Migori COUNTY HIV & AIDS Strategic Plan
2015/2016 - 2018/2019
“Towards Ending the HIV Epidemic in Migori County”
“Towards Ending the HIV Epidemic in Migori County” Any part of this document may be freely reviewed, quoted, reproduced or translated in full or in part, provided the source is acknowledged. It may not be sold or used for commercial purposes or for profit.
ii MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Table of Contents
Acronyms and Abbreviations v Foreword vi Preface vii Acknowledgement viii Executive Summary ix
CHAPTER ONE: BACKGROUND INFORMATION 1 1.1 Demographic features 2 1.2 Population Size and Composition 2 1.3 Climatic conditions 2 1.4 Socio economic activities 2
CHAPTER TWO: HIV SITUATION ANALYSIS 4
CHAPTER THREE: RATIONALE, STRATEGIC PLAN DEVELOPMENT PROCESS AND THE GUIDING PRINCIPLES 8 3.1 Purpose of the MCASP 8 3.2 Process of developing the HIV Plan 8 3.3 Guiding Principles: 9
CHAPTER 4: VISION, MISSION, OBJECTIVES & COUNTY STRATEGIC DIRECTIONS 11 4.1 Vision 11 4.2 Mission 11 4.3 Objectives of MCASP 11 4.4 Strategic Directions of the Migori County Hiv & Aids Strategic Plan 11
CHAPTER 5: IMPLEMENTATION ARRANGEMENTS 31 5.1 Governor 31 5.2 County HIV Committee 31 5.3 County HIV Coordination Unit 31 5.4 Stakeholder management and accountability 32 5.5 Reporting Mechanisms 32 5.6 Sustainability 32
“Towards Ending the HIV Epidemic in Migori County” iii Table of Contents
CHAPTER 6: RESEARCH MONITORING AND EVALUATION OF THE PLAN 35
CHAPTER 7: RISKS, ASSUMPTIONS AND MITIGATION PLAN 38
CHAPTER 8: FINANCING OF THE MIGORI COUNTY HIV STRATEGIC PLAN 41
ANNEXES 42 Annex 1: Results Framework 42 Annex 2: List of Drafting and Technical Review Teams 46 Annex 3: References 47
iv MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Acronyms and Abbreviations
AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Clinic ART Antiretroviral Therapy ARV Anti-Retroviral Drugs BCC Behaviour Change Communication CBO Community Based Organization CCC Comprehensive Care Centre CCM Country Coordination Mechanism CHEWs Community Health Extension Workers CHW Community Health Worker CSO Civil Society Organization DHIS District Health Information System DTC District Technical Committee EBI Evidence Based Intervention EMTCT Elimination of Mother to Child Transmission ETR End Term Review FBO Faith Based Organization FSW Female Sex Worker GBV Gender Based Violence HBC Home Based Care HBTC Home Based Testing and Counselling HCBC Home and Community Based Care HIV Human Immunodeficiency Virus HMIS Health Management Information System HPV Human Papillomavirus HTS HIV Testing Services IEC Information, Education, and Communication IGAD Intergovernmental Authority on Development IPC Infection Prevention and Control KAIS Kenya AIDS Indicator Survey KASF Kenya AIDS Strategic Framework KDHS Kenya Demographic and Health Survey KEPH Kenya Essential Package for Health KNASP Kenya National AIDS Strategic Plan KP Key Populations MCASP Migori County AIDS Strategic Plan MDAs Ministries, Departments and Agencies M&E Monitoring and Evaluation MoH Ministry of Health MIPA Meaningful involvement of people living with HIV and AIDS LMIS Logistics Management Information System CECM County Executive Committee Member
“Towards Ending the HIV Epidemic in Migori County” v Foreword
Progress has been made with HIV prevalence dropping by 2% in the last 5 years in Kenya. Migori County has, however, experienced an increase of 0.4% from 14.3% to 14.7% during the same period. HIV continues to contribute the highest mortality rate, burdening households and hence straining the county health system.
With this understanding, the Migori County AIDS Strategic Plan 2015-2019 exemplifies the firm commitment by my government, stakeholders and partners working in Migori to support County Health Services to deliver better health for all with a focus on cost The Migori County AIDS Strategic Plan effective and socially inclusive interventions to focuses on leadership in the HIV response. prevent and manage HIV and AIDS. It emphasises an equitable HIV response in all sub counties including Suna East, Suna My government will continue to support and West, Kuria West, Kuria East, Uriri, Nyatike, create an enabling environment to offer HIV Awendo and Rongo to ensure no one is services up to household level. I encourage left behind. The county identifies main HIV all stakeholders to work closely with my driving factors that are linked to the various government to ensure new infections are socio-economic activities like fishing along reduced by 75%, AIDS related mortality the beaches of Lake Victoria, mining areas of is reduced by 25%, HIV related stigma Nyatike, Rongo, Suna West, Kuria East and and discrimination is reduced by 50% and Kuria West, tobacco growing areas of Kuria, domestic financing of the HIV response is Uriri, Suna East and Awendo sugar belt. Truck increased to 50% in the next 5 years as per drivers along the Migori- Isebania Highway MCASP objectives. and retrogressive cultural practices are among other HIV driving factors.
H.E. Hon. Zachary Obado The Governor, Migori County
vi MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Preface
sectoral response to HIV and outlines roles and expected actions from different sectors and actors. A coordination and governance structure led by the County Department of Health takes cognisance of devolved functions of health department to sub counties, health facilities, development partners, communities and other stakeholders’ involvement for results.
The plan identifies several cross cutting areas of existing or potential strengths in HIV and AIDS response that require increased health department funding and partner support. The MCASP outlines an innovative leverage funding approach based on implementation of the HIV Migori is a cosmopolitan county with resource mobilisation, increased access to HIV diverse socio-cultural characteristics and and AIDS care and support for those living with dynamic economic growth. The Constitution HIV and ultimately subsidising Migori County’s of Kenya 2010 heralded the best and most future liability to HIV prevention and treatment. comprehensive Bill of Rights in Kenya. In There is political will and financial support to particular, Article 43 (1) (a) guarantees every health services to ensure HIV integration in all person the right to the highest attainable sectors in this county. standard of health care services. In line with devolved governance structures, NACC The development of this plan was participatory, developed Kenya AIDS Strategic Framework involving all key stakeholders in HIV response. It (KASF) to guide every county in formulating is my firm conviction that the implementation of county HIV response specific plan. In this this AIDS strategic plan will provide a roadmap regard, the county health department has for health services and ensure that Health developed the Migori County HIV and AIDS Department meets its constitutional mandate Strategic Plan (MCASP) 2015-2019. by providing integrated and high quality promotive, preventive, curative, rehabilitative This strategic plan focuses on leadership in and palliative health care services to her people. the HIV response. It emphasises on equitable In this regard therefore, my department is HIV response that ensures no one is left committed to facilitating achievements of behind. This is a priority for this county to results articulated in this Strategic Plan. In doing achieve her goals. It promotes calibration of this, we will build on the progress made so far our efforts through effective prioritisation of through years of hard work, unity of purpose, interventions. It focuses on effective evidence courage and commitment to step up the based- best interventions, which target priority momentum towards ending AIDS pandemic. and key populations while ensuring that all Migori people are reached and stigma and discrimination are reduced for improved health outcomes. The strategic plan is aligned to the Constitution of Kenya, the Vision 2030, and Rtd. Col Kepha Nyamita the Sustainable development goal 3 on HIV County Executive Committee Member, controls. It recognises the centrality of a multi- Department of Health
“Towards Ending the HIV Epidemic in Migori County” vii Acknowledgement
We thank development partners, public sector institutions, private sector players, civil society organisations, faith-based organisations, key population representatives, People Living with HIV (PLHIV), Persons with Disabilities (PwD), the elderly and the community who put in their efforts to come up with this plan. We also acknowledge the government agencies led by NACC through the Regional HIV Coordinator, NASCOP and Migori County department for health for the technical support. It is from these engagements that we have put forth a vision, setting us on a trajectory that will assure the achievement of The Migori County HIV Strategic plan our County HIV and AIDS goal. (MCASP) will provide direction to all stakeholders in the HIV and AIDS response. It draws from our past successes, lessons We are grateful to the Technical Working learnt and gives us the opportunity to provide Group members, including Dr Jerry Ndege, the direction for our future. It emphasises on Dr. Otengah A.P Wilson (PhD), Joshua O. a multi-sectoral approach and accountability Odembo, Alfred Tulu, Eliza Owino, Evon Sarah, among all stakeholders. Simeon Okuthe, Daniel Oneya, John Odira and Dorothy Ogidi, whose tireless efforts This plan has been developed through the and dedication helped come up with this efforts of a large number of stakeholders as important document. espoused in the constitution of Kenya 2010. In particular, we thank the County Executive The Department of health is committed Committee Member for Health (CECM) and the Chief Officer for Health for providing the to strengthened coordination, fostering necessary leadership in this process. We collaboration and facilitating delivery of an also acknowledge the enabling environment effective and efficient HIV response. that was provided by the County Assembly Committee for Health.
Dr. Gondi Joel O. (MPH, MBA) County Director of Health, Migori
viii MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Executive Summary
Migori County is one of the 47 counties. The • Reduction of new HIV infections by 75% county has a diverse background comprising of • Reduction of AIDS related mortality by 25% urban and rural set-ups as well as a rich ethnic, • Reduction HIV related stigma and racial and cultural diversity. There are seven sub discrimination by 50% counties within Migori County where the major • Increasing domestic financing of the HIV economic mainstay of the residents include: response to 50% Fishing, Farming (subsistence and sugarcane) and Trade. With a HIV prevalence rate of 14.7%, These objectives will be realised through the the county has been categorised among the eight (8) strategic directions with support from 9 counties that account for the highest new the various HIV stakeholders implementing an HIV infections in the country. Therefore, there array of programmes in Migori County with is need to have a better understanding of the the coordination of the county government. epidemiological, biomedical, social, economic, religious and cultural factors affecting the This Strategic Plan is anchored on Kenya’s pattern of the epidemic in the county. This Vision 2030 description of HIV and AIDS will enable provision of a strategic focus as “one of the greatest threats to socio- through prioritisation to improve efficiency and economic development”. It marks a change in effectiveness in the HIV response. the approach of managing the response from doing “business as usual” to evidence and Migori County AIDS Strategic Plan (MCASP) results-based multi-sectoral and decentralised 2014/15-2018/19 is the strategic guide for planning. It is also aligned with the response to HIV at the county level. This Constitution of Kenya 2010, which guarantees document addresses the drivers of the the policy environment for the national HIV HIV epidemic and builds on the past gains and AIDS response, while also presenting a to achieve its goal of contributing to the major paradigm shift in the governance and country’s vision 2030 through universal response which is county led and specific. access to comprehensive HIV prevention, treatment and care. The MCASP is derived This document was developed through a from the Kenya AIDS Strategic Framework consultative process that comprised of the (KASF) 2014/15-2018/19 which is the strategic dissemination of the KASF, drafting, reviewing guide for the country’s response to HIV and validation of the MCASP. epidemic at the national level. The vision is to have a county free of HIV infections, stigma and AIDS related deaths. This vision will be achieved through the following objectives;
“Towards Ending the HIV Epidemic in Migori County” ix 01 BACKGROUND OF THE COUNTY BACKGROUND borders Homa Bay to the South, Republic of INFORMATION Tanzania to the South and South West, Kisii to the North East, Narok to the East and North Migori County is one of the 47 counties in East and Lake Victoria to the West. The county Kenya and has a projected population of has a Population density of 355 per KM 1,006,499 inhabitants. The county covers square and the poverty level is estimated at an area of 2,597 KM square. Migori County 43% as at the year 2013.
Figure 1: The Map of Migori County
Source: Migori County Integrated Plan, 2013
“Towards Ending the HIV Epidemic in Migori County” 1 1.1 Demographic features 1.3 Climatic conditions Migori is a multi-ethnic county with the The county has an inland equatorial climate dominant tribes being the Luo, Suba, modified by effect of altitude, relief and the Kuria, Luhya, Kisii and Somalis. There are 8 influence of Lake Victoria. Rainfall is generally constituencies in the county namely Suna continuous with little distinctions between East and West, Nyatike, Uriri, Rongo, Awendo, short and long rains. Long rains come Kuria East and Kuria West. It has an average between March and May, while short rains population density of 355 persons per km2 are between September and November. Dry with Kuria West constituency recording the seasons are between December and February highest population density of 490 persons and June and September. Nyatike and Kuria per km2. Nyatike constituency has the lowest East sub counties have comparatively harsher population density of 213 persons per km2. climatic conditions than other sub counties. Generally the county does not experience any extreme climatic conditions. Temperatures 1.2 Population Size and range between a minimum of 24 Celsius and Composition maximum of 31 Celsius. The total population of Migori County according to the 2009 population census was 1.4 Socio economic activities 917,170 comprising of 444,357 males (48.6%) and 472,814 females (51.4%). This figure was The presence of Lake Victoria, Migori and Kuja expected to grow at a rate of 3.8 per cent rivers and the relatively good weather patterns per annum to stand at 1,028,028 persons in in Migori County have allowed the soils in the the year 2012, 1,152,165 persons in 2015 and region to be well drained, making the county 1,243,272 persons in the year 2017. conducive for agriculture. Agricultural produce consists of tobacco, sugar cane, maize, beans, Migori County has a young population. coffee, groundnuts and vegetables. Livestock Children below 15 years constitute 49 percent farming is also undertaken in small scale. of the population while those below 30 years Fishing is also a major activity in Lake Victoria. constitute 78 per cent of the population. This implies that the county government and Due to mineral resources available in the other development partners will have to plan county such as gold and copper, there is a and invest more resources for sustainable growing mining industry particularly gold provision of food security, schooling and mining. training, medical and career counselling among others. This youthful population has a momentum for faster population growth and therefore calls for heavy investment in reproductive health and family planning commodities to manage population growth.
2 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 02 HIV SITUATION ANALYSIS HIV SITUATION ANALYSIS Table 2.1: HIV Burden in Migori County By the end of 2013, Migori County had a HIV prevalence of 14.7 % with 88,405 people Rank* living with HIV. This places Migori County as Total Population (2013) 1002499 32 one of the 9 counties that contribute to the highest HIV incidences and thus a burden HIV adult prevalence 14.7% 44 to the country. Children constitute 12% of (overall) those living with HIV in the county. The county Number of adults living 77,700 43 had about 6,786 new adult infections in with HIV 2013. Adult ART coverage stood at 89% and Number of Children children ART coverage at 37%. Approximately 10,705 43 living with HIV 1,876 adults and 682 children died of AIDS Total number of people related conditions in 2013 in the county 88,405 43 (Kenya HIV County Profiles 2014). living with HIV
Source: Kenya HIV County Profiles, 2014 The HIV prevalence among women in Migori County is higher (15.7%) than that of men (13.6%) (Kenya HIV Estimates 2014). There *In this HIV burden and indicator ranking were about 5,262 pregnant women living (table2.1), the highest burden County is 47, with HIV in the County by 2013. About 57% while the lowest burden County is 1 of HIV-positive pregnant women in the county do not deliver in health facilities. Only 41% of Over the years, the women living in the pregnant women attend the recommended county have been more vulnerable to HIV four antenatal visits (KAIS 2014). infection than the men. This is attributed to less opportunity to negotiate for safe sex and Approximately 55% of individuals in Migori compounded by a male dominated society had their first experience of sexual intercourse whose sexual beliefs are not scientifically before the age of 15, an indication of correct. early sexual debut. Some communities in Migori County culturally do not circumcise HIV counselling and testing and linkage to men, while others do. Only 28% of poor care and treatment are important steps in households with orphans are beneficiaries of reducing the sexual transmission of HIV. a cash transfer programme. Despite the huge importance of HIV testing as a way to increase prevention and treatment, Stigma and discrimination, the resulting about 73 per cent of people in Migori County isolation from the community and other had never tested for HIV by 2009- (Source) harms experienced by people living with Insert HTS on the PWD). HIV, works against realisation of the enabling environment required to facilitate individual There were about 5,262 pregnant women disclosure of HIV status before taking part living with HIV in Migori County in 2013. in high risk activities, uptake testing and treatment and the full productive participation Approximately 1,876 adults and 682 children of people living with HIV and AIDS. Migori died of AIDS related conditions in 2013 in County Stigma Index currently stands at 34.5 Migori County. %( Kenya Stigma Index report 2014). The County Government, beginning this financial year 2016/2017, allocated funds to support HIV and AIDS programs.
4 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Table 2.2: Migori County HIV treatment Table 2.4: HIV Testing Services for the year access annually 2014/2015
Indicator Indicator Sub County Total tested Total % (including Positive Positivity MCH) Adults in need Children in need 39,147 8,419 of ART of ART Awendo 57,280 1,747 3.0 Adults receiving Children 34,927 3,136 Rongo 50,366 2,241 4.4 ART receiving ART Uriri 55,207 1,497 2.7 County ART County ART 89% children 37% Kuria West 24,808 1,690 6.8 adult coverage coverage Kuria East 26,791 261 0.9 National ART National ART 79% 42% coverage coverage Suna East 61,550 2,388 3.9 Suna West 25,708 1,233 4.8 County ranking County ranking of ART coverage 15 of ART coverage 25 Nyatike 107,979 3,678 3.4 among adults among children Total 409,689 13,045 3.3 Source: Kenya HIV County Profiles, 2014 Source: HIS, Calendar Year 2015 It can be noted that 63% of children living with HIV and AIDS in Migori County in need of antiretroviral therapy (ART) are not under treatment
Table 2.3: Migori orphans and social welfare indicators
Orphans and vulnerable children Estimates beneficiaries
Households with an orphan* 47,400
Poor households with an orphan* 22,026
Cash transfer beneficiary households*** 8350
Source: National Social Protection Secretariat
“Towards Ending the HIV Epidemic in Migori County” 5 Table 2.5: Strengths, Weaknesses Opportunities and Threats (SWOT) analysis of the HIV situation in Migori County.
Strengths Weaknesses
• Political goodwill. • Inadequate human resources for health & poor deployment • Availability of policy and research documents that of personnel. can guide in identifying the gaps that need quick • Challenges in disclosure. interventions and what resources are needed in order • Stigma and discrimination. to address the gaps. • Inadequate supportive supervision. • Availability of health structures which can support the • Erratic supply of commodities and drugs. care and treatment of PLHIVs. • Inadequate reporting tools & late reporting. • Ability of the county to mobilise stakeholders and • Irregular data quality audits & poor utilisation of data. partners in support of the elimination of new HIV infections by funding activities geared towards • Early sexual debut before 15 years. achievement of national objectives. • Low percentage of cash transfer programs. • Availability of a quality control and standards team. • Inadequate number of community units. • Ongoing mentorship activities supported by partners. • Lack of viral load and PCR testing machines and Lab. • Availability of 3 GeneXpert machines for diagnosis of • Inadequate GeneXpert machines. TB and co-infection. • Lack of meaningful involvement of people living with HIV • Operationalized beyond zero mobile clinics. and AIDS. • Support by the NACC in providing a strategic • HIV funding is currently dependent on partners’ funding. framework in the fight against HIV and AIDS. • Response to PWD, KP, adolescent and young people. • Irregular supply of nutrition commodities. • HIV and AIDS cachexia (malnutrition) as a result of late intervention of nutrition assessment both for paediatric and adults.
Opportunities Threats
• Availability of County political goodwill in participating • Retrogressive cultural practices. and championing HIV & AIDS response. • Poverty • Domestic financing. • Alcohol and drug abuse. • Established community structures. • Sexual and Gender based violence. • Ability to partner with other state actors and • Information access and utilisation. stakeholders in financial support of HIV activities in • Multiple sexual partners. the county. • Existence of legal frameworks that protect the rights of People Living with HIV (PLHIV). • Availability of willing partners in funding and ensuring the success of the HIV activities. • Availability of a County HIV committee that oversees the success and implementation of the MCASP. • MCASP towards elimination of new HIV infections and care and support of PLHIV. 03 RATIONALE, STRATEGIC PLAN DEVELOPMENT PROCESS AND THE GUIDING PRINCIPLES RATIONALE, STRATEGIC • Provide the basis for consolidating PLAN DEVELOPMENT strategic partnership especially with civil PROCESS AND THE society organisations, public, the private sector and development partners. GUIDING PRINCIPLES • Articulate county priorities, results and The policy environment of HIV response is targets that all stakeholders and partners defined by the Constitution of Kenya, 2010, will contribute. which establishes a right “to the highest attainable standard of health” and the • Establish the basis for consolidating resulting devolution of the responsibilities for its efforts in developing sustainable the implementation of most health services financing systems for HIV and AIDS including the HIV response at county level. response based on KASF. The document is guided by a number of policies that include the national development 3.2 Process of developing strategy, Vision 2030, that underscores the the HIV Plan importance of health as a key building block in transforming Kenya into a successful middle- This plan was developed through in-depth income country; the HIV policy of 1999, which analysis of available data and a highly defines HIV as a disaster and provides a participatory process involving a wide range framework for a multi-sectoral response; and of stakeholders from the county. The process the Kenya Health Policy that prioritises the of development of the Migori County HIV and elimination of communicable diseases. AIDS Strategic Plan involved the following:
Migori CASP defines the results to be • The dissemination of Kenya AIDS achieved in the next five years and offers Strategic Framework (KASF) to the key broad strategic guidance to the County on stakeholders. the coordination and implementation of the HIV response. It is also a guide for resource • Formation of Technical Working Group to mobilisation, allocation and accountability tool. draft the County HIV and AIDS plan. It ensures that HIV response remains multi – sectoral and that key institutions at the county • Consultations with stakeholders. level play their critical mandate synergistically to achieve common results. • Drafting and technical review by the County TWG to form Zero draft. 3.1 Purpose of the MCASP • Review by National technical support The MCASP has been developed to: team.
• Provide strategic framework which • Validation by key stakeholders in the will guide and inform the planning, county. coordination, implementation, monitoring and evaluation of the multi- • Editing, design and Printing. sectoral and decentralised HIV and AIDS response with the aim of achieving zero • Launching. new HIV infections, zero discrimination and zero AIDS related deaths. • Dissemination to stakeholders.
8 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 3.3 Guiding Principles: involving PLHIV and affected communities in the HIV response makes a powerful The following principles will guide the County contribution to the pandemic by enabling HIV and AIDS response: individuals and communities to draw on their experiences, thus contributing to reducing Respect and fulfilment of basic human stigma and discrimination and to increasing rights: Respect, protection, promotion and the effectiveness and appropriateness of the fulfilment of human rights is a pre-requisite HIV response. for an efficient and effective HIV and AIDS response. Efforts will be made to ensure Evidence–based planning and results– that duty bearers and other service providers based management: The planning and respect and fulfil their obligations to provide management of the county response will quality and comprehensive services to all be informed by empirical qualitative and people. Rights holders (beneficiaries) will quantitative evidence and implementation will be empowered to access and utilise such focus on measurable output, outcome and services. output results.
Integrated Service delivery: The MCASP Creating an enabling environment: An will support service integration as a strategy enabling environment is premised on the to improve synergy between interventions, existence of appropriate and effective complimentary and optimised use of policies, laws, operational guidelines and resources. standards, and more importantly the respect and fulfilment of human rights. During the Equity: Access to services is a basic human MCASP implementation period, policies right. MCASP will make efforts to ensure and legislations will be reviewed and access to services to all people especially strengthened. Monitoring of stakeholders’ those most at risk and other key populations. compliance with such policies and legislation will be intensified. Meaningful Involvement of people living with HIV (MIPA): MIPA is the involvement of Gender sensitivity and responsiveness: PLHIV and affected communities as a specific The MCASP has identified strategies that will expression of the right to active, free and address gender inequalities in the county HIV meaningful participation in all aspects of the response. This includes all aspects of planning HIV and AIDS response. This recognises that and service delivery.
“Towards Ending the HIV Epidemic in Migori County” 9 04 VISION, MISSION, GOALS, OBJECTIVES & COUNTY STRATEGIC DIRECTIONS VISION, MISSION, 4.3 OBJECTIVES OF MCASP OBJECTIVES & COUNTY 1. Reduce new HIV infections by 75% STRATEGIC DIRECTIONS 2. Reduce AIDS related mortality by 25 %
4.1 VISION 3. Reduce HIV related stigma and A county free of new HIV infections, stigma discrimination by 50% and AIDS related deaths 4. Increase domestic financing of HIV response by 50% 4.2 MISSION To contribute towards achievement of 4.4 STRATEGIC DIRECTIONS OF Vision 2030 through universal access to THE MIGORI COUNTY HIV & comprehensive HIV prevention, care and AIDS STRATEGIC PLAN treatment. Migori County has adopted the eight strategic directions as provided by the KASF. MCASP, however, identifies its priorities in each strategic direction as follows;
Table 4.1: MCASP Strategic Directions
Strategic Directions Priority intervention areas
1. Reducing new HIV • Increase coverage of combination HIV prevention interventions. Infections • Prioritise populations and geographic locations for an equitable HIV response. • Leveraging on different sectors and emerging technologies for HIV prevention. • Maximising on the efficiencies and effectiveness of an integrated HIV, TB/SRH prevention response.
2. To improving health • Improve timely identification and linkage to care for persons diagnosed with HIV. Outcomes and wellness • Increase coverage of care and treatment with a particular focus on reducing the loss in the of All people living with cascade of care. HIV • Scale up interventions to improve quality of care and improve health outcomes. • Scale up nutrition interventions to improve nutrition status and improve health outcomes.
3. Using a human rights • Build a competent, motivated and adequately staffed workforce at county and sub county approach to facilitate levels to deliver HIV services integrated in the essential health package. access to services for • Strengthen health service delivery system at county and sub county levels for the delivery of PLHIV, key populations HIV services integrated in the essential health package. and other priority groups • Improve access to and rational use of quality essential products and technologies for HIV in all sectors prevention, treatment and care services. • Strengthen community service delivery system at national and county levels for the provision of HIV prevention, treatment and care services.
5. Strengthening • Resource and implement a HIV research agenda informed by MCASP. research • Increase evidence-based planning and use of implementation science outcomes to optimise and innovation to inform programming and policy changes. the MCASP mission • Strengthen synergies between HIV research and other disease and development areas.
“Towards Ending the HIV Epidemic in Migori County” 11 Strategic Directions Priority intervention areas
6. Promoting utilisation • Implement a unified and functional M&E framework under the NACC. of strategic information • Strengthen M & E capacity to effectively track MCASP performance and the HIV epidemic at for Research and county and sub county levels and across sectors. Monitoring and • Conduct regular evaluations of the HIV prevention and treatment cascade at the county level Evaluation (M&E) to gauge programme effectiveness. to enhance HIV programming
7. Increasing domestic • Promote innovative and sustainable domestic HIV financing options. financing for a • Align HIV resources/investment to the strategic framework priorities. sustainable HIV • Maximise efficiency of existing delivery options for increased value and results within response existing resources.
8. Promoting • Build and sustain high level political and technical commitment for strengthened county accountable ownership of the HIV response. leadership for delivery • Entrench good governance and strengthen multi-sector and multi-partner accountability to of the MCASP results by delivery of MCASP results. all sectors and actors • Establish and strengthen functional and competent HIV co-ordination mechanism at the county and sub county level.
4.5.1 STRATEGIC DIRECTION cent of men who participated in a national 1: REDUCING NEW HIV survey in 2009 reporting that they had been INFECTIONS circumcised. The practice should be carried out in a safe and hygienic way before the age Kenya aims to reduce annual new HIV of sexual debut. Approximately 55 per cent infections among adults by 75% and HIV of individuals in Migori County had their first transmission rates from mother to child from experience of sexual intercourse before the 14% to less than 5%. Migori County has age of 15, an indication of early sexual debut. annual adult new HIV infections of 6,786 Other drivers of HIV epidemic in the county (KAIS, 2014). Despite the huge importance of are early marriages among the girls and high HIV testing as a way to increase prevention school drop outs. The county will prioritise the and treatment, about 73 percent of people following key interventions to reduce new HIV in Migori County had never tested for HIV by infections. 2009. Most communities in Migori County traditionally circumcise men with over 91 per
12 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) R esponsibility National and County MoH NACC NASCOP Implementing partners National and County MoH NACC NASCOP Implementing partners county areas by G eographic County/sub- All Sub Counties All Sub Counties Target Population Target Key Populations General Populations population Vulnerable –paediatrics, youth, adolescents and young women initiate family friendly To services in all health facilities HIV positive mothers and members of support groups All pregnant and lactating women § § § § § § § § § § § § Structural Implement gender based violence prevention and response programmes Strengthen community empowerment Develop and review policies impacting on HIV Strengthen disclosure and partner testing Defaulter tracing of HIV positive mothers and children Strengthen mentor mother programme § § § § § § § § § § § § Behavioural Stigma reduction campaigns Comprehensive condom promotion and lubricant programs Peer-to-peer outreaches for the targeted population Psycho social support services Promote exclusive breast feeding Skilled birth attendants Promote safe sex practices Strengthening Positive Health and dignity program Involvement of men in EMCT Up scaling HIV and AIDS RH programs through community health services § § § § § § § § § § § § § § § § § § § § Sub-Activity/ I ntervention Biomedical Scale up innovative HTS models Roll out VMMC to all facilities Early linkage to care, support and treatment of those testing HIV positive Reduce MTCT by initiating EMCT in all facilities Prevention and management of co infections and co morbidities HIV care and treatment for the mother and child Provide all 4 prongs of PMTCT in all the health facilities in the county § § § § § § § § § § § § § § Key Activity Scale up HIV testing, care and support services Reducing HIV transmission rates of mother to child by 75% Scale up uptake of PMTCT services among HIV positive pregnant mothers CASP R esults Reduced annual new HIV infections among paediatrics, youth, adolescents and adults Reduced HIV transmission rates from mother to child from 14% to less than 5% Reducing new HIV infections Reducing new HIV infections KASF objective R educe new H I V infections by 75% Strategic Direction 1: R educing new H I V infections Table 4.2: Table
“Towards Ending the HIV Epidemic in Migori County” 13 4.5.2 STRATEGIC DIRECTION 2: systems. Lower coverage of ART among IMPROVING HEALTH OUTCOMES children implies retention of a heavy reservoir AND WELLNESS OF ALL PEOPLE LIVING WITH HIV of HIV in the general population. Improper co-ordination between health and other A total of 39,147 adults in Migori County are sectors such as education, legal and social in need of ART. Sixty three percent (63 %) services lowers quality of care delivered to of children living with HIV in Migori County clients. Reduction in loss in the cascade of are in need of antiretroviral therapy (ART) but care and treatment requires clear detection are not under treatment. Approximately 1876 of determinants and points of loss of patients adults and 682 children died of AIDS related and resolving them at service delivery points conditions in 2013 in the county. and county levels. This should be done by recognising the need to focus on different The county health systems face varied population based on age, sex and sexual challenges in the delivery and promotion of activity including focus on their geographical services ranging from identification, linkages location, situation and challenges in the to care, retention and viral suppression. There cascade of care, treatment and reason for loss is inadequate and unequal access to health or attrition. services and human resource. Additionally, services to PLHIV are characterised by poor The Migori County government and other referral and tracking, weak commodity and sectors shall put efforts towards the tracking supply chain as well as inadequate skills and and improvement of quality of care and infrastructure for information management treatment outcomes.
14 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) R esponsibility MoH Implementing Partners NACC G eographic areas (County) All the 8 sub counties in Migori County Target Target Population General Population Key Population Structural Establish and strengthen peer mentor group Develop and print defaulter tracking tools and disseminate Put in place mechanisms for defaulter tracing Integrate HIV testing, care and treatment services into maternal, neo-natal and child health services Link all the HTS service provision points online Incorporate HIV CHVs into the curriculum training manual Develop county specific stigma reduction interventions Strengthen supply system and ensure continuous availability of quality HIV commodities at the point of service delivery Empower care givers with IGA for sustainability Behavioural Sub-Activity/ I ntervention Scaling up treatment literacy and defaulter tracing to enhance adherence Develop and print age population specific IEC materials on treatment and care CHVs on HIV modules Training Develop facility and community linkages with inter and intra facility referral protocols linkage strategies Intensify public and care givers education for care and treatment Encourage formation of more integrated youth friendly services Utilise information technology and social media to facilitate retention and adherence among the youth Scale up anti-stigma campaigns to increase access and uptake to care, treatment adherence Strengthen support supervision of CHEWs and CHVs so as to strengthen community/facility linkages Reduce stigma and discrimination increase access to care and treatment Scale up anti-stigma campaigns to increase access and uptake to care treatment adherence Encourage community based mechanisms to support quality of care and health outcomes Enhance and strengthen HIV information communication at the community level Biomedical Scale up number of ART sites in the county Increase accessibility of ART services Address and cascade the identified gaps in HIV prevention and treatment Provide screening and diagnostic equipment for TB, NCDs, malnutrition and opportunistic infections Standardise methodologies for disclosure by and to adolescents living with HIV Improve efficiency and effectiveness of quality lab services (availability of equipment, viral load screening and reagents) Key Activity Increase the number of HTS service points Increasing access of ART by HIV clients Community based adherence support CASP R esults Increase linkage to care within two weeks of HIV diagnosis to 90% for children, adolescents and adults Increased ART coverage to 90% for children, adolescents and adults Scaling up Interventions to improve quality of care and improve health outcome Improving health outcomes and wellness of all people living with HIV health outcomes and wellness Improving KASF objective R educe A I DS related mortality by 25% utcomes and Wellness of all people living with H I V Strategic Direction 2: I mproving Health O utcomes and Wellness I ntroduction Table 4.3: Table
“Towards Ending the HIV Epidemic in Migori County” 15 4.5.3 STRATEGIC DIRECTION 3: USING (2013) reported stigma and discrimination A HUMAN RIGHTS APPROACH at over 45%. An estimated 15% of TO FACILITATE ACCESS TO SERVICES PLHIV reported discrimination by a health professionals through disclosure of their sero- The violation of the rights of people in status without their consent. Harassment of the community and particularly in service female sex workers by the police is rampant in delivery negatively affects the achievement the county. The Migori county AIDS strategic of the intended objective of that service. plan calls for effective and appropriate The purpose of recognising and protecting responses to stigma, discrimination and human rights and freedoms is to preserve the gender-based violence in order to have dignity of individuals and communities and interventions that facilitate access to services to promote social justice so as to realise the for vulnerable and key populations. potential of all human beings. It is, therefore, the duty of all sectors and actors in the HIV Migori County expects to reduce self- and AIDS response to observe, respect, reported stigma and discrimination related promote and fulfil the rights of PLHIV, key to HIV and AIDS by 50%. It also expects to populations and other vulnerable groups while reduce sexual and gender-based violence for providing services. PLHIV, key populations, women, men, boys and girls by 50% by 2019. Migori County will Article 27 of the Constitution of Kenya 2010 achieve this target by prioritising the following outlaws discrimination on the basis of one’s interventions; health status. The Kenya Stigma Index Survey
16 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Table 4.4: Using a Human Rights Approach to Facilitate Access to Services
Strategic Direction 3: Using a Human Rights Approach to Facilitate Access to Services
Geographic CASP Target areas by KASF objective Key Activity Sub-Activity/ Intervention Responsibility Results Population County/sub- county Reducing Reduced Sensitisation Integration of services Key All the 8 sub CDH HIV related self-reported of general Involvement of PLHWHV population counties Stigma and Stigma and and targeted of Migori NACC-Regional Discrimination discrimination population with Community empowerment Religious County Coordinator groups against PLHIV related to HIV anti-stigma Formation of post-test clubs and CASCO and Violence and AIDS in awareness support groups General against key Migori county messages Sensitise health workers to population Development populations by by 50% reduce stigmatising attitude in -PLHIVs Partners 50% Educate Increased communities health care setting Implementing protection of on legal issues Dialogue forums at the Partners human rights on rights community level Religious groups and improve Enrolment of priority groups in access to Ensuring access to social protection program Human Rights justice for organisations PLHIV justice for Encourage religious leaders to PLHIV and Key promote acceptance of priority Reduce social Population groups as part of their community exclusion for when violated Sensitise and engage religious PLHIV, Key leaders on KP’s stigma reduction populations, campaigns women, men, boys and girls Educate communities on gender by 50% and legal issues Partner involvement on HIV related issues Sensitise law and policy makers to enact laws and policies that prohibit discrimination and support access to treatment, care and support and prevention Review existing policies and laws to ensure they impact to the response of HIV positively Provide HIV Train peer groups on risk factors pre and post associated with GBV and safer –exposure sex practices prophylaxis amongst Facilitate campaigns to reduce survivors of stigma and discrimination, sexual violence GBV and promote uptake of and priority HIV services and prevention population. interventions Monitor and Conduct measurement of HIV evaluate related stigma through PLWHIV stigma, stigma index both in health care discrimination setting and community Implement programmes aimed at reducing stigma and discrimination against priority populations Support development of community forums for social empowerment including PLHIV and other interested groups to campaign against HIV related stigma, discrimination and to challenge harmful gender norms
“Towards Ending the HIV Epidemic in Migori County” 17 Strategic Direction 3: Using a Human Rights Approach to Facilitate Access to Services Geographic CASP Target areas by KASF objective Key Activity Sub-Activity/ Intervention Responsibility Results Population County/sub- county Reduce social Ensuring Identify under-utilised Key All the 8 sub CDH exclusion for access to opportunities in the private population counties of PLHIV, Key justice for sector by communities and Migori County NACC-Regional population, PLHIV and Key individuals Religious Coordinator groups women, men Population CASCO boys and girls when violated Sensitise law and policy makers on need to enact laws General by 50% population Development and regulations and policies Partners that prohibit discrimination -PLHIVs and support access to HIV Implementing prevention, care and treatment Partners and support at county level Religious groups Formulate and Implement county workplace policies to guide law Human Rights makers and enforcers. organisations Implement a programme aimed at upholding the rights of priority populations Hold county forums to assess the impact of GBV, stigma and discrimination on key populations. Facilitate access to justice and readiness in cases of HIV related discrimination or other legal matters
4.5.4 STRATEGIC DIRECTION 4: distribution of health workers, high levels of STRENGTHENING INTEGRATION attrition, unfavourable working conditions OF COMMUNITY AND HEALTH and inadequate and weak community health SYSTEMS structures. The system also experiences weak The Migori County AIDS Strategic plan staff performance appraisals, weak linkage intends to build strong, robust and sustainable mechanisms between training institutions systems for HIV service delivery at the county offering pre-service training with the level. This will be achieved through promotion services and requisite updates at the facility of specific health and community system levels, inadequate policy guidelines on ideal approaches, actions and recommended competencies and skills required for specific interventions that greatly support HIV cadres and compounded by lack of training response. The main aim of the County facilities for in-service training. Strategic Plan is to improve both Health and HIV response outcomes. The Migori County AIDS Strategic Plan aims to improve the health service delivery The county health systems has shortage of work force to stabilise HIV response within qualified and competent human resource for the health facilities and community by the health resulting from inadequate employment following interventions; of health personnel, uneven geographical
18 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Table 4.5: Strengthening integration of community and health systems
Strategic Direction4: Strengthening integration of community and health systems Geographic KASF CASP Key Target areas by Sub-Activity/Intervention Responsibility objective Results Activity Population County/ sub- county Enhancing Strengthened Provision of Staff recruitment by county to improve staff: HIV service In all the 8 HIV service a strong and community competent, population ratio at both community and providers sub counties providers suitable health motivated and facility level Community of Migori Community actors system for systems adequately County Redistribution of staff to ensure availability of actors Partners HIV service to provide staffed health competent and skilled health personnel delivery competent workforce Implementing CDH through HIV services Health staff incentives e.g. training and partners specific remunerations health and Improve capacity of staff in HIV management community Develop Health staff retention policy systems approaches, Develop and implement a system for caring actions and for care givers interventions to support HIV Strengthening Increasing access to comprehensive HIV response health service services by key populations delivery Integration of HIV referral and linkage system services into mainstream health services Upgrading of health facilities to meet basic standards for HIV service provision Implement existing policies targeting Key Population(s) increase their access to HIV services Formation of support groups Timely forecasting and procurement of HIV commodities Strengthen HIV commodity management and supply chains monitoring at county and health facility level Effective distribution and storage of HIV commodities at county and health facility level Supporting CBOs to spearhead HIV related activities Support community units services Improvement of infrastructure
Improving Promote appropriate prescription practices access and rational use of HIV commodities to quality essential Develop a robust LMIS to facilitate timely health transmission of stock status data products Provision of adequate and functional HIV and HIV diagnostic equipment (VL, CD4 machines) technologies Review and strengthen laboratory systems for effective diagnosis and monitoring of ART
Decentralisation of comprehensive HIV services to all levels of service delivery Strengthening of Quality Improvement Teams (QIT) and Work Improvement Teams (WIT)
“Towards Ending the HIV Epidemic in Migori County” 19 Strategic Direction4: Strengthening integration of community and health systems Geographic KASF CASP Key Target areas by Sub-Activity/Intervention Responsibility objective Results Activity Population County/ sub- county
Enhancing Strengthening Strengthen governance and leadership for HIV service In all the 8 County a strong and community community and workplace health actions at providers sub counties Government, suitable and all levels MoH of Migori Partners, system for workplace County HIV service service Community actors delivery delivery Enhance human resource capacity for through system development and implementation of specific community and workplace health at all levels health and community systems Strengthen institutional capacity for approaches, implementation of community and workplace actions and actions and services at all levels interventions to support Establish standards for guiding community HIV and workplace health implementation and response practice
Empower communities and improve workplaces to ensure improved capacity and capability to take charge of their health
Articulate an integrated, comprehensive and quality community and workplace health package for HIV prevention, treatment and care
4.5.5 STRATEGIC DIRECTION 5: mother-to-child interventions and discovery STRENGTHENING RESEARCH of broadly neutralising antibodies for HIV AND INNOVATION AND vaccine development. The revelations that INFORMATION MANAGEMENT safe Medical Male Circumcision reduces TO MEET MCASP GOALS HIV acquisition in males by 60% remain a By 2019, Migori County is expected to have landmark achievement in Kenya and the world. delivered increased evidence-based planning, The country has also contributed to ground- programming and policy changes by 50%, breaking socio-behavioural and epidemiologic increased implementation of research on studies amongst different populations at risk the identified CASP related HIV priorities and evaluations of structural interventions. by 50% and increased capacity to conduct However, efficient translation of strong HIV research at county level by 10%. research findings into policies and practices Kenya has an outstanding track record for remains weak. Research is dependent on research on HIV. This includes pre-exposure donor funding and not harmonised with prophylaxis, efficacy of prevention of national and county HIV research priorities.
20 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) R esponsibility NACC National and county government Research partners (KEMRI) NACC National and county government Research partners (KEMRI) NACC National and county government Research partners (KEMRI) G eographic areas by County/ sub- county County Target Target Population County planners and implementers of HIV agenda planners and implementers of HIV agenda planners and implementers of HIV agenda Evaluate: scale-up of combination prevention; effectiveness structural interventions; impact of scaling up Migori treatment guidelines on HIV acquisition and morbidity at individual community level; impact of stigma and GBV reduction programmes on HIV incidence mortality; impact of new technologies and programmes in priority populations. Granulate drivers of new HIV infections in priority and bridging populations Costing and cost effectiveness of interventions models care delivery Determine socio-behavioural, cultural and gender-related factors as Determine socio-behavioural, cultural and gender-related determinants of health outcomes and adherence to treatment; drug, alcohol substance use on HIV acquisition, care and treatment outcomes; predictors of loss to follow up, defaulting and retention; drivers of mortality associations between aging and treatment; determinants of stigma reduction. Understand risk perceptions, adherence and retention in HIV prevention Investigate less adherent dependent and cost-effective prevention technologies (such as microbicides, preventive and therapeutic vaccines cure), long-acting and ARVs for treatment; interaction of HIV with non-communicable PrEP and PEP, diseases and geriatric diseases; better treatment for children the elderly living with HIV. Determine optimal multi-purpose prevention (STIs, HIV and pregnancy) technologies and options Assess associations of hormonal contraception on HIV acquisition and treatment Characterise young women at high HIV risk Implement bio-behavioural survey framework for key and vulnerable populations Integrate GBV and IPV data collection in HIV survey Create and maintain a HIV research best practice data base § § § § § § § § § § § § § § Sub-Activity/ I ntervention § § § § § § § § § § § § § § Interventions for increasing evidence planning and programming Key Activity Biomedical Research Priorities analysis Increased evidence based planning, programming and policy changes by 50% CASP R esults Allocate and implement high impact research priorities, innovative programming and capability and capacity strengthening to conduct research Strategic Direction: 5 Strengthening research, innovation and information to meet MCASP goals KASF objective Strengthening research, innovation and information to meet MCASP goals meet MCASP to and information innovation research, Strengthening 4.6: Table
“Towards Ending the HIV Epidemic in Migori County” 21 R esponsibility NACC National and county government Research partners (KEMRI) G eographic areas by County/ sub- county County Target Target Population planners and implementers of HIV agenda Develop county HIV research agenda through a consultative process with research, academic institutions and health facility service delivery data at various levels at community based organisations to complement the Health Research Agenda Strengthen synergies between HIV research and other health areas such as TB and SRH Invest in in-county capacity for sound research and peer reviewed publication Strengthen co-ordination and tracking of HIV research -Sensitise Ethics Review committees on CASP priorities Strengthen Ethics Review Committees to facilitate high quality HIV-related studies (fast-track mechanisms; quality assurance, complex biomedical trial designs, key populations and adolescent ethics sensitivities) Strengthen county HIV research capacities including epidemiologic surveillance, good laboratory and clinical practice ethics Establishment of service delivery points in HIV with focus at the health facilities Integrate research funding in CASP priorities and develop resource mobilisation plan Advocate for allocation of 20% health research budget through a sound investment case NACC allocate 10% of HIV resources to research funding through competitive and transparent processes -Advocate for research centres and academic institutions to allocate 10% of their research resources for HIV prevention Establish a multi-sectoral and interactive web-based Kenya HIV research hub TB and SRH; with geographic mapping of all research on HIV, Develop and disseminate regular review of papers on key research findings, local funding and practice implications innovations, systematic reviews of their policy, Embracing modern technology in data collection, analysis and dissemination Creating of HIV situation room at the Governors’ office Periodic dissemination of HIV trends to the community on new infections and prevalence through short text message alerts attached to M-Pesa message. This information can also be passed through electronic bill boards that are strategically placed across the county Use the so many solar lighting masks erected in shopping centres to display research § § § § § § § § § § § § § § § § § § § Sub-Activity/ I ntervention § § § § § § § § § § § § § § § § § § § Key Activity County HIV research agenda Implement research agenda at county levels Resource the HIV agenda HIV information portal for Kenya research, synthesising data routinely CASP R esults Strategic Direction: 5 Strengthening research, innovation and information to meet MCASP goals KASF objective
22 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) R esponsibility NACC National and county government Research partners (KEMRI) G eographic areas by County/ sub- county County Target Target Population planners and implementers of HIV agenda based HIV prevalence messages in the county Publish systematic reviews of research on the CASP priorities and draft briefs annually Invest in capacity development within responsible agencies for research reviews and collation Update the stakeholders on current trends and projections of HIV from research results Establish communities of practice (CoP) on the CASP priorities to review evidence and propose policy recommendations Display the research based ranking of HIV trends for all sub-counties public information Establish standing or ad hoc research committees to identify county priorities, determine policy changes from existing research and disseminate findings Establish research ethical approval committees at the county to identify priorities, determine policy changes from existing research and disseminate findings and to hasten county research permits issuance § § § § § § § § § Sub-Activity/ I ntervention § § § § § § § § § Key Activity Reviews of research Communities of practices County research engagements CASP R esults Strategic Direction: 5 Strengthening research, innovation and information to meet MCASP goals KASF objective
“Towards Ending the HIV Epidemic in Migori County” 23 4.5.6 STRATEGIC DIRECTION 6: The Migori County AIDS Strategic plan PROMOTE UTILIZATION OF expects to contribute to achievement of the STRATEGIC INFORMATION FOR RESEARCH AND MONITORING following results by 2019; AND EVALUATION TO ENHANCE PROGRAMMING • Increased availability of strategic information to inform HIV response at The availability of strategic information county level in a timely manner is critical for effective tracking of HIV epidemic dynamics in Migori • Planned evaluations, reviews and County. The Constitution of Kenya requires surveys implemented and results participation of the people in decision disseminated in timely manner making, transparency and accountability as recognised by this strategic plan. This plan • M&E Information Hubs established will be informed by various data sources at county level and providing which will provide trends in HIV prevalence comprehensive information package and incidences. The plan will strengthen on key CASP Indicators for decision coordination, ownership and data use for making. evidence based planning and decision making.
24 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) R esponsibility County government, NACC, NASCOP, Research teams Partners G eographic areas by County/sub- county All the sub counties Target Target Population MCASP Implementers Establish a multi-sectoral HIV programming web-based data management system Promote data demand and use of HIV strategic information to inform policy and programming Develop and implement CASP evaluation agenda Create and strengthen M&E Information Hubs at county level Organise forums for dissemination and updating the stakeholders on HIV AIDS programme findings through seminars and conferences Dissemination of real-time HIV and AIDS information through situation rooms in board rooms, electronic billboards and short text messages Dissemination of real-time HIV information through group social media platforms Align the country M&E system to new governance structure Conduct county M&E engagements Conduct M&E capacity assessment and development at county levels Establish and strengthen functional multi-sectoral HIV M&E co-ordination structure and partnerships at county levels Develop comprehensive HIV M&E systems guidelines, tools and standard operating procedures Put in place sustainable financing for HIV M&E planned activities Identification and harmonisation of HIV AIDS indicators to be monitored by the implementers and M&E team i.e. develop comprehensive HIV system guidelines, tools and standard operating procedures Strengthen HIV M&E data management at county level Harmonise and create linkages between data collection tools databases Conduct periodic data quality audits and verification Conduct M&E supervision Scale up coverage of ongoing HIV programme surveillance and surveys Honour national and county HIV reporting obligations Strengthen routine and non-routine HIV information systems Improve on M&E of HIV programme surveillance and survey § § § § § § § § § § § § § § § § § § § § § § Sub-Activity/ I ntervention § § § § § § § § § § § § § § § § § § § § § § Key Activity Establish multi-sectoral and integrated real-time HIV platform to provide updates on HIV epidemic response accountability Strengthening M&E capacity to effectively track the CASP performance and HIV epidemics at all levels Ensure harmonised, timely and comprehensive routine and non–routine monitoring systems to provide quality HIV data at county level MASP R esults Increased availability of strategic information to inform HIV response at county level M&E Information Hubs established at county levels and providing comprehensive information package on key CASP Indicators for decision making Planned evaluations, reviews and surveys implemented and results disseminated in a timely manner SD 6: Promoting the utilisation of strategic information for research and monitoring evaluation to enhance programming KASF objective To improve To data quality, demand, access and use of data for decision making at the county and national level Promoting the utilisation of strategic information for research and monitoring and evaluation to enhance programming to and evaluation and monitoring research for information the utilisation of strategic Promoting 4.7: Table
“Towards Ending the HIV Epidemic in Migori County” 25 4.5.7 STRATEGIC DIRECTION 7: This plan aims at realising the following INCREASING DOMESTIC interventions; FINANCING FOR SUSTAINABLE HIV RESPONSE • Maximise efficiency of existing service The dwindling of resources for HIV delivery options for increased value and response demands smarter investments results within existing resources. for every shilling to priority areas that produce efficiently high impacts. The Migori • Promote innovative and sustainable County AIDS Strategic plan will contribute county HIV financing options. to increased domestic financing for HIV response by 50% by 2019 through the • Align HIV resources/investment to the following priority interventions; County Health Strategic Plan and the CIDP priorities.
• Increase county budget for HIV sub program by 20% per year.
26 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) R esponsibility County government, NACC NASCOP, Partners CSOs G eographic areas by County/sub- county County Target Target Population Stakeholders Partners Implementers National and county governments Sub-Activity/ I ntervention government allocations to the different county Track departments Engage the Commission on Revenue Allocation to consider HIV as an added parameter for consideration in resource allocation Develop a HIV investment criteria for resource allocation based on need Facilitate implementation of deliberate measures to unblock the financial, human, infrastructural, institutional (within the health system) and structural (outside system) bottlenecks that impact absorptive capacity to financing HIV programmes Strengthen development partners’ HIV forum to facilitate alignment with county HIV plan Facilitate quantification of county resource needs through relevant information on county support as defined in the Migori County Integrated Development Plan Implement a partnership accountability framework at county level to ensure alignment of resources Migori County AIDS strategic plan priorities Facilitate planning by reporting contribution to CASP bi- annually Key Activity Establish a county driven domestic financing kitty for HIV response (domestic resource mobilisation) CASP R esults Increased domestic financing for HIV Increasing domestic financing for a sustainable HIV response for a sustainable HIV domestic financing Increasing SD 7: I ncreasing domestic financing for a sustainable H V response KASF objective I ncrease domestic financing of the H I V response to 50% Table 4.8: Table
“Towards Ending the HIV Epidemic in Migori County” 27 4.5.8 STRATEGIC DIRECTION 8: AIDS, civil Society and other key stakeholders; PROMOTE ACCOUNTABLE LEADERSHIP FOR DELIVERY OF existing community and religious leaders. THE MCASP RESULTS BY ALL In the context of shrinking HIV and AIDS SECTORS resource basket, Migori County Government will strengthen accountability within all The County Government will continue systems and units responding to HIV and promoting responsive leadership, ensure AIDS and also encourage public Private mainstreaming of HIV and AIDS across all Partnerships (PPP) investments on the entire sectors through multi sectoral approach, health sector. involvement of Persons Living with HIV and
28 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) R esponsibility County Government Committee of Health in the County Assembly County government, NASCOP, NACC,CSOs County government, NACC, NASCOP, CSOs G eographic areas (County) County County County Target Target Population County Assembly CECM Health Key Stakeholders Sub-Activity/ I ntervention Develop policies and implement systems that strengthen good governance of the HIV and AIDS response Build capacity of stakeholders for resource management and accountability through institutionalised technical support mechanisms coordinating Reform and strengthen the HIV AIDS inter-agency committee for monitoring of the HIV and AIDS response Build capacity of stakeholder networks faith communities, civil key populations and persons living with HIV AIDS to society, promote strong accountable institutions that hold duty bearers accountable for the HIV and AIDS response Strengthen the Migori County Development Partners’ HIV Forum focusing on alignment to CASP priorities Key Activity Policies and systems Stakeholder accountability develop To policies for development partners’ accountability CASP R esults Good governance practices and accountable leadership entrenched for the multi- sectoral HIV and AIDS response at all levels Effective and well-functioning stakeholder co-ordination and accountability mechanisms in place and fully operationalized at county level legal and An enabling policy, regulatory framework for the multi-sectoral HIV and AIDS response strengthened and fully aligned to the Constitution of Kenya 2010. Promoting accountable leadership for delivery of the Migori County HIV strategic plan County HIV strategic of the Migori delivery accountable leadership for Promoting SD 8: Promoting accountable leadership for delivery of the Migori County H I V strategic plan KASF objective Promote good governance practices by identifying, developing and nurturing effective and committed leaders for the H I V and A I DS response Table 4.9: Table
“Towards Ending the HIV Epidemic in Migori County” 29 05 IMPLEMENTATION ARRANGEMENTS IMPLEMENTATION HIV. The committee shall be chaired by the ARRANGEMENTS County Executive Member for Health or his/ her appointee and will consist of membership The KASF recognises that counties are from the sub county HIV committees, HIV responsible for implementation of HIV implementing partners, PLHIV and other services and programmes across different special interest groups in the county. sectors. It has within its coordination structure, singled out the county governments The county HIV committee shall be: as providing the link with the sub counties, HIV committees, implementers, PLHIV and • The custodian of the MCASP. special interest groups; hence the need to provide a strategic communication framework • Holding meeting on a quarterly basis to to coordinate the efforts of all stakeholders. review implementation plan.
Figure 2: The HIV Coordination organogram for delivery of the MCASP • Responsible for the effective delivery of the HIV response at the county level through periodic review and monitoring County Executive Committee of the MCASP. Chaired by the Goveror County Assembly • Approving the County HIV targets and plan. CEC Health Services
• Playing an advisory role in the budget County HIV County HIV Committee County Health Cooordinating Chair: CEC Health Services or Management process for HIV. Unit NACC his appointee Team CHMT • Setting the county HIV agenda.
Constituency HIV Cooordinating • Receiving reports on MCASP progress Committees from the monitoring committee.
County TWGs e.g. Adolescent, Key Populations, M&E, Research etc, • Forming TWGs to review and advice on County ICC, partner programmes emerging issues on HIV priority areas.
5.1 Governor 5.3 County HIV Coordination Unit
The Governor shall implement national and This will be the responsibility of the NACC county legislation to the extent that the secretariat at the county level. The unit shall legislation requires and is responsible for the coordinate the day to day implementation of delivery of a range of services, planning and the strategic plan at county level, working prioritisation of resource allocation to address closely with the County Health Management HIV in the county. Team and the various line ministries and departments at the county level with a direct link with NACC secretariat at the national level. 5.2 County HIV Committee The County HIV Coordination Unit shall; The committee shall be accountable to the • Ensure quarterly county stakeholders Governor of Migori County for the performance HIV meetings are held and follow up on of their functions on matters relating to county stakeholders HIV actions.
“Towards Ending the HIV Epidemic in Migori County” 31 • Ensure HIV agenda is active in the 5.5 Reporting Mechanisms CHMT The County HIV and AIDS Monitoring and • Engage all state and non-state Evaluation system provides mechanisms for actors within the county in planning, stakeholders to implement timely collection, prioritisation, implementation, analysis and use of the data at various levels. monitoring, and evaluation of HIV and All these are overseen by Monitoring and AIDS programmes. Evaluation committees supported by County M&E staff at these levels. The availability of • Strive to strengthen linkages and quality HIV and AIDS information is the main networking among stakeholders and factor in the county’s ability to appropriately provide technical assistance, facilitation, allocate resources, improve programs and support for MCASP delivery. make decisions to support effective response to HIV and AIDS in Migori County. The • Monitor county legislation on HIV related reporting and coordination will be in the spirit Bills. of three principle where all stakeholders will be required to submit quarterly reports to 5.4 Stakeholder management and County HIV Committee. accountability The Migori County HIV Committee will have Migori County HIV Committee will establish a primary role of the technical arm in matters an inventory of all stakeholders implementing of HIV in the county. This will ensure that HIV HIV and AIDS activities. Efforts will be made is mainstreamed in the county development to ensure all stakeholders align their activities programs. The committee brings together to this strategic plan and are accountable for county multi-sectorial team to ensure that their results. All stakeholders will be required HIV and AIDS programmes take into account to report to the County HIV Committee. all aspects of development in the county. The County Stakeholder Management Platform will committee shall be responsible for quality contain the database of what the stakeholders assurance at the county level and shall be are undertaking, sources of funding and tasked with reviewing all HIV intervention geographical coverage. Further, the county will reports and offering technical back up for hold regular engagements with all stakeholders HIV intervention activities. The County AIDS to receive feedback, assess progress and make Coordinator (COAC) is expected to report to future plans. National AIDS Control Council through the regional NACC coordination office and the Partnerships generally involve voluntary County executive committee members for agreement, shared objectives, distinct health through the health management team. accountabilities and reciprocal obligations and are expected to add value to what each partner could achieve alone. Strategic partnerships 5.6 Sustainability can help define local priorities for social investment, assign responsibilities, apportion The Migori County HIV Committee will ensure costs, mitigate risks, establish accountabilities, effective delivery of the Migori County HIV improve productivity and resolve conflicts. plan. The committee will mobilise all partners Ideally, partnership avoids duplication of effort, to align their activities and priorities to the capitalises on each actor’s expertise, and pools county HIV plan. The plan will promote public resources to tackle the most challenging and private partnership to compliment national complex social and business problems. and the county government’s funding for
32 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) HIV and AIDs response. This strategic plan is The coordination of all development partners aligned to the County Integrated Development and implementers of HIV interventions will Plan and thus captures the aspiration of the ensure that there is reduced double funding plan. This strategic plan will promote the for effective achievement of HIV intervention private, public partnerships for purposes of results. ensuring sustained HIV reduction efforts.
“Towards Ending the HIV Epidemic in Migori County” 33 06 RESEARCH, MONITORING AND EVALUATION OF THE PLAN RESEARCH, MONITORING various levels. The design and implementation AND EVALUATION OF THE of these systems do not facilitate integration of PLAN different sources of health information within the health system. There is poor integration The County M&E system is aligned to the of vertical programs and administrative existing national M&E system which outlines information into the routine Health Information the different M&E sub-systems: DHIS, System. Consequently, there is no sharing LMIS, and community systems among of information among healthcare providers others. Currently, reports from Community in the health system. Hence, there is need Health Volunteers from community units to harmonise various reporting systems and are forwarded to the link facilities who then strengthen the current DHIS. compile the reports at Level 2 facilities (dispensaries) and report to the Sub-County Research is a critical component for effective Health Information Officers (SCHRIO) on delivery of the MCASP as it will enhance a monthly basis. Level 3, 4 and 5 facilities evidence-based decision making. The (health centres, sub-county hospitals and identified county research priorities need to the County Referral Hospital) report to the be implemented to strengthen the existing same officer for data entry into DHIS which knowledge management system. Further, provides further analysis. This enables all users access to the national HIV research hub needs including the county and national governments to be enhanced for evidence-based policy and program officers at all levels to generate formulation and programming at the county. information for decision making and public health interventions. Figure 2 shows how data will flow from service delivery points through to County HIV However, the existing Health Information data hub and eventually to the National unified Systems are highly fragmented with no M&E system. linkages with other healthcare providers at
“Towards Ending the HIV Epidemic in Migori County” 35 MDAs, FB O Construction Sector, Private Sector, Sector, Transport, Transport, Sector, Work place Work interventions & community interventions reporting Work place Work WD, O VC and county research) National Surveys (KAIS, KDHS, HIV estimates, MoT Mo E reports interventions School heath School program R eports programs Development Cash-transfer Cash Transfer Cash Transfer County Social National M& E System Migori County M& E System R C O BPA CS O & intervention Partners Community-based nmates, KP, employees, P L I nmates, KP, adolescent & young people, P L H I V, Community, DH I S intervention Facility-based Partners County MoH & L M I S Commodity management Migori County HIV & AIDS Response Data Flow Chart Chart Flow AIDS Response Data County HIV & Migori Data Actors Systems Programs Figure 3: Figure I nformation Beneficiaries
36 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 07 RISKS, ASSUMPTIONS AND MITIGATION PLAN RISKS, ASSUMPTIONS AND challenges that may hinder or disrupt proper MITIGATION PLAN implementation. They may include availability of resources, leadership and governance An assumption has been made that among others. However, anticipated risks implementation of this plan shall proceed will be assessed and mitigated through without hitches. The actualisation of the continuous review. plan will depend on various factors and
Table 7.1: Risk mitigation Matrix
Risk Category Risks Status Probability Impact Mitigation Responsibility When
Technological Inadequate Active- Medium High Mitigate – County Y1-2 capacity inadequacy budget money Government for both in terms of for training personnel equipment, ,equipping NACC and personnel at and equipment the moment recruitment of personnel
Political Instability Passive- Medium High Community County Y1-5 due to County and county Government political government organisation processes involved to National some extent in Government HIV response
Operational Inadequate Active –lack Medium High Lobby County HIV Y1-5 resources of specific resources Oversight HIV and Committee AIDS related policies
Financial Inadequate Active- There Low High Lobby County –HIV Y1-5 allocation is inadequate partners for Coordination for HIV funds in the funding. Unit and AIDS budget response in Increase the budget visibility of the plan
38 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Table 7.2: Assumptions Matrix
Category Assumptions Status Impact Mitigation Responsibility When
Technological There is The county is High Training of the County Y1-2 enough currently embracing existing staff government technical technology in the and recruitment capacity in the service delivery of new staff. county
Political 2017 General So far the situation High Put in place County Y1-5 election will is peaceful sustainability government be peaceful strategies for HIV interventions like enough stock of ARVs and other commodities.
Operational All the Not all required High Continuous County HIV Y1-5 logistical logistical support Training and oversight support and and staff are in capacity committee staff are in place building place
Surveys and Some study results High Implement HIV County operation have not been well research agenda Government research will disseminated to be undertaken inform programming to provide County specific data for population based programming surveys have not been undertaken
Legislative All HIV related Review of the High Review the CEC- Health Y2 bills will be existing policies and existing policies passed in good laws at the county and laws and time level has not been formulate as done planned. Lobby the County Assembly to pass the laws
Financial Funds will be The available funds High Lobby partners County –HIV Y1-5 available are inadequate for funding. Coordination Unit
Increase visibility of the plan
“Towards Ending the HIV Epidemic in Migori County” 39 08 FINANCING OF THE MIGORI COUNTY HIV STRATEGIC PLAN
40 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) FINANCING OF THE MIGORI resource requirement was estimated at USD COUNTY HIV STRATEGIC 306.17 million for the 5-year period of the PLAN plan. This cost was envisaged to rise steadily from USD 52.83 million in 2014/15 to USD Considering the national estimate of 306.17 million in 2018/19 due to the planned resources for the various components of scaling up of priority HIV interventions to the HIV programming including unit costs of meet all the expected programmatic targets in commodities and services, the total gross the MCASP as shown in table 8.1.
% of Specific Resource Strategic MCASP dedicated 2014/2015 2015/2016 2016/2017 2017/2018 2018/2019 Total Directions Intervention for the Areas strategy
SD1 HIV Prevention 25% 13.210 15.04 16.98 19.00 20.58 84.81
SD2 Treatment and 53% 28.000 30.62 31.98 32.57 32.16 155.32 care
SD3 Social inclusion, 7% 3.700 4.80 5.98 7.25 8.62 30.36 human rights and gender
SD4 Health systems 3% 1.580 1.43 1.17 1.05 0.55 5.78
Community 3% 1.580 1.42 1.17 1.05 0.55 5.77 systems
SD5 Research 1% 0.530 0.60 0.66 0.70 0.74 3.23
Supply chain 1% 0.530 0.60 0.66 0.70 0.74 3.23 management
SD6 Monitoring and 2% 1.060 1.07 1.05 0.98 0.89 5.05 evaluation
SD7 & SD8 Leadership, 5% 2.640 2.68 2.61 2.46 2.22 12.61 governance and resource allocation
Grand Total 100% 52.83 58.27 62.25 65.77 67.04 306.17
Table 8.1: Resource need for the implementation of MCASP in USD
“Towards Ending the HIV Epidemic in Migori County” 41 Annexes
Annex 1: Results Framework
STRATEGIC DIRECTION 1: REDUCING NEW HIV INFECTIONS
MCASP Baseline & Mid Term End Term KASF objective Key Activity Indicators Results Source Target (2017) Target (2019)
Reduce new Reduced new Reducing new HIV HIV incidences 30%- 2013 40% 75% HIV infections HIV infections infection cases in the County (DHIS2) by 75% among adults by 75%
Reduced HIV MTCT rate in 7.2- DHIS 6% <5% transmission rates the county of mother to child from 14.7 to less than 10.7
STRATEGIC DIRECTION 2: IMPROVING HEALTH OUTCOMES AND WELLNESS OF ALL PEOPLE LIVING WITH HIV
Mid Term End Term KASF Baseline& MCASP Results Key Activity Indicators Target Target objective Source (2017) (2019) Reduce Increase enrolment Increase the Percetage of new HTS service AIDS to care within 3 number of HTS points established 2013 related months of HIV service points HFs -167 40% 75% mortality by diagnosis to 90% for 25% children, adolescents 30% and adults Increased ART Increasing % of children0-9 years on ART 30% 50% 90% coverage to 90% for access of ART % of adolescents 10-19 years children, adolescents by HIV clients 40% 60% 90% and adults on ART % of adults on ART 60% 79% 90% % of identified HIV infected pregnant women started on 60% 75% 90% HAART % of children 0-9 years retained on ART at 12 months 66% 72% 90% % of adolescents 10-19 years retained on ART at 12 months 65% 79% 90% % of adults retained on ART 69% 79% 90% at 12 months % of children 0-9 years virally 50% 72% 90% suppressed % of adolescents of 10-19 59% 79% 90% years virally suppressed % of adults virally suppressed 69% 79% 90% Scaling up Establishing Number of support groups community community established 122 122 200 interventions to based Number of lay counsellors improve quality of adherence 122 122 122 care and improve support groups Number of clients retained 32,136 51,878 5,6270 health outcome on care
42 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) STRATEGIC DIRECTION 3: USING A HUMAN RIGHTS APPROACH TO FACILIATTE ACCESS TO SERVICES FOR PLHIV, KEY POPULATIONS AND OTHER PRIORITY GROUPS IN ALL SECTORS
Mid Term End Term KASF Baseline MCASP Results Key Activity Indicators Target Target objective & Source (2017) (2019) Reducing Reduced self- Sensitisation Percentage of HIV related reported stigma of general people sensitised 30% 40% 75% stigma and and discrimination and targeted discrimination related to HIV and population with Number of against PLHIV AIDS by 50 % anti-stigma sensitisation 122 305 456 and violence messages meetings held against Key populations by Increased Educate Number of public 12 24 36 50% protection of communities on meetings held human rights and legal issues and improve access to rights Number of people justice for PLHIV sensitised on legal 2000 3000 5000 issues
Reduced social Ensuring access Number of SGBV exclusion for to justice for cases reported to 52 76 80 PLHIV, Key PLHIV and Key the police Populations, Populations women, men, boys when violated Number of SGBV and girls by 50% cases reported to 79 85 99 the hospitals
STRATEGIC DIRECTION 4: STRENGTHENING INTEGRATION OF HEALTH AND COMMUNITY SYSTEMS
End Term KASF MCASP Baseline & Mid Term Key Activity Indicators Target objective Results Source Target (2017) (2019)
Build a Strengthen Provision of Number of health strong and community competent, staff workers 123 354 981 suitable health motivated and capacity built systems for systems adequately HIV service to provide staffed health Number of staff delivery competent staff workforce recruited and 0 123 300 through HIV services retained specific and community Strengthening Data strengthening systems, health service meetings 172 364 402 actions and delivery systems interventions to support Improving Provide essential HIV response access to quality commodities to GOK 166 189 230 health essential facilities products
Strengthening Strengthen community Community Health 166 189 230 and work place Services initiate service delivery CUs
“Towards Ending the HIV Epidemic in Migori County” 43 STRATEGIC DIRECTION 5: STRENGTHENING RESEARCH AND INNOVATIONS AND INFORMATION MANAGEMENT TO MEET MCASP GOALS
Mid Term End Term KASF MCASP Baseline Key Activity Indicators Target Target objective Results & Source (2017) (2019)
Allocate and Increased Interventions Number of implement evidence based for increasing undertaken 166 289 231 high impact planning, evidence planning interventions research programming and programming priority, and policy Biomedical Number of innovative changes 166 289 231 programming, Research priorities Biomedical reports capability analysis Number of research and capacity 166 289 231 strengthening conducted to conduct research Behavioural Number of data for research priorities decision making 166(HFs) 289 231 analysis available
Number of Behavioural 5 Partners 8 12 research conducted
STRATEGIC DIRECTION 6:PROMOTING UTILISATION FOR STRATEGIC INFORMATION FOR RESEARCH AND MONITORING AND EVALUATION TO ENHANCE PROGRAMMING
Mid Term End Term MCASP Baseline& KASF objective Key Activity Indicators Target Target Results Source (2017) (2019)
To improve Increased Establish multi An integrated M & data quality, availability sectorial and E information hub 1 1 1 demand, of strategic integrated HIV in place access and information platform to provide use of data to inform HIV update on HIV Number of reports 9 (8 sub delivered in the county & for decision response at the epidemic. 9 9 making at the county level information hub 1 County county and level) national level Planned Ensure Number of evaluation, harmonised, timely evaluation and reviews and comprehensive review reports and service routine and non- 9 (8 SC&1 implemented routine monitoring 9 9 and results systems to provide County) disseminated in quality HIV data at a timely manner the county level
44 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) STRATEGIC DIRECTION 7: INCREASING DOMESTIC FINANCING FOR A SUSTAINABLE HIV RESPONSE
MCASP Baseline& Mid Term End Term KASF objective Key Activity Indicators Results Source Target(2017) Target(2019)
Increase domestic Increased Establish a A county financing of the domestic county driven domestic kitty HIV response to financing for domestic established 0 0 9 50% HIV financing kitty for HIV response Number of contracts signed for HIV 0 0 9 interventions
Budget line on HIV 0 1 2
STRATEGIC DIRECTION 8: PROMOTE ACCOUNTABLE LEADERSHIP FOR DELIVERY OF MCASP RESULTS BY ALL SECTORS
Mid Term End Term MCASP Baseline& Target KASF objective Key Activity Indicators Target Results Source (2019) (2017)
Promote good Good Develop Number 0 (Done At governance governance policies and of policies national practices by practices and implement developed level) identifying, accountable systems developing and nurturing leadership 0 0 effective and for the multi committed sectoral HIV and leaders for AIDS response HIV and AIDS at all levels response Effective and Reform and Number of 166 (facility well-functioning strengthen the reports availed based stakeholder HIV and AIDS reports from coordination inter agency DHIS) and coordinating accountability committee for 189 231 mechanisms in the monitoring place at county of the HIV and level AIDS response
“Towards Ending the HIV Epidemic in Migori County” 45 List of Drafting and Technical Review Teams
County Drafting Team
1. Joshua O. Odembo COAC - Team Leader
2. Elizabeth Owino CASCO
3. Dr. Jerry Ndege MOH
4. Dr. Wilson A.P. Otengah (PhD) Rongo University
5. Simeon Okuthe CACC Nyatike
6. Tulu Alfred IMC
7. Evon Sarah Atieno Statistics
8. Daniel Oneya Deputy CASCO
9. John Odira CHRIO
10. Dorothy Ogidi SCACO
Technical Support Review Team
1. Gevonce Ooyi NACC
2. Inviolata Mmbwavi ICWK
3. Kavutha Mutuvi
4. Edwin Lwanya NACC
46 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) References
Government of Kenya (2014), The Costs and Returns to Investment of Kenya’s Response to HIV/AIDS: A HIV Investment Case Technical Paper. NACC: Nairobi, Kenya.
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50 MIGORI COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019)