PHE CONTINUING STUDY:

Project Title:The effectiveness of the distribution approach of the basic care package and the suitability of

the package for the Kenyan Context

Name of Local Co- Investigator: Not yet identified, Mildmay international Kenya

Project Description:

USAID is currently piloting with the Ministry of Health (MoH) the introduction of a basic preventative care

package, initially supplying packages to 150,000 patients across Kenya. This includes treated bednets,

Cotrimoxazole (CTZ), Vitamin A, condoms and safe water vessels and is based upon the success of

clinical trials undertaken in Uganda. These trials did not, however, address approaches to integration within

a MoH systems and national level scale up. In this initiative Mildmay, in partnership with the MoH and key

stakeholders, will evaluate the appropriateness of the contents of the package, distribution mechanisms and

possible strategies for scale up.

Timeline:

FY 2008 = Year 2nd of activity

Year started: to be started: 2007

Expected year of completion: 2008

Funding:

Funds received to date: none

Funds expended to date: none

Funds requested to complete the study:

FY 07: $ 250,000

FY 08: $ 0

Beyond FY08: Not yet known

Describe funds leveraged/contributed from other sources:

None

Status of Study:

To be started.

Lessons Learned:

N/A - study has not yet started.

Information Dissemination Plan: still to be determined.

Planned FY08 Activities:

The evaluation will be undertaken over a one year period, including report writing. It will use Action

Research methodology, which emphasizes active participation of and ownership by stakeholders and

participants. A survey of Provincial and District Health Management teams, health facilities, CHWs and

patients will be undertaken in addition to observation and qualitative interviews with Key Informants. Key

Informants will include patients and community representatives, policy makers, health service and support

service managers. The evaluation will be undertaken by a research team comprising of specialist

consultants from Kenya, and technical staff from Mildmay International. In addition, Mildmay is able to draw

on specialist international consultants for specific aspects of the evaluation if required.

Population of Interest:

The evaluation will focus on four provinces, representing a range of prevalence rates and a comparison of

urban and rural areas. Selection of the provinces will be made in collaboration with the MoH and

stakeholders. The population understudy will include patients receiving the package, CHWs and MoH staff

involved in distributing the package at community, health centre and district level. Systematic probability

sampling will be used and an appropriate sampling frame will be developed in partnership with

stakeholders.

Budget Justification for FY2008 Budget (USD):

N/A - study is not requesting funds for FY08.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in HBHC: Basic Care Package TBD (#8849), HBHC (#8936), HBHC (#8928)

and HBHC (#8931).

2. ACTIVITY DESCRIPTION

Over 2 million Kenyans are thought to be living with HIV/AIDS. The HIV/AIDS epidemic has increased the

number and percentage of people seeking health services and increased the cost of health care. This is

demonstrated by the overwhelming demand for health care services with bed occupancy rates for patients

with HIV/AIDS ranging from 50-75%. The KNSP 2005-2010 has identified the need for comprehensive

Home Based Care (HBC) and Palliative care as key strategies required to respond to this need. Over the

past three years Mildmay has provided technical assistance to enable MTC Kisumu to develop tailor made

courses on HBC. The courses include short courses for divisional level services providers, for District

Health Management Teams (DHMTs) and a diploma validated by MTC Nairobi to train District Home Based

Care co-ordinators. Mildmay has also provided MTC Kisumu with technical assistance to develop a

Business Unit. The Business Unit is now running courses on HBC relatively independently and is starting to

market these courses to the Ministry of Health and other agencies such as World Vision. In FY 2008

Mildmay plans to support further institutional strengthening by working with MTCs in Kakamega, Thika and

Nairobi to enable them to also offer these types of courses. Over the three year program Mildmay will focus

on further institutional capacity development for MTCs across the country. There are 22 MTCs in Kenya and

they provide training for 80% of health professionals in the country. The first stage of the program will focus

on four MTCs with the aim of reaching half of the MTCs in Kenya by the end of the program. Institutional

Capacity Building In order to ensure that MTCs can provide sustainable quality training, places will be

offered on the Mildmay Degree course (validated by Manchester University) to MTC tutors and their counter

parts in the PHMTs. The Mildmay Degree was developed in Kenya and has been specifically designed to

strengthen institutional capacity within the health and medical education systems in relation to HIV/AIDS

care training and service development. A total of 86 participants from Kenya have completed the first part of

this program (level two) graduating with a diploma in HIV/AIDS care. Of these, 20 were from MTCs.

Mildmay is now able to offer the next stage of this program (level three) which enables participants to

graduate with a degree. The level three training prepares participants for leadership roles in relation to

education and service development on HIV/AIDS care. The course is run jointly with Mildmay Uganda, with

half of the modules held in Kenya and half in Uganda. This provides a unique learning environment so that

participants can learn from experiences in both countries. Places will be offered to Tutors from MTC

Kisumu, Nairobi, Thika, and Kakamega and senior Ministry of Health staff from these provinces. In addition,

12 places will be offered on the first part of the program, level two. This is also an 18 month part time

course. Places will be offered to staff from MTCs in Thika, Kakamega, Nairobi and Senior Ministry of Health

staff from Western, Nairobi and Central provinces. MTC Diploma MTC Kisumu will complete the pilot of the

locally validated diploma in February 2007. This course has been adapted by MTC Kisumu from the

Mildmay Degree and aims to prepare senior managers to develop effective HBC and HIV/AIDS care

services at district level. In March 2008 MTC Kisumu and MTC Nairobi will offer this course to a total of 50

participants, 25 per site. Priority for places on this program will be given to Ministry of Health staff that are

collaborating with APHIA II partners in Western, Nairobi and Central provinces. It is anticipated that this will

be the required course for qualification as a District HBC Coordinator. MTC Kakamega and Thika will be

provided with technical assistance in year one to prepare them to run this course in year two. Short Courses

on HBC and Palliative Care APHIA II partners that are developing HBC services and involved in providing

the Basic Care package will be requested to select, in collaboration with the PHMTs and DHMTs, Ministry of

Health staff for training on short courses and the local diploma offered by the MTCs. It is envisaged that the

health care professionals graduating from MTC courses will take up posts as District and Divisional HBC

Coordinators. They will then be expected to train CHWs using NASCOP curricula so that carers in turn can

be trained. Mildmay will provide technical assistance to enable the MTCs to integrate issues related to

Palliative Care and the Basic Care package into these curricula. In the year 175 participants will be trained

on MTC short courses. MTC Kisumu has the capacity to train additional participants if APHIA II partners

directly support places on courses.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to the FY 2008 targets by training 325 government health workers in Medical

Training Colleges (MTCs) in courses ranging from short to degree-level to enhance their ability to provide

quality HIV/AIDS services that are responsive to clients' needs.

4. LINKS TO OTHER ACTIVITIES

This activity is linked to HBHC APHIA II partner activities as follows: HBHC (#8849), HBHC (#8936), HBHC

(#8928) and HBHC (#8931).

5. POPULATIONS BEING TARGETED

This activity targets public health care workers including doctors, nurses and other health workers by

providing training to enhance their ability to provide quality HIV/AIDS services that are responsive to clients'

needs.

6. KEY LEGISLATIVE ISSUES ADDRESSED

The legislative issues being addressed are reduction of stigma and discrimination.

7. EMPHASIS AREAS

There are three minor areas of emphasis. First, there will be a Development of Network/ Linkages/ Referral

Systems by training and following up students in their places of work and ensuring they are linked to share

and exchange experiences. Second, Local Organization Capacity Development will occur by developing the

capacity of staff. Third, Quality Assurance, Quality Improvement and Supportive Supervision will occur

during the field component of the coursework and continued support will be provided following graduation.

Finally, training is the major emphasis of this activity.