Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3478
Country/Region: Kenya
Year: 2009
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: University
Funding Agency: USAID
Total Funding: $2,080,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $300,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:

+The extension of the PMTCT supervisory model from district to lower level facilities (Health centers) to

sustain provider performance through continuous on-the-job (OTJ) cascade training and support

supervision. Subsequently all facility-level supervisors will be encouraged to regularly provide on-the-job

orientation and support to PMTCT frontline workers using a cascade on-the-job (OTJ) approach.

+The activity also strives to strengthen linkages between PMTCT, CCCs and PLHIV support groups in order

to increase access to HIV prevention and ART for adults, adolescents and children who are most likely to

benefit.

+The standards based management and recognition support being provided in four provincial hospitals will

be rolled out to the whole country with ACCESS providing technical support.

COP 2008

The only changes to the program since approval in the 2007 COP are the extension of the PMTCT

supervisory model from district to lower level facilities (Health centers) to sustain provider performance

through continuous OTJ cascade training and support supervision. Subsequently all facility-level

supervisors will be encouraged to regularly provide on-the-job orientation and support to PMTCT frontline

workers using a cascade on-the-job (OTJ) approach. The activity also strives to strengthen linkages

between PMTCT, CCCs and PLHA support groups in order to increase access to HIV prevention and ART

for adults, adolescents and children who are most likely to benefit.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities by NASCOP in Prevention of Mother-to-Child Transmission.

2. ACTIVITY DESCRIPTION

In FY 2008 USAID's ACCESS Project implemented by JHPIEGO supported the DRH to strengthen its

supervisory function, quality assurance program and referral systems to ensure the delivery of high quality

PMTCT services at public sector and faith-based facilities. Because the linkages between PMTCT and

CCCs are still weak, HIV-free survival of infants born to HIV infected mothers cannot be guaranteed. In FY

2009, JHPIEGO will continue to build upon FY 2008 initiatives by further supporting the MOH's Division of

Reproductive Health, to develop the capacity of 16 provincial and 120 district level DRH and NASCOP

officers to oversee the integration of reproductive health (RH) with HIV services and assure better referrals

and linkages between PMTCT and ART services. In FY 2009 the DRH with NASCOP will continue to

provide guidance on how to strengthen PMTCT/FP/ART integration to 500 provincial and district level DRH

and NASCOP officers using the standard-based management and recognition approach and will help rollout

this approach nationally. Through regular support to the district and provincial PMTCT training and

supervision teams, DRH with NASCOP will ensure a coordinated scale up of integrated HIV care and

treatment, family planning, postnatal care including psychosocial support while assuring effective linkages

between PMTCT, PMTCT plus services and HIV care and treatment services for HIV positive women, their

infants and family members. In FY 2009 JHPIEGO will participate in the MOH's Technical Working Group

for PMTCT (jointly led by DRH and NASCOP) to ensure coordination of activities and compliance with MOH

guidelines for service delivery.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

The MOH's division of reproductive health provides leadership, coordination and advocacy for national

reproductive health programs and NASCOP. By supporting the provision of integrated PMTCT/FP/ART

services the DRH will significantly contribute to the PEPFAR goals for primary prevention, care and

treatment. The decentralized training and supervision system will build capacity of provincial and district

DRH and NASCOP officers in managing comprehensive PMTCT with HIV and RH services and universal

access to ARV prophylaxis across provinces. This activity also contributes substantively to Kenya's Five-

Year strategy of availing services, which can reduce mother-to-child infections, and providing critical links to

HIV/AIDS treatment as a step towards preserving the family unit. It also contributes to the strategy to

integrate testing with other health services and improving the referral links among all of these services.

4. LINKS TO OTHER ACTIVITIES

This activity relates to activities in PMTCT through NASCOP to improve the quality and supervision of

integrated prevention care and treatment services. It also enhances referral linkages within HIV services.

5. POPULATIONS BEING TARGETED

Strategies to improve quality of services will directly target policy makers, National AIDS Control program

staff, other Ministry of Health staff working as program managers in the DRH at provincial and district level.

Service providers such as doctors, nurses, mid wives, other health care workers including clinical officers

and public health officers working in both public and faith based facilities, as well as infants and pregnant

women in rural and urban communities will also benefit from support supervision. The PMTCT TWG works

with faith-based organizations, non-governmental organizations and implementing organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will increase gender equity in programming through PMTCT services targeted towards

pregnant women and their spouses. Increased availability of PMTCT and PMTCT+ services and the BCC

program for infant feeding will increase access and help reduce stigma at community and facility level. This

activity has a wrap around component namely supporting linkages between HIV/AIDS and RH services.

7. EMPHASIS AREAS

The activity includes a major emphasis on quality assurance and supportive supervision. There is a minor

emphasis on development of network/linkages/referral systems and information, education and

communication. The activity will support strategic information through printing and dissemination of data

collection tools.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14857

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14857 4811.08 U.S. Agency for JHPIEGO 6959 3478.08 ACCESS $300,000

International

Development

6925 4811.07 U.S. Agency for JHPIEGO 4239 3478.07 ACCESS $1,082,740

International

Development

4811 4811.06 U.S. Agency for JHPIEGO 3478 3478.06 ACCESS $250,000

International

Development

Table 3.3.01:

Funding for Biomedical Prevention: Injection Safety (HMIN): $380,000

1. ACTIVITY DESCRIPTION AND EMPHASIS AREAS

In 2009, The ACCESS project implemented by JHPIEGO will disseminate the injection safety and waste

management guidelines in all districts in Rift Valley Province and provide orientation to health workers.

Subsequently these health workers will give service orientation to 12,000 health workers using a cascade

on-the-job approach. This activity will promote awareness of injection safety among health care workers

resulting in improved injection safety and waste disposal practices in Ministry of Health facilities, a vital part

of HIV prevention. JHPIEGO will support the Ministry of Health and National AIDS and STI Control Program

(NASCOP) to develop an orientation package that breaks down the knowledge component of the guidelines

and allows continuing education credit for health workers successfully completing this orientation. This

orientation for health workers helps to improve the quality of injection safety practice. An additional intent is

to develop sustained capacity to continue these programs after the project ends by encouraging ‘‘bundling''

of injectable vaccines, injectable contraceptives and medicines in donor supported programs with single-use

needles and syringes that include re-use prevention features and safety boxes. JHPIEGO will also work

closely with other stakeholders in the area of injection safety including the Ministry of Health Infection

Prevention and Control Committee, the Nosocomial TB/HIV Prevention Unit of NASCOP and John Snow,

Inc./Making Medical Injections Safer (JSI-MMIS). At the planning stage, both central and appropriate

peripheral levels of the Ministry of Health will be involved along with other stakeholders.

This activity has major emphasis on training to impart improved skills, knowledge and attitudes regarding

safe injection practices to health care workers, waste handlers and the community. The Ministry of Health

(MOH) has recently approved the national policy on injection Safety and medical health care waste

management. JHPIEGO will work with MOH and the National Aids and STD Control Program (NASCOP) to

disseminate this policy to stakeholders. This activity will complement training of health care workers in safe

injection practices conducted by JSI-MMIS. Where possible, health delivery facilities will be encouraged to

implement this policy with their own training and procurement resources. The MOH has already committed

to procuring AD syringes and safety boxes. These however are insufficient to meet the national

requirement. This activity will enable the Injection Safety program make a leap towards reduction of HIV

transmission through medical injections.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to reduction in HIV transmission in Kenya. In 2009, dissemination of the

guidelines will strengthen and improve safe injection and waste disposal practices through training of 1,000

trainers of trainers.

3. LINKED ACTIVITIES

The injection safety initiative is linked to the Kenya Expanded Program for Immunization (KEPI), which

already procures non re-use injection devices for its program. Other Kenyan stakeholders in the area of

injection safety have been mobilized including the Ministry of Health Infection Prevention and Control

Committee and the Nosocomial TB/HIV Prevention Unit of NASCOP. A National Injection Safety Steering

Committee has been established at the Ministry of Health chaired by the Deputy Director of Medical

services and Head of Preventive Health Services. Membership to this committee is drawn from all the

programs at the MOH and incorporates the National Environmental Management Authority (NEMA). World

Health Organization (WHO), National AIDS Control Council (NACC), CDC and USAID. The

ACCESS/JHPIEGO injection safety activities will relate to all the other injection safety activities under the

PEPFAR initiative and coordinated by the Ministry of Health, National AIDS and STI Control Program

(NASCOP) and CDC.

4. POPULATIONS BEING TARGETED

This activity targets health care workers, the community, medical waste handlers, and policy-makers.

5. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address GOK and international standards and guidelines for universal precautions. This

activity will contribute to the development of Quality Assurance Standards (the Kenya Quality Model - KQM)

as outlined in the MOH Second National Health Sector Strategic Plan of Kenya, August 2005. This activity

will also contribute to the Kenya National HIV/AIDS Strategic Plan 2005/6 - 2009/10.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.05:

Funding for Treatment: Adult Treatment (HTXS): $500,000

ACTIVITY UNCHANGED FROM COP 2008

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key cross-cutting attributions in human capacity development through its training

program for health workers ($500,000).

COP 2008

1. LIST OF RELATED ACTIVITIES

The training activities in Eastern, Nairobi and Central Province will link to health workers in JHPIEGO

APHIA II Eastern program in ART, as well as other partners funded in the HTXS and PDTX program areas.

2. ACTIVITY DESCRIPTION

In FY09 USAID'S ACCESS project (implemented by JHPIEGO) will continue to build the capacity of health

workers in Ministry of Health (MOH) facilities in Eastern, Central and Nairobi Provinces in order to initiate

and provide comprehensive HIV/AIDS treatment and care services. In collaboration with National AIDS and

STD Control Program (NASCOP) JHPIEGO will disseminate, train and mentor health workers on the

already developed competency-based orientation materials for comprehensive care, based on MOH

National Guidelines for HIV/AIDS treatment. In FY2006-2007, ACCESS supported the MOH to adapt the

World Health Organization's Integrated Management of Adult and Adolescent Illness (IMAI) training

approach in Kenya. IMAI builds the knowledge and skills of nurses and clinical officers to provide HIV

prevention, care and treatment in first-level health facilities. This highly successful training approach utilizes

people living with HIV as ‘expert patient trainers'. ACCESS assisted the MOH to develop training materials,

developed over 100 trainers at national and provincial level, trained over 500 service providers, trained 56

people living with HIV as Expert Trainers, helped initiate ART services in 92 new sites including pediatric

HIV care and treatment. In FY 2008, ACCESS is building the capacity of providers caring for HIV-infected

persons to integrate family planning (FP) services and management of sexually transmitted infections (STI)

into HIV care and treatment. Additionally, ACCESS reprinted and disseminated Prevention with Positives

(PwP) training materials, and trained PwP TOTs at national, provincial and community level; developed

national Mentorship Implementation Guidelines and trained a first batch of Mentor TOTs.

Reproductive health choices and the unmet need for family planning for people living with HIV remain

largely unaddressed. An integrated approach for ART/FP/STI services will reduce missed opportunities and

narrow the gap for unmet FP needs.

In FY2009, it is envisioned that JHPIEGO will continue to strengthen these services by building on FY2008

activities, completing the ACCESS steps for capacity building in PwP and clinical mentorship in ART. In

addition, capacity building in advanced IMAI for second level service providers (targeting clinical officers

and medical officers to enable them to offer ARV drug substitutions, drug failure, and manage side effects

and opportunities infections) is now thought to be a priority intervention

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to the 2009 Emergency Plan result for increased availability of skilled health

workers to provide care and treatment. It will enable service providers to identify and initiate HIV infected

patients on ART. This activity will increase access to quality treatment services particularly among

underserved. It also contributes to Kenya's 5-year strategy emphases of developing effective linkages

between prevention, care and treatment services within an integrated network.

4. LINKS TO OTHER ACTIVITIES

The training activities in Eastern, Nairobi and Central Province will link to health workers in JHPIEGO

APHIA II Eastern program in ART, as well as other partners funded in the HTXS and PDTX program areas.

5. POPULATIONS BEING TARGETED

This activity targets people living with HIV/AIDS, HIV positive infants, HIV positive children. It also targets

other MOH staff including program managers in the NASCOP, and public health care doctors and nurses.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will help to reduce stigma associated with HIV status by increasing the availability of

comprehensive care.

7. EMPHASIS AREAS This activity includes major emphasis on training and development of

network/linkages/referral systems as detailed in the activity description in Section 1 above.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14860

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14860 12493.08 U.S. Agency for JHPIEGO 6959 3478.08 ACCESS $500,000

International

Development

12493 12493.07 U.S. Agency for JHPIEGO 4239 3478.07 ACCESS $1,000,000

International

Development

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Safe Motherhood

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $500,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Prevention: HIV Testing and Counseling (HVCT): $900,000

ACTIVITY UNCHANGED FROM COP 2008

COP 2008

The only changes to the program since approval in the 2007 COP are:

+ geographic coverage has been revised and expanded to include Eastern, North Eastern, and Nairobi and

Central provinces

+ to provide Provider Initiated Counseling and Testing.

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in TB/HIV care activities, HIV/AIDS treatment services, abstinence and be

faithful, OVC, HBHC, other prevention and PMCT.

2. ACTIVITY DESCRIPTION

Since 2005, ACCESS has provided critical support to NASCOP to introduce quality Diagnostic Testing and

Counseling (DTC) and later Provider-Initiated Testing and Counseling (PITC) to meet the Government of

Kenya's priority of expanding access to testing and counseling services through the health system. As part

of this support, state-of-the-art materials in HIV testing and counseling have been developed and

disseminated, 95 trainers have been developed at central and provincial levels, and over 400 service

providers trained on PITC.

ACCESS will build on the successes and lessons learned from FY 2005, FY 2006 and FY 2007 activities to

continue to promote the availability and delivery of high quality HTC services in public Ministry of Health

(MoH) facilities and communities. In FY 2007, ACCESS is supporting the National AIDS and STI Control

Program (NASCOP) to develop new and harmonized HIV testing and counseling guidelines, which includes

client-initiated counseling and testing, provider-initiated testing and counseling, home-based testing and self

testing. Over the next two years, ACCESS will disseminate these guidelines, develop an orientation

package to build skills in testing and counseling in clinical and home settings. Working with the APHIA

provincial partners, selected districts/facilities will be supported to demonstrate the provision of high quality

PITC services and effective referral linkages with HIV-related services such comprehensive HIV care

centres (CCC), psychosocial support services, legal and other services available in the community.

In subsequent years, ACCESS will support efforts in expanding counseling in care for HIV clients and other

emerging priorities in the area of HTC. Currently, most of the testing and counseling services have focused

on identification of HIV-infected persons, an essential component in HIV prevention, care, and treatment.

As more people are identified and brought to care, there is need to build/strengthen the capacity of health

providers to offer continued counseling for infected persons (counseling in care). Counseling in care

addresses the continued support needs of people living with HIV such as psychosocial support, gender

issues, adherence to therapy, child counseling, and couple counseling. The ACCESS steps to building

sustainable training capacity and its comprehensive approach to training will be the foundation in each

priority area.

Activities include

- Dissemination of HTC guidelines

- Develop/adapt training materials including orientation packages and job aids for clinical, home and self

testing

- Development of HTC trainers at provincial level

- Development of supervisors and mentors at provincial level

- Training/orientation of service providers at selected districts

- Orientation of service providers through the cascade / echo approach

- Implement SBM-R approach for quality improvement for HTC

- Assist APHIA II partners to implement the training and orientation of service providers

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to the 2008 Emergency Plan result for increased availability of diagnostic

counseling and testing through training of health workers. It will enable service providers to identify the large

numbers of HIV infected patients who are potential candidates for ART. This activity will increase access to

prevention and treatment services particularly among underserved and high risk populations. It also

contributes to Kenya's 5-year strategy emphases of encouraging Kenyans to learn their status and

developing strong links between counseling and testing and HIV services for those who are HIV positive

and in need of health care.

4. LINKS TO OTHER ACTIVITIES

JHPIEGO/ACCESS activities are focused on trainings and are therefore linked to counseling and testing

activities conducted by the APHIA II partners in counseling and testing in the different provinces: Coast, Rift

Valley, Western, NEP, Eastern, Nairobi/Central, Nyanza. It is also related to NASCOP/MOH counseling and

testing. This activity is also related to JHPIEGO/ACCESS activities in Injection safety.

5. POPULATIONS BEING TARGETED

This activity targets MOH staff including program managers in the NASCOP, public health care doctors and

nurses, other health care workers including community health workers. 4,000 health care workers will be

trained.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will help to reduce stigma associated with HIV status by increasing the availability of routine

testing for diagnosis in medical settings.

7. EMPHASIS AREAS

This activity includes major emphasis on training and minor emphasis in development of

network/linkages/referral systems as detailed in the activity description in Section 1 above as well as minor

emphasis on policy and guidelines.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14859

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14859 4155.08 U.S. Agency for JHPIEGO 6959 3478.08 ACCESS $800,000

International

Development

6924 4155.07 U.S. Agency for JHPIEGO 4239 3478.07 ACCESS $500,000

International

Development

4155 4155.06 U.S. Agency for JHPIEGO 3478 3478.06 ACCESS $500,000

International

Development

Table 3.3.14:

Cross Cutting Budget Categories and Known Amounts Total: $500,000
Human Resources for Health $500,000