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: 2008 2009
Updated April 2009 Reprogramming. Increased by $187,500. Partnership Framework: 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.
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
1. ACTIVITY DESCRIPTION
APHIA II NEP will support facilities to provide a comprehensive antenatal package for all pregnant women
including screening, prevention and treatment for any infections (such as sexually transmitted infections and
malaria), nutrition support, prophylactic ARVs, counseling on safe infant feeding, counseling and HIV testing
of women and their partners. APHIA II NEP will support established support groups that are formed around
PMTCT sites by mothers who have benefited from the project services. In addition referral linkages will be
established within facilities where APHIA II NEP is providing antiretroviral therapy, through which HIV
positive clients are assessed and put on treatment where necessary. The number of HIV positive women
and children on treatment is expected to increase steadily through these networks. Laboratory networks will
also be established that will greatly improve ART uptake as well as early infant diagnosis. In 2009 APHIA II
NEP will provide HIV counseling and testing to 29,373 (36%) of 85,587 pregnant women and provide
antiretroviral prophylaxis to 207 (36%) out of 574 HIV-positive women. Of these 104 will receive AZT/NVP,
62 will receive single dose nevirapine only and 41 will receive HAART. 104 exposed infants will receive
PCR for early infant diagnosis. At the community level lay counselors will be trained to strengthen the
delivery of PMTCT services and to provide continued support for the HIV-positive women and their families.
To help reduce stigma and have support from the men, 5875 spouses will be provided with CT services.
The project will train community health workers to provide community components of PMTCT services. In
order to improve the quality of care, 50 health supervisors will learn management skills, including utilization
of data for decision making. In 2008, this project will strengthen District Health Management Teams
particularly in 8 new newly formed districts), and referral networks for PMTCT-plus activities. The project will
train 120 health workers in 60 sites in PMTCT and comprehensive HIV management for HIV-positive
mothers and their families. Efforts will be made to increase early infant diagnosis in order to identify infants
that require HIV care and treatment and offer more appropriate advice on infant feeding choices. More
efficacious regimens for PMTCT will be introduced and scaled up in all the sites offering services. Linkages
to FP/RH will be made as well as to laboratory services in order to offer a more comprehensive package of
care.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute CT to 2.3% of the overall 2009 Emergency Plan PMTCT targets for Kenya.
Community participation and male involvement will significantly contribute to PEPFAR goals for primary
prevention, access to care and treatment, and support of those affected and infected. Technical assistance
to the Ministry of health facilities will contribute to improvement of the quality of services.
3. LINKS TO OTHER ACTIVITIES
Linkages to HIV care and treatment services will be strengthened, to ensure immediate appropriate care for
the woman and exposed infants, as well as other family members, thus optimizing utilization of
complementary services created through Emergency Plan funding. This activity will relate to the ARV
services, OVC care, TB/HIV services, HBHC and STP services funded under the APHIA II NEP.
4. POPULATIONS BEING TARGETED
This activity targets adults, pregnant women, HIV+ pregnant women, HIV affected families, and HIV+ infants
with service provision. Health care providers including doctors, nurses and other health care workers will be
targeted for training on PMTCT using the national NASCOP PMTCT CDC/WHO based curriculum.
5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address gender equity in HIV/AIDS programs through improved PMTCT service delivery at
antenatal clinics and maternity units. Community Health workers will conduct community mobilization
activities that will help increase service uptake as well as address issues of stigma and discrimination at
community level. This is also hoped to help address male norms and behaviors as well as reduce violence
and coercion against women. This activity includes emphasis on human capacity development through
training and supportive supervision. Attention will also be paid to Quality Assurance, Community
Mobilization/Participation and Development of Network/Linkages/Referral Systems. Data collection and
utilization is paramount to successful program implementation and support will be given to strategic
information. Linkages to safe motherhood will be created to improve outcome of interventions in that hard to
reach population.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15989
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15989 15989.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $550,000
International International Eastern
Development
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $40,230
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY UNCHANGED FROM COP 2008
The only changes to the program since approval in the 2007 COP are:
+ Prime partner Pathfinder International has been competitively selected to implement the activity;
+ The target population has been revised to include teachers who, in collaboration with the Ministry of
Education and other stakeholders, at approximately $30,000 plus funding from OP and OHPS totaling
$150,000, 750 teachers will be sensitized about HIV/AIDS prevention and the AIDS policy for the education
sector;
+ 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;
+ HVAB funds totaling $23,000 will contribute to the sensitization of teachers as a worksite population
linking with additional HVOP and OHSS funds for a $150,000 activity to reach 750 teachers and train 20.
1. LIST OF RELATED ACTIVITES
This activity relates to activities in Other Prevention Counseling and Testing (#8778), Palliative Care:
TB/HIV (#9066), and Prevention of Mother-to-Child Transmission (#7087).
2. ACTIVITY DESCRIPTION
Kenya's North Eastern Province (NEP) is fortunate to have much lower HIV prevalence rates than other
provinces in the country. The KAIS shows rates varying from 0-2% across the province. The primary focus
of APHIA II NEP will be to maintain low prevalence rates through reinforcing the attitudes of local religious
and societal leaders around abstinence and being faithful and using them as culturally acceptable means
for influencing the local population. However, PMTCT data from UNICEF's work in the region shows areas
of rapid expansion of the epidemic mainly around Garissa (5%) and other urban centers which are acting as
catalysts in fueling the spread of the HIV epidemic. Urban areas within NEP generally feature significant
populations of civil servants, uniformed services personnel and commercial traders, most of whom are from
other regions of the country and are living in isolated areas unaccompanied by their spouses or families.
Despite the general perception of NEP as an Islamic province with conservative social morals, these urban
centers feature "hot spots" for commercial sex and opportunities for the AIDS virus to enter the mainstream
population through sex with widows and polygamous unions. In FY 2009, APHIA II NEP will target youth
and adults with AB messages that are appropriately segmented to different target groups and are culturally
sensitive. Islamic leaders in NEP are in full support of promoting abstinence and being faithful and will be
important channels for communicating these messages, as well as addressing issues around stigma and
VCT. Emphasis will be on delayed sexual debut, and secondary abstinence will be encouraged for those
youth who are already sexually active. Two local radio stations which broadcast in the Somali vernacular
and have wide audiences within NEP will be utilized for broadcasting public service announcements and
dramas. Existing outreach programs reaching more isolated populations offer an excellent opportunity for
building in culturally appropriate behavior change communication on abstinence and being faithful. APHIA II
NEP anticipates utilizing PLWHAs from the province as spokespersons for raising awareness and
decreasing stigma. It is expected that 200,000 individuals will be reached by 1,389 trainers with culturally
appropriate messages that promote abstinence and/or being faithful. In conjunction with the OP and OHPS
activities, 750 teachers will be targeted as a worksite population who will be sensitized to the AIDS policy for
the education sector and receive instruction on HIV/AIDS prevention.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute significantly to the overall 2009 Emergency Plan Prevention/AB targets for
Kenya. Integrating prevention into all community outreach for treatment and care, with special emphasis on
men and youth, will significantly contribute to PEPFAR goals for primary prevention. Prevention messages
will also be given to those who are HIV+ in CT and ART sites.
4. LINKS TO OTHER ACTIVITIES
Support to AB will be one component of a package of integrated support at health facility and community
levels in the region, holistically addressing HIV prevention, treatment and care. This activity relates to
activities in Counseling and Testing (#8778), TB/HIV (#9066), and PMTCT (#7087).
5. POPULATIONS BEING TARGETED
This activity targets both in- and out-of-school youth for abstinence and both adults and youth for being
faithful. Special emphasis will be placed on reaching men through outreach by PLWA and involvement of
community and religious leaders, by couples' counseling in PMTCT and through worksite interventions.
Counterparts from NGOs, CBOs, FBOs and schools will be targeted for training to implement prevention
programs.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address culturally sensitive issues surrounding gender, including male norms and
behaviors. They will also address stigma and discrimination which are quite high in marginalized areas such
as this one where AIDS information is limited.
7. EMPHASIS AREAS
This activity includes a major emphasis on capacity building of implementing partners, community resource
persons (CORPS) and other community level implementing partners. Community involvement in the design
and implementation of activities will play an integral part in ensuring the success of this result area. They
will train the target groups in IEC and develop networks and referral systems.
Continuing Activity: 14698
14698 9074.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $1,000,000
9074 9074.07 U.S. Agency for To Be Determined 4919 4919.07 APHIA II - North
International Eastern
Workplace Programs
Table 3.3.02:
+ Clients of commercial sex workers will be targeted with specific interventions that focus on consistent
condom use and knowing HIV status.
+ Specific prevention messaging targeting women, men, and discordant couples will be incorporated into
counseling and testing interventions. Specific messages will be developed for each population.
+ Specific AB messages will target both adult men and women with the aim to reduce the number of
multiple concurrent partners.
•Prime partner Pathfinder International has been competitively selected to implement the activity
•$100,000 of this allocation will be used to carry out formative evaluation to determine the drivers of the
epidemic in "hot spots' of North Eastern province
1. LIST OF RELATED ACTIVITIES
This activity links with other activities in Abstinence and Be Faithful Programs (#9074), Counseling and
Testing (#8778), Prevention of Mother-to-Child Transmission (#7087) and Palliative Care: TB/HIV (#9066).
$100,000 of this allocation will be used to carry out formative evaluation to determine the drivers of the
epidemic in "hot spots' of North Eastern province. In FY 08, this activity will reach 7,000 individuals with
other prevention interventions and train 60 people. In addition condoms will be distributed through 100
outlets. Kenya's NEP is fortunate to have much lower HIV prevalence rates than other provinces in the
country. The KAIS shows rates varying from 0-2% across the province. The primary focus of APHIA II NEP
will be to maintain low prevalence rates through reinforcing the attitudes of local religious and societal
leaders around abstinence and being faithful and using them as culturally acceptable means for influencing
the local population. However, PMTCT data from UNICEF's work in the region shows areas of rapid
expansion of the epidemic mainly around Garissa (5%) and other urban centers which are acting as
other regions of the country and are living in isolated NEP unaccompanied by their spouses or families.
centers feature "hot spots" for commercial sex and opportunities for the HIV virus to enter the mainstream
population through widows and polygamous unions. Condom use as an HIV/AIDS prevention strategy is an
extremely sensitive issue among the Muslim community in NEP and must be approached carefully. APHIA
II NEP will carefully target segmented components of the NEP population, working primarily with
commercial sex workers; bar owners; long-distance truck drivers; commercial traders and civil servants from
outside the province; and, members of the uniformed services. The project will collaborate with partners
such as the ROADS project and PSI for reaching targeted groups with condoms and will employ proven
approaches such as the Men as Partners program for developing healthier behaviors within the uniformed
services.
By supporting the CORP/TBAs to ensure use of sterile birth equipment the project shall reduce the risk of
HIV transmission through the use of contaminated tools. Strengthened referral by the CORP/skilled birth
attendant system for pregnancy and pregnancy related issues will increase the number of pregnant mothers
accessing essential antenatal services including VCT and PMTCT. Increased use of condoms by clients of
CSWs will reduce opportunities for sexual transmission of the virus among high risk groups.
This activity relates to activities in Counseling and Testing (#8778) and Abstinence and be faithful (AB)
activities (#9074). These OP services will be complemented by other ongoing health activities, which
include community and religious outreach programs for awareness creation and behavior change and
prevention among literate and illiterate populations of North Eastern Kenya. The CORP/TBAs shall provide
basic health services, disseminate HIV/AIDS AB messages and mobilize the pastoral community for
HIV/AIDS services including TB (#9066) and PMTCT (#7087).
These activities target special populations particularly the mobile populations of Northern Kenya. OP
information and condoms will be passed to truck drivers who are a risk group as they move from high
HIV/AIDS prevalence zones of Kenya in search of animals for international markets. Appropriate HIV/AIDS
messages will be disseminated through brochures, billboards, fliers and police road signs. In addition,
special populations, particularly commercial sex workers, in the target districts will be equipped with
appropriate information and empowered to use HIV/AIDS preventive methods at all times. Altogether, 6,000
people will be reached.
The key legislative issue addressed is Gender: working with the women in the project districts who will be
empowered to be decision makers on matters of reproductive health and be persuaded to accept the use of
condoms in a polygamous Muslim population. The KDHS 2003 study indicates that knowledge about
condoms, their acceptability and use is very limited in the project districts of North Eastern Kenya. The OP
program will advocate for and promote strategic condom distribution and use while considering religious,
cultural and gender sensitivities.
The major emphasis area for this component is development of network/linkages/referral systems
developing strong referrals through their skilled birth attendants. In addition another major area is
Information, Education and Communication with activities that will enhance HIV/AIDS prevention behavior.
Knowledge of contraceptive methods in general, and about condoms in particular is low. Acceptability and
use of condoms is less prevalent in the project districts. The Supreme Council of Kenya Muslim (SUPKEM)
Activity Narrative: religious leaders have rejected condom use among Muslim populations in the project area. The argument
that condoms curtail fertility and save lives is pitted against condoms as a symbol of immorality and
uncontrolled sexual activity. The resultant discourse portrays real conflicts faced by Muslims when they
have to decide whether or not to use condoms. The project will hence discover ingenious avenues to
promote condom use in the project districts and increase both demand and supply to groups at risk.
Continuing Activity: 14699
14699 8937.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $450,000
8937 8937.07 U.S. Agency for To Be Determined 4919 4919.07 APHIA II - North
Table 3.3.03:
This activity supports key cross-cutting attributions in human capacity development through its training
program for health workers ($20,000).
This activity relates to activities in Counseling and Testing, TB/HIV, Adult Treatment Services, Pediatric
Care and Treatment services and PMTCT.
This activity relates to care and support for adults affected by HIV/AIDS under the APHIA II North Eastern
Project. APHIA II will oversee implementation of both community and facility-based basic health care and
support programs in conjunction with the TB/HIV and antiretroviral therapy programs being established and
expanded in the North Eastern Province of Kenya. These activities will contribute to the results of expansion
of opportunistic infection management and prevention in both clinical and community settings for HIV-
positive patients, strengthened human resource capacity to deliver this care, and a strengthened referral
network for provision of HIV care services in North Eastern Province. Cotrimoxazole prophylaxis and where
indicated, fluconazole prophylaxis, will be the basic standard of care for HIV infected people within the
clinical facilities. APHIA II North Eastern's approach is to build capacity among health care workers at the
Garissa Provincial Hospital and other high volume facilities to care for HIV+ adults and children. In FY 2009
APHIA II will work closely with NASCOP and key stakeholders to rollout an effective HIV care strategy that
utilizes the network approach to HIV care and treatment, where the provincial and district hospitals will be
the main HIV care referral centers, and effective referral systems will be established between community
outreach, facility-level and CBO-based programs. Due to the predominantly nomadic nature of the
populations in this region, and the vast distances involved, basic care packages will be distributed and
replenished through outreach campaigns established with local partner agencies and providing
comprehensive health and information services.
Through these programs 1,100 HIV-infected adults will be supported through community outreach, facility-
level and CBO-based programs at 80 facilities and surrounding host communities.
This activity will be linked to the PMTCT-APHIA II- activity, Pediatric Care and treatment services, adult
treatment service TB/HIV and counseling and testing services which are provided by this and other partners
in same region. This will ensure optimum utilization of complimentary services created through the
Emergency Plan and other partners.
This APHIA II activity mainly targets HIV positive adults living with HIV/AIDS. Health care workers such as
doctors, nurses, pharmacists, laboratory workers and clinical officers in public facilities are also targeted for
training. The community activity targets to recruit train and retain community health workers that will be the
link between clinical and community-based services.
The key legislative issue addressed is reducing stigma and discrimination at community and facility level in
order to ensure that people who would not have otherwise gone for treatment are able to do so.
This activity puts major emphasis on training of health care workers with minor emphasis on needs
assessment, quality assurance and supportive supervision and development of networks / linkages / referral
systems.
Continuing Activity: 14700
14700 8867.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $500,000
8867 8867.07 U.S. Agency for To Be Determined 4919 4919.07 APHIA II - North
Estimated amount of funding that is planned for Human Capacity Development $20,000
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 ($50,000).
This activity relates to activities in Counseling and Testing, TB/HIV, Pediatric Care and treatment, Adult
Care and Support and PMTCT.
This activity relates to treatment for adults affected by HIV/AIDS under the APHIA II North Eastern Project.
APHIA II will oversee implementation of both community and facility-based treatment programs, including
infrastructure, training clinicians and other providers, clinical monitoring, related laboratory services, and
community-adherence activities.
Through these programs 400 adults will newly initiate ART; 960 adults will have ever received ART by the
end of FY 2009; and, 800 adults will be receiving ART by the end of FY 2009 at 20 facilities in NEP.
This activity will be linked to the PMTCT activity, Palliative Care: TB/HIV and counseling and testing
services which are provided by this and other partners in same region. This will ensure optimum utilization
of complimentary services created through the Emergency Plan and other partners.
This APHIA II activity mainly targets HIV positive adults living with HIV- AIDS. Health care workers such as
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: 14704
14704 8805.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $600,000
8805 8805.07 U.S. Agency for To Be Determined 4919 4919.07 APHIA II - North
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
program for health workers ($5,000)
This activity relates to activities in Counseling and Testing (#8980), TB/HIV (#9066), Pediatric and adult
Treatment Services and PMTCT (#7087).
This activity relates to care and support for 100 children affected by HIV/AIDS under the APHIA II North
Eastern Project. APHIA II will oversee implementation of both community and facility-based basic health
care and support programs in conjunction with the TB/HIV and antiretroviral therapy programs being
established and expanded in the North Eastern Province of Kenya. These activities will contribute to the
results of expansion of opportunistic infection management and prevention in both clinical and community
settings for HIV-positive patients, strengthened human resource capacity to deliver this care, and a
strengthened referral network for provision of HIV care services in North Eastern Province. Cotrimoxazole
prophylaxis and where indicated, fluconazole prophylaxis will be the basic standard of care for HIV infected
children within the clinical setting and good infant feeding practises within the family and community setting.
APHIA II North Eastern's approach is to build capacity among health care workers at the Garissa Provincial
Hospital and other high volume facilities to care for HIV+ children. Early infant diagnosis and improved
(Focused) antenatal care will act as entry point for pediatric patients into care. In FY 2009 APHIA II will work
closely with NASCOP and key stakeholders to rollout an effective HIV care strategy that utilizes the network
approach to HIV care and treatment, where the provincial and district hospitals will be the main HIV
diagnostic and care referral centers, and effective referral systems will be established between community
outreach, facility-level and CBO-based programs. This will involve improved laboratory and pharmacy
services. Due to the predominantly nomadic nature of the populations in this region, and the vast distances
involved, basic care packages will be distributed and replenished through outreach campaigns established
with local partner agencies and providing comprehensive health and information services.
Through these programs 100 HIV-infected children will be supported through community outreach, facility-
level and CBO-based programs at 80 facilities.
This activity will be linked to the PMTCT-APHIA II- activity, Palliative Care: TB/HIV and counseling and
testing services which are provided by this and other partners in same region. This will ensure optimum
utilization of complimentary services created through the Emergency Plan and other partners.
This APHIA II activity mainly targets HIV positive children living with HIV- AIDS. Health care workers such
as doctors, nurses, pharmacists, laboratory workers and clinical officers in public facilities are also targeted
for training. The community activity targets to recruit train and retain community health workers that will be
the link between clinical and community-based services.
Estimated amount of funding that is planned for Human Capacity Development $5,000
Table 3.3.10:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS:
This activity relates to activities in Counseling and Testing (#8980), TB/HIV (#9066), Adult Care and
Treatment, Pediatric HIV care and PMTCT (#7087).
This activity relates to treatment for children affected by HIV/AIDS under the APHIA II North Eastern
Project. APHIA II will oversee implementation of both community and facility-based treatment programs,
including infrastructure, training clinicians and other providers, examination clinical monitoring, related
laboratory services, and community-adherence activities.
Through these programs 50 children will newly initiate ART with 80 children receiving ART by the end of FY
2009. This will result in the total ever treated being 96 children. Services will be provided at 10 facilities in
NEP.
Table 3.3.11:
program that targets health workers ($15,000).
This activity will be linked to Adult Care and Treatment services, Pediatric Care and Treatment, and
Counseling and Testing.
There are a number of variables that distinguish North Eastern Province (NEP) from the rest of the country
and have important implications for health programming. First, NEP has the lowest utilization of health
services in the country. This is due to a combination of factors, including poorly staffed facilities; vast
distances between facilities; very high illiteracy rates of both men and women; extraordinary stigma,
particularly around the use of condoms; high rates of TB (though to date this is largely unassociated with
HIV) and stigmatization of those with TB; low rates of HIV prevalence in persons being treated for TB
(typically only around 3-4%); religious and social attitudes and beliefs which discourage the use of health
facilities for deliveries; harsh conditions which contribute to understaffing and poor retention of those who do
report for duty. Outreach services, which are able to respond to the movement of pastoralists, can help to
address the inaccessibility of distant Service Delivery Points (SDPs); however, the quality of services
provided by SDPs must also improve significantly. While stigma is the major cause for people in NEP not
knowing their HIV status, the availability and quality of counseling and testing services requires significant
improvements. Intensified TB screening for 200 HIV patients and HIV screening for 200 TB
suspects/patients will be offered as a standard of care in all the facilities; approximately 100 HIV patients
will be treated for TB infection.
This activity will build on USAID investment through UNICEF to provide support for strengthening and
expanding palliative care in clinical settings to address TB and HIV. Emphasis will be on filling gaps in
service delivery and linking to community based services. TB prevention, treatment and care programs will
be strengthened and effective linkages made between TB and HIV services. TB "manyattas" in each district
will be renovated. Service quality and supervision at all levels of facility care and referral will be improved.
Drug supply management, case management, records systems, supervision and community-based
adherence/follow-up will be strengthened. All health facilities targeted by the project will provide OI
treatment, including TB, cotrimoxazole prophylaxis, and nutritional support. APHIA II NEP will work to
expand diagnostic and DOTS case management capacity, including improving the quality of TB diagnostic
laboratories. It will provide guidance for training of nurses and CHWs, annual refresher training on
TB/HIV/AIDS care and education. It will pilot ART provision in TB clinics in an effort to decentralize and treat
patients where they are presenting for care.
In NEP and northern parts of Eastern and Rift Valley provinces in FY 2009, 100 people with HIV infection
will be provided with TB treatment services and 200 with TB will receive counseling and testing for HIV and
train 50 health workers in TB/HIV related activities in 80 health care facilities.
Clinic-based palliative care is one component in a comprehensive treatment and care approach under
APHIA II, such that clients will benefit from long term ART and linkages to community services. Linkages
will also be made with the DLTLD and CT, PMTCT and OVC sites.
This activity targets clients at antenatal clinics, VCT sites, in-patients and clients of DTC, TB-ward patients
and clients of home and community support services who are referred for clinical care by community health
workers and Health care.
This activity will address stigma and discrimination against persons dually infected with TB and HIV.
Continuing Activity: 14701
14701 9066.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $150,000
9066 9066.07 U.S. Agency for To Be Determined 4919 4919.07 APHIA II - North
Estimated amount of funding that is planned for Human Capacity Development $15,000
Table 3.3.12:
+ Prime partner Pathfinder 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 4,500 with testing and
counseling. Of those tested, approximately 360 will be identified as HIV-exposed or infected and enrolled
into facility-based HIV care and treatment services to receive cotrimoxazole (CTX), evaluation for ART
eligibility and other basic HIV care services.
+ In 2009, the activity will support the referral of particularly vulnerable OVC to the Nutrition and HIV/AIDS
Program and ensure that an increased number of OVC requiring food and nutritional services will be
reached with food supplements procured through the NHP.
+ In 2009, the activity will support the development of OVC standards for Kenya and in supporting quality
improvement approaches for monitoring and improving the quality of OVC programs at the provincial level.
+ In FY09, the activity will also focus on integrating prevention activities. The activity will link with prevention
programs to support male circumcision and counseling and testing for OVC as well as prevention with
positives for adolescents.
+In 2009, the activity will also focus on establishing appropriate linkages with PMI and ensure that OVC
being supported are also able to benefit from mosquito nets procured by PMI.
This activity will support key cross cutting attributions of the budget amounting to $ 15,000 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 $ 25,000. A further $ 5,000 will be
attributed to provision of safe water guards for households looking after OVC.
This activity relates to counseling and testing (#8778), ARV Services (#8805) and Palliative Care: basic
health care and support (#8867).
This activity relates to expanded support to be provided to OVC in hard to reach areas. APHIA II NEP will
provide integrated, age-appropriate services to build resilience of children infected with and affected by
HIV/AIDS. Emphasis will be placed on development of healthy and supportive home and community
environments where OVC and guardians/families have access to psychosocial support, education, health
and nutrition services, economic livelihood support, shelter and protection from exploitation and abuse.
Institutional capacity and technical expertise of implementing partners will be strengthened. OVC support
will be integrated with and linked to the project's home and community support. Village Health Committees
and implementing partners will identify OVC, who are often in the same households as those individuals
receiving home-based care and support. It is anticipated that in FY 2009 a total of 5,000 will be reached.
Training of individuals in caring for OVC will cover 450 care givers. Local implementing partners and
community based organizations will be given capacity as appropriate in order provide care and support for
OVC. Caretaker support groups will include OVC needs.
This activity will contribute significantly to the overall FY 2009 Emergency Plan OVC targets for Kenya
ensuring equity in these marginalized, inhospitable and hard to reach areas. Through its OVC activities
APHIA II NEP will address the primary needs of 5,000 OVC and train 450 caregivers.
This activity will be closely linked with other APHIA II North Eastern Province activities in counseling and
testing (#8778), ARV Services (#8805) and Palliative Care: basic health care and support (#8867).
This activity targets orphans and vulnerable children, caregivers, community health workers, teachers,
guardians, educators and volunteers involved with OVC. It also targets community-based and faith-based
organizations in the area.
Issues addressed are stigma and discrimination by developing education for the community about OVC in
an effort to reduce stigma as well as wrap around services for the OVC in the area of food and education.
This activity includes major emphasis on child protection through capacity building of local implementing
partners and community health workers (CHWs). Minor emphasis is in the area of community mobilization
and the development of information, education and communication as they relate to the needs of the OVC.
Community involvement in the design and implementation of activities will play an integral part in ensuring
the success of this result area.
Continuing Activity: 14702
14702 9067.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $1,200,000
9067 9067.07 U.S. Agency for To Be Determined 4919 4919.07 APHIA II - North
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Estimated amount of funding that is planned for Economic Strengthening $15,000
Estimated amount of funding that is planned for Education $25,000
Estimated amount of funding that is planned for Water $5,000
Table 3.3.13:
+ Target population will be expanded to include testing for OVCs
+ APHIA II North Eastern will expand counseling services within the province and include outreach services
provided through existing and new VCT sites that are integrated within health facilities. The CT services will
include testing of family members of the infected individuals receiving care and treatment within the facility
and other outreaches. PITC services will be scaled up.
This activity is related to activities in ARV services, TB/HIV, palliative care basic health care, AB and Other
Prevention.
In 2009, this activity will provide VCT services to 12,800 individuals through 40 sites including mobile
services and will train 100 providers in VCT, PITC and HBCT. This activity relates to support to be provided
to increase VCT coverage while taking account of the need to emphasize provider initiated testing and
counseling (PITC) as well. Mobile VCT will complement fixed sites. Youth friendly services will be
emphasized. Where possible, VCT will be integrated with facility and community level treatment and social
support services for individuals testing positive and with prevention activities for discordant couples and
individuals testing negative. PITC will be scaled up in support of the National AIDS and STI Control
Program. Year 3 will see expansion and strengthening of PITC in high volume facilities and TB treatment
sites, PMTCT and in district hospitals and health centers with laboratory capacity. Counselors from targeted
facilities will be trained and they will work with GOK and NGO counterparts to ensure supervision.
Individuals who test positive will be systematically referred to CCC and higher levels for comprehensive
testing and linkages to community services. APHIA II NEP will liaise with NASCOP to ensure HIV test kit
supply.
The project is covering the costs of 22 VCT Counselors recruited and hired through Capacity project on
behalf of the Ministry of Health.
This activity will contribute significantly to the overall 2009 Emergency Plan Counseling & Testing targets for
Kenya. Integrating promotion of VCT into all community outreach for treatment and care will significantly
contribute to PEPFAR goals for primary prevention. This activity will result in 12,800 people tested and
counseled.
Support to counseling and testing will be a linchpin activity in APHIA II NEP resulting in increased numbers
of individuals accessing care, treatment and support and in strengthening prevention efforts. This activity
will specifically be linked to ARV services, TB/HIV, palliative care basic health care, AB and Other
This activity targets a wide range of population groups, including, for PITC, TB patients on treatment and
those receiving other clinical services, and for VCT, the general population, with emphasis on sexually
active individuals, youth, and high risk groups such as sex workers, their partners, long distance transport
workers and discordant couples. Health service providers will be targeted for training.
This activity will address the GOK VCT policy and guidelines and legislation related to protection of human
rights and confidentiality. It will address gender issues and stigma and discrimination to ensure that women
who are disproportionately affected by HIV are identified and linked with care and treatment programs.
Couples in discordant relationships will also benefit from knowing their status so that they can make
informed decisions in their sexual relationships.
This activity includes major emphasis on training to build capacity of Counseling &Testing providers and
Community Health Workers. The activity emphasizes VCT as a major prevention strategy; implementing
Partners, Community Own Resource Persons and other community level implementing partners are key to
its success. Community mobilization and the development of network/linkages/referral systems are all minor
emphasis areas in this activity.
Continuing Activity: 14703
14703 8778.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $400,000
8778 8778.07 U.S. Agency for To Be Determined 4919 4919.07 APHIA II - North
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 11 data clerks to reduce increased data management burden on health care workers in the province.
+ Conduct basic program evaluations (process evaluations, assessments, program reviews and some
outcome level evaluations) in prevention, care and treatment programs to document implementation and
short-term effectiveness of programs.
SECONDARY CROSS CUTTING ATTRIBUTIONS
This activity supports key cross-cutting attributions in human capacity development through training of GOK
and USG partner personnel in HMIS, M&E and Surveillance both at national and regional level
The only changes 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.
Funding level has also changed. 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
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 (CACCS) levels by NACC through 3
key components. Component 1: Support APHIA II NEP/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 NEP/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 NEP/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 15 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 NEP/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 35 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 NEP/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 North Eastern province. These efforts
should result into demonstrated evidence in increased national level reporting by up to 60% from health
facilities to NASCOP national database.
The activity builds on the FY 2006 activities that support the national M&E systems as well as contributing
to the Emergency Plan's training outputs. In overall, the activity will provide technical assistance to fifteen
local organizations/health facilities in strategic information in addition to supporting the training of 35 SI and
program managers in M&E/HMIS, reporting and data use for program management.
This activity is related to the strategic information activity to be carried out by University of North
Carolina/MEASURE Evaluation (#7098), where MEASURE Evaluation will be supporting NACC in rolling
out COBPAR system for community level reporting. It is also related to the strategic information to be
carried out by NASCOP (#7002), where NASCOP will be rolling out Form 726, Form 727 and program
specific client registers for data collection and reporting at health facilities. It is also related to SI TE/TBD
(#9220), that will attempt to investigate the causes for low reporting rate by health facilities and recommend
strategies for achieving 100% reporting level by health facilities.
This activity targets host government and other health care workers like M&E and HMIS officers responsible
for data collection, analysis, reporting and use at both health facilities and community level. Program
managers are as well targeted for orientation on the role M&E program management.
6. EMPHASIS AREAS
Activity Narrative: 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: 14705
14705 8864.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $150,000
8864 8864.07 U.S. Agency for To Be Determined 4919 4919.07 APHIA II - North
Estimated amount of funding that is planned for Human Capacity Development $90,000
Table 3.3.17:
ACTIVITY UNCHANGED FROM COP 2008.
In 2009 APHIA II North Eastern will continue to strengthen the dissemination of key Government of Kenya
(GOK) policies and guidelines, developed at national level, to the district level. In addition APHIA II North
Eastern will continue to support provincial and district health systems strengthening by convening
consultative meetings and various stakeholders' forums.
In addition, APHIA II North Eastern will continue to strengthen the institutional capacity of various local
partners at grassroots level using very participatory methodologies. This will include institutional
strengthening for 15 organizations. APHIA will also build the management and supervisory capacity of
District Health Management Boards (DHMTs) to effectively carry out their roles. All persons trained under
APHIA will also be equipped with skills for stigma mitigation. The prevention peer educators and community
health workers will engage the community on dialogue on stigma with the aim of enabling people to identify
stigma in their community and work towards stigma reduction, other approaches to be utilized will include
community theatre and outreaches.
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 North Eastern activities, particularly in AB and OP.
This activity will target all population of North Eastern province including youth, women, and men.
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: 17316
17316 17316.08 U.S. Agency for Pathfinder 6914 4919.08 APHIA II - North $100,000
Table 3.3.18:
