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 $187,500. Partnership Framework: 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 and 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
The only change in the narrative is in references to emphasis areas, and provision of mother (mama) packs
to pregnant women to encourage hospital deliveries (because Western province has one of the lowest
hospital delivery rates in the country).
1. LIST OF RELATED ACTIVITIES
This activity links to ARV services, palliative care TB/HIV, Counseling and testing services, Abstinence and
Be Faithful and Condoms and other prevention activities.
2. ACTIVITY DESCRIPTION
This activity will continue the expansion of PMTCT services in public sector and faith-based health facilities
in Western Provinces building on the support previously provided through USAID's AMKENI
EngenderHealth, Family Health International IMPACT, the Catholic Medical Mission Board and Elizabeth
Glaser Pediatric AIDS Foundation Call to Action Projects in the region. In 300 facilities across the all the
districts, counseling and testing will be provided to 158,538 (93%) of 169,726 pregnant women and
antiretroviral prophylaxis to 7616 (93%) of 8153 HIV-positive women in geographic area of coverage. Of the
positive women, 3808 will receive AZT/NVP, 1523 HAART and 2285 single dose nevirapine only for
prophylaxis. 3808 infants will be targeted with PCR for early infant diagnosis while 31,708 spouses of
pregnant women will be reached with counseling and testing services. Service delivery will continue to
incorporate best practices including the opt-out approach for testing, rapid testing and appropriate referrals
for care, treatment and support. Priority will be given to the provision of integrated services, including family
planning, reproductive health, maternal and child health and the management of opportunistic infections.
"Mama packs" will be provided to pregnant women to encourage hospital deliveries. Effective referral
linkages will be established to support postnatal follow up of HIV+ mothers and exposed infants including
early infant diagnosis and ART. Significant changes from 2008 will include emphasis on universal
counseling and testing of antenatal clients; the use of more efficacious regimens for ARV prophylaxis,
decentralization of care and treatment services through capacity building and task shifting, quality
improvement through scaling up standards based management and recognition and the establishment of
referral linkages for the provision of HIV treatment, care and support for HIV infected mothers and
immediate members of the child's family. As mentioned above emphasis will also be put on early infant
diagnosis, ART for infected mothers, babies and their families, male involvement and greater involvement of
people living with HIV/AIDS as care givers and lay counselors. These program refinements will improve the
geographic coverage for services within the districts and strengthen the service delivery networks.
Emergency Plan funds will be used to increase the supported sites to at least 300 and train 300 service
providers in PMTCT and in HIV stigma reduction. This activity will use the Ministry of Health's WHO/CDC-
based curriculum, comply with Ministry's clinical and reporting guidelines, and participate in the MOH's
Technical Working Group and GOK led PMTCT regional meetings to ensure coordination of activities
between the public and private sectors. Support to infrastructure development, procurement of medical
equipment and improved data collation will enhance service provision. Facilitative supervision by the District
Health Management Teams (DHMT), standards based management and recognition and innovative
deployment of health workers will improve service quality. Behavior change communication (BCC) activities
amongst rural community members will focus on stigma reduction, psychosocial support, promotion of
antenatal care services, facility based deliveries and PMTCT services. Operations research to determine
and test appropriate interventions for HIV stigma reduction among community members will be conducted.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
PMTCT in this geographical area will significantly support PEPFAR goals for primary prevention and care
by contributing 12.2% of 2009 overall Emergency Plan PMTCT targets for Kenya. Increase in number of
sites contributes to the program's efforts to achieve district wide coverage for services. Support to high
volume health centers and district hospitals will significantly strengthen networks for PMTCT and PMTCT
plus services. Access to services and linkages to sites where medical treatment and care are provided will
encourage rural women in underserved communities to attend ante natal care services. Subsequently
health workers will be able to plan for post natal follow up of HIV positive women, infants and their family
members. This APHIA II Western activity also contributes substantively to Kenya's 5-year strategy of
encouraging pregnant women to know their status, availing services which can reduce mother-to-child
infections and providing critical links to HIV/AIDS treatment as a step towards preserving the family unit. It
also contributes to the strategy to integrate testing with other health services and improving the referral links
among all of these services.
4. LINKS TO OTHER ACTIVITIES
These activities will link to APHIA II Western CT activities, other prevention, BHCS activities and ARV
services. PMTCT services include counseling and testing which is largely diagnostic, provision of ARV
prophylaxis, and appropriate referrals for the management of opportunistic infections and HIV/AIDS
treatment. This activity will also conduct operations research on stigma reduction.
Activity Narrative: 5. POPULATIONS BEING TARGETED
This APHIA II Western activity targets adults of reproductive health age, pregnant women, family planning
clients, infants, and HIV positive pregnant women. BCC activities will involve community leaders and
community based organizations to increase demand for services amongst community members. Strategies
to improve quality of services will target private and public health doctors, nurses, midwives and other
health care workers such as clinical officers and public health officers in both public and faith based
facilities.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This APHIA II Western activity will increase gender equity in programming through partnering with women's
groups in the design of community mobilization approaches. The behavior change communication (BCC)
activities will promote a family approach to PMTCT to address male norms, encourage male participation
and help reduce stigma and discrimination. Increased availability of services with appropriate referrals for
PMTCT plus will also reduce stigma.
7. EMPHASIS AREAS
This APHIA II Western activity includes emphasis on human capacity development through training, quality
assurance and supportive supervision within MOH and private facilities to manage and supervise programs.
Support to strategic information will be provided as well as linkages created to family planning, safe
motherhood, malaria and TB programs.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14992
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14992 8738.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $2,300,000
International Appropriate Western
Development Technology in
Health
8738 8738.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $1,200,000
Emphasis Areas
Construction/Renovation
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 $134,100
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 $200,000 for HIV Free Generation activities targeting youth
+ In response to a request from the Ministry of Education, the KARHP methodology will be strengthened
targeting teachers and in-school youth
The only changes to the program since approval in the 2007 COP are:
•Prime partner PATH has been competitively selected to implement the activity
•$200,000 of this activity supports the healthy youth initiative and is programmed with funds from the $7
million FY 08 plus up
•Geographic coverage has been expanded to include all 14 districts
•The KARHP methodology will be rolled out in collaboration with the Ministry of Education, Ministry of
Health and Ministry of Gender, Sports, Culture and Social Services
•Peer education activities will be rolled out with the Kenya Girl Guides Association
•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
•Most-at-risk populations in Malaba and Busia along the Mombasa-Kampala transport corridor will be
targeted with prevention activities using a "cluster" approach
This activity relates to activities in Condoms and Other Prevention (#8927), HIV/AIDS Treatment: ARV
Services (#8826), and Counseling and Testing (#8777).
In 2009, this activity will reach 363,461 youth and adults with AB messages. 2,524 individuals will be
trained. In addition, $200,000 of this activity supports the healthy youth initiative. APHIA II Western uses
both traditional and public channels to reach out to the in-school and out-of-school youth on AB. These
include music, drama, one-to-one counseling and peer education. APHIA will continue to strengthen
KARHP activities in 800 existing schools with one teacher each that has been trained and will train an
additional 400 teachers in 400 new schools in 2009 (100 secondary and 300 primary), making a total of
1200 teachers trained. (This training will also include a review and dissemination of the Education Sector
Policy for HIV/AIDS.) Each of the teachers trained from these schools will recruit and train 20 student peer
educators. APHIA has taken the project to scale by facilitating formation of provincial youth committees
under the auspices of the provincial Director of Education with technical support of the provincial public
health officer and provincial director of youth affairs for the coordination of youth in-school and out-of-school
activities. This committee meets every quarter for review of activities and progress-monitoring. APHIA II
Western has developed a register of schools which indicates the presence or absence of Straight Talk,
Scouts and Girl Guide Clubs or other health clubs as a way of determining existing structures through which
AB messages may be disseminated to youth in schools. APHIA will also begin to work with the Kenya Girl
Guides program and determine how to best integrate these groups into ongoing APHIA activities such as
the teacher/youth program above. Peer education encourages involvement of the youth in school around
health risk behavior by building and linking with existing structures and encouraging positive adult attitudes
and behavior among the teachers and parents.
3. CONTRIBUTIONS TO OVERALL PROGRAM
AREA AB in this geographical area will contribute substantively to the Kenya Five-Year Strategy for primary
prevention which puts youth first to protect them from infection. The child-to-child program provides
significant support for appropriate messages to pre-adolescents and their families.
This activity carries forward previously approved activities in Western province, including counseling and
testing (#8777), OP (#8927) and ART (#8826). Community media messages will encourage safer behavior
and promote CT.
5. POPULATIONS BEING TARGETED
This activity targets girls, boys, adolescents (in and out of school), adults, and teachers.
6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address male norms and behaviors, reducing
violence and coercion through peer family programs aimed at changing social norms.
7. EMPHASIS AREAS This activity primarily emphasizes community mobilization/participation through peer
education by youth advocates with a minor emphasis on training of youth, parents and community leaders
as detailed in the activity description in Section 1 above. Local civil society organizations will be
strengthened to carry out these activities, and information, education and communication materials will be
disseminated as appropriate and needed.
Continuing Activity: 14993
14993 8994.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $2,100,000
8994 8994.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $625,000
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.
+ This activity will target police, uniformed services, women, opinion leaders, and others on issues of
gender-based violence.
•Geographic coverage has been revised to all 14 districts in Western Province.
•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 Western will work with select health facilities, police, uniformed services, opinion leaders and
others on issues of gender-based violence.
•APHIA II Western will also expand their activities with CSWs and MSMs in Western.
This activity relates to all other program area activities for APHIA II Western-PATH: Abstinence and Be
Faithful Programs (#8994), Counseling and Testing (#8777), HIV/AIDS Treatment: ARV Services (#8826),
Orphans and Vulnerable Children (#9073), Palliative Care: TB/HIV (#9068), and especially in the areas of
Palliative Care: Basic Health Care and Support (#8931) and Prevention of Mother-to-Child Transmission
(#8738).
In 2009, APHIA II Western will reach 570,657 individuals with OP messages, train 4,455 people and
distribute condoms through 508 condom outlets. Over the past years APHIA II Western has worked in
partnership with the community in promoting behavior change beyond abstinence and being faithful as well
as demand for HIV/AIDS, RH, TB, MCH, malaria services and gender through multi-prong approaches. In
the COP 09 APHIA II Western will continue to promote dialogue and interaction at the community level,
including ABC. The approach employs the use of Community Health Workers (CHWs) from the district to
the village level. Each CHW conducts a serious of dialogue groups in their community. In COP 09 the
number of village CHWs will increase to 4520. The sub-locational Community Health Workers with the
responsibility of monitoring the Village CHWs will be 188 in number and each will have a maximum of 10
villages linked to them. The project will strengthen and/or form 1760 VHC in COP 09 from the initial 1380
VHC in the previous years. CHWs will make more than 1.5 million contacts with the dialogue groups. In
addition, the health facilities and the CORPS are significant outlets for condom distribution and promotion
and it is the responsibility for the Public Health Office and the sub-locational CORP to ensure that the
condoms are available in the community and during outreaches. The CHWs are recruited within proximity of
the imperative sites to create a referral network between the community and health facilities within the sub-
locations. The CHWs also play an important role in conducting auxillary activities via community linkages
with health facilities and worksites. Family communication will continue to be enhanced through 250 family
discussion groups who will promote HIV/AIDS prevention by utilizing other behavior change beyond
abstinence and being faithful. These peer family facilitators will reach out to a father, mother and 2
adolescent children in each family. In tandem with the faith based organizations 800 older married women
mentors will continue to conduct dialogue groups with young married adolescent women to provide
education on HIV/AIDS, reproductive health, family planning and couple counseling and testing. The
capacity of women groups will also be strengthened through support of their livelihood with the aim of
reducing gender biases and retrogressive cultural norms to enhance their capacity to negotiate for safer
sex. APHIA has expanded its prevention activities to reach out to high risk populations such as low-income
community women; commercial sex workers, beach communities and transport workers. Men will continue
to be targeted through the formal and informal worksite programs. By COP 09, approximately 10 worksites
will be identified with 400 worksite peer educators trained to conduct dialogue groups with employees. In
COP 09, this program will expand to include 5 more companies and 200 more worksite motivators. APHIA
will attempt to target teachers via the worksite program either via teachers unions or learning institutions.
Worksites programs will be complemented with materials for worksites on ABC. Further, 192 youth magnet
theatre members from 24 theatre troupes will be trained or re-trained in ABC to reach out-of-school youth.
The project will continue to facilitate the integration of HIV/AIDS and RH messages in the music festivals
that has reached an estimated number of 120,000 young people in primary and secondary schools. APHIA
will also establish a gender-based violence program in COP 09. This may include the following type of
activities: training of police and local leaders to sensitize and create an improved environment form women
to report GBV or rape; making PEP available at health centers; establishing rape hotlines and ensuring
psychosocial counseling services are made available. All community work will be complemented by a
series of health newsletters and community radio and used as a mechanism of magnifying behavior change
and sharing information. In addition, the continued community work will be supported by a BCC Advisory
Committee that meets regularly, as well as change teams throughout the region who help guide and solicit
improvements in programs, as well as recognize and utilize success stories.
This APHIA Western TBD activity will contribute substantially to the 2007 Emergency Plan risk reduction
strategy. This activity also provides significant support to Kenya's 5-year strategy, KNASP 2006-2010,
which focuses on primary prevention and calls for attention to the increased vulnerability of women.
Through increased access to integrated services with linkages to HIV services, women and other
community members will be encouraged to utilize these services. This activity also provides significant
support to Kenya Essential Package for Health (KEPH) and National Health Sector Strategic Plan 2005-
2010 (NHSSP).
This activity carries forward previously approved 2007 COP activities of APHIA II Western - TBD. The OP
Activity Narrative: activities link to other all other program area activities for APHIA II Western PATH, including AB (#8994), CT
(#8777), ARV Services (#8826), OVC (#9073), TB/HIV (#9068), and especially in the areas of HBHC
(#8931) and PMTCT (#8738). STI prevention and treatment services form an integral part of PMTCT and
palliative care.
This activity targets adults, family planning clients, pregnant women, people living with HIV/AIDS,
community leaders, doctors and nurses in both public and private sector, other health care providers
namely clinical officers and community-based organizations. It also targets men and women in the work
place, male and female sex workers and their partners and clients, and other high-risk populations including
truck drivers and out-of-school youth.
The behavior change communication activities for STI and HIV prevention will promote gender equity
through partnering with women's organizations in the design and implementation of community activities.
The activity will address male norms and behavior including multiple sexual partners through community
interventions. It will also address issues of stigma and discrimination.
The actual emphasis of this APHIA II Western activity will be elaborated during the CA award but will
include community mobilization/participation, training, development of networks and referral systems, and
local organization capacity development. Programs will target 20,000 adults with alternatives to sex work as
well as protective barriers to HIV transmission, both with commercial partners and steady boyfriends and
husbands. They will train 50 peer educators to work with this target population. This activity will provide
support in HIV prevention and supportive services where the incidence of victims of gender-based violence
is reportedly high. Through awareness creation, targeted support services integrated with care and support
programs, anti-rape campaigns and education and training for the police in Western province, they will train
50 police, community leaders and women's groups to reach 120,000 people including youth. Further
activities targeting high-risk youth will be carried out with $100,000. Building on the KAHRP project which
targeted in-school youth, they will utilize a cross-sectoral approach, collaborating with the Ministries of
Youth Affairs, of Home Affairs and of Gender, Sports and Culture. They will target sexually active out-of-
school youth in particular, utilizing community theatre and other interventions. They will train another 100
peer educators and community leaders to reach 120,000 high-risk youth.
Continuing Activity: 14994
14994 8927.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $1,100,000
8927 8927.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $1,120,000
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).
1. ACTIVITY DESCRIPTION
This activity will provide integrated and comprehensive home and basic health care to 19,000 people with
HIV/AIDS linked to 51 comprehensive care centers. Through a training of trainers, primary care facility
health workers will be trained to provide comprehensive and integrated care training to home /community
based care workers. They in turn will train the primary care givers at home, which will to complement the
facility based services.
In the FY 2009 COP APHIA II Western will continue and expand care and support to PLWHA activities will
include 1) providing PLWHA and their families with a comprehensive package of home-based and
community support 2) increase the capacity of public and private health facilities to provide quality services
for the management of opportunistic infections 3) upgrade laboratories in several districts to improve
treatment for opportunistic infections and referrals to comprehensive care centres 4) provide psychosocial
support through facility and community based support groups for PLWHA 5) provide livelihood support skills
to PLWHA and their households through establishment of backyard kitchen gardening and dairy farming 6)
Reduce stigma and encourage positive living through Ambassador of hope and channel of hope models
targeting PLWHA and religious congregations respectively, 7) business skills training for PLWHA and their
households through linkages with community based micro finance institutions (MFI) as well as production
and marketing organizations, and 8) provide organizational capacity building and sub grant to 27 CBO/FBO
to be able to implement community based care and support to the PLWHA. EGPAF will ensure that at the
facility level, cotrimoxazole and (where indicated- fluconazole) prophylaxis becomes part of basic standard
of care for HIV infected patients. EGPAF and JHPIEGO will also ensure that the procurement of OI drugs is
done at the central level as is the case with ARVs. The partner will also ensure that the basic care includes
activities that enhance prevention with positives, as well as active TB screening in all HIV infected patients.
More clients will be linked to ARV and ARV and DOTS adherence will be stepped up in FY 2009. It is
expected that 19,000 HIV positive individuals will be provided with standard basic care and 180 caregivers
trained.
2. CONTRIBUTIONS TO OVERALL PROGRAME AREAS
The APHIA II Western will reach 19,000 clients through the home based care program and 500 individuals
will be trained to provide palliative care at home. This APHIA II Western activity responds to NACC's priority
areas #2 "Improve the quality of life of people infected and affected by HIV/AIDS" and #3 "Mitigation of socio
-economic impact". It is expected that the APHIA II Western will adhere to GOK policies and guidelines and
participate in national-level HIV technical working groups.
3. LINKS TO OTHER ACTIVITIES
These APHIA II Western 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 Western 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: 14995
14995 8931.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $900,000
8931 8931.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $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 ($400,000).
These APHIA II Western activities will be tightly linked to the FY 2008 activities and across the continuum of
care with other services supported by APHIA II Western 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.
These COP 2009 activities will build on the 2008 COP activities and other past support in order to scale up
antiretroviral treatment (ART) services and improve the quality of service delivery in Western province. In
FY 2009 USAID'S APHIA II Western project in extending and optimizing quality of life for HIV infected
clients will continue to build the capacity of health care workers in Western province through: training of 60
health care workers on ART commodity management; 30 on the use of the ART dispensing tool; 60 health
care workers on adherence counseling and 120 on the Integrated Management of Adult/Adolescent Illness
(total trained will be 270). The NASCOP curricula will be used throughout and these trainings will be
supported with follow up supervision and mentorship in 51 treatment sites to reach 4,000 new ART patients
and 9,000 patients currently on treatment at the end of FY 2009.
The APHIA II Western project will continue to improve laboratory capacity and networking in all 19 districts
of the province. HIV treatment will continue to be integrated in the TB clinics to continue to strengthen the
integrated management of TB and HIV/AIDS in the 51 health facilities. APHIA II Western will continue to
support the implementation of Quality Improvement of HIV treatment including institutionalizing site-specific
work plans as part of the annual work plans. The project will enhance quality of care through improved case
management and Electronic Medical Records (EMR) to ensure patients needing second line ARVs are
identified early and transferred to appropriate treatment.
In FY 2009, The APHIA II Western project will also continue with improvements in infrastructure through
renovations to the existing 51 treatment sites to better enable them to provide quality and comprehensive
HIV care and treatment, and to enhance decentralization and downward referral of HIV patients in
accordance to the Ministry of Health/NASCOP strategy. APHIA II Western will capacity build and create
systems to strengthen facility-community linkages, by implementing best practices and lessons learnt from
the Zingatia Maisha project. COP 2009 will continue to support youth friendly services to ensure that HIV
treatment service provision in the health facilities are not intimidating and increase the uptake of HIV
treatment among youths.
The APHIA II Western project will continue to support and strengthen workplace ART sites and build the
capacity of faith-based and private service providers. This will involve offering ART site support,
procurement and distribution of laboratory, pharmaceutical and other commodities as per the needs for
these sites and build the capacity of health care workers to provide HIV treatment. Because the issue of
stigma and discrimination is still high among health workers in Kenya, the APHIA II western project, while
conducting clinical training, will also train health workers on stigma and discrimination using curricula
specifically produced for this purpose.
The Project will continue to offer technical support to the sites, continue salary support of those staff
supported in FY 2008 and will continue to support the DHMTs for both supervision and planning. As part of
the exit strategy, we will build on the successes of the stress management and team building initiatives
among the health workers, and will train more of the PHMT and DHMT members on the same, in order to
enhance leadership skills.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREAS
These APHIA II Western 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 Western
province. As a result of these activities, 4,000 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 number of
individuals who ever received ARVs by the end of reporting period will be 10,800.
These APHIA II Western 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.
Activity Narrative: programs that target both adults and children, as well as Health Related Wraparound Programs addressing
Continuing Activity: 14999
14999 8826.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $3,300,000
8826 8826.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $2,470,000
Estimated amount of funding that is planned for Human Capacity Development $400,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS: this activity supports key cross-cutting
attributions in human capacity development through its training program for health workers ($10,000)
These activities will be tightly linked to the FY 2008 activities and to other APHIA II Western 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 Western will build upon the gains in FY 2008 to improve access to pediatric HIV health services,
improve widespread use of opportunistic infection (OI) prophylaxis and improve community and political
commitment to the Pediatric HIV agenda. The project will enhance the quality of care for pediatric HIV
patients and will build on the gains from FY 2008 to strengthen the quality of HIV care and support at the
facility level for HIV exposed and infected children. This will be accomplished by sensitizing all facility staff
and implementing the "minimum package of pediatric HIV care and support" at 51 facilities. The Project will
train 60 health care workers in pediatric HIV care and 60 workers in pediatric psychosocial counseling (total
trained will be 120). APHIA II Western will aim to optimize the continuum of care for HIV exposed and
infected infants through provision of clinical, psychosocial, spiritual, and social and prevention services for
2,100 children. It will also support efforts towards routine testing of sick children in pediatric medical
settings, which is expected to rapidly identify large numbers of HIV positive children, who will be enrolled
into care and support. It will also support efforts towards family-based HIV testing approaches so that HIV
infected family members of enrolled HIV-infected patients may be identified and enrolled into care. In FY09,
APHIA II Western enhance the linkage of HIV-exposed children identified in the PMTCT and MCH clinics to
the HIV clinic by supporting the sites with the HIV exposed Child register. This will help ensure routine use
of the Mother - Child card that was rolled out in FY 2008. In addition training health care workers on early
infant diagnosis methods (EID, DNA for PCR) and early antibody testing using the on-the-job training
approach, supporting the commodities for the EID testing and ensuring the systems for specimen referral
are streamlined using approaches that are sustainable will also be used. This Project will institute strategies
to improve the management for pediatric patients on care by establishing pediatric-specific care clinics on
specific days to improve retention, ensure appropriate and timely treatment and hence provide quality of
care. It will sensitize the providers on the "Guidance on infant feeding within HIV settings", offer linkages to
nutritional support services and will enhance community participation in infant nutritional needs. Where
required, it will support the malnourished children with food supplements. It will also support and strengthen
the pediatric support groups, and encourage the use of Child peers to enhance acceptance of status,
disclosure and adherence to HIV care within the pediatric population. APHIA II Western will support and
strengthen prevention and treatment of OI including malaria and diarrheal diseases by training 120 health
care workers on HIV care and support (clinical and psychosocial), and sensitizing the health care workers
on the management of opportunistic infections. It will support the distribution of free cotrimoxazole to eligible
children and will scale up "prevention with positives" in young people. We will also support sites with Job
Aids to enhance correct protocol use in the management of OIs and national guidelines on prevention and
treatment of malaria. We will also support the sites with emergency stocks of drugs for both prevention and
treatment of OIs, including Septrin, fluconazole, antibiotics, anti-diarrheals and anti-protozoals. It will also
link with community awareness efforts within APHIA II Western to educate and support caregivers and to
inform them about available services and to reduce stigma.
These APHIA II Western activities will expand established pediatric care and support sites within the HIV
programs to include new areas in Western province. As a result of these activities, 2,100 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 Western 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:
attributions in human capacity development through its training program for health workers ($30,000) 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 Western will ensure that pediatric antiretroviral treatment (ART) services continue to be
strengthened in 40 of the Adult ART sites. The Project will train 60 health care workers in adherence
counseling and 60 in care pediatric ART. The Project will institutionalize task shifting / task sharing to
address the human capacity gaps .The Project will sensitize the staff and support the implementation of the
"minimum package for pediatric HIV treatment" at these sites to provide quality health care and appropriate
referrals. The Project will also 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. In addition, the Project will
pilot on-site training on Pediatric HIV treatment, using the "Module Staggered Approach" in order to limit
interruption of services during training. APHIA II Western will continue to improve and maintain
infrastructure and will continue to strengthen systems and logistics management for ARVs and other
essential supplies in order to support HIV treatment initiation for 100 new patients and achieve 1,000 HIV
infected children ever started on ARVs by the end of the period. This will bring the total ever treated to
1,200. The Project will continue to support child friendly centers. Following the gains from FY 2008 in
laboratory capacity building and systems strengthening for HIV diagnosis and other related pediatric tests,
The Project will continue to support the laboratory services to enable facilities to evaluate HIV infected
children for the initiation of ART, and to maintain those continuing on treatment. The program will support
the training of staff in commodity logistics, will strengthen the laboratory network in hard to reach areas, and
will institutionalize the use of ‘stabilized tubes' for sample collection for later processing for ART eligibility
evaluations. The Project will support the sites with resource materials for pediatric HIV treatment including
clinical manuals, pocket guides and job aids. The Project will continue to institutionalize the Quality
Improvement strategies and systems that will have been established in FY2008, including the use of the
Electronic Medical Records and the Cohort summary register. To improve and sustain HIV treatment
adherence in children APHIA II Western will continue to provide psychological and social support through
the already established Pediatric support groups with Child Peers, will offer nutritional assessments and
provision of food, and will link them to other community support structures. The APHIA II Western will
continue to offer technical support to the sites, to support the salaries of staff supported in FY 2008 and will
continue support to the DHMTs for both supervision and planning in pediatric HIV treatment. As part of the
exit strategy The Project will build the capacity within the Ministry of Health PHMT, DHMTs and health care
workers for leadership and ownership to take an active lead in the pediatric HIV treatment services.
These APHIA II Western activities will expand established pediatric ART programs to include new areas in
Western province. As a result of these activities, 100 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 Western activities will be tightly linked to the FY 2009 activities and across the spectrum of
care with other services supported by APHIA II Western 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 Western activities target people affected by HIV/AIDS, Orphans and vulnerable children,
Estimated amount of funding that is planned for Human Capacity Development $30,000
Table 3.3.11:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS:
program that targets health workers ($30,000).
palliative care services and generally improve the quality of the service delivery and ensure continued
provision of basic health care and support. This will include providing clinical prophylaxis and treatment for
TB to 500 HIV patients and HIV counseling and testing for 1,000 TB patients. In FY 2009 USAID'S APHIA II
Western project will continue to increase the capacity of public and private health facilities to provide quality
services for the management of opportunistic infections. The activities will include upgrading laboratories in
TB sites to improve the diagnosis, laboratory monitoring and treatment for opportunistic infections. The
linkages between facilities will continue to be enhanced with regard to laboratory networking.
APHIA II Western will provide additional staff as required, support intensified screening of HIV cases for TB,
support upgrading of laboratories with additional equipment, and renovation of laboratory space, as
necessary. CTX prophylaxis will be introduced for all HIV infected TB cases.
TB screening in all HIV positive patients will continue to be emphasized and HIV care and treatment for
TB/HIV co infected patients strengthened. In FY 2009, APHIA II Western will Intensify TB screening for HIV
patients and HIV screening for TB suspects/patients will be offered as a standard of care in all the facilities;
approximately 500 TB patients will be identified as being infected with both TB and HIV. In addition,
APHIA II Western COP 2009 activities will further support 241 TB diagnostic and treatment centers in the 19
districts. In FY 2009 activities will strengthen linkages between the TB clinics and the Comprehensive Care
Clinics
These APHIA II Western activities will increase the number of HIV positive individuals receiving TB care and
support and thereby help identify HIV positive individuals who are potential candidates for TB care as per
the national guidelines. This activity also provides significant support to Kenya's 5-year strategy, KNASP
2006-2010, Kenya Essential Package for Health (KEPH) and National Health Sector Strategic Plan 2005-
This APHIA II Western TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 500 HIV
patients, HIV counseling and testing to 1,000 TB patients and train 200 health workers in TB/HIV related
activities in 241 health care facilities in Western Province.
These APHIA II western activities will be tightly linked to the FY 2008 activities and carries forward 2008
COP approved activities. This activity is linked to the HIV/AIDS Treatment/ARV services, Abstinence and
Being faithfully, PMTCTand strategic information.
These APHIA II Western activities target people affected by TB, HIV/AIDS, Orphans and vulnerable
children. 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 main legislative issue is the reduction of disease burden of PLWHAs and TB patients by improving their
health and increasing the possibility of returning to work to contribute to their families' welfare.
Continuing Activity: 14996
14996 9068.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $300,000
9068 9068.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $300,000
Table 3.3.12:
+ Prime partner Program for Appropriate Technology in Health has been competitively selected to
implement the activity.
+Activity will be on the strengthening of the coordinating and supervisory role of the AAC for partners and
local community/faith based organizations (CBO/FBO) involved in support and care of OVC and extend
services to older OVC.
+SWAK will strengthen paralegal networks of trained Community Health Volunteers, provincial
administration, the judicial system, police, civil society, counselors, social services and spiritual leaders on
paralegal issues, referrals and role of each player (chain value) in the referral and action system.
+ World Vision will coordinate with EGPAF and JHPIEGO to expand the scope of CHW child monitors to
strengthen health referral systems linking the OVC to specialized pediatric services, including pediatrics
ART and 2-way clinic-community referrals.
+ 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 54,000 with testing and
counseling. Of those tested, approximately 4,320 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 also able to benefit from mosquito nets procured by PMI.
This activity will support key cross cutting attributions of the budget amounting to $135,000 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 $225,000. A further $45,000 will be
attributed to provision of safe water guards for households looking after OVC.
This activity relates to activities in counseling and testing (#8777), TB/HIV (#9068), PMTCT (#8738) and
Palliative Care: home based care (#8931).
The majority of Kenya's 1.7 million orphans, having lost one or more parents to AIDS, live in precarious
conditions. OVC are frequently left behind in terms of education, life skills, access to health services and
nutrition, and they are at greater risk of HIV infection and domestic violence. The FY 2007 COP activity
addressed OVC needs within the context of the six essential elements of OVC support. These essential
services were agreed upon by all stakeholders and include: nutrition, education, health, protection,
psychosocial support, basic material needs and livelihood capacity building. In order to ensure an agreed
upon level of quality for each of these services, all seven are being defined by the OVC ITT and OVC
PEPFAR stakeholders. The FY 2006 focus of AED/Speak for the Child Program was to train household
mentors through community based organizations to support OVC. AED has implemented global health
programs for more than 30 years and planned to work with existing local implementing partners in the new
districts to enroll new OVC and extend services to older OVC. In its scale up AED/Speak for the Child
program selected experienced community based organizations (CBOs) with extensive outreach to OVC.
CBOs were to recruit and train household mentors in the SFC program, establish school, health clinic, and
pharmacy agreements and procure commodities. Trained mentors visit households weekly to facilitate
household problem-solving with caregivers on issues of health, nutrition, and psychosocial care. In FY 2006
COP, the COPHIA activity applied approaches and activities to include: a Community Health Worker role in
monitoring health; training service providers in pediatric HIV/AIDS; strengthening linkages to specialized
pediatric services; 2-way clinic-community referrals; vocational training; provision of uniforms, books and
shoes; linking secondary students to bursaries; nutrition education; food production; income generating
activities; training teachers in child counseling; support to community based counselors, paralegals and
support groups; obtaining clothing and housing improvements; and involving the community for improved
linkages with relevant services. The FY 2006 COP focus for World Vision Kenya activity included training of
church leaders, traditional birth attendants, youth peer educators, community psychosocial counselors,
PMTCT service providers and community based organizations/faith based organizations (CBO/FBO) staff in
providing HBC, supporting voluntary counseling and testing (VCT) services, providing food aid and
treatment of infections for needy HIV-positive orphans and vulnerable children (OVC), life skills training for
older OVC, micro-enterprise development for foster families and assisting with the payment of OVC school
fees. This FY 2009 COP APHIA II Western activity will continue the expansion of support for orphans and
vulnerable children in Western Province, building on the support previously provided through USAID's
World Vision, COPHIA, and AED projects. The detailed activity will be enunciated through discussions with
the consortia that will be awarded the cooperative agreement.
The FY 2009 activities will reach 60,000 OVC and train 5,400 caregivers. The APHIA II Western will
respond to the National OVC Action Plan by mobilizing communities, building family and community
capacity to protect and care for OVC, and improving access to health, education, food and shelter. The
APHIA II Western will ensure that GOK policies and guidelines are utilized and communicated, and staff
participates in national level HIV Technical Working Groups.
Activity Narrative: 4. LINKS TO OTHER ACTIVITIES
OVC activities are an element of home and community support. Prevention is a cross-cutting theme. CHWs
link clients with PMTCT, ART and non-ART services and provide follow-up. This activity is linked to the
APHIA II for Palliative Care: home and community support (#8931), counseling and testing (#8777), TB/HIV
(#9068), and PMTCT (#8738).
Individuals infected and affected by HIV/AIDS, OVC - especially the girl child and caregivers. By focusing on
building the local capacity of caring for the OVC efforts will also target community and religious local leaders
as well as partnering with community and faith based organizations.
Increased gender equity in HIV/AIDS will be addressed by ensuring the girl child receives equitable OVC
services. Wrap around services in the area of food and education will also be addressed by building the
local capacity along other existing community institutions in serving the needs of the OVC.
The major emphasis area is in development of network/linkages.
The referral and minor emphasis is training and community mobilization as well as in local organization
capacity and development.
Continuing Activity: 14997
14997 9073.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $4,400,000
9073 9073.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $3,100,000
* Increasing women's access to income and productive resources
* Reducing violence and coercion
Estimated amount of funding that is planned for Economic Strengthening $135,000
Estimated amount of funding that is planned for Education $225,000
Estimated amount of funding that is planned for Water $45,000
Table 3.3.13:
+ Geographic coverage has been revised and expanded to include additional districts in the Western
Province
+ Target population will be expanded to include testing for OVC
+ APHIA II Western 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.
+ 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 Western
+ 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 is related to activities in HIV/AIDS treatment services, Abstinence and Be Faithful Program,
OVC, HBHC, HVTB care activities, OP, PMCT, and strategic information.
In 2009, through APHIA II Western, it is expected that 150,000 individuals will receive CT services in 50
sites and 300 providers trained. USG has previously supported HVCT activities in Western Kenya through
USAID projects. In 2006 COP, USAID's APHIA II TBD activity was funded to build on activities approved in
2005 and implemented through World Vision. The activity aimed at increasing access to VCT services,
particularly among underserved and hard-to-reach populations in a few districts in Western Kenya by
forging partnership with community-based organizations (CBOs) and faith-based organizations (FBOs) to
mobilize communities for VCT and make appropriate referrals to MOH-supported Specialist Centers
(clinics). The facilities also offered diagnostic counseling and testing services, and treatment including
ARVs. The second assistance was through the FY 2006 USAID'S ACCESS project implemented by
JHPIEGO. The main aim of the activity was to continue to promote the availability and delivery of high
quality counseling and testing services in public Ministry of Health (MOH) facilities. The MOH's National
Guidelines for Counseling and Testing in clinical and medical settings were to be disseminated in selected
districts of Western Province and orientation provided to about 100 health workers. Subsequently these
health workers would give service orientation to 500 health workers using a cascade on-the-job (OTJ)
approach. The activity would promote the availability of PITC in Ministry of Health facilities and strengthen
referrals and linkages to care, treatment, and prevention. The third previous support was through the 2006
APHIA II TBD activity that consisted of activities approved in 2005 and implemented through FHI/IMPACT.
The 2006 APHIA II TBD activities was to provide counseling and testing services through existing static
sites, expanded testing in clinical settings, and increased outreach services. Increasing access to
antiretroviral therapy dictates that CT efforts quickly transform to accommodate active case finding through
provider initiated testing (PIT) in clinical settings, in addition to the more passive client initiated testing (CIT).
The activity was to ensure that existing integrated VCT sites are used to support these efforts in the interim
but strengthened to support DTC efforts (e.g. supporting start up activities, providing testing for partners and
other family members of index patients, providing ongoing counseling, providing bedside counseling,
consolidating CT returns, and managing HIV test kit supplies etc) in the future.
This activity will contribute to the 2009 Emergency Plan result for increased availability of counseling and
testing through training of health workers. It will enable service providers to identify the large numbers of
HIV infected patients who are potential candidates for ART. It therefore contributes to Kenya's 5-year
strategy emphases of encouraging Kenyans to learn their status and developing strong links between
counseling and testing and HIV services for those who are HIV positive and in need of health care.
This activity links with the APHIA II Western Counseling and Testing activities will relate to HIV/AIDS
treatment services, Abstinence and Be Faithful Program, HKID, HBHC, HVTB care activities, OP, PMCT,
and strategic information.
This APHIA II Western activity will target the general population: adult men and women of reproductive age,
and HIV/AIDS-affected families, underserved and hard-to-reach populations, particularly in rural
communities. It will also target MOH staff including program managers in the NASCOP, public health care
doctors and nurses, other health care workers including community health workers and non-governmental
organization.
This activity will help to reduce stigma associated with HIV status by increasing the availability of routine
testing for diagnosis in medical settings. 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.
Activity Narrative: 7. EMPHASIS AREAS
The major emphasis is on community mobilization and participation with minor emphases on development
of network/linkages/referral systems, local organization capacity development, and quality assurance and
supportive supervision. The minor emphasis is the development and implementation of referral systems,
quality assurance and supportive supervision for CT counselors. Another minor emphasis is in the area of
training.
Continuing Activity: 14998
14998 8777.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $1,100,000
8777 8777.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $500,000
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 12 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
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 the strategic information activity to be carried out by University of North
Carolina/MEASURE Evaluation (#7098), strategic information activity to be carried out by NASCOP (#7002)
and strategic information 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 (CACCS) levels by NACC through 3
key components. Component 1: Support APHIA II WESTERN /TBD 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 WESTERN /TBD 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 WESTERN /TBD 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 WESTERN /TBD
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
120 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 Western/TBD 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 Western 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.
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 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: 15000
15000 8855.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $250,000
8855 8855.07 U.S. Agency for Program for 4918 4918.07 APHIA II - $90,000
Estimated amount of funding that is planned for Human Capacity Development $180,000
Table 3.3.17:
In 2009 APHIA II Western 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 Western will
continue to support provincial and district health systems strengthening by convening consultative meetings
and various stakeholders' forums.
in addition, APHIA II Western 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 Western activities, particularly in AB and OP.
This activity will target all population of Western 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: 16339
16339 16339.08 U.S. Agency for Program for 6999 4918.08 APHIA II - $100,000
Table 3.3.18:
