USAID KENYA (APHIAPLUS NAIROBI-COAST HEALTH
SERVICE DELIVERY PROJECT
QUARTERLY PROGRESS: FY 2014, Q2 REPORT
APRIL – JUNE 2014
USAID/APHIAPLUS NAIROBI - COAST HEALTH SERVICE DELIVERY PROJECT
FY 2013 Q4 PROGRESS REPORT (01 APRIL – 30 JUNE, 2014)
AWARD NUMBER: USAID/KENYA RFA NO: 623-10-000009
PREPARED FOR:
AOR: MS. JERUSHA KARUTHURI UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT/KENYA C/O AMERICAN EMBASSY UNITED NATIONS AVENUE, GIGIRI P.O. BOX 629, VILLAGE MARKET 00621 NAIROBI, KENYA
PREPARED BY
PATHFINDER INTERNATIONAL THE WATERMARK BUSINESS PARK, KAREN, FOUNTAIN COURT, 1ST FLOOR NDEGE ROAD, OFF LANGATA ROAD P. O. BOX 1996 – 00502 KAREN, NAIROBI, KENYA OFFICE: +254-20-3883142/3/4 MOBILE: +254-733-618359/+254-722-516275 FAX: [+254 20] 2214890 WWW.PATHFINDER.ORG | FACEBOOK | TWITTER
The authors’ views expressed in this report do not necessarily reflect the views of the United States Agency for International Development or the United States Government. c
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TABLE OF CONTENTS
ACRONYMS AND ABBREVIATIONS ...... III LIST OF FIGURES ...... VI LIST OF TABLES ...... VII LIST OF PHOTOS ...... VIII SECTION I: EXECUTIVE SUMMARY ...... 9 SECTION II: QUALITATIVE PRESENTATION OF KEY ACHIEVEMENTS ...... 14
RESULT 3: INCREASED USE OF QUALITY HEALTH SERVICES, PRODUCTS AND INFORMATION...... 14 3.1: INCREASED AVAILABILITY OF AN INTEGRATED PACKAGE OF QUALITY HIGH-IMPACT INTERVENTIONS AT COMMUNITY AND HEALTH FACILITY LEVELS ...... 14 3.1 INCREASED AVAILABILITY OF AN INTEGRATED PACKAGE OF QUALITY HIGH-IMPACT INTERVENTIONS AT COMMUNITY AND HEALTH FACILITY LEVELS...... 29 3.2 INCREASED DEMAND FOR AN INTEGRATED PACKAGE OF QUALITY HIGH-IMPACT INTERVENTIONS AT COMMUNITY AND FACILITY LEVELS ...... 30 .3.2: INCREASED DEMAND FOR AN INTEGRATED PACKAGE OF QUALITY HIGH-IMPACT INTERVENTIONS AT COMMUNITY AND HEALTH FACILITY LEVELS...... 38 RESULT 4 – SOCIAL DETERMINANTS OF HEALTH ADDRESSED TO IMPROVE THE WELL-BEING OF TARGETED COMMUNITIES AND POPULATIONS ...... 41 4.1: MARGINALIZED, POOR AND UNDERSERVED GROUPS HAVE INCREASED ACCESS TO ECONOMIC SECURITY INITIATIVES THROUGH COORDINATION AND INTEGRATED WITH ECONOMIC STRENGTHENING PROGRAMS...... 41 4.3 MARGINALIZED, POOR AND UNDERSERVED GROUPS HAVE INCREASED ACCESS TO EDUCATION, LIFE SKILLS, AND LITERACY INITIATIVES THROUGH COORDINATION AND INTEGRATION WITH EDUCATION PROGRAMS ...... 47 4.4: INCREASED ACCESS TO SAFE WATER, SANITATION AND IMPROVED HYGIENE...... 48 4.5 STRENGTHENED SYSTEMS, STRUCTURES AND SERVICES FOR PROTECTION OF MARGINALIZED, POOR AND UNDERSERVED POPULATIONS ...... 49 4.6: EXPANDED SOCIAL MOBILIZATION FOR HEALTH ...... 50 CROSS-CUTTING ISSUES ...... 51 CONTRIBUTIONS TO HEALTH SYSTEMS STRENGTHENING: RESULTS AREAS 1 AND 2 ...... 54 SECTION VI: PERFORMANCE MONITORING ...... 61 SECTION VI: PROGRESS ON LINKS TO OTHER USAID PROGRAMS ...... 61 SECTION VII: PROGRESS ON LINKS WITH GOK AGENCIES ...... 62
SECTION VIII: SUSTAINABILITYAND EXIT STRATEGY ...... 62 SECTION IX: SUBSQUENT QUARTER’S WORK PLAN ...... 64 SECTION X: FINANCIAL INFORMATION ...... 89 Constraints and Critical Issues ...... 90
SECTION XIV: SUCCESS STORY GUIDELINES & PREP SHEETS ...... 92
SUCCESS STORY 1: USE OF SMS SERVICES TO IMPROVE ON REPORTING TIMELINES ...... 92 SUCCESS STORY2: ADOPTION OF REGIONAL TOTS FOR HMIS TOOLS ...... 92 SUCCESS STORY 3: MITIGATION FROM COHORT ANALYSIS ...... 92 SUCCESS STORY: 4: USE OF E-HEALTH SMS SERVICES IN DEFAULTER TRACING ...... 93 CASE STUDY 1: MATHARE NORTH HC HEI LOST TO FOLLOW UP (LFTU) ...... 93 SECTION XII: SCHEDULE OF PLANNED ACTIVITIES ...... 94 ANNEXES ...... 108
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ACRONYMS AND ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care AOP Annual Operation Plan APHIA AIDS, Population and Health Integrated Assistance APHIAplus AIDS, Population and Health Integrated Assistance People-centered Local Leadership Universal Access and sustainability ART Antiretroviral Therapy ARV Antiretroviral (Drugs) BCC Behavior Change Communication CaCx Cancer of the Cervix CBHIS Community Based Health Information System CBO Community Based Organization CCC Comprehensive Care Center CHC Community Health Committee CHEW Community Health Extension Worker CHS Community Health Strategy CHU Community Health Unit CHW Community Health Worker CLTS Community-led Total Sanitation CLUSA Cooperative League of the USA CME Continuous Medical Education COPE Client Oriented Provider Efficiency CPGH Coast General Provincial Hospital CSA Community Self-Assessment CSI Child Status Index SW Sex workers CU Community Unit CYP Couple Years of Protection CASCO County HIV/AIDS and STI Control Office DBS Dry Blood Samples DHIS2 District Health Information System CHMT County Health Management Team CHRIO County Health Records Information Officer DMOH District Medical Officer of Health DNA Deoxyribonucleic Acid DQA Data Quality Analysis DTC Diagnostic Counseling and Testing DTLC District Tuberculosis and Leprosy Coordinator EBI Evidence based Initiative EID Early Infant Diagnosis EPI Expanded Program on Immunization FBO Faith Based Organizations FGD Focus Group Discussion FP Family Planning FSW Female Sex Workers GBV Gender Based Violence GIS Geographic Information System GoK Government of Kenya HAART Highly Active Anti-Retroviral Therapy HCBC Home and Community Based Care HCM Health Communications and Marketing HCS Home Community Support HTC HIV Counseling and Testing HCW Health Care Workers HEI HIV Exposed Infant
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HES Household Economic Strengthening HFG HIV Free Generation HH Household HIM Healthy Images of Manhood HIV Human Immunodeficiency Virus HMIS Health Management Information System HMT Health Management Team HRIO Health Records Information officer HTC HIV Counseling and Testing ICF Intensified case finding IGA Income Generating Activity IMAM Integrated Management of Acute Malnutrition IMC International Medical Corps IMCI Integrated Management of Childhood Illnesses IP Implementing Partner IPC Interpersonal Communication IPT Intermittent Preventive Therapy ITN Insecticide Treated Net IUCD Intrauterine Contraceptive Device IYCF Infant and Young Child Feeding KAP Key Affected Populations KARHP Kenya Adolescents Reproductive Health program KEMRI Kenya Medical Research Institute KEMSA Kenya Medical Supply Agency KEPH Kenya Essential Package for Health KGGA Kenya Girl Guides Association KNH Kenyatta National Hospital LCHW Lead Community Health Worker LIP Local Implementing Partner LLITN Long Lasting Insecticide Treated Net LOC Locational OVC Committee MCH Maternal and Child Health MDH Mbagathi District Hospital MDR Multi-Drug Resistant MNCH Maternal, Newborn and Child Health MOA Ministry of Agriculture MOH Ministry of Health MOL Ministry of Labor MOMS Ministry of Medical Services MOPHS Ministry of Public Health and Sanitation MSM Men who have Sex with Men MSW Male Sex Workers MT Metric Tons MTCT Mother to Child Transmission MVA Manual Vacuum Aspiration MYSA Mathare Youth Sports Association NARESA Network of AIDS Researchers of Eastern and Southern Africa NASCOP National AIDS and STI Control Program NGI Next Generation Indicators OJT On-the Job Training ORT Oral Rehydration Therapy OVC Orphans and Vulnerable Children PAC Post abortion Care PCR Polymerase Chain Reaction PCV Pneumococcal Vaccine PDCS Provincial Director of Children Services PE Peer Educator
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PEMA People Marginalized and Afflicted PEP Post Exposure Prophylaxis CHMT Provincial Health Management Team PHO Public Health Officer PI Pathfinder International PITC Provider Initiated Testing and Counseling PLHIV People Living with HIV PLTC Provincial Leprosy and Tuberculosis Coordinator PMP Performance Monitoring Plan PMST Provincial Medical Services Team PMTCT Prevention of Mother to Child Transmission PPH Post-Partum Hemorrhage PSI Population Services International PTA Parents and Teachers Association PWID People who Inject Drugs PwP Prevention with Positives QI Quality Improvement RH Reproductive Health RRI Rapid Results Initiative SAPTA Support for addiction prevention and treatment in Africa SGC Small Group Communication SILC Saving and Internal lending for communities SMS Short Message System SOA Sexual Offences Act SOLWODI Solidarity with Women in Distress SP Sulphadoxine-Pyrimethamine SRHR Sexual and Reproductive Health and Rights STI Sexually Transmitted Infections SW Sex Workers TA Technical Assistance TB Tuberculosis TBA Traditional Birth Attendants TBICF TB Intensive Case Finding TOT Trainer of Trainers TWG Technical Working Group UN United Nations USAID United States Agency for International Development VCT Voluntary Counseling and Testing VHC Village Health Committee VILI Visual Inspection with Lugol’s Iodine VMMC Voluntary Medical Male Circumcision VSL Voluntary Savings and Loans VYC Village Youth Committee
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LIST OF FIGURES FIGURE 1: PMTCT CASCADE, Q1 AND Q2, 2014 ...... 14
FIGURE 2: A+ MTAANI PERFORMANCE ANALYSIS ON EID AND PCR ...... 15
FIGURE 3: MTAANI HTC PERFORMANCE ANALYSIS: JAN-JUN, 2014 ...... 16
FIGURE 4: A+ MTAANI PROJECT PERFORMANCE ANALYSIS- HIV CARE AND TREATMENT: APR-JUNE, 2014 ...... 19
FIGURE 5: A+ MTAANI PROJECT PERFORMANCE ANALYSIS: PERCENTAGE OF HIV CLIENTS SCREENED FOR TB ...... 21
FIGURE 6: A+ MTAANI PROJECT PERFORMANCE ANALYSIS - ACTIVE TB CASE FINDING/TB/HIV INTEGRATION ...... 21
FIGURE 7: PERFORMANCE ANALYSIS-UPTAKE OF CONTRACEPTION, APR-JUNE, 2014 ...... 23
FIGURE 9: TOTAL CYP DISTRIBUTED ...... 23
FIGURE 9: PERCENT CYP BY METHOD...... 23
FIGURE 10: A+ MTAANI PROJECT PERFORMANCE ANALYSIS- ANC ATTENDANCE ...... 24
FIGURE 11: A+ MTAANI PROJECT PERFORMANCE ANALYSIS-MATERNAL AND NEWBORN HEALTH CORE INDICATORS, JAN-JUN 2014 ...... 25
FIGURE 12: A+ MTAANI PROJECT PERFORMANCE ANALYSIS- CORE MNCH INDICATORS ...... 25
FIGURE 13: A+ MTAANI PROJECT PERFORMANCE ANALYSIS-IMMUNIZATION SERVICES: APR-JUN 2014 ...... 27
FIGURE 14: NUMBER OF HIV EXPOSED INFANTS BY FEEDING TYPE AT 6-12 MONTHS ...... 28
FIGURE 15: PERFORMANCE-CONFIRMED AND CLINICAL MALARIA CASES DISAGGREGATED BY COUNTY, JAN-JUNE 20141 ...... 29
FIGURE 16: TRENDS SHOWING INCREASE IN CHVS H/H VISITS AND CLIENTS’ REFERRED FOR HEALTH SERVICES ...... 35
FIGURE 17: A+ MTAANI PROJECT PERFORMANCE-KEY CHIS INDICATORS ...... 36
FIGURE 18 : LIVELIHOOD ACTIVITIES IMITATED BY MEMBER OF CUS FOR H/H ECONOMIC STRENGTHENING ...... 43
FIGURE 19: NUMBER OF OVC RESCUED FROM THE STREETS BY AIC KISUMU NDOGO IN MALINDI ...... 51
FIGURE 20: MYCHECK ANALYSIS FOR PMTCT, APR-JUN, 2014 ...... 55
FIGURE 21: FP COMMODITY REPORTING RATES BY COUNTY ...... 56
FIGURE 22: PEADTRIC EMERGENCY TRAINING ...... 59
FIGURE 23: NUMBER OF IN-PATIENT VCT CLIENTS TESTED FOR HIV IN MOI VOI HOSPITAL, APR-JUN, 2014 ...... 60
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LIST OF TABLES TABLE 1: APHIAPLUS NAIROBI-COAST HEALTH SERVICE DELIVERY PROJECT: SUMMARY PERFORMANCE TABLE, FOR RESULT AREA 3 ...... 11
TABLE 2: SUMMARY TABLE OF COUNTY-LEVEL PERFORMANCE: YEAR4, JAN-JUNE, 2014 ...... 12
TABLE 3: APHIAPLUS NAIROBI-COAST HEALTH SERVICE DELIVERY PROJECT: SUMMARY PERFORMANCE FOR RESULT AREA 4 ...... 13
TABLE 4: EARLY INFANT DIAGNOSIS (EID) PERFORMANCE ANALYSIS, APR-JUNE, 2014 ...... 15
TABLE 5: PITC COUNSELOR SUPPORT, APR-JUN, 2014 ...... 17
TABLE 6: CAPACITY BUILDING ON NEW HTC ALGORITHM ...... 18
TABLE 7: A MATRIX HEALTH FACILITY SUPPORTED FOR VMMC ...... 18
TABLE 8:CD4 TESTING ...... 20
TABLE 9: VIRAL LOAD TESTING ...... 20
TABLE 10: MATRIX OF FACILITIES SUPPORTED TO MANAGE THE MDR TB CASES ...... 22
TABLE 11 : FACILITIES SUPPORTED ON GENE XPERT TESTING ...... 22
TABLE 12: MATRIX OF SUPPORTED MAMA TO MAMA GROUPS ...... 29
TABLE 13: VSL/SILC QUARTERLY SUMMARY ...... 41
TABLE 14: HIGHLIGHTS OF MENTORSHIP PRIORITY INTERVENTIONS SUPPORTED FOR THE PERIOD: APR-JUNE, 2014 ...... 57
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LIST OF PHOTOS
PHOTO: 1: CHILDREN IN STAREHE SUB-COUNTY DISPLAYING THEIR FINGERS AFTER POLIO VACCINATION ...... 28
PHOTO: 2: AMERICAN AMBASSADOR TO KENYA AND OTHER LEADERS FROM MOMBASA DURING WORLD TB DAY NATIONAL CELEBRATION AT
PORT REITZ DISTRICT HOSPITAL ...... 31
PHOTO: 3: WORLD TB DAY COMMEMORATION EVENT ...... 33
PHOTO: 4: CHEWS ATTACHED TO MTWAPA HEALTH CENTRE (SHIMO LA TEWA C.U), ASSIST FACILITY STAFF TAKE WEIGHT OF <5S IN A
COMMUNITY OUTREACH HELD IN BARANI VILLAGE. CLOSE WORKING RELATIONSHIP BETWEEN THE CU AND FACILITY HAS INCREASED ACCESS
TO QUALITY HEALTH SERVICES ...... 33
PHOTO: 5: CHEWS FROM KWALE COUNTY TAKING CARE OF JIGGER TREATMENT TO THIS YOUNG CITIZEN. THE RIGHT PHOTO SHOWING THE
EFFECT OF JIGGER MANIFESTATION TO THESE SMALL CHILDREN ...... 35
PHOTO: 6: CLOCKWISE: JAMES AT HIS FOOD VENDING KIOSK. SICILY AT HER CHIPS KIOSK IN KIAMBIU. ECD CENTRE IN KIAMBIU MANAGED BY
TWO MEMBERS OF JIKAZE VSL GROUP. THEY WERE ABLE TO PURCHASE EXTRA DESKS AND THEY ARE CATERING FOR 100 CHILDREN UP
FROM THE 40 THEY HAD BEFORE THEY JOINED VSL. KHADIJA AT HER WATER VENDING KIOSK IN KIAMBIU ...... 42
PHOTO: 7: OVC CAREGIVERS UNITED TO PREPARE AND CLEAN THE HARVESTED CROPS FOR STORAGE ...... 43
PHOTO: 8: CONTACT FARMERS PREPARING CONSERVATION AGRICULTURE DEMONSTRATION PLOT IN TAITA-TAVETA COUNTY ...... 45
PHOTO: 9: PHOTOS SHOWING (LEFT) THE COUNTY COORDINATOR MR. MOHAMED MWACHAUSA ADMIRING THE URBAN KITCHEN GARDEN AT
KWALE HOSPITAL, WHILE (RIGHT), THE COORDINATOR BRIEFS THE NUTRITION ASSISTANT, WHO IS ALSO A CHW AND A TBA, ON HOW TO
INFLUENCE PREGNANT AND OTHER TBAS TO EMULATE THE TECHNOLOGY ...... 45
PHOTO: 10: PHOTOS SHOWING (LEFT) THE PREVENTION TECHNICAL ADVISOR, MR. MWAYULI, ADDRESSING SEGA FARMERS DURING THE
EXCHANGE VISIT AT THE KENYA BIXA FARM, SHIMONI, WHILE (RIGHT) THE COUNTY COORDINATOR, MOHAMED MWACHAUSA, GIVING
THE GROSS MARGINS FOR BIXA FARMING ...... 46
PHOTO: 11: THE 3 ECD SCHOOLS ENJOY DESK AND CHAIRS SUPPLIED BY THE PROGRAM THROUGH MATCHING FUNDS...... 47
PHOTO: 12: A CHW ASSISTING THE OVC TO DO THEIR SCHOOL OVC IN GROUP WORK DISCUSSION AT THE SAFE PLACE ...... 47
PHOTO: 13: GENDER MAINSTREAMING SESSION ...... 51
PHOTO: 14: COMMUNITY SENSITIZATION SESSION ...... 52
PHOTO: 16 BEFORE...... 60
PHOTO: 15: AFTER ...... 60
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SECTION I: EXECUTIVE SUMMARY This report describes APHIAplus Nairobi-Coast Health Service Delivery Project performance for the second quarter (April to June 2014) period across all result areas stipulated under the Project’s Strategic Goal for health; “Sustained improvement of health and well-being for all Kenyans”, The report is presented in 11 sections (I- XI), provides information on the Project key result areas (Result Area 3- which covers the core health services package as defined by KEPH, i.e. HIV and AIDS, TB, Maternal and Neonatal Child Health (MNCH), Malaria, TB, WASH; the Social Determinants of Health; Result area 4 and finally contributions/support to health systems strengthening (Result area 1 and 2). Within each intermediate result area, the performance is analyzed in correspondence with the with the Project’s PMP.
Towards that end, the report outlines defined activities that have been undertaken, within the quarter, to mitigate the broader barriers and constraints to access and utilization of health services. The report concludes with sections on Financial Report, the PMP matrix, the schedule of future activities which constitute part of the annexes which should be read side-by-side with the narrative report. The report further illuminates on the implementation of different activities and strategies aimed at increasing availability of services address geographic, socio-cultural, economic, legal/regulatory barriers that impede access to care and treatment, with special reference to the poor and “hard to reach” populations.
During the reporting period, the Project continued to build on and scale up activities across all the six counties that define Zone 2 (i.e. Kilifi, Kwale, Lamu, Nairobi, Mombasa, and Taita-Taveta) while focusing on priority interventions as defined in the Extension work plan. With commitment to continuity and sustainability of service delivery, the Project focused on supporting targeted interventions at both the facility and community levels to improve communities’ uptake of services. These included; capacity building of the health staff through orientations, continuing medical education (CME), mentorship, technical district/zonal meetings in all service areas (e.g. ART, PMTCT, HTC, MNCH, RH/FP, TB, malaria, nutrition, VMMC, and GBV). Key among the targeted was HTC aimed at first testers and increasing the number on of patients accessing care and treatment which recorded significant increase of about 1-2 %.
In order to improve HIV diagnostics and monitoring, the Project continued to support lab networks for CD4 in the six counties through nodal sites. With regard to improving MCH services; integrated outreach, FP camps, and cervical cancer screening camps were conducted in select areas across the Project zone. As part of task-shifting and enhancement of compliance to treatment and care, the Project offered psychosocial support groups, peer groups, and mother-to-mother support groups to help in the facilities with adherence counseling, patient referral, tracking, and defaulter tracing. Male-only clinics were also created to promote increased male involvement in HIV and maternal and child health (MCH) services, particularly to support facility deliveries and PMTCT services uptake. Non-clinical counselors continued to offer HIV testing and counseling (HTC) services in the facilities under the Project support and Ministry of Health (MoH) supervision. Home-based HTC continued to be supported in selected counties. Other forms of HTC outreach targeting MARPS, staff at the workplace, the national drama festival, RAVE, and FP camps.
At the county and community levels, during the quarter, the Project has focused on system strengthening through a variety of activities, including training of county, sub-county and facility teams on strategic planning and ownership of service delivery systems. Several Project-supported community units are showing improved performance in CBHIS data. This is reflected in improved performance of key indicators related to their linkages to health facilities. Additionally, the Project awarded PIPs to the approved local implementing partners (LIPs) in a shift of strategy from sub-award grants in order to continue more effective and resource constrained implementation of interventions targeting most-at-risk populations (MARPs), workplaces, in and Out of School Youth, and to address gender issues.
With regard to gender and related activities, community sensitization on gender issues and prevention and response to GBV, child abuse and neglect (CAN) and other harmful traditional practices were conducted in all the counties. Youth- focused gender-based violence (GBV) dialogue sessions were also supported through magnet theatre outreaches. The Project collaborated with the Yes Youth Can campaigns, local community groups and selected facilities to offer targeted youth friends and cost effective services. The project also integrated MSM friendly services into the promotion of gender and rights mainstreaming in health service provision.
As a continuation of activities from the previous quarter, Result Area 4 interventions focused on strengthening households’ economic capacities, improving food production, farming, post-harvest management skills and techniques with a view to enhancing capacities of targeted households and communities to adopt healthy nutritional practices. School and community-based educational structures were strengthened to ensure improved educational access, retention and completion for orphaned and vulnerable children while at the same time strengthening the literacy skills of caregivers. Access to safe water, sanitation, and hygiene practices were improved for the marginalized, poor, and underserved children and communities in the Zone. To ensure sustainability of these interventions, the Project strengthened the governance, leadership and management skills and competencies of leaders, staffing personnel and volunteers of community-based organizations.
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Based on the service delivery data and information, as presented in the summary table here below, there is evidence that the Project has progressively improved performance both quality and effectiveness with most of the targets showing over-achievement. Detailed explanation and descriptions of various activities undertaken with challenges and recommendations suggested, for Project activity implementation improvement, are outlined in the respective sections of the main report. Furthermore based on the experiences of the Project, the team submitted 15 abstracts to the AIDS2014 conference in Melbourne; 10 of them were selected. Through Project prime, the project will present the abstracts and conduct a workshop on a number of issues relating to HIV prevention, care and treatment.
In the coming quarter, the Project will continue to focus on supporting both the national and sub-national structures (Counties and sub-counties) to strengthen systems for service delivery, increase ownership and support the MOH in finalizing various tools under review.
Table 1, 2 and 3 here below summarizes the cumulative Project performance including this quarter for the indicators under the two strategic objectives.
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Table 1: APHIAplus Nairobi-Coast Health Service Delivery Project: Summary Performance Table, for Result area 3 Indicator Yr. 1 Yr.1 Ach. Yr. 1 % Yr. 2 Yr.2 Ach. Yr. 2 % Yr. 3 Yr.3 Yr. 3 % Yr. 4 Yr. 4 Yr. 4 % Cumm. Cumm. Cumm Targets Ach. Targets Ach. Targets Ach. Ach. Targets Ach. Ach. Target Achiev. % Ach. PMTCT PMTCT/C&T 126369 130963 104% 172,000 186,035 108% 195,000 177,728 91% 114,102 82209 72% 607,471 576,935 95% Mother prophylaxis 6793 5618 83% 7,600 8,009 105% 9,000 5,931 66% 3,824 2613 68% 27,217 22,171 81% # of 4 ANC visits 80106 57126 71% 112,216 84,183 75% 95,000 77,121 81% 46,491 41147 89% 333,813 259,577 78% # of deliveries with a skilled birth attendant 82604 70322 85% 97,220 93,684 96% 105,640 99,397 94% 54,975 41038 75% 340,439 304,441 89% (SBA) VMMC #of males circumcised 52 169 325% 4,060 3,128 77% 2,421 3,168 131% 1,000 515 52% 7,533 6,980 93% HTC # counseled and tested 669428 549379 82% 600,000 594,617 99% 594,253 510,447 86% 200,086 169264 85% 2,063,767 1,823,707 88% ARV ART New clients 8472 10227 121% 10,900 11,288 104% 12,050 9,778 81% 6,030 4798 80% 37,452 36,091 96% ART Current clients 69053 48382 70% 61,180 53,543 88% 70,500 52,828 75% 60,555 57551 95% 60,555 57,551 95% TB # of TB Patients Tested HIV 10500 8040 77% 15,000 13,645 91% 15,200 12,466 82% 7,808 5783 74% 48,508 39,934 82% MNCH # of children under five receiving Vitamin A 401710 262094 65% 236,748 376,252 159% 420,000 176,982 42% 167,674 101933 61% 1,226,132 917,261 75% # of children less than 12 months of age 30463 57000 187% 128,468 146,191 114% 100,000 124,092 124% 84,199 79968 95% 343,130 407,251 119% who received DPT3 # of children who have received measles 113926 129557 114% 146,034 147,008 101% 165,000 136,106 82% 83,190 50248 60% 508,150 462,919 91% vaccine by 12 months # of children <1 year fully immuniz00ED 105059 74367 71% 123,723 140,438 114% 156,700 135,284 86% 85,919 74219 86% 471,401 424,308 90% # of Long Lasting Insecticide Treated Nets 59776 215191 360% 250,000 245,412 98% 250,000 79,426 32% 54,500 43988 81% 614,276 584,017 95% (LLITN) distributed FP FP - CYP 66375 197032 297% 260,000 320,369 123% 375,000 310,923 83% 198,085 182267 92% 899,460 1,010,591 112%
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Table 2: Summary Table Of County-Level Performance: Year4, Jan-June, 2014 NAIROBI COUNTY MOMBASA COUNTY KWALE COUNTY KILIFI COUNTY TAITA TAVETA COUNTY LAMU COUNTY ZONE 2 PERFORMANCE PERFORMANCE PERFORMANCE PERFORMANCE PERFORMANCE PERFORMANCE PERFORMANCE TOTALS
June 2014 June 2014 June 2014 June 2014 June 2014 June 2014 June 2014 June
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Indicator Targets 4 Yr Jan Ach. % Targets 4 Yr Jan Ach. % Targets 4 Yr Jan Ach. % Targets 4 Yr Jan Ach. % Targets 4 Yr Jan Ach. % Targets 4 Yr Jan Ach. % Targets 4 Yr Jan Ach. % PMTCT PMTCT/C&T 50,204 26,806 53% 21,299 16,177 76% 15,214 10,122 67% 15,214 11,546 76% 7,607 4,101 54% 4,564 3,772 83% 114,102 82,209 72% Mother prophylaxis 1,882 1,257 67% 714 544 76% 510 303 59% 510 382 75% 255 123 48% 153 4 3% 3,824 2,613 68%
# of 4 ANC visits 20,456 13,702 67% 8,678 7,561 87% 6,199 5,990 97% 6,199 5,110 82% 3,099 2,901 94% 1,860 988 53% 46,491 41,147 89%
#of deliveries with a 24,189 15,744 65% 10,262 9,733 95% 7,330 6,766 92% 7,330 5,171 71% 3,665 2,719 74% 2,199 905 41% 54,975 41,038 75% skilled birth attendant (SBA) VMMC # of males circumcised 440 363 83% 187 58 31% 133 0 0% 133 54 41% 67 8 12% 40 32 80% 1,000 515 52%
HTC # counseled and tested 88,038 52,090 59% 37,349 34,322 92% 26,678 20,112 75% 26,679 17,755 67% 13,339 8,988 67% 8,003 6,977 87% 200,086 169,264 85% ARV ART New clients 2,653 2,212 83% 1,126 1,001 89% 804 399 50% 804 313 39% 402 298 74% 241 201 83% 6,030 4,798 80%
ART Current clients 26,644 26,422 99% 11,304 9,888 87% 8,074 7,676 95% 8,074 10,453 129% 4,037 2,766 69% 2422 1,309 54% 60,555 57,551 95% TB/HIV # of TB Patients Tested 3,436 2,524 73% 1,457 711 49% 1,041 556 53% 1,041 305 29% 521 46 9% 312 287 92% 7,808 5,783 74% HIV MNCH #of children under five 73,777 54,342 74% 31,299 19,099 61% 22,357 14,555 65% 22,357 4,988 22% 11,178 2,399 21% 6,707 6,550 98% 167,674 101,933 61% receiving Vit. A #of children less than 12 37,048 20,191 54% 15,717 9,817 62% 11,227 7,001 62% 11,227 10,989 98% 5,613 4,334 77% 3,368 2,989 89% 84,199 79,968 95% months of age who received DPT3 # of children who have 36,604 23,411 64% 15,529 10,011 64% 11,092 5,699 51% 11,092 3,005 27% 5,546 1,881 34% 3,328 6,241 188% 83,190 50,248 60% received measles vaccine by 12 months # of children <1 year 37,804 20,171 53% 16,038 14,515 91% 11,456 7,676 67% 11,456 4,092 36% 5,728 2,008 35% 3,437 3,090 90% 85,919 74,219 86% fully immunized # of Pregnant women 23980 0 0% 10,173 8,988 88% 7,267 6,760 93% 7,267 5,922 81% 3,633 3,828 105% 2,180 1,919 88% 54,500 43,988 81% supplied with LLITNs
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Table 3: APHIAplus Nairobi-Coast Health Service Delivery Project: Summary Performance For Result Area 4 Indicator Yr. 1 Y1 Ach Yr. 1 % Yr. 2 Y2 Ach. Yr. 2 Yr. 3 Y3 Ach. Yr. 3 Yr. 4 Y4 Yr. 4 Cumm. Cumm. Ach. Cum Targets Ach. Targets % Ach. Targets % Ach. Targets Ach. % Ach. Target m. % Ach. Households trained on VSL 3745 10560 282% 23,000 10,933 48% 27,083 19,674 73% 4,917 84% 58,745 45,281 77% 4,114
Households initiated an 0 0 0% 53,000 53,256 100% 3,097 44,973 1452% 2,714 236% 58,811 104,623 178% IGA 6,394 CBOs linked to MFI 0 0 0% 2,262 2,360 104% 577 783 136% 158 104% 2,997 3,307 110% 164 #of children trained on 300 322 107% 2,105 620 29% 1310 1,224 93% 428 342% 4,143 3,631 88%
basic financial literacy 1,465 Result Area 4.1 Area Result #of farmer groups formed 0 0 0% 1,000 949 95% 1,300 1,561 120% 173 217 125% 2,473 2,727 110% # of producer organizations 0 0 0% 75 75 100% 75 224 299% 25 16 64% 175 315 180% formed & linked to
marketing networks
Result Result Area 4.2 # of supported schools with 272 276 101% 340 375 110% 500 832 166% 343 417 122% 1,455 1,900 131% children's health and/or
rights clubs
Result Result 4.3 Area #of individuals reached 27000 5596 21% 50,000 75,506 151% 0 11,987 166% 17782 3443 19% 94,782 10,550,489 1113 through theatre sessions on 1% safe water and hand washing
Liters of drinking water 125000 229,28 183426 101,000 105,890 105% 125,000,000 295,971,740 237% 13200000 10457 79% 239,325,000 631,153,906 264%
disinfected with USG- 2,700 % ,000 ,700 400 supported, point-of-use treatment products # of households with 20000 48381 242% 65,000 45,329 70% 50000 112,056 224% 12013 8766 73% 147,013 205,783 140%
functional pit latrines Result Area 4.4 Area Result #of functional GBV working 6 4 0% 15 12 80% 25 18 72% 10 17 170% 56 42 75% groups supported
#of male champions 12 1 8% 5 5 100% 6 46 767% 5 8 160% 28 65 232%
networks supported
Result Result Area 4.5 # of special events 4 5 125% 18 27 150% 20 44 220% 8 13 163% 50 89 178% supported (MOYA youth
week, Malezi Bora/BF
weeks
Result Result Area 4.6
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SECTION II: QUALITATIVE PRESENTATION OF KEY ACHIEVEMENTS
The Project continued to intensify efforts on continuous improvement of the efficiency and sustainability potential of the interventions, as part of the phase-out strategy across all the result areas. The Project facilitated strengthening of facility-community linkages and referral mechanisms thus ensuring effective and reliable access and availability of health services and products. This section presents performance and achievements of the Project during the 2014 FY third quarter. The section is organized according to the Project results framework: result area 3, 4 and contributions to systems strengthening.
RESULT 3: INCREASED USE OF QUALITY HEALTH SERVICES, PRODUCTS AND INFORMATION
The result area 3 focuses on realization of increased access and use of quality health services, products and information through increased availability of, and corresponding demand for, an integrated package of quality high-impact interventions both at community and health facility levels. To pursue this result, the Project continued to support the MOH structures and other key GoK department to strengthen the ability of facility and community based services to provide an integrated package of high impact interventions at all tiers of health care.
3.1: INCREASED AVAILABILITY OF AN INTEGRATED PACKAGE OF QUALITY HIGH-IMPACT INTERVENTIONS AT COMMUNITY AND HEALTH FACILITY LEVELS
3.1.2 HIV PREVENTION, CARE, TREATMENT AND SUPPORT
Elimination of Mother to Child Transmission of HIV (eMTCT) The figure 1 here below presents the PMTCT Cascade that summarizes the project accomplishments under eMTCT sub- thematic HIV Prevention programming pillar for the reporting period Jan-June, 2014. Each of the quarterly cascades (Q1 and Q2) is to be independently interpreted and no comparison analysis is implied in this presentation.
39,514 First ANC Visit 44,100 32,024 Women Tested Antenatal 42,690 2,969 Women Tested Labour and Delivery 2,909 595 Women Tested Postnatal (within 72hrs) 1,022 35,588 Total Women Tested (PMTCT) -(ANC,L&D & PN) 46,621 815 Known positive status (at entry into ANC) 857 780 Known HIV +ve ANC 1,019 197 Known HIV +ve Labour & Delivery 178 28 Known HIV +ve Postnatal (within 72hrs) 48 1,820 Total Positive (PMTCT) 2,102 36,403 Total with known status 47,478 108 Prophylaxis – NVP only 64 598 Prophylaxis – (AZT + SdNVP) 900 404 HAART(ART) 441 33 Prophylaxis – Interrupted HAART 40 1,168 Total Client received PMTCT prophylaxis 1,445 1,053 Infant ARV (Total No. of Infants issued prophylaxis) 1,226
Figure 1: PMTCT Cascade, Q1 and Q2, 2014 Some of the critical technical assistance and support to the MOH structures that have made a contribution to highlighted project achievements presented herein are outlined here under:
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Capacity building for eMTCT: Technical orientations were conducted at the Coast, Taita Taveta and Kwale Counties reaching 39 HCW. CME on the revised PMTCT guidelines were held at Taita Taveta and Mbagathi DH reaching 70 HCW. The focus of the orientations was on improving HEI diagnoses in pediatric wards, PMTCT documentation and adoption of option B plus; while other TA visits targeted strengthening of support groups.
TA visits were held to strengthen and establish support groups and provide eMTCT updates in Lamu sub-county. At Soweto clinic, TA was given on the importance of diagnosis and management of women at ANC. A meeting was held in the same venue with 5 staffs discussed importance of maintaining proper and accurate patient records. Files and registers have been updated. Other three facilities received TA on reporting for ART prophylaxis. For sites that had reported single dose nevirapine (sdNVP) as the only form of prophylaxis; the clients had late attendance for ANC thus were issued with sdNVP to be taken at start of labor. These mothers then delivered at a different site and so the register maintained sdNVP. Three service providers from DIWOPA were trained in PMTCT by FUNZO to overcome knowledge gaps. eMTCT task force meetings 7 e-MTCT task force meetings were supported in Lamu, Mombasa, and Kilifi with a total of 137 participants attended.
Early infant diagnosis (EID)-PCR Testing As presented in the table 4 here below, a total of 1575 samples were collected and analyzed for HIV using PCR, 94 (5.96%) were positive compared to 5.76% in the last quarter. Table 4: Early Infant Diagnosis (EID) Performance Analysis, Apr-June, 2014 April May June NEGATIVES REJECTED POSITIVES TOTAL NAIROBI 194 228 189 583 0 28 611 COAST 192 130 642 858 40 66 964 TOTAL 386 358 831 1,441 40 94 1,575
The project continues to follow-up on the positive children and links them to care and treatment. In order to strengthen identification of HEI, testing and follow-up of the babies up to 18months as stipulated in the national guidelines, the Project Service Delivery (SD) team, in collaboration with MOH officers provided mentorship at 11 facilities in Nairobi County PCR positivity rates had been high in previous quarters. The figure 2 below summaries the project accomplishments in strengthening early infant diagnosis within the tenets of the national guidelines and policy framework
A+ Mtaani Perfomance Analysis-EID.PCR, Jan-Jun, 2014 1,656 Jan-March 2014 April-June2014 1,445 1,378 1,207 1,014
791 843 704
411 303 351 236 119 108 80 35 29 24 25 21 20 74
PCR (within 3 PCR Positive – PCR (from 3 toPCR Positive – Serology PCR Positive – PCR (from 9 to Total HEI Total PCR Total HIV Total Exposed months) (by 3 months) 9 months) (3 – 9 months) antibody (9 – 12 months) Tested by 12 Confirmed Exposed 6 12 months test(from 9 to 12months) months Positive months 12 months)
Figure 2: A+ Mtaani Performance Analysis on EID and PCR
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In the reporting period, a total of 18 facilities in Taita Taveta County, were provided with responsive, need-based on-site technical assistance with a total 60 health workers benefiting from OJTs on EID. In Nairobi, facilities1 were supported to report in the NASCOP EID data base after a high number of PCR positive children had no reported outcomes. TA involved identification of the gaps in HEI follow up, which included not taking correct client bio data, poor documentation at the laboratory and communication breakdown between the SDP where HEI were served. MDT meetings were held to give feedback and document findings. During MDT meeting held in Mathare North HC, it was reported that most mothers just came to deliver in Nairobi and then went back upcountry immediately after. This made it difficult to track them down. At the same time there were a lot of self-transferred other facilities with the mother baby pair seeming to be lost follow up. In Kahawa West HC, the staff met to give account of seven infected babies. The facility staff have successfully teamed up and embraced the mentor mother program in follow up of HEI.
a. Mentor mothers In order to strengthen community-facility linkages, the project supported 17 mentor mothers; 1 at Moi DH, 2 in Diani HC, 3 at CPGH, 2 at Kisauni, 1 at Kongowea, 2 at Likoni, 1 at Mtongwe and 3 in Portreitz hospital. The mentor mothers will have to transit most psychosocial support work to mama support groups with the project support. This being their last quarter, they will be hired on locum basis to help in formation of the support groups. Some of the key strategies that project employed in the reporting month include: Data feedback to facilities on correct documentation and use Intensified OJT on follow up of identified HEI till 18 months Training on New HTC algorithm Support for CMEs, OJT and topical updates on revised guidelines on e-MTCT has led to improved knowledge of health workers, hence improved quality of services being offered to the pregnant mothers. CHEWS review meetings to emphasize on importance of CHWs being e-MTCT advocates
HIV Testing and Counseling (HTC) During the reporting period, as shown in the figure a total of 77,250 clients accessed HIV testing compared to 92,015 in the last quarter. 4,225 (5.5%) were positive and were referred for prevention, care and treatment to the nearest facility. A+Mtaani Project Perfomance Analysis-HTC: Jan-Jun, 2014 94225 92015 79637 77250 Q1 (Jan-March 2014)
Q2 (April-June 2014)
5000 4225
Total Counselled Total Tested Total HIV+ Figure 3: A+ Mtaani HTC Performance Analysis: Jan-Jun, 2014 The Project scale strategy was to get more positive through targeted testing although shortage of test kits remained a challenge. 45,577 (59%) of those tested were females. 4,692 children were tested and 201 (4.3%) tested positive. Some of the technical assistance and support strategies adopted in strengthening the subnational MOH structures to deliver improved quality HTC services to the communities in the reporting period are summarized as here under: Engagement of PITC counsellors to target high volume sites reaching the infected clients as opposed to waiting for clients to bring themselves. Refocusing the HTC demand creation efforts to targeted new testers with high positivity rate. In hard to reach areas, clients received health information on HIV/AIDs and HIV Counseling and testing services. This has increased the uptake of HTC services in the community including the hard to reach areas. Using Index clients (HIV positive clients), for home based testing strategy to test the clients.
1 Kayole II, Mukuru Reuben, Mukuru MMM, MLKH, Soweto, Mathare North, St. Francis, Uzima, Bahati, Kahawa West, Getrude’s children hospital and St. Mary’s mission hospital
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Making reference to the Data from OVC Longitudinal Management Information Systems (OLMIS) collected by the CHW was used to identify OVC not tested who were mobilized by the CHW and together with the care givers for the consent. Apart from the CT for HIV, psychosocial support, child right education and a meal were provided.
Highlights of key project supported priority interventions linked to the project achievements presented in figure 3 here below are detailed here under:
a. HTC Outreaches A total of six targeted HTC outreaches were con ducted in the zone, informed by the needs identified in the community. In Nairobi, a total of 4 outreaches were conducted; one, at a refugee camp in Kasarani sub-County where a total of 90 clients were counselled and tested, of which 21, out of the 26 couples tested, were new testers and one HIV positive client was referred to Kasarani HC; at Uhuru Park, Nairobi, an integrated outreach was conducted in collaboration with COTU and FKE to mark Labor Day celebrations which targeted employees who do not have time to go for services. During this event, the following services were provided: - HTC, TB screening, IEC and condom distribution. Of 205 clients tested (136 male and 69 female), 45 were new testers and 8 couples were tested. No couple tested positive or had discordant results and ten clients who tested positive for HIV were referred for care and treatment. The third and fourth outreaches were held in Utawala Embakasi Estate,where a total of 222 clients were counseled, tested, and 6 positive clients were referred for care services at Ruai HC. Fourthly, a workplace outreach was held at Kenya Pipeline Embakasi where 86 workers were tested and 2 positive clients were referred to Mater hospital for care and treatment.
In Lamu County, integrated outreaches were supported in hard-to-reach areas with a total of 166 (62 male and 104 female) clients receiving counseling and testing services for HIV and 1.2%, 2 (a male and female) clients tested positive and were enrolled into care. In Mombasa County the Project supported an index client HTC reaching 37 males and 54 females (Newly tested 17 males; 24 females, KAPS tested 2 males; 5 females and 6 couples were tested). Only one 1 female tested positive and was linked to care.
b. Child Testing In Taita Taveta child testing was conducted in 7 OVC LIPs where 428 (172 male, 256 female) children were tested together with 89 (22 male, 67 female) care givers, none tested HIV positive. In Mombasa the project supported 2 events where 98 (48 males, 50 females) were tested for HIV, 2 females tested positive and were linked to Port Reitz Hospital. In Nairobi, child testing was conducted in Mukuru Reuben, 30 children were tested and 18 were new testers. One child tested positive child and was referred to Lea Toto Reuben.
c. PITC Counselor Support APHIAplus continued to support the allowance for volunteer HTC counselors placed in high volume facilities in Nairobi and Coast. Table 6 here below highlights some of the supported high volume facilities (HVFs) currently being provided with PITC counselors as part of the capacity strengthening efforts for provision of improved quality, expanded and sustained HIV counseling and testing services under the realm of HIV prevention, care and treatment programming.
Table 5: PITC Counselor Support, Apr-Jun, 2014 No. Tested Total positive % positive Mama Lucy K. hospital 344(142 males 202 females) 10 (6 males and 4 females) 2.9% Mbagathi DH 921(males females) 113(45 males 68 females) 12.2% St Mary’s hospital 1444 (66 males and 1378 females) 50(20 males and 30 females) 3.4% Moi and Taveta DH 369 (183 males and 186 females) 42 (14 male and 28 females) 11.4% Mpeketoni SDH, Lamu DH, 444 (192 male and 252 female) 1 male 0.2% Witu HC Kilifi DH, Mariakani DH and Malindi DH
d. Support To Counselor Supervision Sessions The Project continued to support counselor supervision sessions though with reduced number of meetings held as a result of reduction in resources to support the counselors’ transport. Kilifi County supported thirty-five HCW from Malindi, Mariakani, Kilifi and Mtwapa sub counties in four meetings. In Nairobi, two sessions were conducted.
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Other than routine supervision, issues addressed were: challenges with the new RTKs i.e. the faintness that comes with the 2nd test kit (first Response is very faint making it hard for both client and service providers to interpret results), how to strengthen referral systems, child testing and use of ARVs in discordant relationship.
e. Proficiency Testing Panel for proficiency testing were distributed in the six counties, in accordance to quality HTC provision. Performance analysis is being awaited so that follow up can be made on arising concerns.
f. Program staff capacity building With roll out of the new algorithm, the Project supported the three-day training. Nairobi was largely supported to train by global fund while counties at the coast had various partners e.g. Funzo, HCM, AHF and Bomu medical center. HTC counselors, nurse counselors and laboratory technicians attended updates in the six counties as shown below:
Table 6: Capacity Building on New HTC algorithm County Total providers trained Kilifi 35 Kwale 20 Mombasa 26 Lamu 22 Taita Taveta 31 Nairobi 40 Total 174
The Project printed 50 copies of Job aids of the New HTC algorithm for Nairobi County sites.
g. Status of RTK RTKs were distributed in the month of April and in Nairobi County most of the sites were not provided with Unigold for tie breaking. In Msambweni sub-County, few Unigold were distributed hence already experiencing stock outs before the quarter is over.
Voluntary Medical Male Circumcision (VMMC) Table 9 here below summarizes the Project’s continued to support VMMC services at 4 facilities in Nairobi County; Mathare North HC, Jericho, Mama Lucy Kibaki and Mbagathi District Hospital. Taita-Taveta County conducted three outreaches and thirty-seven males were circumcised.
Table 7: A Matrix Health Facility Supported for VMMC Facility Number Less than 14 15-25years More than 25years Mama Lucy Kibaki hospital 29 11 8 10 Mathare North HC 34 13 15 6 Mbagathi DH 24 3 10 11 Jericho HC 16 6 5 5 Taita Taveta outreaches 37 0 36 1 Total 140 33 74 33 Some of the project technical assistance strategies adopted included: Engagement of satisfied clients to refer clients. Engagement of a dedicated VMMC team to provide services at the 4 supported sites on a rotational basis per facility. Distribution of posters to the community and the facilities showing where and when VMMC services are provided for free.
HIV Care and Treatment In the reporting period, a total of 2511 patients were started on HAART during the quarter and of this 7.4% were children less than 5 years. The Project continued supporting 57551 clients on HAART, and 77463 clients on cotrimoxazole prophylaxis. Up to 7,627 (13.4%) children remain on treatment and this number is expected to go up with implementation of the new guidelines. A significantly higher number of females (35,491) compared to males (17,566) who were >15 years of age were currently on treatment.
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A+ Mtaani Project Performance Analysis- HIV Care and Treatment : Apr-June, 2014
83,637
57,551 Newly Started on ART 49,298 Current on ART 35,491 26,712 Cummulative on ART
17,566
3,840 3,787 2,511 83 2,249 701 104 2,245 1,623
Male Child (age <15) Male Adult (age 15 or Female Child (age Female Adult (age 15 Total greater) <15) or greater)
Figure 4: A+ Mtaani Project Performance Analysis- HIV Care and Treatment: Apr-June, 2014
Some of the key technical strategies employed by the project included: Provision of airtime for defaulter tracing Support groups to improve retention Continuous TA to clinic staff using my check tool Lab network for CD4s ART outreach in hard to reach areas Vibrant eligibility committees which meet on a monthly basis composed of Medical officers, Pharmacist, Clinical officer in charge and the SCASCO to discuss category of clients to be initiated on HAART, switching to second Line and discordant couples.
Some of the priority interventions that the project focused on in the reporting months are detailed here below: a) Capacity Building Continuous medical education: seven (7) CMEs were conducted in various counties in support of care and treatment and reached 236 HCW. At the Coast, CME were held at, Taita Taveta County and Kwale County. A CME on side effects of ARVs was held at Port Reitz hospital. In Mpeketoni and Lamu DHs, 43 HCW were reached. In Nairobi’s Coni clinic a CME on PEP and data management was supported for staffs from all departments, they were trained on how to report in MOH 711 and 731. Due to the facility reporting large number of burst condom cases, clinicians were taken through the PEP guideline.
b) Technical Assistance At Dandora II HC, TA was supported on client enrollment, retention; follow-up of the clients from the counseling room and referrals of to the clients’ preferred facility of choice. Counselors were encouraged to maintain contact with the newly positive clients, lead CHWs were guided on support group establishment and facilitation for new clients on ART in order to improve adherence among newly enrolled. Mama Lucy Kibaki Hospital CCC staff was supported to form support group for KAPs and provide education on risk reduction. Marurui HC which had referred 16 clients to Kiambu DH was supported to start a CCC. Kasarani Health Centre and Kariobangi HC were supported to provide first line regimen as per the new circular from the Director of Medical Services. TA was provided at 10 facilities to strengthen monitoring of clients using viral load instead of CD4 count. Health worker were taken through, sample collection, transportation and interpretation of results.
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c) Multi-disciplinary team meetings Two meetings were supported at Diani HC and Port Reitz hospital. The aim of the meetings was to strengthen retention of clients on care. Also, Two MDT meetings were held in Nairobi. At Reuben Centre, teenage clients were not comfortable been attended for FP services on the same day as older clients. During the meeting it was agreed that the teenagers need to be fast tracked and plans are underway to revive CBD at community level since there is no public facility in the settlement. At Soweto clinic staff discussed the importance of maintaining good patient records and this has resulted in improved documentation.
d) Psychosocial Support Support groups were strengthened to provide emotional, psychosocial and educational support to clients through experience sharing and provision of health education. A total of 78 facilities based psychosocial support groups for PLHIV were supported in Nairobi, and 39 teens and pre-teens were facilitated in a support group at Mbagathi district hospital. Issues discussed included disclosure, adherence and reproductive health. At the Coast, focus was on sustainability, partnership and linkages. Thirty support groups were sensitized on joining cooperatives and other micro financing institutions for economic empowerment. The Project gave technical assistance during support group meetings to help in addressing issues of stigma. Kilifi County has been supporting a weekly discordant couples’ group meeting in Malindi, and 10 active pediatric support groups spread throughout the three sub-Counties in Kilifi.
e) Defaulter tracing In order to enhance patient retention to treatment and reduce risk of drug resistance, the Project supported facilities monthly airtime for defaulter tracing. Reasons given for defaulting included: Lost to follow up, self-transfer, decline to resume treatment, no contacts and some had extra drugs so came later to collect drugs. In all the six counties 2,116 defaulters were traced; 961 being traced back, 964 still being traced, and 150 transfer out.
f) Laboratory a. CD4 TESTING Table 8:CD4 Testing REGION APRIL MAY JUNE TOTAL NAIROBI 2,394 2,540 2,179 7,113 COAST 2,116 1,682 4,657 8,811
TOTAL 4,510 4,222 6,836 15,924 There was a decline in CD4 testing this quarter from 19,958 in the last quarter to 15,924, attributed with lack of BD platform reagents which caters for 9 referral testing Labs.
b. VIRAL LOAD Table 9: Viral Load Testing
APRIL MAY JUNE TOTAL 587 715 472 1,774
The Project continues scaling-up on viral load testing and had a total of 1,774 samples collected in Nairobi region. Coast region samples could not be analyzed as the machine at CPGH was not able to read viral load on DBS. There is now a Cobas machine installed (for analyzing viral load on DBS samples), and testing has commenced. Two updates were conducted in Kwale County for Samburu and Lunga Lunga HCs on use of PIMA machines and on data upload for the EID database; four HCW were reached.
a) Status of Laboratory Reagents CD4 Reagents There was inadequate stock of CD4 reagents (BD platform) throughout this quarter with Mbagathi most severely hit. In St Joseph Mukasa, Getrudes children hospital and St Francis hospital no Partec reagents were received for the machines there.
EID Reagents CPGH continue receiving their reagents with minimal stock outs while KEMRI continues to support Nairobi County facilities with no stock outs registered in the reporting months.
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Viral Loads Stock out of collection tubes was experienced starting the month of May and has continued to date.
b) Monthly ART outreaches Twelve outreaches were conducted in the quarter in hard-to-reach areas. One in Taita Taveta County where 60 patients received care, and 50 ART; in Lamu County, 11 outreaches were conducted in Manda, Maweni, Majembeni and Moa ; 173 (77 male and 96 female) clients received ART services and information on HIV.
HIV /TB Integration The Project supported with screening tools and TA on TB. Screening for all HIV patients continued; 87% of the patients in the CCC were screened, 99% of the HIV positive patients were given cotrimoxazole prophylaxis. Out of 2,772 TB cases detected, 2,248 (81%) were tested for HIV and 39% tested positive. The challenge faced in testing for HIV was shortage of test kits
A+ Mtaani Project Perfomance Analysis: Pecentage of HIV clients screened for TB 98% 97% 96% 95% 95%
91% 90% 89% 87% 87% Q1 Q2
Male Child (age <15) Male Adult (age 15 or greater)Female Child (age <15)Female Adult (age 15 or greater) Total
Figure 5: A+ Mtaani Project Performance Analysis: Percentage of HIV clients screened for TB
Highlights of priority interventions supported in the reporting quarter to strengthen TB/HIV integration programming are documented here below:
a) TB active case finding As documented in the figure 6 here below, the project continues to support the use of TB ICF cards in the patient file to identify TB suspects at the CCC and tracing of defaulters
A+ Mtaani Project Performance Analysis - TB/HIV Integration: Apr-Jun, 2014
57,291 Total TB Tested 56,100 2,772 Total TB cases detected 3,215 2,248 Total TVB Patients Tested for HIV 2,796 1,699 Total TB completed treatment 1,866 1,454 Total Smear Positives 1,569 1,565 Total Smear Negatives 1,472 850 Total TB Patients HIV+ 940 841 Total TB HIV patients on CPT 894 116 Total TB death 127
Total TB Defaulters 45 55 Q2 Q1
Figure 6: A+ Mtaani Project performance Analysis - Active TB case finding/TB/HIV integration
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b) Capacity Building At the Coast, CMEs were conducted in 9 facilities where 99 health workers were reached. OJT was conducted in 18 health facilities, 60 health workers were reached.
c) Isoniazid Prophylactic Therapy (IPT) – IPT continues to be offered in MDH and Dandora II HC. SCTLCs in the County advised against initiation of IPT in the quarter due to a possible shortage of TB drugs in the country.
d) MDR TB TA was provided to the staff on adherence counseling, documentation and follow-up of the MDR clients. NineMDR TB patients continue to be followed up at various supported facilities:
Table 10: Matrix of facilities supported to manage the MDR TB cases NO Facility Name MDR Client Treatment Status 1 Mercy Medical Missionaries Mukuru 1 Ongoing 2 Reuben Centre 1 Ongoing 3 Kasarani HC 2 Ongoing 4 Mama Lucy Kibaki Hospital 1 Ongoing 5 Kayole Soweto HC 2 Ongoing 6 Portreitz District Hospital 2 Ongoing
e) Gene xpert testing Five gene xpert machines were installed: Mbagathi DH, Ngaira dispensary, Moi Hospital, Msambweni SDH, and Malindi hospital during the quarter. The APHIAplus Project team facilitated the installation of the machines at the facilities. The two sites are operational and QC is ongoing.
Table 11 : Facilities supported on Gene Xpert Testing Testing Facility Total tested TB positive Rifampicin resistance Port Reitz District Hospital 131 37 0 Malindi district Hospital 156 33 0 Coast General Hospital 70 28 2 Mbagathi DH 33 5 1 Rhodes chest clinic 17 5 0 TOTAL 407 108 3 A total of 407 patients were tested; 108 had positive results of which 3 were Rifampicin resistance. There were 5 active gene Xpert sites.
f) TB/HIV collaborative meetings Two meetings were conducted in Kilifi and Kwale counties reaching 40 HCW respectively.
REPRODUCTIVE HEALTH AND FAMILY PLANNING
During the reporting period April-June 2014, the Project continued to provide Technical Assistance (TA) to all the supported health facilities and community units in the Zone 2 Counties (Kilifi, Kwale, Lamu, Mombasa, Nairobi and Taita Taveta). More focus was laid on strengthening and improving the quality of integrated RH/FP/MCH and HIV services while improving access to services for marginalized and hard to reach persons through targeted in-reaches and out- reaches.
During the quarter, 44,410 new clients were provided with family planning services compared to 39,234 new clients in the previous quarter. Reported FP revisits during the quarter were 127,184 compared to 79,853 revisit clients who were provided with family planning services in the APHIAplus Nairobi-Coast supported sites in the previous quarter.
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Family Planning services uptake Jan-June 2014 127,184 Overall FP New Clients Overall FP Total Clients
79,853
44,410 39,234
Jan-March 2014 April-June 2014
Figure 7: A+ Mtaani Project Performance Analysis-Uptake of Contraception, Apr-June, 2014
Injectable contraceptive was the commonest used method for family planning followed by Implants and Pills as shown in pie chart below. There has been a consistent effort in advocating for uptake of long acting and permanent methods and this will continue. During the report period, the Project achieved a total CYP of 95,627 compared to 92,780 and 63,640 in the previous quarters. Injectable contraceptives, Implants and pills contributed to the greatest CYP as shown in figures 7 and 8 here below.
A+ Mtaani Project Perofmance Analaysis- CYP distribution: Jan-Jun A+ Mtaani Project Perfomance Analaysis- 2014 Percent CYP by method Apr-Jun 2014 95,627
Jan-Mar 2014 Apr-Jun 2014 92,779.90 0% 1% 1% Pills Injections 16% 51,644 23% 45,938.50 IUD Implants 31,895.50 5% Sterilization 22,058 54% 15,068 Condoms 8,555.40 4,129.20 4,578 910 550 238.6 315 1,112.70 1,414 Natural
Pills/oral Injections IUD Implants Sterilization Condoms Natural Total contracep method
Figure 9: Percent CYP by method Figure 9: A+ Mtaani Project Performance Analysis-Total CYP distributed
The project experienced general stock out of IUCDs towards the end of last quarter and that could partially explain the drop in IUCD insertions. In the same period we have had constant supply of pills and a relatively good supply of implants (especially Implanon) and that could explain the rise in the two methods. Closely correlated with the availability of implants; the ready availability could have affected IUCD insertions given the attitude of clients and health workers. There is tendency for preference for implants over IUCDs.
Some of the priority interventions supported to create demand and increase access and utilization of contraception services aare highlighted herein under:
a) Capacity building of service providers To ensure provision of quality RH/FP services and enhance provider’s confidence, the Project staff continued to provide technical assistance, targeted CMEs and on job-training to service providers on areas identified as weak during routine facility and support supervision visits.
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Capacity building focused on Family Planning compliance and integration of Contraception into Maternal Newborn and Child welfare clinics, Post Abortion Care services, TB and HIV services. OJT on provision of Long Acting Reversible and permanent methods of contraception was done for recently employed health workers. Service providers in Makadara Sub-County were also orientated on the new Implanon NXT insertion during the facility in-charges meeting held in May. During the facility visits by Project staff, health workers were reminded and encouraged to provide clients with comprehensive counseling on all available methods, voluntarism and informed consent. b) Integrated Outreaches During the ended quarter, the Project supported targeted RH/FP integrated outreaches and in-reaches where provision of FP services was provided alongside other services like immunization and growth monitoring, and HIV services. A total of 17 in-reaches and 4 outreaches were supported across the Project supported counties. c) Youth friendly services (YFS) Sensitization of YFS guidelines: The Project continued to put efforts in strengthening YFS in high volume facilities through County and facility whole site sensitizations. In Kwale county 36 health workers including CHMT members were sensitized on YFS guidelines. Facility whole site sensitizations were also conducted in 7 facilities (3 in Nairobi2 and 4 in Taita Taveta3).The Project worked with facilities to come up with youth friendly initiatives as follows:
Youth clinic appointment days: Mbagathi and Gertrude’s hospitals continued to provide services on specific youth appointment days where a set of integrated health services for young persons were provided. Gertrude’s hospital has adopted the internal CCC youth clinic model and replicated it at the outpatient department; the ‘all-star clinic’, an initiative embraced by both the service provider and the clients.
Young mothers support groups: Facilities now run ‘young mamas groups’ where young women seeking ANC services meet monthly for health talks and psychosocial support. AtMakadara Health Centre, young mothers and their spouses are invited by the Facility In-Charge to the meeting, to promote birth preparedness and enhancing male involvement in MNCH.
Kenyatta University: A total of 17 housekeepers were trained in YFS to support contraceptive distribution at the hostels, and make referrals to the university health facility. e) Cervical cancer Screening The Project supported activities to increase access and availability of cancer of the cervix screening services. Commodities for cervical cancer screening were distributed in 35 facilities and as a result, 1,480 clients were screened. In addition, on- site orientation on use of cryotherapy machine was done to service providers in Lunga Lunga health Center Nairobi.
MATERNAL, NEWBORN AND CHILD HEALTH (MNCH) During the reporting quarter, 39,514 new and 87,455 revisit, ANC clients were seen in the Project supported ANC sites compared to 49,411 new and 89,110 revisit ANC clients in the previous quarter. Clients who completed 4 focused ANC visits were 21,453 compared to 20,983 and18, 591 in the last 2 quarters respectively. The Project sites are therefore registering an improved number of 4th ANC visit clients though there is more work to be done to ensure that the proportions improve further. Additionally, 19,529 pregnant women received IPT 2 dose and 22,516 were provided with ITNs for Malaria prevention. A+ Mtaani Project Performance Analysis- ANC Attendance: Apr-Jun 2014 87,455
39,514 21,453
1st ANC Visits Total Revisits Completed 4th ANC visits Figure 10: A+ Mtaani Project Performance Analysis- ANC Attendance
2 Kenyatta University, St. Francis, and Makadara Health Centre. 3 Moi and Taveta District Hospital, and Mwatate and Wundayi Sub-District Hospitals.
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The Project continued to support deliveries with 29,175 women delivered under the care of a skilled attendant, 2,799 of them being emergency obstetric cases that were delivered by caesarian section. This is a further increase from the 24,205 and 21,542 in the previous 2 quarters. This trend shows that more women are now accessing safe skilled deliveries possibly with the free maternity services. Maternal deaths reported in the Project supported sites were 33; they were audited. More neonatal deaths were reported, The Project will continue working with the community structures to provide education for early and timely facility visits. A+ Mtaani Project Perfomance Analysis- Maternal and NewBorn health core indicators
29,175 Total deliveries 24,205 26,579 Live births 23,526 24,665 No. of Babies Discharged Alive 23,220 24,110 Normal deliveries 20,887 2,799 Caesarean Sections 2,995 1,487 Under weight Babies (< 2500 grams) 1,502 2,501 Q2 Referrals 1,062 695 Q1 Pre-Term Babies 817 987 Maternal Complications Alive Dead 811 2,668 Still births 672 318 Breech Delivery 339 231 Assisted vaginal delivery 321 307 Neonatal Deaths 200 33 Maternal Deaths 38
Figure 11: A+ Mtaani Project Performance Analysis-Maternal and Newborn health core indicators, Jan-Jun 2014
During the reporting period, 29,249 children under one year received Penta 3 vaccine; 70,898 children under 5 years of age received Vit.A while 33, 703 received measles vaccination. Children under one-year reported as fully immunized were 32, 0231.
A+ Mtaani Project Perfomance Analaysis- Core MNCH Indicators 137040
Q1 75,799 70,898 Q2 53469 42078 39,102 38985 35461 40117 32775 33,703 29,249 32,231 31331 27722 22,815 26,377 27,381
Number of ORT Number of Number of Number of Pregnant women Number of Number of Number of Number of Long cases treated children children under children who receiving two children less children <1 year pregnant women Lasting dewormed 5years of age have received doses of than 12 months fully immunised supplied with Insecticide atleast once a who received measles vaccine Intermittent of age who LLITNs Treated Nets year Vitamin A by 12 months Presumtive received DPT3 (LLITN) Theraphy(IPT) from USG- distributed) supported programs
Figure 12: A+ Mtaani Project Performance Analysis- Core MNCH Indicators
The Project staff continued to provide TA in supported facilities and community units to ensure that mothers are healthy throughout pregnancy and childbirth. Continued emphasis was put on early ANC attendance to allow for completion of 4 FANC visits while encouraging skilled delivery attendance. Pathfinder with support from the private sector procured and
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distributed to needy high volume facilities 10 delivery and 10 maternity beds. This will go a long way in improving quality of care and patient dignity as we see an upsurge of patients after the announcement of free maternity services.
a) BEmONC Baseline survey and Scale up In an effort to mitigate effects of complications in labour and delivery, the Project supported orientation of BEmONC strategy (the Seven Signal Functions) and monitoring of labour through CME and TA to 140 service providers. In the supported coastal Counties at the coast, MNCH TWG was formed to spear head the rollout the eMTCT agenda and scaling up of the BEmONC services. Baseline data for BEmONC was collected from selected facilities (11 in Kilifi, 12 in Mombasa, 10 Kwale and 16 in Nairobi). Kilifi, Mombasa and Nairobi Counties were nominated nationally as priority counties for BEmONC scale up.The results for the baseline survey focusing of the seven signal functions were as follows:
Kilifi
Mombasa
Nairobi
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The Project is working with the Counties to finalize an action plan to address the identified gaps in the baseline survey.
b) Dignified care The Project staff received feedback on undignified care at the maternities. Disrespect and abuse in maternity services represents a major barrier to utilization of skilled birth. To address this issue the program staff provided TA in 75 high volume facilities on how to treat mothers with dignity and respect.
c) Maternal and perinatal and Neonatal Deaths Audits To evaluate the causes of maternal and perinatal deaths and identify preventive measures, the Project supported death audit/review meetings in the facilities that reported mortalities. The reviews indicated delay in seeking care as a major contributor to maternal deaths. To address this, health education sessions were conducted on early medical seeking behavior, and Individual Birth Plans (IPB).
d) Post natal care The Project staff continued to provide information during sensitization, CMEs, SCHMT/facility in-charges meetings and during the TA sessions emphasizing on the importance of providing focused and timely PNC services, and also on early detection and management of post natal complications. Lack of documentation of PNC services (at the mother baby booklet and the post natal care register) was identified as a major hindrance to early detection and management of post natal complications. The Project staff therefore offered TA on proper documentation of the same.
a) Child Health During the quarter, the Project continued to support service providers with sensitization on essential newborn care. Emphasis was laid on helping the baby breath, early initiation of breastfeeding, cord care and baby warmth aimed at increasing child survival. b) Immunization: The project performance on immunization is summarized in the figure below. + Mtaani Project Performance Analysis-Immunization services: Apr-Jun 2014 39,421 39,086 Q2 32,813 29,681 32,059
16,453
2,892
109 138 2,170
Above 1yr Above 1yr Above
Under 1 yr 1 Under yr 1 Under
Under 1 Year 1 Under Year 1 Under
Above 1 Year 1 Above Year 1 Above
Under1yr(100,000 IU) Under1yr(100,000 Above1yr(200,000 IU) Above1yr(200,000 DPT/HepB+HiB 3 Pneumococal VITAMIN A (Supplemental) Measles Fully Immunized
Figure 13: A+ Mtaani Project Performance Analysis-Immunization services: Apr-Jun 2014 Some of the tested strategies for implementation at scale that the project employed are detailed here below:
ORT corners: During the quarter, the Project paid special attention to strengthening the support Oral Rehydration Therapy (ORT) corners within the facilities by ensuring that they are functional and with proper documentation in the new ORT registers.
Service providers in supported facilities were encouraged to ensure provision of the first immunization at the maternity or within the 1st twenty four hours, or on first contact to minimize on missed opportunities. To increase access and coverage, integrated outreaches were supported in all the Counties.
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The Project also supported a sensitization on immunization targeting and forecasting for vaccines for health workers from 35 health facilities in Taita Taveta County. Additionally, support was provided for photocopying of the new immunization tools and also distribution and provision of TA on recording reporting.
Rotavirus: The Project supported County sensitizations on the introduction of Rotavirus Vaccine to the National Immunization Schedule; ensuring that all public facilities offer the vaccine with effect from 1st of July 2014. In the sub - Counties, plans of rolling out the vaccine are at different stages and a series of facility and community health workers sensitizations are ongoing.
Polio campaigns: The Project supported the Counties to conduct the Polio vaccination campaigns by conducting community mobilization and supporting transportation to distribute vaccines.
In Lamu County, the MOH was supported to carry out an Immunization Data Quality Audit (DQA). Some of the Key observations during the DQA were: most of the facilities had Photo: 1: children in Starehe sub-county displaying their enough vaccines in stock, Immunization schedule is being fingers after polio vaccination followed as per KEPI guideline, with most facilities meeting their immunization targets.
NUTRITION The Project continued to support Nutritional assessment counseling and support (NACS) and integration of Nutrition in HIV and TB. Capacity building through CMEs on MYICN for 160 health care providers was supported. During these CMEs, health workers were also sensitized n was on the low cost high impact nutrition interventions. CME on breastfeeding was also conducted and reached 31 service providers in selected facilities. Figure 14 here below presents the number of HIV exposed infants by feeding type at 6 and 12 months for the reporting months, which is a core reported indicator under HIV/Nutrition programming Number of HIV exposed infants by feeding type at 6 to 12 months
Q1 Q2 1,710
1,451 1,253
1,002
118 107 141 144
Exclusive Breastfeeding Exclusive formulae feeding Mixed feeding Total
Figure 14: Number of HIV Exposed infants by feeding type at 6-12 months
During Malezi Bora week, the Project supported County Health management Teams to conduct supportive supervision; gaps identified were addressed through OJT. In addition, the Project supported the Counties and Sub Counties health management teams to commemorate the Malezi bora week in May. The support included both Technical assistance and logistical support at community and facility level.
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MALARIA To ensure quality of malaria diagnosis, the Project supported the sub counties Medical laboratory technologists to carry out a Malaria diagnosis quality assurance and control in all the testing sites. This quarter, the DQA was conducted in 2 Counties in Kilifi counties and Taita County. Support was also extended to the DHMTs to do redistribution of RDTs, AL, and LLITNs to avoid stock outs of malaria commodities. The Project also joined the County Governments to celebrate the world malaria day which was held on the 25th of May 2014. Messages on Malaria prevention, early detection of signs and symptoms and clinical services were provided during the event. A+ Mtaani Project Perfomance-Confirmed and clinical malaria cases disaggregated by County, Jan-June 2014 2,693 April-June 2014 7,196 Clinical Malaria
Taita 7,314 Taveta County Jan to Mar 2014 2,298 Confirmed Malaria 23,070 April-June 2014 21,848
Jan to Mar 2014 20,463 Mombas a County a 16,503 202 April-June 2014 852
Lamu 858 County Jan to Mar 2014 736 24,892 April-June 2014 28,411
Kwale 35,872 County Jan to Mar 2014 20,631 17,499 April-June 2014 25,987
Kilifi 18,510 County Jan to Mar 2014 21,418
Figure 15: performance-confirmed and clinical malaria cases disaggregated by county, Jan-June 20141 As can be depicted from figure 15 above, there are more reported confirmed cases of malaria treated compared to clinically suspected case in the reporting months which is a sign of quality improvement; better patient management and proper use of antimalarial commodities.
3.1 INCREASED AVAILABILITY OF AN INTEGRATED PACKAGE OF QUALITY HIGH-IMPACT INTERVENTIONS AT COMMUNITY AND HEALTH FACILITY LEVELS.
3.1.1: Community Maternal, New born and Child Health Mama to Mama support groups to promote MNCH. Mama to mama support groups comprise of pregnant mothers and those with infants below three months old. They are selected and sensitized through the ANC/child welfare clinics by the facility in-charges. The mothers are taught on focus ante natal care (FANC), MNCH, importance of skilled delivery and adherence to fourth visitation.
During the first sessions the mothers are actually taken round various maternities to get a feel of the quality services offered and given a role to entice and sensitize others. Support group meetings for Mama Groups established last quarter continued with some new mothers joining and others dropping after delivery. Fourth visits adherence and facility utilization in the facilities with Mama support groups has increased as shown below for Makadara, Kayole, Jericho and Soweto health facilities. The Project also procured 18 maternity and delivery beds for Makadara and Kayole2 facilities in Nairobi to meet the rising demand for services at the facilities.
Table 12: Matrix of Supported Mama to Mama Groups KAYOLE II HC Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14
New Visits 327 253 138 354 314 285 252 Revisits 783 623 381 464 647 646 571 Total Visits (Utilization proxy) 1110 876 519 818 961 931 823
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4th ANC Visit (quality measure) 205 114 106 115 154 136 165 4 ANC Proportion of Revisits 26% 18% 28% 25% 24% 21% 29% Total No. Deliveries (Denominator) 93 106 41 73 92 137 148 MAKADARA HC Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 New Visits 236 190 119 303 203 271 227 Revisits 409 410 287 393 542 537 535 Total Visits (Utilization proxy) 645 600 406 696 745 808 762 4th ANC Visit (quality measure) 112 94 60 95 63 87 80 4 ANC Proportion of Revisits 27% 23% 21% 24% 12% 16% 15% Total No. Deliveries (Denominator) 98 80 62 95 80 111 113 JERICHO HC Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 New Visits 77 56 31 75 55 55 71 Revisits 115 104 69 86 95 112 106 Total Visits (Utilization proxy) 192 160 100 161 150 167 177 4th ANC Visit (quality measure) 23 24 19 29 30 23 34 4 ANC Proportion of Revisits 20% 23% 28% 34% 32% 21% 32% Neonatal Deaths (Numerator) Total No. Deliveries (Denominator) NO MATERNITY IN THE FACILITY
Male Involvement in MNCH To enhance meaningful involvement of people living with HIV, the Project supported community forums targeting men living with HIV in Kilifi County. The Project continued to support sessions focused on mobilizing community and facility health workers to form male support groups in the following facilities: Malindi sub-county, Kakuyuni, Gongoni, Municipal clinic, Mariakani Sub County Hospital, Kilifi County Hospital and marafa.
3.2 INCREASED DEMAND FOR AN INTEGRATED PACKAGE OF QUALITY HIGH-IMPACT INTERVENTIONS AT COMMUNITY AND FACILITY LEVELS
3.2.1: PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV (PMTCT)
Mentor Mothers sessions on PMTCT: The mentor mothers were based at the MNCH, and linked with other departments like maternity, pediatric ward, female ward and the CCCs. They educated and supported HIV positive pregnant women on prevention of mother-to-child transmission through individuals, couples and group sessions. To improve on the follow-up of mother-baby pairs including their partners and minimize losses and ensure timely diagnosis of HEI the Project provided technical assistance to 15 KMMP sites in Kwale, Mombasa, Taita Taveta and Kilifi Counties. Monthly technical assistance sessions which involved PMTCT support group meetings were held in all the sites attended by the Project coordinators as well as MCH in-charges. The Project supported the mentor mothers with monthly allowances, airtime for defaulter tracing and refreshments during support group meetings.
In Taita Taveta County, APHIAplus Nairobi-Coast with the support from SCASCO was able to sustain the mentor mother in Moi Hospital. The mentor mothers were facilitated to attend an OJT on filling the tools at Tudor hospital in Mombasa. Unfortunately, the mentor mothers’ contracts ended in June 2014. With the support from M2 we managed to conduct sub-county review meetings to lobby for their retention. Two facilities, Mtwapa and Vipingo did manage to retain one mentor mother each, with plans underway for Kilifi County Hospital and Malindi Sub County Hospital to each retain theirs
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as well. In April 2014, Kilifi County Hospital graduated 68 HEIs out of 96 earlier enrolled, these had completed the required 18 months and were therefore declared negative.
General Group Health Education: Mentor mothers (with the facility nurses) conducted general group health education talks for women and their partners accessing outpatient services at the 15 KMMP sites. Several sessions were held with the purpose of raising awareness and motivating behavior change related to MNCH and PMTCT outcomes.
Group Pre-Test HIV Education: Mentor mothers conducted group pre-test education sessions for all pregnant women during antenatal care prior to HIV testing with the support of the facility nurses. The purpose was to encourage pregnant women to undergo HIV testing, prepare women for the results of the test and motivate behavior change. The sessions focused on the importance of HIV testing in pregnancy, the implications of positive and negative results, PMTCT basics and the role of the male partner. A total of 1,716 pregnant women, 947 post natal women and 193 male partners were reached during the quarter. eMTCT In June 2014, Kilifi County held its EMTCT TWG meeting and agreed to offer technical support to the County structures and program teams to realize the county objective of Getting to Zero. During the meeting a County TWG was formed and the members were attached to various high volume facilities. Responsibilities of TWG members in the attached facilities are ass highlighted here under: Sensitize the facility staff on EMTCT and BEMONC issues Help them come up with Work Improvement Teams (WITs) in their facilities. Get the baselines for the EMTCT dashboards Get a work plan on priority indicators in the dashboard to start with.
3.2.2: HIV CARE AND TREATMENT
Pre-ART preparation sessions High volume facilities have been the focus of community health for the quarter, 35 link desks were supported to help in disseminating PWP sessions to clients in preparation for ART uptake
Retention and defaulter tracking for PLHIV on ART Defaulter tracing activities have continued to be intensified with the treatment buddies, physical tracing, and telephonic support being offered to those infected with HIV that needed to ensure their colleagues are supported across all counties. A frontline SMS system was to be facilitated as an outcome of the defaulter tracing review meeting. This has seen a tremendous reduction in the number of people with compliance rates standing at 95% in Taita Taveta.
Technical support to facility and community staff on maintaining an appointment diary/daily register, transferring of missed appointments, phone calls, categorization, physical tracing were done. Provision of airtime for phone calls for missed appointments and review sessions on defaulter tracing outcomes with health facility staff were supported at the high volume facilities. Taita Taveta County is still implementing the ‘front SMS‘whereby Moi hospital in Voi saw its defaulters reduce from 71 to 11 during the quarter. In total we managed to trace 650 defaulters with the help of the CHWs, Mentor mothers and the health workers.
Psychosocial support and topical updates for support groups: Through the livelihood component, the project continued to provide technical support to the groups on sustainable income generating activities through linkages and capacity building. Kilifi County has a Photo: 2: American Ambassador to Kenya and other discordant couple which meets on weekly basis and 10 active leaders from Mombasa during World TB Day National pediatric support groups. Celebration at port Reitz District Hospital
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Psychosocial support and topical updates for support groups: For sustainability purposes, Partnership and linkages had been the focus for the quarter where the support groups (30) were sensitized on joining cooperatives and other micro financing institutions for economic empowerment. To provide emotional, psychosocial and educational support to clients through experience sharing and provision of health education, the Project gave technical assistance during support group meetings to help in addressing issues of stigma. Topical updates were also conducted during the monthly group sessions. Kilifi County has been supporting a discordant couple in Malindi which meets on weekly basis and 10 active pediatric support groups spread throughout the three sub Counties.
Follow-up on adherence, and HIV exposed infants (HEI) To improve on the follow up of mother-baby pairs including their partners and minimize losses and ensure timely diagnosis of HEI as well as continuous support for appropriate infant feeding, care of HIV exposed infants till 18 months and HIV care and treatment for the mothers and partners, the project continued to provide technical assistance to the now 15 KMMP sites in Kwale, Mombasa, Taita Taveta, and Kilifi Counties. Monthly technical assistance sessions which involved PMTCT support group meetings and defaulter tracing follow-ups were held in all the sites attended by the Project coordinators as well as MCH in charges. The Project supported the mentor mothers with monthly allowances, airtime for defaulter tracing as well as refreshments during support group meetings.
Community Prevention with Positives (CPwP): The Project continued to support community-based programs to reach PLHIV with a minimum package of prevention interventions and services. At the facility levels, the referral desks manned by the CHWs and the PWP advocates also assisted in giving out the messages in preparation for ART uptake. The programme supported the quarterly meeting for PWP advocates in Taita Taveta County; advocates were also sensitized on the new form for community PWP to be filled in their respective support groups and hand completed forms to the CCC sites attached to them. In Nairobi APHIAplus Nairobi-Coast conducted 18 PWP/health literacy sessions for PLHIVs in 18 different CCC.
Orphans and Vulnerable Children (OVC) Summary During the second quarter total of 159,993 OVC (80,083 male, 78,120 female) (100%) were served. Out of these 142,773 OVC (72,615 male, 70,158 female) (89.3%) received 3+ services while 17,120 OVC (8,366 male, 8,754 female) (10.7%) received 1 or 2 supplemental services. A total of 121876 OVC were reached with educational support services and vocational skills training, 89,207 OVC accessed health services in level 1 and level 2 facilities. Child protection information and services were provided to 95,864 OVC and CHWs continued with home visits offering PSS services to 142,594 OVC and their caregivers.
1. OVC Child Testing During the period under review, the OVC program was able to reach 2,632 OVC with HIV counseling and testing services. A total of 10 children tested positive and were referred to health facilities for care and treatment. Also, during this period, there was a shortage of test kits nationwide resulting to many OVC who turned up not getting tested.
2. Strengthening Orphans and Vulnerable Children (OVC) Support Groups A total of 162 OVC support groups comprising of 3,693 OVC (1,699 male, 1,994 female) were strengthened through regular monthly supportive meetings in collaboration with MOH. The topics covered during the support group sessions included drug adherence, disclosure, proper nutrition, PwP, RH/FP, PEP, personal hygiene. The counseling sessions also helped to improve self-esteem and positive living.
The Project also supported OVC in support groups with food rations to boost nutritional requirements. Using the Journey of life Manual (JOL) to elicit discussion, 67 OVC from IDEWES and 35 in HAKISHEP support groups were sensitized on coping mechanism after death of loved ones. Parent clubs for HIV positive OVC continued with VS&L and SILC activities which have enabled them to have income for providing of basic needs for their households.
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Support groups sessions for caregivers of OVC with disability During the quarter, 11 groups of caregivers of OVC with disabilities held 108 sessions to promote sharing of challenges and how to improve their services to the OVC. This has fostered oneness and shared responsibility over their children. The 226 caregivers attested to understanding the multi-disciplinary approach to successful rehabilitation in disability management thus involvement of different professionals. Members are engaged in VS&L bead work, soap making and poultry keeping which generate income to support the OVC with basic needs
HIV/TB Integration– Intensive Case Finding sensitization TB is often the first opportunistic infection in PLHIV. It is the leading killer of HIV infected individuals and may also accelerate progression of HIV infection to full blown AIDS. For this reason, TB-ICF among PLHIV is an essential intervention required to reduce the burden of TB among them. Consequently, 28 CHWs from Mathare 3 and 4 units were sensitized after it was noted that there were high incidences of TB in the area. Congestion in the area was identified as a key barrier to curbing the increased incidences. As a way forward, the CHWs organized to conduct a one week door-to- door sensitization on TB. During the sensitization, 6 new cases were identified and for treatment.
Social Mobilization for National Health Events-World TB Day Events
The Project worked closely with CHMT, MOH and other stakeholders in all the Counties to organize for pre-world TB day events. This entailed edutainment, TB screening. In Mwatate, 80 people were counseled, tested and issued with results. In Mombasa, TB School Health talks were conducted in 18 primary schools from Mvita and Kisauni Sub-County (16 primary schools and 1 secondary school). The school health talks were conducted by 12 Public Health Officers, supported by the APHIAplus BCC Team. Total reach was 4,210 children (2,122 Boys, 1,992 Girls) and 96 teachers. Photo: 3: World TB Day Commemoration Event Growth monitoring, De-worming and Vitamin A supplementation The Project supported MOH in undertaking nutritional screening and growth monitoring activities, reaching a total of 1,359 OVC. A total of 4,294 OVC under five years of age were dewormed, 2,499 were supplemented with vitamin A and 2,569 were growth monitored in community growth monitoring outposts. 380 OVC who were found to be malnourished were enrolled for supplementary feeding in health facilities. Though there has been a persistent shortage of supplementary food in health facilities, the project has continued to collaborate with other partners in providing food supplements 207 ECD centres were supported and contacted health screening of OVC including immunization, Vitamins A supplementation, de-worming and treatment of Minor illnesses.
Community Outreaches Community outreaches are interventions initiated to address economic and geographical barriers for vulnerable communities not able to access health services. During the quarter 54 community outreaches were conducted and reached out to 3,408 people (1,390 men and 2,017 women) in 35 CUs. A total of 160 service providers offered variety of integrated health services. For effective mobilization 356 CHWs and CHC members actively assisted in growth monitoring, health education sessions, community, administering VIT A and de-worming as well as treatment of jiggers. During the session 5,510 IEC materials and 2,075 male condoms were distributed by CHWs and CHC member.
A total of 3,600 CHWs and CHC members were oriented on livelihood initiative contact farmer replicated this to 44,248 household initiating IGA. This resulted in 23 household setting kitchen garden and 4 homes initiating local poultry farming to Photo: 4: CHEWs attached to Mtwapa health centre (Shimo supplement nutrition for affected children. This intervention la Tewa c.u), assist facility staff take weight of <5s in a community outreach held in Barani village. Close working relationship between the cu and facility has increased USAID-APHIAplus Nairobi-Coast Health Service Delivery Project Q2, 2014 Report Page 33 access to quality health services
translates to increased nutrition value to their household and surplus production sold on the local markets improving health outcomes and reducing social economic vulnerability.
Youth Friendly Services (YFS): Strengthening YFS at community and facility levels The Project continued to increase demand for Youth Friendly Services (YFS) by supporting facility based youth resource centers in nine (9) GoK sites in Coast. The Centers attracted adolescents and youth between the ages of 10-24 years. In Kilifi County, youth resource centers received 1,030 (608 male, 422 female) youths aged 15 and 24 years. Among them, 626 (281 male, 345 female) participated in health talks, 244 (78 male, 146 female) received HTC services and 123 females were screened for cervical cancer.
In Mombasa, the youth resource centre’s at Port Reitz hospital and Mlaleo CDF Clinic have so far linked 58 (12 male, 46 female) adolescents Living with HIV (AYLWH) to the Comprehensive Care Centres (CCCs) for HIV care and treatment. Among them, 24 (7 male, 17 female) are in Port Rietz hospital, 15 (2 male, 13 female) are in Mlaleo CDF clinic Annex Dispensary while 21(5 male, 16 female) are in Shimo Annex dispensary. In Kwale County, the youth centre’s in Tiwi and Magondzoni health centres as youth CBOs linked to health facilities in Kwale, Kinango and Diani referred 237 (116 male, 121female) youth for HTC services, 105 (67male, 38female) for RH/FP services and 29 (19male, 10female) for STI screening and treatment. All of them were reached during small group communication sessions using Shuga movie and facilitation guide. In Taita Taveta, 1,208 (952 male, 728 female) visited the Sagalla and Njukini youth resource centers. 78 (40 male, 38 female) among them received HTC services.
Nairobi County a total of 3,277 young people (635 male and 2,642 female) accessed various health services vie youth desks at Dandora II, Kangemi, Kasarani, Mathare North and Mukuru Rueben health facilities.
Involvement of men in MNCH Male champions meetings were held in Taita Taveta and Malindi aimed at ensuring that male figures take roles in health matters especially on RH/FP. Men CHWs were at the fore-front in identifying their peers to come out for the orientations. At the facilities, expectant mothers were asked to bring their partners during clinics. Those with partners were given the first priority as a way of encouraging them.
Community based distribution: Youth Peer Educators and Community Health Workers (CHWs) continued to build their peers knowledge and skills on correct and consistent condom use. This is aimed at promoting safer sexual practices, lowering early and unplanned pregnancies among the youth as well reducing HIV and other STI infections. They also distributed condoms during peer led small group sessions conducted in the community. The total number of male condoms distributed was 91,340 (Kilifi and Lamu 69,000, Mombasa 8,000, Kwale 4,800 and Taita Taveta 9,540). mHealth Pathfinder International’s mHMtaani project is facilitating improved health outcomes and data transfer at the community level through the use of a CommCare mobile phone application, coupled with a pay-for-performance scheme with payments initiated by MPESA. mHMtaani utilizes CommCare to monitor the health of pregnant mothers, as well as orphans and vulnerable children (OVC) in Kilifi County, Kenya. Through funding from NetHope and Visa, Pathfinder is integrating the use of performance metrics to drive performance-based payments that are delivered to Community Health Workers (CHWs) via MPESA. To date, 218 CHWs are actively using the application. As of June 2014, 1,725 clients were registered in the application for active follow-ups. In May 2014 alone, a total of 413 OVC were registered in the application; of which 118 were the head of households. From the HMIS reporting form since the start of the project, CHWs reported conducting 3,419 household visits; 313 post natal care visits within 48 hours of delivery and 973 women counseled and referred for family planning services.
Malaria Prevention The Project has continued to focus on interventions to increase access to the number of families sleeping under ITNs from 121,779 reported last quarters to 123,305 household this translated to 1,526 new purchases and use of ITNs. A total of 16 CHWs group have initiated ITNs sale as part of their IGA with Mtogwe CHWs group being nominated by PSI to be the regional ITNs distributor in coast region. The group reported to be distributing over 25,000 nets to willing CHWs CBO and other community distribution agents. During CHWs household visits 356 suspected malaria cases were identified and clients referred for treatment at the nearest health facilities.
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3.1.3: SUPPORT TO COMMUNITY STRATEGY: The Project has continuously supported the MOH to roll out and enable functionality of 86 out of 168 community units formed in coast region. During the reporting period the project supported MOH build capacity of 3,600 CHWs, 790 CHC members and 75 CHEWS by supporting this community structures hold monthly review meetings. The project builds the capacity of these structures to become strong, self-sufficient entities capable of organizing constituents and catalyzing social change. The Project also supports community units to facilitate microcredit groups for caregivers of orphans and vulnerable children, and for other marginalized groups. Reflecting their potential to catalyze change, APHIAplus Nairobi- Coast supported registration of this structure as community-based organizations (CBOs), thereby broadening their scope and enabling them to independently generate income. To further foster sustainability, the Project supports training of key members of community units on proposal development and other income-generating activities, enabling units to pursue independent funding. Nine units were paid monthly allowances as part of support for community strategy.
Community Health Dialogue Days A total of 214 community dialogue days were held with 19,894 members (7,453 males, 12,441females) attending the sessions. During the ending quarter the topics of discussion focused on diarrhea and its prevention, compound hygiene in prevention of malaria and family planning. In Mombasa, Kilifi and Kwale counties SACCO sensitization meeting were mainstreamed during dialogue session with the essence of building capacity of community to save and access to loaning facilities.
Photo: 5: CHEWs from Kwale County taking care of jigger treatment to this young citizen. The right photo showing the effect of jigger manifestation to these small children Community Outreaches Community outreaches are interventions initiated to address economic and geographical barrier for vulnerable communities not able to access health services. These services are advocated for by CHC members after community dialogue days targeting key health issues affecting their community. During the ending quarter, 67 community outreaches were conducted and reached out to 8,326 people (3,106 men and 5,220 women) in 67 CUs in coast region. A total of 201 service providers offered variety of integrated health services. For effective mobilization 578 CHWs and CHC members actively assisted in growth monitoring, health education sessions, community, administering VIT A and de worming as well as treatment of jiggers. During the session 47,648 IEC materials, 2,338 ITNs and 3,905 condoms were distributed by CHWs and CHC member. Other development partners have come in strongly to offer technical and financial support for these activities – a step toward sustainability.
Household Visits and Referrals- The household dialogues are conducted by CHWs where they engage with the 50000 communities in the processes of assessing their health 40000 situation, and to dialogue with them on causes and current 30000 actions in order to identify gaps that may require additional 20000 knowledge and skills and thus improve health practices and 10000 therefore health status. 0 Total # of H/H During the ending quarter a total of 48,531 Households were Visits visited by 3,202 CHWs and 780 CHC members with health Total # of messages reaching out to a population of 192,723 people Referrals (77,313male, 115 410 female). A total of 16, 445 clients Figure 16: trends showing increase in CHVs h/h visits and clients’ referred for health services
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were referred for health services and 55,100 male and female condoms were distributed in 87 sites supported by APHIAplus Nairobi-Coast project. Main issues focused on during household visits were malaria prevention, immunization, safe water usage, safe deliveries under skilled birth attendants, use of ITNs, and latrine usage. Kitchen gardens for nutrition were advocated for to reduce malnutrition. Lamu County reported low attendance during household visits due to insecurity.
A+ Mtaani Project Performance-Key CHIS indicators
160000 139535 142726 142726 140000 121779 123305 124382 120000 Total # of household 90178 91530 91737 100000 # of H/H sleeping 80000 under ITNs
60000 # of H/H with functional latrines. 40000 # of H/H with hand 20000 washing facilities 0
Figure 17: A+ Mtaani Project Performance-Key CHIS indicators
The household referrals stimulated 5% increase in the number of households sleeping under ITN from 123,305 to 124,382; this was attributed by the efforts of the CHWs in awareness creation during their regular household visits. Latrine coverage increased by 3% from 91,530 household reported in the preceding quarter to 91,737 households this quarter. There was remarkable increase in the number of household initiated hand washing facilities from 72, 565 to 74,402 as a result of the dialogue sessions which was the theme of the quarter. As a result of this initiative there were reduced diarrhea and Malaria cases in the sites with community units.
CHWs, CHC member and CHEWS Monthly Review meetings- The CHWs structure is the pivot of the community strategy interventions and the monthly CHW review meetings enhance the bond between the CHWs and the CHEWs. This forum provides a platform for sharing successes, best practices and the challenges they encounter in their support to communities. Total of 3,202 CHWS representing 1,376 men and 1,826 women attended monthly feedback meetings in 86 Community Units. The CHWs shared their achievements since they volunteered to support the community strategy. Many positive experiences were cited and most of the members were proud that they could advocate for better health services in government hospitals.
CHWs in Ng’ombeni CU of Kwale County reported that the kitchen gardens were doing so well and that they donated some vegetables to mothers of underweight children to boost their nutrition. In Chitsanze CU, the urban Kitchen garden at the Kwale Hospital is a centre of attraction for client coming into the facility to seek health services. The clients on MCH as well as hospital staff have been impressed and have been taking lessons from the technology to replicate at their households. In Ndavaya CU tomatoes, Sukuma wiki (Kale) and “Mchicha” seedlings were transplanted on the sunken beds, while the maize in the minimum tillage plots and Zypits were doing very well.
CHEW Review Meetings; CHEW review meetings are held quarterly to share CU progress reports with a purpose of reviewing implementation strategies. A total of 10 meetings were held and attended by 6 CPHOs, 9 County Focal Person for CS and 297 CHEW from respective 96 health facilities. Progress reports from the CUs, targets and indicators for AOP, reporting tools, roles and responsibilities for CHEWs were among the issues discussed. The CHEWs praised the efforts of
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the CHWs/CHC members in the measles, “Malezi Bora” Day, polio and Dengue disease campaigns for their support during mobilization. The CHEWs acknowledged receipts of 45 community chalk boards which were part of project support to the community units. All CHEWs were aware of the livelihood activities going on in the CUs especially the demonstration plots for conservation Agriculture which were challenging the conventional agriculture and pledged to continue supporting this new technology.
Growth Monitoring, De-worming and Vitamin A Supplementation OVC were reached with health screening and growth monitoring activities in collaboration with MOH. Children diagnosed with severe malnutrition were referred to GoK facilities for further therapeutic management. In collaboration with MOH 8,300 (3,910 male, 4,390 female) under 5 years of age OVC in ECD centers were growth monitored and dewormed out of which 1,057 (475male, 582 female) were given vitamin A supplement. CHWs sensitized the caregivers on barriers to good nutrition and encourage them to ensure children received all recommended immunizations. A total of 1,277 caregivers were reached with nutrition education.
Caregivers Sensitization on Disability Mainstreaming A one-day sensitization for caregivers to OVC with disabilities was conducted on issues of disability mainstreaming in which 253 attended. The aim of this training was to create awareness on how to link caregivers living with physically and mentally challenged OVC to The National Council for Persons with Disabilities (NCPWD). The training covered the following areas; Process of registration for persons and children with disabilities, groups’ registration and services offered to groups which include; economic empowerment (revolving funds and loans), building classrooms for challenged children and eligibility for cash transfer which is only for persons with severe disability
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.3.2: INCREASED DEMAND FOR AN INTEGRATED PACKAGE OF QUALITY HIGH-IMPACT INTERVENTIONS AT COMMUNITY AND HEALTH FACILITY LEVELS. Continuous sensitization was done to schools previously supported with hand washing vessels to promote healthy behaviors. Trained CHWs have continued to sensitize OVC caregivers on the importance of using pit latrines and the dangers of open defecation. They have also been sensitized on the importance of using soap for hand washing reaching a total of 62,764 children. A total of 80 pit latrines have been constructed through such health campaigns. Additionally, 340 child rights clubs that were supported in schools helped in reaching pupils in their respective schools with messages on hand washing and environmental health.
In and Out of School Youth
Adolescent Reproductive Health (ARH) Project The Kenya Adolescent Reproductive Health Program (KARHP) which targets in-school youth commenced this quarter. This is a Program that equips in-school girls and boys with positive and sustainable life skills and health information including HIV/AIDS and reproductive health and is implemented by Kenya Girl Guide Association (KGGA). KGGA conducted refresher training for 31 teachers and 2 young leaders in April 2014 at Kenya Girl Guides grounds. The goal of the training was to equip the guide and young leaders with knowledge and skills on guiding and life skills so that they could refresh the units in their schools. The total number reached was 10,612 (5,864 Girls, 4,748 Boys) aged10-14 years.
The program is implemented in 115 selected schools in Nairobi, Mombasa, Kilifi, Kwale and Taita Taveta counties. They were reached through small group peer education sessions using the KARHP peer education curriculum. The sessions were facilitated by girl guides with the support of guide leaders. The sessions were aimed at reaching the youth with comprehensive information on how to delay sex debut and how to practice it safer. Monitoring visits were made to all the schools to ensure that quality is adhered to and offer technical support to the Guide Leaders and peer educators. Fifty four guide leaders were also oriented on the revised reporting tools.
Healthy Choices for a Better Future The Project implemented Healthy Choices for a Better Future (HC11), an Evidence Informed-Behavioral Intervention (EBI) that targets and promotes delayed sexual debut and safer sex practices among 13-17 year old youths. It aims at reducing early pregnancies and STIs. It was implemented in Mombasa and Kilifi Counties and reached a total of 1,774 (686 male, 1,088 female) youths between the age of 10-19 years. The program covered eight modules that are conducted in four two hour sessions and which address among others decision making,
“I have never been able to interact with facilitators who could teach us so openly, especially using condom and I was surprised also to see female condom for the first time. I am now in a position to negotiate with my boyfriend and at all times will use SWAT technique as my defense to protect myself against contracting STI, HIV and unplanned teen pregnancy,” Jane
“In our religion and at home, issues to do with sexuality are taboo to be taught to females. Last year my Older sister was who was in form three was impregnated because she didn’t know how to protect herself. But now I know how to say no to sex and how to protect myself, thanks to Healthy Choices. I will teach my fellow peers who are not privileged to be in such a class,” Madina communication, negotiation and refusal skills. Among those reached were OVC and Adolescents Living with HIV (ALWH). The ALWH were reached during the clinic days when they visit the CCCs for treatment. During the quarter, 1,127 young people (540 males and 587 females) completed all the eight modules of Healthy
Choices II.
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Shuga Screening and Small Group Sessions During the quarter, youth Peer Educators and CHWs continued to reach the youth between the age of 15-24 years with prevention messages through small group sessions using the MTV Shuga movie and facilitation guide; 2,918 (1,591male, 1,327 female) youths aged 15-24 years. This was after they participated in and completed a minimum of five (5) Shuga screenings (episodes) and engaged in small group discussions. The sessions addressed multiple concurrent partnerships, correct and consistent use of condoms, personal risk perception, stigma and discrimination against PLWH, transactional sex, gender based violence, parent child communication and alcohol use and abuse. Among those reached were OVC and Adolescents Living with HIV. New Shuga facilitators were oriented on the new tool kit while the old facilitators were refreshed on the same. The one-day orientations and refreshers were facilitated at the CBO level by Project staff reaching 114 (50 male, 64 female) peer educators in Kwale and Kilifi Counties. This was done in an effort to address the high attrition among the Shuga facilitators due to youth mobility. Use of the new tool kit has improved the quality of sessions leading to increased uptake of SRH services among the target group.
Education Through Listening: Youth 15 – 24 years Peer led small group sessions were conducted in Taita Taveta, Kwale and Lamu Counties using Education through Listening (ETL) facilitation methodology. The total number of youth reached aged between 15 and 24 years was 6,868 (3,322 male, 3,546 female). Among them, 2,252 were between the ages of 15-19 years while 4.416 were aged 20 - 24 years. These sessions took place in the community and were facilitated by youth peer educators and CHWs. They addressed condom self-efficacy, concurrent sexual partners, and knowledge of HIV status as well as promotion of health services among the target audience.
Families Matter! Program This is an Evidence Informed Behavioral Intervention (EBI) that targets parents or caregivers of 9-12 years old pre- adolescents. It equips them with knowledge, skills, comfort and confidence to discuss Sexual reproductive health issues with their children. The total number of caregivers who completed the five (5) small group sessions in Coast counties was 917 (177 male, 740 female). During the fifth and last sessions the caregivers were joined by their pre-adolescent children and practiced parent child communication focusing on SRH issues.
The program was implemented within Community Units in informal settlements and rural areas in Mombasa and Kilifi Counties. Among those reached were OVC caregivers and PLHIV support group members. During the reporting quarter, Nairobi County saw 756 parents/guardians (78 male & 678 female) reached through the Families Matter! Program. Additionally, 756 children (328 male & 428 female) attended the fifth parent- child communication session with their parents. This allowed the parents to practice the communication skills they had learnt in the previous sessions. Below is feedback from one of the parents who attended an FMP session;
“Teaching children from my point of view was a women’s affair. Participating in the program has made me learn to actively get involved in my children life. Unfortunately I was the only man in the session, but enjoyed the sessions and will mobilize other men to also get involved in the great process, said Peter.’’ Some of the FMP facilitators who are also Community Based Distributors of Family Planning distributed family planning pills to 28 female parents/ guardians and referred 22 clients for the long term methods. They also distributed 518 male & 100 female condoms after the sessions
Outreaches to Primary and Secondary Schools Youth CBOs were supported to mobilize caregivers within Community Units (CUs) with an aim of encouraging the knowledge of the HIV status of their children especially OVC. This mobilization took place during the April school holiday in Chaani CU in Mombasa where an integrated outreach was conducted. In total, 200 children were mobilized out of whom 98 received HTC services, two (2) tested positive and were linked to the CCC at Port Rietz hospital.
Integrated Outreaches: Schools that were supported with 340 hand washing water vessels continued to use them effectively, promoting adoption of hygiene among the pupils. Child health clubs helped in reaching pupils with messages on hand washing, personal hygiene and environmental health. OVC and their caregivers received messages
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on healthy behaviors such as washing hands with soap, use of pit latrines and clearing the bushes to reduce breeding of mosquito. A total of 43 pit latrines were dug and are in use, changing the behavior of the community from open defecation practices. In collaboration with BCC component, 85 children in child rights clubs in Mombasa and Kwale counties were trained on Healthy Choices, and certified. The Kisauni child rights club benefitted from linkage with Unilever Kenya who donated soaps and other items to the children. They also took them through the school of five hand washing technique, to ensure proper hand washing, cleanings of school compound, and digging of rubbish pit and its proper use.
INTERVENTIONS WITH KEY AFFECTED POPULATIONS APHIAplus Nairobi-Coast continued to support local implementing partners and Key affected populations –led groups through Pathfinder Implemented Projects (PIPs) to carry out activities aimed at increasing access to quality health services, products and information by the Key Affected Populations in Nairobi, Mombasa, Kilifi, Kwale and Lamu counties. The Project provides services to the key populations using the combination prevention model through peer education and outreach program.
Female Sex Workers (FSW) During the April–June 2014 quarter, the Project worked with FSW peer educators and reached total 3,549 FSW, of which 1,454 were new FSW with individual and small group level sessions. 102 FSW were taken through Sister to Sister EBI in Nairobi. Through the Sister to Sister motto- “Respect Yourself, Protect Yourself because You Are Worth it”, the sex workers understand their feelings of personal vulnerability and now have techniques of negotiating with their partners on condom use and making condom use fun and pleasurable. One of the sex workers had this to say after the Sister to Sister session- “This is the best method ever for convincing our clients/partners to use a condom, if you watch the videos; you will never have unprotected sex again” A total of 2,574 FSW (1,287 Coast, 1,287 Nairobi) accessed HTC services in the drop in centres and during moonlight outreaches, 163 tested HIV positive. Those who tested HIV positive were referred to various facilities for care. A total of 325 accessed cervical cancers screening and 528 accessed various FP services. A total of 374 male and 509 female KAP and their clients accessed STI screening and treatment.
Men who have Sex with Men and Male Sex Workers (MSM/MSW) During the second quarter, 2,660 MSM were reached with individual and small group level sessions. 1, 224 were new peers. Four hundred and seven (407) accessed HTC services and nine tested HIV positive. A total of 79,123 water based lubricants were distributed to MSM. There is a rise of Ugandan MSM in HOYMAS Pangani DISC due to anti-guy laws in Uganda. A total of 1, 082, 456 male condoms, 14,593 female condoms were distributed to FSW and MSM during the months of April, May and June 2014 in the project areas.
People Who Inject Drugs - PWID’s & People Who Use Drugs - PWUD’s A total of 1,743 PWUD (1,209 male and 535 female) and 740 PWID (578 male and 162 female) were reached with behavioral or harm reduction messages and information during the quarter through DISC and injecting dens. New PWID clients were 79. The number of women accessing services at the DISC improved from the previous quarter as a result of aggressive mobilization by the outreach workers. A total of 488 PWU/ID accessed HTC and 22 who tested HIV positive were linked to treatment. Eighty eight (88) PWU/ID was assisted with nutrition support. During the quarter MEWA started 49 PWUD on withdrawal treatment and 9 clients completed detoxification treatment. Reachout Centre enrolled 30 male drug users into the Half Way House as part of the three month re-integration process. The table below is a summary of harm reduction commodities distributed to the key population through peer educators, outreach workers and DISCs. Male Condoms 1,609,056 Female condoms 14,593 Water-based Lubricants 34,061 Alcohol patches 99,684 IEC Materials 19,115 Distilled water vials 99,684
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Bleach packets 99,684 Cotton sachets 99,684
Matatu Drivers and Touts During the quarter, a total of 1, 015 Matatu Operators were reached with individual and small group level sessions conducted at major Matatu stages in Mombasa County by APHIAplus Matatu Operators Initiative (AMOI).
Other Structural Interventions for Key Affected Populations For the period under review, Master Facility List Codes were granted to the ReachOut Centre DISC in Ukunda and ICRH- K DISC in Ukunda. This means that activities of the two facilities will be reported to the KDHIS directly and ensure closer supervision and linkages with respective County and GoK agencies and departments. The Project supported twelve drop in service centres (DISC) in for use as safer spaces and provision of biomedical and behavioral services to the key populations. The DISCs are 2 for MSM/MSW, 3 for FSW managed by ICRH and BHESP and 7 for PWU/ID run by ROCT, OMAR, SAPTA and MEWA.
APHIAplus Key Affected Populations LIPs (MEWA, ROCT & TOP) actively participated in the World Anti-Drug Day fete that was celebrated on 26th of June 2014 conducted in various locations in Mombasa and Kilifi Counties. The LIPs participated by mobilizing for and providing HTC, provision of commodities like t-shirts (which was funded outside APHIAplus Nairobi-Coast funding stream) and IEC materials.
RESULT 4 – SOCIAL DETERMINANTS OF HEALTH ADDRESSED TO IMPROVE THE WELL-BEING OF TARGETED COMMUNITIES AND POPULATIONS
4.1: MARGINALIZED, POOR AND UNDERSERVED GROUPS HAVE INCREASED ACCESS TO ECONOMIC SECURITY INITIATIVES THROUGH COORDINATION AND INTEGRATED WITH ECONOMIC STRENGTHENING PROGRAMS.
4.1.1 Voluntary Savings and loans (VS&L) and SILC During the quarter, 10 633 OVC caregivers (7,580 in Coast and 3,053 in Nairobi) in 738 VS/L/SILC groups continued to be strengthened through support supervision by trained TOTs during their monthly meetings. The caregivers have been empowered economically through savings and borrowings, expanding their businesses. This has enabled the caregivers to provide for basic needs such as food, health and education for their households. In coast, caregivers in VSL/SILC groups have managed to cumulatively save Kshs 14,625,802 and borrow Kshs 13,017,135. In Nairobi County the caregivers saved Ksh.6, 739,700 during the reporting period. Follow up visits to 768 OVC households previously supported with IGAs capital boost have indicated improved businesses for caregivers. The IGAs supported by the project included livestock rearing, crop farming (vegetables, maize and beans) cereals and cooked food vending in the villages, fruit vending, soap making, tailoring and dressmaking. The numbers of caregivers of children with disabilities engaged in economic strengthening activities increased from 45 to 92 in the quarter. The activities included; VS&L, soap making, beadwork and poultry keeping.
Table 13: VSL/SILC Quarterly Summary Cluster Total membership No of groups Cumulative savings (Kshs) Cumulative value of loans (Kshs) Lamu 435 33 515,080 882,220 Kaloleni 522 25 170,662 39,186 Mombasa 1,072 107 1,033,269 1,224,963 Malindi 921 52 2,113,123 1,532,253 Upper Kilifi 1,292 81 3,183,650 1,006,385 Lower Kilifi 2,002 144 4,127,218 2,463,100 Taita Taveta 801 48 2,252,800 4,134,101 Kwale 761 55 1,230,000 1,734,927 Nairobi 3795 255 9,721 269 26, 523,665 TOTAL 11,601 800 24,347,071 39,540,800
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Photo: 6: Clockwise: James at his food vending kiosk. Sicily at her chips kiosk in Kiambiu. ECD Centre in Kiambiu managed by two members of Jikaze VSL group. They were able to purchase extra desks and they are catering for 100 children up from the 40 they had before they joined VSL. Khadija at her water vending kiosk in Kiambiu
Aflatoun Fourteen (14) teachers trained on Aflatoun continued to train pupils in clubs using the booklets issued by the project. The pupils sensitized on this savings methodology have been reported to have improved their savings behavior and responsibility in ensuring proper usage of the available resources. Additionally, the project supplied Aflatoun manuals to 25 schools to guide the children plan, save and manage their funds.
Livelihood Partner’s Forum;- During the quarter a total of 10 livelihood stakeholders’ forums were conducted in 5 counties of coast region. These attracted 319 people (193 men and 126 women) from 34 development partners. Representatives included the ministries of health, agriculture, livestock, fisheries, water, and some chief officers from the county governments. Others were Kenya Red Cross, Coast Development Authority, Kenya prisons, Aga khan Foundation, Plan International, Offices of the Members of County assembly, Department of youth, office of the registrar of births, office of gender and social development, Kenya Bixa Ltd, Base titanium Limited. The CUs and the partners were able to find clear opportunities for collaboration, and they all documented them. Equity bank pledged to train CHWs and Contact farmers on commercial trading encouraging them to use tractors and other large scale faming machinery. World vision indicated that they are doing training on livelihoods to groups within Changamwe Sub County to promote livelihood and sustainability among households. Ministry of youth affairs through the UWEZO fund loans to support and assist youth groups and farmers groups in proposal writing and business startup.
Support of CBOs and linkage to MFI During the ending quarter 672 community groups were linked to microfinance institutions which included 35 farmers groups that registered as CBOs representing the entire community. The famers groups are key beneficiaries of the initiative as most of them were capacity built by CHWs to initiate SILC program in their groups.
Implementation of livelihood activities in the HHs- Livelihood activities have continued to take place in the community units since the integration of initiatives to address social determinants of health through empowering contact farmers, facilitating IGAs at household levels, linking CBOs to microfinance, training OVC and PLHIV caregivers, linking TBAs to microfinance institutions and training them on urban kitchen gardens, among other interventions. As regards technical support by contact farmers, at least 956 farmers’ dialogue sessions were recorded to give technical advice on food production, as well as additional 16,056 household visits by CHWs and contact farmers to share key health information and referrals to enhance the health aspect of livelihood wellbeing.
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Below in a chart showing livelihood activities imitated by member of CUs for H/H economic strengthening
FIGURE 18 : LIVELIHOOD ACTIVITIES IMITATED BY MEMBER OF CUS FOR H/H ECONOMIC STRENGTHENING The CHW groups are the most vibrant structures within the CUs in the CHS context. As a result of the IGAs initiated the household members are able to earn income to enable them to access family health services and education bills. There was remarkable improvement in farming technology as most household visited by CHWs and Contact farmers used certified seeds and fertilizers during planting which translated to increased farm produce. Mobilization and sensitization efforts of CHWs and Contact farmers resulted in recruitment and registration of identified vulnerable members in the cooperative societies.
Amounts in KSH
18000000 1765628517723837 17500000 17000000 16353805 16500000 16000000 Amounts in KSH 15500000
4.2: IMPROVED FOOD SECURITY AND NUTRITION FOR MARGINALIZED, POOR AND UNDERSERVED POPULATIONS
4.2.1: Caregivers’ sensitization on barriers to good nutrition In collaboration with MOA and MOH 1,277 OVC caregivers were equipped with knowledge in nutrition education such as eating a well-balanced diet at a lower cost; utilization of traditional high value foods in their diets; proper storage, cleaning and preparation of foods.
4.2.2 Improved food security for OVC households In collaboration with MoA, OVC caregivers were sensitized on best farming methods such as suitable livestock, right insecticides and appropriate farming methods for semi-arid areas, harvesting rain water in water pads and planting drought resistant crops. The farm produce include; millet, maize, rice, green grams and cowpeas and excess produce is taken to the markets.
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Photo: 7: OVC caregivers united to prepare and clean the harvested crops for storage
4.2.3 Food support for targeted OVC Through linkages with partners such as Catholic Diocese of Mombasa, Action Aid and World Vision, 27,943 OVC were supported with food during the reporting period (14,130 coastal counties and 13, 812 in Nairobi). The supplies included; Unimix for under-5, rice, maize flour, beans, Ndengu and cooking oil.
A close collaboration with MOH saw a total of 1,037 OVC below 5 years in coast provided with nutritional supplements (unimix, vitamin A). This resulted to a reduced risk of malnutrition, improved school attendance and improved health status. A total of 48,639 OVC (24,675male, 23,964female) were reached through food and nutrition education services.
To improve the care and support provided to children living HIV, 50 (9 male and 41 female) Caregivers from KENWA have been reached with information on proper nutrition through demonstration on how to prepare a proper and balanced meal at affordable cost. 4.2.4: Contact farmer’s feedback meeting Contact farmer’s feedback meetings are platforms for farmers to share progress report, best practices, new innovation and technology in agriculture. During the quarter contact farmers continued to hold dialogue sessions with their respective farmers groups to share topical updates and address issues affecting them. Strategies and intervention initiated by these partners included support of contact farmers with certified seed and fertilizers. However, support on farming technology was spearheaded by the county branches of KARI and agricultural offices.
During the period 65 Contact farmers’ feedback meetings were held, with a total of 3,692 farmers (1,846 male, 1,846 female) attended the meetings representing 1,650 farmers groups. Contact farmers report improvement in record keeping after members had been oriented in book keeping. More training are being conducted by the line ministries and other partners as the CU act as entry points to the community. Lower Mwachabo CHWs were inspired and support OVCs by donating 400kgs of Maize; 200 kg sweat potatoes and 200kgs of Green grams to Kamtonga Primary school from their livelihood program. This prompted the head teacher to lease out 5 acres of the school farm to the contact farmers so that they can use it for farming.
During the ending quarter 56 contact farmers were taken for 3 days sensitization training by Farm Concern International on cassava planting. Contact farmers reported sensitization meetings for contact farmers to register in the formed SACCO and cooperative societies to enhance their capacity access farm input and negotiate for better prices of their farm produce. In Lamu County, all the contact farmers were given cotton seeds to distribute to the farmers groups to revive cotton production. A total of 2,400 acres of land have been prepared for maize production, 800 acres for cotton, and 600 acres for cow production. In Kwale County, the contact farmers used the feedback meeting support to attend to their demonstration gardens on new technologies in Agriculture, especially in Sega, Vitsangalaweni, Ndavaya,and Vyongwani CUs.
During this season farmers do experience high mortality rate in poultry due to diseases. Many farmers reported death especially of chicken due to disease outbreak of New Castle. Early vaccination was suggested as a way to cub the disease.
4.2.5: Contact farmers and CHWs Orientation on New agricultural technology
(i) Conservation agriculture and farmer’s demonstration plot. Agricultural technology is the key to unlocking agricultural production, especially in the rain deficient zones of Coast region. Technologies such as Conservation Agriculture, Zypit gardening, sunken beds, fertility trenches, basket farming, double digging, and gunia gardening.have to be trained, emulated and nurtured to enhance food production. Apart from just trainings, the Project embarked on an initiative to set up several demonstration plots where such new technologies were practiced, to avail an avenue for case studying, and field days for other farmers to learn practically and replicate on their farms. During the quarter, a total of 24 training sessions on new agricultural technologies were supported, via the involvement of Ward Agricultural Extension Officers, and therefore 24 demonstration plots were set up as well. The sessions brought together at least 475 participants (260 male, 215 female) representing 240 farmers groups.
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In the spirit of integration, the participants mainly included contact farmers, but also accommodated CHWs, TBAs, OVC caregivers and support group members for people living with HIV and AIDS. Most farms practiced minimum tillage techniques, cover cropping, rotational planting, minimum use of herbicides and fertilizers. In other areas, especially those experiencing extreme dry conditions, they practiced Zypit gardening, sunken beds and double digging. In the urban setting, the technology used was mainly gunia gardens and basket farming. From this initiative 9,000 acres of land was prepared and attended by 3,692 contact farmers with an estimated harvest of 9,500 tons of maize. The contact farmers’ shifted focus on conservation agriculture way of farming with aim to improve production while conserving the environment.
PHOTO: 8: CONTACT FARMERS PREPARING CONSERVATION AGRICULTURE DEMONSTRATION PLOT IN TAITA-TAVETA COUNTY
(ii) Fish Food Production Training. The objective of the training was to equip contact farmers with knowledge on fish feed production in order to minimize speeding on the ever rising fish feed prices. Topics covered were introduction to fish farming, pond management, fertility of pond, proper feeding of fish, fish feed formulation and feed classification. (iii) Training on balcony farming/micro gardening/urban farming A total of 8 CUs were supported to set up demonstration plots on urban Kitchen gardens at Shonda, Shella dispensary, Kwale District hospital. The Demo training at Chitsanze CU involved 10 TBAs and 10 Contact farmers. The TBAs involvement was a strategy to influence pregnant mothers and their husbands, together with mothers of children under the age of 5 years, to emulate the technology and set up kitchen gardens with stocks of vegetables for nutritional supplementation. By the time the kitchen garden was complete, several people, including nurses and other hospital staff, were requesting to be taught the technology so that they can set up their own gardens at home.
Photo: 9: photos showing (left) the county coordinator Mr. mohamed Mwachausa admiring the urban kitchen garden at Kwale hospital, while (right), the coordinator briefs the nutrition assistant, who is also a CHW and a TBA, on how to influence pregnant and other TBAs to emulate the technology
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(iv) Producer Organization Exchange Visits The purpose of this activity was to expose the producer organization members to other well run organizations to learn best practices in management and also production. In Kwale county producer organizations were taken for exchange visits, namely Wakulima wa Vitendo in Sega CU and Infernet in Matuga Sub-County. The Ndavaya Producer Organization opted for KARI Mtwapa to see livestock production. The infernet farmers were taken to Sega to visit
Photo: 10: Photos showing (Left) the Prevention Technical Advisor, Mr. Mwayuli, addressing Sega farmers during the exchange visit at the Kenya Bixa Farm, Shimoni, while (Right) the County Coordinator, Mohamed Mwachausa, giving the gross margins for Bixa Farming Wakulima Wa Vitendo group and learn more about cassava farming, value addition and marketing. They learnt a lot and even got some cassava cuttings from the improved varieties of Shibe, Tajirika and Karembo for free. The Sega Group was taken for an exchange visit at Kenya Bixa, Shimoni Farmer to learn more about Bixa Farming, where the farm has 1,000 acres under Bixa and Poultry farming where the farm keeps 50,000 layers for chicks’ production. The farmers benefitted so much from the tour, and learnt that Bixa farming is lucrative, and with safeguards. The farmers resolved to embark on commercial Bixa Farming immediately, alongside their current cassava farming. Sega Farmers entered into contract with Kenya Bixa to commit 48 acres to Bixa farming and use some of the money to conduct community health outreaches in the community.
(v) Mombasa County Farmers’ Agricultural Tour During the quarter, 5 contact farmers from Mombasa County were privileged to tour 5 counties in Eastern and Central province namely: Embu, Kiambu, Kirinyaga, Murang’a, and Meru, , and. As part of the best practices learned, wherever they visited each farmer had records and they learnt that it was an everyday activity. Contact farmers learnt that a business plan was always a necessary tool before you start any business activity; it was a guide to success and to achieving success in farming business. Continuous education and training would enable a farmer to save a lot of money.
(vi) Cooperative Society Launches:- Cooperative societies are avenues for collective bargaining on access to inputs, economies of scale in production, and mass marketing and bigger bargains in selling of farm produce. These aspects are sure ways of enhancing productivity and ensuring food security in the CUs, and community at large. During the period, a total of 3 new cooperatives were launched in Taita/Taveta County by the National Commissioner of Cooperative from the Ministry of Industrialization and Enterprise Development from Nairobi. The launch was attended by 51 members composing of contact farmers, OVC care givers and CHWs involved in horticultural farming and livestock farming.
(vii) Cooperative Management Committee meetings This forum was attended by 173 elected executive members and facilitated by the county Commissioners of Cooperatives. During the meetings member reiterated that the executive officers are known by all the relevant local authorities. Members brainstormed on how to ensure that they meet their set targets in savings and membership for this quarter. In Mombasa County an accountant was to be found to reconcile the bank statements and to introduce a cashbook for the SACCO. Members reported to have recruited 2,566 members with working capital of Ksh. 2.8 million.
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4.3 MARGINALIZED, POOR AND UNDERSERVED GROUPS HAVE INCREASED ACCESS TO EDUCATION, LIFE SKILLS, AND LITERACY INITIATIVES THROUGH COORDINATION AND INTEGRATION WITH EDUCATION PROGRAMS
4.3.1 Education support (provision of scholastic materials and school fees)
To ensure increased enrollment, retention and progression in schools, a total of 121,876 OVC (60,982 male, 60,894 female) were supported by the Project and other partners within the quarter to access education service. These included exercise books, crayons, pens and pencils and geometrical sets and leveraging for school fees through partnership. Through leveraging with Conrad N. Hilton Foundation grant, the Project supported back to school
Photo: 11: The 3 ECD schools enjoy desk and chairs supplied by the program through matching funds. campaigns through chiefs barazas to increase enrolment of children below five years in ECD centers. This was achieved through community mobilization and sensitization meetings to create awareness on importance of education. A total of 5 community meetings, reaching 400 caregivers, were done in Kaloleni Sub County.
4.3.2 Sensitizations on available opportunities for secondary /vocational OVC bursaries and scholarships The Project in collaboration with County Bursary Officer, Ministry of Labor Social Security and Services, Ministry of Education, Department of Children Services and County Development Funds (CDF) in coast sensitized 2,083 OVC caregivers on how to access available opportunities for secondary/vocational bursaries and scholarships. In Nairobi County, 50 older OVC in vocational trainings continued with their practical attachments to improve on their trade skills in readiness for the job market.
4.3.3 Child Friendly schools/Centres Strengthening of CLASSE model continued in 73 (44 Nairobi, 29 Coast) schools during the quarter. Fifteen new schools benefitted from child friendly materials which included play things, environmental clean-up tools, and writing materials for the clubs.
Photo: 12: A CHW assisting the OVC to do their School OVC in group work discussion at the safe place
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Continuous follow-up visits conducted in 29 schools supported in the previous quarter have shown improved participation of pupils in decision making, increased advocacy for children rights in schools and environmental cleanliness. The schools were provided with playing materials (hula hoops, volley balls, foot balls, nets, skipping ropes, and tennis balls), environmental clean-up tools (spades, rakes, gloves, fork Jembe, Slasher, Pangas) and writing materials (pens, box files, hard cover books).APHIAplus Nairobi-Coast supported a community child friendly space at HAKISHEP in Kibera slums by equipping it with chairs, reading tables, textbooks and world maps. The center serves the community as a library to an average of 30 children per day during the week and 50 children during weekends and holidays. The Project supported MOE and Department of Children Services in formation, coordination and monitoring of children assemblies elections at the sub county, county and national levels. This has enabled children to advocate for child rights in schools and the larger community. A total of 340 child rights clubs previously formed to advocate for child rights in schools continued to be followed up and supervised.
4.4: INCREASED ACCESS TO SAFE WATER, SANITATION AND IMPROVED HYGIENE. A total of 61,181 (30,977male, 30,204female) OVC continued benefitting from water purifiers supplied to their households during the previous quarter were sensitized on water treatment and how to increase access to safe water. Two thousand (2,000) OVC households who were supported with water storage tanks during the previous quarter continued benefitting from the same. A total of 105 schools also continued using water tanks supplied by the Project to improve access to safe water and sanitation services for children in schools. A total of 87 primary schools previously supported with hand washing vessels continued to benefit from the same. A total of 3,432,000 litres of water were treated using water purifiers during the reporting period. To improve hygiene, a total of 71,000 OVC received pieces of laundry bar soaps in the quarter.
Provision of sanitary towels for girls and sensitization on menstrual Management A total number of 2,432 girls received a three-month supply of sanitary towels during this quarter. They were sensitized on good hygiene, understanding their body and bodily changes, how to use and dispose-off the sanitary towels. This increased self-esteem and confidence for girls during their menses, enabled them attend school and curb un-hygienic practices for girls who use old clothes during their menstruation period.
Journey of life/Tree of Life During the reporting period, 71 LIP coordinators previously trained on Journey of life (JOL) psychosocial support tool were further trained on Tree of Life PSS tool. Coordinators are expected to cascade the training to the CHWs and Community Resource Persons who will apply it for counseling of OVC and their caregivers during forums and home visits. Tree of life is a psychosocial support tool based on narrative practices. The tool opens up spaces and opportunities for children to tell, hear, and explore stories of hope, shared values, connections to those around them and those not around (dead) but have made a contribution in their lives. Children targeted by the Tree of Life tool include, child clubs, those affected by conflict, those affected HIV/AIDS, extreme poverty and other types of vulnerabilities. A total of 71,430 (36,048 male, 35,382 female) OVC were reached with psychosocial support services by CHW during home visits
Scale up of OVC Cash Transfer /Bursaries During the quarter the project supported Department of Children Services to print 10,000 OVC cash transfer forms which were handed over to the Head of Department in Nairobi. They were meant to target the assessment of OVC in both Nairobi and Coast. The Project supported and participated in child protection forums (AAC, children assembly, DDC, OVC stakeholder’s meeting and child forums).
Day of African Child The Project supported commemoration of Day of African Child national event held at Kizurini Primary School, in Kaloleni, Kilifi County. The theme for the year was ‘A child friendly, quality, free and compulsory education for all children in Africa.’ The event was graced by over 6,000 children who were the main guests, Children’s president, Minister of Labour, Social Security and services, as well as National Council for Children Services. Children supported by the Project participated by presenting colorful dances, skits and inspiring poems advocating for child rights. They highlighted technical and socio-economic challenges such as lack of enough teachers, early marriages and drug abuse that hinders the African Child’s right to education.
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4.5 STRENGTHENED SYSTEMS, STRUCTURES AND SERVICES FOR PROTECTION OF MARGINALIZED, POOR AND UNDERSERVED POPULATIONS
AAC Quarterly Meeting The Project supported the Department of Children Services to hold AAC meetings in 5 sub counties. In Westlands and Dagoretti, the meeting discussed the plight of street children in both sub counties. A committee to was formed to address their needs. In Langata, Njiru and Embakasi, the meetings focused on the expansion of the government cash transfer programme for OVC. Up to 120 households supported by the project in Kibera are currently enlisted to benefit from the cash transfer programme while 86 OVC have qualified for awarded secondary school scholarships. The Njiru AAC also agreed to support the late registration of births for OVC in the coming quarter. The Makadara AAc met and visited CCIs in the sub county. Children in CCIs are living in better conditions due to the frequent support supervision from the Department.
Children Assembly One children’s assembly was held during this quarter. The children were sensitized on the UN children’s chatter and had a chance to also elect new officials. The children’s assembly encourages children to participate in decisions that affect them. It is also an advocacy platform for children to articulate challenges they face to the government and other stakeholders.
Journey of life activities Following a successful Journey of Life training to CHWs last year, the Project provided 31 IPs with visual aids/picture codes and reference manuals to help CHWs offer psychosocial support better to OVC. CHWs reported that the tools have enabled them to isolate PSS issues better and they are able to offer the support OVC need with ease.
Advocacy for child rights and child protection The Project supported IPs in Njiru and Embakasi to rescue one girl from an early marriage, 6 OVC from sexually abusive households, and 3 school drop outs. All the 10 children are back in school and undergoing counselling respectively.
Use of small Group sessions to reach youth with HIV prevention messages The program used peer-led small group communication sessions as a strategy for equipping youth with information and skills on HIV prevention and linking them to health services and products. This strategy was used across all interventions including EBIs such as HC11 and FMP Peer education sessions that use ETL as a facilitation methodology and video based small group sessions using Shuga movie as evidenced by increased demand for information by communities and service uptake such as HTC during the quarter.
Implementing EBIs through CUs Implementation of the EBIs allows the beneficiaries to benefit from standardized messages. Starting the Families Matter! Program within the same CUs where HC II is being implemented has allowed the program to get more people into the program because the parents with children who are in the HC II age bracket (13-17) refer them for the sessions. Some of the FMP facilitators are also community based distributors of family planning so they were able to dispense some commodities to parents/ guardians who attended the FMP sessions.
Social Mobilization The KAPs department of APHIAplus Nairobi-Coast has been implementing Social mobilization among its target populations; organizing them into grassroots organizations which draw its membership from the target populations. This strategy is cost effective, high impact and sustainable. The CBOs provide space for the target populations to own the project leading to project implementation beyond funding period sustainably; and lead in prioritizing their needs/issues/challenges and advocate them in different fora. The organizations also have limited overhead costs. The KAP led groups includes HOYMAS, Tamba Pwani, Ukweli Africa, Kisauni Peer Educators Group among others.
Use of peer education and Discs to provide services to Key Affected Populations As part of KP programming, Peer Education is an important aspect of Behavioral Interventions –It entails identifying and recruiting peers among the members of the key affected population who are them trained and oriented on the program as volunteers. The peer educators then carried weekly small group sessions with peers on all aspects of STI/HIV/ AIDS/ GBV prevention, care and treatment. Other activities carries out as part of peer education include holding one-on- one sessions with peers, referrals to health facilities and DISCs, distribution of condoms, lubricants, and IEC materials. APHIAplus Nairobi Coast is working with 148 trained peer educators in Coast region broken into 63 FSWs, 68 MSM/MSWs and 17 APHIAplus Matatu operators initiative (AMOI). Mostly important the volunteer peer educators
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mobilize their members to access services during outreaches and also report on peer education activities carried during the week.
APHIAplus Nairobi-Coast is supporting 12 DISCs in spread in Kilifi County (2), Mombasa County (3), Kwale (2), 1 in Lamu, and 3 in Nairobi County. The centres provide among others, STI screening and treatment, HTC, cervical cancer screening, FP services and commodities, primary healthcare and nutrition support. The centres also refer clients to nearest GoK facilities for further medical attention. DISCs also act as safe spaces for KPs to interact and network and build cohesion and social capital among the members of the key affected populations. Assorted IEC materials, commodities like condoms, lubricants, alcohol patches, cotton wool and vials of distilled water are also distributed from the centres.
4.6: EXPANDED SOCIAL MOBILIZATION FOR HEALTH CHWs participated in mobilization of caregivers and children during health campaigns such as polio, vitamin A supplementation, nutrition screening, deworming and tetanus campaigns. During these campaigns members of the community were sensitized on nutrition education, child rights, drug abuse, GBV and importance of complete immunization for children less than five years to reduce child mortality rates.
Capacity Building A total of 123 LIPs serving OVC in Coast region received technical support in data collection, analysis as well as discussing solutions to challenges they are facing in supporting OVC enrolled in the program. All the LIPS were provided with technical support and capacity building, including OVC documentation, sensitization on OLMIS, and resource mobilization skills. The OVC contact persons were supported in conducting monthly feedback meetings throughout the quarter. In collaboration with Conrad N. Hilton Foundation grant, 33 LIP representatives were taken through refresher training on JOL to ensure that the skills previously learnt remain fresh and relevant to their communities. A total of 45 monthly Coordinators’ meeting for implementing partners was held to share plans, challenges and possible solutions during this quarter. Dominant issues addressed were; How to effectively serve the OVC whose CHW who have exited from the program, and how deal with the CHWs exit due to dwindled allowances.
Quality Improvement Collaboration with URC and GoK, the Project continued to give technical support to 27 QI teams to improve services offered to OVC. The Project was represented in a national forum in Nakuru to discuss on PSS minimum standard support for OVC. Depending on key service areas addressed by different QI team, there has been a great improvement in quality of services provided.
AIC Kisumu Ndogo Qi Team Malindi The QI team did Child Status Index (CSI) in January 2014 to a sample of 150 children. The CSI results showed that 100 children (from the sample) were abusing drugs and not attending school regularly. They were spending most of their time in the streets. To address the problem the QI team proposed a number of change ideas that included working with the parents, teachers, the community and the affected OVC and other children on the dangers of drug and substance abuse. These they were going to do through community meetings and one-on-one counseling meetings with the affected children. By March 2014, the QI team was able to return 110 OVC back to class. Probing further in the month of April, the team realized that besides drug abuse other OVC in the area were also not going to school because of lack of school fees and school uniforms. Therefore, besides community education on the rights of children, dangers of substance abuse and one on one counseling, the team also paid school fees and provided school uniforms for OVC in need. Change concept Specific change idea Start month results Rescue 100 OVC from Educating the children on the dangers of drug Jan. Jun 2014 245 OVC rescued from the streets drug abuse and substance abuse;Provide school uniforms and brought back to school and pay school fees for OVC in need
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Number of OVCs rescued from the streets by AIC Kisumu ndogo QI team Malindi, Jan - June 2014
300 Total rescued OVCs = 245 250 200 150 CSI analysed and change ideas formualted Implementation and 100 follow up Baseline CSI done 50 0 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14
Month Number of rescued children of rescued Number
Figure 19: Number of OVC rescued from the streets by AIC Kisumu Ndogo in Malindi
CROSS-CUTTING ISSUES
A.GENDER, RIGHTS AND SEXUALITY (GRS) There has been continued support for GBV Working groups with shelters/safe spaces monthly meetings; forums for women on laws of marriage and succession and the Women’s Enterprise Fund; and provision of legal aid services by CREAW in supported districts as well as continued support to the Kenyatta National Hospital Gender Violence Recovery Centre with GBV coordination, community outreaches and provision of psychosocial support services. Quarter program activities focused on: Strengthening GBV coordination working groups through update and exchange meetings; Promotion of healthy images of manhood through sensitization sessions; Promotion of health treatment literacy integrated with GBV sensitizations; Facilitating and supporting events to mark the 16 days of activism; Supporting forums for girls and boys sensitizations on FP/RH, HIV/AIDS and GBV for men and maintenance and strengthening of GBV safe spaces and shelters
Under Gender and Rights, the project tracks five key indicators. Under these indicators, the project made the following achievements: number of working groups supported during the quarter (17); people reached by an individual, small- group, or community-level intervention or service that explicitly addresses norms about masculinity related to HIV/AIDS -1333 (524 m and 809 f); people reached by an individual, small group or community-level intervention or service that explicitly addresses gender-based violence and coercion related to HIV/AIDS- 1592 (644 m and 948 f); people reached by a individual, small-group, or community level intervention or service that explicitly addresses the legal rights and protection of women and girls impacted by HIV/AIDS- 655 (193 m and 462 f) and people reached by a individual, small- group, or community level intervention or service that explicitly aims to increase access to income and productive resources of women and girls impacted by HIV/AIDS -616 (316 M and 300 F).
Given the reduction of funding during the extension, the increase in performance is attributed to increased integration of gender and rights into different areas of service delivery and active involvement of communities through schools and other groups. The project also participated and supported gender mainstreaming in three county health strategic plans: Nairobi, Kwale and Kilifi with notable success. However the process of mainstreaming is ongoing with activities aimed at further buy-in and entrenchment into key county policies and plans. Summary highlights of the project accomplishments with regards to addressing gender and rights are herein:
a) Gender mainstreaming sessions The program staffs were taken through a session on gender mainstreaming during the Monday program meeting. The aim of the session was to ensure effective mainstreaming of Gender and Rights concerns/ improvements in all program areas. It was also to ensure that the integration is responding to the contextual priority needs of women, men, boys and girls. The Project has witnessed increased internal gender awareness with increased disaggregation of indicators during internal program discussions and demand for gender integration in all activities, especially youth, prevention and reproductive health. Gender mainstreaming also included partners who collaborated in community outreaches. These included the Yes Youth Can initiative, Jomvu hospital and the Photo: 13: Gender mainstreaming session APHIAplus Mtaani Progress Report FY 2014 Q2 (April- June, 2014). Page 51
advocacy group SAGE in Mombasa; Sauti ya Wanawake and WEL.
b) PRC forms and register distribution to Health Facilities The project distributed the MOH 363 PRC Forms and registers accompanied with new edition registers along with the second edition of the National Guidelines on clinical management of Sexual assault to all the high volume facilities in the zone. Targeted CMEs were conducted in Nairobi to address high the increasing incidences of inappropriate issuance of PEP by re-orientation with national PEP guidelines. They also included participants being given lessons on how to fill the MOH 363 and guidelines of on the clinical management of sexual assault.
c) Community Sensitizations Community sensitizations on multisectoral coordination were conducted through the working groups that also have TOTs trained on multi-sectoral coordination. Opportunities for increasing community sensitization that the
Project utilized included chiefs barazas and community meetings where gender and rights issues including domestic violence, defilement, early marriages, illegal abortions, child neglect and child labour are addressed at such forums. The legal aspects of addressing GBV were addressed by the paralegals who are members of the working groups. 1,988 people were reached during the quarter Photo: 14: Community sensitization session (717males and 1,271 females).
d) Economic empowerment and livelihood strengthening sensitizations
The Project sensitized 616 people (316M and 300F) were sensitized on the various platform available through the government. The focus of these sessions was on the Uwezo Fund and the Youth Enterprise fund.
The district level social development offices through the various anti-GBV working groups mobilized organized groups as audiences to sensitize them on the requirements of applying for Uwezo funds for instance has to be organized groups of at least ten people practicing table banking and must have a person with disability as a member. Minimum borrowing power per group is a minimum of Kshs. 50,000 and a maximum of Kshs. 5,000,000. The revised version of the application form was shared with the participants. The participants got firsthand information on the various committee members who would help guard against frauds.
e) School Forums Seventeen GBV prevention and response coordination working groups were engaged during the quarter actively strengthening selected school rights clubs by participating in various activities such as tree planting with them The rights’ club members mobilized children of various ages within the schools to address gender issues, and managed to reach 868 children were reached within the quarter (340 males and 528 females).
f) Anti-GBV mobilization and advocacy Various anti-GBV groups have been supported to conduct campaigns and mobilization activities in their communities. The project also distributed exercise books designed with gender-sensitizing child-friendly messages on multisectoral response coordination to GBV. They have also been intensified sensitizing of schools and community members on gender biases and traditional practices that endorse GBV such as FGM and the health implications of such practices. Use of the child rights clubs in school has shown improved peer monitoring of abuse and violations.
g) Key Population (MSM) Support group The integration of MSM into the orbit of gender and rights activities during the quarter achieved the e first support group meeting for HIV positive MSMs at The Mama Lucy Kibaki Hospital in Nairobi as part of the efforts to ensure health service access to marginalized groups.
The support group targeting a membership of 22 with 3 counsellors provides a forum for support and continuous education on adherence, treatment, gender and rights violations awareness and livelihood support. It also provides a safe space for MSM and a model for increasing service delivery systems for marginalized populations.
h) Expansion of awareness of the Sexual Offences Act of 2006 and the Standard Operating Procedures
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The representatives invited the working group members for the launch of the Standard Operating Procedures on held at Intercontinental Hotel, Nairobi. The Project collaborated with the Yes Youth Can initiative in the Coast to expand knowledge and awareness of the Act, the 2-third gender inclusion principles and mainstreaming of gender analysis in activities. Based on these collaborations, the Project jointly organized breast cancer screening and reproductive health fora in poor neighborhoods and slums hence increasing awareness and services to marginalized groups. B. PARTNERSHIPS, ADVOCACY, YOUTH
APHIAplus Nairobi-Coast participated in the members’ validation meeting of the new Health NGOs Network (HENNET) strategic plan III (2014 – 2018) to guide HENNET operations and ensure its continued survival in the health sector, approved by the 100 strong network membership on April 16, 2014. Pathfinder/APHIAplus Nairobi-Coast- the former national HENNET Vice Chair (2010-2013)-remains engaged in network activities because of its critical role as the voice of health CSOs to the MOH.
Kenya PHE Network meeting -APHIAplus Nairobi-Coast Outreach Services Adviser represented the project on May 20, 2014. Chaired by NCPD, participants who included DSW, FHI360, IUCN, FHOK, the Green Belt movement, UNFPA, etc were briefed on the regional policy steering committee, government plans for PHE sensitizations of county population coordinators and the progress of PHE program implementers’ workshops in Nyeri, Homa Bay and Mombasa counties. APHIAplus Nairobi-Coast project already incorporates aspects of PHE in its work e.g. WASH and envisages incorporating other elements of PHE such as the model households’ concept in future programming.
The Health of People & Environment in Lake Victoria Basin (HoPE LVB) project. With funding from the David and Lucile Packard Foundation, and John D. and Catherine T. MacArthur Foundation, together with USAID, Pathfinder collaborates with and host-country governments and local leaders in conservation and health to implement HoPE LVB. Led by Pathfinder International, a consortium of local partners (ECO and OSIENALA) has been implementing Phase 1 of the Project (2011-2014) in Homa bay county, Kenya, and Wakiso and Mayuge counties, Uganda. An end of project, a review was conducted this past quarter, findings were shared with donors and stakeholders in Kisumu between May 5- 9,2014.The results revealed that the HoPE LVB project model (1) more holistically addresses community needs including health and livelihood while considering sustainable use and conservation of local natural resources/ecosystems, and (2) has potential for sustainability and scale-up to surrounding LVB areas, with the possibility of expanded replication in other countries in the LVB region. Consequently, all three original project donors have committed funding for a further three years. In addition, a new partner (the Barr Foundation), has expressed interest in supporting the project.
USAID EA staff visited the HoPE-LVB project in Homa Bay in May accompanied by Lake Victoria Basin Commission personnel. Sites visited included Miriu Health Center, a project link facility; Kogweno primary to observe the school PHE program and community-based PHE Resource Centre; two Model House Holds and an apiary site. Findings from this visit are expected to guide future USAID EA investment in Phase II of the HoPE LVB project.
AYSRH Task Force reviewing the GOK’s ARH & Development Policy of 2003: A Task Force comprising representatives of the MOH, UNFPA, UNESCO, FHI360, CSA, WHO, NOPE, Population Council, DSW, MOE and Pathfinder/APHIAPLUS Nairobi-Coast is assessing implementation of the Adolescent Reproductive Health and Development Policy of 2003, now over a decade old. The TWG has developed terms of reference and recruited a consultant to spearhead the review process. The revised ARHD Policy should be completed by the end of 2014.
End of project dissemination of the PATH/Partnership for an HIV Free Generation (HFG/K) multimedia campaign that aimed to create a generation of young people free from HIV through production of the Shuga TV series I and II, Shuga Radio, the Shuga website and other digital platforms, the Shuga Graphic Novel, and the Facilitators Guide and Toolkit. Hence Shuga has been an integral part of the APHIAplus Nairobi-Coast project’s youth-focused program. Over 40,000 youth were reached during the 3 year life span of the project through small group discussions and over 50% of those, linked to HTC services. The event consolidated the work done, shared results and highlighted opportunities for future programming for youth HIV prevention in Kenya with both current and potential private and public sector partners. New digital tools unveiled included the Shuga mobisodes, an application that made Shuga available on a mobile platform and accelerated the reach of the intervention to even more youth, especially those in rural areas.-an area of interest for APHIAplus.
APHIAplus Nairobi-Coast MNCH/RH/FP staff participated in the Implanon NXT Partners Meeting convened by the MOH to assist the government develop its plan for national roll-out of Implanon NXT by June 2015. In countries where this contraceptive has been tested, Implanon NXT has been found to be very popular with young women. APHIAplus Nairobi-Coast youth and MNCH/RH/FP staff together with other stakeholders provided TA to RMHSU/MOH in the development of national AYSRH training materials in an activity supported by UNFPA.
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Youth Friendly Services (YFS) at facility APHIAplus Nairobi-Coast increased availability of an integrated package of quality high-impact interventions at community and health facility levels through YFS provision at youth desks at Dandora II, Kangemi, Kasarani, Mathare North and Mukuru Rueben health centers. In total, 3,277 young people (the target for the quarter was 3,000), accessed family planning, VMMC, CT, ANC, IEC materials and condoms at these facilities. APHIAplus Nairobi-Coast efforts to strengthen YFS delivery in high volume facilities continued through county sensitizations on national YFS guidelines in Kwale for 36 CHMT and service providers. Whole site sensitizations on YFS were conducted in a total of 7 health facilities in Nairobi (3) and Taita Taveta (4).
At Kenyatta University (student population 63,000-the country’s largest public institution of higher learning), 17 housekeepers were trained in YFS and as CBDs to support contraceptive distribution on campus in student hostels and make referrals for clinical services. As a result of APHIAplus Nairobi-Coast project’s youth targeted interventions (e.g. youth clinics, young mothers support groups etc.), community mobilization, whole site YFS orientations at facility coupled with improved data capture and documentation of young persons4, uptake of services by youth, especially ANC by young mothers , increased this quarter. The Kenya Girl Guides Association’s (KGGA’s) ASRH Nairobi- Coast program for in-school youth activities enables APHIAplus meet PEPFAR Indicator 8.2: Number of the targeted population reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards required. This quarter, 5,199 in-school youth (2,283 males and 2,836 females) were reached by KGGA’s Adolescent Reproductive Health Program. In schools where the program is being implemented, increased discipline has been noted.
CONTRIBUTIONS TO HEALTH SYSTEMS STRENGTHENING: RESULTS AREAS 1 AND 2
Documenting technical assistance through “MyCheck” Service delivery cluster teams continue to apply with greater consistency the documentation of their technical assistance visits to the facilities and as matter of “learning by doing” strategy agreed to document in particular their checks on key aspects of HIV and AIDS/SRH&R. The purpose is to apply the PDCA5 quality improvement process consistently within the project. Indicators assessed in 16 facilities on the area of PMTCT i.e. testing, ARV prophylaxis, linkage to care, laboratory monitoring and EID met the set standard. Mother- baby pair follow-up and TB screening were not well done. Follow up OJTs is being provided to the facilities to improve the reported indicators and this will continue to be tracked over time. CMEs and TA were provided as directed by findings from my check tool. Areas not covered during this quarter will be given priority in the coming quarter.
4 MOH 711 tool does not capture young persons’ data by age (10-14; 15-19, 20-24 years), gender and service. 5 PDCA: Plan, Do, Check, Act
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Figure 20: MyCheck Analysis for PMTCT, Apr-Jun, 2014
Streamlining RHIS-Data capture, reporting and documentation:
With regards to strengthening routine health information systems to responsively helps track progress with YFS activity programming, and cognizance of the current challenges the program has faced with reporting on ASRH services given that the current MOH integrated services tool (MOH711) does not capture ASRH services disaggregated by the different age cohorts (i.e. 10-14; 15-19, 20-24 years), gender, and services provided; the project worked with the division of RHMSU in developing the YFS records book and tools to capture ARHS at facilities this draft is currently part of the discussions around the efforts towards harmonization data capture and reporting tools with the Division of Health Informatics and M&E to be responsive to the integrated health services. Focus was on the following services; Counseling (contraception/dual protection, HIV/AIDS, sexual abuse/violence, clinical services, Testing (STIS, VCT/HIV and pregnancy), Treatment (STIs, PAC, sexual abuse and violence) ANC, PNC, and delivery.
Strengthening Commodity Security and Reporting The Project continued to provide support the County and Sub-County HMT in the redistribution of FP commodities mainly the injectable, implants and female condoms from stocked facilities to those without during support supervision visits to avoid stock outs in the facilities.
In addition, the Project worked with the County Health Management Teams and commodity security committees to improve commodity consumption reporting and requisition including uploading of the data in the DHIS. The Project will continue to intensify efforts to ensure improved reporting rates to at least 80% for contraceptive commodities by September 2014.
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FP Commodity reporting rates by County - FP Commodity reporting rates by County -APHIAPlus APHIAPlus Nrb-Coast Nrb-Coast
34% 35% 86%
17% 19% 34% 37% 70%
43% 18% 75% 55% 34% 35% 45% 17% 19% 38% 34% 37% 77% 43% 18% 64% 55% 54% 45% 83% 54% 64%
May-14 Jun-14 May-14 Jun-14 Jul-14
Kilifi Kwale Lamu Kilifi Kwale Lamu
Mombasa Taita Taveta Nairobi Mombasa Taita Taveta Nairobi
Figure 21: FP Commodity Reporting Rates by County A quick analysis of the progress with Commodity reporting rates before and after May when a workshop was held facilitated by DRH and USAID, shows a sharp rise from end of June into first weeks of July showing a marked significant improvement in the reporting rates as shown in figure 19 above.
The registered sharp increase could be attributed to the joint efforts by our SI technical officers to follow up with the individual facility in charges/officers for reporting/uploading the commodity data into the DHIS2 platform and the DRH web reporting tool. Moving forward, more work will continue to be done to ensure all counties hit the set target of 85% and above by end of September. Lamu County had security challenges and this adversely affected the reporting rates. As the situation calms, backlog data will be uploaded.
Institutional Capacity strengthening Support for Local Implementing Partners (LIPs) APHIAplus provided technical and financial assistance to 3 Local implementing partners, KENWA, Redeemed Gospel Church and Little Sisters of St Francis. They were supported to sensitize their groups on IGA development, strengthen of support groups and given technical support in program and finance management.
Implementing partner Achievement Redeemed Gospel 60 caregivers sensitized on VSL/IGA development. Church Development 780 PLHIV reached through support groups and educated on various topics including program nutrition, adherence and Family planning Little sisters of St 587 people tested for HIV and the positive linked to care Francis CBHC program 10 VSL groups established have a saving of over Kshs 250,000 190 clients attended the monthly support group meetings. The support group includes a men support group (26) and one for discordant couples (20) Kenya Network of 40 PLHIV sensitized on business skills/entrepreneurship Women with AIDs 300 PLHIV attended support group meetings and educated on adherence, nutrition, family planning etc.
Strengthening community facility Referral s and Linkages systems for improved Retention and defaulter tracking for PLHIV on ART:
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To enhance client/patient retention, the Project continued to address the client factors (client knowledge, attitude and practice, adherence, partner testing and disclosure, life style, stigma, dependency, socio-demographic information and psychological status), health systems factors (staff attitude, data documentation, supply chains/commodities and referral systems), community factors (cultural, religious beliefs and attitudes, community structures and social political issues) and geo-physical factors (distance to point of service, decentralization of services and infrastructure)/client retention. Technical support to facility and community staff on maintaining an appointment diary/daily register, transferring of missed appointments, phone calls, categorization, physical tracing were done. Provision of airtime for phone calls for missed appointments and review sessions on defaulter tracing outcomes with health facility staff were supported at the high volume facilities. Household visits by the CHWs have also been found to be effective in doing door to door tracking.
Collaboration with ASSIST: the eMTCT Collaborative As part of the ongoing collaboration with USAID/ASSIST Project, APHIAplus Nairobi-Coast supported conduct of Quality Improvement trainings for Taita Taveta, Mombasa and Lamu Counties. In total 96 participants (country managers, partners, facilities, Comprehensive Care Centre, maternity staff, MCH-PMTCT staff) were trained during the two 5 day QI trainings conducted in Taveta and Mombasa towns. The teams have planned follow up of the trained health workers to support the WIT implementation of QI including monthly Coaching visits that are continuing from the month of August, 2014.
Since the KQMH framework that ASSIST supports is fully part of APHIAplus service delivery strategy, the same goals will be pursued in the counties not included in the Collaborative. In the coming quarter, the project has developed joint program of action with the sub-counties
Mentorship During the reporting quarter, 154 mentorship visits out of 284 planned visits were conducted with, apart from visits with general purpose, the following programmatic focus: Nutrition-21; HMIS-26; Pediatric ART-5; Adult ART-41; MNCH- 29; Pharmacy-15; Laboratory-18 as summarized in the matrix presented in Table 14 here below. The 2014 service delivery strategy of APHIAplus was shared with all mentorship teams. Quality improvement is now tackled with better synergy of supervision, mentorship and QI techniques in mind. Areas that require strengthening through technical support are a matter of joint support.
Table 14: Highlights of Mentorship priority interventions supported for the period: Apr-June, 2014 TA Focus Proposed Achievements for the Quarter(Apr - Reasons for the variance Targets June 2014) Conduct Nrb-(April-35 Nrb-72. We have new mentors whom we mentorship District recruited (together with the SCHMTs) visits in mentors x 1, We did the following sessions in late so they didn’t do any mentorship support of May-37 MOH different program areas: related work March, April and some, service mentors x 1 Nutrition-10 May visits. providers on report, HMIS-8 Competing tasks have also different June-37 MOH Pediatric ART-5 contributed to a few mentors not program Mentors x 1 Adult ART-21 doing some visits. areas. report=109 MNCH-12 reports. Pharmacy-7 Laboratory-9
Coast Nutrition-11 (April:57*1 HMIS-18 May:57*1 Clinical -17 June:61*1) Pharmacy-8
Laboratory -19 (total-177) Counseling/PMTCT - 20 Conduct 2(1 nrb,1 0 in Nairobi. The planned sharing forum for the mentorship coast) 0 in Coast. Nairobi district mentors did not take sharing place due to the fact that some forums. districts didn’t have teams so we had
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to push it to Quarter 3 when we will have all the teams on board. The Coast Sharing Forum was scheduled to be held in July Conducting 1 in Nairobi. 1 in Nairobi-17th and 18th May. The project supported an orientation mentorship 1 in Coast. 1 in Coast-3rd and 4th May. session for the MOH mentors and orientation other facility staff on Emergency sessions for Triage and Treatment, plus Admission the MOH (ETAT+), conducted by the Mentors. Resuscitation Council of Kenya. This training was after we noted a gap in the management of paediatric emergencies in our facilities. In Nairobi we had 55 participants, of which 9 were seen to have the potential to become Instructors. In Coast we had 50 participants of Fourteen (9 of the Nairobi participants and 5 of the Coast participants) were identified as potential regional instructors. Meeting with We held a meeting with the Taita CHMT Taveta CHMT to discuss working relations and sustainability of the mentorship program. In Nairobi, we met the CASCO and we agreed that she will invite the mentorship teams for a discussion on how mentorship can be sustained. We also discussed selecting the good mentors to be the team leads. Sharing of Eight of the eleven mentorship teams in monthly Coast Region, gave their respective activities with SCHMTs feedback on their monthly SCHMT activities. Four out of seven mentorship teams in Nairobi region work closely with the SCHMTs, sharing reports and giving feedback on their activities. Fostering a close working relationship between the SCHMTs and the mentorship teams ensures success and sustainability of the program. Distribution of Coast – 100 These will assist in identifying the T-shirts to Nairobi – 52 MOH mentors as APHIAPlus-Nairobi MOH mentors Coast mentors Distribution of Basic Pediatric Protocol Job Aids Coast – 50 Nairobi-65 Contraceptive Evidence Coast – 20 Nairobi - 21
In the reporting quarter, the project supported a PEDIATRIC EMERGENCY TRAINING based on the Basic Pediatric Protocol Booklet for all the six project supported counties targeting the nurses, registered clinical officers and medical officers which was facilitated by Kenya Pediatric Association and National Resuscitation Council of Kenya to equip the health workers with knowledge and skills to manage neonatal emergencies, common neonatal illness, pneumonia and
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diarrheal illnesses. A total of 45 participants from five of the six counties in the Coast region and 55 participants in Nairobi. Participants were principally clinical mentors and health workers stationed in the MCH, maternity, new born unit and pediatric wards. Figure 22 below summaries the distribution of participants by County and the overall performance in the training. An analysis of the overall performance by the health workers supported in this training shows a notable skills gap as evidenced by the difference in the participants’ performance before and after the course. The participants who successfully completed were awarded a certificate of completion while those who did not pass were awarded a certificate of participation. The content learnt will be disseminated through: Mentorship; OJTs; CMEs; and training TOTs to scale up Pediatric Emergency training in Coast and Nairobi Regions.
Number of Participants by County 10 Nurse RCO 8 MO
6
4
2
0 Taita-Taveta Kilifi Mombasa Kwale Lamu
Overall Course Performance
100%
80% Pass/Retest 60% Pass 40% Fail
20%
0% Pre-Course MCQ Post-Course MCQ Practical
Figure 22: Peadtric Emergency Training
Mentorship has spearheaded improved documentation including the HEI cards and registers.
Cervical Cancer Screening at Port Reitz HIV – infected women are 4-5 times more susceptible to cervical cancer than HIV-negative women. Female clients at Port Reitz CCC are normally referred to the MCH for cervical cancer screening. Unfortunately, the majority do not get screened due to the discouragingly long queues at the MCH. This quarter we successfully established a system in Port Reitz CCC to screen all female clients for cervical cancer on a weekly basis. The initiative was undertaken by the MCH in- charge and the staff. The MCH staff set aside two hours every Wednesday morning to screen the CCC female clients. The first three clients were screened on 28th May 2014.
PITC at Moi Voi County Hospital Funding to support VCT counselors has declined since the onset of 2014, directly impacting HIV testing and Counseling (HTC) at this facility. The first four months have been depicted by a complete lack of PITC activities in the wards. HTC in the VCT has declined as well. Consequently, the mentors in counselling at the facility decided to mentor the Clinical Officer interns on HTC in the months of April and May 2014. This has resulted in some improvement in HTC as illustrated in figure 23 here below.
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NUMBER OF IN-PATIENT AND VCT CLIENTS TESTED FOR HIV IN MOI VOI HOSPITAL FROM APRIL TO JUNE 2014 400
350
300 250
tested PITC
200 VCT Clients 150 100 50
0 Number of Clients of Number Apr-14 May-14 Jun-14
Figure 23: Number of In-patient VCT Clients tested for HIV in Moi Voi Hospital, Apr-Jun, 2014
Improved Documentation
a) Msambweni County Hospital
One of our active laboratory mentors was transferred to Msambweni C. Hospital at the beginning of this year. Msambweni C. Hospital is a referral site for laboratory networking of samples, hence proper documentation of samples received and sent to Coast General Hospital and results received is critical. DBS samples were previously documented in a 3 quire book in which documentation was incomplete. The mentor has obtained an EID register and documentation is now up to date. b) Waa Dispensary
Photo: 16 Before Photo: 16: After c) Dandora II Health Centre. The ANC register, retesting column was being written N/A(not applicable) even for the few retested. This has been difficult to know the exact number of ANC mothers who have been retested for HIV. Through mentorship the retesting column is well filled.
Highlights below presents some of the technical methodological approaches that the project has adopted in strengthening its mentorship program for improved capacity at the facility level for provision of expanded HIV and AIDS/SRH&R services to the target communities:
Phone – Based Support from the Master Mentors- The Master Mentors have continued to provide support to the Ministry of Health mentors especially when they encounter challenging cases. In June 2014, a visit from the Pediatric master mentor to Msambweni County Hospital proved worthwhile in deciding when to initiate HAART in a very ill child. The resident staff was reluctant to initiate HAART at the earliest opportunity due to the risk of the child developing Immune Reconstitution Syndrome (IRIS).
On-the Job- Trainings (OJT) by the MOH mentors to their mentees has empowered them to improving quality of care to clients. This is being done as in-house mentorship and visiting mentees at the satellite facilities. A good example is Dandora II health Centre where the nurse in CCC was referring HIV positive babies to Lea Toto because he wasn’t
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comfortable initiating them on treatment. Through mentorship the clinical officer who has been allocated to work at the CCC is able to initiate babies on ARVs-2 the last 2 months.
At Westlands health Centre the Clinical Officer while going for maternity leave had to mentor a nurse in CWC to take charge while she is on leave. Initially the CWC nurse was not comfortable seeing CCC clients. She once reported that HIV management is complicated, but through mentorship I have seen her become confident in managing the clients. She even initiates clients on ARVs comfortably.
LESSONS LEARNED There is a great need for improving the effective collaboration between managers and monitoring teams, and better practices in well performing clusters were adopted by other cluster teams. The service delivery strategy puts data measurement up front and creates and additional stimulus for such teams to fully explore the data environment. Under the social determinants for health sub-theme, a number of key learnings have come up: Mainstreaming of livelihood programs in health leads to sustainable community support for OVC and PLWHIV initiative. (The community units are now able to survive and grow with modest support.) Strengthening formation of farmers’ cooperative society improves capacity of farmers to lobby and advocate for better prices of their farm produce. Strengthening and supporting formation of community CBOs and SACCO leads to improved household economic strengthening. Continues capacity building of farmers on new farming technology and setting up community demonstrations farms lead to improved food security. Framers exchange visits and trade fare exhibition improves farmers skills and ability to improve food production.
SECTION III: PROGRAM PROGRESS (QUANTITATIVE IMPACT) Refer to Performance Data Table/ Key Indicator Table (KIT), also known as Performance Monitoring Plan (PMP) in Annex I of this report for the quantitative description of the key achievements of the reporting period based on the approved 10 months’ work plan
SECTION VI: PERFORMANCE MONITORING The Project robust performance monitoring systems enables timely monitoring of performance by tracking the relevant service statistics and periodic analyses of outputs towards outcomes and monitoring its contribution towards supporting the GoK/MoH structures to achieve both the sub-national and the national health priorities by strengthening routine process monitoring using integrated facility service statistics (KePMs, ODS/KITs, DHIS2, My Check, MCUL. This has included improvement of tools nationally and locally at the LIPs level. Routinized monthly data use clinics both at cluster implementation units and with the respective sub-national structures (/CHMTs) and the quarterly reviews of performance by program managers have all contributed to keeping the program on track. The M&E plan details the Project Results Chain- “Building the chain of evidence’ with a clear well thought through Performance Monitoring Plan (PMP) with a detailed PIRS/KIT that provides detailed description of activities and corresponding inputs, processes, output and outcome indicators and targets for the life of the project (see Annex I for a pull out of the Quantitative Analysis) which fully captures the project reporting priorities as reflected in the key indicators tables (KIT) that are tracked routinely.
SECTION VI: PROGRESS ON LINKS TO OTHER USAID PROGRAMS APHIAplus A+ Mtaani continues to liaise and coordinate with other national mechanisms to ensure quality and continuity of service delivery and strengthened systems. Working with Futures the Project continued to enhance use of IQCare system through scaled Implementation and continued mentorship. It also partnered with the AfyaInfo project to support the Division of Health Informatics and M&E to develop the RHMNCH Indicator Score card and streamlining of the FP Commodity reporting via the DHIS2 platform.
At the county levels, A+ Mtaani SI teams have continued to work closely with both the Measure Evaluation PIMA Project, the Afya Info project, to support both the Div. of Health Informatics and M&E and the Division of Reproductive and Maternal Health Units to support establishment and strengthening of the routine health information systems for improved quality reporting and data use for strategic decision making.
Regarding Quality Improvement, the project has strengthened the collaboration with the ASSIST project to support QI assessment and trainings across all the supported 6 counties of zone 2. The project continued collaboration with Capacity by working with the officers stationed at facilities in the Coast and Nairobi counties to strengthen data capture and reporting systems at facility.
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Given the strategic positioning of Tier1 in increasing communities access to quality integrated health services package, the project has continued to partner with the other established national mechanisms (URC/ASSIST, Measure PIMA, and Afya Info) in strengthening the MOH structures’ capacity to utilize the CHIS tools to capture and report on progress of activity implementation at level one of the health system. This included tools revisions, alignment of the CHS M&E Plan, drafting of the SoW for the review of the Community Strategy and validation/ review of the quality standards for both facility and community.
SECTION VII: PROGRESS ON LINKS WITH GOK AGENCIES Country leadership and ownership are main drivers of intervention sustainability. In view of that a number of activities are carried out with the GoK ( both national and sub-national structures) such as APHIAplus Nairobi-Coast Health Service Delivery project’s participation in the joint reviews development of the AWPs both at the national ( respective departments/Division and the County levels. Budgets and work plans are made together with Sub- County health management teams to facilitate MoH activities at the sub-county and county levels. Planning with other sectors is approached pragmatically, with intra-sector and inter-sector coordination being the responsibility of the government. The technical assistance mandate of the Project ensures that such coordination benefits from the full range of the technical and financial resources availed by the Project.
Country ownership also means involvement of private and non-government sectors. The Project highly values the entrepreneurial spirit that characterizes these sectors; engaging them by incorporating their strategic visions, orientations and plans in its plans and programs. Work in national level technical working groups continues as before. The Project made efforts to continue walking the Department of Community Health Services through the nascent process of developing/reviewing the Community Health Strategy to perfectly fit the full reading of the devolution of health services and improved delivery of quality services.
SECTION VIII: SUSTAINABILITYAND EXIT STRATEGY Service continuity and the resultant sustainability are critical for any quality service delivery model. APHIAplus seeks to promote continuity of services through (i) strengthening of a two way referral system, i.e. between health facilities and community units and vice versa, (ii) strengthening community systems and (iii) strengthening collaboration and coordination. Ensuring continuity of critical services therefore continues to be of paramount importance as we move closest to the end of this follow-on phase. The year 4 work plan strategy for example; while incorporating the lessons learned, maintains its commitment to country-ownership and focuses on: building local skills and supporting systems for sustainability; improving health service demand, access, and quality and reducing barriers for most vulnerable groups. It also, purposefully, addresses social determinants of health in order to maximize health outcomes, especially for the key populations, the marginalized groups such orphans and other children made vulnerable by HIV and AIDS. . To ensure sustainable impact and continued improvement of services delivery, the project continued to work on its health systems strengthening strategy fully cognizant of eventual exit.
Gender equity is a cross‐cutting issue for development policies in Kenya, in general. As such, it is mainstreamed in national policies and strategies. The Project address gender related issues and mainstream gender in all the Project thematic components, while emphasizing the principles of human rights, equity, non-discrimination, and stigma reduction.
Linkages are another element in the Project’s sustainability strategy. Interventions to ensure a continuum of service delivery include a strong linkage between the health facility and the community and vice versa. Strengthening linkages has numerous advantages, including reducing the risk of loss to follow‐up and defaulter tracing and also improve the efficiency of preventive messages resulting from reinforced and complementary messages between health facilities and the community units. Individuals who test positive are linked to care; women who receive prophylaxis are linked to support groups, and so are patients (youth, women men, orphans or people with disabilities), survivors of GBV, once provided with care, are linked to local empowerment activities, youth who receive vocational training are linked
Through systematic involvement of all key actors and stakeholders in collecting, monitoring, and using data, results are fully owned by the key constituents of the health system: the health providers and managers at different levels of the service delivery pyramid including the staff of LIPs as part of the continuum of securing sustainability. These results are captured by different health or management indicators which the Project has adopted for tracking and reporting the progress made in the health and related sectors.
Moreover, the Project accepts the reality that partnerships, networks and stakeholder participation are essential not only to the multi-agent perspective that is so necessary in a holistic or systems based approach; but are critical characteristics of working and sustainable service delivery strategies. Thus while the sub-counties and the county represents the most relevant level of action for the Project; linkages with MOH structures at national level and the
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USAID defined national mechanisms are of significant importance. Hence in our project supported initiatives, we continue always involve respective Divisions/departments in the Ministry of Health, County Government structures and the sub-national structures. National and sub-national level stakeholder fora, meetings or TWGs represent a strategically effective platform through which the Project leverages the multi-level partnerships necessary for effective and sustainable service delivery and system enhancement. .
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SECTION IX: SUBSQUENT QUARTER’S WORK PLAN All the planned activities for the reporting quarter ( see the Subsequent Quarter ‘Work Plan annexed herein were all completed except the trainings for Nairobi County on QI which has been rescheduled to quarter 3in consultation with the County Health management teams. OUTPUT Planned Activities from Previous Quarter Actual Status Explanations
this Quarter for Variances
(Q2,2014) (if any)
AWP: Act. Ref: Indicator Ref: Result Area 3:Increased Use of Quality Health Services, Products and Information
Intermediate Result 3.1: Increased availability of an integrated package of quality high-impact interventions at community and health facility levels PMTCT NC 3.1 PMTCT/EMTCT topical updates provided to HCWs Support topical updates to health workers in public and private facilities on revised Completed PMTCT guidelines NC 3.1 PMTCT updates provided to CHWs Support topical updates to CHWs on revised PMTCT guidelines Completed NC 3.1 CMEs conducted to sensitize Health workers Monthly CMEs for health workers Completed NC 3.1 OJTs conducted Provide OJTs for health workers in public and private facilities on EID Completed NC 3.1 DBS transported Support the lab network for DBS Completed NC 3.1 Commodity management of PMTCT commodities improved Support sites to submit consumption data and requisition for commodities Completed accurately and timely. NC 3.1 Mentor mothers trained Train mentor mothers on the KMMP package and; 5 days residential training Completed NC 3.1 Mentor mothers engaged Engage and support mentor mothers in PSS Completed NC 3.1 mother/baby pair followed-up Support CHW to follow mother/baby pair Completed NC 3.1 Mother support groups formed Formation of mother support groups Completed NC 3.1 HAART integration in high volume facilities Support HAART integration into MCH in selected high volume facilities Completed NC 3.1 Data tools available in facilities Support availability of data tools Completed NC 3.1 Male partners to MCH for HTC supported Provide invitations of male partners to MCH for HTC Completed NC 3.1 Express service to clients who come with partners implemented provide express service to clients who come with partners Completed
HCT NC 3.1 Integrated HTC outreaches and in-reaches conducted Support integrated Outreaches through MVCT, door to door testing, and moonlight Completed VCT. NC 3.1 Child testing conducted Support Child testing during school holidays. Completed NC 3.1 Counselor supervision sessions conducted Support counselor’s supervision. Completed NC 3.1 locum counselors hired Support hire of locum counselors for PITC. Completed NC 3.1 updates for HCWs done Support HTC updates for health care workers Completed NC 3.1 Proficiency testing done Support proficiency testing for HTC. Completed
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NC 3.1 Door to door counseling and testing done Door to door counseling and testing at CU level. Completed NC 3.1 Facilities supported with HBC desks Support HBC referral desks at the facility. Completed NC 3.1 HTC services provided to the youth Integrate counseling and testing for youths. Completed NC 3.1 Couple counseling and testing supported Support Couple counseling and testing Completed NC 3.1 Moonlight supported Support moonlight MVCT Completed NC 3.1 HTC RRI supported Support HTC RRI Completed VMMC NC 3.1 Outreaches conducted Outreaches targeting specific non-circumcising communities. Completed NC 3.1 OJTs conducted OJT for VMMC staff/team. Completed NC 3.1 Mentorship conducted Mentorship for VMMC staff/team. Completed NC 3.1 Dialogue meetings conducted Conducting dialogue meeting to create awareness. Completed N 3.1 Support staff at selected facilities Supporting staff at facilities. Completed NC 3.1 Equipment procured for selected high volume facilities Procure equipment to support VMMC services in selected high volume facilities. Completed
NC 3.1 supplies/ consumables Procured/ distributed Procure and distribute supplies and consumables. Completed NC 3.1 IEC materials printed and distributed Print and Distribute IEC materials at community and facility level. Completed N 3.1 HCWs trained on VMMC Train staff from private facilities and FBOs to provide VMMC services. Completed NC 3.1 female VMMC champions sensitized Sensitize female VMMC champions to mobilize for services. Completed HIV CARE AND TREATMENT NC 3.1 Health care workers oriented Support orientations and mentorship on adult and pediatric ART Completed NC 3.1 CMEs conducted CMEs on HIV care and treatment and NCDs in relation to HIV Completed NC 3.1 Referral labs provide services Provide logistical support for sample referral to testing labs Completed NC 3.1 MDT meetings conducted Support MDT meetings in ART sites Completed NC 3.1 Support groups established and strengthened Establish and strengthen support groups for PLHIVs (youth, children, adults, Key Completed Populations and OVCs) NC 3.1 CCC offer family days Support family days at selected CCCs and Drop in Centers for Key Populations Completed (FSWs) NC 3.1 CCCs and Drop in Centers integrating CaCx Support integration of CaCx screening in CCCs and Drop In Centers Completed NC 3.1 Logistics supported in high volume sites and drop in centers Provide logistical support for screening of NCDs in selected high volume sites and Completed Drop in Centers for Key Populations NC 3.1 CHWs, PLHIVs, and Key Populations Peer Educators trained on Support training on PWP for CHWs, PLHIVs, and Key Populations Peer Educators Completed PWP NC 3.1 FGDs conducted Conduct FGDs on clients of health services on quality of health services Completed NC 3.1 Defaulter tracing improved Support health workers and CHWs to conduct defaulter tracings Completed 3.1 PLHIV receiving HCBC services Provide HCBC services for PLHIV Completed
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NC 3.1 Linkages established with FUNZO and select Health care workers Linkage with FUNZO for training of health workers; SCMS for laboratory Completed trained commodities, KEMSA and KENYA PHARMA for pharmaceuticals NC 3.1 MOU established with HCSM to secure no commodity stock-outs Linkage with HCSM for commodities and supplies management Completed for the supported SDPs NC 3.1 MOU established with to support the high-volume facilities with Linkage with CAPACITY for HRH Completed enough HRH workforce NC 3.1 2nd line committee meetings supported Formation and support of second line committee meetings on zonal/County level Completed NC 3.1 Meetings supported Support monthly sharing and feedback meetings at the facility and program levels Completed
TUBERCULOSIS NC 3.1 Service providers oriented on MDR TB and TB 5 I's Orient HCWs on MDR TB and TB 5 I's Completed NC 3.1 CMEs provided on MDR TB and TB 5 I's Support CMEs for HCW on MDR TB and TB 5 I's Completed NC 3.1 CHWs oriented Orient CHWs on TB case finding and sputum collection Completed NC 3.1 Meetings supported Support TB/HIV collaborative and stakeholders meetings Completed NC 3.1 Health facilities supported Provide Technical assistance to strengthen TB case management Completed NC 3.1 Logistics supported Strengthen logistics of sputum collection and transportation to reference lab and Completed link to gene-xpert machines NC 3.1 Defaulter tracing improved Support facilities and CUs to conduct TB defaulter tracing Completed NC 3.1 Outreaches conducted Support integrated TB outreaches and in- reaches Completed NC 3.1 Food supplements provided Provide food supplements for TB/HIV patients with identified needs Completed NC 3.1 TB reporting strengthened Provide TA on TB data management Completed NC 3.1 integration of TB screening in the drop-in centers Support integration of TB screening in the drop-in centers serving key populations, Completed MCH, CCC and HTC. HIV AND NUTRITION NC 3.1 HCWs orientated on HIV and nutrition Conduct orientations to HCWs on HIV and nutrition Completed NC 3.1 CHWs oriented on IYCF Conduct orientation of CHWs on IYCF Completed NC 3.1 Facilities supported to conduct screening for malnutrition in HIV Support facilities to conduct screening for malnutrition in HIV&AIDS clients. Completed &AIDS clients NC 3.1 Facilities linked to USAID –NHP for FBP Link supported facilities to USAID-NHP for FBP. Completed RH/FP NC 3.1 Service providers including P/S/CHMTs oriented on healthy Orient service providers including P/S/CHMTs on healthy timing and spacing of Completed timing and spacing of pregnancy at facility level pregnancy at facility level NC 3.1 Redistribution of FP commodities including condoms facilitated Facilitate the redistribution of FP commodities including condoms Completed
NC 3.1 Service providers updated on various RHFP topics through CMEs Update service providers on various RHFP topics through CMEs Completed
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NC 3.1 OJT supported to service providers on PAC Support OJT to service providers on PAC Completed NC 3.1 OJTs supported for CACX screening at facility level as appropriate. Support OJTs for CACX screening at facility level as appropriate. Completed
NC 3.1 Long acting FP methods OJT supported for service providers Support long acting FP methods OJT for service providers Completed
NC 3.1 Annual FP compliance assessment conducted Conduct annual FP compliance assessment Completed NC 3.1 Orientation to service providers on YFS conducted Conduct orientation to service providers on YFS Completed NC 3.1 TA to strengthen YF PAC for selected facilities provided Provide TA to strengthen YF PAC for selected facilities Completed NC 3.1 CMEs conducted to service providers on Nutrition in HIV Facilitate the redistribution of FP commodities including condoms Completed
NC 3.1 Consumables provided Provide consumables to support CACX screening Completed NUTRITION NC 3.1 Nutrition officers sensitized sensitize nutrition officers in nutrition care process Completed NC 3.1 HCW oriented in newborn and preterm nutrition Orient HCW in newborn and pre-term nutrition guidelines Completed
NC 3.1 Health care workers sensitized sensitize service provider on HINI including Vitamin A Management Completed NC 3.1 Immunization ,vitamin A supplementation and deworming Support immunization ,vitamin A supplementation and deworming Completed supported FP/MNCH Integration NC 3.1 FP integrated into MNCH services Integrated FP into MNCH services Completed NC 3.1 National MNCH days and RRIs supported Support national MNCH /RH/FP days and RRIs Completed NC 3.1 Service providers oriented on WASH Orient service providers on WASH Completed NC 3.1 Service providers oriented on FANC Orient service providers on FANC Completed NC 3.1 Service providers updated on various MNCH topics through Update service providers on various MNCH topics through CMEs Completed CMEs NC 3.1 ORT corners Established/Strengthened in all the health facilities Establish/Strengthen ORT corners in all the health facilities Completed
NC 3.1 Service providers oriented on BEOC / CEOC Orient service providers on BEOC / CEOC Completed NC 3.1 Maternal/newborn death audit meetings supported in selected Support selected Facilities to conduct Maternal/newborn death audit meetings Completed facilities NC 3.1 CHMT,S/CHMT sensitized on RED Sensitize CHMT,S/CHMT on RED Completed NC 3.1 EPI annual planning supported Support EPI annual planning Completed NC 3.1 Service providers sensitized on RED Sensitize service providers on RED Completed NC 3.1 Dissemination of MNCH/RHFP guidelines , data collection tools Support dissemination of MNCH/RHFP/Nutrition guidelines and job aids Completed and job aids supported NC 3.1 Service providers oriented on facility IMCI Orient service providers on facility IMCI Completed
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NC 3.1 Integrated MNCH outreaches supported Supported integrated MNCH outreaches Completed NC 3.1 Exchange visits conducted Conduct exchange visit by staff Completed MALARIA NC 3.1 Orientation of service providers on case management including Support orientation of service providers on case management including malaria in Completed malaria in pregnancy supported pregnancy NC 3.1 Redistribution of malaria commodities supported Support redistribution of malaria commodities Completed SUPPORT ESTABLISHMENT OF MARPS FRIENDLY SERVICES NC 3.1 Assessments conducted in MARPS/OVC MARP friendly facilities Assessment of MARP friendly and OVC MARP friendly facilities and conduct linkages. Completed
NC 3.1 Service providers trained on MARP friendly services Training of service providers on MARP friendly services. Completed Result Area 3:Increased Use of Quality Health Services, Products and Information Intermediate Result 3.2: Increased demand for an integrated package of quality high-impact interventions at community and health facility levels RH/FP NC 3.2 Community /religious leaders sensitized on healthy timing and Sensitize community /religious leaders on healthy timing and spacing of pregnancy, Completed spacing of pregnancy, RH (PAC,GBV, Cancers of reproductive RH (PAC,GBV, Cancers of reproductive tract), VMMC tract), VMMC NC 3.2 CHWs and CHEWs oriented on healthy timing and spacing of Orient CHWs and CHEWs on healthy timing and spacing of pregnancy and Completed pregnancy RH(PAC,GBV Cancers of reproductive tract) NC 3.2 Men Sensitized to be advocates of RHFP, HTC, pre pregnancy Sensitize men to be advocates of RH/FP, HTC, pre pregnancy planning, GBV and Completed planning, GBV and VMMC. VMMC. NC 3.2 Trainings of CHWs as CBDs including youth supported support training of CHWs as CBDs including youth Completed NC 3.2 Updates on FP to CHWs including youth Supported support updates of CHWs including youth on FP Completed NC 3.2 Updates provided for existing Male champions. Support updates for existing male champions as advocates of RH/FP including Completed MNCH. NC 3.2 New male champions trained as advocates Train new male champions as advocates of RH/FP including MNCH. Completed NC 3.2 FGDs to identify myths and misconception on use of Conduct FGDs to identify myths and misconception on use of contraceptives Completed contraceptives conducted NUTRITION NC 3.2 CHWs sensitized Sensitize CHWs on HINI Completed MNCH NC 3.2 Growth monitoring outposts strengthened at community level Strengthen growth monitoring outposts at community level Completed
NC 3.2 CHEWs and CHWs trained on MIYCN Trains CHEWs and CHWs on MIYCN:90 CHWs + 45 CHEWs Completed NC 3.2 CHWs sensitized on MIYCN Sensitize CHWs on MIYCN Completed NC 3.2 CHWs and CHEWs trained on community MNCH Train CHWs and CHEWs on community MNCH Completed NC 3.2 Community FGD on MNCH conducted Conduct community FGD on MNCH, Malaria and RHFP Completed NC 3.2 Community mama groups oriented to promote MNCH Orient community mama groups to promote MNCH Completed
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NC 3.2 TBAs oriented as birth companions Orient TBAs as birth companions Completed NC 3.2 Defaulter tracing mechanism for immunization strengthened Strengthen defaulter tracing mechanism for immunization through CHEWs and Completed through CHEWs and CHWs CHWs NC 3.2 CHEWS sensitized on RED Sensitize CHEWS on RED Completed NC 3.2 CHWs and CHEWs trained on community IMCI Train CHWs and CHEWs on community IMCI Completed MALARIA NC 3.2 Community and religious leaders, CHWs and CHEWs sensitized on Sensitize of community and religious leaders, CHWs and CHEWs on bed nets use Completed Malaria and bednets use STRENGTHEN YFS AT FACILITY AND COMMUNITY LEVELS NC 3.2 Youth peer educators mentored Mentor youth peer educators manning youth desks at facilities Completed NC 3.2 Equipment procured Procure equipment for strengthening/ MARPS Friendly/ YFS Completed NC 3.2 Exchange visits conducted Conduct exchange visits to YFS model sites for HCW’s and peer educators Completed NC 3.2 Feedback sessions conducted Conduct quarterly feedback sessions between youth and HCW at the YFS Completed NC 3.2 Youth CBD’s trained Train youth CBD’s Completed NC 3.2 Effective referrals tracked Link YFS to CU’s for service referral Completed NC 3.2 YFS sites branded Brand the YFS sites Completed NC 3.2 Youth provided with integrated services Provide youth with integrated services during the youth events Completed INTEGRATED SERVICES PROVISION FOR KEY POPULATIONS NC 3.2 DISC’s set up Setting up DISC’s for key populations Completed NC 3.2 DISC’s strengthened Strengthen existing MARPS DISCS. Completed NC 3.2 Key populations tested for HIV Provide HTC services to Key populations through DISC's and integrated outreaches Completed
NC 3.2 Key populations screened for STI’s Provide STI screening and treatment services in DISC and outreaches to key Completed populations NC 3.2 Key populations screened for cervical cancer Provide cervical cancer screening and referral services in DISC to key populations Completed STAKEHOLDER ENGAGEMENT NC 3.2 MARPS TWG meetings supported Support MARPs Technical Working Group meetings Completed NC 3.2 National conference/Workshop Hold a MARPs National Conference Completed NC 3.2 Quarterly IP review meetings held Facilitate quarterly IP program review meeting Completed NC 3.2 KP sensitization meetings held Hold KP sensitization meetings Completed Result Area 3:Increased Use of Quality Health Services, Products and Information Intermediate Result 3.3: Increased adoption of health behaviors IDENTIFY, PRIORITIZE AND ADOPT EBI’S FOR KEY POPULATIONS NC 3.3 EBI’s implemented Adopt and implement selected EBI’s Completed
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NC 3.3 National EBI TWG meetings attended Participate in National EBI TWG. Completed NC 3.3 Trainings conducted for staff & LIPS Training of staff and LIPS on EBI’S. Sister to sister, M- powerment and stepping Completed stones. NC 3.3 Monitor the implementation of EBIs Participate in joint EBI field monitoring activities Completed NC 3.3 IEC materials distributed Develop and distribute IEC materials and Job aids to Key population peer educators Completed and Drop in Centers EBI’S FOR THE GENERAL POPULATION NC 3.3 Staff and IP’s trained on EBI’s Train staff and IP’s on EBI’s (Healthy Choices I & II, Shuga, Families Matter) Completed NC 3.3 In school youth reached with HC Reach In school youth with HC I Completed NC 3.3 Out of school youth and OVC reached with HC II Reach out of school youth and OVC with HC II Completed NC 3.3 Out of school youth and OVC reached with Shuga Reach out of school youth and OVC with Shuga Completed NC 3.3 Parents reached with Families Matter Reach parents with Families Matter sessions Completed NC 3.3 Equipment, materials and tools procured Procure equipment, materials and tools to operationalize EBI’S. Completed PEER EDUCATION AND OUTREACH WITH KEY POPULATIONS NC 3.3 Key populations provided with services through integrated Conduct integrated outreaches for key populations Completed
NC 3.3 Support supervision for CCM staff to do PWID outreaches Conduct support supervision meetings Completed
NC 3.3 Peer educators refreshed Conduct Refresher trainings for peer educators Completed C 3.3 Focal Persons meetings for CCM and S/CHMT held Conduct meetings for CCM focal Persons Completed NC 3.3 Key populations reached though small group sessions Reach Key Populations with individual and small group sessions (FSW, PWUD,MSM, Completed MSW and Matatu respectively) NC 3.3 Condoms distributed Distribute condoms to key affected populations Completed NC 3.3 Water based lubricants distributed Distribute water based lubricants Completed NC 3.3 Grants awarded to partners Award grants to partners Completed PEER EDUCATION FOR THE GENERAL POPULATION NC 3.3 Youth/OVC & general population reached through SGC’s Reach youth, OVC and general population with small group communication sessions Completed on integrated messaging NC 3.3 CHW’s & peer educators updated Conduct topical updates for CHW’s & peer educators Completed NC 3.3 BCC/ IEC materials distributed Reprint BCC/ IEC materials on various health areas Completed
YOUTH EVENTS NC 3.3 Youth reached through events Support youth BCC events in collaboration with HFG & MOYAS Completed NC 3.3 GATE events held Support the regional and county level GATE events in partnership with HFG Completed COMMUNITY PWP NC 3.3 Capacity of OVC caregivers and support groups on VS, SPM, PWP Train community OVC caregivers and support groups to deliver PWP package for Completed for OVC strengthened. OVC adolescents.
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MASS MEDIA NC 3.3 Radio spots aired Air of radio spots that address the relationship between HIV & drug use. Completed SOCIAL MOBILIZATION NC 3.3 National events supported Support social mobilization for national health campaigns & RRI’s Completed Result Area 3:Increased Use of Quality Health Services, Products and Information Intermediate Result 3.4: Increase program effectiveness through innovative approaches PROFILING AND ASSESSMENT OF MARPS AND M-HOTSPOTS NC 3.4 Size estimation for MSM and PWUD/PWID conducted Size estimation for MSM and PWUD/PWID in Coast Completed NC 3.4 Social profiling for MSM and PWID conducted Design and conduct social profiling of MSM and PWID, OVC who are MARP Completed NC 3.4 Rapid Needs Assessment for Fisher folks conducted Rapid Needs Assessment for Fisher folks in Lamu, Malindi Msambweni and counties Completed CROSS CUTTING ISSUES Building capacity of LIPS to deliver to MARP friendly services: Institutional capacity strengthening; Build M&E; Strategic management and Sustainability and Continuous strengthening of technical capacity NC Technical capacity of LIPS assessed Conduct Service assessment of the LIPS’ technical capacity to provide MARP-friendly Completed LIPS, CBOS provided with TA services for MARPS friendly services services Provide technical assistance to MARPS implementing organizations. NC MARPS CBO’s mentored Mentor MARPS CBOs to lobby for integrated services. Completed NC MARP CBOs trained on Prevention Programming Trainings of MARP CBOs on Technical Aspects of Prevention Programming Completed NC MARPS CBO’s trained on M & E Training of MARPs CBOS/ LIPs on Monitoring and Evaluation Completed NC Technical briefs developed Develop technical program briefs based on In-depth-Data-Based Evaluations Completed Result Area 4: Social determinants of health addressed to improve the well-being of targeted communities and populations Intermediate Result 4.1: Marginalized, poor and underserved groups have increased access to economic security initiatives through coordination and integration with economic strengthening programs Voluntary Savings and Loans- Linkages to Micro-financial Institutions NC 4.1 CBT’s trained on VS&L /SPM Train CBT’s on VSL/SPM methodology Completed NC 4.1 OVC caregivers sensitized on VS&L/SPM Support cascade Sensitization of OVC Caregivers and support groups on VSL/SPM Completed NC 4.1 OVC caregivers supported on IGAs Support small scale IGAs for OVC caregivers and link them to markets Completed NC 4.1 PLHIV support groups supported with IGA’s Support IGA’s for PLHIV households and links them to markets. Completed NC 4.1 VSL /SILC groups supported Provide support for VS&L /SILC activities. Completed NC 4.1 Capacity building on appropriate economic Link youth CBOs/ CUs to Ministry of Youth for economic empowerment through the Completed strengthening/livelihood skills. Youth Fund. NC 4.1 CUs, SILC groups and PLHIV linked to relevant ministries and MFI Link CUs, SILC groups and PLHIV to relevant ministries and MFI Completed NC 4.1 parents of Children with disability supported with IGA’s Train and support parents of children with disability on IGAs. Completed NC 4.1 CUs and PLHIV support groups trained on business development Train CUs and PLHIV Support groups on business development skills and refer them Completed skills. to micro finance institutions Result Area 4: Social determinants of health addressed to improve the well-being of targeted communities and populations Intermediate Result 4.2: Improved food security and nutrition for marginalized, poor and underserved populations
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C 4.2 Enhanced agricultural and; livestock production Link CUs with MOA to enhance; production of high value nutritional and; drought Completed tolerant crops among vulnerable; household. C 4.2 Producer; organization formed and; linked to MOA and MOCD Support formation of producer groups; and link them with MOA and ministry of; Completed for; production and marketing. cooperative dvt. for trainings in; production and marketing. C 4.2 Cooperative; societies formed in partnership with MOA and Facilitate formation of cooperatives in liaison and partnership with MOA, and Min of Completed MOCD. cooperative dvt. C 4.2 Cooperative societies trained on production and marketing. Train cooperative societies on production and marketing. Completed C 4.2 contact farmers attending monthly feedback meeting Conduct monthly feedback meetings for contact farmers Completed C 4.2 Alternative farming techniques promoted to mitigate adverse Train contact farmers on conservation; Agriculture and value addition Completed production conditions N 4.2 Establishments of Facility; Kitchen gardens supported Support establishment of facility kitchen; gardens in partnership with service Completed delivery component NC 4.2 CHWs trained on; nutritional education Facilitate training of CHWs on nutrition; education in partnership with MOH/MOA Completed C 4.2 Farmers groups; trained of nutrition education in partnership Facilitate training of farmers groups on; nutrition education in partnership with Completed with MOA. MOA N 4.2 Lactating mothers sensitized on nutrition education; Facilitate Sensitization of lactating mothers on nutrition education; Completed NC 4.2 PLHIV trained on; nutrition education Facilitate trainings of PLHIV support; groups on nutritional education. Completed NC 4.2 OVC caregivers; sensitized to address Barriers to good nutrition to Support sensitization for OVC caregivers to address barriers to good nutrition for Completed children children NC 4.2 CHWs, CHCs, Farmers groups sensitized on IGA development Sensitize the CHWs, CHCs and farmers; groups on development of IGAs. Completed NC 4.2 PLHIV sensitized; on IGA development; Sensitize PLHIV support groups on; development of IGAs; Completed C 4.2 youth and adults; GBV survivors sensitized on IGA development Sensitize and support youth and adult; GBV survivors on Development of IGA’s Completed
NC 4.2 CHWs, CHCs and farmers groups linked to MFI; for financial Link the CHWs, CHCs and farmers groups to MFIs for financial literacy, support and Completed literacy and marketing. marketing NC 4.2 PLHIV support groups linked to MFI for financial literacy and Link the PLHIV support groups to MFIs for financial literacy, support and marketing Completed marketing C 4.2 CHWs, CHC, farmers groups, OVC/PLHIV support groups linked to Link CHWs, CHCs, farmers groups, OVC/PLHIV support groups to markets and Completed markets and trade fair exhibitions exhibitions for their produce and commodities (trade fairs, ASK shows etc.) NC 4.2 OVC households, supported with food supply; Support targeted OVC households with; food supply. Completed C 4.2 Target communities linked to ministry of Agriculture for capacity Support contact farmers and farmers groups trainings on post-harvest handling Completed building on postharvest handling C 4.2 Producer organizations linked to support storage commodities Link producer organizations with partners supporting storage commodities and Completed and initiatives initiatives. Result Area 4: Social determinants of health addressed to improve the well-being of targeted communities and populations
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Intermediate Result 4.3: Marginalized poor and underserved groups have increased access to education, life skills, and literacy initiatives through coordination and integration with education programs
Linkages to Economic Security Initiatives N 4.3 Facility based children/ adolescent support groups trained in life Support facility-based children /adolescent support groups with life skills trainings Completed skills NC 4.3 OVC Support groups meetings supported Support monthly OVC support group meetings at LIP level Completed NC 4.3 child friendly schools initiative (CLASSE) strengthened in targeted Strengthen child friendly schools initiative in targeted schools (CLASSE) Completed schools; NC 4.3 OVC supported with scholastic materials Supported targeted OVCs with scholastic materials Completed NC 4.3 older OVC supported in vocational skills Support vocational skills trainings for older OVCs Completed NC 4.3 OVC caregivers; sensitizations on available; scholarships Support OVC caregivers sensitizations on available opportunities for Completed opportunities secondary;/vocational OVC bursaries and scholarships e.g. CDF, LATF, PPP,HELB NC 4.3 initiatives that ensure school enrolment and retention supported; Support initiatives (e.g. block grants ,back to school campaigns etc.) that ensure Completed enrollment; and retention for OVC in schools and ECDs NC 4.3 Clubs supported in social financial education -;Aflatoun Support socio-financial education skills to children in school clubs (AFLATOUN – Completed children savings clubs) NC 4.3 CUS,CBO,s /LIPs linked for continuing and adult literacy Link CUs/CBOs/LIPs caregivers to continuing adult literacy Completed Result Area 4: Social determinants of health addressed to improve the well-being of targeted communities and populations Intermediate Result 4.4: Increased access to safe water, sanitation and improved hygiene NC 4.4 litres of drinking water treated Support OVC/PLHIV HHs with point of use water treatment purifiers Completed NC 4.4 water tanks supplied to schools Support schools with water tanks Completed NC 4.4 CU supported in advocacy for appropriate water harvesting Support advocacy for community participation in appropriate water harvesting Completed techniques techniques NC 4.4 schools supported with hand Washing vessels Support schools with hand washing vessels Completed NC 4.4 CTLS activities supported Promote CLTS activities in the CUs. Completed NC 4.4 OVC supported with laundry bar soap Support targeted OVC with laundry bar soaps Completed NC 4.4 Adolescent OVC girls sensitized Sensitize adolescent OVC girls in menstrual mgt. Completed NC 4.4 CHWs trained on WASH/HIV Train CHWs on WASH-HIV; Completed NC 4.4 Integration of WASH into all health services in the outreaches Support integrated WASH-HIV messages in schools.; Completed
NC 4.4 health action day;/health dialogue days integrated with WASH- Support WASH-HIV Doable actions through Health action days /dialogue days Completed HIV
Result Area 4: Social determinants of health addressed to improve the well-being of targeted communities and populations
Intermediate Result 4.5: Strengthened systems, structures, and services for protection of marginalized, poor, and underserved populations Expected Outcomes NC 4.5 community campaigns on child rights and GBV Create awareness on child rights and GBV through community campaigns and Completed
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sensitization NC 4.5 CUs advocating for child rights in the community Involve CUs in advocating for child rights in the community Completed NC 4.5 child rights clubs supported Work with Child rights clubs to increase child voices on child rights Completed NC 4.5 child friendly community spaces establish Establish child friendly community spaces Completed NC 4.5 children assemblies supported Support DCO’s/DQASO to coordinate and monitor Children assemblies in schools Completed
NC 4.5 OVC suport5ed to acquire birth certificates Support acquisition of birth certificates for OVCs Completed NC 4.5 OVC caregivers/PLHIV/GBV survivors and KPs peer group Link OVC caregivers/PLHIV/GBV survivors and KPs peer group members with NHIF, Completed members linked with NHIF, NSSF, and RBA NSSF, and RBA NC 4.5 OVC /children with disability linked with government Cash Link OVC /children with disability with government Cash transfer program Completed transfer program NC 4.5 Targeted elderly caregivers linked with government Cash transfer Link targeted elderly caregivers with government Cash transfer program Completed program NC 4.5 Collaboration with NCC/MMC/MGCSD /MOPHs strengthened to Collaborate with NCC/MMC/MGCSD /MOPHs to support select priority needs of Completed support select priority needs of street children street children NC 4.5 partnerships established with child rescue centers for Establish partnerships with child rescue centers for management of cases of child Completed management of cases of child abuse abuse NC 4.5 Beneficiary welfare committee (BWC) meetings quarterly Support quarterly Beneficiary welfare committee (BWC) meetings Completed meetings supported NC 4.5 AAC meetings supported Support quarterly AAC meetings Completed NC 4.5 child stakeholders meetings supported Support quarterly stakeholders meetings on child protection Completed NC 4.5 S/CHMT meetings attended Participate in S/CHMT meetings Completed NC 4.5 DDC meetings attended Participate in DDC Meetings to advocate and lobby for OVCs and other vulnerable Completed populations needs NC 4.5 CHWs and Contact persons monthly allowances supported Support monthly allowances for CHWs and OVC Contact persons Completed
NC 4.5 VSL/SPM supervisors allowances supported Support allowances for VS&L/SPM supervisors Completed NC 4.5 VSL/SPM CBTs supported Support allowances for VSL/SPM CBT’s Completed NC 4.5 CHWs/OVC contact persons sensitized on JOL tools Train CHWs/OVC contact persons on JOL tools Completed NC 4.5 TOTs trained on JOL Train TOTs on JOL Completed NC 4.5 quarterly Child forums held Hold quarterly Child Forums. Completed
Result Area 4 : Social determinants of health addressed to improve the well-being of targeted communities and populations
Intermediate Result 4.6: Expanded social mobilization for health
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NC 4.6 national and international events, e.g. World Contraceptive Day, Support national and international events, e.g. World Contraceptive Day, World TB, Completed World TB, and World AIDS Day, 16 Days of Activism , Day of and World AIDS Day, 16 Days of Activism , Day of African Child, International OVC African Child, International OVC Day , International Women's Day, Day , International Women's Day, World Food day, ASK Shows/trade fairs, farmers World Food day, ASK Shows/trade fairs, farmers field days, field days, conferences and exhibitions, Health Campaigns, e.tc conferences and exhibitions, Health Campaigns, supported NC 4.6 religious leaders, opinion leaders, and county leaders mobilized Work with religious leaders, opinion leaders, and county leaders for social Completed and sensitized on addressing social determinants for health for mobilization improved well-being of the communities C 4.6 Mobilization for HADs through CHWs for increased access, uptake Support mobilization for HADs through CHWs Completed and utilization of health services supported NC 4.6 Mobilization for outreaches through CHWs supported Support mobilization for outreaches through CHWs Completed C 4.6 Social mobilization for health through health dialogue days Support mobilization for community dialogues through CHWs Completed supported at CU level through CHWs initiatives 7.2. HEALTH SYSTEMS STRENGTHENING RESULT MATRIX: Result Area: Strengthened Health System Building Blocks in Support of Service Delivery Intermediate Result: Improved service delivery STRENGTHEN MOH SUPPORT SUPERVISION SYSTEM NC CHMT sensitized Sensitize CHMT/ CHMTs to provide effective support supervision Completed NC Joint supervision attended Actively participate in joint MOH support supervision at province /county level Completed NC Joint supervision attended Actively participate in joint MOH support supervision at district level Completed NC Joint supervision attended Actively participate in joint county/ S/CHMT support supervision of CHEWs and Completed CHWs NC Funding for supervision provided Provide financial and technical support to conduction of support supervision Completed NC FU planning is data based Use supervision outcome data for planning technical follow up Completed NC FU visits conducted Conduct technical follow up visits Completed NC Supervision data used Use supervision data in quarterly review meetings Completed NC TOT provided Provide needs based TOT on supportive supervision Completed NC People trained Provide needs based training on supportive supervision NC Mentorship provided Organize supervision mentorship to supervisors 2. STRENGTHEN CLINICAL MENTORSHIP NC Integrated planning of mentorship visits Plan mentorship visits in very close collaboration of mentors, service delivery Completed technical staff NC Mentorship visits conducted Conduct mentorship visits in support of service providers on different program areas Completed NC Mentorship teams oriented Orientate and coach district mentorship teams on all service delivery areas Completed NC HIV-QUAL implemented Provide technical support to facilities to implement HIV-QUAL assessment Completed NC EWI assessments conducted Provide technical support to facilities to conduct EWI assessments Completed
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NC Grand rounds conducted Hold district and facility grand rounds linked with mentorship program Completed
3. STRENGTHEN LINKAGES OF FACILITIES WITH TREATMENT COMMITTEES NC Linkages established Link facilities with treatment committee at district or county level Completed NC Linkages established Foster links of facilities with national level treatment committee when required Completed
4. STRENGTHEN REFERRAL SYSTEM NC Community facility referrals strengthened Work with S/CHMT, CHEWs and facility- in-charges to strengthen referral between Completed facility and community NC Promising practice identified Identify promising practices of existing referral systems Completed NC Promising practices documented Document promising practices of referral systems Completed NC Promising practices promoted Advocate for and organize sharing of promising practices in stakeholder forums Completed
NC Tools dissemination Provide support to dissemination of referral tools as part of other service delivery Completed strengthening interventions NC Peer learning promoted Organize peer learning in establishing functional referral systems Completed 5. SUPPORT FUNCTIONING OUTREACH SERVICES NC Outreaches conducted Work with S/CHMT and facilities in organizing integrated outreaches covering a Completed wide programmatic scope NC QI processes applied Apply Continuous Quality Improvement process to a few outreach interventions Completed
NC Outreaches conducted Increase number of facilities that implement outreaches services Completed 6. SUPPORT FACILITY MANAGEMENT OF CARE DELIVERY NC Meetings supported Support monthly S/CHMT / in-charges meetings Completed NC Meetings supported Support CCCs in setting up multidisciplinary teams Completed NC EMMR compliance improved Support district waste management plans to ensure EMMR compliance Completed
7. PROVIDE SUPPORT TO KQMH IMPLEMENTATION NC Sensitization conducted Sensitization on KQMH for Health where needed at province, county or district level Completed
NC QI committees active Provide technical support to activities of QI committees in facilities Completed NC Staff capacity skilled in QI Build continuous in house capacity of project staff to support QI Completed NC COPE integrated in QI processes Build existing COPE into QI practices of facilities Completed NC Quarterly meetings conducted Conduct quarterly feedback meetings with QI teams at county level Completed
8. WORKING WITH ESTABLISHED COMMUNITY SYSTEMS NC Functional CUs supported Support functional CUs, as per MOH definition and criteria Completed
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NC Not yet functional CUs supported Support CUs that do not meet yet MOH criteria of functionality Completed NC CU set up activities supported Support to training, mapping household registration, situation analysis, action plan, Completed equipping of non-functional CUs NC Facility in charges oriented Orient facility in-charges and health facility committees on the Community Strategy Completed
NC Quarterly supervision conducted Support quarterly supervision by S/CHMT of CUs Completed NC Quarterly meetings of CSCs conducted Support quarterly meetings of District Community Strategy coordinators and CHEWs Completed
NC CHW monthly meetings supported Provide technical and financial support to CHW and CHC monthly meetings on a Completed selective basis NC Topical updates provided to Support topical updates for FMC, CHCs and CHWs Completed NC CHEWs trained Train CHEWs on elements of KEPH Completed NC Community dialogue supported Support selectively community dialogue meetings Completed NC linkage meetings supported Support Community/facility linkage meetings Completed 9. STRENGTHEN LABORATORY SERVICES NC Service contracts financed Provide financing for critical service contracts for lab equipment Completed NC EQAs conducted Provide technical and financial support to facilities to conduct EQA Completed NC Lab coord. meetings supported Support technically and financially the district lab coordination meetings Completed
NC linkages with national mechanism Establish linkage with SCMS on quarterly basis Completed Result Area: Strengthened Health System Building Blocks in Support of Service Delivery Intermediate Result: Improved Human Resource Management 1. HEALTH WORKFORCE COMPLEMENTED WITH RAPID RECRUITMENTS NC HR gaps identified Identify staffing gaps in public facilities Completed NC Linkages with CAPACITY Liaise with CAPACITY to coordinate recruitments for counties Completed NC Capacity staff mentored Provide mentorship and supervision to CAPACITY staff. Completed NC Status reports provided monthly Provide monthly updated status reports on CAPACITY staff Completed NC Advocacy conducted Advocate for rapid recruitments for high volume facilities of FBO and private sites Completed with CDF or CAPACITY 2. SENSITIZE HEALTH WORKFORCE ON THE IMPLICATIONS OF DEVOLUTION NC Promising practices disseminated Document and disseminate promising change management strategies Completed 3. DEVELOP LEADERSHIP AND MANAGEMENT CAPACITY AT FACILITY LEVEL
NC LDP conducted Conduct leadership development program in selected facilities Completed
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NC Training conducted Collaborate with LMS in conducting health systems management training Completed
4. SUPPORT IMPLEMENTATION OF TRAINING PROGRAMS BASED ON THE TRAINING NEEDS ASSESSMENTS NC CMEs available Continue support to P/S/CHMT in standardizing CMEs on different program areas Completed
NC HW trained Coordinate with FUNZO planning, implementation and follow up of HW training Completed program NC Post training follow up conducted Conduct post-training follow up and post training assessments Completed NC Technical support provided Conduct technical support to service providers in collaboration with P/S/CHMT and Completed in line with documented SOP Result Area: Strengthened Health System Building Blocks in Support of Service Delivery Intermediate Result: Improved Infrastructure Maintenance 1. CARRY OUT GENERAL RENOVATIONS NC Renovations carried out Carry out renovations in facilities Completed NC Renovations carried out Carry out renovations on stores for supplies and commodities Completed NC Renovations carried out Carry out minor renovations on waste management structures Completed NC Signage and service charters applied Assist facilities with posting signage and service charters Completed NC Renovations carried out Supply fittings and equipment to stores and pharmacies on a selective basis Completed 2. EQUIPMENT & FURNITURE NC Procurements completed Procure furniture or equipment for office, lab, medical building Completed NC Inventorisation procedures complied with Ensure that furniture and equipment acquired is documented according to Completed inventory procedures of MOH NC Procurement completed Procure equipment, supplies and furniture through DOC2 Dock Completed 3. LINKAGE OF FACILITIES TO OTHER STAKE HOLDERS NC Linkages established Establish linkages with national mechanism for renovations and equipment Completed NC Linkages established Establish linkages with other renovation opportunities Completed Result Area: Strengthened Health System Building Blocks in Support of Service Delivery Intermediate Result: Improved Health Products Management 1. STRENGTHENED MANAGEMENT OF ESSENTIAL DRUGS NC Improved reporting rates Active participation in regional health commodities management committees Completed NC Improved record keeping Support district inventory meetings Completed NC Reduced reporting of stock outs Include health commodity management in quarterly support supervision package Completed
2. STRENGTHENING LMIS IN PHARMACIES AND LABS NC Tools disseminated Dissemination of LMIS tools to selected districts in collaboration with HCMS Completed
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NC improved reporting rates Support selected districts in data usage for ordering key laboratory commodities Completed NC Linkages established Establish linkage with HCSM , SCMS, KEMSA, Completed NC Functional subcommittees Support coordination meetings for laboratory at county level Completed NC Supplies redistributed Support redistribution of supplies and commodities Completed
3. ADDRESS SHORT TIME GAPS IN CONSUMMABLES /REAGENTS NC Procurements completed Procure supplies for emergency stock outs Completed NC Procurements completed Procure consumables and reagents Completed
Result Area: Strengthened Health System Building Blocks in Support of Service Delivery Intermediate Result: Strengthened Information Management 1. STRENGTHEN USE OF THE IQ-CARE FOR MANAGEMENT OF MEDICAL RECORDS NC Equipment in place Support investment in IT infrastructure Completed NC Linkages established Support installation and use of IQ-Care in high volume sites Completed NC EMR in place and used in selective facilities Provide support on EMR implementation Completed 2. SUPPORT TO ROLL OUT OF DHIS AND CBHIS NC DHIS orientations conducted Provide support to orientation on DHIIS Completed NC Tools distributed Ensure inclusion in HMIS CHIS tools distribution system Completed NC Mentorship provided Provide mentorship and OJTs on new data tools Completed NC CHS M&E tools developed, harmonized for improved quality Contribute to development for CHS M&E tools Completed reporting 3. STRENGTHEN DATA QUALITY AND UTILIZATION NC Data feedback & review meetings supported Provide technical and financial support to monthly data feedback & review meetings Completed at district level NC RDQA supported Provide technical and financial support to RDQA Completed NC Orientation provided Orient on new data capture and reporting tools for RHIS Completed NC Checklists for CU monitoring Develop CU monitoring tools/checklists Completed 4. SUPPORT DATA FOR DECISION MAKING OR EVALUATION NC Cohort analysis conducted Support S/CHMTs and facilities in conducting cohort analysis Completed NC AWP reviews supported and attended Participate in AWP 1 reviews at district level Completed NC Orientation conducted Provide orientation on gender program reporting tools Completed
5. DOCUMENTATION OF MAJOR SUCCESSES, ATTITUDE AND PRACTICES NC Small seminars conducted Capacity building program staff, CHWs, CHEWs and CHCs on reporting and Completed documenting NC Success stories documented Document success stories of counties on quarterly basis Completed
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Result Area: Strengthened Health System Building Blocks in Support of Service Delivery Intermediate Result: Strengthened Health Leadership and Governance 1. STRENGTHEN THE QUALITY OF STAKEHOLDERS FORUMS AT COUNTY AND DISTRICT LEVEL NC Technical support provided Provide technical contribution to joint preparation of stakeholder forums Completed NC Financial support provided Provide financial support for joint stakeholder forums in alternation with other Completed stakeholders NC Follow up conducted Follow up on actionable items of stakeholder forums Completed
2. STRENGTHENING COORDINATION AND CAPACITY BUILDING FOR DMOHS NC Mentorship provided Provide needs based mentorship support to DMOH Completed NC S/CHMT coordination meetings supported Provide technical and financial support to conduction of S/CHMT coordination Completed meetings 3. INTEGRATION OF LEADERSHIP, GOVERNANCE AND MANAGEMENT SKILLS INTO THE SUPPORTIVE SUPERVISION PROCESS NC Linkages established Liaise with LDP for coordination of training and mentorship Completed NC capacity building provided Conduct or support CMEs, virtual seminars or e-learning to strengthen planning Completed skills of CHMT and SCHMT 4. SUPPORT COUNTIES AND S/CHMTS IN CARRYING OUT ANNUAL WORK PLANNING TO GUIDE PRIORITY OPERATIONS AT ALL LEVELS NC AWP development supported Provide technical and financial support to AWP2 development Completed NC AWP reviews supported and attended Participate in AWP1 reviews at county level Completed
Result Area: Strengthened Health System Building Blocks in Support of Service Delivery Intermediate Result: Improved Financial Management 1. ALIGNMENT OF ACTIVITY FUNDING WITH HSSF NC Staff trained Train project staff on HSSF Completed NC Visit to pilot site conducted Visit pilot site in Western Province Completed NC Alignment with HSSF promoted Plan facility and CU based activities in alignment with HSSF Completed 8.2. STRATEGIC INFORMATION RESULT MATRIX Contributions to Holistic Health Systems Intermediate Result 2.1: Greater use of strategic information for program management, policy-making and decision-making DATA DEMAND AND INFORMATION USE (DDIU) NC 2.1 60 quarterly data review meeting hosted Support hosting of quarterly data review meetings Completed NC 2.1 CHWs and CHEWs’ capacities strengthened in DDIUs Support the Div. HMIS and Div. CHS to build capacity of CHWs and CHEWs on data Completed demand and use components to include: data collection (including indicators and use of tools), data quality, reporting, DHIS2 module and data use dashboards NC 2.1 225 quarterly Facility Multi- Disciplinary Team data review Support quarterly Facility Multi- Disciplinary Team data review meetings for facility Completed meetings for facility and community programs supported and community programs
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NC 2.1 2 DDIU trainings conducted Conduct tailor-made training on DDIUs targeting A+ staff, LIPs and S/CHMTs Completed KNOWLEDGE MANAGEMENT/ KNOWLEDGE TRANSLATION/ KNOWLEDGE SHARING FOR ORGANIZATIONAL LEARNING ( KM4OL/KMDEVT) NC 2.1 2 technical program briefs developed through data based Support the program to develop technical program briefs through data based Completed evaluation and data mining evaluation and data mining using different analytical methodologies NC 2.1 HSR/OR trainings to program staff facilitated Facilitate HSR/OR trainings to program staff Completed NC 2.1 Number of periodic/Project performance reports disseminated Generate periodic program/project performance reports-statistical analysis reports, Completed charts, graphs NC 2.1 4 exchange visits supported Support facility/community unit exchange programs to facilities/CUs that Completed demonstrate best practices on data use NC 2.1 75 data meetings for CHWs supported Support CHWs on dialogue meetings to share data on key indicators at community Completed provincial administration meetings NC 2.1 4 Quarterly reports developed Develop and share quarterly reports with District level stakeholders MoH (S/CHMTs Completed and shared and CHMTs), USAID NC 2.1 Fully integrated e-health (mobile) technology in M&E and Secure full integration of e-health (mobile) technology in M&E and performance Completed performance improvement established improvement- (m-health; implementation of EMR, CommCare Application, MyCheck) ROUTINE HEALTH INFORMATION SYSTEM (RHIS) NC 2.1 150 Orientation/Remedial sessions on New HMIS tools done Conduct orientation/Remedial sessions on New HMIS tools Completed
NC 2.1 75 High Volume SDPs supported on-Cohort Analysis; OJTs/CMES Support High Volume SDPs ( including Completed on Data Capture and Reporting (Utilization of the standardized EMR sites ) on-Cohort Analysis; OJTs/CMES on Data Capture and Reporting HMIS tools (Utilization of the standardized HMIS tools (ART MNCH, CaCX, Lab)- Mentorship of facility/Community level staff on new data tools NC 2.1 43 community data management systems(LIPs) supported to Ensure community data management systems support generation of reports to Completed generate reports to monitor key indicators monitor key RHIS indicators
NC 2.1 CHWs drawn from 140 CUs supported on community level data Support community health volunteers on recording and reporting on national tools Completed capture and reporting using revised CHIS tools and utilizing the – CHIS tools/ chalkboard skills to adequately report on community level services
NC 2.1 20 DHRIOs supported to strengthen data capture and reporting Support DHROs to strengthen recording, reporting and use of data Completed via the DHIS2/CBHIS platforms through provision of airtime and logistics to guarantee no stock-outs of tools NC 2.1 225 Data Quality Audits (RDQAs, DQAs) conducted Conduct Data Quality Audits (RDQAs, DQAs, OSDVs) to strengthen data collection Completed systems and processes at facility & community levels NC 2.1 OVC longitudinal MIS developed Conduct orientations for program staff and LIPs on OLMIS to secure successful roll Completed out of the database system in supporting OVC programming NC 2.1 # of TWGs attended Facilitate transitioning of KePMS) to DHIS2 through TWG Completed
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NC 2.1 75 high volume facilities supported on dual reporting Support high volume facilities to accomplish dual reporting into KePMS and DHIS2 Completed even after transition NC 2.1 # of people trained Designate personnel to be trained as TOTs on DHIS2 Completed NC 2.1 # and type of tools distributed Support integration of CoreGroup/Dimagi CommCare mHealth Application in MNCH Completed programing NC 2.1 ‘Mycheck’ developed, institutionalized and operationalized as Support programs to implement ‘MyCheck’ for performance improvement Completed one of the performance monitoring tools NC 2.1 S/CHMTs providing RH/FP services supported on commodity Facilitate S/CHMTs in providing FP services with forecasting of tools (quantification Completed quantifications (volumetric analysis) through onsite-technical and volumetric analysis of commodities/supplies (including HMIS tools) through assistance onsite technical assistance and linkages to national mechanisms
NC 2.1 Div. CHS provided with technical support in drafting and refining Support the Div. CHS to develop M&E plans for the Community Strategy Completed the M&E plan for community strategy NC 2.1 NASCOP provided with technical support to develop an M&E Plan Support NASCOP to develop and refine the M&E Plan for EBIs Completed for the EBIs NC 2.1 Div. HMIS supported to develop National HIS Training Resource Support the Div. HMIS in development of the National Training Resource Materials Completed Materials ( including DDIUs/DQAs) on RHIS and DDIUs
NC 2.1 Remedial orientations conducted for S/CHMTs on DHIS2 and Conduct remedial orientations for S/CHMTs on DHIS and CBHIS Completed CBHIS NC 2.1 An harmonized RHIS work plan to support the Div.HMIS Support the Div HMIS to conduct AWP1 Quarter Reviews and to facilitate Completed coordinate the roll-out of RHIS activities in the supported harmonization and coordination of RHIS activity implementation in the supported provinces developed and operationalized districts TECHNICAL AND INSTITUIONAL CAPACITY BUILDING - PROGRAM STAFF,LIPS & MOH (M & E Systems Establishments, institutionalization and operationalization) NC 2.1 Integrated-linked M&E system developed Support LIPs to set up integrated- linked M&E systems responsive to holistic HSS Completed
NC 2.1 8 CHMTs supportive supervision conducted Support the CHMTs to conduct supportive supervision by provincial teams Completed
NC 2.1 Field Performance Monitoring and Technical Assistance Conduct Field Performance Monitoring and Technical Assistance Missions /Onsite Completed Missions/Onsite Technical Assistance to HFs, MOH Structures, Technical Assistance to HFs, MOH Structures, LIPs LIPs conducted NC 2.1 Joint strategy for capacity development developed Strengthen staff/LIPs capacity in Results Based Monitoring and Evaluation and Completed research ( Improved Health Metrics) through tailor made trainings in HSR
NC 2.1 Effective monitoring of project performance and comparing it to Provide technical guidance on program frameworks in the process of LIPs Sub- Completed targets Award Development/ Modifications
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NC 2.1 Harmonized data capture [M&E] tools Design/refine community program monitoring and reporting tools (formats and Completed guidelines) to help harmonize the data capture and reporting systems responding to the different information needs NC 2.1 # of LIPs Supported to set up robust, integrated-linked M&E Support the LIPs to set up robust, integrated-linked M&E systems and ensuring it is Completed systems implemented effectively, linking progress and needed actions, providing timely and relevant strategic information to all stakeholders NC 2.1 # of LIPs, CUs, health facility staff and S/CHMTs mentored on use Provide responsive TA and mentoring of the LIPs, CUs, health facility staff and Completed of DHIS2 S/CHMTs on use of DHIS2 NC 2.1 # of LIPs-level M&E focal persons capacity built on M&E concepts, Build capacity of LIPs-level M&E focal persons through tailor-made competency- Completed strategy and applications based trainings in M&E Fundamentals (M&E concepts, strategy and applications)
NC 2.1 A+ M&E framework developed/updated Integrated M&E plan for Update and revise the A+ Program frameworks and M&E Plan to ensure that the Completed guiding program M&E systems developed/updated M&E system is robust enough to responsively guide activity programming
PROMOTION OF RESEARCH AND INNOVATION NC 2.1 Baseline data/ statistics established and used to reference the Establish baseline statistics by conducting a further analysis of the population based Completed contribution of the APHIA+ to Health Service Delivery based on a studies (KDHIS, 2008/09, KAIS 2007, K-MOT, KESPA, further analysis of the KDHIS 2008/09, KAIS 2007, K-MOT, 2010, and NHA) and an in-depth, analysis of the end-term evaluation of the APHIA II KESPA 2010 and other small HH surveys project. NC 2.1 Program staff and LIPs supported to develop client satisfaction Support program staff and all LIPs, with technical guidance in development of client Completed tools and protocols to gauge the levels of clients satisfaction satisfaction, tools and protocols and oversight in execution of client satisfaction surveys as part of the HSR studies NC 2.1 At least 2 health systems researches/ OR studies conducted by Conduct health systems researches(operations, implementation and policy research Completed thematic programming areas (HIV and AIDS, MNCH, RH/FP and studies-at least one in each thematic program area) Soc. Determinants to help program reposition its strategic orientations and implementation approaches and also helps the project develop best/ promising practices that could be replicated in the future NC 2.1 New fundable concepts and proposals developed based on data- Develop new fundable concepts and proposals responding to health Completed based evaluations and health systems research (HSR) findings and systems research (HSR) findings and innovations in SRH&R programming innovations in SRH&R programming development NC 2.1 Program staff and LIPs’ capacity in Strengthen capacity in operations research and impact/effectiveness evaluations to Completed conducting OR/ Health Systems, Researches strengthened and enable A+ program skills used to develop knowledge products (abstracts, best- Staff and LIPs design and implement evidence-informed interventions [operations practices...) that can be shared with the global community to research (OR) activities demonstrate results and innovations applying research techniques to improve the quality, effectiveness, and efficiency of RH/FP programs and services.]
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NC 2.1 Knowledge products developed by thematic programming pillars Develop technical program briefs and Completed and disseminated/ shared with the global public health technical briefs based on In-depth- community Data-Based Evaluations Result Area: Crosscutting issues Intermediate Result: Across the interventions Whole Market approach is addressed cross-cuttingly BROADEN THE RELEVANCE OF THE COMMUNITY STRATEGY TO NON-STATE ACTORS NC 3.1 Linkages established # initiatives that link CUs with non-state actors Completed NC 3.1 Linkages established Expand mobilization efforts of CUs to orient clients to the private sector Completed
NC 3.1 Linkages established Attract private practitioners to community dialogue days Completed MAINTAIN WHOLE MARKET APPROACH AS A STRATEGY TO EXPAND COVERAGE FOR SELECTED PRODUCTS NC 3.1 Continue to support whole market approach in distribution of bed nets, condoms, Completed
CONTINUE TO PROMOTE PPP NC 3.1 Supply of services increased Tunza expands reach and range of services available to low income groups Completed NC 3.1 Supply of services increased Work with CMMB to adopt long term strategies for growth Completed NC 3.1 Supply of services increased Gertrude Hospital continues to expand services to low income groups Completed NC 3.1 Linkages established Link S/CHMTs with private sector facilities Completed NC 3.1 Linkages established Support involvement of private sector in national campaigns Completed EXPLORE REGULARLY OPPORTUNITIES TO ADVANCE WHOLE MARKET APPROACH NC 3.1 Linkages established Actively promote registration of private facilities in the master list for facilities Completed
NC 3.1 Linkages established Advocate for existing service delivery networks to benefit from national mechanism Completed
NC 3.1 Linkages established Establish linkages with service delivery by private pharmacies Completed NC 3.1 Linkages established Attract novel partners from private sector in supporting service delivery Completed NC 3.1 Linkages established Extend mentorship activities to the private sector Completed NC 3.1 Linkages established Linking vulnerable populations for integrated services with health insurance Completed Result Area: Crosscutting issues Intermediate Result: Across the interventions Youth is addressed cross-cuttingly BUILDING ON PARTNER YFS EXPERIENCE T SCALE UP AND EXPAND THE RANGE OF SERVICES AND DELIVERY CHANNELS NC 3.1 Facilities/service outlets (hospital, clinic, mobile units) Identify and support high volume facilities to mainstream a full package of YFS for Completed implementing YFS 15-24 yr. cohort in model clinic sites NC 3.1 YFS facility assessments conducted Conduct YFS facility assessment to identify QI & SP training needs Completed NC 3.1 Service providers/multi-disciplinary teams mentored in YFS Conduct mentoring/ coaching in YFS of providers/multi-disciplinary teams based on Completed assessment
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NC 3.1 service outlets refurbished for YFS provision Limited YFS refurbishments per assessment results Completed NC 3.1 Facilities/service outlets with staffed youth desks Deploy trained youth Peer Educators, Expert clients, (PLHIV enrolled in services) , Completed CHW and Advocates at youth desks in facilities linked to community-based youth groups NC 3.1 YFS exchange visits conducted Support YFS through exchange visits to model sites that demonstrate best practices Completed
NC 3.1 Low volume sites implement parts of the YFS package Roll–out portions of YFS package in low volume sites (e.g. Youth desks) Completed
NC 3.1 Reports produced Document provision of quality YFS in supported sites Completed EMPHASIZING BEHAVIOR CHANGE WITHIN ALL YOUTH PROGRAMS See prevention interventions: at CU level towards out of school youth, and through Completed district school health programs for in-school youth FOSTERING POSITIVE COMMUNITY NORMS. NC See: prevention interventions: in support of community mobilization strategies to Completed engage parents, teachers, religious leaders, husbands and other gate keepers
NC 3.1 Linkages established Intensify the use of youth desks as link of facilities with CUs, communities, and Completed youth centers, and youth CSOs NC 3.1 Community dialogue supported Support the use of community dialogue forums to address youth issues Completed PROMOTING GENDER EQUALITY AND EQUITY See: gender interventions Completed BUILDING LOCAL CAPACITY AND FOSTERING NATIONAL OWNERSHIP TO ENSURE SUSTAINABLE MULTI-SECTORAL AYSRH PROGRAMS See: YFS, school based interventions and community outreach and involvement of Completed different ministries ( Health, Education, Youth) REACHING DIFFERENT COHORTS WITH TAILORED INTERVENTIONS See interventions targeted at engaged and married couples, very young adolescents Completed 10-14, young men, young PLHIV, adolescent girls, MARPs and MARA/MARY
AYSRH ADVOCACY FOR INCREASED RESOURCES AND SUPPORTIVE POLICIES NC 3.1 AYSRH TWG mtgs conducted and minutes shared Participation in NCPD/MOH - led national AYSRH TWG to share lessons/exchange Completed experiences on YFS and evidence based interventions
NC 3.1 Revised AYSRH Policy & POA Participation in review of GOK AYSRH & Development Policy (2003) and Plan of Completed Action.
Result Area: Crosscutting issues
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Intermediate Result: Across the interventions Equity is addressed cross-cuttingly SUPPORT SMALL SCALE INTERVENTIONS AT THE COMMUNITY LEVEL NC 3.3 Action plans of CUs implemented Encourage small scale initiatives that increase recruitment, knowledge, attitudes Completed and health care seeking behavior NC 3.3 Community level interventions are documented Document these initiatives and ensure ownership Completed SUPPORT TRADITIONAL PUBLIC HEALTH PROGRAMS NC 3.2 Inequities due to access reduced Support large scale outreach programs Completed NC 3.1 Inequities due to access reduced Help people with disabilities access care Completed NC 3.1 Inequities due to inappropriate access reduced Support patient friendly services that integrate youth friendliness, baby friendliness, Completed MARPS friendliness, PLWHIV friendliness etc. SUPPORT LARGE SCALE PROGRAMS NC 3.1 Inequities reduced through expansion of coverage Support RRI that maximize service coverage Completed NC 4.3 Inequities due to exclusion reduced Support forums or advocacy initiatives that work towards greater inclusion of Completed vulnerable groups NC HSS Inequities due to lack of attention during planning reduced Help the planning structures focus on the vulnerable groups during planning Completed
Result Area: Crosscutting issues Intermediate Result: Across the interventions Gender is addressed cross-cuttingly RAISING AWARENESS ON GENDER ISSUES, NEEDS AND STRATEGIES FOR ALLEVIATING GENDER INEQUALITIES NC Gender Audit conducted Gender audit/analysis at community level to adjust interventions Completed NC Technical support provided Provide technical support to program staff and partners on gender mainstreaming Completed and integration NC Gender awareness conducted Integrate gender awareness within project sensitization forums: community Completed dialogues, in- and out of school forums, calendar events NC SITA KIMYA messages disseminated Behavior change communication interventions through use of SITA KIMYA materials Completed : print, video CAPACITY STRENGTHENING OF SERVICE PROVIDERS AND COMMUNITY RESOURCE PERSONS NC 3.1 Health care workers trained and mentored on SAFE Support training of HCWs on SAFE, through CMEs and OJT Completed NC 3.1 Integrate GBV service provision Integrate GBV interventions into overall service delivery components: PMTCT, HTC, Completed Care and treatment, RH/FP/ MCH NC 3.1 Trauma counselors debriefing conducted. Support trauma counselors supervision sessions at district level Completed
EMPOWERMENT OF MEN, WOMEN GIRLS AND BOYS TO PROTECT ECONOMIC, SOCIAL, CULTURAL AND CIVIL RIGHTS
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NC 4.5 Legal literacy and aid provided Support legal literacy and legal aid sessions through sub partners: FIDA and CREAW Completed
NC 4.5 Safe spaces established Replicate and establish safe spaces for psycho social support and economic Completed empowerment NC 4.5 GBV survivors receive protection GBV survivors safety and security is enhanced through the safe spaces and shelters Completed
NC 3.4 HIM advocacy conducted Male champions advocacy on health images of manhood Completed NC 4.1 Vulnerable women trained on VSL/SPM Support training of vulnerable women on VSL/SPM models of economic Completed empowerment NC 4.1 Vulnerable women and men initiate IGAs Support vulnerable women and men to initiate IGAs for improved economic security Completed
MULTI SECTORAL COORDINATION AS ESSENTIAL INGREDIENT OF GENDER INTERVENTIONS NC 4.5 GBV TWGs supported Support TWGs that lead the multisectoral response to GBV Completed
Result Area: MANAGEMENT Intermediate Result: strengthened project management and Project visibility
Project Management NC Grant proposals developed and submitted Develop proposals and approvals for different grants listed in work plan or identified Completed through expression of interest. NC Project Advisory Committee held Conduct Project Advisory Committee Meeting Completed NC PSC quarterly meetings held Facilitate quarterly provincial steering committee meetings Completed NC Quarterly partners' meeting held Hold quarterly project partners meetings Completed NC Stakeholders and TWG meetings participated in Support and participate in the stakeholders and TWG meetings at provincial and Completed district levels NC SAPR and APR submitted Prepare and submit USAID PEPFAR SAPR and APR Completed NC Program review and strategy meetings held Conduct annual program review and strategy meetings Completed NC Quarterly review meetings by Project teams Conduct quarterly project review meetings Completed NC Technical assistance trips undertaken 5 STTA trips from Pathfinder/Boston Completed NC Supervision trips undertaken 5 backstopping and supervision trips from Boston Completed NC Trip undertaken 4 CR/ PD trips to Boston Completed NC International conference attended 14 Project staff and MOH counterparts to attend international conferences (Afria Completed and US) NC Team building conducted Support team building for APHIAplus staff Completed
Communication and Documentation NC Staff and MoH trained Train staff and MoH on documentation and presentation skills Completed
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NC Social sites up to date Develop and continuously update twitter and Facebook pages and Contribute to Completed health blogs NC Select program teams participate in Exhibitions based on themes Participate in international exhibitions in Kenya Completed NC Media breakfasts/round tables held Hold two media breakfast/roundtables together with InterNews Completed NC Videos produced Documentation of program activities through photography and 3-5 minute in-house Completed videos NC Brochures printed Produce program brochures for Coast and Nairobi provinces Completed NC Newsletter editions produced Develop quarterly newsletter editions covering success stories Completed NC Program updates produced Produce bi-monthly program updates with stakeholders Completed NC Stories pitched Pitch best practices to the media houses for coverage NC best practices disseminated Produce APHIAplus communication materials to disseminate best practices Completed (banners, posters, folders, brochures, diaries, annual calendars) NC Websites updated Maintain up to date content on APHIAplus and Pathfinder websites Completed NC Events organized Support the project in event organization, branding and advocacy Completed
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SECTION XI: PROJECT MANAGEMENT Constraints and Critical Issues Constraints/Challenges How they were addressed eMTCT Reduced funding resulting in less of CME and Increased mentorship and OJT was supported in the orientations quarter. Peer parents no longer supported at MDH for HEI Use of peer educators for follow up as well as Mentor follow up, CHWs rarely available due to nonpayment of Mothers in institutions with the program. allowance Erratic supply of test kits Giving priority for HTC to ANC mothers and redistribution of test kits. Relying on MOH circular to implement option B+ in Sensitization of staff on the PMTCT guidelines and TA to some facilities, which has not been released facilities that have the capability to provide option B plus. VMMC Unavailability of VMMC services on a daily basis at Services offered on appointment supported facilities Lack of sustainability in public facilities Incorporate MOH staff at the facilities HTC Shortage of HIV testing kits The project supported redistribution of some of the RTKs to facilities with stock outs, Priority for testing was given to PMTCT and PITC clients, Outreaches were very targeted. CARE and TX Lack of CD4 reagents especially for the BD machines Redirect specimen to laboratories with partec machines though sometimes distance and work load did not favor this. To enhance minimal downtime of CD4 testing, re- distribution of the CD4 reagents from various facilities was facilitated. Frequent breakdowns of FACS count machines. Liaise with NHRL for repair Stock out of Falcon tubes and EDTA tubes The project is planning to procure the tubes HIV/TB Integration Retention and follow up of clients to care and Defaulter tracing mechanisms especially in high volume treatment due to the mobile nature of most patients facilities. especially in the urban set up. MNCH Priority activities for the SCHMT took precedence thus slowing the implementation of some planned project activities. 4th antenatal clinic attendance is still low, continuous education for early ANC attendance will continue Low reporting rates for family planning commodities, Project will continue providing TA and support to improve timely reporting. Health workers transfers and attrition. Training gaps in BeMONC Plans underway to organize the trainings from the supported facilities starting with the HVFs Lack of new immunization tally sheets and reporting To follow up with the Div. Health Informatics and M&E and tools in the sub counties. Div. RMHSU Discussions Low uptake of focused postnatal care MENTORSHIP Availability of new HIV test kits but shortage of staff The various mentors trained on the new HIV testing trained on how to use them algorithm have assisted in disseminating the skills to mentees Staff redeployment has resulted in completely new The mentorship teams have had to treat these sites like
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staff in previously mentored sites. The majority of the fresh sites. Given that they have very few on-site visits staff has little knowledge and skills in HIV care. arrangements are underway to conduct relevant CMEs in these sites Delayed CD4, EID and Viral Load results We have spoken to the concerned partners so as to SMS printers are out of order establish efficient laboratory networking systems. However, it remains a challenge Due to budget constrain means that the master Use of phone based consultation where the MOH mentors mentors are not going to the field to mentor. Instead call the master mentors to consult when faced with we use them during sharing forums, orientation/ difficulties. coaching sessions and grand rounds. This means the MOH mentors are not effectively followed up. The MOH mentors are doing 1 visit in 2 months, thus their mentees are not effectively followed up. In some instances the MOH mentors are reporting that after 2 months when they do follow-up, their mentees have already gone back to what was being done before mentorship. Shortage of HIV test kits (around mid-April and in may) Borrowing HIV test kits from the few facilities which had in the facilities affected effective delivery of services. them was useful in ensuring a good number of clients were tested.
DEMAND CREATION AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH What were the challenges encountered during the Recommendations quarter? Stock out of commodities as supplied by statutory Many partners managed to source for commodities via other bodies (KEMSA) including HTC kits, condoms, channels including liaising with facilities in the catchment water based lubes areas, other partners like AHF Long distance to some CCCs makes it difficult for Support the Ministry to start CCCs in dispensaries where OVC in support groups to attend meetings LIP/CUs with OVC support groups are. regularly Low pace of community members in recruitment Continues sensitization of community’s culture of saving and and share contribution in the cooperative initiation of IGA. Support and strengthening of community societies. CBOs Insecurity in Lamu, Kwale and parts of Mombasa The Government is handling the insecurity issues, and once county has affected delivery of OVC services and done the children will be provided with services reporting. Poor infrastructure to access farm inputs and Advocated and lobbied county government and local market farm produce. administration to assist in development and renovation of roads. Community cultural and religious beliefs Continuous sensitization and mobilization to deal dispel l associated with principles of interest rate and myth and misconception on cooperative societies share deposits in the cooperative societies High expectation from the community especially Implementing partners encouraged to continue linking the for fees support and supplies OVC to available opportunities. Police raid on the Kimathi DISC A local leader’s sensitization meeting was held and explained the project activities Low rains was a hindrance to agribusiness and Community sensitized on recycling and utilizing water used at gunny sacks household level for their kitchen gardens and gunnysacks.
Due to increase in demand for maternity The project procured 18 delivery/maternity beds for utilization inadequate beds. Makadara, Kayole.
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SECTION XII: CHANGES IN THE PROJECT There were no fundamental changes in the project- strategically and structurally. However, sub-award grants mechanisms was modified to PIPs to enhance efficiency due to reduction of funds at the beginning of this follow-on.
SECTION XIV: SUCCESS STORY GUIDELINES & PREP SHEETS
Success Story 1: Use of SMS services to improve on reporting timelines A spot check done on the tracking template for Taita Taveta indicated that Reporting timelines for the county were way beyond the set reporting deadline of 5th of every month. The template indicated that since 2011 the earliest APHIAplus received the county reports was on average the 10th, with other months reporting frequencies around the 14th, 17th or 21st of every month. The reason behind the delay was caused by health facilities submitting their monthly reports to the SCHRIOs office way after all through to the 15th.
APHIAplus RMU with the SCHRIO adopted a database for all the facility contacts which the HRIO used to send SMSes on the 30th of the month reminding facilities to compile and submit their reports to the SCHRIO before or on the 5th of the month. SMS airtime cost to 82 actively reporting facilities including APHIAplus non-Supported sites) is Kshs. 250/=. Tracking is done on the 5th of the month and non-submitting facilities by then are given a follow up call. After the practice, February and March 2014 reporting timelines have remarkably changed to the 6th of the month. See attached tracking template.
Success Story2: Adoption of regional TOTs for HMIS tools With a focus on the 5 key high volume facilities in Taita Taveta County, Technical Assistance is offered to the facilities on staff capacity need base and quality analysis outcomes of facility data. PMTCT and ART have been more focused on based on the fact that the service delivery areas have numerous reporting tools and their source registers. Taita Taveta has 65 APHIAplus supported sites in total. During TA missions it has been impossible to cover all sites within a quarter which has been greatly affecting the sustainability of quality on monthly reporting.
As a result the Health records office in collaboration and APHIAplus RMU came up with a TOT program which nominated facility staff representative who is trained on HMIs and their facilities are best performing in use of the HMIs registers and their reporting tools. Such staff plays the role of Trainer of Trainers to the facilities within their geographical location. It operates more like an exchange learning programme from best performing facilities to those that are yet to pick up. The TOTs are available on need base and whenever there are updates to be shared. This TOTs support differs from the mentorship programme in that this approach provides an opportunity for the facilities to learn from their very own facility counterparts and share experiences and best practices as they face them on the ground. It also guarantees the availability of a TA provider within the locality of the facilities as opposed to mentorship which has only one HRIO representing a whole sub-county who may not cover all facilities within a quarter.
Due to competing tasks from the MOH and APHIAplus as well, it was impossible to provide TA to all 65 APHIAplus supported facilities within the county within a quarter and on need base which resulted to poor quality monthly reports. This has greatly improved the quality of MOH 731 and MOH 711 monthly reports, especially the ART indicators where early last year coinciding indicators figures did not tally. A review on this month’s reports indicated only 2 facilities in the county Njukini and Rekeke had reporting quality issues and this was as a result of new staff postings as compared to last year where 50% of the reports had gaps. See attached TOT allocation template per region.
Success Story 3: Mitigation from Cohort analysis Cohort analysis is key for any ART and PMTCT site since it helps to measure the survival and retention rate of clients as well as the treatment success. In Taita Taveta county, ART cohort analysis and PMTCT’s HIV Exposed Infants cohort analysis is done on a monthly basis in all the ART and PMTCT sites but a key focus has been on the 5 high volume facilities in Taita Taveta. The process involves analysis clients sharing the same cohort month i.e. clients who started a
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treatment programme the same month and reviewing their progress and outcome within the treatment period. In ART Cohort analysis the cohort elements below are analyzed. i) Their survival and retention rate i.e. Total clients started on ART within the same cohort month are reviewed after a 6 monthly, 12 monthly and 24 monthly period to analyse how many will be dead, stopped, Lost to follow up, and total retained alive and on treatment. ii) The treatment success of ART clients will be measured by how frequent an ART client will be substituted on ARV drugs from 1st line, to 1st line alternate or 2nd line. The drug efficacy and less substitution on the client measure the treatment success on this client. A successful ART cohort analysis must be above 75%. Refer to attached analysis for the period Jan- Mar 2014 for the 5 high Volume sites in Taita Taveta.
In HEI cohort analysis, routine testing of exposed infants at 3weeks, 9 months and 18 months and final outcome after 18 months is analyzed. PCR Positives are audited with the MNCH team and currently the newly established EMTCT taskforce. The findings from the cohort analysis are then discussed with the CCC staff and SCHMT key point persons at the facility level and necessary mitigations put in place like defaulter tracing, intensified adherence counselling, and group therapy sessions during support group meetings. For HEI Cohort analysis, findings help on tracking PCR Tests, follow-up of DBS results and eventual outcome and linkage to HIV care for the PCR Positives.
Success Story: 4: Use of E-Health SMS services in defaulter tracing Defaulter tracking for HIV care and Treatment patients is done routinely at every CCC site within the county. APHIAplus provided diaries to High Volume CCC sites for tracking defaulters. Once a CCC patient misses an appointment, they are tracked in the diary and a follow-up call given to the client the following day. If the CCC client does not turn up within two weeks, they are profiled for tracing either through the CHWs, Support groups members, the PHO or another call from the clinician. The CHWs were provided with Bicycles by APHIAplus to facilitate the household level tracing. But still with all these efforts in place, the number of defaulters did not reduce and it was a revolving cycle of clinic day defaulters are tracked and subsequent follow-up made. An E-Health SMS system called Front Line SMS system was introduced in January 2014 and has also been rolled out at Moi District Hospital CCC, which is used to send SMSes to all CCC clients a three days before their CC Clinic day, reminding them to attend their CCC appointment. In the month of Moi DH had 547 active clients on ART, while as at February 2014 the turned up within the month for ART, after the rollout of the SMS system, February 2014 ART clients turn up rose to 745. The number of defaulters has marginally reduced since with a reminder the clients take the effort to attend their clinic appointments.
Case Study 1: Mathare North HC HEI lost to follow up (LFTU)
At Mathare North HC there were complains of HEI lost to follow up. This was identified in the NASCOP data base as; high numbers of DBS collected in the facility and few infants whose samples were reactive and not initiated on HAART. This problem was resolved by the facility organizing for a MDT meeting and a root cause analysis done to identify the gaps. It was noted that staff were not keen in collecting correct contact details of the mothers and there was no sharing of information between mentor mothers, laboratory and CWC. The wrong contacts given made it difficult to follow up the HEI despite the results coming back to the facility on time. After the meeting, all SDP agreed to share relevant information between them and to collect detailed patients’ contact that will enable them to strengthen HEI follow up.
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SECTION XII: SCHEDULE OF PLANNED ACTIVITIES
Result Area 3: Increased use of quality health services, products and information Intermediate Result: 3.1. Increased availability of an integrated package of quality high-impact interventions at community and health facility levels Expected Outcomes: Improved capacity of public sector facilities to provide high quality package of PMTCT interventions at community, dispensary, and health centre. Improved capacity of the private sector to provide a package of high quality, high impact interventions; Increased availability of HIV/AIDS treatment services at points of contact for PLHIV with health system ; Increased capacity of the S/CHMT Health Management Teams to plan and manage service delivery. Expanded coverage of high impact interventions for women and men of reproductive age, youth, vulnerable groups, KAPs, mothers, new-born, and children. Increased availability and capacity of functional skilled birth attendants in public and private sectors and in health facilities and communities; Increase coverage of PMTCT services especially in the private facilities Increase uptake of efficacious regimen & HAART Improve follow up of HIV positive mothers and their HIV exposed children Source TARGET Quarterly (Min/ Timelines OUTPUT Other) ACTIVITY GOK USAID Cont Responsible Party Jul-Sept, 2014 Target Prevention of Mother To Child Transmission (PMTCT) Health workers updated on eMTCT Support provision of topical updates to health workers in public and N/A (1050) PI (A,S, M) x private facilities on eMTCT guidelines C- 23x30 MoH (L,E,M) N-12x30 (@30 CLUSA ( A,S, M) pax) Health workers trained on DBS collection for EID/ support Provide OJTs for health workers in public and private facilities on DBS N/A PI (A,S, M) X TA on DBS collection for EID MoH (L,E,M) DBS transported Support the lab network for DBS NA (75) PI (A,S, M) x C=42;N=33 MoH (L,E,M) Commodity management of PMTCT commodities improved Collaborate with HCM to Support sites to submit consumption data N/A 75 PI (A,S, M);MoH x and requisition for commodities accurately and timely. (L,E,M);HCSM (S) Mothers receiving care and treatment and follow up at Support HIV care and treatment including HAART integration into NA (75) PI (A,S, M) x MCH. MCH in selected high volume facilities. C=42;N=33 MoH (L,E,M) Facilities supported to have eMTCT dashboards Support facilities to have EMTCT dashboards. NA 75 facilities PI(A,S,M);MoH x (L,E,M),NARESA (A,S,M) Data tools available in facilities Support availability of data tools N/A (75) PI (A,S, M);MoH x C=42;N=33 (L,E,M);AFYA Info (S) Counsellor supervision sessions conducted Support counselor’s supervision. N/A (54) PI (A,S, M) x N- 9;C-45 MoH (L,E,M) PITC counsellors facilitated Support allowances for PITC counselors. N/A (15) PI (A,S, M) x N-3;C- 12 MoH (L,E,M) HIV proficiency testing Panel distributed. Support distribution of HIV proficiency testing Panel. N/A 14 PI (A,S, M);MoH (L,E,M) x C-11;N-3
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Corrective measures done for PT failures Support OJT for correctives measures for PT failures / TA NA PI (A,S, M) x MoH (L,E,M) Integrated HTC outreaches provided Support integrated HTC outreaches NA 60 - PI (A,S, M), MoH (L,E,M), X C-42;N-18 PSI (S, M) CLUSA (S) VMMC VMMC Outreaches conducted Support Outreaches targeting non-circumcising communities. 269 (11) PI (A,S, M) x N-2 MoH (L,E,M) C-9 PSI (S, M) CLUSA (S) Quality assurance for VMMC supported) Support quality assurance for VMMC staff/team. NA (8) PI (A,S, M) x N-5 MoH (L,E,M) C-3 CMEs conducted Support CMEs on HIV care and treatment and NCDs in relation to HIV NA (35) PI (A,S, M) x N-9;C-11 MoH (L,E,M) Referral labs providing services Provide logistical support for sample referral to testing labs N/A (75) PI (A,S, M) x C-42;N-33 MoH (L,E,M) MDT meetings conducted Support MDT meetings in selected ART sites N/A (42 meetings ) PI (A,S, M) x N-18 MoH (L,E,M) C- 24 @ 10pax Support groups strengthened Strengthen support groups for PLHIVs (youth, children, adults and NA (80 monthly PI (A,S, M) x OVCs) meetings ) MoH (L,E,M) N-30 CHILD FUND (S) C-50 LIPs (E) Logistics supported in selected CCCs in centres provided Provide logistical support for screening of NCDs including NA (75) PI (A,S, M),MoH (L,E,M) x malignancies in selected CCC N-33;C-42 Treatment literacy on PWP supported to PLHIVs, and Key Support training on PWP for PLHIVs N/A (60) PI (A,S, M), MoH (L,E,M), x Populations N-18;C-19 CLUSA (S) YLHIV provided quality Youth-friendly HIV/AIDS services Support provision of YLHIV services in selected CCCs NA 12 Facilities PI (A,S, M),MoH x N-2;C 10 (L,E,M),CHILD FUND(S) Laboratory network strengthened Support logistics for transport of specimen for viral load and CD4 NA 75 high PI (A,S, M),MoH (L,E,M); x testing volume facilities 2nd line committee meetings held Support of second line committee meetings on sub County level N/A N-36 ;C-44 PI (A,S, M),MoH x (meetings) (L,E,M),HCSM (S) NARESA (S) TUBERCULOSIS CMEs conducted on MDR TB and TB 5 I's Support CMEs for HCW on MDR TB and TB 5 I's NA (17) PI (A,S, M) x N-6;C-11 @ 30 MoH (L,E,M) pax CHWs oriented on TB Case finding Orient CHWs on TB case finding in high density population NA (12) PI (A,S, M), MoH (L,E,M) x settlements N-3; C-9 ,CLUSA (S), CHILD FUND @ 50 CHWs (S)
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Meetings conducted Support TB/HIV collaborative and stakeholders meetings 42 (40) PI (A,S, M) x N-9; C-11 MoH (L,E,M)
Logistics supported Supporting logistics of sputum collection and transportation to NA (75) PI (A,S, M) x reference lab and link to gene expert machines C=42 MoH (L,E,M) N=33 Nutritional counseling and assessment provided Support inclusion of nutritional assessment and counseling to TB/HIV NA (75) PI (A,S, M) x patients C=42 MoH (L,E,M) N=33 CHILD FUND(S) Integration of TB screening in other services. Support integration of TB screening in the drop-in centres serving key N/A (75) PI (A,S, M) x populations, MCH, CCC and HTC. C=42 MoH (L,E,M) N=33 LIPs (E), PSI (S)
World TB day commemoration Support commemoration of world TB day NA 20 sub counties PI (A,S, M) x MoH (L,E,M) LIPs (E), PSI (S) NUTRITION HCW updated on MIYCN Update health workers on MIYCN NA (20) A+NC (SD) -A,M,S: MOH- X N-9; C-11 L,E,M Immunization ,vitamin A supplementation and deworming Support immunization ,vitamin A supplementation and deworming 192 ECDs 192 ECDs A+NC (SD,HCS,OVC)- x conducted A,M,S:MOH-L,E,M S/CHMTs Hospital are Baby Friendly Support BHFHI n S/CHMT Hospitals 21 A+NC (SD, x c-12; N-9 HCS,OVC)A,M,S:MOH- L,E,M RHFP Redistribution of FP commodities including condoms Facilitate the redistribution of FP commodities including condoms 20 20 A+NC (SD)-A,M,S:MOH- X facilitated N=9; C= 11 L,E,M
Service providers updated on various RHFP topics Update service providers on various RHFP topics through CMEs 40 40 = A+NC (SD)-A,M,S:MOH- X N= 18 L,E,M C= 22 OJT conducted to Service providers. Support OJT to health workers on PAC, long acting and permanent FP NA A+NC (SD)-A,M,S:MOH- X methods and Cancer of the cervix. N=9 L,E,M C= 11 Orientation to service providers on YFS conducted Conduct orientation to service providers on YFS NA N=30 A+NC (SD)-A,M,S:MOH- X C = 33 health L,E,M worker TA to strengthen YF PAC for selected facilities provided Provide TA to strengthen YF PAC for selected facilities NA N =5 A+NC (SD)-A,M,S:MOH- X C= 5 facilities L,E,M CBDs updated on health timings and spacing of Support update for CBDS including youth on health timings and NA N-3 sub counties A+NC (SD)-A,M,S:MOH- X pregnancies spacing of pregnancies in selected CUs C – 4 sub L,E,M counties
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Integrated RH/FP outreaches conducted Support integrated RH/FP outreach services in hard to reach areas NA N= 18 A+NC (SD)-A,M,S:MOH- x C= 44 L,E,
Expendables supplies/consumables provided Provide supplies and expendables/consumables 75 A+NC (SD)-A,M,S:MOH- x C – 42;N – 33 L,E,M MNCH FP integrated into MNCH services Support integration of FP into MNCH services 75 Facilities A+NC (SD,HCS)- X A,M,S:MOH-L,E,M National days and RRIs conducted Support national MNCH days and RRIs 3 3 National Days A+NC (SD)-A,M,S:MOH- X L,E,M Service providers updated on FANC Update service providers on FANC 40 40 CMES A+NC (SD)-A,M,S:MOH- X N – 18; C - 22 L,E,M @ 20pax Service providers updated on MNCH topics Update service providers on various MNCH topics NA 40 CMES A+NC (SD)-A,M,S:MOH- X N – 18 L,E,M C - 22 Facilities have functional ORT corners Support and Strengthen ORT corners in all the selected health NA 75 Facilities A+NC (SD)-A,M,S:MOH- X facilities L,E,M Service providers updated on BEOC / CEOC Update service providers on BEOC / CEOC 7Update Sessions A+NC (SD)-A,M,S:MOH- X N – 70;C - 175 L,E,M Maternal/newborn death audit meetings conducted Support sub counties to conduct Maternal/new-born death audit 20 sub counties A+NC (SD)-A,M,S:MOH- X meetings L,E,M EPI annual planning conducted Support EPI annual planning meetings 20 SCs 20 Sub counties A+NC (SD)-A,M,S:MOH- L,E,M MNCH/nutrition guidelines and job aids disseminated Support dissemination of MNCH/Nutrition guidelines and job aids 600 20 A+NC (SD)-A,M,S:MOH- X N- 9; C- 11 L,E,M
Integrated MNCH outreaches conducted. Support integrated MNCH outreaches 40 40 outreaches A+NC (SD)-,A,M,S:MOH- X Outreache N-18; C- 22 L,E,M s Quarterly DQA on immunization conducted Support quarterly DQA on immunization in all the sub counties NA 40 DQAs A+NC (SD)-,A,M,S:MOH- X L,E,M MNCH data collection tools distributed Support distribution of tools for MNCH data collection tools NA 75 High volume A+NC (SD)-,A,M,S:MOH- X SDPs L,E,M Staff updated on the use of patograph Support OJT to update staff on monitoring of labour using patograph NA 75 facilities A+NC (SD)-,A,M,S:MOH- X L,E,M Staff orientations on essential and emergency newborn Orientation of staff on essential and emergency newborn care NA 40 CMES A+NC (SD)-,A,M,S:MOH- X care services services N- 9;C- 11 L,E,M
MALARIA
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Service providers updated on Malaria case management Support orientation of service providers on Malaria case NA 22 CMES In coast A+NC (SD)-A,M,S:MOH- X including malaria in pregnancy management including malaria in pregnancy L,E,M
Redistribution of malaria commodities conducted Support redistribution of malaria commodities NA 11 sub counties A+NC (SD)-A,M,S:MOH- X L,E,M EQA in malaria diagnosis conducted Support EQA in malaria diagnosis while emphasizing on proper on NA 22 DQAs A+NC (SD)-A,M,S:MOH- X internal quality assurance L,E,M STRENGTHENED PROVISION OF KAPs FRIENDLYSERVICES Service providers trained on KAPS friendly services Training of service providers on KAPS friendly services. NA S/CHMTs L-PI/PSI, E-LIP/MOH, A- X (NC 25) NASCOP, S-TWG Service Providers NC 25
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Result 3 - Increased Use of Quality Health Services, Products and Information
Intermediate Result 3.2 - Increased demand for an integrated package of quality high-impact interventions at community and health facility levels
Expected Outcomes: Reduced social, economic, and geographic barriers to accessing and utilizing services; Increased capacity of S/CHMTs to organize appropriate communications strategy; Increased capacity of facilities to provide client-centered, humane and dignified care; Increased capacity of community units to mobilize communities.
TARGET Quart Timelines
OUTPUT ACTIVITY USAID Cont. Resp. Party
,
-
Source (Min/Other) GOK Target Jul Sept 2014 HIV/AIDS EMTCT updates provided to CHWs Support topical updates to CHWs on eMTCT guidelines NA C-16 N-6 PI (A,S, M) x (@50 Pax) MoH (L,E,M) CLUSA ( A,S, M) Mentor mothers engaged Engage and support mentor mothers for PSS NA C - 25 PI (A,S, M) x MoH (L,E,M) Mother/baby pair followed-up Support CHW to follow mother/baby pair N/A (75) PI (A,S, M) x C=42; N=33 MoH (L,E,M) Community health workers sensitized on the Sensitize CHWS on the importance of HTC NA C-22; N-18 x importance of HTC (@50 Pax) Defaulter tracing conducted Support health workers and CHWs to conduct defaulter tracings NA (75) PI (A,S, M), MoH (L,E,M),CLUSA x N-33HF;C-42HF (S) CHILD FUND(S) RHFP CHWs and CHEWs updated on healthy timing and Updating CHWs and CHEWs on healthy timing and spacing of NA 1000 pax A+NC (HCS)-A,M,S:MOH-L,E,M x spacing of pregnancy pregnancy and RH(PAC,GBV Cancers of reproductive tract) N -9;C-11@50pax
Men Sensitized on RHFP, HTC, pre pregnancy Sensitize men to be advocates of RH/FP, HTC, pre pregnancy NA 30 pax A+NC (HCS)-A,M,S:MOH-L,E,M X planning, GBV and VMMC. planning, GBV and VMMC. N -6;C-11 Male Champion updated Support updates for existing male champions as advocates of NA 390 Pax A+NC (HCS)-A,M,S:MOH-L,E,M X MNCH/RH/FP/GBV C-120;N-270
NUTRITION CHWs sensitized Sensitize CHWs on HINI NA Event: 30 A+NC (HCS) -A,M,S: MOH-L,E,M X N-6 ;C – 24
MNCH
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CHWs sensitized on IMAM Sensitize CHWs on IMAM to ensure acceleration of growth NA 38 A+NC (HCS)-A,M,S:MOH-L,E,M X monitoring, early detection and referral of malnourished children N- 10 ;C- 28 CHEWs and CHWs updated Update CHEWs and CHWs on Community MNCH NA 40 A+NC (HCS)-A,M,S:MOH-L,E,M X C- 20; N -20 Community mama groups conducted Support community mama groups to promote MNCH NA 32 groups A+NC (HCS)-A,M,S:MOH-L,E,M X N- 10; C- 22 TBAs working as birth companion Support the TBA to continue being advocates for safe motherhood NA 15 events A+NC (HCS)-A,M,S:MOH-L,E,M X N: 6;C: 9 Defaulter tracing mechanism for immunization Strengthen defaulter tracing mechanism for immunization through NA 75 A+NC (HCS)-A,M,S:MOH-L,E,M X strengthened CHEWs and CHWs N-33; C - 42
CHWs and CHEWs updated on community IMCI Update CHWs and CHEWs on community IMCI NA 30 A+NC (HCS)-A,M,S:MOH-L,E,M X N-9 ; c-21 MALARIA Community, religious leaders, CHWs and CHEWs Sensitize community and religious leaders, CHWs and CHEWs on bed NA C 40 CUs A+NC (HCS)-A,M,S:MOH-L,E,M X sensitized nets use @ 30 Pax
STRENGTHEN YFS AT FACILITY AND COMMUNITY LEVELS Youth peer educators mentored Support and mentor youth peer educators manning youth desks at NA (14) L-PSI, S-PI, A-MOH X facilities N 5+C 9 Feedback sessions conducted Conduct feedback sessions between youth and HCW at the YFS NA (12) ; L- PI, PSI X N 1;C 5 Effective referrals tracked Strengthen Referrals and Linkages between the YFS to CU’s for NA (200) L-PI, S-PSI, A-MOH X service referral N 100;C 100 INTEGRATED SERVICES PROVISION FOR KEY POPULATIONS DISC’s strengthened Strengthen existing KAPS DISCS. NA (5) A-NASCOP,L-PSI PI, M-PI, E- X N 3;C2 PI/PSI Key populations tested for HIV Provide HTC services to Key populations through DISC’s and NA (9500) L-PI/MOH,A-Partners, M=PI S-PI x integrated outreaches N 4,000; C 5,500 Key populations screened for STI’s Provide STI screening and treatment services in DISC and outreaches NA (3500) L-PI/MOH,A-PI/MOH,E-Partners, x to key populations N 2,000; C 1,500 M=PI S-PI Key populations screened for cervical cancer Provide cervical cancer screening and referral services in DISC to key NA (1000) L-PI/MOH,A-PI/MOH,E-Partners, X populations N 500 M=PI S-PI C 500 STAKEHOLDER ENGAGEMENT KAPS TWG meetings supported Support KAPs Technical Working Group meetings NA (5) PI/NASCOP/Partners X NC 5 National conference/Workshop held Hold a KAPs National Conference NA (1) L-NASCOP/ NACC/, PI, M-PI, E-PI X 1 NC KP sensitization meetings held Hold KP sensitization meetings NA (6) N 3+C 3 L-PI/ E-PI &partners X
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Result Area 3: Increased use of quality health services, products and information Intermediate Result:3.3 Increased adoption of healthy behaviors Expected Outcomes: Improved home-based healthy practices with a special focus on the high impact interventions Improved compliance with preventive and curative protocols Improved appropriate health care-seeking behavior Increased risk perception among KAPS. Reduced vulnerability among OVC’S and KAPS who are OVC’S to HIV infection and other related risks.
TARGET Quarterly
Timelines
OUTPUT ACTIVITY Responsible Party ,
Sept
-
Source (Min/Other) GOK Target USAID Cont Jul 2014 IDENTIFY, PRIORITIZE AND ADOPT EBI’S FOR KEY POPULATIONS National EBI TWG meetings attended Participate in National EBI TWG. NA (3) L-PSI/PI, M-PI, Partners, X N 3 C 3 A-NASCOP IEC materials distributed Develop and distribute IEC materials and Job aids to Key population NA 5,000) L-PSI/PI, M-PI, Partners, X peer educators and Drop-in Center N 2,500; C 2,500 A-NASCOP EBI’S FOR THE GENERAL POPULATION Out of school youth and OVC reached with HC II Reach out of school youth and OVC with HC II NA ( 6.000) L/ M- PSI, S- PI, A- X N 3,000;C 3,000 NASCOP/ MOH
Out of school youth and OVC reached with Shuga Reach out of school youth and OVC with Shuga NA ( 4,500) L/ M- PSI, S- PI, A- X N 500;C 4,000 NASCOP/ MOH Parents reached with Families Matter Reach parents with Families Matter sessions NA ( 4,000) L/ M- PSI, S- PI, A- X N 2,000; C 2,000 NASCOP/ MOH Equipment, materials and tools procured Procure equipment, materials and tools to operationalize EBI’S. NA NA L- PI, S- PSI, A- MOH X PEER EDUCATION AND OUTREACH WITH KEY POPULATIONS
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Key affected populations provided with services Conduct integrated outreaches for key populations, matatu and NA ( 8) L-PI/MOH,A- Partners, X through integrated outreaches LGBITs N 2C 6 M=PI S-PI Support supervision for CCM staff doing PWID Conduct support supervision meetings NA (24) L-PI/CCM,A-P,E-CCM, X outreaches and S/CHMTS C-15;N-9 M=PI S-PI Focal Persons meetings for CCM held Conduct meetings for CCM focal persons NA ( 6) L-PI/CCM,A-P,E-CCM, (C- 6 M=PI S-PI Key affected populations reached though small group Reach Key Populations with individual and small group sessions (FSW, NA FSW- 2,800 L-PI/MOH,A-PI/MOH,E- X sessions PWUD,MSM and matatu respectively) N 800;C 2,000 Partners, M=PI S-PI PWUD= 3,000 N 500;C 2,500 PWID= 1,500 N 300;C – 1,200 MSM= 2,500 N 500; C 2,000 Matatu crew (3000);N 500;C 1,000 Condoms distributed Distribute condoms to key populations NA ( 2 Million) L-PI/MOH,A- Partners, X N500,000C 1.5M M=PI S-PI Water based lubricants distributed Distribute water based lubricants NA ( 10,000) L-PI/MOH,A- Partners, X N 4,000 C 6,000 M=PI S-PI Grants awarded to partners Award grants to partners NA ( 10) N 3+C 7 L PI and partners X PEER EDUCATION FOR THE GENERAL POPULATION BCC/ IEC materials distributed Reprint BCC/ IEC materials on various health areas NA N 5,000 L-PSI, S-PI, A- MOH X C 5,000 SOCIAL MOBILIZATION National events supported Support social mobilization for national health campaigns & RRI’s NA N 4;C 4 L-PSI, S-PI, A-MOH X
Result Area 3: Increased use of quality health services, products and information Intermediate Result: 3.4. Increase program effectiveness through innovative approaches Expected Outcomes: Increased use of quality services at community and facility levels, among the marginalized, poor, and underserved populations Increased coverage of services among marginalized, poor, and underserved populations Improved capacity of LIPS and GOK to implement EBI’S.
TARGET Quarterly Timelines
OUTPUT ACTIVITY GOK USAID Contr
Target ,
-
Source (Min/Other) Responsible Party Jul Sept 2014 PROFILING AND ASSESSMENT OF KAPS AND M-HOTSPOTS Programing Needs Assessment for KAP conducted Rapid Needs Assessment to inform programming in Lamu, Malindi, NA (1) Consultant-PSI PI, M-PI, X and Kwale counties C 1 E-PI/PSI LIPs,
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CROSS CUTTING ISSUES Building capacity of LIPS to deliver to KAPS friendly services: Technical and Institutional capacity strengthening including information sharing and collaborative arrangements Technical capacity of LIPS assessed; Conduct Service assessment of the LIPS’ technical capacity to NA 1NC Consultant-PSI PI, M-PI, X provide KAPs-friendly services NC18 E-PI/PSI Partners, A- NASCOP KAPS CBO’s mentored Mentor KAPS CBOs to lobby for integrated services. NA N 10 Consultant- PI, M-PI, E- X C 15 PI/ Partners KAPS CBO’s trained on M & E Training of KAPs CBOS/ LIPs on Monitoring and Evaluation NA 20 N NASCOP,L- PI, M-PI, E-PI/ X 20C Partners Technical briefs developed Develop technical program briefs based on In-depth-Data-Based NA N 1C 1 PSI/PI/Partners X Evaluations
Result Area 4.0: Social determinants of health addressed to improve the well-being of targeted communities and populations
Intermediate Result: 4.1. Marginalized poor and underserved groups have increased access to economic security initiatives through coordination and integration with economic strengthening programs
Expected Outcomes: Increased economic security among target groups of marginalized, poor and underserved populations Established partnership programs with multi-sectoral partners to expand jobs and other sustained economic opportunities for target groups. Investments in programs aimed at achieving sustainable livelihoods for the poor are maximized and coordinated
TARGET Responsible Party Quarterly Timelines OUTPUT ACTIVITY
GOK USAID Cont , ,
Target -
Source (Min.Other) Jul Sept 2014 Voluntary Savings and Loans- Linkages to Micro-financial Institutions Number of OVC caregivers supported on IGAs Support IGAs for OVC caregivers NA (1650) CF (L, E, M) X C=930;N=720 PI (S, M) Number of PLHIV support groups supported with IGA’s Support IGA’s for PLHIV households and links them to markets. NA C=50; N=20 PI(L,E,M) CLUSA X Number of VSL /SILC groups supported Provide support for VS&L /SILC activities. NA C=30; N=40 CF (L, E, M); PI (S, M) x
Number of CUs, SILC groups and PLHIV linked to Facilitate linkages for CBOs, CUs, SILC groups, PLHIV Support groups, VSL NA (650) CLUSA (L,E, M) X relevant ministries and MFI groups, and Key Populations (MARPS), GBV survivors to relevant C=450 CF(L,E,M) ministries, financial institutions, and relevant private partners. N=200 PSI (L,S);MOYA (A) Number of parents of Children with disability Train and support parents of children with disability on IGAs. NA (100) CF (LEM) X supported with IGA’s C=50; N=50 MFIs (A)
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Result Area 4.0: Social determinants of health addressed to improve the well-being of targeted communities and populations Intermediate Result: 4.2: Improved food security and nutrition for marginalized, poor and underserved populations
Expected Outcomes: Increased ability to utilize food and increase production of macro and micro nutrients. Successful transitioned from therapeutic nutritional interventions to programs that improve long term food security Mission investments in programs aimed at improving food security and nutrition are maximized and coordinated. TARGET Quarterly Timelines
OUTPUT ACTIVITY USAID Cont
, ,
Sept
-
Source (Mini/Other) GOK Target Responsible Party Jul 2014 Improved food security and nutrition for marginalized, poor and underserved populations Enhancing agricultural and livestock production Link CUs with MOA to enhance production of high value nutritional NA (90) CLUSA (L,E,M) X and drought tolerant crops among vulnerable household. C=90 PI (E,M), CF(E,M) MOA/MOLD(A) Number of producer organization formed and linked to Support formation of producer groups and link them with MOA and NA C= 75 CLUSA (L,E,M) X MOA and MOCD for production and marketing. Ministry of Cooperative Dvt for trainings in production and marketing. PI (M,S) MOA(A,S) Number of cooperative societies formed in partnership Facilitate formation of cooperatives in liaison and partnership with NA (14) CLUSA (L,E,M) X with MOA and MOCD. MOA, and Min of cooperative Dvt. C= 14 PI (EM) MOA(A,S) Number of cooperative societies trained on production Training of cooperatives on production and marketing NA (14) CLUSA (L,E,M) X and marketing. C= 14 PI (EM) MOCD(A,S) Number of contact farmers attending monthly feedback Support Contact farmer’s feedback meetings to disseminate key NA (2000) CLUSA (L,E,M) X meeting production information and submit reports. C=2000 PI (EM) Promote alternative farming techniques to mitigate Train contact farmers on conservation Agriculture and value addition NA (300) CLUSA (L,E,M) X adverse production conditions C=300 Number of household have established food banks and Facilitate establishment of community food banks, gunny bag NA (10,000) CLUSA (L,E,M) X kitchen garden gardening, kitchen gardening C=9500 CF(L,E,M) N-500 PI(E,M), MOA(A,S) Strengthening of Facility Kitchen gardens supported Strengthening of facility kitchen gardens in partnership with service NA (4) PI(L,E,M) X delivery component N= 4 MOPS(S)
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Number of OVC caregivers sensitized to address Barriers Support sensitization for OVC caregivers to address barriers to good NA (1300) CF (L, E, M) X to good nutrition to children nutrition for children during the monthly feedback meetings C=600 PI (S, M) N=740 CHMT(A,S,M) Number of CHWs, CHCs, Farmers groups sensitized on Sensitize the CHWs, CHCs and farmers groups on development of IGAs. NA (942) CLUSA(L,E,M) X IGA development C=922;N= 20 PI(L,E,M)
Number of PLHIV sensitized on IGA development Sensitize PLHIV support groups on development of IGAs NA (155) PI(L,E,M) X C=80; N= 75 Number of youth and adults GBV survivors sensitized on Sensitize and Link youth and adult GBV survivors on Development of NA (1500) PI (L, E, M) X IGA development IGA’s C=1500 PSI (E, M) Number of CHWs, CHCs and farmers groups linked to Link the CHWs, CHCs and farmers groups to MFIs for financial literacy, NA (1440) CLUSA (L,E,M) X MFI for financial literacy and marketing. support and marketing C=1340 PI(M) N= 100 Number of PLHIV support groups linked to MFI for Link the PLHIV support groups to MFIs for financial literacy, support NA (200) PI(L,E,M) X financial literacy and marketing and marketing C=150;N= 50 Number of OVC households supported with food supply Support targeted OVC households and ECDs with food supply. NA (32,000) CF (L, E, M) X C=16,000 PI (S, M) N=16,000 Linking communities to ministry of Agriculture for Support contact farmers and farmers groups trainings on post-harvest NA (942) CLUSA (L,E,M) X capacity building on post-harvest handling handling C=942 MOA(A,S) No of producer organizations linked to support storage Link producer organizations with partners supporting storage NA (75) CLUSA (L,E,M) X commodities and initiatives commodities and initiatives. C= 75 MOA(A,S)
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Result Area 4.0: Social determinants of health addressed to improve the well-being of targeted communities and populations Intermediate Result: 4.5. Strengthened systems, structures, and services for protection of marginalized, poor, and underserved populations Expected Outcomes: Quality protective services available to survivors of sexual assault, child maltreatment and children without adequate family care Capacity of MGCSD to deliver protective and social services assessed MGCSD supported to develop policies, protocols and guidance to support quality social services Eligible children and families are identified and linked to available government social protection initiatives through CHWs, CSOs, volunteers and local government representatives Strengthened referrals between police, court, health and social services established USG investments in programs aimed at improving sexual assault cases with police and justice, integrated with health investments Source TARGET Responsible Party Quarterly (Mini/ Timelines OUTPUT Other) ACTIVITY GOK Target USAID Jul-Sept, 2014 Contribution Strengthened systems, structures, and services for protection of marginalized, poor, and underserved populations Number of community campaigns on child rights and Create awareness on child rights and GBV through community NA (10) CF (L, E, M);PI (E,S, X GBV campaigns and sensitization C=5;N=5 M);PROVINCIAL ADMIN(S) No. of CUs advocating for child rights in the community Involve CUs in advocating for child rights in the community NA (30) CLUSA(L,E,M)PI(L,E,M),CF X C= 20;N=10 (S); CHMT(S) Number of child rights clubs supported Work with Child rights clubs to increase child voices on child rights NA (90) CF(L,E,M),PI (M); X C=50;N=40 MGCSD(A/S), MOE(A/S) Number of children assemblies supported Support DCO’s/DQASO to coordinate and monitor Children assemblies NA (20) CF (L, E, M),PI (M); X in schools C=11;N=9 MGCSD(A/S),MOE(A/S) Number of linkages Link OVC caregivers/PLHIV/GBV survivors and KPs peer group NA (1,650) CF(E, M),CLUSA(E, M) X members with NHIF, NSSF, and RBA C=930;N=720 PI (, E, M);PSI(E, M) Number of OVC with disability linked Link OVC /children with disability with government Cash transfer NA (630) CF (L, E, M) X program C=360;N=270 PI(M);MGCSD(A,S) Number of linkages Link targeted elderly caregivers with government Cash transfer NA (14) PI (E,S, M) X program C=14 CLUSA(E,M);MGCSD(A,S) Number of partnerships strengthened strengthen partnerships with child rescue centres for management of N (16) CF (L, E, M),PI (S, X cases of child abuse A C=7,N=9 M),MGCSD(A/S) Number of child stakeholders meetings supported Support quarterly stakeholders meetings on child protection N (55) CF (L, E, M) X A C=28;N=27 PI (M);MGCSD(A/S) Number of CHMT meetings attended Participate in CHMT meetings NA (60) PI(E,M);CF(E,M) X C=33;N=27 PSI(E,M);CLUSA(E,M) Number of CHWs and Contact persons Support monthly allowances for CHWs and OVC Contact persons NA (3736) CF(E,M);CLUSA(E,M) X C=2825;N=91 PI(E,M) 5 Number of VSL/SPM CBTs supported Support allowances for VSL/SPM CBT’s NA (183) CF(L,E,M) X C=125;N=58 PI(S,M) Number of Child forums held Hold quarterly Child Forums. NA (207) CF (L,E,M) x C=125;N=82 PI (S,M)
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Result Area 4.0: Social determinants of health addressed to improve the well-being of targeted communities and populations Intermediate Result: 4.6. Expanded social mobilization for health Expected Outcomes: Improved financial, managerial and technical capacity of indigenous organizations serving social and health needs of marginalized, poor and underserved populations County, sub-county and village health committees plan and coordinate implementation of effective multi-sectoral partnerships for health Women, youth, child and MARPs groups meaningfully participate in the design, delivery and monitoring of interventions on their behalf Increased social inclusion and reduced stigma and discrimination of MARPs Source TARGET Responsible Party Quarterly (Min/ Timelines OUTPUT Other) ACTIVITY GOK Target USAID Jul-Sept, 2014 Contribution
Number of HAD supported for health services provision. Support mobilization for HADs through CHWs NA (180,) CLUSA (LEM) X C= 90 MOH(SAM) N=90 MOA(AM),PI(SM) Number of community health outreaches mobilized Support mobilization for outreaches through CHWs NA (250) CLUSA (LEM) X through CHWs C=50 MOH(SAM); MOA(AM); N=25 PI(SM) Number of health dialogue days supported at CU level Support mobilization for community dialogues through NA (260) CLUSA (LEM) X through CHWs initiatives CHWs C=130 MOH(SAM) N=130 MOA(AM);PI(SM)
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ANNEXES
Annex I: A+ Mtaani Project Performance Monitoring Plan (PMP), Q2, 2014
Annex II: A+ Mtaani Project County-level Consolidated Performance Monitoring Plan, Q2, 2014
Annex II: Project Organogram
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