Revealed: Secret details of disputed Sh208b US health deal

President William Ruto witnesses the signing of a health agreement by Prime CS Musalia Mudavadi and US Secretary of State Marco Rubio December 4, 2025 in Washington DC. [PCS] 

Busia Senator Okiya Omtatah says last year's landmark health partnership with the Donald Trump administration is tilted in favour of the US. 

In documents filed before the High Court, Omtatah argues that the Sh208 billion framework has far-reaching commitments entered into without parliamentary approval, public participation, or consultation with county governments.

The agreement compels Kenya to inject billions of shillings into the programme annually for five years, absorb more than 13,000 frontline health workers into the payroll before 2028 and recognise approvals issued by the US Food and Drug Administration (FDA) for medical products.

In his 52-page supplementary submissions filed on Monday, the Senator raises concerns that Kenya could be required to grant American officials direct login credentials to some of the country’s most sensitive national health data, including HIV and tuberculosis records, genomic sequences, and disease surveillance information covering millions of Kenyans.

The submissions have intensified a constitutional battle now before both the High Court and the Court of Appeal.

President William Ruto witnessed the signing of the agreement on December 4, 2025, in Washington D.C., by Prime Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio.

The recent court filings come after a three-judge Court of Appeal Bench last week cleared the government to proceed with the implementation of the framework, lifting High Court conservatory orders issued on December 19.

At the centre of the case is a dispute over how the framework has been presented to the public.

President Ruto described the Health Cooperation Framework as a milestone towards universal health coverage, including investments in medical equipment, workforce expansion, and health insurance reforms.

The US called the pact a “landmark agreement", praising Kenya as a key ally.

Health Cabinet Secretary Aden Duale also said the framework would strengthen “health sovereignty” and improve access to medicines and services.

However, Omtatah’s presents a different interpretation of the financial structure. The framework contains a co-investment schedule that spells out that the Treasury must inject Sh10 billion in the next financial year, which starts in July.

The following year, 2027/2028, that figure doubles to Sh20 billion. By 2028/2029, it will rise again to Sh35 billion and reach Sh50 billion in the final year.

In total, the taxpayer would be committing about Sh115 billion to support a deal that was never been appropriated through Parliament, subjected to the national budget process, or captured in any medium-term expenditure framework.

Even worse, Kenya will be contributing roughly three times what America is providing.

"I submitted that the respondents are committing Kenyans to the framework, which will benefit the United States more than Kenya. Ultimately, the Kenyan public will be left with a huge liability," Omtatah says.

He notes that Paragraph 6.1.1 contains a penalty clause providing that if Kenya fails to meet its share, the US "may… reduce or cease providing funding".

"It is unlikely that the framework will succeed given that the government already struggles to meet the existing funding," Omtatah argues.

 Health PS Dr Ouma Oluga interacts with US Secretary of State Marco Rubio before the signing of the landmark  health deal in Washington, DC, on Thursday, December 4, 2025. [PCS]

Beyond financial obligations, the framework includes a major workforce transition.

Paragraph 2.4.3.1 requires the government to absorb 13,293 frontline healthcare workers by 2028. These are workers currently sustained by US-backed health programmes, and when the five-year agreement expires in 2030, their salaries, their benefits, and their entire recurrent expenditure become Kenya's permanent fiscal responsibility.

The Kenya Medical Practitioners, Pharmacists and Dentists Union, which is a party to the case in support of the framework, has argued that 515 specialised health workers are already dependent on the arrangement and that halting the deal would place them in immediate financial jeopardy.

But Omtatah disputes this, arguing that the government has not demonstrated that existing health budget allocations, including the Sh13.77 billion allocated for this financial year, have been exhausted.

He describes arguments about “clinical peril” as exaggerated and intended to obscure constitutional concerns.

Omtatah also raise questions over pharmaceutical regulation. Under Paragraphs 2.1.2.7 and 2.7.2, Kenya agrees to recognise US FDA approvals for medical products, including during emergencies.

This, Omtatah argues, sidelines the Kenya Pharmacy and Poisons Board and undermines domestic regulatory authority.

"This constitutes an abdication of regulatory sovereignty, contrary to public policy. Health policy priorities appear externally determined, undermining domestic institutions including the Ministry of Health, the Social Health Authority, and the Kenya Medical Supplies Authority." 

He warns this amounts to an erosion of regulatory sovereignty and weakens national institutions responsible for health governance.

Data sharing protection concerns form another central pillar of the case.

Attorney General Dorcas Oduor, in her submissions before the Court of Appeal, assured that no sensitive personal data would be shared. She further explained that all information shared would be de-identified to ensure individuals could not be traced.

But Omtatah disagrees.

Article 2(a) of the Data Sharing Agreement, a companion document signed on the same day as the framework, states that Kenya would not provide individual level data or personally identifiable information only "to the maximum extent practical".

Those five words, Omtatah argues, are not a guarantee or a protection.

"It implicitly acknowledges that there will be circumstances where individual level data or personally identifiable information will be shared."

More significantly, Article 2(c)(i) provides for the sharing of login credentials or secure access mechanisms with US officials for certain health systems which include TaifaCare HMIS, the National Laboratory Management Information System, national surveillance modules, the national health cloud, and genomic sequencing infrastructure.

"Once login credentials are provided, the US government could potentially access underlying personal data, depending on how the systems are configured."

Omtatah is seeking orders to quash the framework and the Data Sharing Agreement, and to compel full disclosure of all related documents.