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.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ Incorporation of the new strategies aimed at increasing male support and participation in PMTCT activities
and Mentor Mothers initiative aimed at strengthening psychosocial support as well as other interventions to
mothers accessing PMTCT services.
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 program will also support capacity
building for community Health workers and peer counselors.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity is linked to UNHCR VCT Program; UNHCR ABY; UNHCR HBC; UNHCR OVC and UNHCR
ARV Services.
2. ACTIVITY DESCRIPTION
The United Nations High Commissioner for Refugees (UNHCR) has been supporting HIV prevention and
treatment programs in Dadaab Refugee Camp since 2005 with PEPFAR funds. Dadaab Camp has an
estimated population of 173,409 with a 49.5 % female to male ratio. The UNHCR is responsible for the
protection of and the provision of assistance to refugees in close coordination and cooperation with other
agencies, namely: Government of Kenya, World Food Program, UNICEF, GTZ, CARE Kenya and the
National Council of Churches of Kenya (NCCK). There are three refugee camps in Dadaab (Ifo, Dagahaley
and Hagadera). These camps cover a total area of 50 square kilometers and are within an 18 km radius of
Dadaab Town. Each of these camps has a health facility providing preventive and curative outpatient
services as well as inpatient services. The HIV programs include HIV Testing and Counseling services
( VCT and PITC), Prevention of Mother to Child Transmission of HIV (PMTCT) , Condoms and Other
Prevention activities, Abstinence and Being Faithful program (ABY), Home Based Care (HBC), Orphans
and Vulnerable Children (OVC) and HIV Care and Treatment services. In FY 2009, UNHCR will continue to
support the expansion and consolidation of PMTCT program in the 3 health facilities within the camp as well
as the Dadaab Health Centre, and will provide HIV counseling and testing services to 2,000 pregnant
women and provide a complete course of ARV prophylaxis to 20 HIV-positive pregnant women. All HIV-
positive pregnant women will have WHO clinical staging and CD4 cell count test done to determine the
appropriate ARV prophylaxis regimen in line with the National PMTCT guidelines and recommendations. All
HIV exposed infants will be given ARV prophylaxis and the program targets to reach all 20 HIV exposed
infants. The program will establish mechanisms for follow up and care of the HIV infected-exposed mother
infant pairs through the Comprehensive PMTCT framework, as well as strengthening postnatal care
services at facility level to include improved access to Family Planning services. The current package of
care for the mother includes regular follow up, linkage to family planning services, OI prophylaxis and
counseling on correct infant feeding practices; infant additional care activities include OI prophylaxis using
Co-trimoxazole starting at six weeks of age, and DBS for HIV- PCR (Early Infant HIV Diagnosis-EID). The
program will target 20 HIV exposed infants for DBS, and will work with the HIV/AIDS treatment program to
ensure linkage to pediatric HIV treatment and care services for all infants with an HIV +ve PCR test. In order
to strengthen HIV prevention, care and treatment services among other family members, the program will
establish linkage mechanisms with the other program areas to increase the number of partners accessing
HIV testing and counseling services, access to OVC care for all HIV exposed and infected infants and TB
screening and linkage to treatment for all HIV infected women and other family members. Other strategies
that will be incorporated to strengthen the program are the Prevention with Positives (PwP) to strengthen
prevention and Mentor Mothers to ensure support on adherence of interventions e.g correct infant feeding
practices to all mothers accessing services in PMTCT program. In 2009 COP the will support the training of
50 service providers on PMTCT including lay counselors and Community Reproductive Health Volunteers.
UNHCR will work with its three implementing partners, GTZ, National Council of Churches of Kenya
(NCCK), and CARE Kenya's Emergency and Refugee Operations (ERO) in implementation of these
activities. UNHCR will work in close collaboration with CDC and other USG agencies for technical guidance
on all Emergency Plan program areas.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to PEPFAR goals for primary prevention and care by contributing 0.15% of
overall 2008 Emergency Plan targets for Kenya in meeting the health needs of women in this special group
(refugee setting).
4. LINKS TO OTHER ACTIVITIES
This activity links to UNHCR activities in HIV ART and care services, Counseling and Testing services,
UNHCR OVC. The program will establish clear linkages to ensure that all HIV-positive pregnant women
and HIV infected infants' access HIV care and treatment services. The program will also encourage male
partner testing and will work with CT services to achieve this objective. Other related activities include
Abstinence and /Be Faithful UNHCR. Persons needing care and treatment for opportunistic infections or
ART care will be referred to Palliative Care: Basic Health Care and Support and Treatment: ARV Services.
5. POPULATIONS BEING TARGETED
This activity will target children less than five years, adolescents of reproductive age, adults, people living
with HIV/AIDS, pregnant women and Refugees/internally displaced persons. The refugee population
especially both men and women of reproductive age are vulnerable to HIV infection and its impact due to
their conflict-affected lives, disintegrated social network and rapid mobility. It will serve rural host
communities of the North Eastern Kenya.
6. KEY LEGISLATIVE ISSUES ADDRESSED / EMPHASIS AREAS
The emphasis areas include increasing gender equity in HIV/AIDS programs through provision of HIV
counseling and testing services to pregnant women and their partners, in-service training of service
Activity Narrative: providers on PMTCT using the nationally adopted WHO/CDC NASCOP PMTCT National Training
Curriculum, as well as wrap around programs in Family Planning, Malaria and Safe Motherhood activities as
part of the PMTCT package of care.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17030
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17030 17030.08 Department of United Nations 7009 4921.08 $100,000
State / Population, High
Refugees, and Commissioner for
Migration Refugees
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Family Planning
* Malaria (PMI)
* Safe Motherhood
Refugees/Internally Displaced Persons
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $9,000
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
This activity relates to activities in Counseling and Testing (#8980), Condoms and Other Prevention
(#9235).
The United Nations High Commissioner for Refugees (UNHCR) will provide targeted Abstinence/ Be
Faithful behavioral interventions to 38,992 young individuals and train 217 people to deliver these
interventions at the Dadaab Refugee Camp in North Eastern Province, Kenya. These include 60
reproductive health motivators will be retrained on HIV Prevention education so that this is incorporated into
their RH education. Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and
Dagahare), and hosts 140,000 Somali refugees and 20,000 Kenyan Somali. Each camp has a hospital and
three satellite health centers. Sentinel surveillance activities in 2005 reported a 1.4% HIV seroprevalence
among ANC clinic attendees, 1.7% among STI patients, indicating a generalized epidemic and providing
estimates of 2300 HIV-infected refugees. UNHCR will build on care activities being provided by its three
implementing partners, GTZ, National Council of Churches of Kenya (NCCK), and CARE Kenya's
Emergency and Refugee Operations (ERO). The AB program will be implemented mainly by two partners;
CARE and NCCK. CARE will target youth in schools and will train thirty teachers from both the camp and
the host population and support them in delivering interventions in school. This will be further boosted by
supporting HIV prevention clubs in schools and training peer educators. NCCK, the lead agency in
community mobilization, education and information on HIV in Dadaab will use multiple approaches to
strengthen behavior change among young people in Dadaab. It will develop age-appropriate and culturally
sensitive IEC material and distribute these widely. It will also expand access to a two-year World Space
radio intervention to increase the number of youth enrolling in listening clubs as well as motivating their
sustained participation. Youth involvement will be enhanced through participatory approaches such as
Magnet Theater. Humanitarian aid workers will also be targeted through workplace programs. These
workers work in isolation from their families for long periods of time and are vulnerable to concurrent and
multiple sexual partnerships. In 2000, UNHCR and its three partners initiated HIV prevention, care and
support services on a limited scale. These partners depend on UNHCR for 80-95% of their Dadaab program
funding. Financial constraints have prevented UNHCR to meet the increasing demand for a comprehensive
HIV program, and additional funding and technical support are necessary to expand the scope and quality
of existing services. Targets are modest because of the extreme remoteness of these areas, and the
challenges associated with conducting activities in the refugee camp and the slow start up expected in
initiating programs in the first year of funding. UNHCR will work in close collaboration with CDC and other
USG agencies for technical guidance on all Emergency Plan program areas.
These activities will contribute to providing comprehensive AB education and life skills to 38,992 youth and
young adults and training 217 people.
These activities will link to condoms and other prevention UNHCR (#9235) and Counseling and Testing
UNHCR (#8980). Populations in Dadaab will be segmented for appropriate interventions and served under
OP and CT programs as need be. The various implementing partners in Dadaab camp will work
collaboratively under UNHCR guidance to offer appropriate interventions to young people including young
married persons.
This activity targets the children and youth from the Dadaab refugee and local population of that North
Eastern Kenya region including youth in school at primary and secondary levels. It will also target out-of-
school youth and refugees in the camp. It also targets community leaders, religious leaders, volunteers and
teachers. These populations are vulnerable to HIV infection and its impact due to their conflict-affected
lives, disintegrated social network and rapid mobility. Program managers and humanitarian aid workers are
also targeted for increased training to improve HIV prevention knowledge and improved perceptions on
Abstinence and Faithfulness.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity addresses legislative issues related to addressing male norms and behavior and increasing
gender equity in HIV/AIDS programs. It will focus on reducing violence and coercion especially as it affects
young refugee girls and women. It will also contribute to addressing stigma and discrimination, a rampant
problem among the refugees and host population.
7. EMPHASIS AREAS
This activity includes major emphasis in community mobilization and participation. It will have a minor
emphasis on human resources, information education and communication, quality assurance and
supportive supervision as well as training.
Continuing Activity: 15014
15014 9215.08 Department of United Nations 7009 4921.08 $200,000
9215 9215.07 Department of United Nations 4921 4921.07 $100,000
Workplace Programs
Table 3.3.02:
This activity relates to activities in Abstinence and Be Faithful Programs (#9215), Counseling and Testing
(#8980), Palliative Care: Basic Health Care and Support (#8736) and HIV/AIDS Treatment: ARV Services
(#8982).
The United Nations High Commissioner for Refugees (UNHCR) will provide condoms and targeted other
prevention activities to 58,826 high-risk individuals and train 175 people to deliver these interventions at the
Dadaab Refugee Camp in North Eastern Province, Kenya. 53 condom outlets, including community-based
distributors and Reproductive health community volunteers will serve as distribution points. This activity will
aim to strengthen condom promotion through increasing the number of condom outlets. 60 nurses/midwives
drawn from all clinics will receive training on safer sexual behavior including correct and consistent condom
use. Community based distributors will enhance social marketing of condoms, increase demand and supply.
Information, education and communication targeted specific groups will be adapted to local languages. 90
health care providers will be trained on post exposure prophylaxis owing to the high levels of sexual
violence. STI refresher training will also be provided. An important focus of this activity will be Positive
Prevention. While general prevention education and campaigns will focus on the general population of
mainly uninfected individuals, special efforts will be put to the small segment of the population who have
HIV and are therefore potentially very high risk individuals in transmitting HIV. Linking up with the
counseling and testing activities, Positive Prevention interventions will ensure that there are targeted
behavioral interventions for individuals with HIV, that unintended pregnancies are prevented among women
with HIV, that there is active STI screening and treatment for individuals with HIV, that there is significant
leadership by individuals with HIV in positive prevention and that most importantly, individuals with HIV
access care and ART treatment to reduce viral load and reduce the risk of HIV transmission. Dadaab,
established in 1991, consists of three settlements (Ifo, Hagadera and Dagahare), and hosts 140,000 Somali
refugees and 20,000 Kenyan Somali. Each camp has a hospital and three satellite health centers. Sentinel
surveillance activities in 2005 reported a 1.4% HIV sero-prevalence among ANC clinic attendees, 1.7%
among STI patients, indicating a generalized epidemic and providing estimates of 2300 HIV-infected
refugees. UNHCR will work with its three implementing partners, GTZ, National Council of Churches of
Kenya (NCCK), and CARE Kenya's Emergency and Refugee Operations (ERO). These partners depend on
UNHCR for 80-95% of their Dadaab program funding. Financial constraints have prevented UNHCR to
meet the increasing demand for a comprehensive HIV program, and additional funding and technical
support are necessary to expand the scope and quality of existing services. Targets are modest because of
the extreme remoteness of these areas, logistical camp challenges and the slow start up expected in
initiating programs in the first project period. UNHCR will work in close collaboration with CDC and other
These activities will contribute to providing comprehensive AB education and life skills to 58, 826 high risk
individuals, including positive prevention among people with HIV. 175 people will be trained to deliver
services. 53 condom outlets will be established.
These activities will link to Abstinence and /Be Faithful UNHCR (#9215) and Counseling and Testing
UNHCR (#8980) as younger youth will be served under the AB program, while those requiring counseling
and testing will be served under CT. Persons needing care and treatment for opportunistic infections or ART
care will be referred to Palliative Care: Basic Health Care and Support (#8736) and Treatment: ARV
Services (#8982).
This activity targets adult men and women as well as Special populations including refugees and out of
school youth. It also targets program, community and religious leaders, volunteers and teachers. These
populations are vulnerable to HIV infection and its impact due to their conflict-affected lives, disintegrated
social network and rapid mobility. This program will also work with community and faith based organizations
including NGOs and implementing agencies. It will serve rural host communities of the North Eastern
Kenya.
This activity addresses legislative issues including increasing gender equity in HIV/AIDS programs,
addressing male norms and behavior and reducing violence and coercion, especially among young refugee
girls and women. These activities will help address stigma and discrimination among the refugees and host
population.
This activity includes major emphasis in community mobilization and minor emphases on human resources,
information education and communication, and training.
Continuing Activity: 15015
15015 9235.08 Department of United Nations 7009 4921.08 $100,000
9235 9235.07 Department of United Nations 4921 4921.07 $100,000
* Addressing male norms and behaviors
* Reducing violence and coercion
Table 3.3.03:
+ New activity emphasis on prevention with positives among patients coming for care and treatment
services.
This activity relates to activities in Abstinence / Be Faithful, Condoms and Other Prevention, Counseling and
Testing, and ARV Services, and OVC.
The United Nations High Commissioner for Refugees (UNHCR) will support expanded palliative care
services to 200 HIV-infected individuals at three sites in the Dadaab Refugee Camp in North Eastern
Province, Kenya that will target both refugees and the local population. Dadaab, established in 1991,
consists of three settlements (Ifo, Hagadera and Dagahare) and hosts 140,000 Somali refugees and 20,000
Kenyan Somali. Each camp has a hospital and three satellite health centers. Sentinel surveillance activities
in 2005 reported a 1.4% HIV sero-prevalence among ANC clinic attendees and 1.7% among STI patients,
indicating a generalized epidemic and providing estimates of 2,300 HIV-infected refugees. UNHCR will
support a package of services that includes clinical evaluation and laboratory monitoring, provision of
cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional support and improved access to
safe drinking water and malaria prevention interventions for at least 50 patients. In addition, 10 health care
workers will also be trained to provide palliative care services using national guidelines. This will include
training in diagnostic counseling and testing to improve/increase provider-initiated testing and subsequently
increase patient enrolment into HIV care. UNHCR will build on established care activities currently being
provided by its three implementing partners, GTZ, National Council of Churches of Kenya (NCCK), and
CARE Kenya, for people with HIV at refugee camp hospitals and health centers. UNHCR will expand care
programs by providing technical support, training staff, supporting staff salaries, conducting laboratory
evaluation, and providing adherence counseling and monitoring. In 2000, UNHCR and its three partners
initiated HIV prevention, care and support services on a limited scale. These partners depend on UNHCR
for 80-95% of their Dadaab program funding. GTZ provides health and nutrition services, the NCCK
supports community-based reproductive health and HIV/AIDS education, and CARE assists with water,
sanitation and education services. Financial constraints have prevented UNHCR from meeting the
increasing demand for a comprehensive HIV program, and additional funding and technical support are
necessary to expand the scope and quality of existing services. UNHCR will work in close collaboration with
CDC and other Unites states government agencies for technical guidance on all Emergency Plan program
areas.
These activities will contribute to expansion of access to palliative care services for people with HIV,
strengthened human resource capacity to deliver care, and a strengthened referral network.
These activities will link to prevention and treatment services provided by UNHCR Abstinence / Be Faithful,
Condoms and Other Prevention, Counseling and Testing, and ARV Services, and to coordination of ARV
scale up supported through National AIDS and STD Control Program.
This activity targets the refugees and local populations, especially people living with HIV/AIDS. These
social network and rapid mobility. Humanitarian aid workers are also targeted for increased training to
improve HIV clinical knowledge and skills.
This activity addresses legislative issues related to provision of care and treatment for refugee populations
and stigma and discrimination.
This activity includes minor emphasis in commodity procurement, human resources, local organization
capacity building, community mobilization, quality assurance and supportive supervision, logistics, and
training.
Continuing Activity: 15016
15016 8736.08 Department of United Nations 7009 4921.08 $100,000
8736 8736.07 Department of United Nations 4921 4921.07 $50,000
Table 3.3.08:
This activity relates to activities in Adult Care and Support, Pediatric Care and Support, TB/HIV Pediatric
Treatment, PMTCT and OVC.
The United Nations High Commissioner for Refugees (UNHCR) will support treatment services for 100 HIV-
infected individuals (including 60 new patients resulting in a 120 ever) at Dadaab Refugee Camp in North
Eastern Province, Kenya and will target both refugees and the local population. Dadaab, which was
refugees and 20,000 Kenyan Somalis. Each camp has a hospital and three satellite health centers. Sentinel
surveillance activities in 2005 reported a 1.4% HIV seroprevalence among ANC clinic attendees, and 1.7%
among STI patients, indicating a generalized epidemic and providing an estimate of 2,300 HIV-infected
refugees. UNHCR will support a package of services that includes clinical evaluation and laboratory
monitoring and provision of treatment services. Training related to treatment services will be provided for 10
health care workers using national guidelines. This will include about adult antiretroviral treatment (ART)
that will subsequently increase patient enrolment into HIV treatment. UNHCR will build on established care
activities currently being provided by its three implementing partners, GTZ, National Council of Churches of
Kenya (NCCK), and CARE Kenya, for people with HIV at refugee camp hospitals and health centers.
UNHCR will expand care programs by providing technical support, training staff, supporting staff salaries,
conducting laboratory evaluation, and providing adherence counseling and monitoring. In 2000, UNHCR
and its three partners initiated HIV prevention, care and support services on a limited scale. These partners
depend on UNHCR for 80-95% of their Dadaab program funding. GTZ provides health and nutrition
services, the NCCK supports community-based reproductive health and HIV/AIDS education, and CARE
assists with water, sanitation and education services. Financial constraints have prevented UNHCR meeting
increasing demand for a comprehensive HIV program. Additional funding and technical support are
CDC and other U.S. government agencies for technical guidance on all Emergency Plan program areas.
These activities will contribute to the expansion of access to palliative care services for people with HIV,
strengthened human resource capacity to deliver care, and an improved referral network.
These activities will link to Adult Care and Support, Pediatric Care and Support, TB/HIV Pediatric
Continuing Activity: 15018
15018 8982.08 Department of United Nations 7009 4921.08 $50,000
8982 8982.07 Department of United Nations 4921 4921.07 $50,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
This activity relates to activities in Abstinence / Be Faithful (#9215), Condoms and Other Prevention
(#9235), Counseling and Testing (#8980), HVTB(#), and ARV Services (#8982).
The United Nations High Commission for Refugees (UNHCR) will support care and support services for 20
HIV-infected children at Dadaab Refugee Camp in North Eastern Province, Kenya, targeting both refugees
and the local population. Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and
among ANC clinic attendees and 1.7% among STI patients, indicating a generalized epidemic and providing
estimates of 2,300 HIV-infected refugees. UNHCR will support a package of services that includes clinical
evaluation and laboratory monitoring, provision of cotrimoxazole prophylaxis, treatment of opportunistic
infections, nutritional support and improved access to safe drinking water and malaria prevention
interventions. In addition, 10 health care workers will be trained to provide palliative care services using
national guidelines. This will include training in diagnostic counseling and testing to improve/increase
provider-initiated testing and subsequently increase patient enrolment into HIV care. UNHCR will build on
established care activities currently being provided by its three implementing partners, GTZ, National
Council of Churches of Kenya (NCCK), and CARE Kenya, for people with HIV at refugee camp hospitals
and health centers. UNHCR will expand care programs by providing technical support, supporting staff
salaries, training staff, conducting laboratory evaluation, and providing adherence counseling and
monitoring. In 2000, UNHCR and its three partners initiated HIV prevention, care and support services on a
limited scale. These partners depend on UNHCR for 80-95% of their Dadaab program funding. GTZ
provides health and nutrition services, the NCCK supports community-based reproductive health and
HIV/AIDS education, and CARE assists with water, sanitation and education services. Financial constraints
have prevented UNHCR from meeting the increasing demand for a comprehensive HIV program, and
additional funding and technical support are necessary to expand the scope and quality of existing services.
UNHCR will work in close collaboration with CDC and other United States government agencies for
technical guidance on all Emergency Plan program areas.
These activities will link to prevention and treatment services provided by UNHCR Abstinence / Be Faithful
(#9215), Condoms and Other Prevention (#9235), Counseling and Testing (#8980), and ARV Services
(#8982), and to coordination of ARV scale up supported through National AIDS and STD Control Program.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.10:
(#9235), Counseling and Testing (#8980), and ARV Services (#8982) and OVC.
The United Nations High Commissioner for Refugees (UNHCR) will support treatment services to 20 HIV-
infected individuals (including 18 new patients) at Dadaab Refugee Camp in North Eastern Province,
Kenya, which targets both refugees and the local population. Dadaab, established in 1991, consists of three
settlements (Ifo, Hagadera and Dagahare), and hosts 140,000 Somali refugees and 20,000 Kenyan
Somalis. Each camp has a hospital and three satellite health centers. Sentinel surveillance activities in 2005
reported a 1.4% HIV seroprevalence among ANC clinic attendees and 1.7% among STI patients, which
indicated a generalized epidemic and provided an estimate of 2,300 HIV-infected refugees. UNHCR will
support a package of services that includes clinical evaluation and laboratory monitoring and provision of
treatment services. Training related to treatment services will be provided for 10 health care workers using
national guidelines. This will include training adult antiretroviral treatment (ART) training that will
subsequently increase patient enrolment into HIV treatment. UNHCR will build on established care activities
currently being provided by its three implementing partners, GTZ, National Council of Churches of Kenya
(NCCK), and CARE Kenya, for people with HIV at refugee camp hospitals and health centers. UNHCR will
expand care programs by providing technical support, supporting staff salaries, training staff, conducting
laboratory evaluation, and providing adherence counseling and monitoring. In 2000, UNHCR and its three
partners initiated HIV prevention, care and support services on a limited scale. These partners depend on
UNHCR for 80-95% of their Dadaab program funding. GTZ provides health and nutrition services, the
NCCK supports community-based reproductive health and HIV/AIDS education, and CARE assists with
water, sanitation and education services. Financial constraints have prevented UNHCR from meeting
Table 3.3.11:
1. ACTIVITY DESCRIPTION & EMPHASIS AREAS
The United Nations High Commission for Refugees (UNHCR) will support TB/HIV to 100 HIV-infected
individuals at Dadaab Refugee Camp in North Eastern Province, Kenya, targeting both refugees and the
local population. Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and Dagahare),
and hosts 140,000 Somali refugees and 20,000 Kenyan Somali. Each camp has a hospital and three
satellite health centers. Intensified TB screening for 100 HIV patients and HIV screening for 200 TB patients
will be offered as a standard of care in all the facilities; approximately 100 patients will be identified as being
infected with both TB and HIV.
Funds will support refresher training of laboratory staff and improvement of basic laboratory microbiology
capacity in order to meet the increased needs for TB testing. 10 health care workers will be trained to
provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals. Funds will support expanded
and strengthened delivery of integrated HIV and TB services including strengthened referral systems.
Additional activities will include community mobilization and dissemination of educational materials to
patients. UNHCR will maintain data concerning the numbers of people served and will report both nationally
and through the Emergency Plan.
UNHCR has been implementing an HIV/AIDS prevention program and outreach to hard-to-reach
populations and rural communities in this area since September 2000. They are uniquely suited to provide
care in refugee situations and remote areas and will build on very substantial existing medical capacity in
the camps. Targets are modest because of the extreme remoteness of these areas, and the challenges
associated with conducting activities in the refugee camps.
This activity relates to activities in Adult Care and Support, Pediatric Care and Support, Adult and Pediatric
ARV Services, Counseling and Testing and OVC.
This activity includes minor emphasis in commodity procurement, development of networks/linkages/referral
systems, community mobilization, human resources, local organization capacity development, quality
assurance, quality improvement and supportive supervision, and training.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
These activities will contribute towards the provision of integrated HIV/TB services for dually infected
patients care by reducing TB morbidity and mortality in HIV-infected individuals and also reducing HIV
related morbidity and mortality in TB patients co-infected with HIV. These activities will strengthen referral
systems, improve diagnostics and treatment of TB among HIV-positive patients and strengthen capacity of
health workers to provide integrated HIV and TB services.
3. LINKS TO OTHER ACTIVITIES
The overall program activity links closely to Adult Care and Support, Pediatric Care and Support, Adult and
Pediatric ARV Services, Abstinence / Be Faithful , Condoms and Other Prevention , Counseling and
Testing , and OVC currently supported by this partner
4. POPULATIONS BEING TARGETED
These activities target children and adults living with HIV/AIDS, including refugees. Public health care
providers, including doctors, nurses, pharmacists, laboratory workers will receive training in the diagnosis
and management of TB using government guidelines.
5. KEY LEGISLATIVE ISSUES ADDRESSED
This activity addresses legislative issues related to stigma and discrimination through community
sensitization activities.
Table 3.3.12:
This activity will attribute $ 10,000 of its budget to supporting education services for OVC as well as $ 1,000
for hygiene improvement and an additional $ 6,000 will be directed to economic strengthening activities
geared at improving household food security for households looking after OVC.
This activity relates to activities in Adult care and support (#), Adult ARV services, PMTCT (#), pediatric
care and support, Pediatric ARV services (#).
The United Nations High Commissioner for Refugees (UNHCR) will provide support services to 2,000
orphans and vulnerable children and train 200 caregivers in the Dadaab Refugee Camp in North Eastern
Province, Kenya. Others who will be trained will include 60 reproductive health motivators who will receive
an OVC orientation so that OVC support is incorporated into their broad RH education and outreach.
Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and Dagahare), and hosts an
estimated total of 173,000 refugees, including 153,000 Somali refugees and 20,000 Kenyan Somali. Each
camp has a hospital and three satellite health centers. Sentinel surveillance activities in 2005 reported a
1.4% HIV seroprevalence among ANC clinic attendees, 1.7% among STI patients, indicating a generalized
epidemic and providing estimate of 2300 HIV-infected refugees. UNHCR will build upon and expand HIV
Prevention and care activities being provided by its three major implementing partners, GTZ, National
Council of Churches of Kenya (NCCK), and CARE Kenya's Emergency and Refugee Operations (ERO).
There are currently approximately 1410 orphans, 351 unaccompanied minors and 3,784 persons with
disability. The OVC program will be implemented mainly by two partners; CARE and NCCK, and others as
UNHCR may consider appropriate. OVC will receive a package of services including as per the PEPFAR
and other UN guidelines, complementary to others services that are already provided through the overall
UNHCR refugee framework. An important element in this program is strengthening HIV prevention
education among OVC to equip them with life skills that would reduce their vulnerability to the risk of HIV
infection. Caregivers will be trained to strengthen the family support system and strong linkages will be
established between PLWHAs, HIV-infected children and health care services, including ensuring that
children and their parents or caregivers and other family members affected access appropriate care and
treatment. The scope of the current programs will be expanded to ensure that they provide a package of
essential services that qualify as primary direct support. All programs will work in close collaboration with
the District Children's Department and will follow guidelines provided by the parent ministry, alongside
PEPFAR and UNHCR guidelines. In 2000, UNHCR and its three partners initiated HIV prevention, care and
UNHCR will contribute 0.4% of PEPFAR-Kenya country targets through providing primary direct support
services to 2000 OVC and training 200 caregivers to support OVC. HIV Prevention education will be
strongly integrated to the OVC program, both for the OVC as well as their caregivers.
These activities will link to Abstinence/ Be Faithful (#9215), condoms and other prevention UNHCR (#9235)
and Counseling and Testing UNHCR (#8980), ARV services (#8982), Basic Health Care and Support
(#8736). The various implementing partners in Dadaab camp will work collaboratively under UNHCR
guidance to offer appropriate interventions to OVC and their caregivers.
This activity targets the Dadaab refugee community, specifically, their orphans and vulnerable children and
their caregivers, unaccompanied minors, older OVC, widows/widowers, HIV/AIDS affected families and
People Living with HIV/AIDS.
6. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED
This activity helps increasing gender equity in HIV/AIDS programs by ensuring the girl children have equal
access to services, and disaggregating data on girl children. It also addresses the wrap around issues of
food and education. It will focus on reducing violence and coercion especially as it affects young refugee
girls and women. It will also contribute to addressing stigma and discrimination, a rampant problem among
the refugees and host population.
Continuing Activity: 16387
16387 16387.08 Department of United Nations 7009 4921.08 $200,000
Estimated amount of funding that is planned for Economic Strengthening $6,000
Estimated amount of funding that is planned for Education $10,000
Table 3.3.13:
The only changes to the program since approval in the 2007 COP are:
+ In FY 2008 UNHCR will implement a broader scope of counseling and testing approaches. This includes
mobile and other integrated outreach CT activities. UNHCR will facilitate the integration of HIV/AIDS service
at community level. In health facilities UNHCR will facilitate training and mentorship for health workers in all
clinical areas. This will lead to expansion of CT in health facilities. This support will be extended to the
nearby heath center and other government facilities in the neighboring areas.
This activity is related to AB, OP, Basic Care and support and ARV services.
IN FY 2009 The United Nations High Commissioner for Refugees (UNHCR) will support counseling and
testing services to 20,000 individuals, for whom 100 counselors and health workers will be trained in 5 sites.
They will be trained in VCT, PITC and couple CT and will work in the Dadaab Refugee Camp in North
Eastern Province, Kenya. The trained CT providers will provide CT services both in the static and mobile
VCT sites as well as in the health facilities in and around the camp. Dadaab Refugee Camp was
established in 1991 and consists of three settlements (Ifo, Hagadera and Dagahaley). It hosts 140,000
Somali refugees and 20,000 Kenyans of the Somali tribe. Each camp has a hospital and three satellite
health centers. Sentinel surveillance activities in 2005 reported a 1.4% HIV sero-prevalence among ANC
clinic attendees, 1.7% among STI patients, indicating that there a generalized epidemic in the camp. From
these statistics, it is estimated that there are 2300 HIV-infected refugees in the camp. UNHCR has been
coordinating health care services in the camp in collaboration with other partners, notably GTZ, National
Council of Churches of Kenya (NCCK), and CARE Kenya. Heath providers trained in PITC will provide
services in the refugee camp hospitals and health centers. Activities will be conducted in close collaboration
with the Ministry of Health personnel to ensure compliance with MOH guidelines as well as to provide
logistical support on the ground. CDC will provide technical support to this activity through conducting site
and service assessments and providing training for counselors through a CDC-designated training agency.
Owing to the low uptake of CT services in Dadaab, intensive community mobilization will be carried out in
conjunction with other activities funded under PEPFAR including OP and AB. Community outreach activities
for primary health care will be integrated so that CT services are seen as an integral part of heath care
delivery.
3. CONTRIBUTION TO OVERALL PROGRAM AREA
The activity will contribute less than 1% of the USG supported CT services in Kenya in FY 2009. However,
the refugee population is considered to be a vulnerable to HIV/AIDS because of the poverty and the
unstable lifestyle. Secondly, there has been insecurity in northern Kenya and Somalia. This means that
services are not readily available or accessible. Kenya, with the support of friendly governments and
international agencies, has an obligation to provide comprehensive health care to refugees and other
displaced persons. Those who will be found to be HIV positive will be referred to care and treatment
facilities.
UNHCR has been working with various sub-partners in Dadaab, in the provision of health services. In FY
2009, it will continue with this trend, by supporting the sub-partners to provide different components of the
HIV/AIDS interventions. This activity will therefore be linked to AB, OP, Palliative Care and ARV services.
This activity will target the entire population in the refugee camp. This includes adults, youth and children. It
will also include refugees and migrant workers
By targeting the entire population, the activity will address issues of gender equity and stigma.
The activity will emphasize community mobilization and capacity building of local organizations. To a lesser
extent they will focus on training, production of IEC materials and development of networks.
Continuing Activity: 21483
21483 21483.08 HHS/Centers for Kenya Medical 6965 1246.08 Uniformed $100,000
Disease Control & Research Institute Services Project
Prevention
Table 3.3.14:
