1. ACTIVITY DESCRIPTION & EMPHASIS AREAS

Kenya has several examples of programming models for WSH and HIV integration especially in Nyanza

Province where EP funded programs include promotion of the Safe Water System (SWS) and hand-

washing through clinics, schools (with CARE) and community based approaches (e.g., CDC's work with the

Safe Water and AIDS Project to train PLWHA support groups to become vendors of hygiene products as a

source of income generation). The SWS consists of chlorination of water at the point-of use with Water

Guard, Aquatabs or PuR, safe storage and hygiene education (promotion of hand washing with soap). In

addition, APHIA II HCM Basic Care Package is being rolled out in Kenya. In FY09, 400,000 kits will be

distributed to PLWHA through the clinic system with accompanying education and follow-up in the home.

The package will include Water Guard, a water storage container, condoms, multivitamins, cotrimoxizole

and a bed net. The distribution of this package of evidence-based interventions has been supported by

CDC in Uganda for several years. The Ministry of Public Health and Sanitation's new strategy for delivery of

Level One services is being implemented. The cadre in this strategy, including the community health

extension workers (e.g., public health technicians) and a community CORPS of volunteers will also be the

implementers of WSH at the community and household level. It is with this background that EP funds will be

used for this new activity which aims to integrate WSH activities into HIV activities.

In FY09, the TBD partner will integrate WSH in National HIV/AIDS Policy and Guidelines. Strong policy

support is essential to integrating WSH into HIV/AIDS planning and implementation. This program approach

will include the review of current HIV/AIDS policy and guidelines on PMTCT, OVC, Home-Based Care, ART

and Clinical Care for evidence-based water, sanitation and hygiene strategies. The process will identify

gaps and make appropriate revisions. During policy development, the program will conduct broad

consultation with national and international experts and local stakeholders, service providers, non-

governmental organizations, community-based organizations and intended users of the service and their

families.

The partner will at a national level develop guidance on best practices for WASH for PLWHA, AIDS

exposed and AIDS affected. The program will develop a WSH toolkit with curricula, behavior change

communication and counseling tools and materials for targeted interventions. The toolkit will facilitate clear,

correct and consistent WSH messages. For community health workers (CHW), the backbone of outreach to

the household, the kit would be developed based on a review of the CHW checklist and training curricula.

Essential elements would include a WASH household assessment tool (or modification of CHW checklist) to

facilitate assessment of existing WSH practices; supplementary curricula on WSH with a special focus on

how to "negotiate" small doable actions at the household level that clients are willing to try; counseling cards

(e.g., a pictorial tool for CHWs to counsel community and family members on WSH actions). Sample

materials are available from the USAID/Hygiene Improvement Project (HIP).

In FY09, It is proposed that some WSH interventions will be piloted in Nyanza, Western and Coast

Provinces, building on MCH WSH interventions in FY 08. These activities include:

I. Integration of WSH into all Service Delivery Trainings (e.g., for health providers, CHWs, caregivers, etc.).

WSH information will be adapted for different audiences (e.g. for PMTCT, messages will include the

importance of safe water, sanitation and hygiene practices for effective maternal nutrition and safe

replacement and complementary feeding). This will result to 100 health facility staff receiving

comprehensive training in WSH and 300 community health workers will be trained in WSH.

II. Integration of WSH messages through community-based approaches of targeted APHIAs. Examples

include the integration of WSH messages into post-test clubs, PLWHA support group discussions, village

health committee activities, cultural activities (songs, community theatre, etc.)

III. Integration of WSH into community and Home-Based Care.

Elements of this approach include the following:

•Development of curriculum and training on WSH for HBC providers (CHWs) by reviewing and

enhancement of current national curriculum. The partner will share curriculum developed for HBC providers

and pictorial counseling card to assist in counseling family members on WSH actions. Checklist on

essential WSH actions will further support CHWs.

•A HBC kit including commodities for household WSH- Water Guard, storage vessel, hand washing stations

(soap, construction of a tippy-tap or water-saving device made of locally available materials such as a

jerican) and household bleach, rubber sheet and gloves for safe feces handling.

IV. Integration of WSH in Facility-Based setting (e.g. for ART, PMTCT, TB-HIV, etc.)This program approach

supports "WASH-friendly" health facilities which include the following elements:

•Presence of a hand washing station and soap for both providers and patients (tippy tap hand washing

stations (soap, Jeri cans for tippy-tap construction).

•Safe drinking water for providers and patients (commodities for SWS and storage vessels)

•A hygienic latrine

•In-service training curricula for providers (physicians, nurses, counselors); counseling cards for use in use

in counseling patients on WSH and resource materials for training patients in the waiting room.

•Ongoing technical support, training and supervision for providers.

EP funded programs will continue to implement similar programs in clinics without running water where the

SWS and hand washing stations are the only water source for providers and patients. The PEPFAR Care

and Support Technical Working Group has contracted with AIDSTAR, a new PEPFAR mechanism, to

produce a facility-based care package including curriculum for providers and job aids for use by providers in

counseling patients on WSH.

The major area of emphasis is water. Minor area is Training of health facility and community staff including

patients and their caregivers on WSH

2. CONTRIBUTIONS TO OVERALL PROGRAME AREAS

Working at 500 sites, this partner will reach at least 15,000 people. 100 health facility staff will receive

comprehensive training in WSH while 300 community health workers will be trained in WSH. This TBD

WSH 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 partner will

Activity Narrative: adhere to GOK policies and guidelines and participate in national-level HIV technical working groups.

3. LINKS TO OTHER ACTIVITIES

This activity links with other PEPFAR partners that provide HBHC services in health facilities or that support

OVCs. These include all of the APHIA II partners and various DOD and CDC-supported service delivery

sites.

4. POPULATIONS BEING TARGETED

The target populations include adults and children living with HIV/AIDS, including pregnant and postpartum

women, OVCs, and public sector nurses, community health workers, caregivers, and program staff (for

training). Some faith-based mission facilities will also be targeted.

5. SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS: this activity supports key cross-cutting

attributions in water ($200,000) and human capacity development through its water sanitation and hygiene

training program for health workers ($50,000).

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water

Table 3.3.08: