The development community may be asking the wrong question about Kenya’s controversial new health agreement with the United States. While digital rights advocates express outrage over data sovereignty violations, they’re missing an economic reality that forced this deal in the first place.
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Last week, President William Ruto signed away 25 years of access to Kenyan health data for $1.6 billion over five years – $5.66 per person annually for a population of 56.5 million to give the US government access to:
- Personal medical records
- Genetic information
- Lab samples
- Insurance details
- Digital health platforms
Why would Ruto bypass the Kenyan Data Protection Act, forgo anonymization guarantees, agree to US federal law governing the framework rather than Kenyan law, and practically give away his citizen’s health data?
3 Potential Reasons for Ruto’s Decision
The truth is more complex than the simplified narrative of American pharmaceutical companies gaining access to drug development data while Kenya gets barely enough funding to maintain existing services.
Kenya didn’t choose this deal from a position of strength. The country was backed into a corner by systematic cuts to US global health funding that have left African health systems scrambling for survival.
Reason 1: PEPFAR Funding Collapse
According to the World Bank, Kenyans spent $90.44 per person on healthcare in 2022, of which $18.41 was from the USA – 20% of the total spending. Then this US administration defunded USAID and froze PEPFAR funding in 2025, creating exactly the desperate conditions that make deals like this inevitable.
For example, when major PEPFAR programs ended, millions of Africans lost access to HIV prevention activities and support for orphans, vulnerable children, and AIDS patients.
The shift from USAID’s development approach to the State Department’s “America First” bilateral agreements forced Kenya to accept less favorable terms or lose access entirely. Kenya became the first to sign because refusing would mean total loss of US health funding.
When you’re facing a healthcare crisis affecting millions and your primary donor suddenly cuts funding, $320 million per year starts looking like a lifeline rather than a sellout.
Reason 2: Military and Economic Leverage
The second factor probably driving this agreement has everything to do with geopolitics. Secretary of State Marco Rubio’s praise for Kenya’s military efforts during the signing ceremony wasn’t diplomatic courtesy. It was a quid pro quo acknowledgment.
Kenya is currently leading a struggling peacekeeping mission in Haiti, deploying 400 police officers in an effort that has shown little progress against gang violence. The US granted Kenya Major Non-NATO Ally status in 2024 and signed a five-year defense agreement in 2023, with American officials explicitly linking military cooperation to economic support.
Opposition lawmakers in Kenya have consistently argued that Ruto’s government joined the Haiti mission only for monetary gains. That could be very true – Kenya barely avoided default on $2 billion in debt due in June.
When you examine the health data deal alongside Kenya’s military commitments and economic strain, the pattern looks clear: Ruto is trading both digital and military sovereignty for American financial support.
Reason 3: Regional Competition Dynamics
Kenya’s agreement also may reflect a calculated gamble that being first would secure more favorable terms than waiting. Secretary Rubio explicitly called Kenya the “perfect partner” for the new bilateral model, language that reveals a competitive selection process at work.
The US State Department has promised to sign agreements with dozens of countries receiving U.S. health assistance in the coming weeks, creating artificial scarcity around what was previously more predictable PEPFAR funding.
This deliberate shift from multilateral assistance to bilateral competition fundamentally changes the power dynamics between the US and African governments. By fragmenting African countries into individual bilateral negotiations, the US effectively prevents coordinated continental responses through institutions like the African Union.
Countries that might collectively demand better terms as a bloc instead compete against each other for American favor. Zambia’s upcoming $1.5 billion agreement and Rwanda’s imminent $228 million deal demonstrate this pattern.
Each subsequent agreement will establish precedents that constrain future negotiations, making Kenya’s willingness to accept these terms a strategic liability for the entire continent.
Digital Health Reality Check
Contrast these three reasons with the high-minded narrative in digital health. We’ve spent years building principles around data protection, privacy, and sovereignty.
- World Health Organization Global Strategy on Digital Health emphasizes that countries should adopt digital health that respects their sovereignty
- Global Digital Health Forum features sessions every year on data protection and digital sovereignty – especially health data.
These are noble principles. They’re also completely irrelevant when African presidents are facing empty health budgets.
Dr. Mugambi Laibuta’s legal analysis found the Kenyan agreement “unconstitutional and unlawful,” but legal frameworks can’t override economic desperation. Kenya’s civil society successfully forced some changes to the agreement terms, proving that organized pressure works, but only when governments have alternatives.
Painful Economics in Data Sovereignty
Here’s where I differ from conventional development wisdom about data sovereignty. We’ve spent years discussing principles around digital sovereignty as a tool to break digital colonialism, but these frameworks assume countries have meaningful choices.
Data sovereignty requires economic security. Full stop. No amount of well-intentioned frameworks can substitute for the bargaining power that comes from not being desperate for external funding.
Consider the budget math facing African health systems. Sub-Saharan African countries spend about $37.50 per capita on healthcare. Compare this to Europe that spends $2,600 per capita for health. That’s a 69-fold difference in resources.
Many LMIC presidents face an impossible choice: accept USA’s data-sharing agreements with unfavorable terms, or watch healthcare systems collapse without donor funding. By 2021, seven African Union countries spent less per person on healthcare through public means than they did in 2000, with Madagascar reducing per-person spending by 62 percent.
True Digital Health Data Sovereignty
Instead of lamenting Kenya’s choice, we should focus on building systems that provide real alternatives. True country ownership means:
- Domestic health data infrastructure that African governments control, not donor-funded systems that can be withdrawn
- Regional health financing mechanisms that reduce dependence on bilateral agreements with individual donor countries
- African pharmaceutical development capacity that ensures data-sharing arrangements include technology transfer and local manufacturing requirements
- Continental data governance frameworks that establish minimum terms for health data partnerships
Kenya’s health data deal isn’t an aberration. This is a preview of what happens when economic pressure meets limited options. We might bemoan selling citizens’ health data for $5.66 per person, but when 20% of a country’s health funding disappears, it may just be the best available option.
We’ll see more countries making similar calculations until we address the systematic underfunding of African health systems.
