PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
Updated April 2009 Reprogramming. Increased by $243,750.
Partnership Framework [$93,750]: The PMTCT Program is currently reaching more than 80% of all
pregnant women accessing MCH clinics with HIV CT services. However, this represents only 61% of all
expected pregnancies in the country. There is need to increase access to ANC care for women in hard to
reach areas including PMTCT services. These activities will be implemented through various APHIA
partners.
Partnership Framework [$150,000]: Scale up - improved and standardized integration of HIV services into
MCH and improved and standardized models of follow up care and referrals. These activities will be
implemented through various APHIA partners.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ More emphasis on decentralization of HIV care and treatment as well as TB services through capacity
building and task shifting
+ Male involvement through targeted couple counseling
+ Greater involvement of HIV+ mentor mothers
+ Quality improvement through standards based management and recognition
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key attributions in human capacity development through the training of health care
service providers on PMTCT and other HIV prevention and care topics in order to equip them with
knowledge and skills to provide quality PMTCT services. These service providers include Doctors, Nurses,
Clinical Officers, Nutrition Officers and Health Record clerks. The activity will also support hiring of health
workers and other key staffs to fill critical gaps in service delivery.
COP 2008
1. LIST OF RELATED ACTIVITIES
The APHIA II Eastern PMTCT activities will relate to HIV/AIDS treatment/ARV services, counseling and
testing, Orphans and Vulnerable Children, Palliative Care, TB/HIV and Condoms and Other Prevention
activities in the same region.
2. ACTIVITY DESCRIPTION
APHIA II Eastern will continue to provide technical assistance to a number of health facilities within targeted
districts in Eastern Province, providing PMTCT services. This assistance will increase management, as well
as technical, capacity of staff at these sites improving quality and productivity. The project will also work to
improve PMTCT outcomes, examining ways to increase compliance with infant feeding and treatment
guidelines and to increase the number of women who return to facilities for delivery and post-partum follow-
up. The APHIA II Eastern will train 300 health providers in 250 facilities providing PMTCT services. In 2009,
the APHIA II Eastern will work with several types of partners in Kenya. First, it will continue to support
expansion and quality improvements for PMTCT services through working closely with the faith-based
facilities, with the explicit purpose of building programmatic and administrative capacity to implement HIV
programs. Second, it will expand support for PMTCT services to public sector facilities in 14 districts that
lack other USG support in the province. Supported sites will counsel and test 93,195 (91%) of 101,962
pregnant women and provide ART prophylaxis to 3,430 (92%) of 3,723 HIV-positive women. Of the HIV
positive women, 1,715 will receive AZT/NVP, 686 HAART and 1029 single dose nevirapine for prophylaxis.
1,715 exposed infants will receive PCR for early infant diagnosis. The APHIA II Eastern will continue to
participate in the Ministry of Health's (MOH) Technical Working Group to ensure coordination of site
selection, project activities, monitoring and evaluation including GOK led regional meetings and linkages
between these sites. They will comply with MOH clinical and reporting guidelines and will use the
WHO/CDC-based national training curriculum. APHIA II Eastern will also help the more mature facilities to
graduate to PMTCT+ sites, providing ART and other care and support services to HIV-positive women and
their families through decentralization, capacity building and task shifting. It will establish laboratory
networks which will provide easy access to CD4 counts as well as other chemistry tests that often hinder
access to ART uptake. It will build on its work already established in some parts of Eastern province to
increase access to these services as well as access to early infant diagnosis. It will put emphasis on male
involvement and counsel and test 18,639 spouses of pregnant women, psychosocial support, as well as
psychosocial support for health care providers and care givers of HIV infected children.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
APHIA II Eastern activities in the specific geographic regions will contribute to 7.2% of 1,300,000 pregnant
women in COP 2009 PEPFAR goals for PMTCT primary prevention and care. Planned activities will
improve equity in access to HIV prevention and care services since the currently underserved communities
will have better access, and APHIA II Eastern will work to ensure there are adequate networks and linkages
between their sites and medical sites where AIDS care and treatment are available for both adults and
children. On top of this APHIA II Eastern will offer PMTCT+ services in selected sites. These activities will
contribute to the result of increased access to counseling and testing services, particularly among
underserved and high risk populations and the result of increased availability of diagnostic counseling and
testing services in medical settings to identify the large numbers of HIV infected patients who are potential
candidates for ART.
4. LINKS TO OTHER ACTIVITIES
Linkages between PMTCT service and care outlets will be strengthened to improve utilization of care
opportunities created through PEPFAR funding. The APHIA II Eastern PMTCT activities will relate to HTXS,
HVCT, OVC, HBHC, HVTB and HVOP activities in the same region.
5. POPULATIONS BEING TARGETED
This activity targets adults of reproductive health age, pregnant women, family planning clients, infants, and
HIV positive pregnant women. Strategies to improve quality of services will target health care workers in
public, private and faith based facilities such as doctors, nurses, and other health care workers such as
Activity Narrative: clinical officers, mid wives and public health officers. It will also target host country government workers
such as the National AIDS control program staff.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This APHIA II Eastern activity will increase gender equity in programming through PMTCT services targeted
to pregnant women and their spouses. Women have the highest HIV burden both through infection and as
care givers. Identifying them through PMTCT will give them an opportunity to access care and improved
pregnancy outcomes for themselves their spouses and their infants. Increased availability of PMTCT and
PMTCT+ services will increase access and help reduce stigma at community and facility level.
7. EMPHASIS AREAS
This activity includes major emphasis on human capacity development through training and supportive
supervision of health care workers in PMTCT service provision, support to strategic information, linkage to
family planning, malaria initiative and safe motherhood programs as well as local organization capacity
development to manage PMTCT services, quality assurance and infrastructure development.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14861
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14861 8752.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $1,300,000
International Eastern
Development
8752 8752.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $630,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $110,750
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
+ Specific AB messages will target both adult men and women with the aim to reduce multiple concurrent
partners
+ This activity will incorporate $300,000 for HIV Free Generation activities targeting youth
The only changes to the program since approval in the 2007 COP are:
• Geographic coverage has been expanded to include Kitui, Makueni, Mwingi and Tharaka districts;
• $100,000 of this activity supports the Youth Prevention Initiative programmed with funds from the $7
million FY 08 plus up;
• AB funds totaling $23,000 will contribute to the sensitization of teachers as a worksite population linking
with additional OP and OHPS funds for a $150,000 activity to reach 750 teachers and train 20 more;
• The KARHP methodology will be rolled out in collaboration with the Ministry of Education at approximately
$250,000;
• Peer education activities will be rolled out with the Kenya Girl Guides Association;
• Communities surrounding Mlolongo along the Mombasa-Kampala transport corridor will be targeted with
AB, OP, OVC and CT activities.
This activity relates to activities in Counseling and Testing (#8782), HIV/AIDS Treatment: ARV Services
(#8792), Orphans and Vulnerable Children (#9041), Condoms and Other Prevention (#8932), and Palliative
Care: Basic Health Care and Support (#8863).
In 2009 this activity will reach 394,645 youth and adults with AB messages. $300,000 of this activity
supports the HIV Free Generation activities. Although the Initiative will primarily be targeting urban areas,
A2E will be able to implement related activities in the peri-urban areas of the province.
After a pilot project in two districts, in FY 2006 PATH and Population Council Frontiers project implemented
the Kenya Adolescents Reproductive Health Project (KARHP) in Western province. Together with local staff
of three Ministries: Health (MOH), Education (MOE), and Gender, Culture and Social Services (MOGCSS),
PATH and Frontiers covered all the districts of the province. This methodology will be rolled out throughout
the country in FY 2009. Although messages need to be tailored to specific target groups, all of them include
reducing stigma associated with HIV/AIDS, the protective effects of abstinence and faithfulness to a partner
of known HIV status, and the importance of knowing one's HIV status and taking appropriate action. These
actions could include starting and adhering to ART if HIV-positive, and practicing healthy behaviors,
including condom use when appropriate, regardless of serostatus. Providing appropriate messages and
services to pre-adolescents and their families will also continue to be a priority. The grant-making process,
including the formation of the technical review committee, establishing criteria, and identifying local partner
capacity-building needs started in FY 2007, as did community entry activities to mobilize village health
committees (VHCs). These serve as a link between the needs of communities and available services
provided by existing health facilities and comprehensive care centers. In FY 2009, the process will be
expanded to provide VHCs with ongoing training and support project-based animators. Communities will
conduct health self-assessments and develop action plans, assisted by "quick-win" grants to operationalize
the necessary structures and enlist widespread support. Health management committees will receive
mentorship and training to introduce transparency into their programmatic and financial operations. Using
the key messages already known and accepted by the community, outreach and health action days will be
implemented as will appropriate activities to reach youth, such as the Youth Sports Initiative, to build life
skills and disseminate HIV/AIDS information focusing on abstinence and being faithful. These sub-grantees
will, depending on the focus of the organization, conduct mobilization activities to engage youth and their
families in ways that will minimize their risk of engaging in unsafe behaviors, reduce stigma associated with
HIV/AIDS, and encourage community members to access local services. Selected groups will be provided
with both structured capacity-building support as well as reinforcement through mentorship. This ongoing
relationship will include assisting sub-grantees to better access local services, to participate in community
mobilization, and to share the results of their work with other local groups. To complement the sub-grants
program, APHIA II Eastern will undertake advocacy with groups including religious leaders, elected officials
and other opinion leaders. In FY 2009, the process will be expanded to reach a larger number of community
members. Organizations that will be selected for grants will, as part of this training and the ongoing
mentoring through supportive supervision that constitutes an essential program activity, be updated on
national policy and international standards.
This activity will reach 394,645 individuals, especially youth and adults, with abstinence and being faithful
messages. 2,741 individuals will also be trained to promote HIV/AIDS prevention through abstinence
and/or being faithful. This will greatly contribute to USG's 5-year strategy in support of Kenya's integrated
HIV/AIDS programs, by developing strong networks at the community level for a sustained response.
Activities will link sub-grantees to other groups undertaking age-appropriate community outreach activities
that deliver prevention messages, involve them in youth sports initiatives, encourage them to participate in
message development, and facilitate reaching them through community-based radio programs.
This activity relates to activities in counseling and testing (#8782), ART (#8792), OVC (#9041), OP (#8932),
and home-based care services (#8863). Capacity development of partners currently engaged in community
mobilization to support the needs of community members using key messages that conform to national
priorities and strategies targeted to local conditions and specific target populations will be addressed.
This activity directly targets in-school youth and their parents to support increased positive communication.
Secondary targets are groups that serve out-of-school youth, as these groups will be supported to better
serve their constituencies using approaches and messages based on state-of-the-art knowledge and
approaches. It also indirectly targets adults in the general population through its efforts to reduce the stigma
Activity Narrative: surrounding HIV/AIDS and to promote gender equity. Strategies to improve the use of services will target
policy makers, the general population, and Ministry of Health staff working as program managers in the
DRH at provincial and district level, and local community leaders.
This activity will reduce stigma associated with being affected by HIV/AIDS, increase gender equity in
programming through the delivery of key messages and wrap around in education.
Major emphasis is capacity building of local organizations and minor emphasis on information, education
and communication and strategic information.
Continuing Activity: 14862
14862 8725.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $2,300,000
8725 8725.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $775,000
* Increasing women's legal rights
* Reducing violence and coercion
Workplace Programs
Table 3.3.02:
+ Clients of sex workers will be targeted with specific interventions that focus on consistent condom use and
knowing of status.
+ Specific prevention messaging targeting women, men and discordant couples will be incorporated into CT
interventions. Specific messages will be developed for each target group.
+ This activity will incorporate $100,000 for HIV Free Generation activities focusing on youth.
The only changes to the program since approval in the 2007 COP are
•Geographic coverage has been expanded to include Kitui, Makueni, and Mwingi
•OP funds totaling $29,000 will contribute to the sensitization of teachers as a worksite population linking
with AB and OPHS funds for a $150,000 activity to reach 750 teachers and train 20 more.
•APHIA II Eastern will work with select health facilities, police, uniformed services, opinion leaders and
others on issues of gender-based violence.
•The OP activity will include Prevention with Positives (PwP) activities working through PLWA support
groups linked to the Comprehensive Care Centers in Eastern province.
•APHIA II Eastern will also expand their activities with CSWs and MSMs in Eastern province
This activity relates to activities in Counseling and Testing (#8782), Prevention of Mother-to-Child
Transmission (#8752), Orphans and Vulnerable Children (#9041), Abstinence and Be Faithful Programs
(#8725), HIV/AIDS Treatment: ARV Services (#8792), Palliative Care: TB/HIV (#9069) and Palliative Care:
Basic Health Care Support (#8863).
In 2009, APHIA II Eastern will reach 629,504 individuals, train 1,871 people and distribute condoms through
560 outlets. Civil society activities are crucial to promoting healthy behaviors. Significant and sustained
behavior change requires not only information transmission, but attitudinal change and sustained
reinforcement that increases levels of perceived self-efficacy that ultimately results in normative change.
Although messages need to be tailored to specific target groups, all of them, developed in harmony with
National AIDS and Sexually Transmitted Infection Control Program (NASCOP) and the Division of
Reproductive Health (DRH), include reducing stigma associated with HIV/AIDS, the protective effects of
abstinence and faithfulness to a partner of known HIV status, and the importance of knowing one's HIV
status and taking appropriate action. These actions could be starting and adhering to antiretroviral treatment
(ART) if HIV positive, and practicing health behaviors, (including condom use and use of MCH/FP services)
regardless of serostatus. In FY 2006, a grant-making process was established through PATH and CLUSA,
who have used this approach in other areas of Kenya. A first set of grants was made and activities started
up. In FY 2009 this program will be expanded to reach more families and communities. Work will include
implementing prevention interventions through civic group partners, and through men's and women's
groups. Activities will integrate prevention messages about parent-child communication, gender-based
violence, and youth participation. Other avenues used will include working through the Youth Sports
Initiative as a means to building life skills. Communities will conduct health self-assessments and develop
action plans, assisted by "quick-win" grants to operationalize the necessary structures and enlist
widespread support. Village health committees (VHCs) within a facility catchment area will form sub-location
health coordination committees, which in turn will serve as forums for sharing among VHCs and for
coordinating activities that affect multiple VHCs. Health management committees will receive mentorship
and training to introduce transparency into their programmatic and financial operations. This ongoing
mobilization, and to share the results of their work with other local groups. Key messages and strategies
developed by National AIDS and Sexually Transmitted Infection (STI) Control Program (NASCOP), and
local DHMTs will form part of all social mobilization activities. In FY 2007 the program will also be expanded
to include identification of workplaces- including those in non-health sectors such as agriculture, banking,
transportation, trade, food and hospitality, fuel service and education- for dissemination of information and
counseling and testing service delivery. For example, due to the long distance travel associated with
commercial trade, truckers often frequent hotels and transient lodges along the highway that runs along the
southeast border of Eastern province. These lodgings are excellent settings for information dissemination
that will build on and complement programs such as the regional Corridors program. Police posts, hotels,
and will also be reached through the program. Peer coordinators will be trained through a cascading
trainers program. Informal workplaces will also form part of the program. PATH will work with youth as a
cross-cutting population that has access to other groups within families. Youth will function both as
advocates during interventions, and as a means of reaching their peers. Using the overall behavior change
communication (BCC) strategy and key messages developed in FY 2006, activities this year will include
community outreach activities that are youth-centered, including production and distribution of Nuru comic,
Magnet theater (a technique already in use elsewhere in Kenya that targets a whole community on a
repeated basis), youth murals, and contest of various types. The team will also train faith-based and non-
governmental organizations (FBOs and NGOs) to deliver ABC messages to high-risk groups, men's groups
to disseminate accurate and appropriate information and promote the use of voluntary counseling and
testing (VCT), prevention of mother-to-child HIV transmission (PMTCT) and antiretroviral treatment (ART)
services, and will expand message reach through community radio programs. Messages will also aim to
reduce stigma. People living with AIDS (PLWAs) will be involved in the design and implementation of
outreach programs. To complement the prevention program, JHPIEGO and its partners (particularly the
DHMT) will undertake advocacy with groups including religious leaders, elected officials and other opinion
leaders.
Activities being carried out will contribute directly to USG's 5-year strategy in support of Kenya's integrated
HIV/AIDS programs, by developing strong networks at the community level for a sustained response. The
activity will serve 560 condom service outlets and 629,504 individuals will be reached through community
outreach that promotes HIV/AIDS prevention through other behavior change beyond abstinence and being
faithful. A total of 1,871 individuals will be trained to promote HIV/AIDS prevention programs.
Activity Narrative: 4. LINKS TO OTHER ACTIVITIES
This activity relates to activities in orphans and vulnerable children (#9041), counseling and testing (#8782),
abstinence/be faithful to promote health behaviors amongst youth and reduce stigma by encouraging
individuals to know their HIV status (#8725). It also relates to PMTCT (#8752), Palliative Care: TB/HIV and
HBHC (#9069) and (#8863) and ARV services (#8792) expanding HIV prevention in care and treatment
settings.
This activity directly targets the general population as well as youth and their parents, as well as at-risk
groups to support increased positive communication and increased use of services. Secondary targets are
groups that serve youth, as these groups will be supported to better serve their constituencies using
approaches and messages based on state-of-the-art knowledge and approaches. Strategies to improve the
use of services will target policy makers as well as the general population, Ministry of Health staff working
as program managers in the DRH at provincial and district level, and local community leaders.
This activity addresses stigma reduction associated with being affected by HIV/AIDS, increase gender
equity in programming through the delivery of key messages.
Major emphasis addressed in this activity is community mobilization/participation and minor emphasis on
development of network/linkages/referral systems, training and linkages with other sectors.
Continuing Activity: 14863
14863 8932.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $1,200,000
8932 8932.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $975,000
Table 3.3.03:
ACTIVITY UNCHANGED FROM COP 2008
This activity supports key cross-cutting attributions in human capacity development through its training
program for health workers ($40,000).
1. ACTIVITY DESCRIPTION
APHIA II Eastern in partnership with MOH and local implementing partners will build upon the gains in FY
2008 to increase access and improve ADULT HIV care and support services at facility and community
levels.
This activity will provide integrated and comprehensive facility and community care and support to 21,000
adult PLWHA. The project will enhance integration and linkages between entry points within facilities, and
formal linkages between health facilities and community work will be strengthened to enhance effective
care, follow-up, tracking of referrals and patient satisfaction; A HBC desk will be established at the facility to
manage referrals to and from the community and facility workers will be trained to use discharge plans, both
formal health care workers and community volunteer workers will be trained on effective referral; and the
roles of Health Facility Community Linkage Coordinating Committees (HFCLCC) will also be enhanced
through trainings and links to community groups; this is expected to result in better health for patients, who
are otherwise not bed ridden but are up and about due to adherence to treatment, good nutrition,
Psychosocial support and family support (reduced stigma).
In order to ensure quality care for adult HIV patients at facility level health workers will be sensitized on
nutritional assessment, psychosocial HIV counseling, and to strengthen prevention and treatment of
opportunistic infections including malaria and diarrhoeal diseases, the project will train and sensitize health
care workers on the management of opportunistic infections, and will distribute free cotrimoxazole to eligible
HIV infected adults. The project will also support the sites with Job Aids to enhance correct protocol use in
the management of OIs, and will support the sites with emergency stocks of drugs for both prevention and
treatment of opportunistic infections including Cotrimoxazole, fluconazole, antibiotics, anti-diarrhoeal and
anti-protozoals. To improve retention and to ensure that initiation of treatment is not delayed, APHIA II
Eastern will dedicate specific days for patients on care. This will improve monitoring of patients on care and
treatment of opportunistic infections. APHIA II Eastern will also support and strengthen hospital capacity to
offer end of life care. In addition, every client on care at the facility will be linked to the APHIA II Eastern
Home and community based care component.
The home and community based care component will be expanded to cover around each facility site
providing care and treatment and continue to provide small grants and capacity building to local
implementing partners, for improving quality and expansion of the following services: community based
psychosocial support, food and nutrition support, prevention including home based family counseling and
testing and condom use, treatment adherence support, basic management of OIs, home hygiene and
nursing care, malaria prevention and treatment sensitization, education and referrals for Family Planning,
TB, RH including cervical cancer screening and other related health care issues. All children of PLWHA will
be linked and cared for under OVC programme; the local implementing partners will use USAID-APHIA II
Eastern tools for assessment to identify the needs for each PLWHA and household.
To ensure quality at community level LIPs and Ministry of Health (MOH) capacity building will continue in
the technical areas of comprehensive home and community based care, system strengthening in
programming and management, continuous technical mentorship through supportive supervision and
quarterly review meetings and sensitization on National program guidelines and policies and equipping
them with approved CHWs training curriculum. FY 2009, 30 MOH and LIP staff will be trained as T.O.T in
Comprehensive HBC to train 250 community health workers who in turn will train primary care givers at
home. This will add to ones already trained in FY 2007 and 2008.
The project will support formation and maintenance of psychosocial support groups in each of the care sites
and at community level. These support groups will focus on treatment adherence support, encouraging
disclosure, stigma and discrimination reduction, reinforcing prevention of HIV transmission messages and
running of IGAs, plus collective responsibility of OVC.
The capacity of PLWHA support groups, CHWs and older OVC will be strengthened so as to enable them to
be proactive leaders, advocates and participants in the response to the epidemic and will also be linked to
other microfinance institutions operating in the region and or trained on how to run IGAs. They will also
receive education on integrated health issues, HIV Prevention and Care and other important topics.
To tackle stigma and discrimination, which is still high among health workers in the province, the APHIA II
Eastern project will further train more health workers on stigma and discrimination reduction using curricula
specifically produced for this purpose.
APHIA II Eastern will support family HIV counselling and testing approaches so that HIV positive family
members of HIV infected enrolled patients are identified and also enrolled into care. The strategy of
Prevention with Positives (PWP) will be encompassed.
The project will support the creation of demonstration gardens at facilities and LIP levels. PLWH support
groups will be supported to use knowledge and skills acquired to create their own gardens hence increasing
their nutritional security, and possibly supplementing their income. The project will also supply insecticide
treated bed nets and safe water systems to HIV infected persons and their families.
2. CONTRIBUTIONS TO OVERALL PROGRAME AREAS
These APHIA II Eastern activities will expand on the established care programs in Eastern province. As a
result of these activities, 21,000 adult patients will receive care and support contributing to the results of
expansion of care and support services and acting as a pool from where those eligible for ART treatment
Activity Narrative: will be drawn from. This will also link well with the other activities targeting prevention with positives. Also
330 individuals, including 80 health care workers and 250 CHWs, will be trained in care and support; 50
sites will provide care.
3. LINKS TO OTHER ACTIVITIES
These APHIA II Eastern activities will be tightly linked to the FY 2009 activities across the spectrum of care
including programmes of Orphans and vulnerable children, Prevention of Mother to child HIV transmission,
TB/HIV, RH/FP services, Abstinence and Behavior change and Counseling and testing. It will also link with
programs providing appropriate nutrition for PLWHA.
4. POPULATIONS BEING TARGETED
These APHIA II Eastern activities target people living with HIV/AIDS, HIV/AIDS affected families, and
caregivers of OVC and PLWHA. It also targets the community, in order to improve community support and
the health care providers in public, private and faith based health facilities.
5. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address Stigma and Discrimination associated with people infected and affected by HIV, as
well as increasing gender equity in programming through the delivery of key messages, Linkages will be
created with systems/groups offering support in health, psychosocial aspects, food, microfinance, and
reproductive health. Also to provide access to increased resources in order to address the wide spectrum of
problems that is faced by households when dealing with a debilitating disease in an adult family member.
6. EMPHASIS AREAS
The main Emphasis Areas for these activities will be workplace HIV prevention; care and treatment
programs that target both adults and children, as well as Health Related Wraparound Programs addressing
Family Planning and Safe Motherhood needs of adults.
Continuing Activity: 14864
14864 8863.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $700,000
8863 8863.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $250,000
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.08:
The narrative has been split to reflect adult and pediatric care and support and treatment. References to
targets have been updated including emphasis areas and budgets.
program for health workers ($150,000).
These APHIA II Eastern activities will be tightly linked to the FY 2008 activities and across the continuum of
care with other services supported by APHIA II Eastern in basic HIV care and support, Orphans and
vulnerable children, Prevention of Mother to child HIV transmission, TB/HIV, RH/FP services, Abstinence
and Behavior change and Counseling and testing. It will also link with programs providing appropriate
Nutrition for PLWHA.
In FY 2009 USAID'S APHIA II Eastern project will continue to build on and consolidate gains made from the
start of the project. In FY 2009 APHIA II will continue to build the capacity of health workers in Eastern
province to further scale up provision of ARVs. The capacity building will also cover for staff attrition due to
multiple factors. APHIA II will train 50 health care workers on Adult ART, 25 on ART commodity
management and 25 on IMAI and adherence counseling. In these trainings, APHIA II Eastern will use the
TOT pool created in FY 2007 and 2008 and will use NASCOP curricula. The trainees will be followed up
with facilitative supervision and mentorship using the capacity built within the region.
The APHIA II Eastern project will consolidate the laboratory networks' capacity to serve the 17 districts
(New) namely Moyale, Sololo, North Horr, Marsabit, Laisamis, Garbatulla, Isiolo, Igembe, Tigania, Imenti
North, Imenti Central, Imenti South, Maara, Meru South, Embu, Mbeere and Tharaka to provide ART to
3,600 new adult patients and maintain the 7,300 patients on ART and the end of COP 2009 period. The 4
laboratory networks- Embu PGH, Meru DH and Isiolo DH and the Moyale DH lab will be supported with
reagents, other consumables and logistics to enable them to effectively serve their respective networks.
In FY 2009, The APHIA II Eastern project will focus on decentralization and downward referrals of HIV
patients to 50 ART sites in accordance to the Ministry of Health (MOH)/NASCOP current strategy to enable
sites to provide quality HIV care. This activity will be closely linked to the capacity building one above. The
project will enhance quality of care through improved clinical monitoring; improved case management and
use of Electronic Medical Records (EMR) which is being introduced by NASCOP. Using lessons learnt from
the Zingatia Maisha project, adherence counseling will be further strengthened and supported through the
psychosocial support groups. The use of EMR will ensure patients needing second line ARVs are identified
early and put on appropriate treatment. The EMR will also ensure prompt identification of treatment
defaulters who shall then be quickly traced through the network of support groups and brought back to
treatment.
APHIA II Eastern will capacity build and create systems to strengthen facility-community linkages, building
on the best practices and lessons learnt from the Zingatia Maisha project. The APHIA II Eastern project will
enhance integration and linkages within facilities and from one facility to another in order to strengthen the
continuum of care, and continue to institutionalize the Quality of care improvement strategies that will have
been established in FY2008. Stigma reduction strategies started in COP 08 shall also be continued.
The APHIA II Eastern project will continue to support linkages and referrals from workplaces to ART sites
and continue to build capacity of faith based and private providers. The APHIA II Eastern project will offer
ART site support, which in addition to supply of pharmaceuticals, laboratory commodities and capacity
building of health care workers, will also conduct some site renovations.
As part of the exit strategy, APHIA II Eastern will build on capacity within the MOH (PHMT/DHMT) and
continue to support leadership and ownership of activities by the health care workers in HIV treatment
services.
3. CONTRIBUTIONS TO OVERALL PROGRAME AREAS
These APHIA II Eastern activities will greatly contribute to USG's 5-year strategy in support of Kenya's
integrated HIV/AIDS programs by expanding established ART programs to include new areas in Eastern
province. As a result of these activities, 3,600 new patients will receive ARVs, contribute to the results of
expansion of ART treatment for clinically qualified HIV positive patients, strengthen human resource
capacity to deliver ART treatment, and strengthen referral network for provision of ART. The number of
individuals who ever received ARVs by the end of reporting period will be 8,760.
These APHIA II Eastern activities target people affected by HIV/AIDS, people living with HIV/AIDS,
HIV/AIDS affected families, and caregivers of OVC and PLWHA. It also targets the community, in order to
improve community support and the health care providers in public, private and faith based health facilities.
The major emphasis area is training of health workers with minor emphasis development of
networks/linkages/referrals systems, information, education and communication and workplace programs.
Continuing Activity: 14868
14868 8792.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $1,700,000
8792 8792.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $1,792,474
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
program for health workers ($10,000)
These activities will be tightly linked to the FY 2008 activities and to other APHIA II Eastern activities
including HIV treatment, orphans and vulnerable children, Prevention of Mother to Child HIV Transmission,
TB/HIV, RH/FP services, Abstinence and Behavior change and counseling and testing. It will also link with
programs providing appropriate Nutrition for PLWHA.
APHIA II Eastern will build on the gains from FY 2008 to strengthen and enhance the quality of HIV care
and support at facility level for HIV exposed and infected children. We will train 25 health care workers in
pediatric HIV care and 25 in pediatric psychosocial counseling. The project will aim to optimize the
continuum of care for HIV exposed and infected infants from birth through provision of clinical, psychosocial,
spiritual, and social and prevention services to enroll 2,300 HIV infected children in care. The project will
also support efforts towards routine testing of sick children in pediatric medical settings (provider initiated
testing and counseling), which is expected to rapidly identify large numbers of HIV positive children, and
provide links to treatment and care. APHIA II Eastern will support efforts towards family-based HIV testing
approaches so that infected family members of HIV-infected persons are identified and enrolled into care.
APHIA II Eastern will enhance the linkage of HIV exposed children to the HIV clinic by supporting the sites
with the HIV exposed child register and the newly introduced Mother Child card. The identification of HIV
exposed children will be enhanced by training the health care workers on Dried Blood Spot (DBS) sampling
for Early Infant Diagnosis (EID), using the "on-the-job" approach, supporting the commodities for the EID
testing and ensuring the systems for specimen referral are streamlined using approaches that are
sustainable. Linkages of the PMTCT program to the care and treatment program will be further
strengthened so that exposed children are appropriately followed up. The project will sensitize the health
care workers on the "guidance on infant feeding within HIV settings", will offer linkages to nutritional support
services and will enhance community participation in infant nutritional needs. APHIA II Eastern will support
and strengthen the pediatric support groups and encourage the use of Child Peers to enhance adherence to
HIV care, reduce stigma and discrimination, and empower the older children to prevent HIV transmission by
using "Prevention with Positives" strategies. The project will support and strengthen prevention and
treatment of opportunistic infections (OIs) including malaria and diarrheal diseases by training and
sensitizing the health care workers on the management of OIs, distributing free cotrimoxazole to eligible
children and scaling up prevention in young people. We will also supporting the sites with Job Aids to
enhance correct protocol use in management of OIs, and support the sites with emergency stocks of drugs
for both prevention and treatment of OIs including Septrin, fluconazole, antibiotics , anti-diarrheals and anti-
protozoals. The project will also supply Insecticide Treated Bednets and safe water systems to HIV infected
children and their families. The project will link with and support efforts in community awareness to educate
and support caregivers, to inform them about available services and to reduce stigma. Support groups will
be formally linked to facilities through ‘Health Facility-Community Linkage Coordinating
Committees' (HFCLCC). Linkages with the OVC program will be strengthened further.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREAS
These APHIA II Eastern activities will expand established pediatric care and support sites within the HIV
programs to include new areas in Eastern province. As a result of these activities, 2,300 children will be
offered facility based care and support; they will have clinical, psychological, social, spiritual and nutritional
care during both specific clinics and the support groups, led by child peers.
These APHIA II Eastern activities targets people affected by HIV/AIDS, orphans and vulnerable children,
people living with HIV/AIDS, HIV/AIDS affected families, HIV positive infants and children and caregivers of
OVC and PLWHA. It also targets the community, in order to improve community support and the health care
providers in public, private and faith based health facilities.
Estimated amount of funding that is planned for Human Capacity Development $10,000
Table 3.3.10:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS:
program for health workers ($20,000) and Food and Nutrition by providing nutritional assessments and
food/nutritional supplements directly to project beneficiaries and/or linking them to other programs as
appropriate.
This activity relates to activities in Counselling and Testing, Paediatric Care and Support, Adult care and
Treatment, TB/HIV, and PMTCT.
In order to maintain and improve the pediatric HIV treatment services that will have been achieved in FY
2008, APHIA II Eastern will ensure that pediatric antiretroviral treatment (ART) services continue to be
strengthened in 35 ART sites. We will train 25 health care workers in pediatric ART and 25 in pediatric
adherence support. The project will institutionalize task shifting / task sharing to address the human
capacity gaps. APHIA II Eastern will sensitize the staff and support the implementation of the minimum
package for pediatric HIV treatment at these sites to provide quality HIV treatment and appropriate referrals.
The project will build upon the achievements of FY 2008 by engaging the regional mentors to offer regular
pediatric HIV care mentorship in all the satellite pediatric HIV sites and to include mentorship in clinical
monitoring and management of HIV-related complications and treatment. The project, in consultation with
NASCOP and the PMO, will pilot on-site training on pediatric HIV care, using the "Staggered Module
Approach" in order to limit interruption of services during trainings. APHIA II Eastern will continue to improve
and maintain infrastructure to make them child friendly and continue strengthening systems for forecasting
and logistics management for ARVs, OI drugs and other commodities. This will enhance treatment initiation
by 460 new children resulting in 800 HIV infected children being enrolled in treatment by the end of the
reporting period. This will bring the total ever treated to 960. The project will support the laboratory services
for HIV infected children by supporting some staff salaries, training in commodity logistics management,
strengthening the laboratory network in hard to reach areas, and institutionalizing the use of ‘stabilized
tubes' for sample collection to improve identification of HIV infected children eligible for ART. We will
support the site with resource materials for pediatric HIV treatment including clinical manuals, pocket guides
and Job Aids. The project will also continue to institutionalize the Quality Improvement strategies and
systems that will have been established in FY2008. To improve pediatric adherence we will support the
ongoing psychological and social support through the already established pediatric support groups with
Child Peers and linking to community support structures. We will also provide nutritional assessments and
food/nutritional supplements directly or will link to other programs as appropriate. As part of the exit strategy
we will build capacity within the MOH management structures and health care workers to strengthen
leadership and ownership of the program to take a lead role in the pediatric HIV treatment services.
These APHIA II Eastern activities will expand established pediatric ART programs to include new areas in
Eastern province. As a result of these activities, 460 new patients will receive ARVs, contributing to the
results of expansion of ART treatment for clinically qualified HIV positive, pediatric patients, strengthen
human resource capacity to deliver pediatric ART treatment, and strengthen referral network for provision of
pediatric ART.
These APHIA II Eastern activities will be tightly linked to the FY 2009 activities and across the spectrum of
care with other services supported by APHIA II Eastern in Palliative care, Orphans and vulnerable children,
Prevention of Mother to child HIV transmission, TB/HIV, RH/FP services, Abstinence and Behavior change
and counseling and testing. It will also link with programs providing appropriate nutrition for PLWHA.
These APHIA II Eastern activities target people affected by HIV/AIDS, Orphans and vulnerable children,
Estimated amount of funding that is planned for Human Capacity Development $20,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000
and Service Delivery
Table 3.3.11:
this activity supports key cross-cutting attributions in human capacity development through its training
program that targets health workers ($30,000).
The activity will link up will all other APHIA II program area activities of CT, HBC, BCC and ART at
community, facility, District and provincial level in close tandem with the National framework.
In FY 2009 USAID'S APHIA II Eastern project will provide support to TB control activities within the Division
of leprosy, Tuberculosis and Lung Diseases (DLTLD) strategic plan by contributing to the strengthening of
TB control and management of health workers within Ministry of Health (MOH) facilities in Eastern Province.
This will equip health workers with the skills and knowledge needed to provide TB and HIV treatment and
care services. APHIA II Eastern will continue to contribute to the provincial stakeholders meeting in TB
technical updates to ensure coordination of TB activities and compliance with MOH guidelines in order to
maintain quality of service being provided. APHIA II Eastern will increase the number of providers and sites
that can offer effective TB care, which will in turn increase case holding and case detection rate of TB
patients. This activity seeks to provide TB treatment to 500 patients attending TB treatment centers. This
activity will also increase the number of patients offered testing and counseling and knowing their status
through provider initiated counseling and testing for 1,000 TB patients. Intensified TB screening will be
offered in comprehensive care clinics (CCC) through an enhanced index of suspicion by health care
workers in the CCC. TB screening algorithms will be provided in all CCCs and referral linkages between
CCC and TB clinic enhanced. The activity will support training of HIV and TB care staff on routine diagnostic
testing and counseling of TB suspects and cases using the DLTLD/NASCOP curriculum, provide additional
staff as required, screen HIV cases for TB, upgrade laboratories with additional equipment, and renovate
laboratory space, as necessary. CTX prophylaxis will be provided for all HIV infected TB cases and referrals
for ART made to all CCCs. Planning, monitoring and supervisory mechanisms for collaborative activities will
be strengthened at provincial, district and community levels. TB screening in congregate settings (prisons)
will be initiated and innovative measures of using prisoners as DOT advocates and peer supervisors will be
sought. Through integration and cooperation with BCC group in APHIA II, school TB program will be
provided in 300 schools in Eastern Province.
The APHIA II Eastern TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 500
patients, HIV counseling and testing to 1,000 patients and train 300 health workers in TB/HIV related
activities in 10 districts and sensitize 300 health care workers in TB across 40 health facilities.
This activity targets HIV infected patients in the 10 districts in central and upper north regions of Eastern
Province. The other group is prisoners joining the prisons services and those entering screening for TB.
Continuing Activity: 14865
14865 9069.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $300,000
9069 9069.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $220,000
Estimated amount of funding that is planned for Human Capacity Development $30,000
Table 3.3.12:
+ Prime partner JHPIEGO has been competitively selected to implement the activity.
+ Activity will strengthen roles the roles of the children's department at the provincial level and in all districts
within Easter Province.
+The activity will focus on supporting processes for strengthening sustainable OVC responses at
implementing partner, community and household levels in all the districts in Eastern Province.
+ The activity will place an emphasis on the HIV counseling and testing of children with a focus on provider-
initiated home and community-based testing as an entry for care and support services to children. Using the
opt-out approach; the activity will test 90% of OVC enrolled; targeting approximately 53,100 with testing and
counseling. Of those tested, approximately 4,250 will be identified as HIV-exposed or infected and enrolled
into facility-based HIV care and treatment services to receive cotrimoxazole (CTX), evaluation for ART
eligibility and other basic HIV care services.
+ In 2009, the activity will support the referral of particularly vulnerable OVC to the Nutrition and HIV/AIDS
Program and ensure that an increased number of OVC requiring food and nutritional services will be
reached with food supplements procured through the NHP.
+ In 2009, the activity will support the development of OVC standards for Kenya and in supporting quality
improvement approaches for monitoring and improving the quality of OVC programs at the provincial level.
+ In FY09, the activity will also focus on integrating prevention activities. The activity will link with prevention
programs to support male circumcision and counseling and testing for OVC as well as prevention with
positives for adolescents.
+In 2009, the activity will also focus on establishing appropriate linkages with PMI and ensure that OVC
being supported are also able to benefit from mosquito nets procured by PMI.
This activity will support key cross cutting attributions of the budget amounting to $138,000 towards
Economic Strengthening through the support of income generating activities to support increased
household food security. The activity will also attribute a portion of its budget to supporting educational
activities targeting OVC enrolled in the program in the amount of $230,000. A further $46,000 will be
attributed to provision of safe water guards for households looking after OVC.
This activity relates to activities in Counseling and Testing (#8782), ARV services (#8792), Palliative Care:
Basic Health Care and Support (#8863).
The Ministry of Home Affairs, particularly the Children's Department, in partnership with the Ministries of
Health and Education, provide leadership and coordination to the National OVC program. Part of the GOK's
role has been the development of a policy on OVC. The APHIA II-Eastern project will use this policy as a
framework to support locally based NGOs, CBOs and FBOs to provide services to OVC as part of a
comprehensive care system. In FY 2006, APHIAII Eastern worked with PMO staff, the District Children's
Officers and the DHMT to adapt a grant-making process and cycle modeled after the Maanisha model that
has been in place in Nyanza and Western for several years. With AMREF, the developer and successful
implementer of the model, taking the lead on this activity, the grant-making process, including the formation
of the technical review committee, establishing criteria, and identifying local partner capacity-building needs
has commenced. In FY 2009, the process will be expanded to reach a larger number of OVC. Organizations
that will be selected for grants will identify OVC and families and support communities to support OVC in
non-institutional settings in a variety of ways, depending on the focus of the organization. Examples include
working to keep OVC in school (paying for school fees and uniforms), providing them with vocational
training, providing psycho-social support assisting them to obtain health services and/or nutritional support,
and otherwise engaging them in ways that will minimize their risk of engaging in unsafe behaviors. All sub-
grantees will, as part of this training and the ongoing mentoring through supportive supervision that
constitutes an essential program activity, be updated on national policy and international standards.
Selected groups are not simply given funds and asked for reports, but they are provided with both
structured capacity-building support as well on on-the-job type training and reinforcement. This ongoing
mobilization, and to share the results of their work with other local groups.
The 2009 activities will serve 59,000 OVC and train 1,000 more caregivers. APHIA II Eastern will also train
30 Area Advisory Council members and strengthen capacity of CBOs, and FBOs that will serve as outlets
for OVC. Through its activities APHIA II Eastern will emphasize strengthening community-level capacity to
develop, implement and sustain appropriate responses to the HIV/AIDS crisis.
This activity is linked to the counseling and testing (#8782) and efforts to prevent future HIV infections,
home based care (#8863) community services and provision of care for those already infected, and creating
a positive image of VCT. Efforts will link to work being done on offering effective ART (#8792) and provision
of care to HIV infected children so that families with affected and infected children can benefit from
appropriate care. This will be accompanied with appropriate child and caregiver counseling , treatment
adherence support, nutrition support and accompanying the family in the disclosure process.
This activity directly targets OVC and adults that are involved in providing them with care. It also indirectly
targets adults in the general population through its efforts to reduce the stigma surrounding OVC and policy
makers. Building the local capacity of these communities will rely on closely working with community and
religious leaders as well as local community based and faith based organizations.
This activity will reduce stigma associated with being affected by HIV/AIDS as well as increasing gender
Activity Narrative: equity in programming through the delivery of key messages. Linkages will be created with systems/groups
offering support in food, microfinance, education, and as appropriate, reproductive health.
Major emphasis will be development of networks/linkages and referral systems while minor emphasis is
information, education and communication, and strategic information.
Continuing Activity: 14866
14866 9041.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $5,500,000
9041 9041.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $2,500,000
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Economic Strengthening $138,000
Estimated amount of funding that is planned for Education $230,000
Estimated amount of funding that is planned for Water $46,000
Table 3.3.13:
+ Target population will be expanded to include testing for OVCs
+ APHIA II Eastern will expand counseling services within the province and include outreach services
provided through existing and new VCT sites that are integrated within health facilities. The CT services will
include door to door CT and testing of family members of the infected individuals receiving care and
treatment within the facility and other outreaches as well as institutionalizing testing and counseling in
health care settings. PITC services will be scaled up.
+ This activity will also provide support at the provincial and district levels for the annual national HIV testing
campaigns.
+ geographic coverage has been revised and expanded to include additional districts in the Eastern
Province
+ target population will be expanded to include OVCs
include door to door VCT and testing of family members of the infected individuals receiving care and
treatment within the facility.
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.
In 2009, APHIA II Eastern project will intensify CT services and concentrate more on quality assurance and
control. Focus will be on institutionalizing quality assurance and quality control in facilities offering CT
activities APHIA II Eastern will strengthen MOH capacity to sustain a high quality service provision and
maintain a system that will deliver these services The CT services will include door to door VCT and testing
of family members of the infected individuals receiving care and treatment within the facility. In 2009 alone,
this activity will reach 120,000 individuals with CT services including PITC, VCT and HBCT through 50
outlets and will train 300 providers.
Project will continue to promote the availability and delivery of high quality counseling and testing (CT)
services in public Ministry of Health (MOH) facilities, an essential element of clinical and preventive care.
We have found that ART initiation is increased when the diagnostic testing and counseling program was
established. APHIA II Eastern project will collaborate with the Ministry of Health's (MOH) National AIDS and
STI Control Program (NASCOP) and National TB and Leprosy program (NLTP) to strengthen structures
and systems at provincial, district, facility and community level for the management and coordination of
Counseling and Testing. This will be done through the following strategies; strengthen planning,
implementation and coordination of CT in-service training; develop a provincial core team of trainers by
conducting a training of trainers course (TOT) for NASCOP/NLTP / and Provincial Health Management
team (PHMT). In the remaining period, this activity will be expanding its geographical coverage to increase
access for couples and families. A total of 20 new VCT sites will be established in public and faith based
health facilities. Training in VCT and PITC will be provided for 60 counselors and health care workers
respectively. Approaches that will increase access to HIV counseling and Testing will ensure that eligible
HIV infected people are able to access antiretroviral therapy. The program will focus on supporting the MOH
to scale up PITC in clinical settings. PITC outreaches in the communities will ensure that as many people as
possible are able to receive counseling and Testing. Existing VCT counselors will be trained in other HIV
testing approaches to ensure no missed opportunities to HIV counseling and Testing. VCT sites are
particularly well placed to support these efforts; they will be strengthened to support DTC efforts e.g.
supporting start up activities, providing testing for partners and other family members of index patients, and
providing ongoing counseling. Testing in clinical settings will require supportive supervision, ongoing
monitoring, and mainstream CT reporting. The project will continue supporting the governments efforts of
accelerating counseling and testing through innovative approaches such as moonlight CTs, participation in
national HTC campaigns and CT mobile outreaches targeting couples and young people aged 24 and
below. Targeted CT outreaches will also be carried out in institutions of higher learning in Eastern province.
The project will also scale up gender based prevention program and counseling programs. This will entail
training of clinicians in clinical management of survivors of sexual violence, GBV sensitization sessions for
the provincial administration, HCWs, teachers, FBOs, CBOs, the police and other stakeholders in the
province. CT messaging encouraging first time HIV testers will be developed to encourage people who have
never tested before to go for HIV testing. Strengthening of the CT referral systems will be critical in ensuring
that eligible CT clients are enrolled into ART programs. The project intends to develop an exit strategy
towards the end of the program to ensure smooth handing over process to the ministries involved.
This APHIA II Eastern project will contribute to the Kenya 5-Year Strategy which focuses on HIV prevention.
Targets in this project will contribute to numbers counseled and tested for HIV/AIDS. The proposed program
contributes to COP 2008 targets, and is consistent with the PEPFAR 5-Year Strategy, in the following
manner: Increased access to counseling and testing clinical services, and increased availability of
counseling and testing clinical services.
The APHIA II Eastern Counseling and Testing activities will relate to HIV/AIDS treatment services,
Abstinence and Be Faithful Program, OVC, HBHC, TB/HIV care activities, OP, and PMCT. This activity will
ensure referral for services for those that test positive especially to prevention services and post test clubs
and to care services such as TB, and treatment while others will be referred to post test clubs.
This activity will target the general population including adults (men, women, FP clients, youth), People
Activity Narrative: affected by HIV/AIDS (children born of HIV infected mothers, spouses of HIV infected persons, family
members of an HIV infected person), community members including faith based organizations, non-
governmental organizations, and community based organizations. Health providers both in the private and
public sector providers will be targeted.
Gender is a key legislative issue addressed in this activity. This includes activities supporting counseling
that challenges norms about masculinity, delayed sexual activity and reduced multiple sex partners for boys
and men and transactional sex. The activity also include support for testing and support services for victims
of sexual abuse and violence, training on couple counseling, risk assessment, stigma reduction, and
supporting women to mitigate potential violence.
This activity supports the development and implementation of referral systems, quality assurance and
supportive supervision for CT counselors. The activity will also support the training of additional counselors
especially targeting testing for youth and in clinical setting. The activity will also work with local
organizations and MOH in Eastern province to strengthen their capacity to implement programs.
Continuing Activity: 14867
14867 8782.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $1,200,000
8782 8782.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $630,000
Table 3.3.14:
+ Jointly with program and MOH technical staff strengthen integration, linkages and/or referral systems
between facility-based and community-based monitoring and reporting systems especially with regard to
enrollment and retention of HIV+ clients on care and support (PMTCT, CT, TB, OVC and ART)
+ Increasingly, shift focus to quality of prevention care and treatment through planned and regular analysis,
feedback and use of data on quality indicators at facility/community, district and provincial data review
meetings.
-Support MOH/PMO/PHRIO in strengthening HMIS functions especially on overall reporting rates, records
keeping, ART data reconstruction, structured supportive supervision using M&E focused supervisory
checklists, promotion of data use by all stakeholders and hiring of data clerks to reduce increased data
management burden on health care workers in the province.
+ Conduct basic program evaluations (process evaluations, assessments, program reviews and some
outcome level evaluations) in prevention, care and treatment programs to document implementation and
short-term effectiveness of programs.
SECONDARY CROSS CUTTING BUDGET ATTRIBUTIONS
This activity supports key cross-cutting attributions in human capacity development through training of GOK
and USG partner personnel in HMIS, M&E and Surveillance both at national and regional level.
The only changes to the program since approval in the 2007 COP include
+development of data quality improvement plan, training data point persons on DQA tools and
implementation of regular data quality audits at sampled health facilities and community level programs.
Targets and funding level have also changed.
This activity is related to strategic information activities to be carried out by University of North
Carolina/MEASURE Evaluation (#7098), NASCOP (#7002), and SI Targeted Evaluation/TBD (#9220).
This activity will strengthen the provincial and district level Health Management Information Systems (HMIS)
currently in use by MOH at health facilities and Community Based Program Activity Reporting (COBPAR)
currently being rolled out at Constituency AIDS Control Committees (CACC) levels by NACC through three
key components. Component 1: Support APHIA II EASTERN/JHPIEGO and MOH program data collection
processes for performance reporting needs (quarterly, semi-annual, annual). This component will support a
participatory, coordinated and efficient data collection, analysis, use and provision of information to track
achievement of APHIA II EASTERN/JHPIEGO and MOH's district level Annual Operation Plan II objectives,
and inform decisions at the local, district and provincial levels, using standardized M&E/HMIS tools
approved by the MOH. Component 2: Strengthen community and facility based reporting systems being
rolled out by NACC and NASCOP. The component will support APHIA II EASTERN/JHPIEGO and MOH to
measure progress towards its contribution to the overall country's Emergency plan, National Health Sector
Strategic Plan II and Kenya National HIV/AIDS Strategic Plan goals and results frameworks. Specific
activities will include building capacity of 40 local organisations and facilities to collect, report, analyse, and
use both routine facility and non-facility data for planning and program improvement. Component 3: Take
lead role in coordinating M&E activities in the province to meet the information needs of USAID/Kenya, the
Emergency Plan, MOH, NACC and other stakeholders, in line with the "three ones" principle. APHIA II
EASTERN/JHPIEGO will organize district-level consensus building forums on M&E issues, distribute
standardized data collection and reporting tools, conduct regular data quality assurance processes at all
data generation points, train 100 facility and community based data point staff on the new data
collection/reporting tools and data use for improving program performance, and hold provincial level
quarterly and annual stakeholders' information dissemination meetings. APHIA II Eastern/JHPIEGO will be
held accountable for tangible results, especially in increased use of harmonized data collection and
reporting tools at health facilities developed by MOH, increased data use in planning and at dissemination
workshops to various stakeholders, increased supportive-supervisory visits and routine data quality
assessments at all data collection points by M&E/HMIS officers, and improved coordination of M&E
activities in Eastern province. These efforts should result into demonstrated evidence in increased national
level reporting by up to 60% from health facilities to NASCOP national database.
The activity builds on the FY 2006 activities that support the national M&E systems as well as contributing
to the Emergency Plan's training outputs. In overall, the activity will provide technical assistance to twenty
local organizations/health facilities in strategic information in addition to supporting the training of 55 SI and
program managers in M&E/HMIS, reporting and data use for program management
This activity is related to the strategic information activity to be carried out by University of North
Carolina/MEASURE Evaluation (#7098), where MEASURE Evaluation will be supporting NACC in rolling
out COBPAR system for community level reporting. It is also related to the strategic information to be
carried out by NASCOP (#7002), where NASCOP will be rolling out Form 726, Form 727 and program
specific client registers for data collection and reporting at health facilities. It is also related to SI TE/TBD
(#9220) that will attempt to investigate the causes for low reporting rate by health facilities and recommend
strategies for achieving 100% reporting level by health facilities.
This activity targets host government and other health care workers like M&E and HMIS officers responsible
for data collection, analysis, reporting and use at both health facilities and community level. Program
managers are as well targeted for orientation on the role M&E in program management.
The major emphasis area is Health Management Information Systems (HMIS) and minor areas include
Activity Narrative: Monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.
Continuing Activity: 14869
14869 8875.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $200,000
8875 8875.07 U.S. Agency for JHPIEGO 4914 4914.07 APHIA II - $75,000
Program Budget Code: 18 - OHSS Health Systems Strengthening
Total Planned Funding for Program Budget Code: $12,500,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Key Result 1: Strengthened Government of Kenya (GoK) systems for policy, planning and budgeting.
Key Result 2: Enhanced capacity and skills of leaders and managers of indigenous organizations, both in terms of HIV service
delivery and advocacy.
Key Result 3: Increased supply, utilization, and effectiveness of human resources for health (HRH).
Key Result 4: Strengthened systems for health commodities procurement and logistics management.
CURRENT PROGRAM CONTEXT
During the Emergency Plan's (EP) initial five years, it has supported the GoK and non-governmental organizations (NGOs) to
initiate and implement key HIV-related policy reforms; strengthen capacities at the national, provincial, and community level for
expanding HIV service delivery; improve Kenya's health management, procurement, and logistics systems; and confront critical
barriers to scaling up of HIV prevention, care, and treatment services. Rapid expansion of the national HIV program has been
both a driving force behind and a clear beneficiary of these advancements.
Despite considerable gains, Kenya still faces significant gaps in the systems strengthening arena. There is a clear need to foster a
more enabling policy and legislative environment for additional HIV-related reforms, to augment the capacity of GoK institutions
and indigenous NGOs to assume greater responsibility for managing the national HIV response, and to strengthen Kenyan health
systems and personnel to sustain and support continued programmatic expansion.
Working closely with the GoK and other partners, the EP is uniquely positioned to support further development in these critical
areas.
STATISTICS
In the area of policy development and reform, the EP has supported the GoK in developing a HRH Strategic Plan that provides an
overarching framework for addressing HRH issues in Kenya, as well as the Management and Leadership Strategy and a National
Health Training Policy to enhance training for health care workers (HCWs) and improve the quality of health services for Kenyans.
The EP has also engaged with relevant GoK and civil society stakeholders to support passage of key legislation, including the HIV
Act and the Sexual Offenses Act, and early efforts toward their implementation.
The EP has helped strengthen the capacity of numerous Kenyan NGOs, including local networks of people living with HIV
(PLHIV), through targeted support both to enhance their ability to deliver HIV services and to advocate within key decision-making
fora on HIV-related issues, including in the areas of stigma and discrimination, gender, and community mobilization for provision
of HIV prevention, care, and treatment.
While inadequate supplies of HRH remain a substantial barrier to HIV service scale up in Kenya, EP assistance has enabled the
country to begin bridging this gap. The EP has supported the recruitment and deployment of 830 Emergency Hiring Program
(EHP) staff, which currently provide HIV services in 200 facilities throughout the country. With the EHP's success, the GoK has
adopted the program's merit-based recruitment and rapid-hiring model into national-level systems and, in the coming years, will
gradually assume financial responsibility for most EHP staff.
Through EP assistance, Kenya has initiated development of a comprehensive HCW database to more systematically capture and
keep current data on HCW supply in the country, with the overall aim of better informing and guiding HRH priority-setting and
investments. The EP continues to recruit and place senior technical advisors and managers within key GoK ministries and
management units to fill critical capacity gaps, while providing additional technical assistance from U.S. government staff in many
key areas.
In the area of procurement and logistics management, the EP has helped establish a "pull" procurement and delivery system
(including consumption monitoring, demand-driven ordering and delivery) for HIV-related commodities in Kenya. Recent rapid
acceleration of HIV service delivery in the country has significantly strained the GoK's national procurement system and the EP
system has been instrumental in assuring the regular and reliable supply of anti-retroviral drugs (ARVs) and other key
commodities at the facility level. To improve performance and support long-term sustainability of commodities procurement,
warehousing, distribution, and monitoring, the EP provides technical assistance to KEMSA, which includes leveraging the
Millennium Challenge Corporation (MCC) Threshold Program's targeted support to procurement systems in Kenya. The EP also
provides technical assistance and training to NASCOP in the decentralization of ART commodity management including Standard
Operating Procedures (SOPs), job-aids, and costing.
U.S. government technical leadership in laboratory policies, strategies, and operating systems has been widely recognized and
utilized by the GoK, as have EP contributions to strengthening GFATM management structures, including technical assistance in
grants management and information systems.
SERVICES
In the area of planning and budgeting, past technical assistance has focused on national-level activities supporting the NACC and
MPND. In 2009, the EP will continue this support while also strengthening planning, costing, budgeting, and financial
management capacities at the provincial and district levels. Moreover, while maintaining support for development partner
coordination, HIV program reviews, GFATM proposal development and grants management, renewed efforts will be made to
address persistent concerns in these areas.
In 2009, the EP will continue grants to non-governmental, community- and faith-based organizations to strengthen their capacities
in leadership and management, including around systematized decision-making, mobilization of resources, and improved financial
management, as well as advocacy, delivery of HIV services, reducing stigma and discrimination, and addressing gender issues.
Targeted technical assistance will be provided to new and established networks of PLHIV to train their members in networking
and advocacy, expanding access to HIV prevention (including Prevention with Positives), treatment, and care services by their
members, as well as in the reduction of stigma, discrimination, and gender-based violence.
Without capable and competent human resources, even well-developed health systems will likely under-perform. Therefore, EP
funds in 2009 will aid development of supportive policies, training, and management systems to improve the overall performance
of HCW. As staff shortages are often exacerbated by poor incentives, motivational factors, and inadequate financial resources of
national governments, performance improvement strategies, innovative retention schemes, and enhanced training management
and guidelines will be developed. The EP will continue support to the institutionalization of a unit within GOK responsible for HRH
planning, budgeting, budget advocacy, policy development, and coordination.
Building on the recently-completed national HRH training needs assessment, in 2009, the EP will support more systematized and
targeted health sector education and training. The EP will support the Kenya Medical Training College (KMTC) to undertake a
comprehensive review and updating of pre- and in-service curricula and training guidelines to incorporate critical aspects of HIV
management and ensure all HCW cadres have comprehensive HIV-related information and skills. The EP will continue support to
the GoK's Continuing Professional Development Unit and professional associations to complete the Continuing Medical Education
database.
Activities will be conducted to respond to the leadership and management strategic plan completed in 2008, including targeted
training for health managers at the national and provincial level, and within networks of faith-based organizations. EP assistance
will also support continued implementation of the national Human Resource Information System (HRIS) and capacity-building for
the GoK to effectively manage this system and to use it to guide thorough HRH gap analyses and long-term HRH work plan
development.
While EP support for in-service trainings will continue in 2009, including promoting greater on the job training, the portfolio will
emphasize increased breadth and depth of pre-service training, enabling more HCW to enter the workforce already equipped with
core HIV competencies. A comprehensive review and rationalization of the scopes of practice of personnel to enhance task-
shifting will be supported in line with rollout of the GoK's Community Health Strategy and other pertinent policy guidance to
address HCW shortages.
While promoting better utilization of existing HRH, the EP will also encourage innovative approaches to building new health
capacities, including ongoing support for the HIV fellowships program launched in 2008, piloting of new HCW cadres, including
youth, women, and PLHIV health corps, and re-engaging retired HCW, including nurses. Activities to promote gradual GoK
absorption of staff hired under the Capacity Project EHP and identify other innovative retention strategies will also be pursued.
The EP will support longer-term planning and forecasting to better anticipate future needs for commodities, equipment, and
renovations. While global procurement has produced some efficiency gains, the EP will focus on strengthening logistics
information systems, management capacities, and implementation of tracking surveys to measure progress in HIV commodities
distribution and use at KEMSA and the TBD Kenya Pharma Project, even as the global partnership with the Supply Chain
Management System (SCMS) continues. Specific emphasis will be placed on strengthening pediatric supply-chain management
as efforts expand to reach more children with ARVs and other HIV-related commodities.
The EP will support wrap-around activities with the MCC Threshold Program to improve overall health commodities procurement
and delivery, including for HIV. Technical assistance, training, and other related support will be provided for implementing systems
improvement in warehousing and distribution of HIV commodities. Additionally, support will be provided in the implementation of a
logistics management information system (LMIS). Further, the EP will support the development and implementation of quality
assurance initiatives for key commodities such as ARVs and test reagents. Other initiatives to improve the efficiencies of HIV
commodities procurement, delivery, and their use will be pursued, including EP-supported technical staff additions as appropriate
within GoK ministries or units.
In 2009, the EP will pursue closer involvement of civil society and communities in the delivery of public services, including their
greater participation in key oversight activities, such as commodities procurement and monitoring of district, facility, and village
health committees.
REFERRALS AND LINKAGES
Finally, the EP will support initiation and expansion of various public-private partners and additional leveraging opportunities within
the health systems strengthening portfolio. These efforts may include 1) twinning of KMTC and other national training institutions
for health with appropriate U.S. universities; 2) pairing KEMSA with a private sector partner experienced in procurement and
logistics management systems; 3) partnering with ICT and other innovative private sector organizations; and 4) leveraging of the
International Health Partnership, for which Kenya is a pilot country, to optimize financial support to HRH in the country.
POLICY
Guided by a recent private sector assessment, the EP will support activities to expand HIV services by improving the policy and
regulatory environment for private provision of health products and services, increasing the participation of private for-profit health
providers and demand for private sector products and services, and expanding health financing and opportunities for private
sector provision.
In 2009, the EP will continue to support development of policies and systems to enable the GoK and its civil society partners to
assume increasing responsibilities for HIV program development, management, financing, and implementation. EP support will
strengthen leadership and management in the public sector and among indigenous organizations to enhance ownership and
sustainability. Furthermore, the EP will fund development of policies and incentives for enhancing HCW capabilities and
effectiveness and improving HIV commodities management by public and indigenous organizations.
Ongoing EP assistance will help to develop and implement health sector-wide and HIV-specific policies and guidelines.
Challenges to sustaining recent reforms and effective implementation are expected to grow in number, complexity, and will
demand the participation of broader stakeholders. The EP will confront these challenges with technical assistance, training, and
support to the GoK for maintaining a policy management and tracking system and a policy database, and by building capacity in
the analysis of critical operational barriers to policy implementation.
SUSTAINABILITY
Close collaboration between the EP, the GoK, and other implementing partners will be continued in 2009. With an eye toward long
-term sustainability, and in support of the "Three Ones" principles, EP-supported partners will continue to work closely with the
GoK to implement against the Kenya National HIV/AIDS Strategic Plan (KNASP) - and its forthcoming update, expected June
2009 - ensuring the EP remains well-aligned with nationally-driven principals and priorities.
WORK OF HOST GOVERNMENT AND OTHER IMPLEMENTING PARTNERS
The EP health systems strengthening team will continue to work closely with relevant GoK stakeholders, including the ministries
of Planning and National Development, Public Health & Sanitation, Medical Services, and the National AIDS Control Council, as
well as with key development partners, including the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the World Bank, the
Department for International Development, and the Joint United Nations Programme on HIV/AIDS. The health systems
strengthening team is also an active participant of the Development Partners in Health Kenya.
Table 3.3.18:
In 2009 APHIA II Eastern will continue to strengthen the dissemination of key Government of Kenya (GOK)
policies and guidelines, developed at national level, to the district level. In addition APHIA II Eastern will
continue to support provincial and district health systems strengthening by convening consultative meetings
and various stakeholders' forums.
In addition, APHIA II Eastern will continue to strengthen the institutional capacity of various local partners at
grassroots level using very participatory methodologies. This will include institutional strengthening for 15
organizations. APHIA will also build the management and supervisory capacity of District Health
Management Boards (DHMTs) to effectively carry out their roles. All persons trained under APHIA will also
be equipped with skills for stigma mitigation. The prevention peer educators and community health workers
will engage the community on dialogue on stigma with the aim of enabling people to identify stigma in their
community and work towards stigma reduction, other approaches to be utilized will include community
theatre and outreaches.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to strengthening Government of Kenya systems on policy, planning and
budgeting. This will be done by enhancing dissemination and understanding of key government policies
and guidelines, which will be developed or reviewed nationally, out to the districts through provincial
channels and building the capacity of local APHIA implementing partners.
This activity will link to other APHIA II Eastern activities, particularly in AB and OP.
This activity will target all population of Eastern province including youth, women, and men.
5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED
The main emphasis area for this activity will be local organization capacity building via serving to enhance
the management and coordination capacity of district and provincial health management teams in at least ¾
of the districts in the province served by the implementer.
Continuing Activity: 16333
16333 16333.08 U.S. Agency for JHPIEGO 6960 4914.08 APHIA II - $100,000
