1. LIST OF RELATED ACTIVITIES This project links with hundreds of health service delivery sites across the country in order to meet PEPFAR targets in those areas. It also links to the Capacity Project in other program areas such as ARV Services (#6919), Laboratory Infrastructure (#6920), and Systems Strengthening (#8693).

2. ACTIVITY DESCRIPTION Emergency Hiring Plan (EHP): This project will assist in providing critical human resource management support to ensure increased service delivery for realization of health outcomes with specific emphasis on HIV/AIDS services at recipient sites. The availability and retention of trained health personnel, particularly in the public health sector, is the cornerstone of Kenya's response to the health needs of the country and its response to the HIV/AIDS epidemic. Currently, Kenya's public health sector and not-for-profit health organizations are overwhelmed by the strain of coping with HIV/AIDS prevention, treatment, care and support in addition to other priority health services. Their human resource systems are also unable to keep up with requirements for HIV/AIDS program planning, management and implementation. This ground breaking emergency hiring and training program seeks to increase resources in qualified human capital that will be made available to Kenya's public health sector. In areas where the bulk of health care services including ARVs are provided by facilities managed by faith-based organizations and where they are clearly faced with staffing shortages, the program has attracted and deployed health workers in such facilities.

Specifically, this initiative will enhance the capacity of the public health sector in Kenya to initially expand access to treatment and care for HIV/AIDS patients and also strengthen the provision of quality health programs especially in rural priority posts. The project shall consider various approaches that hold promise for enhancing and sustaining the local health workforce both in the short and long term. As such, this initiative should be envisioned as a strategic and humanitarian intervention in a setting that currently lacks sufficient and adequately qualified health workers to mount an effective counterattack on HIV/AIDS and continue to provide other essential health services at the same time. All the available evidence seems to suggest that without such reinforcement of critical cadres of human resources for health, PEPFAR as well as the Ministry of Health's ambitious coverage and treatment targets for Kenya will be difficult if not impossible to achieve. The objectives of this emergency hiring plan are: 1) to develop and implement a fast-track hiring and deployment model that will mobilize 830 additional health workers and deploy them in the public sector to urgently tackle the HIV/AIDS crisis; 2) to develop and implement an accelerated "crash training program" that will rapidly address the gaps in skills and competencies for the new hires; and 3) to design and implement a monitoring, quality assurance and support system that will enable health care workers by site to increase their efficiency and effectiveness. After the successful recruitment and deployment of 830 health providers to government and faith-based facilities in 2006/7 on three-year contracts, this project will, in 2007/8, support the management of the new hires to fill critical gaps in HIV/AIDS services. This includes support to facilities providing PMTCT services, and PMTCT clinics. The PMTCT program area will support 58 nurses. Capacity will document and develop tools and initiatives that will improve job satisfaction, supervision systems and retention for the new hires. The new hires' salaries have been matched with Ministry of Health salaries by position and qualification and Capacity, through its improved administration system, will continue to ensure the timely monthly payment of each hire until the end of their three-year contract. In addition, the project will strengthen on-site monitoring and supervision through its Workforce Mobilization Program which seeks to make simple, cost-effective changes to the workplace that improve supervision, monitoring, and staff morale.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA Capacity Project supports GOK and Mission service-delivery sites across the country by ensuring they have the qualified staff they need to meet the patients' needs. The project maintains 830 health care providers at facilities across the country, develops on-site supervision, and is working nationally to make these system improvements sustainable. 58 nurses will be supported under PMTCT.

4. LINKS TO OTHER ACTIVITIES This project links with hundreds of health service delivery sites across the country in order

to meet PEPFAR targets in those areas. It also links to the Capacity Project in other program areas such as ARV services, Lab Infrastructure, and Systems Strengthening.

5. POPULATIONS BEING TARGETED This project targets health care providers in the public sector, in particular nurses at facilities that provide PMTCT.

6. KEY LEGISLATIVE ISSUES Through the emergency hiring plan, staff hired will help address gender equity in HIV programming and improve service delivery to pregnant women, their infants and spouses. The staff hired will also help address male norms that often hinder access to critical services by women.

7. EMPHASIS AREAS The major emphasis area for this project is Human Resources. The minor emphasis area is on Quality Assurance and Supportive Supervision. The project, in managing EHP staff, seeks to improve on-site supervision quality through its Workforce Mobilization Program.

1. LIST OF RELATED ACTIVITIES This activity relates to Capacity Project in other program areas: PMTCT (#8647), Laboratory Infrastructure (#6920), and System Strengthening (#8693).

2. ACTIVITY DESCRIPTION Emergency Hiring Plan (EHP): This project will assist in providing critical human resource management support to ensure increased service delivery for realization of health outcomes with specific emphasis on HIV/AIDS services at recipient sites. The availability and retention of trained health personnel, particularly in the public health sector, is the cornerstone of Kenya's response to the health needs of the country and its response to the HIV/AIDS epidemic. In areas where the bulk of health care services including ARVs are provided by facilities managed by faith-based organizations and where they are faced with staffing shortages, the program has attracted and deployed health workers in such facilities. This initiative will enhance the capacity of the public health sector in Kenya to initially expand access to treatment and care for HIV/AIDS patients and also strengthen the provision of quality health programs especially in rural priority posts. The objectives of this emergency hiring plan are: 1) to develop and implement a fast-track hiring and deployment model that will mobilize 830 additional health workers and deploy them in the public sector to urgently tackle the HIV/AIDS crisis; 2) to develop and implement an accelerated "crash training program" that will rapidly address the gaps in skills and competencies for the new hires; and 3) to design and implement a monitoring, quality assurance and support system that will enable health care workers by site to increase their efficiency and effectiveness.

After the successful recruitment and deployment of 830 health providers to government and faith-based facilities in 2006/7 on three-year contracts, this project will, in 2007/8, support the management of the new hires to fill critical gaps in HIV/AIDS services. ART program area will support 682 staff. At the same time, Capacity will implement long-term human resource planning with the Ministry of Health. This activity will support the Ministry of Health's division to standardize their HIV/AIDS curricula, will assist the Office of Continuing Professional Development (OCPD) to develop the National Health Training Plan (NHTP), and will help develop a database of health worker information and training participation, towards a goal of developing an accreditation program of curricula and continuing education credits. In addition to the EHP, this year the project will work with health sector leaders and primary stakeholders to strengthen HRH within the national health system, assist the ministry to develop core technical capacity in HRH planning, management and offer support.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA Capacity supports 830 health care providers at facilities across the country, develops on-site supervision, and is working nationally to make these system improvements sustainable.

4. LINKS TO OTHER ACTIVITIES This activity relates to activities in all PEPFAR facility-based services.

5. POPULATIONS BEING TARGETED This project targets health care providers in the public sector, in particular nurses, pharmaceutical technologists and clinical officers.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses issues surrounding gender equity in AIDS programming.

7. EMPHASIS AREAS The major emphasis area for this project is Human Resources. The activity has a minor emphasis in policy and guidelines, and QA/QI/SS, as it will help implement the HRH policy, help develop the NHTP, and improve on-site supervision.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in ARV services (#6919), System Strengthening (#8693) and Prevention of Mother To Child Transmission (#8647).

2. ACTIVITY DESCRIPTION This activity supports the management, supervision, and administration of the 90 laboratory technicians hired by Capacity to primarily government facilities. In addition to filling critical gaps in HIV/AIDS laboratory services, the new hires support anti-retroviral therapy (ART) screening and monitoring, HIV care and prevention services. This project assists in providing critical human resource management support to ensure increased service delivery for better health outcomes, specifically in HIV/AIDS at recipient sites. The availability and retention of trained laboratory personnel, particularly in the public health sector, is the cornerstone of Kenya's response to the health needs of the country and its response to the HIV/AIDS epidemic. Currently, Kenya's public health sector and not-for-profit health organizations are overwhelmed by the strain of coping with HIV/AIDS prevention, treatment, care and support in addition to other priority health services. Their human resource systems are also unable to keep up with requirements for HIV/AIDS program planning, management and implementation. This ground breaking emergency hiring and training program seeks to increase resources in qualified human capital that will be made available to Kenya's public health sector. In areas where the bulk of health care services including ARVs are provided by facilities managed by faith-based organizations and where they are clearly faced with staffing shortages, the program has attracted and deployed health workers in such facilities. Specifically, this initiative will enhance the capacity of the public health sector in Kenya to initially expand access to treatment and care for HIV/AIDS patients and also strengthen the provision of quality health programs especially in rural priority posts. The project shall consider various approaches that hold promise for enhancing and sustaining the local health workforce both in the short and long term. As such, this initiative should be envisioned as a strategic and humanitarian intervention in a setting that currently lacks sufficient and adequately qualified health workers to mount an effective counterattack on HIV/AIDS and continue to provide other essential health services at the same time. All the available evidence seems to suggest that without such reinforcement of critical cadres of human resources for health, PEPFAR as well as the Ministry of Health's ambitious coverage and treatment targets for Kenya will be difficult if not impossible to achieve. The objectives of this emergency hiring plan are: 1) to develop and implement a fast-track hiring and deployment model that will mobilize 90 additional laboratory workers and deploy them in the public sector to urgently tackle the HIV/AIDS crisis; 2) to develop and implement training programs that will rapidly address the gaps in skills and competencies for the laboratory workers; and 3) to design and implement a monitoring, quality assurance and support system that will enable the laboratory workers at sites to increase their efficiency and effectiveness. In 2007 and 2008, the Emergency Hiring Plan (EHP) will strengthen the health sector systems to improve and sustain the new hires and facility performance to deliver the essential services. Capacity will document and develop tools and initiatives that will improve job satisfaction, supervision systems and retention for the new hires. The new hires salaries have been matched with the Ministry of Health salaries according to position and qualifications and will be paid on time at the end of each month. At the same time, Capacity will implement long-term human resource planning with the Ministry of Health. The EHP can only generate sustainable results if its lessons and promising practices are taken up, applied and combined with existing effective measures to address all the components of the Human Resources in Health (HRH) Framework. It will be important to ensure appropriate skills amongst health workers to meet the health needs of the Kenyan population, which means expansion of educational opportunities and curricula reforms. With donor support, the MOH recently completed a three year Human Resource Strategic Plan and implementation plan. The MOH will need to be encouraged and supported to take this strategic initiative forward. This project will work with health sector leaders and primary stakeholders to strengthen HRH within the national health system, assist the ministry to develop core technical capacity in HRH planning, management and offer support by a) providing targeted technical assistance to assist the MOH with the implementation of the 3 year HR strategic plan b) introducing an integrated human resource information system (HR IS), c) streamlining and strengthening HR management processes and practices especially recruitment, deployment, transfers, supervision and performance management and linking HR and payroll data, d)enrolling selected HRH leaders and managers in a leadership development course, and d) working with the OCPD

on and MOH divisions to standardize curricula as needed, and e) expanding the Work Climate Improvement Initiative that seeks to improve job satisfaction and aid retention, to sites with new hires.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA Capacity will support the 90 laboratory personnel who will provide HIV and AIDS services to selected sites across the country.

4. LINKS TO OTHER ACTIVITIES Health care providers will be deployed to sites around Kenya with the greatest need in order to meet PEPFAR targets in those areas. Most of these facilities are GOK facilities, and many are supported by PEPFAR partners. This activity links to Capacity activities in other program areas as well: PMTCT (#8647), ARV Services (#6919), System Strengthening (#8693).

5. POPULATIONS BEING TARGETED This project targets laboratory technicians primarily in the public sector, and MOH policymakers, HR administrators, and hospital supervisors.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address the issue of increasing gender equity in HIV/AIDS programs.

7. EMPHASIS AREAS The major emphasis area for this project is human resources as it manages and seeks to retain 90 laboratory personnel to scale up HIV/AIDS services. Minor emphasis areas are Policy and Guidelines and QA/QI/SS, as Capacity will work with the MOH on implementation of its Human Resource in Health policy, and seeks to improve on-site supervision through its Workforce Mobilization Program.

1. LIST OF RELATED ACTIVITIES This activity relates to all facility-based service delivery projects. It also relates to Global Fund support under the Futures Group/HPI project [HPI] in this same program area. 2. ACTIVITY DESCRIPTION The Capacity Project will continue to implement long-term human resource planning with the Ministry of Health. The Emergency Hiring Plan (EHP) can only generate sustainable results if its lessons and promising practices are taken up, applied and combined with existing effective measures to address all the components of the Human Resources in Health (HRH) Framework. It will be important to ensure appropriate skills amongst health workers to meet the health needs of the Kenyan population, which means expansion of educational opportunities and curriculum reforms. Kenya is also faced with a unique absorptive capacity challenge: although it does not produce enough health providers to plug gaps in coverage, it is also unable to find work for all its graduates, creating a "phantom surplus" of qualified, unemployed health workers. Moreover, in most training schools, the curriculum is misaligned with the country's health problems (for example, HIV/AIDS is not adequately covered), and pedagogic methods are outdated, excluding practical problem-solving skills. Training and production of health workers is based not on working competencies but on certification or traditional roles that are often controlled by and aligned to the goals of professional bodies. This activity will strengthen three key aspects of long-term human resources development in Kenya through: 1) support to the Ministry of Health's division to standardize their HIV/AIDS curricula, 2) assistance to the Office of Continuing Professional Development (OCPD) to develop the National Health Training Plan (NHTP), and 3) support for the development of a computerized database of national health worker information and training participation, towards a goal of developing an accreditation program of curricula and continuing medical education credits. The Capacity Project will also provide focused technical assistance to the Global Fund as well as capacity building of the Country Coordinating Mechanism (CCM) Secretariat. While it is essential to mobilize additional health workers to avert the current workforce crisis and help combat priority diseases like HIV/AIDS, it is as important to help develop and sustain policies and strategies over the longer term. All of these activities will be done in close collaboration with the Ministry of Health (MOH). With donor support, the MOH recently completed a three year Human Resource Strategic Plan and implementation plan. The MOH will need to be supported to take this strategic initiative forward. In addition to the EHP, this year the project will work with health sector leaders and primary stakeholders to strengthen HRH within the national health system, assist the Ministry to develop core technical capacity in HRH planning and management and offer support by a) providing targeted technical assistance to assist the MOH with the implementation of the 3 year HR strategic plan, b) introducing an integrated human resource information system, c) streamlining and strengthening HR management processes and practices especially recruitment, deployment, transfers, supervision and performance management and linking HR and payroll data, d) enrolling selected HRH leaders and managers in a leadership development course, e) supporting the OCPD to develop the NHTP and training database, and f) expanding the Work Climate Improvement Initiative that seeks to improve job satisfaction and aid retention, to sites with new hires. Secondly, the Capacity Project continues to support seconded staff, and under this program area, will support the Advisor for HIV/AIDS Mainstreaming at the Ministry of Planning and National Development (MPND). This person provides pivotal technical assistance by supporting various arms of the government including the National AIDS Control Council (NACC) and the National AIDS and STD Control Program (NASCOP) to engage in the national budgeting process with the goal of increasing allocations for HIV and AIDS activities. The Advisor also provides technical assistance to MPND to accelerate the agenda of mainstreaming HIV/AIDS through the national Poverty Eradication Strategy (PRSP) in the public sector, and provides critical technical input into the collection and management of data systems at the Central Bureau of Statistics that captures and addresses the national level impact and mitigation strategies against the effects of HIV and AIDS. Lastly, the Capacity Project will allocate $250,000 of its Systems Strengthening budget for support the Global Fund Country Coordinating Mechanism (CCM) in Kenya with the implementation of the Transition Team Action Plan and management of Global Fund grants. The GFATM has established transparent disbursement procedures, project implementation modalities, oversight responsibilities, and financial and program performance reporting responsibilities to ensure Principal Recipient (PR), CCM and

sub-recipient accountability to the Government of Kenya and to the GFATM. There are basic conditions which a country must meet before funds are released for the approved projects. In Kenya, the Ministry of Finance is the PR and the performance of all the major grants that fall under its purview has been unsatisfactory. The Capacity Project will provide technical assistance to improve the management and implementation of these grants, including support to the CCM secretariat. This might include recruitment of secretariat staff and meeting the costs of establishing a web-based database of appropriate GF and CCM material such as approved meeting minutes, proposals and other documentation. 3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The Capacity Project will contribute policy-level guidance on the critical processes of health planning and management in support of national level goals and ensure sustainability of PEPFAR-supported hiring and training activities. 4. LINKS TO OTHER ACTIVITIES This project links with hundreds of health service delivery sites across the country to meet PEPFAR targets in those areas. 5. POPULATIONS BEING TARGETED This activity targets government policy makers to improve the planning and management of human resources, and implementation and development of HRH policies and systems at the national level, and also works with HR and OCPD staff to develop their capacities. The USG and its collaborating agencies are under continuous pressure to hire highly experienced professionals to guide PEPFAR-supported programs. As a result, we have hired away over a dozen of the MOH's most qualified personnel. Many of these staff have over 15 years experience in health management and their loss to the MOH has resulted in the weakening of capacity of the very system that PEPFAR is pledging to build. Making matters worse, at the same time that there are increasing shortages of senior health managers, there are deteriorating working conditions and growing demand to incorporate new and labor-intensive services, such as antiretroviral therapies for HIV/AIDS. We propose to help address these issues through the development of an intensive program of management strengthening and staff development within the MOH and, more specifically, NASCOP. This corresponds with a similar program being undertaken with the Kenya Medical Supplies Agency (KEMSA) under the Millennium Challenge Account Threshold Agreement.