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
This activity relates to counseling and testing, ARV services, palliative care: home based care and support,
abstinence and be faithful and other prevention activities.
2. ACTIVITY DESCRIPTION
This APHIA II Rift Valley activity will expand PMTCT services in the Rift Valley province, building on the
support previously provided through USAID's IMPACT and AMKENI Projects. It aims to increase the uptake
of counseling, testing (CT) and ARV prophylaxis to all pregnant women presenting for ANC services in
supported sites. In 450 facilities across several districts in Rift Valley Province CT will be provided to
160,183 (76%) of 210,688 pregnant women, ARV prophylaxis to 8,055 (76%) of 10,643 HIV-positive women
in the geographic area of coverage. Of these 4028 HIV positive women will receive AZT/NVP prophylaxis,
2,416 will receive single dose nevirapine only while 1,611 will be put on HAART. Service delivery will
incorporate best practices namely opt-out approach and rapid testing. Sites will include, or be linked to,
comprehensive care centers with a big emphasis on decentralization of care and treatment and TB services
to lower level health facilities. Opportunistic infection prophylaxis, the use of more efficacious regimens for
ARV prophylaxis and PMTCT plus services will start in selected sites. Improved capacity to carry out
postnatal follow up of infected mothers and exposed babies including early infant diagnosis to reach 4028
exposed infants in the mother and child health clinics (MCH) are priorities. This will be supported through
training of health care workers, roll out of combined mother baby card and support to laboratory networks.
Male involvement will be supported through greater involvement of men with counseling and testing
provided to 32,107 spouses of pregnant women.
Significant changes from 2008 include the provision of universal and more comprehensive PMTCT services
in Rift Valley. Strategies to provide CT in maternity services during labor and delivery, emphasis on early
infant diagnosis, male involvement, and greater involvement of people living with HIV/AIDS through scale
up of the mentor mothers project and deployment of additional counselors to ANC sites are other important
changes. Postnatal follow up of infants and mothers will include infant diagnosis, cotrimoxazole prophylaxis,
treatment, and support for infant feeding practices and appropriate linkages for nutritional support. In 2009
APHIA II Rift Valley will support 450 sites, train 122 additional health care providers and provide logistical
support, renovation, supervision and monitoring. Support to PMTCT plus services will include training of
service providers, strengthening of laboratory and commodity logistics capacity, increased access to HB,
FBC and CD4 assays and linkages to comprehensive care centers.
This activity will use the Ministry of Health's WHO/CDC-based curriculum for training, comply with MOH's
clinical and reporting guidelines, and participate in the MOH's Technical Working Group including regional
GOK PMTCT meetings to improve quality and ownership of the program. Community links in rural areas to
provide support especially to HIV-positive pregnant women will be established through national
organizations of PLWHA and mentor mothers' project. Agreements with Provincial Medical Officers will
ensure that PMTCT skills are taught to multidisciplinary treatment and care teams at comprehensive care
facilities, and that primary HIV care is integrated into MCH clinics.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
PMTCT in this geographical area will significantly support PEPFAR goals for primary prevention and care
by contributing 12.3% of 2009 overall Emergency Plan PMTCT targets for Kenya. Additional sites contribute
to the program's efforts to achieve district wide coverage for services. Support to high volume health
centers, district and provincial hospitals to provide PMTCT plus services significantly increase opportunities
to identify HIV infected patients who are potential candidates for ART. Access to services, medical
treatment and care will encourage rural women in underserved communities to attend ante natal care
services. This will facilitate postnatal follow up of HIV positive women, infants and their family members.
This APHIA II Rift Valley activity also contributes substantively to Kenya's 5-year strategy of encouraging
pregnant women to know their status, availing services to reduce mother-to-child infections and providing
HIV/AIDS treatment as a step towards preserving the family unit. It also contributes to the strategy to
integrate services and improve the referral links.
Activity Narrative: 4. LINKS TO OTHER ACTIVITIES
This activity relates to CT, ARV services, Palliative care, OVC, AB and other prevention activities described
in the APHIA II Rift Valley in other areas of the COP. PMTCT plus services include counseling and testing
which is largely diagnostic, provision of ARV prophylaxis, management of opportunistic infections and ARV
services. Strengthening laboratory services and improving commodity logistic systems is a crucial part of
HIV/AIDS treatment services.
5. POPULATIONS BEING TARGETED
This APHIA II Rift Valley activity targets adults of reproductive health age, pregnant women, family planning
clients, infants, people living with HIV/AIDS, HIV positive pregnant women and HIV positive infants. BCC
activities will involve community leaders and community based organizations to increase demand for
services. Strategies to improve quality of services will target Ministry of Health staff, doctors, nurses,
midwives, laboratory workers, pharmacists and other health care workers such as clinical officers and public
health officers.
6. KEY LEGISLATAIVE ISSUES ADDRESSED
This APHIA II Rift Valley PMTCT activity will increase gender equity in programming through partnering with
women's groups in the design and implementation of community mobilization approaches. The behavior
change communication (BCC) activities will promote a family approach to PMTCT. This will address male
norms, encourage male participation and help reduce stigma and discrimination. Increased availability of
services will also reduce stigma.
7. EMPHASIS AREAS
This activity includes emphasis on human capacity development through training and task shifting,
development of network/linkages/referral systems to wrap around programs in malaria, family planning, safe
motherhood, TB and nutrition programs. Support to strategic information will be provided.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14797
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14797 8733.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $2,630,000
International International Valley
Development
8733 8733.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $1,400,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
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 $156,450
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 $150,000 for HIV Free Generation activities targeting youth
The only changes to the program since approval in the 2007 COP are:
• $100,000 of this activity supports the Youth Prevention Initiative programmed with funds from the $7
million FY 08 plus up
• Geographic coverage has been expanded to include Pokot West, Pokot East, Trans Nzoia South, Trans
Nzoia North, Baringo North, Baringo Central, Turkana North, Turkana South, Marakwet and Keiyo districts
• The target population has been expanded to include the disabled population, Kenya Girl Guides
Association and teachers at the worksite
• $23,000 in AB funds will go toward this worksite activity complemented by allocations in OP and OHPS
totaling $150,000 to reach 750 teachers and train 20 more
• In response to the Ministry of Education's request the KARHP methodology will be rolled out targeting
teachers and in-school youth
• APHIA II RV will expand to include activities of the former TCI in at least one community (Salgaa) along
the Mombasa/Kampala highway
This activity relates to activities in HVCT (#8776), HBHC (#8929), HTXS (#8797), HVOP (#9040), HKID
(#9029), MTCT (#8733) and HVTB (#9065).
In 2009 APHIA II Rift Valley (A2RV) will reach 363,461 individuals with abstinence and being faithful
messages in the Rift Valley. They will employ a 360 degree Model of Protection that seeks to delay first sex
and increase secondary abstinence among youth between the ages of 10-24 years and increase safer
sexual practices among sexually active youth as well as promote fidelity and monogamous relationships
among the general population of Rift Valley. They will also seek to reach community women in low
resource settings, teachers, health care providers, the clergy and religious leaders with a special and
specific focus on PLWHA and provide the targeted populations with comprehensive skills for prevention of
infection by STIs in general and HIV in particular. The model calls upon families, schools, health facilities,
places of worship and communities to meet the HIV/AIDS needs of the populations by developing activities
that build the capacity of the populations to establish and maintain healthy behaviors to avoid HIV and STIs
and to advocate for cultural changes that promote low-risk behavior. The model aims to encompass
individuals with a supportive environment at every level of their lives (family, peers, school and community).
2,524 individuals will be trained to provide AB programs in the different groups. The AB program will be
implemented by FBO sub-partners and other NGO/CBOs to integrate life skills programs for HIV/AIDS
prevention, drug and alcohol abuse. In addition, A2RV will work with the Kenya Girl Guides Association
(KGGA), the Ministry of Education and the Kenya Network of Positive Teachers, utilizing the Kenya
Adolescent Reproductive Health (KARHP) methodology, to reach out to more youth in and out of learning
institutions. Young Mens Christian Association (YMCA) will target underserved populations with Abstinence
and Being Faithful programs targeting Christian and Muslim faithful in Naivasha and Gilgil. The activity will
work with Islamic leaders like Imams and Madrassa teachers to reach the Muslim faithful. Partners for
Progress (PfP) will target youth out of school in Nakuru North, Nakuru South, Molo, Naivasha, Narok North,
Narok South, Kajiado, Loitokitok, Laikipia East and Laikipia West districts as well as target young female
sex workers in all the districts with livelihood skills to provide them an alternative to sex work. SWAK will
work with community women and their partners in low resource settings to promote mutual fidelity. The
activity will engage the Girl Guides in community outreach to deliver messages on prevention. The activity
will also develop, produce and distribute prevention communication material through the various partners
and networks implementing the activities in the Rift Valley province. Adolescent OVC's will be targeted by
integrating prevention education and life skills into the OVC support activities and by involving KGGA in
community outreach programs to target such vulnerable peers. The activity will expand the youth peer
education interventions using the Y-Peer approach established by Youth-Net and UNFPA; work with the
Provincial Education Office, Kenya National Union of Teachers (KNUT) and KGGA to roll out life-skills peer
education programs to schools in Rift Valley Province; and work with tertiary training colleges, polytechnics
and universities to integrate HIV/AIDS education using the ‘I Choose Life' approach and NOPE's
Ambassadors of Change (AOC) approach. APHIA II Rift Valley will collaborate with more local youth
groups and partners to implement the program. The activity will link to counseling and testing, RH/FP, and
other facility based services that enable the reached populations to access treatment and other services.
Particular attention will be given to creating linkage with Gender based violence prevention and mitigation
This activity will reach 363,461 people through AB messages, contributing significantly to the overall 2007
PEPFAR goals. The activity will seek to integrate prevention with all community outreach for treatment and
care with a special emphasis on youth. It will significantly contribute to PEPFAR's goals for primary
prevention.
4. LINKS TO OTHER ACTIVITIES The activity will link to other APHIA Rift Valley activities in CT (#8776),
HBHC (#8929), ART (#8797), OP (#9040), OVC (#9029), PMTCT (#8733) and TB/HIV (#9065) that all seek
to provide comprehensive, district-based services coordinated at the provincial level.
This activity targets adults, children and youth, particularly girls, boys, primary and secondary school
students.
6. KEY LEGISLATIVE ISSUE ADDRESSED Key legislative issues which will be addressed include gender,
addressing male norms and behaviors, volunteers, stigma and discrimination, and education at primary and
secondary levels.
Activity Narrative: 7. EMPHASIS AREAS
The activity will have a major emphasis on local organizational capacity development with lesser emphases
on information, education and communication, training and community mobilization and participation.
Continuing Activity: 14798
14798 9070.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $2,400,000
9070 9070.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $1,725,000
* Addressing male norms and behaviors
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 $200,000 for HIV Free Generation activities focusing on youth.
+ This activity will target police, uniformed services, women, opinion leaders, and others on issues of
gender-based violence.
•Geographic coverage has been revised to include Pokot West, Pokot East, Trans Nzoia South, Trans
Nzoia North, Baringo North, Baringo Central, Turkana North, Turkana South, Marakwet and Keiyo.
•$100,000 of this OP activity is programmed with funds from the $7million FY08 plus-up for the Youth
Prevention Initiative.
•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 Rift Valley will work with select health facilities, police, uniformed services, opinion leaders and
others on issues of gender-based violence.
This activity relates to activities in and Testing (#8776), Palliative Care: Basic Health Care and Support
(#8929), HIV/AIDS Treatment: ARV Services (#8797), Abstinence and Be Faithful Programs (#9070),
Orphans and Vulnerable Children (#9029), Prevention of Mother-to-Child Transmission (#8733) and
Palliative Care: TB/HIV (#9065).
In 2009, this activity will build on HIV/AIDS prevention activities implemented under FY 2008 in the area of
"other prevention." Additionally the activities will also create linkages with STIs, Malaria, RH/FP, MCH and
TB services. The activities will reach 842,066 individuals through multifaceted community outreach
programs and train 2,502 people through existing local NGOs, CBOs, FBOs, Professional associations and
trade unions and the private sector and distribute condoms through 1017 condom outlets. The activities will
reach target populations in Nakuru North, Nakuru South, Molo, Naivasha, Narok North, Narok South,
Kajiado, Koibatek, Baringo, Transoia West, Transoia East, Uasin Gishu, Nandi North, Nandi South, Keiyo,
West Pokot, Samburu, Laikipia, Turkana, and Samburu districts in Rift Valley Province. Under the
leadership of National Organization of Peer Educators (NOPE) the activities will target to reach both men
and women in the formal and informal workplaces; their extended families and also most at risk youth-out-of
-learning institutions with HIV/AIDS prevention messages. Local NGOs, CBOs, professional associations,
trade unions and FBOs will target the other high risk populations including low-income community women,
persons with disability, sex workers (with young female sex workers as special focus), long-distance truck
drivers and other men in the transport sector such as matatu/ tour van drivers, touts and bicycle taxi (boda-
boda and Tuk-Tuk) drivers, cattle traders and cattle drivers and the women who provide them services at
cattle markets or en route, street families, uniformed services - the Kenya Police, Armed Forces, NYS,
KWS, Prisons Service and their families, discordant couples and women in churches and mosques in Rift
Valley Province. Professional associations, trade associations and labour unions will target teachers and
health care providers and their families. Kenya National Union of Teachers (KNUT) and Kenya Association
of Positive Teachers will reach teachers in primary and secondary schools as well as tertiary training
colleges. Technical assistance partners will continue to provide assistance and capacity building to partner
organisations to implement strategic behaviour change preventive programs. The activity will work and link
with and provide referrals to existing networks of HIV counseling and testing as well as facilitate mobile and
home based testing, TB screening, home based care and ART programs in the program areas. Prevention
activities will include the following: community theatre targeting both in school and out-of-school and at-risk
youth with prevention information leading to behavior change and referral to youth friendly services;
supporting peer education and peer counseling interventions with community women in low resource
settings, sex workers in Nakuru, Naivasha, Gilgil, Mai-Mahiu, Salgaa, Narok and support the setting up of
drop-in-centres; link them to VCT, PMTCT, care and support services; support prevention activities among
teachers, health care providers, support prevention efforts among the uniformed services and their family
members by supporting peer education among the ranks and working with provincial police Aids Control
Units (ACU); support prevention activities among people in confinement e.g. prisons, remand homes,
borstal institutions, promote advocacy among cultural gatekeepers and law enforcement agencies leading
to greater sensitivity to gender based violence and exploitation, expand the peer education program. This
intervention will result in reduced HIV risk in the general population, especially among young adults. They
will provide increased access to HIV/AIDS prevention services for high-risk and under-served populations,
and increase awareness of HIV/AIDS preventive behaviors through the Ministry of Health (MOH) and other
partners. This will also include targeted condom promotion and distribution to high-risk populations and
referral for STI services by the MOH and other partners. Local implementing partners will integrate
prevention messages into models of care and support for orphans and vulnerable children (OVCs) and
people living with AIDS (PLWA). Technical assistance will continue to be provided to partners implementing
behavior change communication (BCC) programs in HIV and substance abuse and develop new print
materials addressing alcohol abuse, stigma and discrimination.
This activity will contribute to the overall 2007 Emergency Prevention Plan for Kenya target reaching
individuals through other behavior change beyond abstinence and/or being faithful. The activity will seek to
integrate prevention with positives into all community outreach for treatment and care with special
emphases on youth. It will significantly contribute to PEPFAR's goals for primary prevention.
4. LINKS TO OTHER ACTIVITIES
The activity will link APHIA Rift Valley to other activities in CT (#8776), HBHC (#8929), ART (#8797), AB
(#9070), OVC (#9029), PMTCT (#8733), and TB/HIV (#9065) that all seek to provide comprehensive district
Activity Narrative: -based services coordinated at the provincial level. It will also link with the comprehensive cluster projects of
the FHI-TCI project along the major Mombasa-Busia highway.
The activity targets special populations particularly the most-at-risk populations of commercial sex workers,
military personnel, discordant couples and truck drivers. The activity also targets adult men and women.
6. KEY LEGISLATIVE ISSUE ADDRESSED
The activity addresses both gender and stigma and discrimination.
The major emphasis area for this activity is training with minor emphases on information, education and
communication and community mobilization/participation. APHIA II Rift Valley will undertake (1) prevention
activities with HIV positives (PwP) working through PLWA support groups linked to the Comprehensive
Care Centers in Nakuru and Naivasha. $50,000 of unallocated funds will provide support to patient support
groups and post-test clubs in VCT centers to ensure promotion of faithfulness and condom use by HIV-
infected persons. This will empower 5 people in each of 10 patient support groups to become peer and
advocacy leaders in prevention at the community level and will reach 10,000 PLWAs.
Continuing Activity: 14799
14799 9040.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $1,900,000
9040 9040.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $2,140,000
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 ($55,000).
These APHIA II Rift Valley 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.
This activity will provide integrated and a comprehensive home and basic health care package to 23,000
people with HIV/AIDS linked to 145 comprehensive care centers and a network of Rural Health Facilities
(RHFs). Through a cascade training of trainers approach, primary care facility health workers will be trained
to provide comprehensive and integrated care training to the home /community based care workers who in
turn train the primary care givers at home, to complement the facility based services. At the health facility
clinic, integrated training following NASCOP/DRH/Malaria/NLTP curricula will be offered to identified staff to
offer services for the prevention, identification and management of OIs, monitoring of the infected adults
and their families, coupled with appropriate counseling and education. A case manager will manage
referrals to and from the community. The community based component will include treatment literacy, basic
management of OIs, antiretroviral treatment (ART) and TB treatment adherence, adequate nutrition, home
hygiene and nursing skills, malaria prevention and treatment, FP and identification and referral of clients
suspected of having HIV and TB. The main link to and from the health facility will be the CHWs many of
whom will be treatment supporters. Formal linkages between health facilities and the community-based
activities will be strengthened to enhance effective care, follow-up, and tracking of referrals and assessment
of patient response and satisfaction with the services. Both formal health care workers and community and
home-based volunteer care workers will be trained on effective referrals. In some instances, lay treatment
support volunteers will be recruited and trained, using the CRS training curricula to provide psychosocial
support, adherence support for ART, TB and regular clinic visits. This activity will also lead to the
mobilization and strengthening of organizational and institutional capacity of 25 APHIA Rift supported
districts and relevant DHMTs institutions to integrate, plan, lead, monitor and evaluate home and community
care support programs. This activity will lead to the linkage of 871 families with economic support programs
using the CRS SILC model. Community members including PLWA and some OVC will be trained on this
methodology and also in basic financial and management and skills for their projects and also linked to
other microfinance institutions operating in the region. 5,223 PLHA and their family members will receive
nutritional and food support and through continued collaboration with AGRI, 3,000 people will be trained on
improved agricultural techniques for food production. APHIA will tap into other USAID/FFP program to
provide supplementary nutrition to families caring for OVC. To ensure continued support for this effort at the
community level, FBOs, CBOs, PLHA groups, women and youth groups will be trained in basic program
and financial management skills as part of capacity building. Paralegal and child counselor training will be
strengthened and through active monitoring and follow-up to assess its impact to the children and PLWA.
Provision of safe water supply in the homestead will be supported to reach clients households. In addition,
these families will be linked to a supply of insecticides treated bed nets targeting especially those with
pregnant women and children under five years. Nutritionally deficient bed ridden patients will be supported
with food supplements. Vulnerable households will be linked to food security and extension services.
3. CONTRIBUTIONS TO OVERALL PROGRAME AREAS
These APHIA II Rift Valley activities will expand on the established care programs in Rift Valley province. As
a result of these activities, 23,000 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
will be drawn from. This will also link well with the other activities targeting prevention with positives. 1,000
individuals will be trained to provide palliative care through 302 service outlets.
These APHIA II Rift Valley 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.
6. 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.
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: 14800
14800 8929.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $900,000
8929 8929.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $200,000
Estimated amount of funding that is planned for Human Capacity Development $55,000
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 ($200,000).
These APHIA II Rift valley activities will be tightly linked to the FY 2008 activities and across the continuum
of care with other services supported by APHIA II Rift Valley 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.
This activity will be carried in APHIA II Rift Valley (across the entire South Rift Valley and parts of North Rift
Valley), which means consolidating established programs and expanding the activities to include new areas.
As a result of these activities, a total of 14,000 people with HIV will receive antiretroviral therapy (ART)
(including 3,000 patients that will initiate treatment) at 145 CC/ARTs and Rural Health facilities for treatment
follow-up by nurse health workers. This brings total number ever receiving ART to 16,800. A total of 245
health care workers will be trained in the provision of antiretroviral therapy (145 trained on rational use of
ART and 100 trained on IMAI - Integrated Management of Adulthood Illness for the Rural health facility
based health care workers). Activities will include infrastructure improvements for laboratories and service
delivery areas, supply of equipments and commodities such as laboratory reagents and pharmaceuticals,
production and dissemination of informational materials such as pamphlets addressing adherence to
antiretroviral, training of health workers for adult ART, and institutionalization of QA/QI and supervision
systems.
In addition to supporting outpatient provision of ARVs, specific activities will increase the opportunities to
detect eligible patients for ART in the in-patient wards and from key service areas of the health facilities like
TB clinics, MCH/FP services. The laboratory networks for CD4 count tests will be strengthened and
improved to ensure that all patients are screened to assess eligibility for ART, all health facilities offering
HIV care and treatment will be linked to the laboratory with CD4 count machines. All services will be tightly
linked across the spectrum of care with other services in basic home-based care and community support in
conjunction with systems strengthening. For the lower level facilities (Rural health facilities) the providers
will be mentored by a selected team of experienced service providers from the district level through a
theoretical and on-job practicum training sessions to ensure sufficient confidence is build by the provider to
be able to effectively assess and initiate eligible patients on treatment and effectively monitor the patient on
treatment thereafter. Health care workers and PLWA who have openly disclosed their HIV status will be
trained to advocate for ART adherence at health facility and community level. Equipped with the necessary
skills and relevant IEC materials they will educate with the patients attending ART clinics to enhance
adherence to the ARTs. The above activity will also target the private sector approach through the Gold
Star Network initiative working with private practitioners, private hospitals and nursing homes and workplace
clinics; the scope has been increases to also include not only medical doctors but also clinical officers and
Nurses. Additional 50 providers in the private sector will be recruited in Rift Valley through the GSN, and 50
private providers will be trained to offer Comprehensive HIV care and treatment. The providers within the
network will be linked with the public sector through the GSN support centers to access laboratory facilities
and PEPFAR drugs for patients who can not afford to purchase the ARTs.
Other activities will involve strengthening referrals from all entry points of HIV care and support to the
centers offering ART, which will optimize access to treatment. Also strengthened human resource capacity
to deliver ARV treatment at all levels of care will further improve service delivery.
These APHIA II Rift Valley 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 Rift valley
province. As a result of these activities, 3,000 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 total number of
individuals who ever received ARVs by the end of reporting period will be 16,800.
These APHIA II Rift valley 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.
6. EMPHASIS AREAS
Continuing Activity: 14804
14804 8797.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $2,400,000
8797 8797.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $2,200,000
Estimated amount of funding that is planned for Human Capacity Development $200,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS:
program for health workers ($10,000)
These activities will be tightly linked to the FY 2008 activities and to other APHIA II Rift Valley 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.
This activity will provide an integrated and comprehensive home and basic health care package to 2,500
children with HIV/AIDS that will be linked to 145 comprehensive care centers and a network of Rural Health
Facilities (RHFs). Through a cascaded training of trainers approach, primary care facility health workers will
be trained to provide comprehensive and integrated care training to the home /community based care
workers. In turn these home / community workers will train the primary care givers of the children, which will
complement the facility based services. At the health facility clinic, integrated training will be offered to
identified staff to offer services for the prevention, identification and management of OIs, monitoring of the
infected children and their caregivers, coupled with appropriate counseling and education. All babies and
children of HIV infected mothers will be followed up at the CCCs or MCHs and appropriately managed. A
case manager will manage referrals to and from the community. The community based component will
include treatment literacy, basic management of OIs, antiretroviral treatment (ART) and TB treatment
adherence, adequate nutrition, home hygiene and nursing skills , malaria prevention and treatment to
Community Health workers and caregivers. Through home testing, OVC identified as being infected will
registered at the CCC for entry to care and support through a referral system between the OVC program
and the CCCs. The main link to and from the health facility will be the CHWs many of whom will be
treatment supporters. Formal linkages between health facilities and the community-based activities will
continue to be strengthened to enhance effective care, follow-up, and tracking of referrals of pediatric
clients. APHIA will continue to equip the community health workers in pediatric psycho social support skills
to provide adequate support to children and the caregivers. This activity will also lead to the continued
strengthening of organizational and institutional capacity of 25 APHIA Rift supported districts and relevant
DHMTs institutions to integrate, plan, lead, monitor and evaluate home and community care support
programs for children. A total of 783 families with pediatric clients on care and support will be provided with
nutritional support. To ensure continued support for this effort at the community level, FBOs, CBOs, PLHA
groups, women and youth groups will be trained in basic program and financial management skills as part
of capacity building. Paralegal and child counselor training will be strengthened and through active
monitoring and follow-up to assess its impact to the children on care and support. The provision of safe
water supply in the homestead will be supported to reach clients households. In addition, these families
will be linked to a supply of insecticides treated bed nets targeting especially those with pregnant women
and children under five years.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREAS
These APHIA II Rift Valley activities will expand established pediatric care and support sites within the HIV
programs to include new areas in Rift Valley province. As a result of these activities, 2,500 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 Rift Valley 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:
program for health workers ($20,000)
This activity relates to activities in Counselling and Testing, Paediatric Care and Support, Adult care and
Treatment, TB/HIV, and PMTCT.
This activity will be carried out in APHIA II Rift Valley (across the entire South Rift Valley and parts of North
Rift Valley), which means consolidating established programs and expanding the activities to include new
areas. As a result of these activities, 923 new Children with HIV will be initiated on antiretroviral therapy
and 1,420 are expected to be on treatment at the end of the period, which brings the total ever treated to
1,704. These services will be provided at 145 Health facilities. A total of 245 health care workers will be
trained in the rational use or provision of Pediatric antiretroviral therapy (ART). Other support activities will
include infrastructure improvements for laboratories and service delivery areas, supply of equipments and
commodities such as laboratory reagents and pharmaceuticals, production and dissemination of
informational materials such as pamphlets addressing adherence to antiretroviral, and institutionalization of
QA/QI and supervision systems. In addition to supporting outpatient provision of Pediatric ARVs, specific
activities will increase the opportunities to detect eligible patients for ART in the in-patient wards; TB clinics,
MCH/FP services and other community support services (i.e. OVC and Home based care program client
families). High volume MCH clinics will be given adequate capacity to deliver Pediatric ARTs and hence
minimize time spend in the facility by mothers and also reduce stigma among the mothers. The laboratory
networks for CD4 count tests will be strengthened and improved to ensure that all infected Children are
screened to assess eligibility for ART. In MCH settings exposed babies and those whose mothers HIV
status is not established, blood samples for DBS will be collected for early infant diagnosis. This DBS
networks will be strengthened to include all facilities offering PMTCT services in the supported areas.
Health care workers from these sites will be orientated on the standard operating procedures for effective
collection of samples and timely retrieval of results. All services will be tightly linked across the spectrum of
care with other services and community support in conjunction with overall systems strengthening.
Facilities, in terms of Pediatric ART initiation with poor performance with high potential and lower level
facilities (Rural health facilities) in terms of initiating children on ART, the providers will be mentored by a
selected team of experienced service providers from the district level through a theoretical and on-job
practicum training sessions to ensure sufficient confidence is build by the provider to be able to effectively
assess and initiate eligible children on treatment and effectively monitor the patient on treatment there after.
Health care workers and PLWA who have openly disclosed their HIV status will be trained to advocate for
ART adherence at health facility and community level. In addition, 100 health care workers and 60 PLWA
will be trained on pediatric psychosocial support to be able to effectively offer the needed services. Relevant
pediatric IEC materials they will distributed to educate patients parents and guardians attending ART clinics
to enhance adherence to the ARTs. The above activities will also target the private sector approach through
the Gold Star Network initiative working with private practitioners, private hospitals and nursing homes and
workplace clinics. An additional 50 providers in the private sector will be recruited in Rift Valley through the
GSN, and 50 private providers will be trained to offer Comprehensive Pediatric HIV care and treatment.
The providers within the network will be linked with the public sector through the GSN support centers to
access laboratory facilities and PEPFAR drugs for patients who can not afford to purchase the ARTs. Other
activities will involve strengthening referrals from all entry point of care and human resource capacity to
deliver Pediatric ARV treatment at all levels of care.
These APHIA II Rift Valley activities will expand established pediatric ART programs to include new areas in
Rift Valley province. As a result of these activities, 923 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 Rift Valley activities will be tightly linked to the FY 2009 activities and across the spectrum
of care with other services supported by APHIA II Rift Valley 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 Rift Valley activities target people affected by HIV/AIDS, Orphans and vulnerable children,
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.11:
program that targets health workers ($40,000).
The activity will link to APHIA Rift Valley other activities in CT, Palliative Care: Basic Health Care and
Support , ARV services , Condoms and Other Prevention , Orphans and Vulnerable Children , Prevention of
Mother to Child Transmission and Abstinence and Be Faithful.
The APHIA Rift Project has been working with Ministry of Health in area of HIV/TB collaboration which
includes screening and training in HIV/TB co-infection, HMIS and support supervision. In the nomadic
pastoralist population of Samburu district, APHIA will continue to fund SADIA Project to carry out TB case
detection, referral, and treatment and follow up. The Project will continue to support community based
DOTS through the community health workers (CHWs). This activity seeks to provide 1,000 HIV infected
clients attending HIV care/treatment services treatment for TB disease and increase the number of service
outlets providing clinical prophylaxis and/or treatment for TB for HIV infected individuals to 28. A total of
2,000 registered patients with TB will also receive counseling and testing for HIV.
Intensified TB screening for HIV patients and HIV screening for TB suspects/patients will be offered as a
standard of care in all the facilities. The activity will support training of HIV and TB care staffs on routine
diagnostic testing and counseling of TB suspects and cases using the NLTP/NASCOP curriculum, screen
HIV cases for TB, upgrade laboratories with additional equipment, and renovate laboratory space, as
necessary. CTX prophylaxis will continue being 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. The capacity of select HIV/AIDS CBOs and local
NGOs will be increased to integrate TB into their on-going HIV/AIDS activities. Low literacy materials on
TB/HIV will be reproduced and supplied. The private providers will be trained and linked to either the public
HIV/AIDS and TB programs or the Gold Star Network whose target is paying clients in the private sector.
This APHIA II RV TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 1,000 HIV
patients, HIV counseling and testing to 2,000 TB patients and train 65 health workers in TB/HIV related
activities in 28 health care facilities in Rift Valley Province.
Support , ARV services , Condoms and Other Prevention, Orphans and Vulnerable Children , Prevention of
Mother to Child Transmission and Abstinence and Be Faithful that all seek to provide comprehensive district
based services coordinated at the provincial level.
This activity targets People Living with HIV/AIDS, HIV/AIDS affected families and individuals diagnosed with
TB.
Family Planning and Safe Motherhood needs of adults. This activity has a major emphasis on
networks/linkages/referral systems and minor emphases in supportive supervision, development of referral
systems, IEC, and linkages with other sectors and initiatives.
Continuing Activity: 14801
14801 9065.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $450,000
9065 9065.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $250,000
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.12:
+ Prime partner Family Health International has been competitively selected to implement the activity.
+ 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 81,000 with testing and
counseling. Of those tested, approximately 6,480 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 supports 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 $186,000 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 $310,000. A further $62,000 will be
attributed to provision of safe water guards for households looking after OVC.
This activity relates to Abstinence and Be Faithful (#9070), Counseling and Testing (#8776), Palliative Care:
basic health care (#9065), PMTCT (#8733),TB/HIV (#9065), Other Prevention (#9040), and ARV (#8797).
Orphans and Vulnerable children remain a key challenge in the provision of care and support and Rift
Valley Province faces huge challenges in this area as it is estimated to have the second highest number of
OVC in Kenya after Nyanza Province. There are already existing programs responding to the needs of OVC
but these are in most cases providing a scattered and uncoordinated response. A corresponded response
will be achieved by provision of a comprehensive package of support by APHIA Rift Valley directly but also
work to coordinate partners to ensure that a comprehensive package of support to OVC is provided by all
partners. Through the technical leadership of World Vision and Social Impact the capacity of NGOs, CBOs,
FBOs will be strengthened through training of trainers so as to enable them train caregivers to provide a
high quality comprehensive care to OVC. Recognizing the role that they play in the response to taking care
of their own, key community stakeholders who include civic leaders, parents, caregivers, community
leaders, religious leaders and community groups will be engaged through capacity development activities to
survey vulnerable children and their needs, assess existing community resources and gaps, establish a
coordination and referral mechanism, plan and monitor a joint response to the OVC. CLUSA (Cooperative
League of the USA), one of the APHIA Rift Valley technical partners will provide support in mobilizing the
community to lead the response to OVC.
This activity therefore seeks to provide comprehensive support to 90,000 orphans and vulnerable children
and their households directly and through leveraged resources from other partners in the region and also
train 8,100 caregivers. This will contribute significantly to the overall 2009 emergency plan targets for
Kenya.
This activity links to APHIA Rift Valley other activities in Abstinence and Be Faithful (#9070), Counseling
and Testing (#8776), Palliative Care: basic health care (#9065), PMTCT (#8733), TB/HIV (#9065), Other
Prevention (#9040), and ARV (#8797) that are intended to enhance service delivery and linkages between
the community and service delivery sites as well as strengthening the referral network for care.
This activity targets people affected by HIV/AIDS and specifically orphans and vulnerable children and also
caregivers of OVC. In addition this activity will target the community including community leaders and
religious leaders as well as community based and faith based organizations in the capacity development of
the community to serve the needs of the OVC.
This activity will address mainly issues in gender, particularly for the girl child, as they relate to issues of
child labor, increasing women and girls access to income and productive resources and addressing the
issues of inheritance rights and protection of property rights for children and women. Wrap- around issues
as they relate to food and education will also be addressed.
The major emphasis area will be in community mobilization/participation with minor emphasis in the area of
local organization capacity development.
Continuing Activity: 14802
14802 9029.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $4,700,000
9029 9029.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $3,200,000
Estimated amount of funding that is planned for Economic Strengthening $186,000
Estimated amount of funding that is planned for Education $310,000
Estimated amount of funding that is planned for Water $62,000
Table 3.3.13:
+ Geographic coverage has been revised and expanded to include additional districts in the Rift Valley
Province
+ Target population will be expanded to include testing for OVC
+ APHIA II Rift Valley 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 like moonlight VCT as well as institutionalizing testing and
counseling in health care settings. PITC services will be scaled up.
+ HBCT services will be provided in Nakuru.
+ 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 Rift Valley
+ target population will be expanded to include OVC
include door to door VCT and testing of family members of the infected individuals receiving care and
treatment within the facility.
This activity relates to activities in HIV/AIDS treatment services, abstinence and be faithful, OVC, HBHC,
TB/HIV care activities, other prevention, PMCT and strategic information.
In 2009, this activity will reach 200,000 individuals with CT services provided through 100 sites and will train
400 providers in VCT, PITC, and home based testing. This activity will provide counseling and testing
services to people through the broadened entry points which include clinical care settings through the
provider initiated testing (PIT) and the traditional VCT sites, both integrated and free standing. Whereas
previous efforts concentrated on diagnostic testing mainly of patients who had signs and symptoms of HIV
disease and clinical indications of AIDS, APHIA will strengthen universal testing for all in and outpatient
clients in various service areas. The project will continue to support dispensaries to provide CT services.
Home-based/family CT will also be initiated in most of the 25 APHIA supported districts starting with the
families of index patients who are enrolled in home based care and OVC programs. This will require
continuous orientation and training session staff and community counselors who will work closely with
mobile/outreach teams. Building on NOPE's work with workplace HIV/AIDS programs, APHIA will continue
to integrate CT in workplace programs and actively link those that are infected to care and treatment either
through the public program or the Gold Star Network. The increased service provision will require that at
least 137 service providers are trained in PITC especially at lower levels of health care provision. The
training will encompass aspects of care and treatment and the need for systematic referral. The training will
infuse elements of prevention for positives and discordant couples to enable counselors address prevention
for PLWHAs. Using the FHI model for SBC, community mobilization campaigns for universal counseling
and testing will be conducted.
This APHIA II Rift Valley 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 2009 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 Rift Valley Counseling and Testing activities will relate to HIV/AIDS treatment services,
Abstinence and Be Faithful Program Abstinence and Be Faithful Program, OVC, HBHC, TB/HIV care
activities, OP, PMCTC and strategic information. 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
affected by HIV/AIDS (Children born of HIV infected mothers, Spouses of HIV infected persons, Family
members of an HIV infected person, OVC), 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. This activity will also target most at risk populations like commercial
sex workers, discordant couples, street youth, truck drivers, migrant workers, out-of-school youth and
partners of CSWs.
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 has a major emphasis in the promoting universal testing within health facilities and
strengthening the referral systems while not losing sight of quality assurance and supportive supervision for
Activity Narrative: CT counselors.
Continuing Activity: 14803
14803 8776.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $1,200,000
8776 8776.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $650,000
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, structured supportive supervision using M&E focused supervisory checklists, data use and hiring
of data clerks to reduce increased data management burden on health care workers in the province.
+ Roll out of ART electronic system to lower level facilities while supporting the existing systems in district
facilities. Quality assurance activities including exit interviews shall also be conducted and results
disseminated for program improvement,
+ 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
The only change to the program since approval in 2007 COP are:
+ plans to conduct group workshops centred on data use, one on one feedback sessions during supportive
supervision rounds focussing on data use to improve program and patient management, plans to improve
quality of data through increased frequency of data quality audit rounds will be increased and data
management capacity improved through workshops, on-job-trainings and through support supervision,
planned rapid assessment, mapping and zoning for the new districts as well as conducting Behavioural
Monitoring Survey for the new districts of north Rift valley. Computer needs assessment will be conducted
and subsequently, 12 computers will be procured and distributed for data management in selected sites.
This activity also includes the 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 the strategic information activities to be carried out by University of North
Carolina/MEASURE Evaluation (#7098), NASCOP (#7002), and TE/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 Rift Valley/FHI 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 Rift Valley/FHI 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 Rift Valley/FHI 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 Rift Valley/FHI
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
200 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 Rift Valley/FHI 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 Rift Valley 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
five local organizations/health facilities in strategic information in addition to supporting the training of 75 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 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 workers and other health care workers like M&E and HMIS officers for
Activity Narrative: 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 program management.
The major emphasis area is Health Management Information Systems (HMIS) and minor areas include
monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.
Continuing Activity: 14805
14805 8895.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $400,000
8895 8895.07 U.S. Agency for Family Health 4916 4916.07 APHIA II - Rift $90,000
Estimated amount of funding that is planned for Human Capacity Development $340,000
Table 3.3.17:
1. ACTIVITY DESCRIPTION
In 2009 APHIA II Rift Valley 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 Rift
Valley will continue to support provincial and district health systems strengthening by convening
consultative meetings and various stakeholders' forums.
In addition, APHIA Rift Valley 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.
3. LINKS TO OTHER ACTIVITIES
This activity will link to other APHIA II Rift Valley activities, particularly in AB and OP.
4. POPULATIONS BEING TARGETED
This activity will target all population of Rift Valley 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: 16337
16337 16337.08 U.S. Agency for Family Health 6947 4916.08 APHIA II - Rift $100,000
Table 3.3.18:
