MSH will partner with AMREF to strengthen integrated laboratory services for the prevention, diagnosis, surveillance and management of HIV/AIDS, STI, TB, Malaria, neglected tropical diseases and non-communicable diseases. Specifically, MSH will: Strengthen the capacity of Ministry of Health to provide stewardship, technical guidance and oversight for laboratory services through coordination of partners and targeting of available resources; empower county health systems establish high performing laboratories at all levels of care for better equity and universal access to quality, efficient, and cost effectiveness laboratory services; strengthen the regulatory environment for policy and governance of laboratories; support lab accreditation efforts, laboratory networking and establishment of structures for a national quality assurance system ; and develop capacity of lab managers to use facility data for planning, budgeting and mobilization of resources.MSH strategy has been to use local Kenyan or regional staff and not long term expatriates. MSH will gradually transition administrative and project management functions to local operating units to reduce financial costs. Facility based training has been employed to improve on cost-efficiency.Transition to country: The MSH approach enhances country buy-in and ownership, collaboration, and empowerment thus leads to self confidence, replication of processes and practices and eventual sustainability. The partnership between AMREF and MSH will be maintained and strengthened.Vehicle information: This partner has not used PEPFAR funds for vehicle purchase in the past. The partner will apply to purchase a vehicle in FY12 to facilitate provision of TA to laboratories across the country. This activity supports GHI/LLC.

The overarching goal of the CDC cooperative agreement with Management sciences for Health (MSH) is to strengthen medical laboratory Systems in Kenya. KNASP III acknowledges laboratories as an essential part of the countrys healthcare plan to support HIV/AIDS prevention, treatment, and care and proposes to increase the percentage of health facilities with the capacity to perform clinical laboratory tests for HIV patients. This activity takes cognizance of GHI principles of principles of country ownership, sustainability and health systems strengthening by focusing on capacity building and development of laboratory policies for MOH. In COP12, MSH will continue to strengthen and expand laboratory systems with emphasis on gaining efficiencies, program quality and country ownership.Support for policy formulation and organizational restructuring will strengthen management and leadership capacity, forecasting for laboratory supplies, budget negotiations and financial management. Lab managers will be empowered to develop budgets and annual operational plans at all levels of service delivery.An integrated systems strengthening approach will be taken with emphasis on; improving access to laboratory services through strengthening of defined and coordinated laboratory networks for specimen referral. These networks which will be operationalized through facility based PEPFAR Care & Treatment partners will also be used to reinforce quality systems and support dissemination of the laboratory policies through a regional approach.MSH will support laboratory accreditation efforts for 25 laboratories, supported at facility level by ASCP and AGHPF, through GCLP/QMS, biosafety, ISO 15189, and leadership trainings. Leadership and management training, follow-on to SLMTA, will target hospital management teams including clinicians, administrators and laboratorians. A total of 200 health care workers will be trained. Support to the national accreditation steering committee (NLASC) will enable MOH make significant moves towards driving the accreditation process. All accreditation applications to KENAS and other accrediting bodies will be channeled through MSH. This will ensure that no conflict of interest arises between the assessors and partners directly supporting QMS improvements.MSH will strengthen laboratory monitoring and evaluation systems and D4DM at national and regional level through implementation of reporting tools, data analysis and dissemination.In partnership with AMREF, MSH will expand national EQA access through the East African Community REQAS program. Additionally AMREF will directly support accreditation of five Nairobi City Council health centers through the WHO Step-wise accreditation process.To build leadership and country ownership for medical laboratory activities, MSH will work with local laboratory related professional associations such as AKMLSO and KACP to develop a core of opinion leaders to diffuse supportive innovations and ideas. Training in writing of scientific papers in peer reviewed journals and grant proposal applications will be supported so as to enhance sustainability of laboratory improvements in Kenya.The integrated approach to laboratory strengthening will benefit not only HIV testing but also testing related TB, malaria, opportunistic infections and neglected tropical diseases.Please see the partners overview narrative for information on the strategy to transition to local partners.

Goals and ObjectivesManagement Sciences for Health (MSH) will contribute to the prevention of medical transmission of HIV (and other blood borne pathogens) through sharps and other medical waste. It will do this by supporting training in Biosafety and blood collection/phlebotomy. Blood drawing has been recognized as a high risk procedure in the country that puts health workers at risk of acquiring HIV and other blood borne pathogens. CDC worked in partnership with NASCOP and BD Company in a public-private partnership (PPP) to pilot this training in 8 health facilities in 2010. In 2011 MSH together with NASCOP have expanded to 19 more facilities throughout the country. Through this funding MSH will scale up these trainings to reach all regions and health workers who draw blood. Additionally MSH will strengthen Biosafety through trainings; this is a key component of laboratory quality and accreditation.Coverage and scope of activitiesMSH will support training of 600 health workers in safe blood collection and 600 health workers in Biosafety. Initial training will aim to develop regional capacities by ensuring that every county in the country has some trained trainers (TOT). Blood collection training will target laboratory workers, clinical officers, doctors, nurses and all health workers identified to collect blood. The training will incorporate some aspects of IPC and waste management. The Biosafety training will target laboratory workers and will also aim to strengthen quality systems. Additionally MSH will support development and dissemination of occupational safety and post-exposure prophylaxis (PEP) policies as well as strengthen sharps injury surveillance system.Integration into programMSH will ensure integration of injection safety, Biosafety, waste management and infection prevention and control principles into HIV and other health programs by training on the same. It will support the pre-service training institutions to integrate the same into training curricula.Country ownership and sustainabilityMSH will adopt the TOT approach to ensure that the country has a pool of qualified and competent trainers throughout all counties. These will then cascade the trainings further down and will ensure sustainability of the efforts.Partnerships and collaborationMSH will work closely with NASCOP and other partners to roll out its activities. As different partners are supporting the Biosafety training it will need to be coordinated by the Biosafety office at national public health laboratories (NPHLS).Quality improvement and M&EQuality assurance and improvements will be a key component of this program. MSH will ensure this by rolling out a strong monitoring and evaluation system with indicators for tracking along the lifespan of the project.Commodity securityThe training in safe phlebotomy and blood collection will have a component on commodity and logistics management. This will ensure that even as health workers join the working field they have the capacity to ensure appropriate forecasting, procurement and usage of various blood drawing devices.