1. LIST OF RELATED ACTIVITIES This activity relates to activities in System Strengthening and Policy Analysis (#7040) and Orphans and Vulnerable Children (#7041).

2. ACTIVITY DESCRIPTION This activity is a follow on to activities carried out by the POLICY project in FY 2006 which contributed indirect results to the Palliative care area through activities with the Networks such as the Network of People Living with HIV/AIDS in Kenya (NEPHAK) and the National Muslim Council of Kenya (NMCK). Various problems impinge on service delivery in this area and include the following: a) Ineffective referral linkages particularly between home and communities to institutional services compounded by weak capacities amongst community groups and People Living with HIV/AIDS networks; and b) Gender imbalances that lead to barriers to accessing care and treatment for women and girls because of i) their vulnerability to HIV/AIDS due to poverty and low social status compounded by harmful traditional customs and ii) the burden of care predominantly falling on women that sees them expend enormous costs in time, energy and resources caring for sick parents, orphans and vulnerable children (OVC), running households etc.

This activity will seek to expand access to community based non-clinical palliative care and strengthen the referral network for opportunistic infections (OIs) and tuberculosis (TB) treatment services. The activity will train 680 individuals and establish 150 service outlets which will provide HIV-related palliative care and reach 6,000 individuals with HIV related palliative care. This will be achieved through: strengthening the capacity of People Living with HIV/AIDS (PLWHA), faith-based organizations (FBOs), teachers and people with disabilities networks to provide palliative care in their communities through training and mentoring; providing community-based care and support and linking adults and children to antiretroviral therapy (ARVs), opportunistic infections (OIs) and tuberculosis (TB) treatment; providing technical assistance to strengthen the traditional community structures to target the vulnerable and hard to reach women in HIV prevention care and treatment; and, providing technical assistance to build the capacity of community institutions in gender equity in home and community based care focusing on social transformation for increased male involvement.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute 2.4% to the overall target area of number of individuals provided with community-based HIV-related palliative care by working with PLWHA and FBO networks.

4. LINKS TO OTHER ACTIVITIES This activity links to HPI's activities in: the program areas of Systems Strengthening and Policy Analysis (#7040), that seek to enhance the capacity of local institutions and PLWHA networks; of OVCs (#7041), working to create a supportive social and policy environment for OVC and care givers to access basic services.

5. POPULATIONS BEING TARGETED These activities target OVC, PLWHA and caregivers of OVC and PLWHA.

6. KEY LEGISLATIVE ISSUES ADDRESSED The key legislative issue addressed is gender.

7. EMPHASIS AREAS The main emphasis area for this program is development of network/linkages/referral systems and a minor emphasis on local organisation capacity development.

While it is well documented that TB is the single most important cause of morbidity and mortality among PLWHA, TB advocacy has always trailed behind HIV. Indeed a number of PLWHA organizations have dedicated resources to HIV advocacy, almost at the expense of TB issues. There a growing reciognition of the important role of TB/HIV advocacy in expanding access to prevention, care and treatment services for the two diseases, especially during this time when more resistant TB variants are emerging in many countries. This Plus-up funding will enable the Health Policy Initiative to support nascent networks of people living with HIV/ AIDS to be better advocates on TB/HIV issues at national level. The main outcome of these activities will be increased awareness of TB/HIV at the national level.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Systems Strengthening and Policy Analysis (#7040), Palliative Care: Basic Health Care and Support (#8863, #8867, #8928, #8929, #8931, #8934, #8936), TB/HIV (#9059, #9062, #9065, #9066, #9068, #9069, #9072), CT (#8760, #8776, #8777, #8778, #8781, #8782, #8976) and OP (#8874, #8927, #8930, #8932, #8937, #8942, #9040).

2. ACTIVITY DESCRIPTION Various issues beleaguer OVC support in Kenya today and include the following: the government has a National OVC response plan but it is yet to be operationalized; the Ministry of Home Affairs has taken on increased responsibilities in mainstreaming OVC issues into its cores functions but lacks the requisite technical and management capacity to deliver effectively; the need to build the capacity of communities and PLWHA groups to promote women and OVC's access to services and property ownership; the need to link OVC to available support like bursaries, psychosocial support and counselling services.

This activity will serve to ameliorate the above problems and result in creating a supportive social and policy environment for OVC and caregivers to access basic services. This will be achieved through: providing technical assistance to strengthen government systems and structures to enact OVC legislation and responsive laws and support policy dialogue and advocacy on the protection of children's rights with the HIV/AIDS and OVC networks; strengthening the technical and management capacity of the Ministry of Home Affairs (Children's Department) to co-ordinate OVC policy implementation including monitoring and supervision; providing technical assistance to strengthen legal and traditional community structures to promote OVC and women access to essential services and property ownership under the Women Property Ownership and Inheritance Rights (WPOIR) initiative; providing technical assistance and training to Kenya Network of Positive Teachers (KENEPOTE), Parents-Teachers Associations (PTA) and caregivers to improve OVC access to education and strengthen related psychosocial support; and, train and build the capacity of indigenous CBOs/NGOs to scale-up and/or initiate new and sustainable programs on OVC psychological support through small grants programs.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA It is anticipated that in FY 2007 this activity will contribute to the indirect target of over 100,000 affected/infected OVC. This will be done through the dissemination and roll out of OVC Policy, dialogue and advocacy to community based, non-government and faith based organizations, policy makers, community leaders, religious groups and various HIV/AIDS and OVC networks.

4. LINKS TO OTHER ACTIVITIES This activity links to HPI's activities in: Systems Strengthening and Policy Analysis (#7040), that seek to enhance the capacity of local institutions and PLWHA networks; Palliative care (#8863, #8867, #8928, #8929, #8931, #8934, #8936) that expand access to community based non-clinical palliative care and strengthen referral networks to OIs and TB medical treatment services; Counselling and Testing (#8760, #8776, #8777, #8778, #8781, #8782, #8976) that enhances CT amongst people with disabilities (differently-abled persons) and other prevention (#8874, #8927, #8930, #8932, #8937, #8942, #9040) that promotes HIV/AIDS prevention amongst positives through other behavior change messages beyond abstinence and being faithful by providing technical assistance to PLWHA networks to develop their own behaviour change messages.

5. POPULATIONS BEING TARGETED This activity targets policy makers, community and religious leaders and Country coordinating mechanism. It also targets people affected by HIV/AIDS and specifically orphans and vulnerable children and also caregivers of OVC, widows and widowers.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses issues related to gender increasing women's legal rights and access to services.

7. EMPHASIS AREAS The main emphasis area for this activity is capacity of local organisations specifically the Children's department in the Ministry of Home Affairs and minor emphasis is community

mobilization/participation serving to increase the participation of PLWHA groups in caring for OVC.

1. LINKS TO RELATED ACTIVITIES This activity relates to activities in Strategic Information (#9012), Palliative Care: Basic Health Care and Support (#8823), Orphans and Vulnerable Children (#7041) and other System Strengthening activities including (#8693).

2. ACTIVITY DESCRIPTION In this program area, the Health Policy Initiative (HPI) will work in several distinct but related components, as described below.

1) While Kenya continues to expand its HIV/AIDS care and support services, the capacity of existing institutions and particularly the networks of people living with HIV/AIDS (PLWHA) are fragmented, with poorly coordinated multi-sectoral responses, limited capacity to develop and implement policies and programs for advocacy of stigma reduction; weak institutional structures for PLWHA networks with high staff turnover; insufficient attention to gender, poverty and human rights issues; ineffective leadership for community action; and limited engagement by PLWHA in the policy process. HPI will work in this area to strengthen local institutions and networks such as the Kenya Network of Positive Teachers and Educators (KENEPOTE), NEPHAK, a Muslim organisation, UDPK, KENERELA, and KETAM for policy and program implementation. HPI will also work closely with a TBD partner in this program area to develop support groups for medical professionals living with HIV/AIDS.

2) In the policy arena, several issues have been identified for support, including the need to disseminate user-friendly national policies to PLWHA and other target groups; the lack of policies that pay attention to orphans and vulnerable children, food security and safety nets; operational policy barriers that impede access to HIV treatment care and support; lack of an appropriate index on stigma and discrimination activities; and an inadequate exchequer allocation to HIV/AIDS due to lack of advocacy within the Medium Term Expenditure Framework (MTEF) process that would provide increased allocations for HIV/AIDS.

HPI will work on policy development, advocacy and implementation, and also work to build the Government of Kenya's capacity to mobilize resources for HIV/AIDS. Specifically, HPI will provide technical assistance to the National AIDS Control Council (NACC) and the National AIDS, STI Control Program (NASCOP) to review, update and disseminate existing policies to PLWHA networks and target groups. HPI will further provide technical assistance to NACC and Ministry of Planning and National Development to mainstream HIV/AIDS into the MTEF budgeting and planning process, as well as other areas of assistance that will be identified in close consultation with NACC.

3) There is an identified need to increase the participation in the Sector Wide Approach to health programming to include networks of faith based organisations (Inter-religious Consortium) and the private sector (Kenya Private Sector Advisory Network); to strengthen the GFATM's country coordinating mechanism (CCM) and AIDS-Interagency Coordinating Committee (AIDS-ICC) in accordance with the governance manual; and the need to increase contributions by civil society organisations and other grass root level stakeholders in the Joint AIDS Program Review (JAPR), all of which affect the MTEF planning and budgeting.

In FY 2007, HPI will continue to offer technical assistance to strengthen Global Fund activities by strengthening Civil Society member organizations of the CCM. HPI will convene and facilitate FBOs, NGOs and private providers involved in the planning and budgeting process, and provide technical assistance to NACC to promote the participation by CSOs and other stakeholders at the grass-root level in the JAPR process.

4) In the stigma and discrimination arena, HPI will field test the "USAID Interagency Working Group On Stigma & Discrimination Indicators" questionnaire on measuring HIV/AIDS related stigma and discrimination.

5) In FY 2007, as part of PEPFAR's support to public private partnerships, HPI will also work closely with the Nairobi Women's Hospital (NWH) Board of Directors to strengthen its capacity as a decision-making body, and to help expand a vital resource, NWH's Gender Violence and Recovery Center (GVRC), to other parts of Kenya. The GVRC offers

counseling, treatment and support for women battling rape and gender violence. Currently, GVRCs are located in Nairobi and Nyanza only.

These activities will result in 4,000 individuals trained in community mobilization, 150 individuals trained in institutional capacity building and also policy development; and 1,800 individuals trained in stigma and discrimination reduction. In addition 15 organisations will benefit from institutional capacity building and 20 organisations receive help in HIV-related policy development.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA System Strengthening activities under HPI contribute directly to building the management and leadership abilities of indigenous organizations, fortifying the GFATM management structure, and to creating an active and engaged policy environment surrounding issues of HIV/AIDS.

4. LINKS TO OTHER ACTIVITIES This activity links to HPI's activities in palliative care that expands access to community based non-clinical palliative care and strengthens referral networks to OIs and TB medical treatment services; orphans and vulnerable children working to create a supportive social and policy environment for OVC and care givers to access basic services; counseling and testing that enhances CT among differently-abled persons; and other prevention that promotes HIV/AIDS prevention amongst positives through other behaviour change messages beyond abstinence and being faithful by providing technical assistance to PLWHA networks to develop their own behaviour change messages.

5. POPULATIONS BEING TARGETED This activity will target People Living with HIV/AIDS, HIV/AIDS affected families, caregivers of OVC and PLWHA, host country government workers including policy makers, teachers, NACC staff and other MoH staff including NASCOP. In addition the activities will target CBOs, FBOs, NGOs, and the CCM for the GFATM.

6. KEY LEGISLATIVE ISSUES ADDRESSED HPI's activities will address issues related to gender, as well as stigma and discrimination.

7. EMPHASIS AREAS Emphasis areas include local organisation capacity building, policy and guidelines, and community mobilisation and participation. The Health Policy Initiative (HPI) Kenya office has been a key partner in PEPFAR/Kenya's groundbreaking work in supporting networks of People Living with HIV/AIDS (PLWHA). In addition to support for a single inclusive national network, HPI has provided critical organizational and capacity building support to networks of HIV-positive educators, religious leaders, persons with disabilities, and Muslim women. These networks are increasingly proving their effectiveness in elevating the level of policy dialogue between providers and recipients of services as well as holding providers, donors and the host government accountable for results and transparency. ($50,000) On a separate project, HPI will also work closely with National AIDS Control Council (NACC) to continue strengthening its ability to coordinate AIDS programming in Kenya. Funds will also assist with costs of relocation and establishment of more user-friendly offices for NACC ($200,000).