USAID KENYA (APHIAPLUS IMARISHA)
ANNUAL PERFORMANCE REPORT
Figure 1: Participants in a consultative meeting on November 14, 2018 in Nairobi, between Amref Health Africa in Kenya and County Health Leaders from Garissa, Isiolo, Mandera, Marsabit, Tana River and Wajir Counties USAID/KENYA APHIAPLUS IMARISHA ANNUAL PROGRAMME REPORT FOR FY 2016 Page 1DECEMBER 2018
This publication was produced for review by the United States Agency for International Development. It was prepared by Amref Health Africa in Kenya
USAID KENYA APHIAPLUS IMARISHA FY 2018 ANNUAL PERFORMANCE REPORT
01 OCTOBER 2017 – 30 SEPTEMBER 2018
Award No: AID-623-A-12-00015
Prepared for Teresa Simiyu, AOR United States Agency for International Development/Kenya C/O American Embassy United Nations Avenue, Gigiri P.O. Box 629, Village Market 00621 Nairobi, Kenya
Prepared by: African Medical and Research Foundation Wilson Airport, Lang’ata Road P.O. Box 30125, GPO 00100
DISCLAIMER The authors’ views expressed in this report do not necessarily reflect the views of the United States Agency for International Development or the United States Government.
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CONTENTS I. APHIAPLUS IMARISHA EXECUTIVE SUMMARY...... 1 II. KEY ACHIEVEMENTS ...... 4 III. ACTIVITY PROGRESS (Quantitative Impact) ...... 24 IV. CONSTRAINTS AND OPPORTUNITIES ...... 25 V. PERFORMANCE MONITORING ...... 26 VI. PROGRESS ON GENDER STRATEGY ...... 28 VII. PROGRESS ON ENVIRONMENTAL MITIGATION AND MONITORING ...... 29 VIII. PROGRESS ON LINKS TO OTHER USAID PROGRAMS...... 30 IX. PROGRESS ON LINKS WITH GOK AGENCIES ...... 30 X. GRANTS MANAGEMENT ...... 31 XI. SUSTAINABILITY AND EXIT STRATEGY ...... 32 XII. GLOBAL DEVELOPMENT ALLIANCE ...... 33 XIII. SUBSEQUENT QUARTER’S WORK PLAN ...... 33 XIV. FINANCIAL INFORMATION ...... 35 XV. ACTIVITY ADMINISTRATION ...... 37 XVI. INFORMATION FOR ANNUAL REPORTS ONLY ...... 38 XVII. GPS INFORMATION ...... 40 VIII. SUCCESS STORY ...... 45 ANNEXES & ATTACHMENTS ...... 45
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LIST OF TABLES
TABLE 1: PROJECT PERFORMANCE SUMMARY ...... 2 TABLE 2: TOWARDS 90 90 90 ...... 3 TABLE 3: HTS PERFORMANCE BY COUNTY...... ERROR! BOOKMARK NOT DEFINED. TABLE 4: HIV POSITIVE YIELD BY AGE PER COUNTY ...... ERROR! BOOKMARK NOT DEFINED. TABLE 5: SHOWING PRE-ART TO ART TRANSITION RATES ACROSS THE COUNTIES ...... ERROR! BOOKMARK NOT DEFINED. TABLE 6: TEST AND ART START CASCADE ...... ERROR! BOOKMARK NOT DEFINED. TABLE 7: RETENTION ACROSS THE COUNTIES ...... ERROR! BOOKMARK NOT DEFINED. TABLE 8: FACILITIES THAT HAVE BETTER VIRAL LOAD COVERAGE ...... ERROR! BOOKMARK NOT DEFINED. TABLE 9: VIRAL LOAD SUPPRESSION BY AGE FOR THE PERIOD OCT 2017 - SEPT 2018 .... ERROR! BOOKMARK NOT DEFINED. TABLE 10: TB CASCADE ...... ERROR! BOOKMARK NOT DEFINED. TABLE 11: TB GENE XPERT TESTING ...... ERROR! BOOKMARK NOT DEFINED. TABLE 12: ISONIAZID PROPHYLAXIS THERAPY (IPT) UPTAKE ...... ERROR! BOOKMARK NOT DEFINED. TABLE 13: ISONIAZID PROPHYLAXIS THERAPY (IPT) COHORT ANALYSIS ...... ERROR! BOOKMARK NOT DEFINED. TABLE 14: TB TREATMENT OUTCOME IN NAL CENTRAL SUPPORT COUNTIES ERROR! BOOKMARK NOT DEFINED. TABLE 15: PMTCT KNOWN HIV STATUS FOR THE PERIOD JANUARY TO MARCH 2018 ... ERROR! BOOKMARK NOT DEFINED. TABLE 16: E-MTCT CASCADE ACROSS 6 COUNTIES SUPPORTED BY APHIAPLUS IMARISHA . ERROR! BOOKMARK NOT DEFINED. TABLE 17: EID ACROSS THE COUNTIES FOR OCT 2017 - SEPT 2018 ...... ERROR! BOOKMARK NOT DEFINED. TABLE 18: COST EXTENSION OVC AND HH TARGETS ...... ERROR! BOOKMARK NOT DEFINED.
TABLES OF FIGURES
FIGURE 1: BALLOON BURSTING COMPETITION DURING OVC GRADUATION CEREMONY AT PWHE LIP GROUNDS IN ISIOLO ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 2: TESTING DISAGGREGATED BY AGE GROUPS PER COUNTY ...... 4 FIGURE 3: TESTING YIELD BY SERVICE POINT MODALITY ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 4: POSITIVITY YIELD ACROSS 6 NAL COUNTIES: A COMPARISON OF THE ACHIEVEMENT VS. QUARTERLY TARGET ...... 5 FIGURE 5: POSITIVITY RATES BY COUNTY ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 7: HIV POSITIVE YIELD BY AGE AND SEX ...... 6 FIGURE 8: HTS TO CARE LINKAGE WITHIN THE COUNTY DATIM FACILITIES ...... 7 FIGURE 9: CURRENTLY ON CARE TO ART TRANSITION CASCADE ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 10: NEW ON ART QUARTERLY PERFORMANCE ...... 8 FIGURE 11: CURRENT ON ART QUARTERLY TRENDS ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 12: ART ACHIEVED VS. GAP TOWARDS APR TARGET ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 13: VIRAL LOAD COVERAGE TRENDS ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 14: VIRAL LOAD SUPPRESSION AS AT SEPT 2018 ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 15: VIRAL LOAD SUPPRESSION BY GENDER ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 16: OVERALL IMARISHA PMTCT CASCADE ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 17: EID POSITIVITY BY AGE ...... ERROR! BOOKMARK NOT DEFINED. FIGURE 18: EID CASCADE ...... ERROR! BOOKMARK NOT DEFINED.
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ACRONYMS AND ABBREVIATIONS
AAC Area Advisory Committees CPWG Child Protection Working Group ADT ART Dispensing Tool cPwP Community Prevention with Positives AIC Africa Inland Church CQI Continuous Quality Improvement AIDS Acquired Immune-Deficiency Syndrome CRH County Referral Hospital AGM Annual General Meeting CRS Catholic Relief Services ANC Ante- Natal Care CSI Child Status Index AIDS, Population, Health Integrated APHIA CSO Civil Society Organization Assistance APR Annual Performance Report CU Community Unit DANID ART Anti-Retroviral Therapy Danish International Development Agency A ARV Antiretrovirals DBS Dry Blood Sample Applying Science to Strengthen and ASSIST DHIS District Health Information System Improve Systems Adolescent Sexual and Reproductive ASRH DM Domiciliary Midwives’ Health BCC Behavior Change and Communication DMPA Depot Medroxy Progesterone Acetate BEmON Basic Emergency Obstetric and DPT Diphtheria, Pertussis and Tetanus C Newborn Care BMI Body Mass Index DQA Data Quality Assessment BRHC Broad Reach Health Care EBI Evidence-Based Intervention C4D Communication for Development EBF Exclusive Breastfeeding C&T Care and Treatment ECD Early Childhood Development CASCO County AIDS and STI Coordinator ECDE Early Childhood Development Education Emergency Pastoral Assistance Group of CBO Community Based Organization EPAGK Kenya CCC Comprehensive Care Centers EID Early Infant Diagnosis CDC Center for Diseases Control EMP Environmental Management Plans CHAI Clinton Health Access Initiative EMR Electronic Medical Records Elimination of Mother to Child CHC Community Health Committee eMTCT Transmission CHEW Community Health Extension Worker ENA Essential Nutrition Actions County Health Records Information CHRIO EWS Early Warning System Officer Culture Information and Pastoralist CIPAD FANC Focused Ante-Natal Care Development CME Continuous Medical Education FBF Fortified Blended Flour CHMT Community Health Management Team FBO Faith Based Organization CHV Community Health Volunteer FBP Food by Prescription Facility Consumption Data Reports and CHW Community Health Worker F-CDRR Requests CLTS Community-Led Total Sanitation FFS Farmer Field School CM Community Midwife FGM Female Genital Mutilation CME Continuing Medical Education FHK Food for the Hungry Kenya CMLT County Medical Laboratory Technologist FP Family Planning CNTF County Nutrition Technical Forums FSW Female Sex Worker CNC County Nutrition Coordinator GAM Global Acute Malnutrition GBV Gender Based Violence MC Male Circumcision GMP Growth Monitoring and Promotion MCA Member of County Assembly GOK Government of Kenya MCH Maternal and Child Health HAART Highly Active Antiretroviral Therapy MDR Multi Drug Resistance HBC Home Based Care MNCH Maternal Neonatal and Child Health
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HC Health Center MOA Ministry of Agriculture HCA HEI Cohort Analysis MOH Ministry of Health HCBC Home and Community Based Care MSM Men who have Sex with Men HCM Health Communications and Marketing MUAC Mid Upper Arm Circumference Health Commodities Management HCMP MWA Millennium Water Alliance Platform Health Commodities and Services Nutrition Assessment, Counseling, and HCSM NACS Management Support HCW Health Care Worker NAL Northern Arid Lands NASCO HEI HIV Exposed Infant National AIDS and STI Control Program P HES Household Economic Strengthening NDMA National Drought Management Authority National Environment Management HII High Impact Interventions NEMA Authority HINI High Impact Nutrition Interventions NEP North Eastern Province HIV Human Immunodeficiency Virus NEWS North Eastern Welfare Society HMIS Health Management Information System NHIF National Health Insurance Fund HP Horse Power NVP Nevirapine Health Promotion Advisory Council HPAC ODF Open Defecation Free Meeting Health Commodities and Services Organizational Development and System HSCM ODSS Management Strengthening HTC HIV Testing and Counseling OJT On-the-Job ICF Intensified Case Finding ORS Oral Rehydration Salts Information, Education and IEC ORT Oral Rehydration Therapy Communication IGA Income Generating Activities OTP Outpatient Therapeutic Programme Integrated Management of Acute IMAM OVC Orphans and Vulnerable Children Malnutrition Integrated Management of Childhood IMCI PD Positive Deviance Illnesses International Non-Governmental INGO PE Peer Educator Organization IYCN Infant and Young Child Nutrition PBF Performance -Based Financing KEMSA Kenya Medical Supplies Agency PGH Provincial General Hospital KWFT Kenya Women Finance Trust PHASE Personal Hygiene And Sanitation Education LARC Long-Acting Reversible Contraception PITC Provider-Initiated Testing and Counseling LIP Local Implementing Partners PLHIV People Living with HIV Logistics Management and Information LMIS PMTCT Prevention of Mother to Child Transmission System LSE Life Skills Education PNC Postnatal Care MARP Most At Risk Population POC Point of Care M2M Mother to Mother Support Group PwP Prevention with Positives Pastoralists Women for Health and M2MSG Mother to Mother PWHE Education MAM Moderate Acute Malnutrition QI Quality Improvement RDQA Routine Data Quality Audit SS Stepping Stone RH Reproductive Health STI Sexually Transmitted Infection Reproductive, Maternal, Newborn and RMNCH TA Technical Assistance Child Health RTK Rapid Test Kits TAT Turnaround Time SAIDIA Samburu Aid in Africa TB Tuberculosis SAM Severe Acute Malnutrition TBA Traditional Birth Attendants SAPR Semi Annual Performance Report ToT Trainer of Trainers Social Behavior Change and SBCC TWG Technical Working Group Communication Suguta Campaign Against AIDs SCAAP UNFP United Nations Population Fund Programme UNICE SCH Sub County Hospital United Nations Children's Fund F SCMOH Sub County Medical Officer of Health URC University Research Corporation United States Agency for International SDH Sub District Hospital USAID Development Page | vi USAID/KENYA APHIAPLUS IMARISHA ANNUAL PROGRAM REPORT FOR FY 2018
sdNVP Single Dose Nevirapine USG United States Government SCHMT Sub County Health Management Team VAS Vitamin A Supplementation SFP School Feeding Program VCT Voluntary Counseling and Testing SHG Self Help Group VIP Ventilated Improved Pit Savings and Internal Lending SILC VL Viral Load Communities SIMAH Sisters Maternity Home VMMC Voluntary Medical Male Circumcision O Site Improvement through Monitoring SIMS WASDA Wajir South Association System SMS Short Message Service WASH Water Sanitation and Hygiene SND Strategies for Northern Development WFP World Food Programme SOL Shepherds of Life WHO World Health Organization Water and Sanitation Management SOP Standard Operating Procedure WSMC Committee SRH Sexual and Reproductive Health YPE Youth Peer Educators Sexual and Reproductive Health and SRHR Zn Zinc Rights
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I. APHIAPLUS IMARISHA EXECUTIVE SUMMARY
Qualitative Impact During the year, APHIAplus IMARISHA continued to provide intensified quality HIV services across all the central support counties in partnership with the county governments’ MoH departments of Health to provide integrated quality HIV/AIDS services in narrowing the gap towards achieving the UNAIDS 90- 90-90 goal in the country. The implementation approach continued to emphasize integrated technical assistance and mentorship within the DATIM health facilities prioritizing high burden facilities and focusing on HIV/AIDS services delivery, identification, linkage to care/treatment and VL suppression among other services.
In the reporting period, we noted our programmatic performance was below expectation in regards to achieving FY18 APR targets of key performance indicators. We then initiated the Rapid Results Initiative, RRI during the fourth quarter. We also introduced an Output Based Funding (OBF) approach in selected facilities to also boost the performance. Over the reporting period, a total of 190,785 individuals were reached with HTS services out of the targeted 198,946 representing a 96% achievement of the HTS target in the support counties. 1,300 clients were identified HIV positive and 1,054 (81%) were linked to care and started on ART as per the guidelines recommendation. The lay Counsellors were re-engaged to act as linkage agents to ensure no missed opportunities to enrolment. While taking audit of the missed opportunity cases not started on ART, in the coming quarter, we will enhance patient education by engaging adherence counsellors and mentor mothers in high volume facilities whose role will be to complement the work of clinicians and nurses in support of client education and retention.
Elimination of mother-to-child transmission of HIV eMTCT, is a core driver of HIV prevention towards achievement of HIV-free generation. In recognition of this we were able to test 95.5% of all mothers who presented in ANC. There was an increase in absolute number of clients presenting for ANC, the performance stood at 34,809 against last year where attendance was 19,672. Mentorship and OJT HCW on universal testing in the operational maternities, MCH and postnatal wards, will be strengthened to further improve on the 95.5% testing coverage. A total of 262 HIV positive mothers were identified of the expected 436 giving a 60% achievements with all the mothers started on lifelong ART, this was an improvement from the previous year performance of 39% achievement.
In EID a total of 321 initial PCR samples were sent and processed at national reference laboratories of the expected 436 giving a 74% achievements of the annual target. We identified 36 HIV infected Infants by 12 months of age out of the 321 EID samples drawn in the quarter, making it a 11 % HIV positivity rate. These positives originated from Tana River, Isiolo, Marsabit and Garissa counties, all except 8 were started on ART, the eight not on ART, seven were lost to follow up and efforts are ongoing to trace back the mothers and one infant passed on.
For our OVC program, this quarter marked the final implementation period of the 9 months extension. APHIAplus IMARISHA continued to work with 12 Local Implementing Partners (LIPs) and 406 Community Health Workers (CHWs) in accelerating all the cost extension pending activities and to ensure a smooth transition of the project beneficiaries (10,936 OVC) out of active PEPFAR support. With the close out period scheduled for September, the project was in top gear with implementation to ensure that all the planned health and social services were given to the targeted OVC and caregivers across the six counties.
Quantitative Impact
During the period under review, APHIAplus IMARISHA made progress towards achieving project targets for the key service areas summarized in Table 1 below which shows selected indicators that
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provide a general overview of the quarterly project Performance and Progress towards APR. The detailed results against targets are presented in the performance data table.
Table 1: Project Performance Summary (Oct 2017 - Sept 2018)
% Annual Performance INDICATOR NAME Target Achievement Achieved Number of individuals who have been newly enrolled on (oral) antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period. TBD 15 Number of individuals who received HIV Testing Services (HTS) and received their test results 198,946 190,785 96% Number of pregnant women with known status (includes women who were tested for HIV and received their results) 63,529 34,809 55% Number of infants born to HIV-positive women who had a virologic HIV test done within 12 months of birth 436 321 74% Number of HIV-infected infants identified in the reporting period, whose diagnostic sample was collected by 12 months of age TBD 18
Number of adults and children with advanced HIV infection newly enrolled on ART 1,925 1,054 54% Number of adults and children with advanced HIV infection receiving antiretroviral therapy (ART) 7,403 5,574 75% Number of HIV-positive pregnant women who received antiretrovirals to reduce risk for mother-to-child-transmission (MTCT) during pregnancy and delivery 436 262 60% Percentage of ART patients with a viral load result documented in the medical record and/or laboratory information systems (LIS) within the past 12 months with a suppressed viral load (<1000 copies/ml) 3,901 2,880 71.9% Percentage of adults and children known to be on treatment 12 months after initiation of antiretroviral therapy (Note: reporting 24 and 36 months is recommended, but optional) TBD 454
Towards 90 90 90 During the reporting period, we provided quality HIV services across all our supported facilities partnering with County and Sub-County Health Management teams. The implementation approach emphasized on integrated technical assistance and mentorship prioritizing high burden facilities and focusing on HIV testing, identification, linkage to care/treatment and VL suppression among other services. The annual achievements for HIV positives identified is 1,300 (66%) out of a targeted 1,972. Current on ART at 5,574 (75%) out of a targeted 7,403 and 3rd 90 VL suppression is at 71.9%.
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Table 2: Towards 90 90 90 3rd 90 VL County 1st 90 Identifications 2nd 90- ART suppression Isiolo 456/774 61% 1630/2,300 71% 71.6% Marsabit 227/324 70% 1,092/1,413 77% 68.8% Wajir 84/48 175% 274/294 93% 79.7% Mandera 110/148 74% 555/711 78% 63.5% Garissa 197/392 50% 963/1,404 69% 83.2% Tana River 226/316 72% 1060/1,281 83% 63% APHIAplus 5,574/7,403 1,300/1,972 66% 71.9% IMARISHA 75%
Constraints and opportunities During the year under review, there were a number incidences reported in the NAL region including displacement of families due to flooding incidences in Tana River and Garissa counties and sporadic insecurity incidences in Moyale and Tana River counties.
Subsequent Quarters Work plan We plan to engage the Rapid Results Initiative to meet the gaps noted in the previous quarters across our indicators. We purpose to engage our HTS counsellors to beef up targeted HTS, technical officers to support dissemination of key approaches through onsite mentorship, CMEs and routine support supervision aimed at enhancing roll out of PrEP, same day ART start and scaling up of differentiated care model. In order to improve quality of care the project will enhance timely monitoring of viral loads as per recommendation of the new ART guidelines through enhanced support of sample networking to national reference laboratories and deploying of adherence counsellors at all the county referral hospitals for enhanced counselling and follow up of clients with high viraemia. In selected high volume facilities across the counties, the program will focus on provision of targeted HTS services through scaling up of approaches namely sensitization and roll out of partner notification services (PNS), Index client’s family testing, Targeted Hotspots HIV testing in Marsabit, Loyangalani, Moyale and Isiolo, optimization of facility based testing at the TB clinics, mother child clinics and maternity wards. We will engage HTS lay counsellors to double up as linkage officers to minimize missed opportunities in linking clients to care.
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II. KEY ACHIEVEMENTS
SUB-PURPOSE 1: INCREASED AND EXPANDED QUALITY HIV SERVICES
Output 1.1: Elimination of Mother to Child Transmission (eMTCT) Output 1.2: HIV Care and Support Services Output 1.3: HIV Treatment Services Output 1.4: HIV prevention and HTS services Output 1.5 TB/HIV Co-Infection Management
HIV PREVENTION and HTS SERVICES
Output 1.4: HIV prevention and HTS services During the year, we managed to provide HTS to 190,785 clients, 96% performance for the year. This is attributed to the rapid results initiative exercise, RRI conducted in the last 2 months of the third quarter. Key strategies adopted include facility level PITC in all the clinical care entry points within the supported facilities, through utilization of the hired additional HTS counselors in an effort to bridge the performance gaps. Additionally, output based financing, OBF was also used as an incentive for high performance in select core indicators during the RRI exercise. Out of the 190,785 tested individuals, 6,182 were pediatrics (below 9yrs), 32,028 adolescents (10-19yrs) and 152,575 (above 20 yrs) adults. The chart below summarizes the number of people tested per county.
HTS Performance by county, FY18
35,000 160% 152% 30,000 140%
120% 25,000 105% 107% 104% 100% 20,000 79% 80% 15,000 Number 69% 60% 10,000 40%
5,000 20%
- 0% GARISSA ISIOLO MANDERA MARSABIT TANA RIVER WAJIR Q1 3,386 2,534 2,683 2,103 4,136 2,379 Q2 8,502 4,379 5,504 8,142 8,677 3,976 Q3 7,643 4,198 3,502 9,252 8,296 4,264 Q4 30,389 11,703 16,952 10,984 16,950 10,251 APR Performance 105% 107% 69% 152% 79% 104%
Figure 1: HTS performance by County
Testing yield by modality
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TB clinic had the highest yield by proportion, at 5.2% but with the lowest number of clients tested, 1% contribution (1,826 clients). VCT testing followed with 1.1% HIV positive yield, OPD where the bulk of the tests were done, 48.7% (92,959) the yield stood at 0.5%.
HTS yields by service point modalities 100,000 6.0% 5.2% 90,000 5.0% 80,000 70,000 4.0% 60,000 50,000 3.0% 40,000 2.0% 30,000 1.1% 20,000 0.8% 0.5% 0.3% 1.0% 10,000 0 0.0% OPD VCT ANC IPD TB Total Tested 92959 52645 34662 8693 1826 Pos 468 556 115 66 95 Yield 0.5% 1.1% 0.3% 0.8% 5.2%
Total Tested Pos Yield
Figure 2: HTS yields by service point modalities.
HIV Positivity /Positive Yield During the period under review, from the 190,785 clients tested, we obtained 1,300 positive HIV results, a positivity rate of 0.7%. Isiolo, and Marsabit Counties had the highest HIV positive yields at 2.0% and 0.7% respectively as seen in Figure 3 below. Isiolo County still maintains the high positivity, the possible contributors of high positivity are heavy presence of military barracks around Isiolo, improved road connectivity with influx of population for trade and employment.
HIV Tests & Yield by County
200,000 190,785 4.0
180,000 3.5 160,000 3.0 140,000 2.5 120,000
100,000 2.0 2.0
Number 80,000 1.5 60,000 49,920 38,059 1.0 40,000 28,641 30,481 22,814 0.7 20,870 0.7 0.6 0.5 20,000 0.4 0.4 0.4 197 456 110 227 226 84 1,300 - - Garissa Isiolo Mandera Marsabit Tana River Wajir Imarisha Tests 49,920 22,814 28,641 30,481 38,059 20,870 190,785 Positive 197 456 110 227 226 84 1300 Yield (%) 0.4 2.0 0.4 0.7 0.6 0.4 0.7
Figure 3: Positivity yield across the counties
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The highest yield was evident among the 20+yrs, with a yield of 0.7% where 80% of the tests were conducted. Going forward, we will now focus on PNS and Family testing so as to improve on the yield with fewer number of tests conducted.
HIV Positive Yield by Age
180,000 0.7 0.8
160,000 0.7 140,000 0.5 0.6 120,000 0.5 100,000 0.4 0.4 80,000 Number 0.3 60,000 0.2 40,000
20,000 0.1
- - 1-9 10-19 20+ Tests 6,182 32,028 152,575 Positive 22 173 1105 Yield (%) 0.4 0.5 0.7
Figure 4: HIV Positive Yield by Age
Cascade of HTS to Care linkage in our supported Counties We worked closely with the HCWs in the health facilities to improve linkage of HIV positive clients into care and treatment in order to ensure that the second goal of 90-90-90 strategy is met: 90% of all people diagnosed HIV+ receive ART. In the period under review 1,300 new HIV Positives Clients were identified with a total of 1.054 (81.1%) linked to care and started on ART. Wajir and Mandera counties recorded our best linkage at 97.6% and 97.3% respectively, whereas Isiolo had the lowest at 67.5% linkage. Resources have been directed to support navigated/escorted retesting and linkage especially in the implementation of index partner testing others strategies that will ensure 100% linkage, include intensive pre and post-test counselling.
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HTS & Proxy Linkage
1400 120.0 1,300
99.1 1200 97.3 97.6 100.0 1,054 82.2 1000 81.1 75.2 80.0 67.5 800 60.0
Number 600 456 40.0 400 308 227 225 226 197 162 170 20.0 200 110 107 84 82
0 0.0 Garissa Isiolo Mandera Marsabit Tana River Wajir Imarisha Positive 197 456 110 227 226 84 1300 TX_New 162 308 107 225 170 82 1054 Proxy Linkage Rate (%) 82.2 67.5 97.3 99.1 75.2 97.6 81.1
Figure 5: HTS to Care linkage in the supported Counties
Pre-Exposure Prophylaxis A cumulative number of 15 clients have been initiated on PrEP across the supported counties. We will support in generating the line list of discordant couples for PrEP initiation and whereas others are still undergoing counselling to ensure adherence to treatment once they start PrEP.
HIV CARE SUPPORT TREATMENT SERVICES Output 1.2: HIV Care and Support Services Care and Treatment Treatment New Trends During this reporting period, 1,054 newly identified PLHIV were initiated on ART against a target of 1,925 translating to a 54% achievement. Majority of these clients were from Isiolo County, 29.2% contribution followed by Marsabit and Tana River counties at 21.3% and 16.1% contributions respectively. Wajir County contributed the least at 7.8%.
We will continue engaging HTS counsellors on a weekly basis to ensure there are no missed opportunities and ensure 100% linkage to treatment on those newly diagnosed HIV positive. In order to increase ART uptake, our focus will be to scale up HTS service delivery models such as partner notification services and index client based family testing in all the supported facilities.
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County TX_New performance 600
500
400
300 Number 200
100
0 Garissa Isiolo Mandera Marsabit Tana River Wajir Imarisha Quarterly Targets 92 175 39 76 86 14 481 Q1 25 53 21 28 12 14 153 Q2 39 70 37 66 38 30 280 Q3 50 85 25 51 54 18 283 Q4 48 100 24 80 66 20 338
Figure 6: County TX_NEW Achievement
Differentiated Model of Care During the quarter under review, 726 stable ART clients accessed differentiated care models across the 6 counties as summarized in the table 4 below. Facility based fast-tracked drug refills is the most preferred model by clients. However, 1 community based ART group has been introduced in a facility in Tana River County. We will continue to support in clients categorizations into stable and unstable clients across our County referral hospitals and continue enrolment into DCM services.
County No. of clients enrolled in DCM Marsabit 175 Garissa 325 Isiolo 120 Tana River 53 Mandera 32 Wajir 21 Total 726
Table 3: DCM enrollment by County
Clients currently on ART Overall, we have 5,574 clients currently on ART translating to 75% achievement against the annual target of 7,403 for the supported DATIM facilities, a drop from the previous 5,969 clients active on treatment reported in the last quarter. This drop is attributed mainly to a data cleaning and reconstruction exercise conducted in Isiolo County ART sites which hold majority of our clients. 80% of the ART clients are over 20 years of age while adolescents (10-19 years), and younger children (1-9 years) account for 18% and 2% respectively as summarized in the figures below.
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Figure 7: Current on ART targets against achievement
Figure 8: Current on ART by age
Net ART Clients At the close of the last quarter, we had total of 5,969 clients on ART, during this reporting period, a total of 388 clients were newly initiated on ART expecting an ART aggregate of 6,357. However, the current on ART stands at 5,574 as explained in the preceding section
ART Retention strategy The use of defaulter registers, expert clients to conduct community/household visits, follow-up phone calls and text messaging was utilized to support client retention in the program. Effective use of EMR systems eased defaulter management in high volume facilities and thus improved retention in care and treatment.
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HIV Treatment Monitoring Viral Load testing Access and Viral Suppression During the reporting period, 4,004 clients accessed routine viral load testing in which 2,880 clients reported as < 1000 copies/ml translating to a 71.9% viral suppression rate as summarized in the figures below. However, this remains below our 90% suppression target and going forward we will conduct an RRI around viral load coverage and enhanced adherence counselling in order to improve issues on adherence and re-suppression rates.
Table 4: Viral load suppression across the counties Counties Tests <1000 cp/ml % Suppression Marsabit 682 469 68.8% Garissa 875 728 83.2% Tana River 874 551 63% Isiolo 1,178 843 71.6% Mandera 159 101 63.5% Wajir 236 188 79.7% Imarisha 4,004 2,880 71.9%
There are plans to calibrate/configure the Gene Xpert machine at the Mandera, Marsabit, Wajir, Garissa, Hola and Isiolo county referral hospitals for viral load and EID point of care testing, an initiative being facilitated in partnership with the Clinton Health Access Initiative (CHAI). This is expected to improve viral load access, upon approval from MoH thereby mitigating challenges faced in the past as regards to optimal HIV treatment monitoring and HEI early infant diagnosis uptake in the region.
TB/HIV CO-INFECTION MANAGEMENT Output 1.5 TB/HIV Co-Infection Management TB/HIV Management Addressing the HIV/TB burden: Our main mandate in TB/HIV service delivery is to enhance the uptake of TB/HIV collaboration services as stipulated in both the national and WHO TB/HIV co-management guidelines and partner with USAID national mechanism (TB ARC) in strengthening service delivery at county level. We supported HCWs to effectively implement the five “I’s” of TB control (Intensive case finding, Immediate ART initiation, Infection control, Isoniazid Preventive Therapy and Integration of HIV/TB services) in facilities offering TB/HIV services by building the capacity of the HCWs to offer integrated, quality TB/HIV services. During the period under review, in addressing TB/ HIV burden out of 791 clients detected to have TB, 755 were tested for HIV, and 30 were found to be newly TB/HIV co-infected and 30 (100%) clients who were co infected with TB/HIV were all initiated on CPT and ART. We will continue to provide TA/ mentorship on intensive case finding in all DATIM facilities.
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Table 5: showing TB cascade across the counties for the period July-sept 2018 TB cases TB/HIV TB/HIV TB cases TB patients TB cases Known +ve +ve Month: Tested for Testing Detected HIV+ve Started on Started on HIV HIV +ve at entry CPT ART Isiolo 141 16 112 12 12 12 Marsabit 141 6 138 13 13 13 Wajir 167 0 163 0 0 0 Garissa 114 5 114 1 1 1 Mandera 127 0 127 2 2 2 Tana River 101 2 101 2 2 2 IMARISHA 791 29 755 30 30 30
GeneXpert utilization
Use of GeneXpert for TB diagnosis
GeneXpert, a molecular diagnostic test able to detect Mycobacterium tuberculosis and rifampicin resistance from sputum specimens within 2 hours, has been available in all the counties. The care and treatment mentorship team has continuously been sensitizing the CHWs on the indications of GeneXpert for MTB diagnosis and MDR-TB surveillance during the routine TA for optimal utilization of this service as a result during quarter a total of 2,722 samples underwent trough Gene Xpert testing, with 258 turning Positive and 2,421 turning Negative.
The table below summarizes the Utilization status per county during July-September 2018 period.
Table 6: TB Gene Xpert testing Tana Wajir TB Gene Xpert testing Marsabit Garissa Isiolo Total River Total # Gene pert tests done 826 787 475 144 490 2,722 # MTB negative 738 710 386 126 461 2,421 # MTB positive 72 79 68 10 29 258 # MTB positive and RIF Sensitive 68 52 68 8 0 196 # MTB positive and RIF Resistant 3 2 0 2 0 7 # MTB positive and RIF indeterminate 1 3 0 0 0 4 # of invalid results 9 18 7 1 0 35 # of errors 7 2 14 7 0 20
Isoniazid Prophylaxis Therapy (IPT) uptake
HIV/IPT Cascade
During the quarter the project teams continued with sensitization and starting eligible clients on IPT, a total of 265 (14%) Clients representing 253% of the eligible were started on IPT. The project shall continue to endeavor in upscaling the IPT uptake, through enhanced mentorship and OJT
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Table 7: Isoniazid Prophylaxis Therapy (IPT) uptake
Adults Pediatrics No. Eligible No. % No. Eligible No. started % Started on County for IPT in Started on Started for IPT in on IPT IPT CCC IPT on IPT CCC Garissa 704 54 8% 10 0 0% Mandera 24 24 100% 0 0 0% Wajir 63 3 5% 2 0 0% Isiolo 902 70 8% 54 4 7% Tana River 105 78 74% 14 7 50% Marsabit 43 24 56% 7 1 14% IMARISH 1,841 253 14% 87 12 14% A
IPT Cohort Analysis: The table below explains the treatment outcomes analysis for 270 clients who were put on IPT 6 months ago. In the distribution below there was overall completion rate at 95% varying across the counties.
Integration of services
The project continued to advocate for integration of TB/HIV services as means to ensure more efficient service delivery and better treatment outcomes for the TB/HIV co-infected Clients, this has enabled the project increased access to TB /HIV services and as at end of the current quarter 90% of sites have integrated TB/HIV services as shown in the table below.
County TB/ART sites TB/HIV integrated % Integration Isiolo 12 11 92% Wajir 5 4 80% Mandera 4 3 75% Garissa 5 4 80% Tana River 13 13 100% Marsabit 21 19 90% IMARISHA 60 54 90%
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ELIMINATION OF MOTHER TO CHILD TRANSMISSION (e- MTCT) Output 1.1: Elimination of Mother to Child Transmission (eMTCT) Elimination of mother-to-child transmission of HIV eMTCT, is a core driver of HIV prevention towards achievement of HIV-free generation. In addressing eMTCT gaps the project has ensured reduced waiting time and missed opportunities in the supported six NAL counties in Kenya. In the reporting year, we supported various activities towards elimination of mother-to-child transmission of HIV. In total 36,434 women attended first ANC visit, of which 34,809 (95.5%) women accessed HIV testing services. This was occasioned by reliable and consistent supply of RTKs in all the six counties and prioritization of pregnant women for HTS services. To address the challenge of missed opportunities and waiting time, we embarked on integration of PMTCT into MCH services. So far all referral hospitals in the region have embraced integration. We are now embarking on ensuring that this is cascaded to the lowest facility level. The number of expectant mothers who were aware of their HIV status stood at 34,809 (55%) against a target of 63,529. There was an increase in performance compared to the previous year where performance stood at 28%. This was partly due to deployment of dedicated lay HTS counsellors to reduce missed opportunities due to workload and unstructured client flow at ANC. The counsellors also improved documentation and reporting. Of those tested, a total of 147 KPs and 115 new positives were linked and initiated on ART which reflected 60% performance, against the quarterly target of 436. This was also an improvement from the previous year performance of 39%. This was achieved through acceleration of activities during the month of RRI in Q4. In the subsequent year, we will continue to provide TA, OJT and Mentorship to HCW and lay counsellors to ensure sustainable quality PMTCT services across all the counties supported. A summary of achievements over the reporting period is shown in the graphs below.
Figure 9: PMTC testing achievement vs target Early Infant Diagnosis During the reporting period, we had an achievement of 321 HEIs, 74% performance against our target of 436, an increase from the previous year of 46% performance. The achievement was realized through sustained technical assistance, mentorship and OJT to HCW to ensure eMTCT. We also supported integration of PMTCT into MCH services (mother-baby pairing) to reduce missed opportunities and Page | 13 USAID/KENYA APHIAPLUS IMARISHA ANNUAL PROGRAM REPORT FOR FY 2018
defaulters due to referral to the CCC. This was realized through mentorship and OJT aimed at reducing missed opportunities, improving documentation and reporting.
Of the 321 HEIs identified (142 < 2 months; 179 >2 months to 12months), 36 (11%) tested PCR positive for HIV (5 below 2 months; 35 >2 months to 12months). Subsequently 28 infants were linked and initiated on HAART, 7 infants were lost to follow up, and we continue to look for them through the mentor mothers in our facilities, 1 infant passed on.
Our audit attributes the transmission to late enrolment/identification of mothers on HAART as well as poor adherence to care among the contributing factors. To address the challenge, the project has increased surveillance of the entire continuum of care to ensure there is no missed opportunity that leads to late diagnosis. The project also involves Mentor mothers and adherence counselors in high volume facilities to increase follow up of HIV positive mothers and HEIs at ANC to help increase adherence.
Figure 10: HIV Testing (PCR), positivity and linkage for under 2 Months EID
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Figure 11: HIV Testing, positivity and linkage for 2-12 Months EID
Output 1.6: OVC Services During this reporting period, the project focused on conducting a fresh graduation readiness assessment (GRA), analyzing the GRA data, sharing the findings with key stakeholders and using the findings to guide implementation. The GRA was done post a as refresher orientation of CHWs and local implementing partner staff in June 2018. Other activities in the quarter included provision of direct services to OVC guided by the 2018 Graduation Readiness Assessment (Household Economic strengthening activities, School fees support, OVC station days, NHIF registration support and OVC HTC), OVC graduation ceremonies, SILC and QIT meetings, transition team meetings, resource mobilization meetings with Department of Social Services and private sector organizations. Project closeout stakeholders meetings across the 6 target counties were also held with a purpose of celebrating achievements and discussing closure and managing post closure concerns. The GRA looked at 4 domains of Stable, Healthy, Schooled and Safe. The overall results categorized the OVC into 3; ready for graduation (306), on the path to Graduation (5,090) and on the path to transfer 5,480. The worst performing domain was the Stable domain with the household majorly reporting intermittent meals for the family members due to financial strain. All the key stakeholders were involved in planning and implementation of activities throughout the quarter. The DCS assisted in planning and mobilization for all community and stakeholder’s meetings and the GRA exercise. During project closeout meetings, MOUs were signed with the DCS that will ensure continued lobbying for support and service provision for OVC on pathway to graduation. Data was shared with the DCS and other stakeholders for continued resource mobilization and support to pending case load. As at September 2018, the project managed to graduate 406 OVC and successfully transferred the remaining case load of OVC to both the local implementing partners (11%) and the department of children services through the Transition teams (89%) across the 6 counties
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Expected Outcome: 1.6.1: Increased access to health and social services for OVC and their families. 1.6.1.1 Greater Community Involvement in health and social services delivery, promotion and utilization for OVC wellbeing. The project continued to work with community-based structures to ensure ownership and sustainability of actions undertaken. During the quarter, the program engaged various community-based structures in supporting transition and exit activities. These included CHW cluster groups, caregiver forums, quality improvement teams, and locational area advisory councils that were involved in community dialogue sessions on transition and exit. OVC graduation readiness assessment was done in July 2018 and data was analyzed and shared with the project stakeholders. A summary of the findings from the GRA is shown below.
GRA results 6,000 5,480 5,000 5,090
4,000
3,000 2,349 2,000 1,575 1,532 1,000 768 870 529 552 753 686 272 279405 366 0 19 46 52 5 46 198 GARISSA MANDERA TANARIVER WAJIR ISIOLO MARSABIT Grand Total
Transfer path OVC Path to Graduation OVC Graduation ready OVC
After the GRA, LIPs developed case plans for OVC on pathway to graduation and OVC on pathway to transfer. The case plans were filed in OVC files at the LIP offices and also photocopied and shared with the OVC caregivers for easy follow-up on case plan achievement by CHVs. During this year’s GRA exercise, 244 OVC met the criteria for graduating and the exiting process has been accomplished.
OVC graduation ceremony in Moyale and Isiolo respectively
The QIT (Quality Improvement Team) members offered psychosocial support during home visits to OVC as well as guidance and counselling to both OVC and caregivers. They encouraged OVC to put more effort in education and to observe good morals to enable them to achieve their goals. Among the achievements they have heard so far include identifying new OVC and linking them to existing organizations. Moyale had linked 5 OVC to CDF bursaries, 2 girls in Moyale had been rescued from early marriage and both Marsabit and Moyale QIT make constant visits to caregivers alongside SILC Page | 16 USAID/KENYA APHIAPLUS IMARISHA ANNUAL PROGRAM REPORT FOR FY 2018
members to offer advice to House Holds on IGAs. 380 OVC received school fees payments through APHIAplus IMARISHA support.
1.6.1.2 Increased number of OVC receiving age appropriate and quality services, including HIV services. During this reporting period, service provision was guided by case plans. OVC station days was conducted in four counties of Marsabit and Isiolo, Wajir and Garissa. A total of 1,485 OVCs participated in basic counselling, sex and sexuality for adolescents and HIV testing. Out of the 780 OVC who received HTC during station days, 2 OVC and 1 caregiver who were found to be HIV positive were enrolled into treatment within their communities.
Case plan achievement for on path to graduation 1,200 120% 1017 983 1,000 100%
800 100% 100% 100% 100% 96% 97% 80% 91% 645 83% 600 60% 397 400 304 304 62% 40% 211 247 157 157 211 224 125 120 200 53 44 45 45 20% 0 0% NHIF Birth Sec School School IGA support Shelter Food ration HTC pss enrolment to certificate fees support uniform renovation support OVC
On Path to Graduation Total Total Achievd % achieved
Provision of essential services to OVC
a) Health and Nutrition: The project continued support to 226 HIV positive OVC on treatment. Out of the 216 OVC who had their viral load tracked, 75% were suppressed. The viral load information informed the case plan reviews and to meet the unique needs of HIV positive children. The project has ensured that all the 226 positive children together with their households are enrolled in the National Hospital Insurance Fund. During home visits, the project facilitated 200 CHVs from 12 LIPs to educate 2,000 OVC caregivers on healthy dietary practices including nutrition from animal sourced foods, benefits of exclusive breastfeeding and optimal complementary feeding practices.
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Goromuda Caregivers group in Moyale is a sustainable project that has already started paying fees for several OVCs from the kitchen garden/shadenet project.
The CHVs also demonstrated hand washing techniques at critical times, disseminated information on use of iodized salts and dietary diversification.
HIV Positive Data 300 256 250 228
200
150 100 89 88 100 83
50 34 30 21 18 12 7 1 1 0 TanaRiver Isiolo Marsabit Garrisa Wajir Mandera Total
No. HIV+ Linkied to C&T
b). Promote school enrolment, retention and transition and provide education support services in the long term and after project phase out. This quarter, the project worked towards reducing barriers to school enrolment, retention and transition by assessing the educational support needs required by OVC enrolled in secondary school through the July 2018 graduation readiness assessment. The project addressed those needs through development and implementation of case plans. Among 1,273 OVC in secondary schools, the project through the LIPs, directly supported school fees payments for 380 (187M & 193F) in Garissa, Tana River Wajir and Mandera. • In Garissa, SIMAHO LIP directly paid school fees for 58 OVC in Garissa • In Tana River County, CARITAS LIP paid school fees support for 68, while MARIDHIANO and KICE LIPs paid school fees for 10 and 30 students respectively. • In Wajir, WASDA, SND and OPAHA LIPs directly supported school fee payments for 75 OVC in various institutions. • In Mandera RACIDA and EPAG, provided school fees support to 39 OVC. • Marsabit supported 52 OVC with school fees while In Isiolo 50 OVC were supported. During the cost extension start up and closure stakeholder meetings, the project used the forums to advocate for OVC inclusion into County bursaries, the Constituency Development Fund (CDF) and the Presidential bursary award. Through stakeholder coordination and strengthened referrals and networking, the project further linked 337 OVC with CDF and county bursaries. A total of 26 OVC 4 in Wajir, 3 in Mandera, 4 in Isiolo, 4 in Marsabit, 2 in Garissa and 9 in Tana River who are on path to transfer have been linked to the presidential bursary award and will have full scholarship until they complete their secondary education.
Table below shows distribution of OVC at Various levels of education within the 6 Counties: OVC IN SCHOOL DATA M F ECD 435 544 Primary School 3,835 4,023
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Secondary School 433 420 Class 8 322 450 Vocational Institution 65 43 TOTAL 5,090 5,480
c) Child protection and legal support Integration of interventions of the transition teams, quality improvement teams and AACs was stepped up to enhance sustainability. One QIT in Garissa held a joint community awareness creation meeting on the realization of the rights of children to protection, survival and development at community level reaching out to 76 caregivers and 114 community members in Fafi, Garissa County. The project also continued to reach OVC and their households with protection services, including facilitation/acquisition of birth registration certificates. • In Garissa County SIMAHO LIP facilitated birth certificate acquisition for 75 OVC on path to transfer and on path to graduation. • In Tana River County, a total of 121 OVC were provided with birth certificates by the LIPs MARIDHIANO, KICE and CARITAS. • In Wajir and Mandera Counties, LIPs processed birth certificates for 398 OVC. The birth certificate is a significant document for exam registration • In Isiolo and Marsabit counties, 423 HH caregivers were sensitized on the birth acquisition process. A total of 160 OVC Households from Marsabit were linked to the social safety nets programs through the county transition team spearheaded by the county children services officer. Through quarterly support supervision visits, the project staff provided technical support to LIPs and CHVs in education on child protection issues for caregivers and community structures involved in child protection, as well as identification of cases and reporting procedures. The project jointly with the USAID-funded 4Children project, supported the DCS to hold quarterly stakeholder meetings to coordinate children issues in the counties. d) Psychosocial care and Support OVC and caregivers received psychosocial support during the monthly visits and the GRA conducted by the CHVS. During the quarter, 406 CHVs continued with their household visits and provided psychosocial support to 6,133 OVC. The project also prioritized PSS sessions and sensitization of OVC caregivers on positive parenting, adherence to sustain positive parenting practices.
1.6.1.3 Strengthened and documented referrals and linkages to essential services for OVC through coordination and integration with other sectors The project continued to strengthen the referral, linkages and collaboration with the transition team, department of children services and other project actors. During this quarter, the project focused on coordination for sustainability towards transition and exit. The 6 county transition teams made up of key stakeholders have significantly strengthened the stakeholder engagement in discussing their roles in sustaining OVC work.
Expected Outcome 1.6.2: Capacity of households and communities strengthened to protect and care for OVC 1.6.2.1 Build sustainable economic initiatives to enable households to meet their basic needs During the quarter, the project provided start up kits, technical assistance and supportive supervision to caregiver groups to ensure 1023 HHs targeted for HES activities were able to meet their IGAs needs as
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sustainability strategy as the project phases out. The HES needs were documented during the July 2018 Graduation Readiness Assessment and needs addressed through household case plan implementation. This has strengthened economic capacity of HHs with OVC on pathway to graduation and on path to transfer 1.6.2.2 Support SILC initiatives towards sustainability During the reporting period the project continued to support SILC activities among the 134 SILC groups. Field agents that had been certified as PSPs continued with their support to SILC groups and supported in the mentorship of 7 new agents. The project also facilitated MoA technical team to provide support supervision and conduct HES mentorship to the 116 IGA on path to graduation SILC groups and number of OVC benefiting No. of active No. of caregivers No. of OVC County SILC groups in SILC benefiting Tana 70 1,330 2,650 River Garissa 5 87 102 Wajir 22 220 78 Mandera 19 437 174 Isiolo 10 112 181 Marsabit 8 98 120 Total 134 2,284 3,305
1.6.2.3 Facilitate linkages of OVC households to social safety net programs in Garissa, Mandera, Wajir & Tana River Counties Through strengthened referrals and networking, the project facilitated linkage of OVC households to OVC cash transfer and other safety net programs. A total of 556 OVC HHs on path to transfer were linked to OVC CT managed by Department of CS. The project signed MoUs with DCS and transferred all OVC HH on path to transfer to DCS for ongoing support. The Government of Kenya is expected to upscale the OVC Cash Transfer programs in November 2018 and the DCS has shown commitment to ensure all the transferred cases are registered for the OVC CT. 1.6.2.5 Increase knowledge and skills of caregivers on OVC care and protection During the reporting period, the project sensitized 1,017 HHs on path to graduation and 1,710 caregivers on transfer path on the available social safety net programs increasing demand for support. As an exit and sustainability strategy, the APHIAplus Imarisha project signed MoUs with DCS to continue advancing the quest to address the OVC needs and provision of the much-needed services to the beneficiaries. Through routine household visit by CHVs, 2,727 caregivers were reached with service providers’ directory that indicates who provides what services and where to enhance uptake of essential OVC services after project phaseout. LIPs in Garissa and Tana River counties, supported radio talk shows on child protection and reporting and referrals mechanisms
Expected Outcomes 1.6.3: Strengthen the Capacity of County institutions and local organizations to deliver quality services to OVC 1.6.3.1 Strengthen the capacity of County institutions and local partners to respond to OVC care and protection needs. APHIAplus IMARISHA continued hosting and facilitating monthly county transition team meetings to discuss transition and sustainability issues, linkages of OVC to other service providers, advocate for resource mobilization from counties. During the reporting period, the project through LIPs supported
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county and sub county AACs to hold forums on transition issues. This has strengthened capacity of county structures in responding to OVC needs The project supported DCS to conduct support supervision of LIP activities to increase capacity of DCS and local organizations in responding to OVC needs. This has strengthened partnership, effective referrals and linkages
Capacity building of LIPs APHIAplus IMARISHA conducted support supervision visits to LIPs aimed at following up on implementation of approved LIPs workplans. The supervision visit was a process that guided and encouraged LIPs staff to optimize their work performance and ensure holistic services to OVC and their caregivers 1.6.3.2 Strengthened coordination of care across community stakeholders to improve OVC wellbeing During the reporting period, the project shared OVC data base and information on case management plans with the county transition teams which has strengthened information sharing and reporting for decision making and planning amongst key county stakeholders The project through LIPs also facilitated AACs to hold forums on transition issues and all hosted county stakeholders cost extension closure meeting to review project successes in Wajir, Mandera, Garissa and Tana River counties
Some lessons learnt over this reporting period include the following: • The transition process is a long and complex one which involves policy changes at county level. For an effective transition, this process should in tandem with project start or even before. • Community buy-in into project implementation is key to program success (Transition Team/Stakeholders) • Timely approval of LIPs budgets would have provided better transition outcomes • Stop and start process in OVC programming requires a period beyond 1 year
ACTIVITY PHOTOS:
Case plan development – FHK Marsabit Transition team meeting – Isiolo
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SUB-PURPOSE 2: INCREASED ACCESS AND UTILIZATION OF FOCUSED MATERNAL, NEONATAL, CHILD HEALTH (MNCH), FAMILY PLANNING (FP), WATER, SANITATION AND HYGIENE (WASH) AND NUTRITION SERVICES
While APHIAplus IMARISHA did not directly invest in activities to improve indicators under this sub purpose, the project continued to collaborate with the various national mechanisms, national and county governments as well as other implementing partners to promote uptake of services. The project continued to participate in the County MNCH TWGs and eMTCT task force meetings to contribute technical input towards improving maternal, neonatal and child health as well as improve uptake of FP services and implementation of eMTCT focused activities.
The project continued to provide integrated FP services within the CCC settings and continued to routinely undertake Nutritionals assessment and counselling services at all the supported Comprehensive care clinics.
SUB-PURPOSE 3: STRENGTHENED AND FUNCTIONAL COUNTY HEALTH SYSTEMS
Output 3.1: Governance and Strategic Planning
APHIAplus IMARISHA continued participating in important planning meetings at county level across the NAL. In the subsequent quarter, APHIAplus IMARISHA will work with the CHMTs to create County Transition Teams (CTTs). The composition of these teams will be agreed with the County Health Leadership and would include e.g. the CEC Health, Chief Officer Health, County Director of Health (CDH) and County AIDS Coordinator (CASCO). To facilitate cross-county learning and fertilization of ideas, APHIAplus IMARISHA will support two meetings of the 6 CTIT in conjunction with NASCOP. It is envisaged that through these discussions and agreements guidance will be provided to ensure a smooth transition of support to HIV services management to the Counties and National Government.
Output 3.2: Human Resources for Health Services
APHIAplus IMARISHA continued supporting the NAL counties with Human Resources for health in all the 6 Counties. In the subsequent quarter, we will continue supporting the NAL counties with Human resource for health drawn from different cadres, key among the HRH are the HTS lay counselors who have been brought on board to support provision of optimal testing within the high volume heath facilities.
Output 3.3 Health Products and Technologies (HPT)/ Commodities Health Supply Chain Management (HSCM In the quarter under review, APHIAplus IMARISHA strengthened the support for the Online reporting of the RTK HIV Testing commodities to the DHIS2 platform. The project strengthened the team work of the SCHRIOs and SCMLCs and this ensured timely reporting of the MoH 643 reports to DHIS and HCMP in timely manner. Consequently the team followed up the verification of the commodities that were supplied by KEMSA within the quarter. The project will continue to support on re-distribution of
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commodities to supported facilities, participate and support commodity security committee meeting at the county level, distribute PrEP to facilities with identified discordant couples.
Laboratory Strengthening APHIAplus IMARISHA continued strengthening the Laboratory services in the supported facilities in region. In this reporting period, the project supported Sample Networking for the sample for CD4, EID, GeneXpert and Viral Load Testing. The program emphasized the Viral Load access for the active patients as well adherence to the National EID algorithm with key emphasis for repeat testing at the facilities. During the period, the project alongside the CHMT and other stakeholders worked along to ensure adequate commodities availability for Sample networking and HIV testing through the Laboratory Technical working group (Lab TWG) meetings. Specific activities conducted and their outcome within the period under review is as follows: • Laboratory Commodity Management • Sample Networking • Quality Assurance in HIV Testing • Laboratory Commodity Management • Lab TWG meetings
RTK online Reporting/Commodity Management for Laboratory Services APHIAplus IMARISHA in conjunction with County & other stakeholders spearheaded the verification of the commodities supplied by KEMSA. Through the Laboratory Technical Working Group meetings, the team has ensured a secure commodity capacity in the county and its facilities that would last the county through the quarter. The Project supported the County Lab Coordinators and Sub-county Lab Coordinators to attend the National RTK review meetings. The project intends to spearhead the strengthening of the County Commodity Security committees to foresee the management of the RTKs in Northern arid lands counties. RTK status In the quarter under review, APHIAplus IMARISHA strengthened the support for the Online reporting of the RTK HIV Testing commodities to the DHIS platform. The project strengthened the team work of the SCHRIOs and SCMLCs and ensured timely reporting of the MoH 643 reports to DHIS and HCMP in timely manner. Consequently the team followed up the verification of the commodities that were supplied by KEMSA within the quarter. EID/VIRAL LOAD commodities
APHIAplus IMARISHA in collaboration with Testing Laboratory ensured commodity security for the EID/Viral Load consumables so that services won’t be disrupted by the transition period. The project also redistributed the filter papers within the counties to cushion those with less supply
QA/QI In the reporting period, HIV testing continued in the DATIM supported sites in central support counties. The project employed staff in collaboration with MoH staff supported the activity. In the quarter, the QA/QI activity for the HIV testing was participation in the Proficiency testing. In spirit to ensure that Quality testing is adhered to at testing laboratory in the region, the project supported in collection & Distribution of GeneXpert & HIV PT panels.
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III. ACTIVITY PROGRESS (QUANTITATIVE IMPACT)
The quantitative achievements are enumerated in detail in the attached Performance Data Table.
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IV. CONSTRAINTS AND OPPORTUNITIES
Some of the constraints and opportunities experienced by the project over the reporting period include:
Insecurity, armed conflict, crime, terrorism, hazards: The NAL region continues to experience a number incidences ranging from armed conflict, terrorism, Crime, Civil unrest and Hazards. Nevertheless, despite these challenges, program activities continued uninterrupted. Below are some of the incidents during this reporting period.
Armed Conflict: On Wednesday April 4, 2018 four people including three police officers were killed in an ambush by cattle rustlers close to Archers Post along Samburu-Isiolo-Laikipia border in Samburu East, Samburu County. In North Horr, Marsabit County armed Samburu men raided the Gus Market on May 14, 2018. Government forces deployed anti stock theft officers and reservists to repel the attackers. Again on May 21, 2018, three people were killed and over 300 head of cattle were stolen from the community when armed Turkana bandits attacked Loruko village and four people could not be accounted for after the attack which caused tension in the area. In Wajir County one person was killed on June 23, 2018 at Ibrahim Ure following clashes of herders over pasture.
Terrorism Terrorism related incidents continued to be reported in the North Eastern areas of Garissa, Wajir and Mandera. On April 18, 2018 suspected Al Shabaab operatives took over the mosque in Buramayo village on the border of Wajir and Mandera Counties and preached to villagers for hours. In Mandera, four civilians were killed and several others injured in a small arms attack targeting non-local quarry workers on May 3, 2018. On May 8, 2018 a General Service Unit (GSU) vehicle was hit by a roadside Improvised Explosive Device (IED) between Dabacity and Borehole II in Mandera. Injuries were reported and the vehicle damaged beyond repair. In a similar incident, 5 GSU officers were killed and 3 seriously injured on June 6, 2018 when their vehicle was struck by an IED along the Liboi-Dadaab road in Garissa County. Yet another IED attack in Boji Garas in Wajir County killed 5 Administrative Police officers on their way to Kotulo.
Crime Several crime related incidents were reported over this reporting period and are summarized below. On April 9, 2018 in Dadaab, Garissa County, roadside banditry criminals armed with an AK-47 stopped a vehicle by firing in the air and robbed the occupants of KES 67,000 and three phones. Police trailing the suspects arrested one and recovered two phones. On May 28 at IFO 2 camp in Dadaab three criminals armed with firearms raided a commercial facility and fired three times before robbing the owner of KES 480,000. No injuries were reported. Still in Dadaab, Police on patrol engaged in an exchange of fire with suspected criminals on May 29. but the suspects managed to escape into thick bush. In addition, an exchange of fire was reported between police and suspected criminals in Dadaab on June 4. Other incidents reported during this period include: • Shooting to death of an armed man identified as Hassan Abdi Mohammed at Kutulo AP camp in unclear circumstances on June 27.
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• Killing of a militant on June 27 at Bojigaras, Tarbaj in Wajir following an exchange of fire with security officers. • Bodies of two people were found buried in shallow graves in Bojigaras, Wajir. The two were among 4 men arrested earlier by police officers from their shops in Konton and Khorof Harar during a security operation. • In Isiolo 6 criminals armed with AK-47 rifles raided an NGO office facility on June 1, 2018 and stole assorted goods and a motorbike. Civil Unrest During the period under review, few civil unrest incidents were reported. On April 15, some public disorder was reported around 10km from Moyale town in Oddah and 20km from Moyale in Kinisa as members of the Garre and Gabra communities clashed. The clash was over the killing of a Gabra motorcyclist from the Ethiopian side of the border by suspected Garre tribesmen. The clash led to arson attacks targeting vehicles on the road. Hazards The month of March and April was characterized by heavy rainfall across the country, and the situation was no better in the NAL areas. The United Nations Office reported that in April, fifteen counties were affected and the most hit included Tana River, Garissa, Isiolo-Mandera, Wajir, and Marsabit. Areas of Moyale Sub-County badly affected with reports of several villages near the Ethiopia border unable to access food and water because the road to Moyale was flooded and therefore impassable. On 26th April, the Kenya Red Cross had to intervene to save several families affected by flooding in Garissa. They evacuated several families affected by flooding in Raya and Balambala. Rift Valley fever was also reported within NAL. In June, 26 deaths were recorded, of which 24 were in Wajir and two in Marsabit. The outbreak was first reported in Eldas Sub-County, Wajir, on 7th June.
V. PERFORMANCE MONITORING During the period under review, performance monitoring activities supported by the project focused on strengthening Health Information Systems across the six counties in NAL by addressing data quality gaps identifying through data verification, addressing reporting rates and data review meetings. The key data quality improvement activities facilitated by the project included data reconstruction, electronic medical records, data quality assessments and mentorship.
Data Quality Assessment: During the reporting period, NASCOP together with USG agencies (USAID, CDC and Walter Reed) performed a data quality assessment (DQA) exercise to assess HIV data quality from 300 sampled Health Facilities across the Country targeting ART Current (TX_Curr) indicator. The exercise was conducted by National Officers accompanied by implementing partners from CDC, USAID and other agencies. The team assessed 14 health facilities from the six (6) APHIA plus IMARISHA supported counties. The exercise revealed a number of places that the project needed to address in its implementation, and below are the resolutions from the project on the way forward towards addressing them. The areas were batched into six broad areas.
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Issues Identified Way Forward Immediate Short Term Documentation (Patient files, and filing) • Full recount of files and proper re-filing • Defaulter tracing • Discrepancy between patient file and • Need to keep trail of data from TB registers/EMR Manyatta • Chart abstraction discordance on patient • Provide DAR at TB Manyatta status • Use the revised preparation register • Filing system (1 facility) • keep track of reports and file copies • ART tracking in TB Manyatta wanting • File segregation be done properly DHIS & DATIM & MOH 731, EMR, • SCHRIO to enter missing DHIS data DAR Discrepancy • Enter correct numbers in to the DHIS as • DHIS not up to date per the findings of the DQA • DHIS, DATIM, DAR/ART Register, MOH 731, IQCare have discrepancy on TX_NEW and TX_CURR VIRAL LOAD • Patient files properly updated with recent • Viral load not done VL results/print and file results • Viral load not filed in patient files • Patients due for VL to take VL samples HMIS TOOLS • Facility to immediately use new tools i.e. • Training of staffs on new • Training on new HMIS tools maternity register, DAR, treatment HMIS tools (OJT & • New HMIS tools not in use preparation register where new tools are CMEs) available • New HMIS tools not available • Encourage facility staff to participate in the NASCOP online M&E training • SCHRIO/IMARISHA to first tract provision of revised tools – awaiting USAID direction EMR • Update IQCare • Staffs training on EMR • NO EMR (IQCare) • Assess facilities preparedness for EMR and IQCare • EMR not updated categorize them accordingly for rollout of • Rollout IQCare or Excel • Discordance between EMR and ADT IQCare or Excel data systems or manual based databases to ready status systems facilities • Training on IQCare ADT • IMARISHA, CHAI and county pharmacist • Rollout IQCare pharmacy • No ADT to troubleshoot the ADT machines as soon modules to facilities with • ADT not working (computer crash) as possible IQCare and no ADT • Pharmacy ADT had concordance issues • Update ADT where necessary • • Strengthen Manual System
Electronic Medical Record (EMR): APHIAplus IMARISHA continued to support staff in EMR facilities to maintain the use of the EMR system (IQCare) installed the facility. The support included continuous mentorship, report generation support, continuous data cleaning and system configuration and upgrade. Some of the outcomes of the strengthened EMR system include: − Timeliness in reporting: all the required reports are available on time because of ease of generating data from IQ care. − Data Accuracy: the EMR system is able to generate more accurate and reliable reports due to continuous data cleaning support provided by the team.
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− Defaulter tracing: Defaulter tracing has been made easier. Through the IQ care the hospital is able to identify defaulters and put measures for follow up. This has improved appointment management and the number of clients currently active has steadily been increasing. As part of supporting the facilities, the project conducted an assessment of the facilities where IQCare had failed and the reasons behind the failure. From the assessment, some County CHMTs had refused to embrace IQCare and did not have champions to support the rollout and maintenance. They included Garissa and Isiolo counties. In particular, Garissa county had introduced a simple excel spreadsheet that was tracking number of clients as they were enrolled. The excel was able to tell how many clients had ever been enrolled by age and gender. Also the excel could generate number of patients ever started ART by CDC staging, regimen type by age and gender. However, the excel could not give accurate numbers of TX_CURR, could not generate ART cohort analysis, daily appointments, missed appointments, Viral load information, IPT, and TB. Using the excel in Garissa, the project developed a new Excel based database (named ASoft ART System) that addressed most of the issues raised above. The excel has a better buy in from the county HRIO department and has been rolled out in Garissa PGH, SIMAHO HC, Iftin SCH in Garissa County and Merti HC in Isiolo county. The ASoft system has enhanced accurate reporting significantly for these facilities.
EMR Upgrading: During the quarter under review, EMR was upgraded in the following EMR sites: Isiolo CRH, Laisamis MH, Marsabit CRH, Sololo MH and Moyale SCH. This exercise was led by Palladium in collaboration with APHIAplus IMARISHA and aimed at upgrading the system to conform to new revised HIV HMIS tools, which includes ART register, treatment preparation register, MOH 731, Green card and other data elements which were incorporated into the new system like DQA, clinical data summary etc. Mentorship and OJT were done for the mentioned facilities for using the upgraded system.
Data Review Meetings: To ensure data use in decision making, APHIAplus IMARISHA supported quarterly a data review meeting in Tana River County in September/October 2018. During the review, the project supported the county in data analysis and development of dashboards that were used to lead discussions in the meeting. The health managers were able to see areas that needed update and focus. Some of the areas that were highlighted as being in need of refocusing included HEI (due to high levels of MTCT), ART (varying TX_CURR between the months, large patients still on NVP), and Viral load (low uptake and low suppression rates).
DHIS2 Concordance Meeting: DHIS2 concordance meetings were held with the SCHRIO’s with the aim of ensuring what was reported in MOH 731 is same both in the DHIS2 and program data base as well as ensure reporting rates are 100% for facilities supported by APHIAplus IMARISHA.
Internet Bundles for data entry and reporting: SCHRIOs in the county were supported with internet bundles to enable them enter all the data sets for respective facilities into DHIS2 and on time, which is the main system for facility data. This helps in ensuring that all the data is available for use in decision making at the sub counties and monitor people reached with different health services.
VI. PROGRESS ON GENDER STRATEGY
Following the adoption of the Sustainable Development Goals (SDGs), the achievement of gender equality and empowerment of all women and girls (SDG 5), the government and the private sector is increasingly committed to reducing gaps between men and women not just because it is the right thing to do, but because
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it makes business sense. Gender equality is also central to the APHIAplus IMARISHA project’s own goals of increase in the availability & use of quality health services, information & products. No society can develop sustainably without transforming the distribution of opportunities, resources and choices for both males and females so that they have equal power to shape their own lives and contribute to their families, communities, and countries well-being. Promoting gender equality is a smart development policy.
APHIAplus IMARISHA continues to ensure that women are involved in health decisions that affect them thus increasing better health outcomes for women and children. The project has employed strategies to increase the participation of women in various groups so that they have better health outcomes and increase household income as well as provide health services to both male and female equally.
VII. PROGRESS ON ENVIRONMENTAL MITIGATION AND MONITORING Small Scale irrigated farming: The project continued to collaborate with Government Ministry of Water, Agriculture and Irrigation for continued provision of technical support to PLHIV Psychosocial groups to increase land under drip irrigation farming for increased production of high value vegetable production. There were no environmental risks observed as a result of these crop production activities. The project continued to encourage organic farming by facilitating training of producer groups on preparation of compost manure. During IGA sessions, the producer groups are sensitized/ trained on establishment of fodder trees, are given seeds for fodder trees and linked to the forestry department for sourcing of fruit trees and other environmental friendly trees as a mitigation for farming methods that could cause soil erosion. The project did not directly purchase pesticides. Nevertheless, the project worked with government staff from Ministry of Water, Agriculture and Irrigation to ensure that the PSSG groups engaged in vegetable production under drip irrigation and poultry production are trained on safe use of pesticides approved by the Pesticides Control Products Board of Kenya (PCPB) and disposal of the same. Staff from the Ministry of Water, Agriculture and Irrigation continued to monitor the same.
Health Care Waste Management: Medical wastes are segregated and disposed by incineration pursuant to the GoK Environmental Management & Coordination regulation 2006. Key staff have been trained on safe handling and disposal techniques; incinerators constructed by the program were approved by NEMA. During the reporting period APHIA plus IMARISHA staff continued to provide technical assistance in safe medical waste disposal. Facilities are now equipped with color coded waste disposal plastic bins to ensure safe disposal of medical waste. All the project sites continue sensitizing health care workers to ensure safe waste disposal in compliance with regulations.
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VIII. PROGRESS ON LINKS TO OTHER USAID PROGRAMS
During the reporting period under review, APHIAplus IMARISHA efforts to link project activities with the Kenyan Government agencies at both national and county are summarized below: APHIAplus IMARISHA Collaboration with other USAID programs
Other USAID Activities programs NHPplus: • Supports community nutrition activities in Samburu and Marsabit • NHPplus continued to ensure supply of commodities for Food by Prescription in APHIAplus IMARISHA supported facilities across NAL 4C project • Joint collaboration with IMARISHA in implementation of OVC program transition activities in the central support counties. • 4C project continued to support the Transition Teams across the 6 central support counties, APHIAplus IMARISHA having graduation and transitioned OVC to partners and the DCS in the previous quarter
IX. PROGRESS ON LINKS WITH GOK AGENCIES
During the review period, APHIAplus IMARISHA linked its project activities with the Kenyan Government agencies at both national and county level as summarized in Table below.
Ministry/Government Agency Activities Ministry of Livestock • Continued to provide extension services on good husbandry practices for caregiver groups that are currently engaged in poultry and goat production Ministry of Agriculture • Technical support and extension services to groups practicing small scale irrigation farming Department of Children Services • Coordinating child protection issues and secretariat for the OVC County Transition Teams (TTs) • Support children with bursaries
County Commission’s Office • Coordinating and chair of the County TTs • Coordinating the stakeholder mapping exercise Department of Gender, Culture and • Coordinating the development of the Tana River Child Social Services protection policy • Supporting caregiver groups with HES
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NDMA • NDMA continued to provide leadership in series of County Government, Health discussions at the county steering group meetings to deliberate department and PREG partner on the drought monitoring and mitigation measures in NAL Counties. Ministry of Health • Supporting OVC in treatment of minor illnesses. • Support set-up the KIDs play center and treatment for HIV positive clients. • Treatment for HIV positive OVC & PSSG linkage • APHIAplus IMARISHA household economic strengthening focused empowerment of households through IGAs and Peer exchange aimed at overcoming stigma and discrimination and development of a positive attitude among the PSSG members. The focus was on diversification of livelihoods, with more effort directed towards skills training in Handcraft and poultry management.
X. GRANTS MANAGEMENT
Achievements a) Joint monitoring and on-site mentorship by Grants, and technical team was done on Compliance and financial management and Programmatic performance for all the 12 funded LIPs. Results indicated that there is tremendous improvement in both financial reporting and programmatic reporting and documentation. b) Funds disbursement for the final tranche was made to the 12 LIPs as per approved scope of work and budgets for the award period. c) Expenses reported by all sub awardees for the period July-August 2018 were promptly reported to finance. d) Internal audit was conducted to 8 LIPs by Amref Health Africa internal auditors for the period January to July 2018. Results indicated that there is tremendous improvement in both financial reporting and programmatic reporting and documentation. e) Refresher training on USAID rules and regulations was conducted to the 12 LIPs key staff covering mandatory provisions for none US organizations, Mexico City policy and how to conduct a SAM search. f) Held a meeting with the transition teams from every county to discuss the transition of OVC after the cost extension period. It was agreed that the households on path to transfer and graduation will be handed over to the district children services who will continue supporting them.
Constrains/challenges a) The Local implementing partners’ have high level of expectation for supporting other activities especially during the current ongoing transition period. This has not been possible due to the budget constraint.
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b) The Implementation period was shorter and therefore the technical team didn’t have sufficient time to monitor the progress of each household to attain the status of graduation.
Lessons learnt a) LIP staff where able to understand the USAID rules and regulations better when the training was conducted in their field offices because of the one on one interaction unlike doing it during the quarterly review meetings.
Local Implementing Partners funded during the quarter include; No Name of Local Implementing Partner (LIP) County Intervention Areas 1 Caritas Diocese of Garissa Tana River OVC/HCBC 2 Maridhiano Community Based Organization Tana River OVC 3 Kipini Integrated Community Enterprise Tana River OVC 4 Culture Information and Pastoralist Development Marsabit OVC (CIPAD) 5 Food for the hungry, Kenya (FH, Kenya) Marsabit OVC/HCBC 6 Pastoralist Women For Health and Education Isiolo OVC 7 Wajir South Association (WASDA) Wajir OVC 8 Strategies for northern development (SND) Wajir OVC 9 Organization of People Affected by HIV & AIDs Wajir OVC/HCBC 10 Rural Agencies for Community Dev. And Assistance Mandera OVC 11 Emergency pastoral assistance group of Kenya (EPAGK) Mandera OVC 12 Sisters Maternity Home (SIMAHO) Garissa OVC
XI. SUSTAINABILITY AND EXIT STRATEGY APHIAplus IMARISHA continued to provide support to the central support NAL counties in line with the approved workplan. APHIAplus IMARISHA’s exit strategy was crafted to ensure sustainability beyond the project close out. The project worked closely with the relevant line ministries at county level, ensuring program activities are well aligned and integrated with County Integrated Development Plans and the County HIV/AIDS Strategic Plans for respective. In addition the project actively participated in the Kenya USAID PREG activities in NAL with more focus on transition of sites identified for layering and integration to relevant partners. During this reporting period, the project continued to engage the central support counties with support to improve the quality of care on HIV management and technical services which had significantly declined
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following the withdrawal of the project from the region. APHIAplus IMARISHA continued engaging with the respective County health leadership to discuss and identify the support needed from the project to enable the S/CHMT improve services. The project continued to encourage the county health leadership in central support counties to continue increasing investments from local resources so as to ensure that the gains made in HIV services are protected. To this end, APHIAplus IMARISHA continued to work closely with S/CHMTs to come up with sustainable initiatives in maintaining and improving the expanded quality of HIV services in priority high volume facilities with minimal cost. In the cost-extension period, support will be recommenced with an approach that emphasizes county leadership and ownership with APHIAplus IMARISHA offering TA and background support such as to sample networking and commodity security management.
XII. GLOBAL DEVELOPMENT ALLIANCE
Not Applicable
XIII. SUBSEQUENT QUARTER’S WORK PLAN
Care and Treatment • Comprehensive Technical Assistance in HIV prevention, care and treatment: • Scale up of partner notification services, index client based family testing, facility level PITC and enhanced patient treatment literacy through the retained HTS counsellors in all the DATIM facilities • Train and sensitize HCWs on the key highlights of 2018 Kenya ARV guidelines • Adopt differentiated care models at the high volume facilities • Enhance viral load access through strengthened sample networking • Administer internal Facility SIMS in the DATIM facilities
PMTCT/EMTCT • Sensitize the county HCWs on the technical updates on HEI management in the 2018 Kenya ARV guidelines • HEI Audit across the supported HFs • Mentorship on Maternal Cohort Analysis. • Mentorship on HEI Cohort Analysis. • EID data Audits • VL Monitoring for PMTCT mothers
Laboratory services • Calibration of the Xpert MTB/RIF system for viral load and EID point of care testing in collaboration with the Clinton Health Access Initiative (CHAI)
• Support and facilitate Sample Networking(CD4, Viral Load, EID and GeneXpert) • DBS/PT Commodity Distribution
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• Continuous mentorship: Sample collection; online result access; Online RTK reporting • Facility based CMEs on GeneXpert utilization • Strengthening External Quality Assurance(EA-REQAS, PT for HTS) • RTK commodity stock rationalization; redistribution • TA – SOP review for Lab • TA and follow up of HTS counsellors’ performance monitoring at facility level.
TB/HIV • Strengthen collaborative services uptake • Scale up use of Gene Xpert in MTB diagnosis and MDR-TB surveillance by strengthening sputum sample referral networks • Routine HCWs mentorship on the TB/HIV collaborative services • Technical support for the implementations of 5’I’s of TB/HIV Co-management • Logistics support in the distribution of TB drugs and M&E tools • Continue IPT evaluation status at supported health facilities.
Monitoring and Evaluation • Maintain EMR in all Priority HFs • Development of facility/county DDIU dashboard templates that counties can customize locally • Orient Facility Management Teams (FMTs) and S/CHMTs on data analysis/dashboards/scorecard, data interpretation and information use • Printing and display of trend charts/dashboards for early warning indicators in service delivery points • Facilitate data quality improvement (CQI) teams to use routine and evaluation data to develop “Small Tests of Changes” • Support an IQCare ToT training for Tana River county • Facilitate HMIS OJT trainings by CHIROs to facility staff • Facilitate EMR champions to mentor peers on EMR • Distribution of HMIS tools from national/county stores to 128 health facilities • Facilitate and participate in M&E TWGs • Facilitate MD-DQITs to conduct 44 rDQAs • Facilitate monthly facility based data review meetings in the high volume health facilities • Facilitate DHIS2 and MOH HIV reporting tools data concordance meetings • Facilitate Performance review meetings at facility and county level • Support SCHMTs to report through the DHIS2 by providing monthly airtime/data bundles • Print and disseminate tools for linkage and referral (referral forms/registers, appointment diaries)
Grant Management • Expensing of any outstanding charges reported by LIPs. • Follow up on compliance review feedback observations made in both programmatic and financial reports for all LIPs as part of sub-award close out process.
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XIV. FINANCIAL INFORMATION
The expenditure burn rate against the current obligated amount for the quarter ending September 30, 2018 was at 96.8%. Personnel, administration and general project running costs were spent according to the tight budget. Activity costs have maintained normal and are expected to be maintained as per the work plan. Reimbursements have been received in a timely manner. To continue enhancing and improving efficiency in operations, the Finance and the compliance office team has continued to make various field visits to further orient staff on various internal control requirements and ensuring compliance to rules and regulations in place. Cash Flow Report and Financial Projections (Pipeline Burn-Rate) CHART 1: OBLIGATIONS VS. CURRENT AND PROJECTED EXPENDITURES
TABLE 3: BUDGET DETAILS
T.E.C.: $62,964,704 Cum Oblig: $60,978,940 Cum Expenditure: $59,018,156
Jul-Sep 2018 Oct-Dec 2018 Jan-Mar 2019 Apr-Jul 2019 Obligation Actual Projected Projected Projected Expenditures Expenditures Expenditures Expenditures
Total: $ 60,978,940 919,741 1,131,717 881,840 905,764 Direct Cost 616,900 905,555 730,000 749,805 Sub-Awardees 174,526 37,807 0 0 Indirect Cost 128,315 188,355 151,840 155,959
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* When applicable.
Budget notes (List assumptions, major changes, estimations, or issues intended to provide a better understanding of the n
BUDGET NOTES
Direct Cost Direct Costs are expected to increase in Q1 compared to Q4 as the projects starts to accelerate in activities.
Sub-Awardees Sub-award costs are expected to decrease with the exit of the OVC component.
Indirect Cost Indirect are at the NICRA rate of 20.8% on direct cost.
TABLE 4: NEW SUB-AWARD DETAILS
Total Amount in the approved budget for sub-awards: $ 23,427,518
Total Amount sub-awarded to date: $ 23,201,406
DO Title: Name of Sub-Awardee: FAMILY HEALTH INTERNATIONAL Activity Title: APHIAPLUS IMARISHA Agreement Performance Period: 15TH MARCH 2012 to 30TH SEPTEMBER 2014 Agreement Amount (Total Estimated Cost): $ 3,639,165 Geographic Locations for Implementation: NORTHERN & ARID LANDS IN KENYA Activity Description: (One concise paragraph)
DO Title:
Name of Sub-Awardee: BROADREACH HEALTH CARE Activity Title: APHIAPLUS IMARISHA Agreement Performance Period: 15TH MARCH 2012 to 14TH MARCH 2017 Agreement Amount (Total Estimated Cost): $ 2,124,439 Geographic Locations for Implementation: NORTHERN & ARID LANDS IN KENYA
Activity Description: (One concise paragraph)
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DO Title:
Name of Sub-Awardee: LAND O' LAKES Activity Title: APHIAPLUS IMARISHA Agreement Performance Period: 15TH MARCH 2012 to 14TH MARCH 2017 Agreement Amount (Total Estimated Cost): $ 2,335,935 Geographic Locations for Implementation: NORTHERN & ARID LANDS IN KENYA Activity Description: (One concise paragraph)
DO Title:
Name of Sub-Awardee: CATHOLIC RELIEF SERVICES Activity Title: APHIAPLUS IMARISHA Agreement Performance Period: 15TH MARCH 2012 to 30TH SEPTEMBER 2018 Agreement Amount (Total Estimated Cost): $ 5,227,614 Geographic Locations for Implementation: NORTHERN & ARID LANDS IN KENYA Activity Description: (One concise paragraph)
DO Title:
Name of Sub-Awardee: UNIVERSITY OF MARYLAND,BALTIMORE Activity Title: APHIAPLUS IMARISHA Agreement Performance Period: 15TH MARCH 2012 to 14TH MARCH 2017 Agreement Amount (Total Estimated Cost): $ 4,614,170 Geographic Locations for Implementation: NORTHERN & ARID LANDS IN KENYA Activity Description: (One concise paragraph)
XV. ACTIVITY ADMINISTRATION
During the last quarter of the year, the project was able to recruit and hire a substantive Deputy Chief of Party as well as a Monitoring and Evaluation Advisor. In addition, following approval of reprogramming funds, the project was also able to recruit 2 PMTCT officers based in Marsabit and Garissa towns as well as a Senior Laboratory Officer based in Garissa. With a full complement of senior and other staff, the project saw a significant improvement in performance across the counties. Following a planned end of the OVC program at end of September 2018, Amref Health Africa in Kenya communicated to the Catholic Relief Services of the impending close-out. It is expected that the close-out process will be smooth. A detailed report of the 9-month OVC program will be shared with USAID as soon as it is ready.
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XVI. INFORMATION FOR ANNUAL REPORTS ONLY
A. Budget Disaggregated by County
Obligation 4th Quarter 1st Quarter 2nd Quarter 3rd Quarter Total: $ $ 919,741 $ 1,131,717 $ 881,840 $ 905,764 ISIOLO COUNTY $ 156,356 $ 192,392 $ 149,913 $ 153,980 MARSABIT COUNTY $ 119,566 $ 147,123 $ 114,639 $ 117,749 SAMBURU COUNTY $ - $ - $ - $ - WAJIR COUNTY $ 119,566 $ 147,123 $ 114,639 $ 117,749 MANDERA COUNTY $ 137,961 $ 169,758 $ 132,276 $ 135,865 GARISSA COUNTY $ 156,356 $ 192,392 $ 149,913 $ 153,980 TANA RIVER COUNTY $ 101,172 $ 124,489 $ 97,002 $ 99,634 TURKANA COUNTY $ - $ - $ - $ - NAIROBI COUNTY $ 128,764 $ 158,440 $ 123,458 $ 126,807
B. Budget Disaggregated by Earmarks (Earmarks for 2016/7 funds shown below; new should be added if/when appropriate.)
Obligation Q1 Q2 Q3 Q4 1,661,296.76 PERPFAR POPULATION NUTRITION MCH WASH
Note: Each year the COR/AOR should be consulted regarding which earmarks are applicable to the activity, and the amounts.
C. Sub-Awards For ALL sub-awards made to date under your agreement, please include/update a table like the one shown below. If your agreement does not use any sub-awardees, please indicate that you do not have any sub- awardees and leave the following table blank. Once a Management Information System is operational at USAID/Kenya, this information will instead be maintained by partners in that system.
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Sub-Awardee Start Sub-Awardee Sub-Awardee Date Last Audit Names of Counties of Partner Sub-Awardee Name Date End Date Amount Conducted Implementation
ISIOLO,MARSABIT,SAMBURU, FAMILY HEALTH AMREF 15TH MARCH 2014 14TH MARCH 2017 $3,639,165 30TH SEPT 2014 WAJIR,MANDERA,GARISSA,TA INTERNATIONAL NA RIVER & TURKANA
ISIOLO,MARSABIT,SAMBURU, AMREF BROADREACH HEALTH CARE 15TH MARCH 2014 14TH MARCH 2017 $2,124,439 31ST DEC 2015 WAJIR,MANDERA,GARISSA,TA NA RIVER & TURKANA
ISIOLO,MARSABIT,SAMBURU, AMREF LAND O' LAKES 15TH MARCH 2014 14TH MARCH 2017 $2,335,935 31ST DEC 2016 WAJIR,MANDERA,GARISSA,TA NA RIVER & TURKANA
ISIOLO,MARSABIT,SAMBURU, AMREF CATHOLIC RELIEF SERVICES 15TH MARCH 2014 14TH MARCH 2017 $5,227,614 30TH SEPT 2018 WAJIR,MANDERA,GARISSA,TA NA RIVER & TURKANA
ISIOLO,MARSABIT,SAMBURU, UNIVERSITY OF AMREF 15TH MARCH 2014 14TH MARCH 2017 $4,614,170 30TH JUNE 2016 WAJIR,MANDERA,GARISSA,TA MARYLAND,BALTIMORE NA RIVER & TURKANA
D. List of Deliverables List all “products” produced during the reporting period. Products cited here could include: surveys, training designs, trip reports, third country visit reports, studies, etc. Submit all deliverable products from the reporting as attachments to this document, and list them here.
E. Summary of Non-USG Funding There is no specific non-USG funding for the project but cost share activities are derived from DANIDA, EU-MNCH, Outreach and WelTel.
F. Type of Accounting System Used During Reporting Period The accounting system in use is Microsoft Dynamic Navision
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XVII. GPS INFORMATION
Task Sectors Implementing Site Name County Longitude Latitude Partner (IP)
TA, Support supervision Health facility AMREF Bura DH Garissa 39.838900 -1.182700 TA, Support supervision Health facility AMREF Garissa PGH Garissa 39.652380 0.448310 TA, Support supervision Health facility AMREF Ijara SDH Garissa 40.169980 -1.690730 TA, Support supervision Health facility AMREF SIMAHO Garissa 39.639660 0.453890 TA, Support supervision Health facility AMREF Iftin SDH Garissa 39.656590 0.475790 TA, Support supervision Health facility AMREF Benane health centre Garissa 38.662880 0.504690 TA, Support supervision Health facility AMREF Dertu health centre Garissa 39.798520 0.272630 TA, Support supervision Health facility AMREF Ijara Health centre Garissa 40.510570 -1.598970 TA, Support supervision Health facility AMREF Kamuthe health Garissa 39.833740 -0.732240 centre TA, Support supervision Health facility AMREF Kotile health centre Garissa 40.206110 -1.969930 TA, Support supervision Health facility AMREF Kulan health centre Garissa 40.644150 0.218750 TA, Support supervision Health facility AMREF Saka Health centre Garissa 39.196790 -0.084850 TA, Support supervision Health facility AMREF Sangailu health centre Garissa 40.729710 -1.313200 TA, Support supervision Health facility AMREF Bura DH Garissa 40.336600 -1.009180 TA, Support supervision Health facility AMREF Bangali Dispensary Tana River 39.016560 -0.725670 TA, Support supervision Health facility AMREF Bura Health Centre Tana River 39.838900 -1.182700 TA, Support supervision Health facility AMREF Garsen Health Centre Tana River 40.107590 -2.270860 TA, Support supervision Health facility AMREF Hola District Hospital Tana River 40.030170 -1.498720 TA, Support supervision Health facility AMREF Idsowe Dispensary Tana River 40.122690 -2.296290 TA, Support supervision Health facility AMREF Kipini Health Centre Tana River 40.527840 -2.523000 TA, Support supervision Health facility AMREF Madogo Health Tana River 39.607730 -0.472780 Centre TA, Support supervision Health facility AMREF Makere Dispensary Tana River 39.997790 -1.331620 TA, Support supervision Health facility AMREF Maziwa Dispensary Tana River 40.134820 -2.184420 TA, Support supervision Health facility AMREF Meti Dispensary Tana River 40.034600 -1.499210 TA, Support supervision Health facility AMREF Mnazini Dispensary Tana River 40.201910 -2.411990 TA, Support supervision Health facility AMREF Ngao District Tana River 40.201930 -2.411980 Hospital TA, Support supervision Health facility AMREF Oda Dispensary Tana River 40.193680 -2.468710 TA, Support supervision Health facility AMREF Pumwani Dispensary Tana River 40.068670 -1.611080 TA, Support supervision Health facility AMREF Semikaro Dispensary Tana River 40.285610 -2.508690 TA, Support supervision Health facility AMREF St Raphael Health Tana River 40.039420 -1.541650 Centre TA, Support supervision Health facility AMREF Wema Catholic Tana River 40.178910 -2.218860 Dispensary TA, Support supervision Health facility AMREF Wenje Dispensary Tana River 40.031360 -1.498840 TA, Support supervision Health facility AMREF Badassa Dispensary Marsabit 38.026260 2.265710 TA, Support supervision Health facility AMREF Butiye Dispensary Marsabit 39.054780 3.509790 TA, Support supervision Health facility AMREF Dabel Health Centre Marsabit 39.246150 3.148320 (Moyale) TA, Support supervision Health facility AMREF Dakabaricha Marsabit 38.003290 2.340080 Dispensary TA, Support supervision Health facility AMREF Dirib Gombo Marsabit 38.061360 2.286240 Dispensary TA, Support supervision Health facility AMREF Dukana Health Marsabit 37.270300 3.998190 Centre(North horr) TA, Support supervision Health facility AMREF Gatab Health Centre Marsabit 37.049150 2.355900 TA, Support supervision Health facility AMREF Kargi Health Centre Marsabit 37.578050 2.506350 TA, Support supervision Health facility AMREF Don Bosco Korr Marsabit 37.496000 2.063620 Dispensary
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TA, Support supervision Health facility AMREF Laisamis Hospital Marsabit 38.025100 1.701010 TA, Support supervision Health facility AMREF Logologo Dispensary Marsabit 38.313918 2.007180 TA, Support supervision Health facility AMREF Loiyangalani Marsabit 36.721670 2.763290 Dispensary TA, Support supervision Health facility AMREF Loiyangalani Health Marsabit 36.717371 2.757710 Centre TA, Support supervision Health facility AMREF Maikona Health Marsabit 37.633900 2.934181 Centre TA, Support supervision Health facility AMREF Marsabit District Marsabit 37.990970 2.323920 Hospital TA, Support supervision Health facility AMREF Moyale District Marsabit 39.050010 3.522540 Hospital TA, Support supervision Health facility AMREF North Horr Health Marsabit 37.071720 3.324030 Centre TA, Support supervision Health facility AMREF Sololo Mission Marsabit 38.658285 3.546318 Hospital TA, Support supervision Health facility AMREF Songa Health Centre Marsabit 38.003730 2.243620 TA, Support supervision Health facility AMREF Turbi Dispensary Marsabit 38.227540 3.182370 (Marsabit North) TA, Support supervision Health facility AMREF Sagante Dispensary Marsabit 38.022840 2.233375 TA, Support supervision Health facility AMREF Mandera County Mandera 41.861700 3.941230 Referral Hospital TA, Support supervision Health facility AMREF Burduras health Mandera 39.882290 3.843980 centre TA, Support supervision Health facility AMREF Elwak district hospital Mandera 40.932870 2.809950 TA, Support supervision Health facility AMREF rhamu sub district Mandera 41.225270 3.933310 Hospital TA, Support supervision Health facility AMREF Takaba District Mandera 40.225560 3.940340 Hospital TA, Support supervision Health facility AMREF Buna SDH Wajir 39.496830 2.791420 TA, Support supervision Health facility AMREF Bute District Hospital Wajir 39.424880 3.370630 TA, Support supervision Health facility AMREF Griftu District Wajir 39.754720 1.996950 Hospital TA, Support supervision Health facility AMREF Habaswein District Wajir 39.509080 1.027140 Hospital TA, Support supervision Health facility AMREF Wagberi Dispensary Wajir 40.084750 1.75666 TA, Support supervision Health facility AMREF Wajir DH Wajir 40.062590 1.747420 TA, Support supervision Health facility AMREF AIC Dispensary Isiolo 37.570180 0.338280 (Isiolo) TA, Support supervision Health facility AMREF Bulesa Dispensary Isiolo 38.533212 0.958180 TA, Support supervision Health facility AMREF Catholic Dispensary Isiolo 37.581320 0.342560 (Isiolo) TA, Support supervision Health facility AMREF Eremet Dispensary Isiolo 37.577869 0.440308 TA, Support supervision Health facility AMREF Gafarsa Health Isiolo 38.588650 0.936960 Centre TA, Support supervision Health facility AMREF Garbatulla District Isiolo 38.514220 0.526970 Hospital TA, Support supervision Health facility AMREF Isiolo District Isiolo 37.588840 0.364800 Hospital TA, Support supervision Health facility AMREF Kinna Health Centre Isiolo 38.206330 0.320420 TA, Support supervision Health facility AMREF Kula Mawe Isiolo 38.196580 0.567250 Dispensary TA, Support supervision Health facility AMREF Malka Galla Isiolo 38.823930 1.249294 Dispensary TA, Support supervision Health facility AMREF Merti Health Centre Isiolo 38.666360 1.066780 TA, Support supervision Health facility AMREF Modogashe Isiolo 39.171950 0.725790 Dispensary
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TA, Support supervision Health facility AMREF Narrapu Dispensary Isiolo 36.957260 0.610010 TA, Support supervision Health facility AMREF Oldonyiro Dispensary Isiolo 36.993800 0.649130 (Isiolo) TA, Support supervision Health facility AMREF Pepo La Tumaini Isiolo 37.573020 0.333450 Dispensary TA, Support supervision Health facility AMREF Sericho Health Centre Isiolo 39.104530 1.137780 TA, Support supervision Health facility AMREF Waso AIPCA Isiolo 37.573990 0.332470 Dispensary(Isiolo) Social determinant of health OVC CRS SIMAHO GARISSA 39.063230 0.044450 Social determinant of health OVC CRS SIMAHO GARISSA 39.185630 0.732570 Social determinant of health OVC CRS SIMAHO GARISSA 39.838900 -1.182700 Social determinant of health OVC CRS SIMAHO GARISSA 40.307740 0.056760 Social determinant of health OVC CRS SIMAHO GARISSA 40.196410 0.235510 Social determinant of health OVC CRS SIMAHO GARISSA 39.639960 -0.448940 Social determinant of health OVC CRS SIMAHO GARISSA 40.729710 -1.313180 Social determinant of health OVC CRS SIMAHO GARISSA 39.656590 0.475790 Social determinant of health OVC CRS SIMAHO GARISSA 40.510560 -1.598960 Social determinant of health OVC CRS SIMAHO GARISSA 39.063230 0.044450 Social determinant of health OVC CRS SIMAHO GARISSA 40.196410 0.235510 Social determinant of health OVC CRS SIMAHO GARISSA 39.780220 -0.607560 Social determinant of health OVC CRS SIMAHO GARISSA 40.169980 -1.690730 Social determinant of health OVC CRS SIMAHO GARISSA 39.185630 0.732570 Social determinant of health OVC CRS SIMAHO GARISSA 39.866800 -0.854590 Social determinant of health OVC CRS SIMAHO GARISSA 39.196790 -0.084830 Social determinant of health OVC CRS SIMAHO GARISSA 39.558910 -0.302560 Social determinant of health OVC CRS SIMAHO GARISSA 39.654900 0.048840 Social determinant of health OVC CRS SIMAHO GARISSA 39.638660 -0.454870 Social determinant of health OVC CRS SIMAHO GARISSA 39.673920 -0.461380 Social determinant of health OVC CRS MARIDHIANO TANARIVER 40.134820 -2.184420 Social determinant of health OVC CRS MARIDHIANO TANARIVER 40.134820 -2.184420 Social determinant of health OVC CRS MARIDHIANO TANARIVER 40.134820 -2.184420 Social determinant of health OVC CRS MARIDHIANO TANARIVER 40.134820 -2.184420 Social determinant of health OVC CRS MARIDHIANO TANARIVER 40.527840 -2.523000 Social determinant of health OVC CRS MARIDHIANO TANARIVER 40.201930 -2.411980 Social determinant of health OVC CRS KICE TANARIVER 40.134820 -2.184420 Social determinant of health OVC CRS KICE TANARIVER 40.134820 -2.184420 Social determinant of health OVC CRS KICE TANARIVER 40.527840 -2.523000 Social determinant of health OVC CRS CARITAS BURA TANARIVER 39.838900 -1.182700 Social determinant of health OVC CRS CARITAS GALOLE TANARIVER 39.838900 -1.182700 Social determinant of health OVC CRS CARITAS GALOLE TANARIVER 40.021610 -1.437400 Social determinant of health OVC CRS CARITAS BURA TANARIVER 39.951650 -1.158030 Social determinant of health OVC CRS CARITAS GALOLE TANARIVER 40.134820 -2.184420 Social determinant of health OVC CRS CARITAS BURA TANARIVER 39.838900 -1.182700 Social determinant of health OVC CRS CARITAS GALOLE TANARIVER 40.031360 -1.498840 Social determinant of health OVC CRS CARITAS BURA TANARIVER 40.031360 -1.498840 Social determinant of health OVC CRS CARITAS GALOLE TANARIVER 40.031360 -1.498840 Social determinant of health OVC CRS CARITAS BURA TANARIVER 39.607730 -0.472780 Social determinant of health OVC CRS CARITAS TANARIVER 39.607730 -0.472780 MADOGO Social determinant of health OVC CRS CARITAS GALOLE TANARIVER 40.068670 -1.611080 Social determinant of health OVC CRS CARITAS TANARIVER 40.068670 -1.611080 MADOGO Social determinant of health OVC CRS CARITAS TANARIVER 39.607730 -0.472780 MADOGO Social determinant of health OVC CRS RACIDA MANDERA 40.849915 3.680632 MANDERA NORTH
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Social determinant of health OVC CRS RACIDA MANDERA 40.446167 3.987561 MANDERA NORTH Social determinant of health OVC CRS RACIDA MANDERA 39.962769 3.195364 MANDERA WEST Social determinant of health OVC CRS RACIDA MANDERA 41.176758 3.902618 MANDERA NORTH Social determinant of health OVC CRS RACIDA MANDERA 40.242920 3.697078 MANDERA WEST Social determinant of health OVC CRS EPAG ELWAK MANDERA 41.520081 3.477782 Social determinant of health OVC CRS EPAG LAFEY MANDERA 41.520081 3.477782 Social determinant of health OVC CRS EPAG MANDERA MANDERA 41.520081 3.477782 EAST Social determinant of health OVC CRS EPAG ELWAK MANDERA 41.742554 3.935500 Social determinant of health OVC CRS EPAG MANDERA MANDERA 41.742554 3.935500 EAST Social determinant of health OVC CRS EPAG ELWAK MANDERA 40.932312 2.742787 Social determinant of health OVC CRS EPAG ELWAK MANDERA 40.556030 2.591889 Social determinant of health OVC CRS EPAG LAFEY MANDERA 40.556030 2.591889 Social determinant of health OVC CRS EPAG MANDERA MANDERA 40.556030 2.591889 EAST Social determinant of health OVC CRS EPAG ELWAK MANDERA 40.638428 2.372369 Social determinant of health OVC CRS EPAG MANDERA MANDERA 40.638428 2.372369 EAST Social determinant of health OVC CRS EPAG LAFEY MANDERA 41.149292 3.135031 Social determinant of health OVC CRS EPAG MANDERA MANDERA 41.797485 3.897138 EAST Social determinant of health OVC CRS CIPAD MARSABIT 38.658285 3.546318 Social determinant of health OVC CRS CIPAD MARSABIT 38.658285 3.546318 Social determinant of health OVC CRS CIPAD MARSABIT 38.658285 3.546318 Social determinant of health OVC CRS CIPAD MARSABIT 38.658285 3.546318 Social determinant of health OVC CRS FH KENYA MARSABIT 39.054780 3.509790 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 37.990970 2.323920 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 37.990970 2.323920 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 37.455139 1.924992 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 37.628174 2.964984 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 38.012695 2.333949 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 38.012695 2.333949 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 38.658285 3.546318 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 38.012695 2.333949 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 38.012695 2.333949 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 38.658285 3.546318 MOYALE NEW Social determinant of health OVC CRS FH KENYA MARSABIT 37.455139 1.924992 MARSABIT S Social determinant of health OVC CRS FH KENYA MARSABIT 38.025100 1.701010
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MARSABIT S Social determinant of health OVC CRS FH KENYA MARSABIT 37.886353 2.004596 MARSABIT S Social determinant of health OVC CRS FH KENYA MARSABIT 36.771240 2.794911 MARSABIT S Social determinant of health OVC CRS FH KENYA MARSABIT 38.012695 2.333949 MARSABIT C Social determinant of health OVC CRS FH KENYA MARSABIT 38.012695 2.333949 MARSABIT C Social determinant of health OVC CRS FH KENYA MARSABIT 38.012695 2.333949 MARSABIT C Social determinant of health OVC CRS FH KENYA MARSABIT 38.012695 2.333949 MARSABIT C Social determinant of health OVC CRS FH KENYA MARSABIT 38.375244 3.305050 MARSABIT C Social determinant of health OVC CRS SND BUNA WAJIR 39.506836 2.778451 Social determinant of health OVC CRS SND BUTE WAJIR 39.506836 2.778451 Social determinant of health OVC CRS SND ELDAS WAJIR 39.259644 2.152814 Social determinant of health OVC CRS SND GRIFTU WAJIR 39.556274 2.092430 Social determinant of health OVC CRS SND WAJIR 39.122314 2.674199 KORONDILLE Social determinant of health OVC CRS SND MATHO WAJIR 39.320068 2.169281 Social determinant of health OVC CRS SND WAGALLA WAJIR 39.874878 1.774008 Social determinant of health OVC CRS WASDA-WJR WAJIR 39.495850' 0.972243 SOUTH Social determinant of health OVC CRS WASDA_WAJIR WAJIR 40.226440 2.092430 EAST Social determinant of health OVC CRS WASDA-TARBAJ WAJIR 40.226440 2.092430 Social determinant of health OVC CRS WASDA_WAJIR WAJIR 39.396973 1.356685 EAST Social determinant of health OVC CRS WASDA-TARBAJ WAJIR 40.122070 1.708121 Social determinant of health OVC CRS WASDA-WJR WAJIR 40.171509 1.801461 SOUTH Social determinant of health OVC CRS WASDA-WJR WAJIR 40.116577 2.180260 SOUTH Social determinant of health OVC CRS WASDA_WAJIR WAJIR 40.116577 2.180260 EAST Social determinant of health OVC CRS WASDA_WAJIR WAJIR 40.072632 1.713612 EAST Social determinant of health OVC CRS WASDA_WAJIR WAJIR 39.990234 1.922247 EAST Social determinant of health OVC CRS WASDA-TARBAJ WAJIR 40.094604 1.730084 Social determinant of health OVC CRS OPAHA WAJIR 39.973755 1.691649 Social determinant of health OVC CRS OPAHA WAJIR 40.127563 1.724593 Social determinant of health OVC CRS OPAHA WAJIR 40.105591 1.812442 Social determinant of health OVC CRS OPAHA WAJIR 40.171509 1.801461 Social determinant of health OVC CRS OPAHA WAJIR 40.127563 1.647722 Social determinant of health OVC CRS OPAHA WAJIR 40.072632 1.735574 Social determinant of health OVC CRS OPAHA WAJIR 40.122070 1.719102 Social determinant of health OVC CRS FH ISIOLO ISIOLO 37.581320 0.342560 Social determinant of health OVC CRS FH ISIOLO ISIOLO 37.581320 0.342560 Social determinant of health OVC CRS FH ISIOLO ISIOLO 38.669128 1.057374 Social determinant of health OVC CRS FH ISIOLO ISIOLO 38.514220 0.526970 Social determinant of health OVC CRS FH ISIOLO ISIOLO 38.206330 0.320420 Social determinant of health OVC CRS FH ISIOLO ISIOLO 38.206330 0.320420 Social determinant of health OVC CRS FH ISIOLO ISIOLO 37.577869 0.440308 Social determinant of health OVC CRS FH ISIOLO ISIOLO 37.588840 0.364800
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Social determinant of health OVC CRS FH ISIOLO ISIOLO 37.581320 0.342560 Social determinant of health OVC CRS PWHE-ISIOLO ISIOLO 37.581320 0.342560 Social determinant of health OVC CRS PWHE-ISIOLO ISIOLO 37.581320 0.342560 Social determinant of health OVC CRS PWHE - MERTI ISIOLO 38.669128 1.057374 Social determinant of health OVC CRS PWHE - GARBA ISIOLO 38.523560 0.530083 Social determinant of health OVC CRS PWHE - GARBA ISIOLO 38.523560 0.530083 Social determinant of health OVC CRS PWHE-ISIOLO ISIOLO 38.196580 0.567250 Social determinant of health OVC CRS PWHE-ISIOLO ISIOLO 37.588840 0.364800 Social determinant of health OVC CRS PWHE - GARBA ISIOLO 38.523560 0.530083 Social determinant of health OVC CRS PWHE-ISIOLO ISIOLO 37.588840 0.364800
VIII. SUCCESS STORY
The Tana River County transition team was formed towards the end of 2017 to help in transition activities of OVC in the county and plan for the remaining OVC in the county. After training on Advocacy for Resource mobilization in April 2018, through the USAID 4Children project, they embarked on work planning for resource mobilization in the county. The team through continued support from 4C and APHIAplus IMARISHA held several meetings to plan and mobilize resources which would continue to support OVC in the county. The TT members and 4C met with County Government officials to push for OVC inclusion in County budgets and policy. This gave fruits as the county has now allocated a budget of Ksh459 Million for OVC activities such as construction of a rescue center and bursary support. There is a draft OVC policy in place and the team continues to push so that it is approved into county law. The efforts of the team also resorted into the governor supporting all the form fours in the county to clear fee balances, while those in form one and two, he paid for each around Ksh. 4000. The County TT members have by now opened an account with Equity Bank and elected signatories, they also have an Mpesa Pay Bill Account (324084. Acc. No. Tana River OVC Welfare). They are now creating awareness through the media to mobilize funds through the Mpesa. The team plans to hold a County fund raising event in mid-July, whereby they will invite dignitaries from the county. They already have a constitution stipulating how the funds will be managed and utilized to continue supporting around 3,000 OVC that were previously supported through APHIAplus IMARISHA.
ANNEXES & ATTACHMENTS
None
Page | 45 USAID/KENYA APHIAPLUS IMARISHA ANNUAL PROGRAM REPORT FOR FY 2018