USAI SE AWAR PR ID/KENY ECOND Q ACTIVITY RD ...

USAI

SE

AWAR

PR

ID/KENY

ECOND Q

ACTIVITY

RD NUMBE

ROJECT D

REPOR

DATE

YA –APHIA

UARTER

Y TITLE:

ER: USAI

DATES: JA

RTING PE

E OF SUBM

Aplus Nai

2012 PR

APHIApl

D/ KENYA

ANUARY 2

ERIOD: A

MISSION

irobi- Coa

ROGRESS

lus NAIRO

A RFA NO

2011 –DE

APRIL - JU

: 23TH AU

ast Projec

REPORT

OBI/COA

O: 623-10

CEMBER

UNE 2012

UG, 2012

ct

AST

0-000009

2013

2

9

2 APHIAPlus Nairobi-Coast Report for Quarter 2 - 2012

TABLE OF CONTENTS

TABLE OF CONTENTS

ABBREVIATIONS AND ACRONYMS

LIST OF TABLES:

LIST OF FIGURES:

EXECUTIVE SUMMARY

PROGRAM DESCRIPTION

CONTRIBUTION TO HEALTH SERVICE DELIVERY (Includes result areas 3 & 4)

a) Description of the Work plan status b) Quarterly Performance monitoring matrix c) Analysis of findings of expected outcomes d) Challenges and Recommendations e) Activities planned for the next quarter

CONTRIBUTION TO HEALTH SYSTEMS STRENGTHENING (Result area 1 & 2)

a) Description of the Work plan status b) Strategic approach c) systems strengthening activities d) Linkages with national mechanisms and other programs

MONITORING AND EVALUATION ACTIVITIES

ENVIRONMENTAL COMPLIANCE

ANNEXES

a) Work plan status matrix b) Work plan performance monitoring matrix c) Performance Monitoring Plan d) Cross cutting issues ( gender , youth, equity, whole market, innovations) e) Financial report f) Implementing partners organogram g) Success stories


ABBREVIATIONS AND ACRONYNMS AIDS Acquired Immunodeficiency Syndrome ANC Antenatal Care AOP Annual Operation Plan APH Ante Partum Haemorrhage APHIA Aids, Population and Health Integrated Assistance APHIAplus Aids, Population and Health Integrated Assistance Plus ART Antiretroviral Therapy ARV Anti-retroviral (Drugs) BCC Behavior Change and Communication BMI Body – Mass Index BOQ Bill of quantities CACC Constituency AIDS Control Council CaCx Cancer of the Cervix CBHIS Community Based Health Information System CBO Community Based Organization CCC Comprehensive Care Center CCN City Council of Nairobi CDF Constituency Development Fund CFI ChildFund International CHAP Community Health Action Plan CHC Community Health Committee CHEW Community Health Extension Worker CHS Community Health Strategy CHU Community Health Unit CHW Community Health Worker CIPK Council of Imams and Preachers of Kenya CLTS Community Led Total Sanitation CLUSA Cooperative League of the USA CME Continuous Medical Education CMMB Catholic Mission Medical Board COPBAR Community Based HIV/AIDS Activities Reporting Form COPE Client Oriented Provider Efficient CPGH Coast General Provincial Hospital CSA Community Self-Assessment CSI Child Status Index CSP Concurrent Sexual Partnership CST Community Support Team CSW Commercial Sex Workers CT Counseling and Testing CU Community Unit CYP Contraceptive-Year Protection D&C Dilatation and curettage DAAC Divisional Area Advisory Council DASCO District HIV/AIDS and STI Control Office DBS Dry Blood Samples DC District Commissioner DCO District Clinical officer DEO District Education Officer DHC Dispensary Health Committee DHIS District Health Information System


DHMT District Health Management Team DHRIO District Health Records Information officer DHSF District Health Stakeholders Forum DLTC District Leprosy and Tuberculosis Coordinator DMOH District Medical Officer of Health DNA Di-ribo Nucleic Acid DPHN District Public Health Nurse DPHO District Public Health Officer DQA Data Quality Analysis DTC Diagnostic Counseling and Testing DTLC District Tuberculosis and Leprosy Coordinator DU Drug User EBI Evidence based Initiative ECD Early Childhood Development EID Early Infant Diagnosis EPI Expanded Program on Immunization ETL Education through Listening FANC Focused Antenatal Care FBO Faith Based Organizations FDP Food distribution point FGD Focus Group Discussion FHOK Family Health Options Kenya FOG Fixed Obligation Grant FP Family Planning FS Facilitative Supervision FSW Female Sex Workers GBV Gender Based Violence GIS Geographic Information System GoK Government of Kenya GSN Gold Star Network HAART Highly Active Anti Retrovirus Therapy HBC Home Based Care HBCT Home based Counseling and Testing HCBC Home and Community Based Care HCM Health communications and marketing HCS Home Community Support HCT HIV Counseling and Testing HCW Health Care Workers HEI HIV Exposed Infant HES Household Economic Strengthening HFG HIV Free Generation HH Household HIM Health Images of Men HIV Human Immunodeficiency Virus HMIS Health Management Information System HMT Health Management Team HRIO Health Records Information officer HTC HIV Counseling and Testing ICF Intensified case finding ICL I choose Life Africa ICRH International Centre for Reproductive Health IDU Intravenous Drug Users IEC Information Education and Communication materials


IGA Income Generating Activity IMAM Integrated management of acute malnutrition IMC International medical corps IMCI Integrated Management of Childhood Illnesses IP Implementing Partner IPC Interpersonal Communication IPT Intermittent preventive Therapy ITN Insecticide Treated Net IUCD Intra Uterine Contraceptive Device IYCF Infant and Young Child Feeding KANCO Kenya AIDS NGO consortium KARHP Kenya adolescents reproductive health program KEMRI Kenya Medical Research Institute KEMSA Kenya Medical Supply Agency KEPH Kenya Essential Package for Health KGGA Kenya Girl Guides Association KNH Kenyatta National Hospital KWS Kenya Wildlife Services LACC Locational AIDS Control Committee LCHW Lead Community Health Worker LGBT Lesbians, Gay, Bisexual and Transgender LIP Local Implementing partner LLITN Long Lasting Insecticide Treated Net LOC Locational OVC Committee LQAS Lot Quality Assurance Sampling MARP Most at Risk Population MCH Maternal Child Health MDH Mbagathi District Hospital MDR Multi-Drug Resistant MEWA Muslim Education and Welfare Association MFL Master Facility List MIP Malaria in Pregnancy MNCH Maternal, Newborn and Child Health MOA Ministry of Agriculture MOCD Ministry of cooperatives development MOE Ministry of Education MOGCSD Ministry of Gender, Children and Social Development MOH Ministry of Health MOL Ministry of Labour MOMS Ministry of Medical Services MOPHS Ministry of Public Health and Sanitation MSM Men who have Sex with Men MSW Male Sex Workers MT Metric Tones MTCT Mother to Child Transmission MVA Manual vacuum aspiration MYSA Mathare Youth Sports Association NARESA Network of AIDS Researchers of Eastern & Southern Africa NASCOP National AIDS & STI control program NGI Next Generation Indicators NHMB Nairobi Health Management Board NHP Nutrition Health program


NPI New partners initiative OD Open Defecation ODF Open Defecation Free OJT On Job Training ORT Oral Rehydration Therapy OVC Orphans and Vulnerable Children PAC Post Abortion Care PARTO Provincial anti-retroviral therapy officer PASCO Provincial HIV/AIDS and STI Coordinator PCR Polymerase chain reaction PCV Pneumococcal Vaccinne PDCS Provincial Director of Children services PDPHS Provincial Director of Public Health and sanitation PE Peer Educator PEMA People Marginalized and Afflicted PEP Post Exposure Prophylaxis PHE Population Health and Environment PHMT Provincial Health Management Team PHO Public Health Officer PHRIO Provincial Health Records Information officer PHT Public Health Technician PI Pathfinder International PITC Provider Initiated Testing and Counseling PLHIV People Living with HIV PLTC Provincial Leprosy and Tuberculosis Coordinator PMP Performance Monitoring Plan PMST Provincial Medical Services Team PMTCT Prevention of Mother to Child Transmission PPH Post-Partum haemorrhage PSI Population Service International PTA Parents Teachers association PwP Prevention with Positives QI Quality Improvement RH Reproductive Health RRI Rapid Results Initiative SGC Small Group Communication SILC Saving and Internal lending for communities SMS Short message system SOA Sexual Offences Act SOLWODI Solidarity with Women in Distress SP Sulphadoxine Pyrimethamine STI Sexually Transmitted Infections TA Technical Assistance TAT Turnaround Time TB Tuberculosis TBA Traditional Birth Attendants TBICF TB Intensive Case Finding TOT Trainer of Trainers TOWA Total war on AIDS TWG Technical Working Group UN United Nations


URTI Upper Respiratory Tract Infections USAID United States Agency for International Development VCT Voluntary Counseling and Testing VHC Village Health Committee VIA Visual Inspection with Acetic Acid VILI Visual Inspection with Lugol’s Iodine VMMC Voluntary Medical Male Circumcision VS&L Voluntary Savings and Loans VYC Village Youth Committee WASH Water Sanitation and Hygiene WFP World Food programme WHO World Health Organization WOFAK Women Fighting AIDS in Kenya YFPAC Youth Friendly Post Abortion Care YFS Youth Friendly Service YFS Youth Friendly Service YYC Yes Youth Can


LIST OF FIGURES

Figure 1: Number of mothers tested at ANC and Maternity in Zone 2 for the period: April-June, 2012

Figure 2: Percent ANC Clients Receiving HIV prevention services at ANC for the period: Jul 2011-June 2012

Figure 3: Number of mothers counseled on infant feeding (Nairobi-Coast Provinces) for the period: Oct.2011-Jun 2012

Figure 4: Number of Clients who received HCT services for the period October-2011-June 2012

Figure 5: Number of individuals who received HIV CT services-Oct 2011- Jun 2012

Figure 6: Percent HIV+ Rates in Nairobi for the period-Oct 2011- Jun 2012

Figure 7: Trends in Couple Counseling and testing for the period-Oct 2011- Jun 2012

Figure 8: Total number of Voluntary Medical Male Circumcision clients disaggregated by Age

Figure 9: Number of New, Current and Cumulative Number of Clients on ARV: Oct, 2011-Jun 2012

Figure 10: Number of New clients enrolled on HIV care by entry-points in the A+Z2 Nairobi supported sites

Figure 11: Number of HBC clients served against Number of HBC clients on ART

Figure 12: Proportion of clients enrolled in HIV Care by Entry point

Figure 13: Trends of newly initiated on ARVs, ever on ARVs and current patients on ART: Jan 2011- Jun 2012

Figure 14: HBC Clients by Age and Sex

Figure 15: APHIAPlus Nairobi-Coast Program Defaulter Tracing Flow Chart

Figure 16: No. of individuals provided with HIV-related palliative care (including TB treatment or prophylaxis)

Figure 17: Number of individuals provided with HIV-related palliative care (including TB treatment or prophylaxis)

Figure 18: Number care givers trained on VS&L, VS&L Groups formed and SILC groups monitored in the two quarters

Figure 19: Highlights of Key Achievements under Mentorship and Performance Improvement

LIST OF TABLES: Table 1: Highlights of the key achievements by sub-themes

Table 2: Summary Statistics for Care and Treatment

Table 3: CD4 Testing by Facilities-Coast Province

Table 4: Distribution of services amongst the PHLIV in the last two quarters

Table 5: Number of clients provided with CT services by age at selected sites, Nairobi -Apr-Jun, 2012


EXECUTIVE SUMMARY

This report presents activities and results for the period April - Jun, 2012. APHIAplus Nairobi-Coast has partnered with the MoH, other Ministries, and local implementing partners to refine the means by which performance data are collected, summarized and utilized for better programme coordination and performance improvement.

This second quarter report describes project performance organized by contributions to health service delivery which tracks accomplishments under each of the sub-result areas of both intermediate result areas 3 and 4. Besides, the report demonstrates how the project has built synergy with result area 1 and 2, the result areas that are the domain of national mechanisms.

The report is organized by key programmatic areas: HIV and AIDS, TB, Reproductive Health and Family Planning, Maternal and Neonatal Child Health, Malaria, and to a lesser extent, water and sanitation.

Under health systems strengthening the report describes contributions to strengthening building blocks of the health system.

The Project continued to build on what started in the first five quarters and collaborated with Provincial and District Health Management Teams (PHMTs/DHMTs) and health facilities to implement facility-specific work plans. The two provinces were supported to review the Annual Operating Plan (AOP) implementation and achievements for the period October 2011 to April 2012 at the district and province levels.

The project continued to support the PHMTs/DHMTs with logistics for support supervision as well as stakeholder and technical review meetings to improve service quality and coverage. Orientation meetings were organized for the DHMTs and HMCs to improve governance and leadership at the district and facility levels.

Various activities were supported at the facility and community levels. These included capacity building of the health staff through orientations, continuing medical education, mentorship, technical district/zonal meetings in all service areas (e.g., ART, PMTCT, HTC, VMMC, MNCH, RH/FP, TB, malaria, nutrition and GBV). In order to improve HIV diagnostics and monitoring, the project continued to support lab networks for CD4 in both provinces. To improve MCH services, integrated outreach, FP camps, and cervical cancer screening camps were conducted. As part of task-shifting and enhancement of compliance to treatment and care, the project supported psychosocial support groups, peer groups, and mother-to-mother support groups to help in the facilities with adherence counseling, patient referral, tracking, and defaulter tracing. Male-only clinics were also created to promote increased male involvement in HIV and MCH services, particularly to support facility deliveries and PMTCT services uptake. Non-clinical counselors continued to offer HIV testing and counseling services in the facilities under the project support and Ministry of Health supervision.

The project continued to support voluntary medical male circumcision services in the Nairobi sites and to a lesser extent in services were introduced in Coast. Home-based HTC continued to be supported in both provinces while various forms of HTC outreach targeting MARPS, the national drama festival, RAVE, and FP camps, among others, were also supported.

To ensure that community units discharge their mandates properly, the project continued a variety of activities, including training of community health extension workers and CHWs in technical service areas; dialogue and health action days; provision of reporting tools, bags and shirts; CHEW and CHC meetings, district summits; and allowances to CHWs. Several project-supported CUs are showing improved performance in CBHIS data and this is also reflecting in improved performance of some key indicators in their link health facilities. The project awarded sub-grants to the approved local implementing partners (LIPs) to implement interventions targeting most at-risk populations (MARPs), In and Out of School Youth, and addressing gender issues. In gender, community sensitization sessions on prevention and response to GBV, child abuse and neglect were conducted in both provinces. Youth-focused gender-based violence dialogue sessions were also supported through magnet theatre outreaches and the ‘Sita Kimya’ and G-pange campaigns were supported in various districts.


Result Area 4 interventions focused on strengthening households economic capacities, improving food production, farming, post-harvest management skills and techniques, and enhancing capacity of targeted households and communities to adopt nutritional practices. School- and community-based educational structures were strengthened to ensure improved educational access, retention and completion for orphaned and vulnerable children while at the same time strengthening the literacy skills of caregivers. Access to safe water, sanitation, and hygiene practices were improved for the marginalized, poor, and underserved children and communities in both provinces. To ensure sustainability of these interventions, the project strengthened the governance, management, and leadership skills of leaders, staff and volunteers of community-based organizations. Table 1 below summarizes service uptake in various areas during the quarter.

Table 1: Highlights of the key achievements by sub-themes Selected, combined Quarter(APRIL-JUNE 2012) Achievements Indicator Nairobi Coast APHIAPlus Nairobi/ Coast No. of health facilities supported 189 414 603 No. of PMTCT clients Counseled and Tested 18,741 25,775 44,516

No. of current adult ART clients 19,158 25,848 45006 No. of current peds ART clients 1,402 2,757 4,159 No. of people receiving counseling, HIV

testing, and test results 45,991 82,735 128726

No. of OVC served 80,273 80,150 160,423 No. of HBC clients served 14,617 15,234 29851 CYP achieved 35,557 58,845 94,402 All prevention reached (A, AB, OP) 84,024 85,362 169386

No. infants tested after 6 wks 297 310 607

No. infants tested after 3 months 187 243 430

Table 2: Summary Statistics for Care and Treatment Oct-Dec '11 Jan-March '12 April-June '12 Total Oct`11

to date Newly enrolled on HIV

Care 4,688 5,538 4,900 15,126

New Initiated on ARVs 2,860 2,978 3,037 8,875

Cumulative on Care 122,870 147,185 149,962 149,962

Cumulative on ARVs 58,606 63,425 66,755 66,755

Currently on ARVs 44,524 48,143 49,165 49,165


PROGRAM DESCRIPTION APHIAplus Nairobi-Coast is a five-year services delivery program funded by USAID implemented through a partnership between Pathfinder International, ChildFund International, Cooperative League of the USA, Population Services International, and the Network of AIDS Researchers of Eastern and Southern Africa. The program works within the government health system and within existing national strategies, building on USAID/Kenya’s AIDS, Population and Health Integrated Assistance Program assistance framework. The APHIAPlus framework focuses on integrated health service delivery program for HIV/AIDS and TB prevention, treatment, care and support and, to a lesser extent, RH/FP, malaria, and MCH services as well as transition to integrated service delivery programs with a geographic focus. In essence then, APHIAPlus pursues rapid scaling up of HIV/AIDS activities under PEPFAR within the Kenya National HIV/AIDS Strategy Plan. APHIAplus’ mandate is to help two provinces in improving service delivery, Nairobi and Coast. Service delivery outcomes are heavily influenced by factors that a health system cannot directly address. In order to tackle root causes of fundamental disparities in health outcomes, other sectors need to perform well. During its first year, APHIAplus tried to build on the achievements of the predecessor projects, while putting in place the approach that would address a key set of social determinants of health. In addition, a shift from an emergency driven approach towards an intervention approach that puts sustainable system strengthening as an important secondary objective was implemented. APHIAplus entered its second implementation year with adjusted emphasis: the program cannot achieve its health system strengthening objective when it cannot deliver sufficiently strongly on the prime service delivery objective. Next, HIV/AIDS prevention, care and treatment focus is stated as an explicit programmatic priority. Third, APHIAplus Nairobi and Coast should lead in addressing prevention, care and treatment among the most-at-risk populations in both provinces. Fourth, APHIAplus needs to be outcome focused rather than process focused. Finally, integration of HIV/AIDS prevention, care and treatment efforts with and within other efforts that address key drivers of mortality and morbidity needed to be implemented with more vigour. APHIAplus planned to support Nairobi province in ensuring that 72,000 pregnant women know their HIV status and that 1,850 HIV positive pregnant women receive antiretroviral to reduce the risk of mother to child transmission. For Coast the numbers are 100,000 and 4,200 respectively. The goal is of course that every child born to an HIV positive mother who entered the PMTCT program should be infection free. The total number of people who should receive counselling and testing services with support of the program and who should have received their test results is 240,000 in Nairobi and 360,000 for Coast. In Nairobi 8,400 people should benefit from VCCM. 1,660 are expected to be receiving this service in Coast. The number of people, identified as most-at-risk population, who should be reached with individual or small group level evidence based preventive interventions is 25,400 for Nairobi and 42,000 for Coast. Abstinence and being faithful interventions, individually or in small groups, and in line with minimum standards should reach 40,000 people in Nairobi and 75,000 people in Coast. Individual, small group or community level interventions that explicitly address norms about masculinity related to HIV/AIDs will reach 13,500 people in Nairobi and 78,600 in Coast. The same for gender based violence will reach 46,500 people in Nairobi and another 45,000 in Coast. Interventions of the same type as above, that explicitly aim to increase access to income and productive resources for women and girls impacted by HIV/AIDs will reach 6,500 women and girls in Nairobi and 27,200 in Coast. In Nairobi province, the program should help in reaching 53,000 people living with HIV/AIDs with a package of PwP interventions. 48,800 people in Coast should be reached with the same. 74,000 orphans and vulnerable


children will be served by OVC programs in Nairobi, 80,000 in Coast. The number of HIV positive adults and children that will receive a minimum of one clinical service with support of the program will be 54,000 in Nairobi and 77,000 in Coast. Finally, 4,200 adults and children with advanced HIV infection will be newly enrolled on ART in Nairobi, while the expected number in Coast is 6,700. The respective numbers for adults and children with advanced HIV infection who will be receiving ART is 26,000 in Nairobi and 35,000 in Coast. APHIAplus is a project about scale up and the frame for such scale-up is provided by MOH: nested in the province health systems are level 1 to level 5 service delivery units. This service delivery pyramid is well designed and regularly performing, but chronically under-resourced. The poor, vulnerable or marginalized, have very limited access to the health package due to gaps in service delivery and client demand. The population to be served by this project is a set of large “communities”, Nairobi and Coast province, each having a population of 3 to 4 million people. APHIAplus targets communities, networked communities, not always defined by physical boundaries, or CU catchment areas, but linked as multiple clusters through attributes they have in common. The service delivery pyramid will not deliver if people are not properly linked with it, in clusters or communities that tackle health restoring functions such as prevention, care, treatment and support. All progress in the Kenya health system came about through partnerships. APHIAplus looks at partnerships as an essential resource to the service delivery improvement. Project activities reflect a belief in country ownership and have a focus on: building local skills and supporting systems for sustainability; improving health service demand, access, and quality; reducing barriers for most vulnerable groups; and purposefully addressing social determinants of health in order to maximize health outcomes, especially for the poor, the vulnerable or the marginalized. APHIAPlus applies a two-pronged approach: 1) Maximizing existing service delivery capacity through deliberate integration of MNCH, nutrition, water and sanitation interventions and application of resources to existing programs to accelerate coverage; and 2) strengthening of broader health systems to further expand and sustain health impact by being able to increase access, efficiency, and equity, especially for poor and marginalized populations. The project design framework represents a transition from emergency response type approach into sustainable systems build through service delivery for HIV and AIDS, tuberculosis, reproductive health and family planning, maternal and child health and malaria is implemented to ensure equitable access for all people but especially for the most vulnerable, poor and marginalized. The implementation framework of APHIAplus Nairobi- Coast aims to strengthen the capacity of provincial and district health management teams (DHMTs) to use data to plan, manage, and supervise service delivery, and to improve the capacity of DHMTs for contracting services. It also aims at supporting the government Ministries through the Division of Community Health services to operationalize and implement the national community strategy, including strengthening the capacity and functional utility of the “community unit” of community health workers (CHWs) and community health extension workers (CHEWS). Both Nairobi and Coast share critical health programming characteristics. Both show a high contribution of female sex workers, men-who have sex with men, and injection drug users to new HIV infections. They also have important gaps in services provision to the youth and vulnerable women; have multiple interrelated MNCH/RH needs among most vulnerable groups, and experience structural barriers that reduce access to health services. To respond to these health priorities, the project applies a double-pronged strategy integrating gender and gender-based violence responses by (i) raising awareness on gender and GBV issues in the community, GOK facilities & structures, and consortium partners; and by (ii) enhancing capacity in service delivery at both the facility and community level to ensure comprehensive GBV response and male involvement.


Key result areas that the project responds to in line with the USAID Results Framework are detailed below: Result 3: Increased use of quality health services, products and information

3.1. Increased availability of an integrated package of quality high-impact interventions at community and health facility levels

3.2. Increased demand for an integrated package of quality high-impact interventions at community and health facility levels

3.3. Increased adoption of healthy behaviors 3.4. Increased program effectiveness through innovative approaches

Result 4: Social determinants of health addressed to improve the well-being of targeted communities and populations

4.1. Marginalized, poor and underserved groups have increased access to economic security initiatives through coordination and integration with economic strengthening programs

4.2. Improved food security and nutrition for marginalized, poor and underserved populations 4.3. Marginalized, poor and underserved groups have increased access to education, life skills, and literacy

initiatives through coordination and integration with education programs 4.4. Increased access to safe water, sanitation and improved hygiene 4.5. Strengthened systems, structures and services for protection of marginalized, poor and underserved

populations 4.6. Expanded social mobilization for health


CONTRIBUTION TO HEALTH SERVICE DELIVERY RESULT 3: INCREASED USE OF QUALITY HEALTH SERVICES, PRODUCTS AND

INFORMATION Under this result area, the project works with GoK partners to strengthen the ability of facility and community based services to provide an integrated package of high impact interventions. It is accompanied by a continuous quality improvement process, improving data capture and reporting systems targeting the districts, facility and community levels (levels 1-4) the health system, support to establishment of strong health facility-community linkages and effective referral systems. While this benefits the health system in general, the program prioritizes a continuum of integrated RH/FP, HIV/AIDS/TB, MNCH, and malaria services. 3.1 Increased availability of an integrated package of quality high-impact interventions at

community and health facility levels

3.1.1. Prevention of Mother to Child Transmission (PMTCT) a) Description of Work-plan status All work plan activities were fully covered. In addition, special attention was given to: • Strengthening uptake of ARV prophylaxis/HAART in PMTCT sites through district PMTCT updates • Supporting the GoK structures with the dissemination of cancer of the cervix program tools and guidelines. • Strengthening EID and strengthening corresponding lab services.

b) Quarterly performance monitoring matrix

In Nairobi: • 11 CMEs were conducted and reached 245 participants: the emphasis was on PMTCT Prong 4, and included

IYCF, ARV use in pregnancy, early infant diagnosis. Management of PMTCT data was also included. In two districts 79 service providers received PMTCT updates. CD4 testing for HIV positive mothers was strengthened in the ANC.

• In PMTCT services 15,777 pregnant women were counseled, tested and received their results at ANC with 755 testing HIV positive and 712 issued with prophylactic ARVs. At maternity, 2,964 women were tested, 193 identified as positive and 276 were issued with prophylactic ARVs. HIV testing uptake at both ANC and maternity was 94% and prevalence was 4.9% and 6.5% respectively. Exposed infants issued with prophylactic ARVs at ANC and Maternity was 646 and 345 respectively.

• EID service uptakes using PCR is improving at all facilities in the CWC clinics, which is an indication that babies are closely being monitored and results, received on time. Infants that were tested for HIV using DBS for PCR were 622, 7 were rejected and 34 (5.5%) tested positive. 60 PCR were done at Mbagathi district hospital CCC and none tested positive. 60 PCR were done at Mbagathi district hospital CCC and none tested positive.

• In Mathare North HC enrollment of pediatric care against the number of infants found HIV infected was low. A stakeholders meeting was held to discuss EID from identification of exposed infants, to sample collection and transportation to the laboratory, results collection and linkage to care for HIV infected infants.

• MOH PMTCT tools were introduced at St Mary’s mission hospital and job aids on WHO staging were provided. • Kayole sub-district hospital has greatly improved in doing PCR. 98% of babies at CWC and maternity get

tested and receive the results. APHIAplus motor riders facilitated collection of EID samples and delivered them to KEMRI.

• 12 faith based facilities benefit from a grant to Catholic Medical Mission Board. They tested 2493 ANC mothers for HIV. 77 of them tested positive and 61 were provided with ARV prophylaxis. 75 mothers were provided with cotrimoxazole prophylaxis, 2,554 mother received counseling for IYCF; while EID for HIV was done for 93 HIV exposed infants. The facilities also provide ART, HCT and integrated TB services.


Figure 1: Number of mothers tested at ANC and Maternity in Zone 2 for the period: April-June, 2012

In Coast • PMTCT uptake in the 286 supported health facilities in Coast Province revealed that, 22,541 pregnant women

received HIV counseling and testing for PMTCT and received their results at ANC. 720 women had a positive result at ANC and 703 (98%) of them were issued prophylactic ARVs for PMTCT . 3,234 women were also tested at maternity and 175 were identified as positive. HIV testing uptake at ANC was 96% and prevalence was 3.1%.

Figure 2: Percent ANC Clients Receiving HIV prevention services at ANC for the period: Jul 2011-June 2012

• The DNA PCR lab of CPGH has improved in functionality analyzing 770 DBS samples from 33 sites (up from 529 DBS samples from 14 sites in Q1). The project helps out with airtime and stationary.

• Lab staffs were mentored in commodity security and volumetric analysis. It improves ordering of supplies and reagents. 174 PMTCT sites (compared to 165 sites in Q1) sent 964 samples to the KEMRI lab in Nairobi.

• All districts held PMTCT providers meetings. Meetings incorporated use of DHIS data to assess the standard package of care for PMTCT. The data fed into planning for responsive mentorship, OJTs and CMEs.

• The project also supported CME sessions on PMTCT for a total of 75 participants, from CPGH and Malindi hospital. Follow up of HIV exposed infants was stressed.

‐ 5 10 15 20 25

Inf. tested for HIV @ 3 mnths

Inf. tested for HIV @ 6 wks

In. given NVP in maternity

Moms given ARV pro.@ maternity

Maternity HIV+

Moms tested for HIV @ maternity

Inf.given ARV prop. @ ANC

Moms given ARV prop. @ ANC

ANC HIV+

Mothers tested @(ANC)

Total ANC HIV tests

1st ANC Visit

# PRN cases tested at ANC and Matenity in '000 Thousands

Combined Nairobi-Coast PMTCT Cascade: Apr-Jun, 2012

Nairobi

Coast

- 20 40 60 80

100 120

Q3/ 2011 Q4/2011 Q1/ 2012 Q2/2012Per

cen

t A

NC

Clie

nts

Time (Quarters)

Percent ANC Clients receiving HIV services at ANC over a period of 9 months

PMTCT ANC test rate

Mothers on ARV prophylaxisat ANCInfants on ARV prophylaxisat ANC


c) Analysis of findings • Efforts to improve IYCF (previous CMEs, TA, and integration of PMTCT in MNCH) result in an increase in the

number of mothers provided with counseling for infant feeding. The project is working with the provincial nutrition teams to improve on infant feeding practices at health facilities and community level.

Figure 3: Number of mothers counseled on infant feeding for the period: Oct.11-Jun 12

• Infant prophylaxis in early pregnancy is still not being issued by all health workers. Many consider the 240ml

packaging wasteful. On the other hand, some clients are still declining to be issued with ARV and education for these clients continues.

• The Nairobi team made efforts to help facilities focusing on linkages to care for mothers who turned HIV+ and on EID services. Provision of infant prophylaxis is improving, especially for the private facilities in Nairobi.

• As part of focused orientations, streamlining data capture and reporting were addressed. Several facilities now use the new HMIS tools. We see now pre-ART registers being used at the ANC clinic.

• At the maternity level, mothers who leave their ARV drugs are re-issued with prophylaxis hence the high numbers reported compared to the number who test positive.

• In Nairobi out of 755 pregnant women who tested positive at ANC, 712 (94%) of them were issued prophylactic ARVs for PMTCT. This is an improvement from previous quarter at 90% and can be attributed to improved quality of PMTCT services.

• In Nairobi more women than those who tested positive in maternity were issued with prophylactic ARVs revealing that some women came to maternity with a known seropositive status but without prophylactic ARVs. This is either because they forgot to bring the prophylactic ARVs with them or had declined to take them at ANC. This calls for support of pregnant mothers who test positive to enhance adherence to prophylactic ARVs

• In Coast, 750 doses of infant Nevirapine for prophylaxis were provided at ANC to the HIV positive women translating to 89% coverage of those identified as positive. This is a great improvement from previous quarters 60% and can be attributed to intensified mentorship and support for documentation.

• In Coast, DNA PCR results from analyzed DBS samples for EID showed 7.4% transmission rates for KEMRI samples and 7.8% for CPGH samples. There is a general decline in positivity rates of the samples. This can be interpreted as a positive trend. Longer time series are needed to confirm this.

d) Challenges and recommendations • Most positive PCRs infants come from the private clinics and mothers attending these private clinics are not

offered PMTCT services. • Mothers are now issued with infant and adult prophylaxis at first visit when they test positive for HIV as per

the national guidelines. However in some private facilities, mothers are still being referred for prophylaxis to the nearest facility as they have not been issued with ARVs. The project is working with the DHMT to ensure that all facilities have ARV for prophylaxis.

• Shortage of ANC and HEI registers.

01000200030004000500060007000

Q4 2011 Q1 2012 Q2 2012

No.

of

Mot

her

s

Time (Quarters)

Mothers counseled on infant feeding-Nairobi province

Mothers counseled on infant feeding

010002000300040005000600070008000

Q4 2011 Q1 2012 Q2 2012

No.

of

Mot

her

s

Time (Quarters)

Mothers counseled on infant feeding -Coast Province

Mothers counseled on infant feeding


e) Activities planned for the next quarter include: • Project activities are in general similar to last quarter. • Continue to strengthen mentorship in Nairobi • Strengthen further lab networking systems for DBS collection, in particular in Coast. CPGH has capacity to

analyse more samples. • Final work on the high-end server at CGPH so that results can go straight to the NASCOP EID server

3.1.2 HIV Counseling and Testing (HCT)

a) Description of Work-plan status In an effort to expand availability of HIV CT services, all HTC strategies to address client initiated and provider initiated HTC service demands are supported including mobile HTC outreach services to reach marginalized persons and during integrated outreaches. The work plan list several activities in support of improved HIV counseling and testing. All are on track. The planned roll out of the National Quality Management Framework was delayed. Dissemination material for HIV prevention guidelines is still not available. Lab proficiency testing in Coast was done, while in Nairobi it is scheduled for next quarter. b) Quarterly performance monitoring matrix • The Oct 2011 rationalisation of USG support in Nairobi province changed the volume of service provided with

project support (see performance indicators). But the Q2 uptake has slightly improved compared with Q1. • In Nairobi, 45,991 individuals were counseled tested and received their results compared to 43,430 last

quarter, as part of PITC and VCT services in public and private facilities, and in community level outreaches. In Coast the number was 82,735. In Coast, moonlight HTC in Mombasa and Kilifi targeted key populations along the beach and other hotspots; door to door testing was also conducted in most districts as per plans and prioritizations for DASCOs.

Figure 4: Coast : number of Clients who received HCT services for the period October-2011-June 2012

• In Nairobi, out of 45,991 people tested during the quarter, 3,281 (7.13%) tested positive for HIV. The prevalence of those tested positive in PITC was 12.4 % while for VCT and outreaches the prevalence is 5.2%. In Coast overall positivity for HIV in client initiated settings is 4%. For the age groups 15-24 and 25 and above female clients had 2.8% and 5.9% and males had 2% and 3.6% respectively.

• In Coast, a very high uptake exist (98% of those who accessed HTC services through their own initiative). One observes the increasing number of youth, age 15-24 who come for testing. This is clearly due to integration of testing activities during youth events: 36 % of the 46,613 individuals who take tests and receive their results are in that age bracket. The positivity rate in that group in Coast is 2.5%.

0

20

40

60

80

VCT PITC

No.

clie

nts

'0

00

Time (Quarters)

Total # of CT clients-Oct,2011- Jun, 2012

Q4-2011

Q1-2012

Q2-2012


Figure 5: Nairobi - number of individuals who received HIV CT services-Oct 2011- Jun 2012

• In Nairobi, 1,600 children less than 15 years of age were counseled and tested, 153 (9.56%) tested positive for HIV. In Coast the positivity of test results of children under 15 is also changing in the last two quarters. In the current quarter 1,477 children were counseled, 710 of them were tested and 40 (5.6%) were positive for HIV.

Figure 6: Percent HIV+ Rates in Nairobi for the period-Oct 2011- Jun 2012

• 81 counselors were taken through 6 CME on PwP messages, HTC testing algorithm, couple counseling and

testing and GBV in relation to HIV, Hepatitis B virus infection and presentation of client work for supervision. In Coast the program also supported need-based CMEs and sensitizations on PITC in all level 4 facilities and CPGH reaching 650 health workers.

• In both provinces, all district received support for counselor supervision sessions. In Nairobi a session average counts 15 counselors (16 recommended by the national guidelines. The average session size in Coast is 34. In Coast and Nairobi these sessions were followed up by targeted supervision by senior counselor supervisors to address emerging issues as well as burnout.

• The project supported 4 VCT counselors in every district for six days in a month to increase counseling and testing services at the VCT.

• Child testing was conducted at Mariguini slum in Makadara. 184 children were tested, 3 tested HIV positive. Guardians were counseled and referred to facilities of their choice for accessing the full continuum of HIV services. To close the community-facility linkages loop, copies of the referral notes were shared with the CHWs. They will help with follow up and ensure that the children and guardians reached the facilities and get the services.

• A total of 156 OVC from Kibera were mobilized, counseled and tested in an outreach that was carried out by counselors from Carolina for Kibera Center. 5 OVC tested positive and were referred to nearby CCCs. CHWs attached to them will follow to ensure that they join a support groups for OVC living positive.

• In Coast HTC laboratory proficiency testing was supported for 176 sites. Results were submitted. Feedback from the HIV reference laboratory is awaited.

• In Nairobi 110 proficiency testing panels were distributed to 23 facilities. 67 results of the 110 were submitted and feedback is awaited from National HIV reference laboratory.

10

30

50

70

90

Q2 '11 Q3- '11 Q4-'11 Q1-'12N

o. c

lien

ts '0

00

Time (Quarters)

Total # of indivinduals who received HIV CT services: Apr-2011- Mar-2012

0.0

5.0

10.0

15.0

20.0

Q4-2011 Q1-2012 Q2-2012HIV+ test ra

tes

Time (Quarters)

HIV + rate(%)-Nairobi: Apr-Jun, 2012

HIV + rate(%)


c) Analysis of findings • Once RRI’s are over (see Oct-Dec 2011) demand for couple counseling drops by a factor 4.

Figure 7: Trends in Couple Counseling and testing for the period-Oct 2011- Jun 2012

• Rates of discordant couples are necessarily higher in routine service delivery. This demonstrates that

community level demand creation in rural and peri-urban hard to reach communities is still needed. National level population-based studies (KAIS/KDHS) point to similar findings: awareness levels about HIV and AIDS are quite high in Kenya, but actual number of people tested is still low.

• In Nairobi, erratic supply of test kits is the reason for the slight decrease in the number of people reached with counseling and testing. Erratic supply of HIV test kits also limits the number of outreaches that can be conducted.

• Mathare North HC in Kasarani district recently established a youth desk. Service uptake is increasing, especially in 15-24 yr age category. A total of 124 clients were served (14 were <14, 75 were 15-24, and 35 were 25+) Of the 124, 4 were HIV positive after CT; one client was self-reported HIV positive. All were referred to CCC.

• In Nairobi, only 23 facilities are in the list of NHRL. The project staff is following up to ensure inclusion of other testing sites.

d) Challenges and recommendations • Shortage of test kits, especially during April and May. This affected many facilities. In June most facilities

actually reported having adequate supplies. Communication and feedback from and with KEMSA worked well. • However at Bro Andrea and Mama Lucy Hospital there were shortages of Uni gold and they did DBS in cases

of discrepancy. Results have a long turnaround time, which causes anxiety to the client. • Shortage of HTC counsellors is hampering counselling and testing services, in the meantime the project hires

temporary staff to cover for the shortage and increase coverage in each district

e) Activities planned for the next quarter include: Nairobi • Submit 43 proficiency testing result to NHRL • Provide feedback to facilities on the proficiency testing and address the identified gaps • Support provincial lab quality management systems meeting Coast • Support provision of complete range of HTC services including full integration of HTC into FP services at

Tunza facilities • Facilitation of monthly integrated HCT outreaches and inreaches. • Train selected CHWs , MARPs, and youth volunteers as HTC counselors.

0

2000

4000

6000

8000

10000

12000

Q4-2011 Q1-2012 Q2-2012No.

cou

ples

cou

nsl

ed a

nd

test

ed

Time (Quarters)

HCT – Trends on couple counseling and testing- Nairobi

Counseled

Tested


• Support child HIV testing and counseling at IP level for OVC. • Support HIV counselor’s supervision and ART and PMTCT providers’ meetings. 3.1.3 Voluntary medical male circumcision (VMMC)

a) Description of Work-plan status The workplan lists three activities that capture the support to VMMC: community outreach, establishment of the service and collaboration with NRHP. Each of the activities is implemented and ongoing. At least three outreaches per district per year are planned. The mobilization of CUs in the main mobilization activity. Much more is done. b) Quarterly performance monitoring matrix • In selected districts education and sensitization sessions create demand for quality VMMC services. The

services are offered as an integrated HIV prevention package. • The approach builds on the experience with community based demand creation through the CS. In Kasarani

district, community mobilization by the VMMC team started in June and targeted factories in the industrial area: the team booked interested clients. The procedure was done by appointment.

• Not all sensitizations lead to high uptake (e.g. NYS Engineering School, organised a campaign but uptake was low). Facility based mobilisation is not effective (e.g Marurui HC). Outreaches are needed; moonlight outreach in Awendo village of Dandora was particularily successful; 56 men were circumcised over 2 days. A 24 hour outreach conducted at Kaloleni gave 44 clients for VMMC. 2 clients tested HIV positive and were linked to Makadara HC.

Figure 8: Total number of Voluntary Medical Male Circumcision clients disaggregated by Age

• A circumcision team, supported by the project, provides the services and transfers the skills to the facility

staff. Five teams comprising of a clinician, nurse, counselor and hygiene officer received a VMMC orientation training. The 25 participants come from 5 facilities in Kasarani, Dagoretti, Westlands, Embakasi, and Kamukunji districts.

• A critical pool of TOTs on VMMC is created by supporting the MoH structures through technical orientation sessions on VMMC for service providers.

• Dandora II HC was renovated during this reporting quarter (a minor theater and a recovery room). A total 109 VMMC clients were registered

• At Mama Lucy Kibaki hospital, 97 clients were reached during the quarter. • Tailor-made CMEs and OJTs were offered in Jericho HC. 20 staff now provide high quality VMMC services as

part of the HIV/STI prevention package. • In Westlands HC and Bahati HC the teams are trained and will perform soon.

0

100

200

300

400

500

Q4-2011 Q1-2012 Q2-2012

Tota

l No.

VM

MC

Cle

ints

se

rved

Time (Quarters)

Total Number of Clients provided with VMMC services by age: Oct, 2011-Jun, 2012

Age <15

Age >=15

Total Circumcised


• In Coast, VMMC services were introduced in Kilindini District. Earlier on demand was created in and around the populous Bangladesh slum, which has a high number of non-circumcising communities.

• Coast does not support VMMC teams, but the Kilidini clinician, nurse and counselors received their training from the Nyanza Reproductive Health Society together with the Nairobi teams.

c) Analysis of findings • Men employed in industries need to be targeted and mobilised separately. The nature of their work prevents

them from accessing information in the facilities. • Outreaches create strong awareness: even after the outreach clients continue to seek VMMC services and cite

the information they receive during outreaches as key motivating information • Projects have introduced incentives to increase demand. Communities are now demanding such incentives.

d) Challenges and recommendations • Lack of pharmaceuticals continue to be a barrier to provision of quality VMMC services • The need for renovations at selected sites delays initiation of VMMC services

e) Activities planned for the next quarter include: • Procurement of essential commodities and supplies for VMMC • Intense community level demand creation and expansion of services to cover additional sites. • Support mobile VMMC • TOT training in VMMC for Nairobi Province

3.1.4 Most at risk populations (MARPS) a) Description of Work-plan status By now, the ten activities contributing to result 3.1. are underway, except support to the provision of opioid substitution therapy. The slowdown of activities of grantees during Q1 was corrected during the quarter. The MARPs strategy now implemented follows national guidelines issued by NASCOP. After the dissemination of research on MARPs population size estimates, NASCOP followed up with a consensus meeting regarding different bounds for the different populations. A lot of debate still exists on the accuracy of figures, but for programming purposes the following estimates are recorded for Nairobi and Coast.

PROVINCE ESTIMATES Female Sex Workers Lower bound Median Bound Upper Bound

Nairobi 15,540 29,717 54,467 Coast 19,198 24,353 43,469 Nairobi CBD 6,834 Mombasa (Kisauni, Likoni, Mvita, Changamwe)

6,719 11,660 18,350

IDU Lower Median Upper Plausible

Nairobi 6,368 6,368 10,937


PROVINCE ESTIMATES Coast 2,766 2,766 5,682

MSM Lower Median Upper Plausible

Nairobi 3,375 10,000 22,222

Mombasa 783

MSW Lower Median Upper Plausible

Nairobi 2,000

Coast 2,182

b) Quarterly performance monitoring matrix Nairobi: • In Westlands, DASCO conducted a MARPs outreach and provided integrated services (CT, FP, CaX screening,

clinical consultation, prevention services for under-fives). During the outreach 51 clients were counseled and tested, 4 tested positive and were referred to the CCC.

• During the quarter 2,692 FSW and 439 MSM were reached with various services. • 30 male sex workers from HOYMAS CBO were trained as peer educators by SWOP facilitators for five days

using the draft NASCOP Peer Educators Training Manual. They will begin conducting peer education sessions in July.

• Through 324 SGC’s done by peer educators 3,131 individuals (439 MSM & 2,692 FSW) were reached • A 5 day training on alcohol and drug abuse screening was offered to VCT counselors, nurses and clinical

officers from public and private health facilities in Eastlands • MARPs access HTC in different settings: hot spots, set up tents, brothels, DISC’s, door to door outreaches. A

total of 4,029 clients (2,389 FSW, 418 MSM/ MSW & 1,222 people from the general population) were counseled and tested. Of those tested 56 FSW, 23 MSM/ MSW and 51 people from the general population tested HIV positive and were referred.

• At drop in centres 810 were new clients (39 MSM and 771 FSWs) and 453 repeat clients (25 MSM and 428 FSW) STI screening was done for 1017 clients (59 MSM and 958 FSW) and 156 clients who reported symptoms of STIs were treated. Four DISC’s in Roysambu, Ngara, Eastleigh and Industrial Area offer STI screening and treatment, counseling and testing and cervical cancer screening services. 156 clients who reported symptoms of STIs were treated; 20 FSW received FP services while 15 FSW were screened for cancer of the cervix and 812 clients (93 MSM and 719 FSW) were counseled and tested .43 (19 MSM and 24 FSW) tested positive and were referred for care and treatment. 20 FSW received FP services.

• During the quarter 294 IDUs (65 females and 229 males) were reached with various services. Out of the 154 IDUs tested this quarter, 14 were HIV positive and they were referred to Kangemi Health centre, Riruta health centre, Mbagathi District Hospital and Bahati health centre. Out of the 41 DUs tested 2 female clients turned positive and they were referred to Kangemi Health centreOutreach workers distributed bleach (Jik) to the IDU clients. This was to ensure that the IDUs were using clean injecting equipment to reduce HIV transmission.

• The project’s IDU program reached a higher number of women drug users, majority of who are sex workers and are using multiple drugs. A “women IDU program” was launched at Kimathi DISC. Female IDU’s are given sanitary towels, underpants and food. Challenges are numerous: drug addiction, homelessness, STI’s, post–abortion problems, rape, lack of FP services, stigma/discrimination by providers etc.

• Mature minors, OVCs, who engage in sex work, were started on a rehabilitation programme (13; 3 males and 10 females). The Kenya Voluntary Women Rehabilitation Centre took them through a 3 day self-awareness training to map out the causes of child sex work as well as to sensitise them on alternative lifestyles. These mature minors have experienced sexual abuse, lack of parenting, poverty and other hostile living conditions.


It was a bonding session to build trust with the children and help them open up and share their experiences in life. They were also encouraged to seek health services at the different health. The children expressed their desire to lead an alternative life. They suggested different vocational trainings they would like to be supported for, like hairdressing and catering.

• In total, 540,892 male condoms, 15,340 female condoms and 1,000 lubricant tubes were distributed this quarter to FSW, MSM, IDU’s, DU’s through the outreach workers, peer educators and HTC counselors during the small group sessions, door to door and HTC outreaches

Coast: • In Coast, the project recruited a MARPs Team Manager and an additional MARPS Coordinator. With these

additions, MARPs activities have been be intensified. • Following up on the dissemination of research findings regarding quantification of the different target

populations in Nairobi, Coast Province MoH took a lead in organizing a first regional MARPS stakeholder conference (2nd and 3rd May, 2012). The project had allocated resources for such event. It represents a milestone with regard to improved coordination and joint planning for MARPs interventions.

• The theme of the Conference was “Joint Action for Universal Access to HIV Prevention Care and Treatment services Among MARPs”. The conference brought together 92 stakeholders drawn from GOK, Donors, the MARPs community, researchers, civil society organizations, and the media. At the end of the conference, the Provincial MARPs Technical Working Group was officially launched by Dr Cherutich , Director NASCOP. The Terms of Reference were signed by the Provincial Director of Medical Services and the Provincial Director Public Health and Sanitation.

• The project also focused on training MARPs living with HIV on treatment literacy, PwP and disclosure. Attention went to procurement and distribution of commodities to MARPs. Services were scaled up by supporting sub-grantees on setting up drop-in resource centres for MARPs and mentoring the supported MARP-CBOs to advocate for availability and use of integrated services.

• Progress review meetings were done with sub-grantees. The project service delivery teams supported the establishment of MARPs-friendly services and MARPs friendly outreaches. In Coast, for instance, during a 4-day HTC outreach at Kirawa and Kihingo areas, 21 MARPs were counseled and tested. One individual was found to be HIV positive and referred for care and treatment.

• Sub grantees provide integrated SRH//HIV/AIDS services, information and products using different service models: individual sessions, small group sessions. The service package consists of condom and lubricant distribution, HTC, STI screening and treatment, provision of FP and other referrals.

• Drop in centers and venue based outreaches, organised by partners, offer services for MSM/MSW. 1,075 MSM/MSW received HTC services, 166 were reached with STI services. 1,012 group sessions were held and 12,588 contacts were made, 4,318 of them being new contacts (2,606 males and 1,712 females). A total of 3,125 sachets of lubricants were distributed. A total of 574,440 male and 12,113 female condoms were distributed through MSM/MSW drop in centers and hotspots. The larger number of MSM/MSW reached with education and services were reached through Mombasa HIV Clinic and Ukunda Drop In Service Centre (in Kwale county).

• A network of 264 trained peer educators supported by a grant to ICRH and SOLWODI implement the FSW interventions. 1,841,199 male condoms were distributed to FSW through a variety of channels. A total of 17, 096 female condoms were also distributed.

• FSW peer educators conducted 2001 small group communication sessions and made 31,381 contacts, of which 5,586 were new contacts. During the same period 944 FWS were counseled and tested for HIV, 532 accessed HTC services through the FSW drop in centers and 412 through four moonlight outreaches; during outreaches 121 FSWs received STI services as part of the integrated package of health. In the same reporting period, 927 female clients (non sex workers) accessed CT services at FSW drop in centers.

• Outreach workers and peer educators in the community of People Who Use Drugs (PWUD) and People Who Inject Drugs (PWID) were trained and capacity built; integrated biomedical services were provided in integrated mobile outreaches and in situ sites. Local implementing partners conducted behavioral interventions making use of BCC and IEC materials. Consumables for harm reduction were distributed. 1,973 People Who Use Drugs (PWUD) including 270 who inject drugs were reached with individual or small group


sessions that meet the standards of evidenced based interventions (1,492 male, 481 female). Out of these, 1,312 PWUD accessed HTC services, (966 male and 346 female) as part the integrated package. In the same reporting period, 158 male and 112 female IDUs were reached. Muslim Education and Welfare Association (MEWA) carried out one community stakeholders’ sensitization and 20 community leaders attended. Mombasa city council sensitized 104 staff on substance abuse.

• Through OMARI Project, 81 prisoners were reached with prevention education in Malindi. Project staff visited Shimo La Tewa Prisons and discussed collaboration. An MOU is forthcoming during the next quarter.

• The community of Lesbians, Gay, Bi-sexual and Transgendered is reached through PEMA Kenya, Tamba Pwani and UKWELI Africa. The granting mechanism is a PIP (Pathfinder Implemented Projects). 40 LGBT peer educators from Tamba Pwani and UKWELI Africa underwent a four day training on Education Through Listening (ETL). Once PEMA comes on board as a sub-grantee, LGBT activities will intensify. Project staff attended the advocacy event on LGBT in the American Embassy. The event commemorated the advances made in identifying the plight of LGBT people in the world.

c) Analysis of findings • The activities currently underway clearly represent a good portfolio for MARPS, but gaps still exist and quality

of programming can be improved. Coordination is a challenge and documentation of results still needs more attention.

• The unsatisfied needs for services for female sex workers who are also IDUs is impressive. Small group sessions conducted with the women IDUs at the drop in centers in Nairobi on addiction counseling, nutritional support and health education revealed how large the gap in services is. A medical in-reach was organized for the women at Westlands Health centre. 63 women were put on family planning, specifically Norplant (as per their request). They were treated for STIs, TB, pneumonia, post –abortion complications and abscesses. 44 children were treated for various ailments mainly pneumonia and flu. 6 babies were also immunized. 48 IDU (39 female and 9 men) were counceled and tested. 3 women tested HIV positive and were link to care and treatment. No men IDU tested positive.

• The individual dramas among female IDUs can be summarized by the following story: a female IDU, with six months old child, requests Norplant to the nurse. The nurse understands the women is pregnant and counsels. The disappointed women tells her story:” this will be my fifth child... I don’t know what to do... I had stayed for a whole day without drugs and the withdrawal symptoms were too overwhelming. One of the men promised to share with me the heroin but only if I had sex with him. I accepted and now I’m pregnant”.

d) Challenges and recommendations • Within the general population, workplaces represent clusters of people with a definite need for targeted

prevention. The project intends to design interventions that better address formal workplaces and matatu workers. Most of the services will probably be provided through integrated mobile outreaches and through the Clustered HIA/AIDS Enterprise Partners (CHEP) Network.

• During the conference, stakeholders requested MOH and APHIAplus to commence activities aimed at targeting fisher folks in Coast. A consultative meeting was held with DASCOs from Kwale, Mombasa, Lamu and Kilifi Counties. There are over 250,000 fisher people in the fishing industry in Coast (boat making and repairs, fishing, transport and fish processing). A learning exchange visit to Nyanza is planned for next quarter.

• Reaching women IDUs still remains a challenge. Through the IDU women program we expect to reach more women IDU. Some health care providers refuse to provide services to IDU’s because IDU’s are either still high or are very dirty. As a result of this, a session on human rights for people who inject drugs and stigma should be added to the trainings. This was done with success in one training.

• Addressing MNCH including the FP unmet needs of IDU women and their children is a major challenge. Through the IDU women program the project will sensitize the women on the need for these services, support FGDs to elicit the barriers on access and sensitize the service providers at facility level on MARPs friendly services.

• Inadequate supplies of antibiotics for use during inreaches at public facilities • The tool that partners use to capture data only captures two indicators. MARPS staff are working with M&E to

develop tools to capture more indicators.


• We still learn what is needed to provide outreach services: in outreach services organised in Westlands, clients were under the influence of drugs and so difficult to handle; men did not voluntarily access services. There is need to have an addiction counselor during outreaches. There is also need to follow up clients who default treatment as a result of being caught by law enforcers during their activities in the night.

• Small sub-groups like OVC MARPS need programs that cater for their specific needs. As MARPs interventions gather momentum, the urban microcosmos reveals individuals at the extreme end of the marginalised spectrum. Those pre-teens are engaged in commercial sex and are targets that need to be safeguarded from early infection : girls, at very young age, sexually active and almost irreversibly connected in the vast network of high risk groups.

• 30 IDUs had been given bleach in April. One month later, they complained that bleach makes their needles blunt, hence they can’t re-use the needles. They did not return for their refills.

• The shortage of test kits affected the numbers of people tested in the drop in centers. The project liaises with DASCOs to ensure adequate supplies.

e) Activities planned for the next quarter include:

Coast

• Assessment of potential MARPS friendly clinics • Produce inventory of organizations working with MARPS in all Coast Counties. • Exchange learning visit to Nyanza. • Technical assistance to MARPS grantees

Nairobi

• Renew the grant for BHESP and SAPTA • Work with IDU women to identify barriers to accessing MNCH including FP services • Hold a MARPs partners meeting to ensure uniformity in approaches • Conduct in reaches especially for women IDUs and their children • Conduct staff orientation for MARPs and outreaches to MARPs

3.1.5 HIV Care and Treatment a) Description of work-plan status Activities under HIV Care and Treatment and HIV/TB integration constitute the single largest component of the workplan. They reflect the importance and complexity of the interventions: strengthening service delivery systems in such manner that service delivery targets for quality HIV care and treatment services can be achieved by the two provinces supported by the program. Most activities, once launched in year one or during the first quarter are ongoing. Among the circa 35 listed individualized activities, the workplan status report identifies the following non implemented activities: • Train peer educators in workplaces on community PwP’s • Support TB pediatric intensive case finding and treatment • Pilot TB intensive case finding tools in OVC community The remaining activities are fully part of the support package that NASCOP and the TB program expect partners to support.



In Nairobi: • Viral load testing, community facility linkages in support of defaulter tracing and establishment of support

groups were priorities for the Nairobi team. Sites who received this support, also received the required registers.

• 9 facilities provided CD4 laboratory hubs for the laboratory network. 11,785 CD4 tests were run from supported facilities in these laboratories

• A full one day CME on treatment failure and viral load monitoring was held for staff working at the CCCs. 13 other CMEs were held: on HBC, management of OIs, defaulter tracing, pharmacovigilance, commodity management, community strategy, HIV data collection tools, resistance to HIV drugs WHO staging in the ANC, and non-communicable disease in HIV positive clients. 428 participants were reached.

• Inter-departmental meetings were held at Kariobangi HC, Kahawa West HC, Jericho HC, STC Casino, Kangemi HC, Westlands HC, Ngong Road HC and Mbagathi DH. These are precious opportunities for multi-disciplinary teams to cover a wide range of subjects relevant to treatment and care: couple counseling, long term family planning methods, follow up of exposed infants at CWC, HIV awareness among post natal mothers, TB/HIV integration, commodity management, record keeping, creation of linkages between PMTCT and CCC, triage, the clients, health literacy training, defaulter tracing, viral load testing and PWP.

• This quarter saw the start of the viral load testing in supported facilities. 189 viral load tests were done, of which 106 were from Mbagathi District Hospital and the rest from Dandora II, Ngong road, and Lunga lunga HCs and Kayole sub district hospital. St Mary mission hospital had 9 tests done for viral load at KEMRI.

• 9 facilities provided CD4 laboratory hubs for the laboratory network. 11,785 CD4 tests were run from supported facilities in these laboratories. All facilities with lab services were provided with logistic support for reagents.

• During the quarter, 1,359 new clients were initiated on ART, 20,560 continued on treatment and the project has to date initiated 27,514 patients to ART in a total of 99 facilities.

Figure 9: Number of New, Current and Cumulative Number of Clients on ARV: Oct, 2011-Jun 2012

0

5,000

10,000

15,000

20,000

25,000

30,000

New Clients Current Clients CummulativeClients

No.

Clie

nts

on

AR

V

Time (Quarters)

Number of New, Current and Cummulative clients on ARV In Nairobi : Oct 2011-Jun 2012

Oct-Dec 2011

Jan -Mar 2012

Apr-May 2012

•

•

•

•

•

•

•

Figure

• APHIAplusand this in

• Mbaghati discordaninterventio

• Gertrude services: male supp

• 152 CHWMakadaraKiambiu, form supp

• A total of 24%. HCmanagem

• 1,280 PLHincluded H

• CUs, CCCUpdates f

No

ofN

ewpa

tien

ts

2 4 6 8

10 12 14 16

No. HBC

Clients

10: Number o

s continued itncludes ARV cDH receives t couples, dons strengtheGarden Childpartial disclo

port group. s drawn from were traineNgomongo in

port groups fo14,617 PLHI

CBC promotesment of OIs, a

Figu

HIV attended HIV+ concordCs, or IPs oftfocus on: ad

0

200

400

600

800

1000

1200

P

No.

of

New

pat

ien

ts

enro

lled

on C

are

No. o

-2,0004,0006,0008,0000,0002,0004,0006,000

Jan - M11

APHIAPlus

of New clients

ts support to commodities the following

drug addicts)en adherence dren’s Hospitaosure to HIV

m Kosovo in Ked in HCBC. n Korogocho,or their clientsIV are enrolles acceptancend for other R

ure 11: Numbe

health literacdant couples, ten request uherence, disc

MTCT VCT

of new patient

Mar Apr - Ju'11

HBC clie

Nairobi-Coa

s enrolled on H

the district pfor CCC and P

g project supp), defaulter and disclosu

al uses projecpositive child

Kamukunji, NOthers were and Kuwinds.

ed in the HCBe for PLHIV RH services a

er of HBC clien

cy/CPwP trainrefugee supp

updates. 62 sclosure, stigm

T TB patients

Points of

ts enrolled forsup

n Jul-Sep11

Time (Q

ents served

ast Report fo

HIV care by en

pharmacists foPMTCT. port: CME, trtracing and re. ct investmendren, support

gomongo in e trained on a (Kibera) in

BC program. 8at househo

nd promotes

nts served aga

ing, providingport groups, ysuch groups

ma, FP, cervic

s In-Patients

f service

r HIV care by epported sites

Oct-Dec.'11

Ja

Quarters)

d against HB

or Quarter 2

ntry-points in

or collection a

ransport, supp commoditie

ts to continut groups and

Kasarani, Sowdefaulter tra

Langata). T

88% of them old and comm

positive living

ainst Number

g a package oyouth and one

received updcal cancer, c

CWC PIT

entry points i

an-March.'12

Apr

BC clients o

2 - 2012

the A+Z2 Nai

and distributio

port groups (es for CCC.

uously innova their links t

weto in Langacing (133 C

The CHWs we

are on ART. munity level,g as well as c

of HBC clients

of integrated e support grodates. They condom use a

TC

n Nairobi ART

J

A

ril-June.'12

on ART

irobi supporte

on of drugs to

(for pregnantPsychosocia

te and strengto microfinanc

ata, and MakCHWs from Kere also enco

Male clients , ensures recommunity Pw

s on ART

messages. Paoup for men oreached 1,10and nutrition

T

an-Mar'12

Apr-may'12

HBC clients

HBC Clients oARVs

27

ed sites

o facilities

t mothers, l support

gthens its ce, a first

kongeni in Kosovo in uraged to

represent eferral for wP.

articipants only. 07 PLHIV. . A youth

on


support group from Mbagathi DH was among them. There was also a support group for men only, which is rare. 12 new support groups were formed this quarter (new total: 196 support groups).

• Youth living with HIV, a support group at Kenyatta University was invited for an exchange visit to Mbagathi DH to learn how to conduct youth days. In exchange, the Mbagathi youth learned that they can progress with their education up to University level as long as they adhere to treatment and care.

• In addition to community-based support groups, there was a great focus on CCC support groups for project-supported facilities.

• 163 caregivers/guardians of OVC (153 females) in 4 support groups received a 2 day sensitization on Treatment Literacy. Sessions were facilitated by experienced HIV AIDs advocates

• Three support groups for people with disabilities held their meetings. Every quarter several OVC with disabilities benefit from specific equipment or aids procured by the project. This time 4 wheel chairs, 1 Yaya seat, standing aid, training walker, two pair of boots, hand splint and KAFO were distributed. Caregivers appreciate this support.

• One child visited Nairobi Audiology Centre at KNH and was diagnosed with autism and mental retardation. Special education was recommended. The project will follow up to enrol him to a special school. 8 OVC with epilepsy continued to attend clinics at Huruma Lions H/C. 24 OVC with disabilities were referred to APDK. Measurements were taken at the IP sites. Procurement for these appliances and aids is under way. 94 OVC were assessed for various disabilities. APDK provided them with treatment recommendations.

In Coast: • All districts received support to conduct quarterly ART provider meetings: the revised guidelines were shared,

providers discuss data from DHIS, identify performance gaps, chart the way forward and discuss challenges such as scale up of pediatric HIV care and treatment.

• Several CME’s were supported. Subjects covered are: ART adherence, cohort analysis, WHO staging and eligibility criteria and HAART regimens as recommended in the GOK guidelines, HIV and TB integration and PwP.

• On-Job-Training on safe phlebotomy to improve the quality of collected blood samples was supported. • All ART sites were provided with logistical support. 6 CD4 testing labs report the following:

Table 3: CD4 Testing by Facilities-Coast Province Testing lab No. of facilities referring samples No of samples analyzed

Malindi D.H 29 1,617

Kilifi D.H 16 826

Port Reitz D.H 8 1,041

CPGH 33 5,605

Kwale D.H 23 847

TOTAL 15,541

• 2,740 clients (1,909 Female and 831 Male) were enrolled for HIV care and 1,678 (566 Male and 1,112

Female) were initiated on ART. 133 (73 Female and 60 Male) were children less than 14 years. majority of new clients enter HIV care from VCT (41%). Outpatient and PMTCT contribute to 32% and 17% respectively.


Figure 12: Coast: Proportion of clients enrolled in HIV Care by Entry point

• Cumulatively, 92,614 persons (9,176 children and 83,438 adults) have ever been enrolled for HIV in the Coast province APHIA plus supported ART sites. 39,241 (14,195 Male and 25,046 Female) have ever been initiated on ART. 28,605 (9,510 Male and 19,095Female) individuals are reported to be currently receiving ART which constitutes 73% active.

Figure 13: Trends of newly initiated on ARVs, ever on ARVs and current patients on ART: Jan 2011- Jun 2012

Table 4: Distribution of services amongst the PLHIVs in the last two quarters

Quarter Adherence counselling

Social support

Supportive disclosure

Risk reduction counselling

Condoms distributed

Receiving nutritional support

Economic empowerment

Screened for TB

Jan-March 2012

7,353 5,394 7,139 6,583 4,772 6,023 665 485

April- June 2012

12,712 12,606 11,997 12,523 13,493 11,077 11,878 1,079

17%

41%

4%3%

3%

32%

% clients enrolled in HIV Care by Entry/Service point

PMTCT

VCT

TB Patients

In patients

CWC

Out patient

05000

1000015000200002500030000350004000045000

Q1-2011 Q2-2011 Q3-2011 Q4-2011 Q1-2012 Q2-2012

No.

Clie

nts

on

AR

Vs

Time (Quarters)

Number of clients newly initiated on ARVs, ever on ARVs and Current on ART- Coast Province: Jan 2011-Jun 2012

Cummulative

Current onARVs


Figure 14: Coast: HBC Clients by Age and Sex

• 507 community PwP service providers (PLHIVs and CHWs) underwent training. • All services to PLHIV increased during : adherence counseling, risk reduction and supportive disclosure

prevention messages. • 9 support meetings were conducted with PLHIV advocates; 270 PLHIV advocates participated. • 8 CCC/ART sites were supported to conduct family days: 580 PLHIVs were reached. • 27 health facilities established HCBC desks for referrals: Mombasa county (4), Kilifi & Kaloleni (6), Lamu &

Malindi (5), Kwale county (6), Taita Taveta (6) • IPs added 5 OVC support groups for children living with HIV (total OVC support groups in Coast : 12). 420

caregivers with HIV positive OVC under their care were sensitized by DASCO’s on how to care for such children in regard to ART and home based care. District children’s officers were also involved. Participating caregivers promised to enroll their children in support groups. The project will also be supporting the participating members with food rations as a motivation and means to their ART nutritional requirement.

c) Analysis of findings • A system for defaulter tracing was put in place in Nairobi facilities. The new system generates a weekly list of

defaulters. In all 9 districts clinicians and CHWs are receiving airtime. Clients are traced, put back on treatment after counseling, linked to CHWs and are encouraged to join support groups. They’re also encouraged to attend treatment literacy training.

0500

100015002000250030003500

Kwale Kilindini Mombasa Taita Taveta Kaloleni Kilifi Lamu Malindi

# of H

BC clients

Districts

Number of HBC clients disaggregated by sex and age

Client 0-14yrs M Client 0-14yrs F Client 15 yrs & above M Client 15 yrs & above F

•

•

•

•

f)

•

•

•

• The transregimentseasy way

• The childrmates: baPLHIV. Th

• The coundiscriminaenquire ab

In responNairobi. Tmeetings)

) Challeng

• Facilities i APHIAplusfacilities lheight antriage whhypertens

• Facilities l

In April, vacutaineat Mbagat

• There is n

and lactat

Figure 15:

sformation fos of their medof taking druren had carriasic facts abohey help eachselors comme

ation and thebout their pro

nse to a meetThis is the re)

ges and reco

n Nairobi exp

s proposed mike Ruben ced retrieving cile the CHW

sive or experie

ack resources

STC Casino Crs, while Matthi DH where

need for drugste strips to fac

APHIAPlus

APHIAPlus

or OVC in sudication. Theirugs. ied out a lot out HIV, posith other takingended the ef

e nurses helpeogress when tting re: avoid

eason for a re

ommendatio

perience staff

modalities of imenter the CHclinical files. Aretrieves theencing weight

s for simple m

CD4 machinethare North Hfollow up wit

s for non-comcilitate quicke

Nairobi-Coa

Nairobi-Coa

upport groupr consumption

of awarenestive living. ThARVs while a

fforts the OVed them undthey make CCding double reduction in th

ons

shortage. It

mproving triagHW has beenAt Dandora IIe files. Triagint loss are not

maintenance o

e broke downHC vortex macth SCMS is on

mmunicable der diagnosis fo

ast Report fo

ast Program

s has been n of drugs (AR

ss creation, fohis changed that school and

VCs were putterstand the b

CC visits. eporting, 741h indicator (1

makes triagin

ge in these fa assisting wiI HC, the facng has greatlt missed out.

of equipment

n; In June, chine broke. ngoing.

iseases, timeor cryptococc

or Quarter 2

m Defaulter T

outstanding. RVS) is very e

or the last thhe perceptionin public plac

ting to ensurbest commun

1 OVC attend1,974 OVCs w

ng at CCC a c

acilities with tith triaging bcility in-chargely improved q

.

Mbagathi DHSuch problem

ely supply of rcal meningitis

2 - 2012

Tracing Flow

They have effective, and

hree months,n of many whces. re they were nication meth

ded the Lea Twho attend m

hallenge.

the limited nuby taking teme allocated a quality of car

H ran out of ms have since

reagents, vacand lactic ac

w Chart

mastered thd some have d

to friends aho discriminat

safe from sthods they cou

Toto support monthly supp

umber of staffmperature, w nurse and are and clients

calibration be been resolv

utainers and cidosis.

31

he various developed

nd school te against

tigma and uld use to

groups in port group

f. In some weight and a room for s who are

beads and ved except

CRAG kits


The project is in the process of procuring the items. The facility has also expressed need for a nutritionist and one was employed under the Capacity project.

• In Nairobi facilities patients were found to have information gaps.

Pre-ART mini groups were therefore introduced. They consist of short sessions on ART for CCC clients waiting to be initiated on ART. PLHIV advocates provide in depth discussions, addressing fears and discussing potential challenges. This complements preparation done at the CCC and addresses misconceptions and provides a forum where clients find answers to their ART questions. The personal experience of these PLHIV advocates, formerly trained by APHIA II or APHIAplus, uniquely qualifies them to address these knowledge gaps among CCC clients. Such sessions were conducted for a total of 60 pre-ART mini groups from the following APHIAplus-supported CCCs: Mbagathi DH, Kivuli Dispensary, Westlands HC, St Mary’s hospital, Kariobangi HC, Mathare North HC, Kahawa West HC, Kasarani HC, St Francis hospital, Bahati HC, Casino HC, and Ngaira HC.

• Disclosure to children: many of the PLHIV who attended the health literacy trainings attested to the fact that they find it very difficult to disclose their status to their children, fearing the effects. However, they were encouraged to do so, especially to older children, because their children form part of their support structure as a family.

• Disclosure was a challenge to caregivers of Children Living with HIV and the DHMT members committed to demystify the same through sensitizations in schools and community dialogues.

• Low turn-out of men for HIV care and treatment – although the numbers of men attending health literacy training is increasing slowly, it is still low compared to women. It was however encouraging to meet a men-only support group who can become advocates to other men.

• Topical updates on ARVs are somewhat difficult for CHWs: during a CHWs monthly meeting at Kivuli an update on ARVs was provided. The classifications of the different regimes confuses CHWs especially with the new ART guidelines. The advocate who is also trained on CPwP updated them on the different regimes used on 1st and 2nd lines and how they should be administered. 26 CHWs attended.

• Need for an additional motorcycle rider to improve on coverage for viral load testing, CD4 testing and DBS collection

• Staff-turnover is high in private sites and this greatly interrupts services at the facilities. Frequent visits to the sites and provision of job aids and SOPs to the facilities are some of the strategies used to address this problem

• Baseline tests are a challenge in most facilities due to equipment failures. There is a lack of service contracts for the Hematology and Chemistry analyzers. Urgent intervention is needed for the repair of analyzers.

g) Activities planned for the next quarter include:

Nairobi • Support multidisciplinary team meetings at ART sites • Support specific referral labs the laboratory transport network • Support CME in nutrition in HIV and pediatric HIV. • Strengthen commodity management for ARV and OI drugs • Treatment literacy training for caregivers supporting OVC with HIV • Support expansion and strengthening of referral desks at the CCCs. • Strengthen and expand support groups for PLHIV. • Conduct orientation of service providers on pediatric HIV care and treatment • Expand progressively the establishment of family days at some CCC. • Strengthen follow up mechanisms for patient defaulter tracing • Support mentorship and supervision on adult and pediatric HIV care and treatment


3.1.6 TB/ HIV Integration a) Description of Work-plan status

Activities are essentially integrated under HIV/AIDS care and treatment, but a few activities are mentioned separately in the workplan. They emphasize the 5 I's for HCW and CHW. There was planned support for Integrate HIV care and treatment in TB clinic, although in Nairobi this is still under discussion at PHMT level. There was also support for strengthening logistics of sputum collection from facility to reference lab transport. Furthermore, there was support to integrated TB out-reaches and in-reaches, to the provision of food supplements for TB/HIV patients with identified needs and finally for TB data management. b) Quarterly performance monitoring matrix

Nairobi: • Integration of TB services into the HIV clinic continues to be supported. TB patients are tested for HIV

infection and CCC clients screened for TB co-infection (use of TB ICF tools at the CCC). Infection control measures are being put in place in the clinic, outpatient as well as at community level. E.g. at Ngaira dispensary, 18 TB clients were traced back and 12 home visits made.

• 151 HCWs were reached with 6 CMEs on nutrition in TB, TB management, TB ICF, MDR TB. • A new MDR client was diagnosed at Jericho. The project supported by providing a tent during treatment. As

an immediate response to strengthen prevention, a CME on MDR management was conducted at Jericho HC and 18 staffs were reached.

• Isoniazid prophylactic therapy (IPT) has not been strong in the program but with the dissemination of the new ART guideline this is being emphasized.

• Orientations on TB case management and MDR TB were conducted for 95 health workers. The Districts conducted TB stakeholders meetings in which CBOs and CHWs reviewed performance of TB indicators and discussed a way forward.

• Active TB case finding was also supported in the Districts

In Coast: • 60 CHWs oriented on TB case management including sputum collection, defaulter tracing and treatment. c) Analysis of findings • The number of new TB cases detected in the TB service outlets were 2,064 of whom 981 were smear

positive. Testing results revealed that 94% of TB patients were tested for HIV, 32% were found to be TB HIV co infected and 95% of those co infected had been enrolled for care and were on cotrimoxazole prophylaxis. 1,268 patients are reported to have completed TB treatment during the quarter.

• A total of 24 patients are receiving treatment for MDR TB. All of them are receiving treatment through the community approach. 10 patients have successfully completed treatment and two died since the program began in 2009.


Figure 16: No. of individuals provided with HIV-related palliative care (including TB treatment or prophylaxis)

Figure 17: Number of individuals provided with HIV-related palliative care (including TB treatment or prophylaxis)

d) Activities planned for next quarter: • CMEs on 5Is, and orientations on TB HIV and MDR TB. • Active TB case finding • Quarterly stakeholders meetings • Procure a tent for treatment of MDR cases in Nairobi province

3.1.7 Reproductive Health and Family Planning a) Description of Work-plan status The project planned to conduct OJTs( PAC, YFS, CTU), to conduct orientation of RHTST Committee on certification tools, to facilitate the re-distribution of FP commodities, to provide updates or training to CHWs on FP, HIM, Community PAC, to provide TA for strengthening YF PAC services in selected facilities, and to expand membership of TUNZA franchise.

-

10,000

20,000

30,000

40,000

50,000

60,000

Q2-2011 Q3-2011 Q4-2011 Q1-2012 Q2-2012

No.

clie

nts

Time (Quarters)

# individuals provided with HIV-related palliative care (including TB Treatment or prophylaxis)

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

Q2-2011 Q3-2011 Q4-2011 Q1-2012 Q2-2012

No.

of

indi

vidu

als

Time (Quarters)

No. of individuals provided with HIV-related palliative care (including TB treatment or prophylaxis)- Coast Province


b) Quarterly performance monitoring matrix In Nairobi: • 84 health facilities were supported reaching 45,377 (17,418 new and 27,967 revisit). • At STC casino and Ngaira dispensaries which have newly started offering FP services are integrating RH/FP

with HIV but have a challenge of low client flow for FP and few nurses have been trained in CTU and cancer of the cervix screening. Staff there will be linked to FUNZO for training. PAC Services

• Five sites were supported to offer PAC services in Nairobi, these were Mbagathi district hospital, Mama Lucy Kibaki hospital, St John’s hospital, Kasarani maternity and Muteithania maternity.

• TA was provided in record keeping and integration of services with family planning and HIV counseling and testing. 330 (238 new and 92 revisit) clients were attended to, 160 were older than 25 years and 167 were between 10 and 24 years. This quarter there was an increase in the under 25 years accessing the services.

• 225 clients had complete abortions and 226 accessed post abortion counseling. MVA provided to all the clients and 134 received FP methods an increase from 128 who received in the last quarter.

Screening of Cervical Cancer

• Cancer of the cervix screening was supported in 16 health facilities. 2,415 (2,304 new and 111 revisit) clients were attended to, compared to 2,146 in the last quarter using VIA/VILI.

• 35 were VIA/VILI positive and 49 had suspicious lesions. 4 were managed by cryotherapy and 80 were referred for further management.

• During screening CACX, STI screening was integrated and of the 1,610 clients screened, 535 were treated for STI while 14 were referred for further management.

• Screening for cervical cancer was emphasized in all the CHWs trainings and women are being referred for this service in the facilities closest to them.

• Eleven cryotherapy machines were distributed to Westlands HC, St Mary Mission hospital, St Francis hospital, Family health options Kenya (FHOK) Langata, Ngaira HC, Kahawa West HC, Ngong road HC, Kayole II sub district hospital, Bahati HC, Lunga lunga HC and Mukuru Reuben clinic. The staff in these facilities have been trained and more are to be trained to ensure that services are scaled up.

In Coast: • The project supported infection prevention CMEs for 120 service providers. Orientation on youth friendly

services was supported for 30 health workers in Kinango District, and sensitization of health workers on youth friendly services (80), PAC (45) and cervical cancer screening (85) was supported.

• In 18 facilities, OJT on IUCD insertion and removal, and on screening of cervical cancer was carried out. • Integrated outreaches were supported. They included provision of FP methods (SA and LA) and screening of

cancer of the cervix. • TUNZA, the franchise of Private Providers introduced demand creation by community volunteers, “Tunza

Mobilizers”. They conducted small group sessions, targeting men and women : full range of FP methods, myths and misconceptions, mapping facilities where RH/FP services can be accessed. The Tunza mobilizers reached 5,028 people (150 male, 4,666 female).

c) Analysis of findings • In Nairobi there was an increase in the number of clients served this quarter 45,377 (17,410 new and 27,967

revisit) compared to the last quarter 42,003 (18, 056 new and 23,947 revisit). The total CYP went up by 3,434 from the last quarter to 35,556.

• There was a drop in the number of new clients using condoms, 3,987 compared to 8,115 in Q1, while more new clients were served with long term methods, 4,537 (1,102 IUD and 3,435 implants) compared to last


quarter, 2,749 (781 IUD and 1,968 implants). All the methods used by new clients went up except condoms and sterilization.

• In Nairobi CYP based upon the volume of all contraceptives distributed in public health facilities was 35,556 compared to 32,122 in the previous quarter. Health talks, outreaches, awareness at CU level and referrals from CBDs are contributors.

• In Coast, 34% of new clients who received family planning were on injectable while 15%, 3% and 0.6% were on implants, IUCD and sterilization respectively. The project will continue engaging the community on focused group discussions and dialogue forums to increase utilization of long acting methods

• The number of clients who received post abortion care services was 504 (469 MVA and 35 D&C). All were provided with family planning.

d) Challenges and recommendations

• Due to this concerted effort to promote cervical cancer screening in Nairobi, some of the facilities, e.g. Kangemi have very long lists of women waiting to be screened.

• Provision of the PAC package of services still a challenge. Project staff will continue to promote and provide TA in comprehensive PAC services. Lack of MVA kits is hampering expansion of PAC services

• Inadequate supplies of lignocaine hamper insertion and removal of implants. Project staff will continue working with the DRH coordinator to support redistribution of the same when necessary

• Need for a LEEP machine for management of cancer of the cervix e) Activities planned for the next quarter include: Nairobi • Procure and distribute basic commodities like gloves, disinfectant, for RH/FP activities • Support CME on FP compliance, CTU and PAC • Conduct sensitization for HCW on YFS • Strengthen gender based violence integration into RH/FP services • Cancer of the cervix screening OJT

Coast • Conduct OJTs to health workers on PAC , YFS, CTU. • Facilitate re-distribution of FP commodities. • Provide updates to CHWs on FP PAC. • Expand membership of TUNZA franchise.

3.1.8: Maternal Neonatal Child Health (MNCH)

a) Description of Work-plan status All activities in the work plan are on track. As per plan, the project would: • Support immunization data review meetings at District level • Strengthen defaulter tracing for immunization through CHEWs, CHWs and CHC • Intensify high impact nutritional interventions during the malezi bora week. • Conduct orientations of service providers and CHEWs and CHWs • Support quarterly maternal mortality meetings at level 3-4 facilities, • Integrate FP, EID, HCT and GBV screening and response in post natal care • Introduce Mother to Mother in selected sites • Orient community mentor mothers to promote MNCH • Establish and strengthen ORT corners in selected facilities • Deliver health services during school health outreaches


b) Quarterly performance monitoring matrix In Nairobi: • APHIAplus supported the Malezi Bora provincial feedback: 75% of facilities reported to have conducted the

activity with a high turn up of clients for services and good partner support. Challenges included transport for supervision, staff shortage and inadequate IEC materials. It was decided that each district was to have at least three integrated outreach clinics in the hard to reach areas in the next Malezi bora campaign and DHMTs were to carry out supervision.

• Malezi bora activities were supported in the nine districts. Facility in-charges were sensitized to the year’s theme:“Together let’s fight malnutrition across continuum of health and nutrition care in human life’’. The support consisted of: CMEs, district sensitization, transport and lunch allowance for DHMT supervisors, social mobilization, photocopying and distribution of IEC materials.

• MCNH workshops (3 days, 50 participants) were supported for Embakasi and Njiru districts. 15 CMEs covered a variety of subjects: post-operative care after C-section, breech delivery and partogragh, EPI updates, neonatal resuscitation, identification and management of malnutrition in children, malaria and diarrhea case management. 487 participants were reached. EPI workshops (3 days, 60 participants) were supported in Dagoretti and Langata district): udates on cold chain maintenance, ordering of vaccines, reporting. A follow up will be made in July.

• An assortment of EMOC items was supplied to 21 supported facilities; the items included 48 height measuring pads, 45 pediatric and 48 adult weighing scales and 70 adult and 86 pediatric resuscitators.

• DNOs from Njiru and Embakasi district sensitized 316 CHWs from 9 IPs and CUs on growth monitoring. This sensitisation aimed at rolling out routine growth monitoring at various growth monitoring outposts.

• 11 mentor mothers support groups with a total membership of 261 regardless of HIV status have been established. The key issues discussed this quarter in the support groups were breast feeding (including how to express and store breast milk), IYCF, the importance of 4 ANC visits and family planning.

• IYCF and IMAM training for CHWs – this was conducted for a total of 279 CHWs from Kamukunji, Dagoretti, Langata, Westlands, and Kasarani. This was in support of malezi bora week and also to address IYCF concerns raised during community dialogues. In addition, 75 CHWs and 15 CHEWs were sensitized on case identification for malnutrition in children in Makadara, Njiru, Embakasi and Starehe districts.

• A FGD was conducted for men above 30 in Hamza, Makadara. The topic was IYCF. Findings showed that malpractices like bottle feeding and mixed feeding were prevalent. The project plans further work with CHCs and elders on infant nutrition.

• The project supported Mathare North HC in conducting a Facility Health Committee meeting. HSSF was useful for buying iron tablets. Congestion and waiting time at ANC was addressed by seeing clients in mornings and afternoons. The chairlady commended staff for improved services integration, reports, cervical cancer screening of postnatal clients. No mother in labor should be sent away, was reiterated as a commitment.

• Items was supplied to various facilities: height measuring pads, pediatric and adult weighing scales and resuscitators.

• In all districts the establishment and strengthening of ORT corners for diarrhea management was enforced. • Outreaches were successful in bringing services to households: outreach at Marurui HC, Mathare 4a area,

Mwiki, St Dominic Catholic Church, Medical camp for street families. • At community level,, out of 434 children assessed through weight for age, 42 were underweight, 12 were

severely underweight, 5 overweight and 7 obese. They were referred to nearby OTP and SFP sites for treatment. Out of 234 children assessed through height for age, 73 were found to be stunted and out of 246 others assessed, 8 were wasted. The project will collaborate with GoK to increase sensitizations on breastfeeding practices and good nutrition habits.

• During April child forums, 34,145 OVC were reached with preventive, curative and therapeutic services. Children under five were growth monitored. 115 OVC were found to be under weight and were referred to level 2 health facilities with follow ups from IP contact persons and the respective CHWs.

• 5048 children in ECD centers were growth monitored during the Malezi Bora campaign, whose theme was “together lets fight malnutrition”. 4 children were severely malnourished while 113 had moderate


malnutrition. They were reffered to the nearby health facilities for treatment and enrollment into a feeding programme. In addition, 13,631 children were de-wormed and 4750 given Vitamin A.

In Coast: • The project supported Malezi Bora activities in all districts. The activities supported included the launch of the

Malezi Bora week, health promotion and education outreaches in the community. • A partnership with Radio Kaya resulted in a successful campaign. Zuia Kuhara, Okoa Maisha educates the

community on diarrhea prevention through water treatment and hand washing. The events reached an estimated crowd of 7,000 people and took place in three sites over a period of three days: Gotani CU in Kaloleni, Bamba CU in Malindi and Kongowea slum in Mombasa. The campaign created product awareness i.e. water guard and pur, aqua tab. IEC/BCC materials were distributed.

• ORT corners for management of diarrhea and education on safe water and hygiene were strengthened. • CMEs and sensitizations were conducted on FANC, IMAM, IPC and IYCF. • Maternal mortality meetings to audit maternal deaths were supported in the Districts • TBA and male dialogue meetings were supported so that TBAs can continue acting as birth companions • CPGH was supported to conduct a CME on post-partum hemorrhage for 50 health providers. • KEPI updates and target setting for children to be immunized was supported for 59 health providers in Lamu

and Malindi Re distribution of vaccines and mother baby booklets was also supported according to the needs of Districts.

c) Analysis of findings In Nairobi: • The Malezi bora supervision activity was conducted in Kamkunji district. Key findings were: training is lacking

in key service areas, especially IMCI, client exit interviews indicated that here was a positive attitude from staffs, that IEC materials were a chhallenge.

• Closer attention to the integrated outreaches in Nairobi showed some challenges: lack of essential pediatric drugs, no Depo Provera during outreach, hampered client flow by heavy downpours.

• When the chalk board was introduced in Mathare North HC, 52 children were identified as not immunized. Defaulters were identifed through the community data and an EPI outreach organized to Mathare area 4a, Mandela village.

• During the Malezi bora campaign, 5,048 children in ECD centers were growth monitored as part of active case finding activities: 4 children were severely malnourished while 113 had moderate malnutrition. They were referred to the nearby health facilities for treatment and enrollment into a feeding programme. In addition, 13,631 children were de-wormed and 4,750 given Vitamin A.

In Coast: • In Coast 23,483 new ANC clients were served. 12,829 expectant mothers reported to have completed four

focused antenatal care visits, while 16,092 deliveries were conducted by skilled attendants. 21,088 ANC mothers received 2nd dose of IPT and 12,859 were provided with ITNs for malaria prevention.

• 28,219 children were fully immunized while 24,932 children under one year and 47,683 children over one year received vitamin A supplementation.

d) Challenges and recommendations Nairobi

• Shortage of ANC and HEI registers; Patients take spoons and cups from ORT corners home. It handicaps services somewhat.

• Waste is not segregated in maternity. Preparation of chlorine solution is now known. TA and training on infection prevention (FUNZO) will address this.

• Neonatal and maternal deaths reports aren’t accurate. Follow up is scheduled.


e) Activities planned for the next quarter include: Nairobi • CME on EPI, training on IMAM; support breastfeeding week • Train CHEWs and CHWs on IYCF and IMAM and offer support supervision • Assess mentor mothers support groups impact on utilization of MNCH services in the health facilities. Coast • Support quarterly maternal mortality meetings at L 3-4, maternal verbal autopsies at community level • Introduce Mother to Mother in selected sites • Establish and strengthen ORT corners in selected facilities • Deliver health services during school health outreaches 3.1.9 Malaria in Coast

a) Description of Work-plan status • Support World Malaria day commemoration • Sensitize health workers on malaria prevention and case management during pregnancy • Conduct quarterly DQA on malaria diagnosis to peripheral laboratories by DMLT

b) Quarterly performance monitoring matrix • The national world malaria day was commemorated in Msambweni district. The support for the activity

included hiring of tents, social mobilization, printing of T-shirts for the day. This year’s theme was “Pamoja tuendelee kuangamiza Malaria”.

• CME’s on malaria in pregnancy (MIP) were conducted in the facilities. • External quality assurance (EQA) on Malaria was also supported in Lamu, Mombasa and Msambweni Districts.

• 340 OVC received mosquito nets from the government increasing the number of OVC with ITN’s to 70,340 up from 70,000 in the previous quarter.

• CHWs in 122 IPs made their monthly home visits to the children to ensure proper use of bed nets. Where there were newborns, CHWs encouraged caregivers to seek ITNs at the nearest HC.

c) Analysis of findings



• Support EQA for malaria diagnosis • Conduct orientation on malaria case management • Support CMEs on Malaria in pregnancy • Support distribution of ITNs


3.1.10 HIV and Nutrition in Coast

a) Description of Work-plan status • Establish and strengthen growth monitoring outposts • Provide anthropometric equipment to nutrition corners in facilities and in CUs • Support growth monitoring, mineral supplementation, vit A supplementation and deworming at ECDs • Provide food for HBC clients


COAST

• CMEs on Nutrition and HIV were supported for 90 health workers. HIV positive patients continued to receive nutritional assessments using the relevant anthropometric measurements and those vulnerable malnourished patients received food supplementation from NHP.

• In Kilifi and Mariakani Hospitals 1,538 and 427 beneficiaries received food support for vulnerable HIV infected individuals and their families through a collaborative effort of APHIAplus, WFP and MOH.

• 55.01 MT of food was distributed and it included 33.440 MT of maize grains, 1.969 MT of bulgur wheat, 11.222 MT of pulses, 2.905 MT of vegetable oil and 5.474 MT of CSB. Two livelihood support trainings for 101 clients were conducted

• Ongoing activities with index clients include: table banking to support existing income generating activities as well as support needy clients with “soft” loans.

• Gunny bag farming demonstrations have been established at Kilifi and Kaloleni food stores. They show clients on food support farming techniques that can be replicated at their homes.

NAIROBI • 6 CMEs were conducted during the quarter on WHO/UNICEF Global strategy for IYCF, outline on BHFI its

importance in areas of high HIV prevalence, International code of marketing of breast milk substitutes, PMTCT 4 prong approach and IYCF and breastfeeding, maternal nutrition and challenges of complimentary feeding.

• Mother and health care workers lack information on diversification of feeds. As a result 223 health care workers in PMTCT supported sites were reached with CMEs

• Nutrition counseling and supplements continue for both adults and children living with HIV at all supported CCC. Linkage to food by prescription was supported for those that qualified by BMI. Facilities are supported with equipment to take the weight and height of the patients.

• At GGCH all HIV exposed OVCs and malnourished groups are currently being supported through a feeding program. This is to compensate for the deficiencies in energy, proteins and micronutrients, and has been a success. All pregnant and lactating women qualify for food support and are supplied with monthly flour mixtures from INSTA Health builders Nairobi. Needy families continue to receive food basket through Gertrude’s Hospital Foundation. 52 mothers and 98 infants and children were reached with nutrition support. As part of public private partnership, the team of nutritionists and social workers collaborated with the ministry of agriculture to train 158 members of existing support groups on how to construct multistory gardens in the community for economic empowerment. Due to the clinic’s successful infant and young child feeding program, for the HIV exposed infant through the PMTCT clinic, the nutritionist was invited as a guest in a live program ‘doctors on call’s Family TV.

c) Analysis of findings • Working mothers are not able to maintain lactation up to six months. • Information gaps on IYCF are considerable. There is need to sentization the mothers and service providers on

complementary feeding


• GGCH clinic effort on IYCF for HIV exposed infants has gained momentum and as a result of their success, the nutritionist participated in the Family TV live program “doctors on call”


• Lack of information on diversification of feeds for IYCF. There is need to train them on breast milk expression and hygienic handling of the same.

• Most patients are not able to secure a reliable source of food and this affects food security, at MDH the support group has been linked to the HCS team and are being supported in development of IGA.

• Myths and misconception affecting IYCF exist and some mothers do mixed feeding. More CME are being provided to educate the HCW.


• CME on HIV nutrition • Health talks for patients on HIV nutrition and IYCF • Strengthen nutrition assessment and counseling through TA • Support BFHI and IYCF at facilities • Strengthen linkage to food support e.g. FBP

• Provide anthropometric equipment to nutrition corners in facilities and in CUs • Establish and strengthen growth monitoring outposts. • Support growth monitoring, mineral supplementation, vit A supplementation and deworming at ECDs • Provide food for HBC clients


3.2 Increased demand for an integrated package of quality high-impact

interventions at community and health facility levels

The work plan has a shorter list of activities targeted at reducing barriers to services, because support to service provision (sub result 3.1) already takes the needs of different clients and patients into account and because interventions are essentially cutting across the different program areas.

In order to increase demand to services, commodities and information the project supports interventions that increase male involvement, that involve religious leaders, and that actively involve MARPs. Several youth interventions have a demand increasing focus ( youth outreaches, youth desks, youth mobilisation and small group sessions, synergy with HFG interventions). And within youth, OVC represent a special group for which interventions are required in order for them to be able to make full use of health services.

In this section, reporting will be at the sub-result level.

a) Description of work-plan status

Most of the circa 30 individual activities under this sub-result are taken on board and are on track. In Nairobi, there is a delay with the screening of the VMMC video, and the Youth Mobile Truck Outreaches were waiting for the grant to DSW to be processed. In Coast, the difficulty of finding the right peer educators to work in the matatu industry put the activity on hold till the next quarter.


PMTCT Apart from the health talks at the facilities and the distribution of IEC materials which are part of routine demand creation, the project planned to strengthen male involvement into PMTC: mothers were encouraged to come with their male partners for services. During the provision of PMTCT updates to CHWs, issues of cultural beliefs, male involvement are included.

HCT • In Nairobi, small group communication sessions to increase demand for counseling and testing services were

supported reaching 84,024 (28,741 males and 55,283 females). The project focused on reaching new testers and couples in the slums by supporting outreach activities that included provision of door-to-door counseling and testing.

• In all 11 districts of Coast peer led small group communication (SGC) sessions promoted use of testing services. In total, 85,362 (39,295 male; 46,067 female) people participated in the SGC’s where discussions explored and addressed barriers that hinder people from accessing CT.

• In Coast, 5,028 (150 male, 4666 female) people were reached with CT messages through volunteers who create demand for the Tunza Franchise of private service providers. This was also done through small group communication sessions where CT messages were integrated with RH/FP messages.

• 96(35 male, 61 female) students of Coast Institute of Technology in Voi received CT services during a moonlight CT event that was conducted during their annual cultural night. A total of 742 students were reached with HIV messages and 72 Gpange posters and flyers distributed.

MARPS • In Nairobi male sex workers from HOYMAS CBO (30) were trained as peer educators in a 5 day training that

used the draft Peer Educators Training Manual of NASCOP. They’ll conduct peer education sessions in July.


• Through 324 small group communications done by peer educators in Nairobi, 439 MSM & 2,692 FSW were reached.

• Matatu peer educators who were trained last quarter, conducted peer education SGC’s at various matatu termini and reached 929 people (893 males and 36 females). The SGC’s covered topics like concurrency, condom efficacy and negotiation, VMMC and the importance of counseling and testing.

• 40 MSM Peer Educators from Tamba Pwani CBO in Malindi and Ukweli CBO in Msambweni were trained on ETL. Tamba Pwani has been in the fore front in advocating for the rights of MSM and other MARPs in Malindi and Kilifi. Majority of the Tamba Pwani members are commercial sex workers.

YOUTH • Through the Youth desks at Mathare North, Kasarani, Kangemi, Mukuru Rueben & Dandora II HCs 2,254

young people (1,045 males and 1,209 females) accessed various services offered at the facilities including VMMC, CT, FP, and ANC, IEC materials and condoms.

• Small Group Communication sessions in Coast explored barriers that hinder people from accessing CT. The most common barriers included fear of testing positive, and being tested by health care workers who are familiar to client.

• The project partnered with HFG and ICRC for an outreach held at St Georges Primary school. The outreach targeted 15-19 year old children. Condom efficacy SGC’s and Shuga screening and discussion sessions were conducted. 102 youth (44 male and 58 female) were counseled and tested. None were HIV positive.

• Additionally, the project partnered with HFG to screen Shuga II at Egerton University- Nairobi campus. After the screening, discussion sessions were conducted on the importance of HTC and correct and consistent condom use. Based on the experiences that the youth shared, it was obvious that many of them didn’t know how to use condoms correctly and they were not using them consistently. The discussion sessions reached 69 young men and 49 young women.

• During FGD on youth friendliness of services in Mbagathi, young people recommended to have a youth day at Mbaghati District Hospital. FGD on FP was also conducted during this special day. The youth day took place.

RH • 15 new providers recruited, selected and trained through the Tunza network. • Support to CHWs, youth peer educators and TUNZA Network mobilizers to conduct small group sessions in

the community, within CU’s and within the catchment areas of the facilities they are linked to. Demand creation activities covered HIV, RH/FP, MCH services, health products such as condoms, water treatment products as well as health information e.g. IEC materials.

• Four facilities in Coast established Youth Friendly Sites: Taveta District Hospital, Diani Health Centre, Gongoni Health Centre and Kinango District Hospital. 4 youth CBO’s comprising of 80 youth peer educators, were taken through an orientation of YFS. In Gongoni, Malindi, 30 community leaders including village elders were also sensitized on YFS for buy-in.. The youth peer educators will do GSC’s during outreaches and events that target youth.



e) Activities planned for the next quarter include: • Peer education training and paralegals training for MARPs • Support small group sessions for FSW/ MSM/ IDU/ matatu populations, youth • Sensitize men on RH/FP, GBV, VMMC • Conduct community FGD on MNCH, RH/FP, GBV, and PAC • Facility collaboration between TUNZA facilities and public facilities in conducting outreaches • Increase the number of Tunza facilities and train new Tunza Mobilizers


• Support the World Population Day 3.3 Increased adoption of healthy behaviors a) Description of Work-plan status

Education through listening (ETL) is the behavior change communication intervention that CHEWs, CHWs and peer educators from different age, socio-economic, or cultural groupings apply or conduct in order to get communities interested in healthy behaviors and actually adopting them at scale.

All activities listed in the work plan are ongoing.

Small group sessions for FSW/MSM/IDU, matatu populations, youth and the adult populations were supported; so were Magnet Theater outreaches to CUs and health facilities. FGDs on HIV prevention, targeting youth, men and women: all these create demand for HIV/AIDS services.


NAIROBI • CHEWs were taken through an orientation of ETL. By this they can effectively monitor and supervise SGC

sessions conducted by CHWs in CUs. • CBO facilitators conducted SGCs sessions within their respective CUs and reached 33,374 adults (8,538 males

& 24,836 females). • Youth CBO’s were also taken through an orientation on YFS to enable them mobilize their peers for services. • CHWs and youth CBOs were supported to conduct integrated ETL sessions targeted at men, women and

youth on HIV. • Youth Polytechnics where OVCs attend vocational courses were reached with HIV sensitizations. • Two CBO’s implementing a PE programs for MSM’s were trained on ETL. • Theatre groups conducted magnet theater (MT) sessions on CT at community and facility levels levels

reaching 4,798 (1,570 males & 3,228 females) • The facilities that conducted the outreaches were Mathare North, Kasarani Health centre, Kangemi health

centre, Dandora II health centre and Mukuru Rueben health centre. The CUs where the MT outreaches happened were: Gitari Marigu A, Gitari Marigu C, Mucesha, Soweto, Mombasa, Lunga Lunga, Kisumu Ndogo, Mathare 4A, Galole, Mwiki, Korogocho, Kianda, Kangemi Central, Gituamba, Mabatini and Mbotela units.

• Mathare & Kawangware held mobile VCTs during soccer games. 12 groups conducted the participative educative theatre which drew huge crowds of young people. Themes were alcohol/drug abuse and HIV infection risks. Outreach workers did one-on-one counseling.

• SGC sessions were done in schools. In school youth reached on ASRH (21,320 children-8,654 males & 12,666 females), alcohol and drug abuse and its relationship to HIV (2,075 children -1,336 boys and 739 girls) messages. 20 girls were trained as young leaders to help with the monitoring of the sessions conducted in the various schools.

• An essay competition was held in the schools. Topics were: “the challenges I face as a young person trying to Chill” for secondary school students and “Why is abstinence the best choice for a Girl Guide” for primary school students. The winning students were given school uniforms and school books as awards.

• A fun filled rally was also held this quarter. The rally was a showcase of theatre and stage talent with poems, songs, skits and dances presented and the winners receiving awards. It was during this rally that the essay competition winners were awarded. Over 2,000 students and 100 teachers participated in the rally.

• Youth out of school were reached through SGC’s, peer counseling, dialogue forums, one-on- one counseling and sensitization sessions and sporting events. There was also door to door, moonlight and centre based counseling and testing offered to the youth.

• Two sporting events that reached 3,466 individuals were conducted and 1,080 youth participated in football, hand ball and basketball. The winning teams were awarded trophies. As the sporting activities were taking place, the participating youth were sensitized on how to challenge HIV/AIDS related stigma and


discrimination. There was MVCT on- site for those who were interested in knowing their HIV status, 1,324 individuals were tested and 23 tested HIV positive.

• SGC’s were done by youth CBO facilitators and reached 24,329 young people (8,650 males & 15,679 females). After sessions, young people are enthusiastic about CT and about condom use. After every SGC session, condoms are distributed to the young men and women.

• Shangilia Youth 2 Youth CBO conducted sessions with young men from boda boda points, matatu termini and ‘bases’. The young men are linked to the youth desk at the Kangemi health centre where they have continued to visit whenever they need information, condoms or medical assistance.

• Kenyatta University used its radio show KU FM 99.9 Hz to disseminate information to the Kenyatta University students and its surroundings. Topics covered : relationships on campus, importance of contraceptives, STIs & HIV& AIDS. These are interactive sessions with clients getting free airtime when they participate on the show.

COAST • 68 CBO’s implement BCC activities. This quarter, they carried out 10,306 initial and follow-up SGC sessions

that addressed HIV. In total, they reached, 85,362 (39,295 male, 46,067 female) people among them youth, men and women. The sessions were peer led and were facilitated by CHWs and youth peer educators. The number of condoms distributed during the sessions was 154,598.

• Men and women aged 25 years and above reached with HIV prevention messages during was 51,906(22,929 male & 28,977 female). These was through SGC sessions that addressed concurrent sexual partnerships and condom use and condom self-efficacy.

• The number of youth aged 15 to 24 years reached was 33,450 (16,366 male; 17,090 female). Among them, 11,211 were aged between 15-19 years. Those between the ages of 20-24 years were the majority at 22,238.

• 60 CHEWs were trained on ETL to enable them offer effective supportive supervision of BCC activities in their respective CU’s. They were from Kilindini, Kwale, Msabweni, Taita and Taveta districts. At the end of the training, they came up with a monitoring and supervision workplan. They will also identify information gaps among the CHWs and youth peer educators and plan for topical updates to ensure the messages being passed in the community are accurate.

• Two youth CBO’s were trained on ETL i.e. Diani Youth Friendly Network in Msambweni district and Nataraji Youth Group in Kinango district. This was followed by an YFS training to enable them create demand for YFS services. 40 youths, 20 per CBO were trained.

• ETL Refresher Training was conducted for 3 CBO’s in Taveta district. 60 CHWs were refreshed on ETL • 1,700 (911 male, 789 female) youths aged between 15 and 24 were reached with prevention messages in 10

youth polytechnics in Malindi and Lamu districts. These are Polytechnics where APHIAplus supported OVC’s are taking vocational courses. This was aimed at sensitizing the OVCs with the peers they interact with and in a non-stigmatizing setting.

• 25 CBO’s implementing BCC activities underwent a one day topical updates. The topics addresed knowledge gaps identified during field visits and during monthly feedback meetings: PMTCT, ARVs and TB. They were facilitated by PHOs and facility staff.

• 4,174 youths, among them 222 older OVC in vocational schools, were reached with messages on RH. The youths were also reached with PEP-information through integrated sessions. Also discussed in the sessions was GBV, drugs and substance abuse. All youths in the same polytechnics, not only OVCs, benefitted.

• All the Vocational centers with enrolled OVC were also identified for branding with RH messages that will roll out in the next quarter.

c) Analysis of findings d) Challenges and recommendations • Low turn-out of men for HIV care and treatment: although the numbers of men attending health

literacy training is increasing slowly, it is still low compared to women. It was however encouraging to meet a men-only support group who can become advocates to other men.


e) Activities planned for the next quarter include: • Train DHMT/CHEWs on ETL, segmentation, targeting and audience profiling and integrated messaging • Support CHWs and CBOs to conduct integrated ETL sessions and provide support to CHEWS supervising them • Train drama groups on Magnet Theatre and integrated messaging, including YFS, and support their activities • Sensitize adolescent OVC on health issues and link them to YFS • Develop radio spots to create awareness on the link between intravenous drug use and HIV • Support CBOs to conduct BCC community outreaches among MARPs

RESULT 4: – SOCIAL DETERMINANTS OF HEALTH ADDRESSED TO IMPROVE THE

WELL-BEING OF TARGETED COMMUNITIES AND POPULATIONS 4.1 Marginalized, poor and underserved groups have increased access to economic security

initiatives through coordination and integration with economic strengthening programs

a) Description of Work-plan status All planned activities are ongoing in continuity with past quarters. In close collaboration with relevant ministries, underprivileged groups such as orphans and vulnerable children, households of people living with HIV and AIDS are linked up with CUs (exit strategy) and provided with opportunities to lift themselves out of extreme vulnerability. A wide range of options are put in place from which people can choose. • Facilitation of the formation of common interest groups for resource mobilization and capacity building. • The project borrowed from Nairobi experience and introduced in Coast S&L groups at CU level in order to

leverage savings for investment in IGAs. b) Quarterly performance monitoring matrix

VS&L, SILC and IGAs • Three household economic strengthening (HES) strategies are in place: Savings Internal Lending

Communities (SILC), in partnership with the Catholic Diocese of Mombasa, Voluntary Savings and Loans (VS&L) and Income Generating Activities (IGAs), for beneficiaries of VS&L and SILC who are at moderate and low levels of vulnerability.

• 30 TOTs received a VSL refresher training. They promote community based savings and credit activities. 30

ToTs already trained continued their sensitization activities. The outcomes are saving groups.

• In Nairobi 439 groups were already oriented on VS&L. Two supervisors now join TOTs when visiting VS&L groups. Supervisors participate in monthly meetings of VS&L TOTs and build skills of data management.

• Caregivers trained on VS&L/SILC increased to 1,007 (up from 315 in Q1). VS&L groups formed increased

accordingly from 21 to 64. While the number of SILC groups monitored and reporting increased from 125 to to 219. Cumulative savings for VS&L and SILC combined is reported at KES. 3,556,624. The number of OVC that benefit from caregivers involved in those activities is 21,874


Figure 18: Number care givers trained on VS&L, VS&L Groups formed and SILC groups monitored in the two quarters

• 2082 caregivers (1185 females / 197 males) in VS&L groups continued with their saving and lending process in the quarter. The 159 groups have a cumulative savings of Ksh 4,868,446 year to date. In the last quarter, 1,485 loans worth Ksh 446,166 were given to the members. They were able to support 7,668 OVC with scholastic materials, school fees and food from loans accessed in the group.

• Through a matching fund of Child Fund, 210 OVC hhouseholds received support for a variety of IGAs:

livestock production, crop farming, soap making, cereals, poultry, second-hand cloth selling and a few others. Management of implementing partners identify the beneficiaries and help caregivers with the choice of IGA. IPs ensure that caregiver’s keep records of their businesses, for monitoring and accountability purposes.

Careen Atieno of Changamwe, found it “unbelievable how she made KES.2,000 profit out of the IGA support she received”. Careen is a PLWH and cares for 3 OVC. Her food vending business received a stock of potatoes, baking flour and cooking oil. She promised to re-plough her profits in the business.

Vocational training • 21 OVC, supported by the project have joined vocational training courses in various institutions in Nairobi. In

collaboration with Gpange, 12 OVCs from Grace Care Group were also enrolled in hairdressing and beauty vocational training courses.

• 11 vocational graduates were supported with 2 mechanics startup kits for their IGAs. They were hosted by their training garage to start the mechanics business and were able to raise Ksh.9,880 from motor vehicle repairs. They hope to move to their own premises in the next quarter.

• Procurement for items to support bead and soap making, goat, chicken and rabbit rearing (for peri-urban IPs) is finalised. Items will be distributed to the IPs during the next quarter.

Financial Education Training • 281 OVC caregivers/guardians were trained on personal financial management by the Equity Group

Foundation. They are taken through sessions which covered budgeting, savings, banking services and debt management. The skills they gain will enable them to make informed choices on their finances.

Social and financial education for children (Aflatoun) • 29 teachers were trained on social and financial education for children (Aflatoun). They’ll soon start Aflatoun

clubs in their schools. • In Mukuru 300 primary school children are members of Aflatoun clubs. The activities expose them to skills in

managing resources, not only fincancial resources, but also resources like water and the environment. They sell snacks, collect the money and at yearend they’ll divide the money collected. School administration and guardians appreciate how the clubs help children learn how to manage precious resources, at an early age.

0

200

400

600

800

1000

1200

Care givers trained on VS &L VS&L groups formed SILC groups monitored

# c

areg

iver

s tr

ain

ed v

s. V

S&L,

SIL

C

Gro

ups

fom

red

Time (Quarters)

Number of Care givers trained on VS&L Vs VS&L, and SILC Groups Formed (Jan-Jun 2012)

Jan-March 2012 April-June 2012


• In Coast , the establishment of Aflatoun Clubs in schools was not possible within the quarter. The clubs targeted schools already with operational health / rights clubs - a process that was delayed by the School Health programme rollout. However, with 350 Primary schools with Health /rights clubs running, the Aflatoun clubs will be implemented in the coming quarter.

• Farming for household economic strengthening at Mbagathi - the farming activities initiated by the Mbagathi support group is progressing well. As previously reported, the hospital gave the support group some of its land to cultivate a vegetable garden as a contribution to household economic strengthening. APHIAPlus funded the initial cultivation of the land, and linked the group to an Officer from the MoA, who supported the groups in establishing seed beds, provision of seed, seedlings and supplies to set up three large gunny sacks.



Caregivers fail sometimes to remain faithful to the VS&L groups and their activities. In that case, success cannot be sustained. The project conducted refresher for the field officers on VS&L management skills for improved monitoring and support of existing groups.

e) Activities planned for the next quarter include: • Refresher training for VS&L field officers; follow up meetings of VS&L / SILC groups • Support IPs to establish more VS&L groups with OVC caregivers • Scale up IGA’s for OVC Households and support and strengthen IGAs in IPs • Support and strengthen AFLATOUN clubs in schools • Increase enrollment of OVC Households in HES

4.2 Improved food security and nutrition for marginalized, poor and underserved populations

a) Description of Work-plan status The three activities listed in the workplan ongoing in continuity with last quarter: sensitize OVC caregivers on good nutrition, support targeted OVC households with food supplies, and partner with NHP on food by prescription.

b) Quarterly performance monitoring matrix • In Coast, 44,721 OVC received nutritional support, in kind or as nutrition education. The OVC caregivers

trained on poultry farming and other farming methods increased to 300 in current quarter up from 30 in Q1. The trainings were done as a food security measure as well as an economic safety net.

• In collaboration with MOA, 270 OVC households were trained on skills (poultry, cassava and water melons farming) that create food and economic safety nets. Others were linked to food support from sources like World Vision and TOWA (Taita Taveta and Kwale Counties), while IPs had already recruited these households into the food security initiatives. MOA will train and support them in crop or livestock farming.

• In Nairobi 45,037 OVCs received were provided with a nutritious meal during the child forum. The meal was a serving of rice, beans and a banana. The children appreciated, since it was during Easter celebration. 1,974 OVC in support groups received 2kgs of Green grams and 3kgs of maize flour to supplement their food at household level. 7,000 children in ECCDs were served with UNIMIX porridge at 10 o’clock, and a lunch daily. 1,500 under-fives received a 3 months UNIMIX ration.

• 2,560 caregivers and CHWs in Nairobi were sensitized on barriers to good nutrition and were encouraged to practice gunny bag farming .

• In Nairobi 201 caregivers and IP members were sensitized on improving food supply: yoghurt production, growing of vegetables in green houses/gunny bags; mushroom growing. The community programme in St Francis reports good results: OVCs see benefits of farming activities. CHWs and caregivers supervise.


• In Coast Child Forums OVCs were provided with food or nutrition education. These took place in all 5 counties. The Day of the African child was celebrated in such forum. The Children’s Department participated in the selection of the children. In Mombasa County, IPs organized school holiday forums for their OVC. Balanced food rations were provided to all children attending. Caregivers present were sensitized.



e) Activities planned for the next quarter include: • Caregivers sensitization on barriers to good nutrition for children • Provide food support to needy OVC households • Food rations for OVC Support groups • Monitoring of OVC Households undertaking farming projects • Establishment of Aflatoun Clubs in Coast

4.3 Marginalized, poor and underserved groups have increased access to education, life skills,

and literacy initiatives through coordination and integration with education programs

a) Description of Work-plan status All planned activities are ongoing: policy dissemination, child forums, safe schools initiative, disability management training to caregivers, educational opportunities for OVC etc.

b) Quarterly performance monitoring matrix • In Nairobi, training on Comprehensive School Health Policy reached 57 teachers, education officers and

school committee members. The training aims at developing safe and healthy school environments. Trainees develop action plans and will run health clubs in schools. In Coast 350 school health teachers were trained.

• Example: Gome Primary school in Changamwe launched its health and rights club, with pomp and color, demonstrating the pupil’s commitment in championing their own rights. Neighbouring schools and local leaders were invited. Children took centre stage: songs, poems, skits and speeches. All demonstrated their ability to advance the message of child protection in the society.

• In Nairobi, 45,037 children attended child forums at various venues in their respective IPs. The theme of the quarter was gender based violence, PEP and risks of casual sex. Youth leaders and nurses led the discussions. The Wangu Kanja poster was used. Children received Vit A and were dewormed. Under-fives received growth monitoring. Games, skits by drama groups, songs and poems.. all was there.

• Nipe Nafasi project in Nairobi held a two day workshop for 10 facilitators and sensitized those youth leaders on the ‘faces of child vulnerability’ in urban settlements. They work with 150 OVC who articulate children’s concerns. The OVCs produce IEC materials for APHIAplus. Their pictures depict child vulnerability in their communities. They express protection concerns through art and essays. AHPIAplus designs a magazine from these messages and will mount some of the art and pictures for an exhibition.

• Out of school OVC in Nairobi were offered career counseling. 62 of them were sensitized on behaviour change in regard to HIV/AIDS, drug abuse, communication skills, negotiation and decision making skills and on how to make appropriate career choices.

• Training on child friendly schools reached 115 teachers from 40 schools in Nairobi. In Coast 2 schools received the training. ToTs from the MoE/QA Department collaborated with the Advisor to Schools of Nairobi City Council. Teachers developed work plans and research questions that they will apply in the implementation of the safe schools approach. Child friendly schools increase child participation in learning, ensure child safety and reduce disaster risks in schools. The training is part of CLASSE method.


• In Coast, the OVC supported to access vocational education increased up to 222 from 151 in Q1. CHWs from all IPs made follow up school visits, and reported that the 114 boys and 108 girls remained in school, as required. Project staff did also a follow up.

• Scholastic materials such as exercise books, pencils rubbers, erasers, sharpeners, biros and spring files went to 34,467 OVCs in Nairobi and 70,000 OVC in Coast. It improves school attendance and retention for OVCs. Don Bosco Boys received scholastic material for 476 institutionalized OVC enrolled into the programme.

• Training on disability management is important for households with physically disadvantaged children. The main theme is mainstreaming disability management at household level, school level and other areas within the community where the children live. The trainings (35 caregivers/guardians) were conducted on the Day of the African Child with the theme “rights of Children with disability; the duty to protect, respect, promote and fulfill”.

• In Coast, a needs assessment identified 54 children with disability. The project partnered with the Association of the Physically Disabled of Kenya (APDK) and trained 151 caregivers of children with disability. 828 caregivers were also sensitized on post rape care and the importance of PEP especially in communities where rape cases were on the rise.

• 264 caregivers in Kwale were sensitized on importance of OVC school enrollment, retention and completion. The sensitizations were made by QI teams in Msambweni and Likoni, in close collaboration with Children’s Department and other Education Departments of the Ministry of Education.

• In Nairobi, the project supported school fees for 84 OVC in secondary school. 350 children in primary school from Huruma, Mathare and Korogocho had their school levies paid for. They are progressing well in their education. 6,000 adolescent OVC enrolled in the program were issued with disposal sanitary towels; 2,452 girls enrolled in the programme received re-usable sanitary towels. This is hoped to enhance monthly school retention for girls.

• In coast, 10,000 adolescent girls were provided with 3 months’ supply of sanitary towels in June, enough to last then until 3rd quarter. Sensitizations were conducted by the CHWs with support from teachers and staff from level 2 facilities in the Counties. Handling and disposal of used towels was addressed. In collaboration with other partners in Taita Taveta, e.g. the Girl Child Network and TOWA CBOs, more sanitary towels were distributed and adolescent girls in 17 schools were sensitized on Menses Management.

• Four Provincial officers in the MOPHS and MOE were supported to undertake School Health Program supervision in Kilifi County. The team was led the PDPHS and comprised school health focal person in MOPHS, MOE and the Public Health Officer. 13 primary schools were visited. Meetings held with District Public Health Officers and Education Officers. It was noted that the Ministry had made commendable progress in school health with the help of development partners.


• Following up on CLASSE interventions, in collaboration with District Education Officers, we see that learners effectively educate their peers:

o in Kilifi (Ganze Primary School) children reporting abuse at school and at home increased hence creating an opportunity for school stakeholders to come up with mitigating measures.

o Schools come up with talking walls (posters) on buildings, trees and walls which encourage children on good habits and school rules.

o Children are involved, which increases ownership. • Elsewhere, District Education Officers are leading their teams in reforming School Management after

stakeholders identified glaring shortcomings: the CLASSE model suggests that all stakeholders are involved in the management of the school, leading to high levels of transparency and involvement of Teachers, Parents, Local leaders and Pupils.

• The DEO Kaloleni supported the TOTs from the school to rollout to an additional school (Shangia primary) the same approach.



• Results from schools with CLASSE show increased enrollment, improved class attendance and more children clubs formed to enhance child participation. There are reports on the fact that children are happy to be involved in school decision making and are ready to do more on awareness with regard to drugs and substance abuse. How can a project engage more with education, health and child protection authorities and structures such as DEOs, DCOs/CPCs, and CHEWs in the implementation and monitoring of CLASSE activities?

• In Coast the Department of Quality Assurance at MOE Headquarters established contact with the Chairman of the Kenya Primary Schools Head Teachers Association (KEPSHA) – Coast Chapter, who is already well trained on CLASSE methodology (Child Friendly Schools). The KEPSHA head expressed optimism that the partnership would help in refreshing the existing CFS TOTs and train more teachers to rollout the programme in schools in the entire region.


• Post Training Follow up by CLASSE Master Trainer / DEO’s • Hold child holiday forums • HIV+ youths life skills camp on career counseling and ASRH • Monitoring the progress of Vocational students’ in school • Provision of school uniforms for targeted OVC • Caregiver training on Disability Management and Post Rape Care

4.4 Increased access to safe water, sanitation and improved hygiene

a) Description of Work-plan status Four activities cover this sub result. All are ongoing: water supply in schools, water supplies to highly vulnerable households, total sanitation approach in communities, WASH integrated in activities.

b) Quarterly performance monitoring matrix • A 5 day workshop for TOTs on WASH-HIV integration was held at Maanzoni Lodge, conducted by MoHPS and

FHI 360 for selected APHIAplus Implementing partners. Two representatives from Kibera attended the workshop. They are expected to carry out cascade trainings to other CHWs.

• In Nairobi, the Health Promotion Officer and the District Nutritionist Officer of Langata district held a hand washing sensitization for the ECDs in 5 venues in Kibera. It reached 4,012 children: at St Juliet ECCD, Undugu Society of Kenya, Lisi Wings of life ECCD, Kamukunji ECDs and St Georges ECCD.

• Drama groups in Nairobi conducted Magnet Theater sessions on water treatment and hand washing within their respective CU’s. Many ineffective behaviors are revealed during such sessions. 9,003 people (4,306 males & 4,697 females) were reached through the MT outreaches.

• 37,833 OVCs in Nairobi were provided with water guard and soap in the quarter. The water guard treated 3,787,300 litres of water for domestic use. To enhance hand washing and good hygiene, the OVCs were provided with a bar of soap, each, for use at home.

• 150 CHWs were trained on the community lead total sanitation (CLTS) methodology: it sensitizes communities on the need to eliminate open defecation (OD) and to become ODF (open defecation free). The CLTS sessions targeted villages low latrine coverage and high incidences of water borne diseases.



d) Challenges and recommendations • A high number of schools is in need of WASH interventions. The project will strengthen the 350 health /rights

clubs in primary schools through WASH initiatives and create a network of stakeholders for sustainability

e) Activities planned for the next quarter include: • Support the scale up of community led total sanitation (CLTS) activities. • Support stakeholders review of the school health program. • Support school health clubs to carry out hand washing/VAD, de-worming through school health program • Sensitize all Head Teachers in the County on school health programme • Establish Health Clubs where there are not and revive the dormant ones. • Installation of hand washing facilities in schools.

4.5 Strengthened systems, structures and services for protection of marginalized, poor and

underserved populations a) Description of Work-plan status

The workplan activities focus on supporting coordination structures, on supporting advocacy initiatives, on establishing linkages, and on specific programs (street children, child abuse, birth certificates, service provision to OVC, CUs and children’s rights.


• In support of continuous improvement of the management of the Cash Transfer Program in Coast, 102 members of the Beneficiary Welfare Committees (a structural unit under the Children’s Department that monitors the GOK Cash Transfer Program) were sensitized on BWC Guidelines and on the Children’s Act 2001. Members are caregivers, OVC representatives and LAAC representatives.

• In Nairobi, in order to achieve high awareness on child rights, 30 CHWs and paralegals, and 458 new caregivers and 59 LAAC members received training: operationalization of community child protection mechanisms, sensitization on the four principles of Child Rights, i.e. Life and Survival, Development, Protection and Participation. Members of LAAC are tasked Members are tasked to carry out resource mapping and mobilization.

• In Coast, LAACs received support to organise peace building forums. 20 IP representatives participated. Topics were: improving security, child protection, living harmoniously, community policing, channeling concerns, rumor mongering. Where needed barazas where held. The project supported the training of all LAACs, and provides transport allowances for their monthly/quarterly meetings.

• The project supported Njiru and Embakasi Districts in launching child labor committees that can identify and refer children. Common forms of child labour are collection of scrap metal, sex work and house help. The committees will also sensitize communities on those issues and ways to address them.

• In two Nairobi districts collaboration between different sectors was promoted. 60 social workers and managers of CCIs and rescue centers were trained on child protection and on integrated health messages. Participants realized the benefit of collaborating with District Public Health officers and Community Strategy coordinators. The civil registrar explained the importance of birth certificates and death certificates. Anecdotes from attendants confirm that sodomy and defilement exist, but they preferred to remain silent about this out of fear of stigmatisation.

• In Nairobi, 27,077 OVCs and their households received IEC materials, including the TSC circulars (post-rape). Caregivers and OVCs were taken through the messages on post rape procedures, which include valuable steps to access legal redress for rape victims. In Coast, 33,965 OVC were reached with child protection messages; 350 child rights clubs are now established in primary schools across the region.

• Child defilement continues to be reported as of grave concern. Consequently, 828 caregivers from IPs in 4 counties were sensitized on post rape care with emphasis on the importance of PEP services. The trainings


were conducted by the DHMTs and District Children Officers. Sensitizations gave caregivers more insight and information to talk to their adolescent children. With the involvement of the Children Department in the sensitizations, the caregivers understood the legal measures to be taken in cases of defilement.

• In Coast, project staff held monthly meetings with 122 OVC contact persons of implementing partners, with a focus on planning and coordination and reporting on service delivery activities. More support will be given to IP during regular activities. In addition 300 CHWs received orientation on reporting tools for OVC programs (current total: 2,300 CHWs)

• In Nairobi and Coast, 5282 OVCs and 3,465 OVCs respectively, were issued with birth certificates. This initiative involves multiple stakeholders: the QI teams, the Children’s Department, the Department of Civil Registration, school heads, area chiefs.

• In Coast, support to street children receives support through a sub grant to WEMA (Coast) where 500 former street children access services directly. The WEMA Centre was supported with books, sanitary towels for adolescent girls, water guards, sensitizations and OVC programming skills.

• In Nairobi, the project collaborated with Nairobi City Council to sensitize 1,500 street children on health and education services available to them in various health clinics and rehabilitation centres of Nairobi City Council. During the sensitizations, 106 street children were assessed and voluntarily rescued to five different rehabilitation centres.

• In Coast, the project already has 80 OVC with disability supported with various services while 151 caregivers of children living with disability were trained on disability management during the quarter with more sanitizations set for the next quarter.

c) Analysis of findings • In Coast, the District Child Officers assisted by VCO’s continued to visit schools. Their supervision ensures

that rights clubs are active and that children understood their rights. This was achieved through debates and discussions in school. Provided with the details of all 350 primary schools with healt or rights clubs, the DCO’s and VCO’s had their work cut out and as a result plans were laid out for appropriate follow-up and to maximize on the opportunity to protect the children from abuse by making them aware of their rights.


e) Activities planned for the next quarter include: • IP/CU Sensitization on community child/youth friendly spaces • Support AAC meetings for 2 Districts • Training of Administration police on child rights • Sensitize caregivers on child rights/protection • LAAC and VCO Training on integrated health messages • Support District AAC qquarterly meetings • Support monthly meetings for OVC Contact persons • Attend DHMT meetings and AWP 1 process 4.6 Expanded social mobilization for health

a) Description of Work-plan status The work plan lists support to the special celebration days. The project monitors those special days and organizes its contribution.

b) Quarterly performance monitoring matrix • Several national days receive support from the project : the Day of the African Child, in 5 counties of Coast in

collaboration with the Children’s Department; the project supported MoPHS to mark the World Malaria Day.


• Religious leaders’ sensitization meetings were held in Dagoretti, Embakasi, Westlands and Kasarani, during which a total of 371 religious and other community leaders were reached. It was surprising to see how much information the religious leaders lacked on HIV and TB. In Kasarani, one of the bishops confessed that he had instructed many members of his congregation to throw away their ARVs. He asserted, “l cannot imagine the mess l have done. I have destroyed the lives of many. I wish I had got this information many years back. Ignorance will kill us”




• International Youth Week – August 12

CONTRIBUTING TO HEALTH SYSTEMS STRENGTHENING

a) Description of Work-plan status

The work plan lists around 70 individual activities which are generic, i.e. non-HIV, non-TB specific etc., and which support the health system “building blocks”, as described in KHSSP III. By the end of this quarter, most if not all relevant activities have been taken on board.

In service delivery Nairobi province project team slowed down the expansion of community units while the Coast team continued to expand coverage. Nairobi province replaced the expansion with district level assessments of the results achieved. Both provinces continued with the support to the CUs. The standard support to the facilities consists of CME’s, OJTs, review meetings, exchange visits and technical support. All activities, except maybe post training follow up sessions, are on track.

Planning support was adjusted to the revised annual planning system of the MoH, and was moved essentially to the next quarter.

Activities in support of quality improvement are support supervision, mentorship, quality assurance interventions such as COPE. The Kenya Quality Health Model was not yet ready for rollout. In the mentorship program progress has been made, but the grand rounds have not yet taken place while the mentorship sharing forums were successfully introduced.

Support to DHIS and CBHIS is very strategic for the project and for USAID and very important for the MOH. It continued full strength. Support to the implementation of EMR was intensified.

The program also maintained a strong pace in renovating facilities in Nairobi and Coast province. Attention was paid to timely procurement of equipment and collaboration with Doc2Dock, an international partner ready to provide equipment and consumables for both provinces, has effectively started.

With the co-location of the HCMS regional coordinator in APHIAplus offices, the activities in support of improved logistics have become more effective.

Lastly, the project continued to respond positively to request to support financially and technically a number of coordination or technical meetings at province or district level. This is essentially support to the governance building block. It is also at this level that the project promotes a strong leadership strengthening component in collaboration with the relevant national mechanism.


b) Strategic approach

The year one work plan narrative contained a detailed description of the different approaches that the project would follow with regard to system strengthening.

In the absence of sound evidence on what constitutes effective health system strengthening, the project relies on GOK guidance on what it expects from partners in order to strengthen the health system. This is also in line with the USAID Implementation Framework 2010-2015 which constitutes a reference on its own with regard to how APHIAplus Service Delivery fits within the overall implementation structure put in place by USAID. The USAID Implementation Framework also contains sufficient references to the Global Health Initiative of which the guiding principles are to be fully internalised by the project.

Nevertheless, these GOK and USAID references need at all times to be complemented by a project strategy, which essentially describes how the project and project staff understand their own role and how it will be played out.

This strategy is the following: in order to give GOK and USAID health system strategies the greatest chance to succeed, APHIAplus will at all times support the continuous development of the building blocks, service delivery in the first place, but focus on the interactions which health system managers, at province, county, district, division, facility community level foster between the different health system components. In addition, the project will pay a similar kind of attention to how, across the sectors or across sector partners, the interactions or synergies are properly activated. This is extremely important - and represents the key added value of the project - since otherwise the ‘support’ will go to building blocks without really changing the way in which the health system – the whole of which the building blocks are only a part - evolves as the novel expression of interacting system components.

In addition, the project refers to complex systems dynamics, in order to remind staff and partners that health systems are about people, not about structures, and that the structures need to prove their relevance, i.e. unless their day to day existence makes a measurable contribution to people’s lives, two health systems might operate like two vast disconnected networks: on the one hand individuals, households, communities who generate health by exploiting relevant resources or access to relevant resources, on the other hand structures or formal entities which have great stakes and interests in health but which do not necessarily have strong links with lives of millions of people, and with their ability to generate more health.

c) System strengthening activities

SUPPORT TO SERVICE DELIVERY

Implementation of the Community Health Strategy is gathering momentum. In both provinces it becomes a focal point. More health promoters are now recognizing CS as the platform for conventional health interventions and social determinants of health. In Coast, the number of functional CUs supported by the project during year two rose by 16 for a total of 81 of the targeted 88. In Nairobi no more CUs were added during the quarter.

In Coast, the second distribution of 750 bicycles to CHWs was a highlight. It improves transportation and accessibility within the communities. Household coverage was augmented by 15,401, for a total of 98,453 households reached. The number of individuals benefitting from CHW services also rose, from 327,160 to 401,554. This growth involved the recruitment and training of 695 new CHWs. In Nairobi, the number of individuals benefiting from CHWs services affiliated to the 83 project supported CUs are 2,075,000.

The CHWs continued with household visits conducting dialogue sessions, reaching community members and making referrals. Community Dialogue Days are held at the CUs. Community members discuss health and the social determinants of health related issues. To enhance community facility linkages, joint CHC/DHC meetings are held. To keep up with activity expansion, trainings in the community health strategy accelerated across all counties.


Community Dialogue Days (CDDs) create a space to identify issues and create solutions and action plans. CDDs are organized and conducted by CHCs, CHWs, and facility staff their respective CUs, in collaboration with chiefs and other GoK agencies. They are facilitated by CHEWs with District health team members in attendance to offer strategic direction. The CDDs are gaining popularity as other development partners are acknowledging that empowerment and community mobilization are more effective and sustainable through organized community structures.

A 2-day orientation on community strategy was conducted for 52 facility in-charges from Starehe, Kamukunji, Njiru, Embakasi and Makadara in Nairobi. The main aim was to improve their understanding of the community strategy so that they would get involved in community/facility linkages through referral and supervision. The sessions were facilitated by the District CS Coordinators, the provincial focal person on CS and a representative from the Division of Community Health Services.

In Nairobi, the project supported community strategy review meetings at district level. The district CS coordinators involve the DHMTS, CHEWs, CHWs and CHC members. The discussions centered around collaboration of DHMTs with the CUs to address for instance support for TB prevention and treatment (in Kibera). CUs start having impact on health indicators: e.g. the CU in Gatwikira did not witness the usual cholera outbreaks that come with the rainy season. In Mathare 4, the CU was commended for identifying children who had not been immunised. This led to an immunisation outreach by Mathare North HC. The meetings also discussed challenges such as CHW attrition and the need for partners to coordinate their activities through the CUs. It was clear to see that the coordination are ensuring that health stakeholders work together and also that the DHMT members are all on board and not viewing the community strategy as a docket for just one DHMT member.

Joint CHC/DHC meetings are designed to bring together the two governing structures to provide feedback and forge a common approach in addressing health issues affecting communities in CU areas in Coast, the following are among the issues raised by CHCs on behalf of the community:

• High cost of health services where communities are forced to pay for hospital deliveries that use disposable commodities that are not part of KEMSA deliverables, and with little or no dialogue with the community.

• Minimum capacity building of the facility management committees thereby leaving them unable execute their role and responsibilities.

• Frequent shortage of drugs at health facilities, forcing communities to buy from local pharmacies. • Shortage of staff at the health facility, creating workloads that compromise the quality of health services.

The following action points were noted:

• Enhanced coordination and collaboration among the DHCs, the CHC, and the staff for more successful level one programming and an improvement of working relations through frequent facility/community linkage meetings

• Joint DHC/CHC review and planning meetings for community activities • Attendance by the chairpersons of the CHC to the quarterly DHC meetings to advocate for community

priority issues and needs • The facility management committees to utilize the HSSF to purchase necessary medicine and engage

community volunteer staff and retired staff on agreeable allowances.

CHWs and community health extension workers (CHEWs) meet every month to share the final consolidated reports from the respective CU/sites and merge work plans for the following month. In Coast, CHWs have initiated income generating activities to encourage group sustainability and economic empowerment of members. A total of 3,680 CHWs, represented by 1,531 men and 2,149 women, and 80 CHEWs attended the meetings in 81 CUs/sites. More than 3,000 CHWs assisted (MOPHS) in mapping and registering some 83,000 households for the mass distribution of free insecticide treated bednets provided by the World Bank during World Malaria Day.


The monthly DHMT/ facility in-charges meetings were supported in all districts, agenda included submission of reports from various health facilities, improvement of quality of care in the facilities and importance of providing correct data.

Monthly progress meetings were held at Mbagathi district hospital between the departmental representatives and APHIAplus staff to discuss progress of service delivery.

Challenges and recommendations.

• CHWs need first aid skills and kits for minor ailments; they have occupied a position in the community where they are regarded as health providers. The project should advocate for these kits.

• Delay in free bednets distribution by the MOPHS left the CHWs/CHCs who were involved in household mapping and registration to be blamed by community members for not delivering on time.

• Lack of reporting tools. The photocopies in use cannot be stored due to lack of proper storage and filling systems.

• Inconsistent data from the household registrations resulting in a delay in updating the registers.

Activities for next quarter include: • Continue establishing more CUs • Support and participate in refresher training for PHMTs/DHMTs • Support and participate in DHMT supportive supervision to CUs • Train newly employed CHEWs in community strategy • Train CHWs and CHCs in community strategy for the new CUs

SUPPORT TO PLANNING The project participated in the district AOP review and HIV stakeholders meetings. Presentations on the activities supported by the project in the district were made.

Guidance for the annual work plans was provided by MoH. The project will support each province with the roll out of the new system.

APHIAplus participated in the DHMT meetings and stakeholder meetings for all districts. The meetings provided a forum for different partners to share on the activities they have already implemented and those planned for the current quarter.

SUPPORT TO PERFORMANCE IMPROVEMENT

Mentorship

MOH mentors were identified, trained and received coaching sessions from the master mentors. The focus in this quarter was on aspects of HIV testing and counseling, adherence counseling and support, Integration of PMCT services and understanding the natural history of HIV in order to better appreciate OIs and the need for accurate WHO staging and its significance in the management of HIV infected persons.

MOH mentors received coaching sessions in counseling including the various points of entry to care and treatment with emphasis on need for comprehensive plans within the facilities to improve HIV testing and counseling both within the facility and in their surrounding communities. PITC was emphasized to the MOH mentors who were encouraged to practice this within their facilities and to cascade this down to their satellite facilities. The counseling series also focused on adherence counseling and support of the patient receiving treatment.

Dtm

CO

Tso

MMw

ATmmq Wctrbn

C•

Fi

Discussions wthe HEI into tmothers seeki

Clinical coachiOIs in HIV. MO

The MOH mesites. Knowledone case to ill

Mentorship acMOH mentorswhen necessa

Analysis of oThe mentorshmentors. Withmanagement quality of care

With improvedcreated for stherapy demarecognized thbeing discussenorm, demand

Challenges a• Staffing le

their clienshifting hfacilities m

igure 19: High

were held withhe MCH and ing care at th

ing focused oOH mentors w

ntors have iddge and skillsustrate variou

ctivities by bos leaning on ary.

outcomes hip activities inh the drive tand generati

e given to pat

d knowledge,supplements and for functis is now beined with the md for isoniazid

and Recommevels remain nt flow and ahas been encmore efficient

35

050

100150200250

# ment

K

Q4‐201

APHIAPlus

hlights of Key

h the variouswell child clineir facilities u

on understandwere also tak

dentified sates have been us skills to the

oth the mastthe master m

n Nairobi havtoward not oon of accurattients is set to

demand is cand improvetional laboratng picked upmaster mentod is created a

mendations a major cha

assess their fcouraged whely.

66 66

tors reporting

Key Achievem

11 Q1‐2012

Nairobi-Coa

Achievements

s teams on honics. The teamup to and inclu

ding the naturken through W

ellite sites in tcascaded by e mentees.

ter mentors amentors for t

ve been scaledonly improvinte data that co improve.

reated withind nutritional tories with re and access t

ors; where thnd needless T

allenge in mofacility data tere volunteer

3569

# facilities me

T

ments under M

Q2‐2012

ast Report fo

s under Mento

ow to tackle ms shared facuding 24 mon

ral history of WHO clinical st

their districtsmeans of ob

and MOH metechnical adv

d up, largely g staff knowcan be consu

the facilities counseling;

eagents; wheto virological e use of routTB infections

ost sites, howo more effecrs can be tra

5270

entored # sta

Time (Quarters

entorshop pro

or Quarter 2

orship and Per

the challengecility patient fnths post-part

HIV and accustaging.

s and commebservation, re

entors have bice during co

due to the cawledge and smed by the f

e.g. where mthe baseline

ere treatmenstudies is ge

tine IPT for cin this popula

wever mentorctively utilize ained to carr

99 86

aff mentored

s)

ogram for Coa

2 - 2012

rformance Im

es of integratflow charts of tum.

urate diagnos

enced mentoreview of reco

been running oaching sessio

ascading of mkills but alsofacilities to tr

malnutrition ise investigationt failure wasenerated and children expoation could be

rs have encothe existing

ry out basic

80

170

# mentorshipsubmit

ast

mprovement

ting PMCT anf pregnant HIV

sis and manag

rship activitiesrds and use

concurrentlyons and via

mentorship byo improved cack their prog

s recognized dns before ins previously second line tsed to TB wae averted.

uraged staff staff. In addtasks in ord

0198

p reportsted

58

nd care of V infected

gement of

s in these of one on

y with the telephone

y the MOH ommodity gress, the

demand is itiation of not being therapy is as not the

to assess dition task der to run


• Inadequate and inaccurate data in registers where staff are overwhelmed with other clinical duties and do not fully appreciate the need to keep complete records or are not sufficiently motivated to do so is a challenge to an efficient HMIS.

• Integration of HIV services with the other services is recommended such that it becomes part of chronic care offered by facilities and that those providing the service are not only a select few. In this way the facilities would benefit more from the mentorship and be better cushioned when staff transfers and attrition occurs, hence ensuring continuity of quality service provision.

• In some sites, the number of satellite facilities is too small for mentors to hone their skills. E.g. Mbagathi DH has few satelite facilities in which the MOH mentors can cascade their skills

Activities planned for the next quarter The following activities are proposed in the next quarter • Standardization of mentorship through the development of checklists per discipline of the specific learning

objectives that must be attained by mentees to aid in benchmarking progress made. • Documenting and archiving of clinical case scenarios for each discipline to be used in standardizing CMEs. • Continued coaching of MOH mentors by master mentors to build technical capacities, improve skills and

confidence in cascading mentorship activities • MOH mentors sharing forum to discuss challenges and best practices QI Team Training QI teams from 7 IPs were trained on the QI minimum standards for OVC in Kenya. The 15 man teams are composed of teachers, counselors, social workers, health workers, older OVC, caregivers, IP coordinators and contact persons. They understood the relevance of the QI minimum standards in OVC Programming; they were taken through the skills of implementing QI and adaptation of the tools. They developed action plans which they will implement in the next 6 months. QI Assessment and QI Teams Training 61 QI team members, 30 and 31 from NOFI in Njiru district and CHF in Embakasi district respectively, carried out OVC service quality assessment on the 8 service areas. The teams prioritized four areas for improvement; i.e. Food and Nutrition, Economic empowerment, shelter and care and education. Towards the end of the quarter, the NOFI team recorded remarkable improvement on education and health. There was slight improvement on Shelter. The CHF team will be carrying out another assessment in the next quarter to assess progress. The teams consist of the DCO, VCO, CHEW, village elders, CHWs, teachers, caregivers and older OVCs.

QI Rollout During the quarter, number of QI Teams formed and fully operational reached 9 up from 4 the previous quarter. The District Children’s Officers took the mandate to train and supervise the work of the newly formed QI Teams in all the clusters. This made it easy for the Children’s Department to internalize the applicability of the OVC Minimum Service Standards developed to guide OVC work in Kenya. As part of the activities in their work plans in Malindi and VOI, the QI Teams managed to conduct birth certificates registration with support of the Civil Registration Department. Additionally, Dabaso QI team mobilized stakeholders to construct 6 ramps in GEDE primary to ease access to classrooms by those with disabilities. In Mombasa, the Majaoni Bamako QI teams held public Baraza’s with the support of the area Chief and sensitized the community on the disadvantages of illicit brew and drugs abuse in the area. During the trainings, the 9 QI teams managed to involve key stakeholders in their communities by co-opting government officials and business people where they thought fit, in the development of their work plans. Key ministries involved during the formation of QI teams included the Provincial Administration, MOPHS, MOE, MOA, Civil Registration Department and Children’s Department.


Post training follow up by OVC QI Coaches

The URC and the Project QI advisor visited the Msambweni QI Teams for supervision and mentoring and some observations made in regard to the OVC QI process. The QI Teams were noted to have made tremendous efforts in identification of the OVC service areas and making fruitful steps towards addressing the identified challenges as outlined in the Teams work plans. However, it was observed that there was need for more QI information and coaching as the locals complained of the tools being in English thus hard to translate. In a briefing meeting between the visiting team, the OVC team and the Deputy Project Director, it was noted that there was need for deliberate efforts to ensure the communities accessed easy to learn materials on QI especially IEC materials in Swahili for the teams to be able to easily understand the Child Status Index domains. Training of child status index and roll out The first Child Status Index assessment was rolled out in this quarter. 42 CHWS were trained on the CSI and supported to assess 1,283 OVC. The sample size was randomised and selected from 25,805 OVC from Njiru, Embakasi and Makadara districts who are enrolled in the programme. Results from the 5 day assessment showed that most children were living in fair conditions with the lowest sub-domain score at 2.61 for food security and the highest sub- domain score at 3.66 for abuse and exploitation. Out of the 19 IPs from which the 1283 OVC were assessed, the service areas needing most attention were shelter and care; and food and nutrition where the score was 2 in 10 and 7 IPS respectively. On presenting these findings back to the IPs, they resolved to carry out the CSI to all the enrolled OVC in their areas of coverage in the next quarter. The project will also focus on household economic strengthening, shelter and care and food security initiatives, in the remaining project period. SUPPORT TO HIS The project works intensively with the Division of HMIS to strengthen the capacity of MOH health providers and implementing partner’s staff to streamline data capture and reporting systems and information utilization for improved decision making and activity programming.

Capacity Building of on data collection and reporting

The project supported several activities aimed at improving how data is captured, analyzed, reported and utilized both at the facility/SDP levels and how that data gets summarized and shared with the other health system levels. This included working with the national-level mechanism on HMIS (Afya Info/Div. HMIS) to ensure availability of the new HMIS tools; strengthening the MOH Health Logistics systems for distribution of HCMs/CHIS tools to health facilities and community health units (CUs).

A number of 3-day technical orientations on the new HMIS tools were conducted. It targeted clinical services coordinators, mentors at district levels. This will help them in populating the DHIS2 with the full list of health sector indicators. Support went to the DHRIOs/HROs to cascade the remedial sessions to cover service providers starting with high volume facilities and with particular focus on both PMTCT and ART sites.

Health care workers were supported to record and report on the national tools by: providing on-site mentorship to health providers and information staff at district hospitals and high-volume ART sites; providing on-site TA and mentoring of the health information staff on use of DHIS to report CU activities. Peer educators across different implementing partners were also trained on the new health communication data collection and reporting tools to strengthen data collection and reporting.

MOH tools from the Division of HMIS and NASCOP were collected and distributed. Some tools were reproduced: ART Daily Activity Register, HEI registers.

Project M&E officers conducted site-level performance monitoring and technical support to help with the appraisal of activity implementation and offer need-based technical assistance. All these efforts result into improved reporting rates by facilities with respect to both MOH 711 and MOH 731 summary sheets. More efforts are required.


Support to strengthen the CHIS and DHIS

As member of the core M&E TWG, the project team collaborated with the Division of Community Health Services in drafting the National M&E plan for the Community Health Strategy, and contributed to guidance on a KAPs survey that will inform development of a Communication Strategy for the Community Health Services.

As part of the continuous roll out of DHIS, M&E officers worked with District teams in addressing challenges in working with the DHIS2 platform. This included discussions with the DHRIOs on issues raised during the NASCOP led data quality reviews, and feedback to harmonize gaps in MOH 7311 reporting.

EMR Roll-out

Preparations are well underway for the installation of the IQ-Care database at Mbagathi District Hospital CCC, Port-Reese Hospital in Mombasa, Malindi District Hospital and Coast Provincial General Hospital to replace the FUCHIA database left by the former project under Medecins san Frontiers. The IQ-Care system was developed with PEPFAR funding by the Futures Group and is available free of charge. The new database has been sanctioned by NASCOP for installation at the CCC.

Improving Data Quality

Conduction of site level Routine Data Quality Audits (RDQAs) aimed at helping orient and mentor implementing partners’ programming staff and health facility staff to ensure data reliability and consistent improvement in data quality. The district teams were also facilitated to conduct supportive supervision and to initiate multi-disciplinary team data review meetings at district, facility and community health unit levels.

SUPPORT TO INFRASTRUCTURE

Assessments done in each province during year one, showed the huge maintenance and renovations need of facilities in Nairobi and Coast. Although renovations were not a program priority, the project allocated resources in line with USAID guidance on budget ceilings per renovated facility per year. In Nairobi, the project works in partnership with MoPH&S, MoMS, NHMB and City Council of Nairobi. NAIROBI PROVINCE Renovations in two facilities, carried out last quarter, were handed over: Jericho HC and Dandora II HC . Five new renovations were started this quarter. They are at different stages of completion. 1. Construction of laboratory worktops and shelves at Mama Lucy District Hospital

To four laboratory rooms concrete worktops were added with under-cabinets and high level shelves. In each room working lab sinks, connected to flowing water. Power outlets in each room. Other general small repairs have been undertaken including a fresh coat of paint in all laboratory working area. A request to put curtain rails in the Post Abortion Care (PAC) room to improve on the privacy of our clients was also honoured.

2. Repairs to cracks and general renovations works to Remand Prison HC CCC block Remand Prison HC CCC block had several cracks caused by an earth tremor sometimes ago. The project carried out the repairs. Gutters of the CCC block that had been worn out by rust were changed, storage shelves to one of the rooms were constructed, the corridor floor that had been worn was reconstructed and a garbage burning cubicle for better management of non-clinical waste was constructed. The whole block was also painted a new.

3. General renovation works at Bahati HC Overhaul renovations to Bahati MCH clinic included extensive repairs to the building clay roof that had been leaking for a while, a new ceiling as the old one had been damaged by rain water; reconstruction of the floor

C T 1

2

3

4

of the flatout. It wamany aremanholes Also, newthe buildiand fittingreplaced

4. ConstThe new wtiles. Hanmosquito was put intiles to all

5. GenerReconstruceiling dopainting. Repaired fittings anReplaced internal w

Detailed a• Renov• Renov• Ssecu

Detailed a1. Renov2. Renov3. Renov4. Renov5. Renov6. Const

COAST PROV

The project ha

1. Installatioserve clien

2. Digging adispensary

3. Renovatioplacenta p

4. Renovatioworks, recplumbing

t roof, and waas hacked outeas damaged

and new dra

w pavement rng, includinggs. Repairs t

truction of a wwaiting bay tod basins wergauze to all tn all the wind the walls for

ral renovationuctioon of a poors, windowsReconstructiodamaged roo

nd installed stdamaged gu

walls, ceilings,

assessments, vation works vations towarurity grills to C

assessments avations to Kanvations to Wevations to Karvations to Karvations to Bahtruction of a t

VINCE

anded over re

on and refurbnts with vario

and constructy does not ha

ons towards ipit. ons towards construction work.

APHIAPlus

aterproofing lt and reconst: a new dra

ainage pipes.

ound the bui bituminous

to previously

waiting bay foo the CCC blore put in all fthe windows dows in Materr easy cleanin

n works to Citpart building s and floors.on of the flooof, replaced teel grill door utters and cadoors and w

documentatiotowards records extension CCC clinic in c

awaiting specngemi HC – Gestlands HC – riobangi Soutriobangi Northhati HC towartoilet block at

enovation wo

bishment of twous nutrition nion of a pit lave a toilet evimprovement

improvementof floors, fitti

Nairobi-Coa

layer of colasructed afreshinage and se

ilding to prevpaint to bottdamaged do

or CCC clientsock was donefour rooms ofand carried drnity ward. Reg. General pa

ty Council Staof the clinic t New plumbors of the CCdamaged ceto outside do

arried generawindows, fittin

on, plans, spenstruction of of laboratory

containers at

cification and General renov

extension of h dispensaryh HC - one wrds creation oJoshua Orbit

rks of five of

wo 20ft contneeds. atrine with a

ven for the staof the mate

t and modificing worktops

ast Report fo

s and tar was h.. The drainaewer system

vent rain wateom of the bu

oors was don

s and general e. The floor off the clinic. Tdecorative paiepairs to genainting was do

ff Clinic that had beeing, new elecCC in the bu

eiling, repaireoor of the builal painting ofgs and all fixt

ecifications, teexisting CCC

y at Mukuru RNgaira HC; ge

quantificationvations an face

the existing – extension owaiting bay aof working labt Village in Ka

the six faciliti

tainers at Ma

a block of fouaff.

ernity wing at

cation of a mwith under c

or Quarter 2

added. The age system in

was for the

er damaging uilding, paintne. All missin

renovations tf the clinic reThe project ainting especiats and ladies one to all the

n condemnedctrical cabling

uilding on useed washroomlding. f the two butures.

endering wasclinic at St. B

Reuben HC eneral paintin

n for renovatielift of the falaboratory of the existingat the CCC andboratory in theayole

ies renovation

riakani Distric

ur toilets at V

t Njukini HC

maternity bloccabinets, new

2 - 2012

floor of the bn the facility we building wa

building waling to windowg and broke

to DIWOPA Ceceived a newalso repaired ally for the chwashrooms,

e washrooms.

d for use. Reg and fittinge, finished ws including r

uildings: paint

s done for threBridget Catho

ng of the clini

on of the follocility

g building strud the other ate new opened

ns started in t

ct Hospital fo

Virangoni Hea

and digging

ck at Challa w sanitary fitt

building had bwas old, blockas built, inclu

ls. General pws and doorsn window gla

Catholic HC –w finish of certhe children

hildren. Mosquincluding new

placement ofs. New plast

with ceramic freplacement o

ting to exter

ee other facillic HC.

c and its wait

owing six fac

ucture. t the pharmad building.

the last quart

or use by CC

alth Dispensa

and construc

HC includinging with the

62

been worn ked and in uding new

painting to s, fixtures azing was

Kayole amic floor ward, put uito gauze w ceramic

f the roof, tering and floor tiles. of broken

rnal walls,

ities:

ting bay.

ilities;

cy

ter:

CC staff to

ary as the

ction of a

g partition necessary


5. Renovations towards improvement and modification of a maternity block at Kitobo Health Dispensary and construction of a placenta pit.

Installation and refurbishment of a 40ft container at Ndilidau Health Dispensary to ease congestion at the only building of the dispensary could not be realized due to scarcity of containers in the country, we have however managed to procure the container and are now transporting it for refurbishment in the next quarter. Renovations towards ten facilities in Kwale could also not be realized as the jobs had to go for a retender, which is now complete and are ready for commissioning the implementation in next quarter.

Detailed assessment, documentation, plans and specifications and tendering for works in twenty other facilities:

• Mombasa & Kilindini: 1. Bukole HC – extension of maternity room 2. Miritini HC – improvement of the maternity room • Msabweni: 1. Mamba dispensary – completion of a stalled building for a maternity block 2. Vitsangaleweni dispensary – construction of a waiting bay and general renovations to existing building 3. Lunga Lunga HC - renovations to existing CCC building • Kaloleni: 1. Vishakani Dispensary - General renovations to existing building and construction of a placenta pit 2. Kinarani Dispensary – General renovations to existing building and construction of a placenta pit 3. Gotani Dispensary – Improvement of security by putting grill doors & general renovations to the existing

building 4. Tsangasini Dispensary - completion of a stalled extension from the main building to act as a delivery

room. • Kilifi: 1. Matsangano Dispensary - rehabilitation of a condemned old building to house the CCC and a TB clinic 2. Muryyachake Dispensary – Additional store to the pharmacy and general renovations to the main building 3. Madamani Dispensary – additional bathroom to existing washrooms and general renovation to the one

building in the facility 4. Mirihini Dispensary – New plumbing works, water connection from council suppliers, new electrical cabling

and power connection from KPLC • Malindi: 1. Chakama Dispensary – General renovations existing building & improvement of existing pit latrine by

putting new doors and painting 2. Kakokeni Dispensary – General renovations to existing building 3. Jilore Dispensary - Anti termite treatment to main building, roof replacement to part of the building (if we

get more funds the whole roof shall be replaced), replacement of ceiling and general renovations to four marked out rooms

4. Kakuyuni Dispensary – General renovations to existing building 5. Maduguni Dispensary – General renovations to existing building and construction of a placenta pit 6. Garashi Dispensary – improvement of delivery room, washrooms and construction of a placenta pit 7. Adu Dispensary – rehabilitation of a condemned old building to act as maternity block by replacement of a

damaged roof, plaster work to walls, new windows and doors, reconstruction of floors and general painting ( this is a facility that we could have done more with more budget)

Constraints / Conclusions

In Nairobi: • Requests from facilities for renovation interventions require higher costs than budget cap provided in

APHIAplus per facility per year such as experienced in Mama Lucy Kibaki – Kayole District Hospital, Bahati H.C. and CCN staff clinic, rationalization and scaling down of the scope works has to be carried out allowing for work that is not comprehensive as desired.


• We have not managed to carry out any renovation works towards improvement of our commodity stores or offices for DHMTs due to lack of space towards the same in our facilities.

In Coast: • We had to prioritize works. Requests from facilities exceed the allowed budget cap per facility • Facilitiesare very much limited in space. There are requests for rooms for competing services, there are

no rooms available for new services. This requires extensions or additions which the project cannot undertake. There are facilities with uncompleted construction projects. The project will try to complete thsese.

Activities planned for next quarter

• Commission and carry out renovation works in all projects were documentation is complete and where tenders are done. No new detailed assessments are to be carried out.

• Complete and handover ongoing projects • Commence four projects for which all documentation work is complete: Ngong Road HC general

renovation works, Ngaira HC renovations to CCC, St. Bridgets HC renovations to CCC and Mukuru Reuben HC extension to laboratory.

SUPPORT TO LOGISTICS

• The district was supported with transport for distribution of ARVs • Mbagathi district hospital ran out of vacutainers in April and the project procured 1,500 as SCMS were also

not able to support • In Nairobi, 21 facilities and 2 DHRIOs were provided with 47 computers to improve data management in the

CCC and pharmacy • The project linked with SCMS, Kenya Pharma, HCSM, KEMSA for strengthening of service delivery at facility

level. LINKAGE WITH NATIONAL MECHANISMS

Regular and sometimes intense coordination takes place with national mechanism: HCM (co-location in Coast), AFYAINFO, FUNZO, FANIYKISHA, CAPACITY, HCSM (co-location in Coast and Nairobi), SCMS, LMS (co-location in Coast and Nairobi - 50% LOE), MCHIP, NSSI (new) Often the initiative for coordination comes from the national mechanisms, as soon as they come into being. Since several of them started after the development/approval of the year two work plan, several adjustments need to be made.

STRATEGIC INFORMATION: The M&E system focuses on activities and results achieved at the community, facility and district levels. The project supports the GK systems and structures to generate quality data and information for decision making. This is done by designing effective ways to collect and analyze data to improve services. The key objectives include to: • Monitor performance in increase in use of quality HIV prevention, care and treatment, TB/HIV, MNCH

reproductive health and FP services • Monitor performance in demand creation for health services at community levels • Monitor performance in addressing social determinants for health among orphans and vulnerable children

(OVC), home-based care clients and other vulnerable target populations


• Measure the program’s contribution to achieving the Ministries of Health and GHI/PEPFAR/USAID objectives • Strengthen the capacity of provincial and district medical health teams, health facilities and community level

services providers to record, and use data to plan, manage and improve services. • Ensure best practices are documented and disseminated.

The ME& team follows the following strategies:

• Capacity Building of M&E officers to improve their knowledge and skills base in providing technical support • Ensuring availability of all requisite HMIS tools at the facility and community levels • Capacity building of MOH, implementing partners an project staff to on data collection and use • Improving data quality and promoting data use for decisions making.

The internal data system of the project consists of administrative procedures, data collection tools and timelines to monitor basic operations. It builds on an existing database developed in earlier years. The data collection tools are primarily tools used in the government system. The database uses MOH reporting formats as its foundation for service delivery statistics and produces reports meeting PEPFAR/USAID, and MOH requirements.

This system provides standardized tools that program managers at all levels of the project, uses to assess progress against targets. Quarterly reviews of performance data by program managers are the basis for direct feedback on performance, contributing to keeping the program on track and strengthening data quality. The APHIAPlus performance monitoring systems also enable project staff to monitor progress and generate quarterly and annual reports.

Data sources used to measure proposed outputs, which are the core of this system and measure the completion or specific products of program activities, include project activity reports, integrated facility service statistics (DHIS2), community records including those derived from NACC’s Community Based Program Activity Reporting (COBPAR) forms, event forms, and IP reports

The project has continued to support the GoK systems and structures on HIS to generate quality data and information for decision making. This has been through working with and supporting the Div. HMIS, NASCOP and NACC with design and effective roll-out of strategies to streamline data capture, analysis and reporting for improved program management. The key objectives under this subtheme remain to be the following: • Monitoring project performance in increased use of quality HIV prevention, care and treatment, TB/HIV,

MNCH reproductive health and FP services • Monitoring project performance in demand creation efforts and initiatives for increased access to improved

quality integrated health services at community levels • Monitoring performance in addressing social determinants for health among orphans and vulnerable children

(OVC), home-based care clients and other vulnerable target populations • Measuring the program’s contribution to achieving the Ministries of Health and GHI/PEPFAR/USAID objectives • Strengthening the capacity of provincial and district medical health teams, health facilities and community

level services providers to record, and use data to plan, manage and improve services; and • Supporting the project knowledge management initiatives to ensure that best practices are documented and

knowledge products are developed and disseminated targeting the different audiences.

The project has strengthened its internal M&E capacity to adequately provide the MOH structures with responsive technical assistance on M&E. The teams have been taken through intense induction including generation of quarterly reporting to USAID and MOH, working via the DHIS2 platform and are ready to streamline the Local Implementing Partner’s data capture and reporting systems. The project has also liaised with the Capacity Project (national mechanism on HRH) and supported most of the high volume facilities and district health records departments and CCCs with HROs to health with data management and reporting. The project has introduced internal monthly data reviews meetings with the technical area leads to validate results, address challenges and provide narratives for the quarterly project performance. At the facility and


community levels, the project has continued to host/ facilitate quarterly data reviews and dissemination fora aimed at strengthening data demand and information use for improved program management. The efforts have been aimed at ensuring M&E take a center-stage in informing and guiding project implementation. The M&E unit ensures that M&E results are presented in ways that facilitate decision making at the facility, district provincial and project levels.

ENVIRONMENTAL MITIGATION AND MONITORING (EMMR)

Monitoring of the environmental compliance was done during the quarter. • At Makadara and Starehe districts, a proper incinerator is lacking; sharps are picked from the facility using

the district utility vehicle which is fueled by HSSF and taken to city mortuary for incineration. • A CME on infection prevention was held at Langata health center to update the service providers on infection

prevention procedures. It was attended by 36 staff drawn from different facilities in the district. • In Coast, CMEs on infection prevention were supported in one health facility - Port Reitz District Hospital • After an assessment on generation, storage, handling and disposal of hazardous and highly hazardous

medical waste, the project procured and distributed colored bin liners.

Facility Red colored (pcs)

Yellow colored (pcs)

Black colored (pcs)

CPGH 200 200 200 Tudor DH 100 100 100

Port Reitz DH 100 100 100 KinangoDH 100 100 100

Kwale DH 100 100 100 Msambweni DH 100 100 100

Mariakani DH 100 100 100 Kilifi DH 100 100 100 Lamu DH 100 100 100 Malindi DH 100 100 100 Taveta DH 100 100 100 Moi Voi DH 100 100 100

TOTAL 1,300 1,300 1,300

USAI SE AWAR PR ID/KENY ECOND Q ACTIVITY RD ...

Documents