
Dr Jean-leah Njoroge is an AI and Innovation executive, recognised amongst the leading women influencing AI by VentureBeat and other industry organisations.
