BUSIA COUNTY HIV & AIDS STRATEGIC PLAN 2014/15 – 2018/19
“My“My County, County, My My Responsibility” Responsibility” 1 BUSIA COUNTY HIV & AIDS STRATEGIC PLAN
2014/15 – 2018/19 Table of Contents
List of Figures and Tables 4
Abbreviations and Acronymns 5
Foreword 7
Preface 9
Acknowledgements 11
Executive Summary 13
Chapter 1:
Background of the County 15
Demographic Information 15
The Evolution of HIV in Busia County. 16
Chapter 2:
Situational Analysis 18
HIV epidemiology in Busia County 18
HIV burden in Busia County 18
Prevalence of HIV by gender in Busia County 18
Administrative Region HIV burden 18
HIV transmission 19
ART uptake and Coverage 19
SWOT analysis 20 Chapter 3:
Rationale, Strategic Plan Development Process and the Guiding Principles Rationale 24 Process of Developing the Busia County AIDS Plan 24 The Busia County AIDS strategic plan guiding principles 25
Chapter 4:
Vision, Mission, Goals, Objectives & County Strategic Direction 26
Vision 26
Goal 26
Objectives of BCASP 27
Strategic Directions 27
Strategic Direction 1: Reducing New HIV Infections 28
Strategic Direction 2: Improving Health Outcomes and Wellness of People Living With HIV 32
Strategic Direction 3: Using Human Rights Based Approach to Facilitate Access to Services for PLHIV, Key Populations and other Priority Groups 37
Strategic Direction 4: Strengthening Integration of Community and Health Systems 43
Strategic Direction: 5 Strengthening Research, Innovation and Information Management to meet BCASP Goal 48
Strategic Direction 6: Promote Utilization of Strategic Information for Research, Monitoring and Evaluation to Enhance Programming 52
Strategic Direction 7: Increasing Domestic Financing for Sustainable HIV Response 55
Strategic Direction 8: Promoting Accountable Leadership for Delivery of the BCASP Results by All Sectors 58
Chapter 5:
Implementation Arrangements 61
HIV Coordination structure for BCASP Delivery – County level 61
Stakeholder management and accountability 62 Chapter 6:
Research Monitoring and Evaluation of the Plan 64
Chapter 7:
Risk and Mitigation Plan 66
Annexes
Annex 1: Results Framework 69
Annex 2: Resources required for implementing BCASP (in USD Millions) 106
Annex 3: References & Operating Documents 107
Annex 4: List of Drafting and Technical Review Teams 108
List of Figures
Figure 1.1: Map of Busia County 17
Figure 5.1: HIV coordination structure in Busia County 62
Figure 6.1: Busia County HIV & AIDS response data flow chart 65
List of Tables
Table 1.1: Population descriptions by age cohort 16
Table 2.1: Prevalence of HIV by gender in Busia County 19
Table 2.2: PLHIV distribution by age and sub-county 19
Table 2.3: PLHIV distribution by age and care per sub-county 19 Abbreviations and Acronymns
AIDS Acquired Immune Deficiency Syndrome
ACU AIDS control unit
ANC Antenatal Clinic
APOC Adolescent Package of Care
ART Antiretroviral Treatment/Therapy
ARV Anti-Retroviral Drugs
BCC Behaviour Change Communication
CBO Community Based Organization
CB-HIPP Cross Boarder Health Integrated Partnership Programme
CCC Comprehensive Care Centre
CCM Country Coordination Mechanism
CEC County Executive Committee Member
CHEWs Community Health Extension Workers
CHRIO County Health Records Information Officer
CHVs Community Health Volunteers
CS Cabinet Secretary
CSO Civil Society Organization
DICE Drop in Centre
DHIS District Health Information System
EBI Evidence-Based Intervention
EPHT Environmental Public Health Tracking
6 eMTCT Elimination of Mother-to-Child Transmission LGBT Lesbian, Gay, Bisexual and Transgender
FBO Faith-Based Organization LVCT Liverpool VCT Care and Treatment
FMS Financial Management System MDAs Ministries, Departments and Agencies
FSW Female Sex Worker M&E Monitoring and Evaluation
GBV Gender-Based Violence MNCH Maternal New born and Child Health (MNCH)
GoK Government of Kenya MoE Ministry of Education
HBC Home-Based Care MoH Ministry of Health
HBTC Home-Based Testing and Counseling MoT Modes of Transmission
HCBC Home and Community-Based Care MSM Men who have Sex with Men
HCW Health Care Worker MSW Male Sex Worker
HIV Human Immunodeficiency Virus NACC National AIDS Control Council
HMIS Health Management Information System NACADA National Agency for the Campaign Against Drug Abuse HPV Human Papilloma virus NASCOP National AIDS & STI Control Programme HR Human Resources NCDs Non-Communicable Diseases HTS HIV Testing (and counseling) Services NGO Non-Governmental Organizations ICC Interagency Coordinating Committee OVC Orphans and Vulnerable Children IEC Information, Education and Communication PEP Post-Exposure Prophylaxis IOM International Organization for Migration PHDP Positive Health, Dignity and Prevention IPC Infection Prevention and Control PITC Provider-Initiated Testing and Counseling KAIS Kenya AIDS Indicator Survey PLHIV People Living with HIV and AIDS KASF Kenya AIDS Strategic Framework PMIS Pharmacy Management Information System KARP Kenya AIDS Response Programme PMTCT Prevention of Mother–to-Child Transmission KCCB Kenya Conference of Catholic Bishops PrEP Pre-Exposure Prophylaxis KDHS Kenya Demographic and Health Survey PwD People/Persons with Disabilities KEPH Kenya Essential Package for Health PWID People Who Inject Drugs KNASP Kenya National AIDS Strategic Plan PHDP Positive Health, Dignity and Prevention KP Key Populations
7 RBM Results-Based Management
SRH Sexual and Reproductive Health
STI Sexually Transmitted Infection
SW Sex Workers
TB Tuberculosis
TWG Technical Working Group
VCT Voluntary Counseling and Testing
VMMC Voluntary Medical Male Circumcision
8 Fore Word
he HIV and AIDS epidemic is the biggest public health concern in both the country and our county of Busia. Following the national government declaration of HIV and AIDS as a national disaster in 1999, and with the establishment of the National AIDS Control Council (NACC) in 2000, the response Tto this epidemic has been guided by the National AIDS Strategic Plans I, II and III. There have been significant achievements towards stemming new infections and forestalling deaths. The country enacted a new constitution in 2010 which brought in a devolved system of government, and more importantly, empowered the county governments to manage the public health sector.
We have therefore prepared this BUSIA COUNTY AIDS STRATEGIC PLAN to meet the unique needs of our county. The strategic plan comes at a time when we are facing challenges of limited resources and even apparent donor fatigue against a backdrop of increased demand for quality services from a very informed public.
The Busia AIDS strategic plan is aligned to the Kenya AIDS strategic framework and we hope it will galvanize an expanded, multi-sectorial county response to the HIV epidemic. In an environment of constrained funding and with the emergence other equally important public health concerns such as cancer, it is important that our efforts be well coordinated coupled with enhanced accountability to reduce our HIV prevalence from the current 6.8%.
9 In Busia County there is indication of sufficient commitment from the political leadership to ensure that, where possible resources are availed to reduce new HIV infections, provide treatment to all those eligible, and protect People Living with HIV (PLHIV), orphans and other vulnerable children (OVC) and communities affected by the epidemic.
I therefore wish to take this opportunity to call upon all stakeholders in Busia County to use this BCASP in planning and implementing HIV and AIDS interventions so that we reduce this epidemic. HIV is a priority concern for our county government and, through the multi-sectorial approach, all the departments are urged to scale up HIV and AIDS control activities through their respective AIDS Control Units (ACUs).
My office is committed to strengthening the coordination and management of the HIV and AIDS response hoping that we will see an end to this epidemic in our lifetime.
H.E HON. SOSPETER ODEKE OJAAMONG GOVERNOR BUSIA COUNTY
10 Preface
HIV and AIDS epidemic remain a major burden to the socio- economic development of Busia County. However, there is evident hope in declining HIV prevalence currently at 6.8% as a result of the efforts and determination of our multi-sectorial responses.
In spite of the decline in prevalence, HIV incidence rates variably remain high among Key Populations (KPs) and other vulnerable groups, particularly the fishing communities, sex workers and cross-border mobile populations. Our County’s proximity to major international cross-border points create an international hub of erratic populations that amplify the HIV burden which often transcends our healthcare budgets including provision of HIV prevention commodities. Sexual transmission remains the most common mode of the HIV transmission and a significant challenge to our HIV response in Busia County.
The BCASP is a product of a highly consultative process involving all stakeholders in the response to HIV and AIDS. This highly interactive process ensured that the BCASP addresses current needs and epidemic trends in Busia County, drawing on new global and national knowledge and information on HIV and AIDS. The technical working team that assisted the county to develop this plan included specialists on various HIV issues. Busia County’s approach is to mainstream these concerns at all levels, and to do this, we are integrating our HIV and AIDS response into our county development agenda. There were also specialists in Monitoring and Evaluation, Resource Mobilization, Costing and HIV prevention.
11 The devolution of the HIV response to county governments in Kenya requires a multi-sectoral and accountable leadership with increased domestic financing of the HIV and AIDS response. It is envisaged that implementation of prioritized interventions in specific strategic directions in our County AIDS Strategic Plan will spark a further decline in HIV prevalence and incidence rates including allied burdens in our communities.
The passion and commitment of the office of the First Lady to the Beyond Zero Campaign provide a positive opportunity to HIV programming in which stakeholders work together in combating our County HIV epidemic. In addition, the establishment of Busia County HIV ICC, County HIV Monitoring Committee and the constituted sub-county HIV committees are ideal avenues for a focused HIV response.
We commit our efforts to achieving the under listed key strategic objectives : 1. Reduce new HIV infections by 75% 2. Reduce AIDS related mortality by 25% 3. Reduce HIV related stigma and discrimination by 50% 4. Increase domestic financing of the HIV response to 50%
The BCASP presents an opportunity for the county response to be more effective in preventing new infections, enhancing care, treatment and support, and mitigating the impact of HIV and AIDS, and if we succeed, we shall be making an impact in the development agenda of the county. Busia County Government aims to sustain the success rate in treatment of people living with HIV, ensuring that OVC enjoy equal rights and care, and scaling up effective evidence-based prevention strategies. The BCASP further supports systems strengthening across all levels to sustain the collaboration and achievements gained by the county, including strengthening our monitoring and evaluation efforts. The County Government will strengthen its monitoring and evaluation efforts to enable implementers to recognize and reinforce good performance, and improve or reprogram activities that are not on track to ensure that the response delivers on the intended results. As we strive to deliver the intended results of this strategic plan, let our ultimate goal rest in eliminating new HIV infections in our communities. Indeed, if not us, who then? And if not now, when?
HON. DR. MAURICE P. SIMINYU C.E.C DEPARTMENT OF HEALTH AND SANITATION BUSIA COUNTY
12 Acknowledgements
he Busia County AIDS Strategic Plan is the first document designed locally to guide the county’s HIV response. It is aimed at guiding stakeholders in the Tplanning, resource mobilization and intervention implementation. The strategic plan was accomplished through a consultative process involving key stakeholders in the HIV response who supported the process in various stages of its development. The Department of Health and Sanitation in the county would like to appreciate all the sectors and partners who were contributory to the development of the document.
The commitment, technical support and overall stewardship from the National AIDS Control Council are highly appreciated. NACC also did provide the Kenya AIDS Strategic Framework that provided guidance to our technical working group.
We thank the County Executive Committee member for Health and Sanitation and the Chief Officer for the appointment of a dedicated technical working group and providing them with the needed moral and financial support to develop the document. We appreciate the role played by many stakeholders including the civil society, the faith based organizations, PLHIV groups, government departments in the county, the private sector and key populations for their engagement and consultations.
We acknowledge the contributions of the various partners during the various stages of development of the document.
We wish to acknowledge with deep gratitude the contribution of the BCASP development task force members led by Mr Stephen Kathaka Regional HIV Coordinator – NACC , Dr Festus Kigen County AIDS and STI Coordinator, Mr Wilfred Magoba County AIDS Coordinator, Dr. Allan Wafula Deputy County Pharmacist, Mr Nelson Andanje County Health Promotion Officer, Mr Napoleon Nyongesa Sub-County AIDS Control Coordinator-Teso North, Mr Bruno Otsyula ADEO, Mr Vincent Oluoch KENEPOTE and Mr Bernard Bosire TB Coordinator- Busia for their tireless efforts and dedication to the task. We also thank the expert reviewers who provided valuable recommendations to improve the CASP.
Dr. Melsa Lutomia Director, Department of Health and Sanitation
13 Executive Summary
The BCASP 2014/15 – 2018/19 is the strategic are expected to yield positive results in line guide for the County’s response to the HIV agenda. with the 90/90/90 initiative of the WHO and The strategic plan addresses the drivers of HIV NASCOP. among various population groups in the county and 3 Strategic Direction Three provides the avenues strategies to contribute to national efforts towards for using a human rights based approach to creating a globally competitive and prosperous nation facilitate access to services through removing with a high quality of life by 2030. barriers to access of HIV, SRH and rights information and services in public and private This Strategic Plan has been developed in line with entities; reducing and monitoring stigma and the devolved governance framework as enshrined in discrimination, social exclusion and gender- the Constitution of Kenya (2010) which guarantees based violence; and improving access to legal the right to the highest attainable standard of health, and social justice and protection for PLHIV, including HIV and AIDS services as found in Article with the expected result of reduced self- 43(1a) and also in harmony with the Busia County reported stigma and increased protection of Integrated Development Plan ( 2013- 2017), and the human rights. Busia County Health Strategic and Investment Plan (2013 - 2017) in seeking to make Busia a “Healthy, 4 Strategic Direction Four aims at strengthening productive and internationally competitive County”. integration of community and health systems by improving access to and rational use of The plan provides for eight Strategic Directions, each quality essential products and technologies for with priority intervention areas: HIV prevention and treatment; strengthening the health service delivery system at the county 1 Strategic Direction One aims at reducing new level and also enhancing the community service HIV infections through breaking down the HIV delivery system in HIV prevention, treatment epidemic to enhance prevention efforts among and care. A strengthened HIV commodity priority populations and geographical areas. management and competent community-level This is expected to reduce new infections by AIDS involvement are key results expected 75% by 2019 among adults and current mother- under this plan. to-child transmission rates to less than 5%. 5 Strategic Direction Five is aimed at 2 Strategic Direction Two focuses on improving strengthening research, innovation and health outcomes and wellness of people living information management to meet the goals with HIV by providing linkage to care, increasing of this plan. This shall be achieved through coverage of care and treatment, and scaling allocation of resources and implementing up interventions to improve the quality of life a HIV research agenda informed by this and healthcare outcomes. These interventions strategic plan and also increase evidence- based planning, programming and policy
14 changes. It is expected that there shall be response in the County through maximizing significant improvement in HIV research and its the efficiency of existing delivery options, implementation. promoting innovative and sustainable domestic HIV financing options and aligning resources 6 Strategic Direction Six focuses on promoting and investments to this plan’s priorities. The utilization of strategic information for research end result shall be a 50% increase in HIV and monitoring & evaluation to enhance financing from county resources. programming. This shall entail establishing a multi-sectoral and integrated real time HIV 8 Strategic Direction Eight promotes accountable platform to provide for updates on HIV response leadership for the delivery of the BCASP accountability in the county; strengthening results by all sectors through building and of the M&E capacity to effectively track the sustaining a high level political and technical performance of the different goals of this plan; commitment for ownership of the HIV response and ensuring the establishment and efficiency and establishing a functional and competent of routine and non-routine monitoring systems HIV coordination mechanism in the county. to cater for the HIV situation in the county. Good governance practices and accountable leadership in a multi-sectoral approach for 7 Strategic Direction Seven aims at increasing HIV response and an enabling policy, legal and domestic financing for a sustainable HIV regulatory framework are key results expected.
15 CHAPTER 1
Background Information on the County
usia County is located in Western Kenya and within the Lake Victoria Basin. It borders the Republic of Uganda to the West and North, Bungoma County to the North East, Kakamega County to the East, and Siaya County to the South. The County is divided into seven sub-counties namely: Bunyala, BMatayos, Butula, Nambale, Samia, Teso North and Teso South. The county covers a geographical area of 1,697 square kilometres and its altitude varies from 1130m to 1375m(Census 1999). Busia County is endowed with resources such as arable land, livestock, water, pasture and forests. The main economic activities include trade, agriculture, tourism, fishing and commercial businesses particularly at the border towns of Malaba and Busia between Kenya and Uganda.. The county is famously known as the origin of the name “Boda boda” referring to the local means of transport between the two countries.
Busia County had an estimated population of 823,504 in the 2013/14 planning year, which is 1.9% of the national population. The annual population growth rate is 2.54% giving a projected population of 908,658 by 2017. The estimated number of households was 164,701 with an average family size of 5. The poverty level stands at 66% while literacy level is at 75.3% . The male to female ratio stands at 1:1 with 48% male and 52% female (Kenya National Bureau of Statistics – KNBS).
16 Fig 1.1: Busia County Map
1.2 The Evolution of HIV in services with clients coming not only from Busia Busia County County but also from other Districts (now Counties) from Western Province such as Bungoma, Vihiga, The upsurge of HIV cases in the County was realized Kakamega and also from Siaya County in Nyanza around the year 1991. During those years the disease Province. was commonly referred to as “Slim” and the response The major point of HIV care was the Busia District to treatment was mainly from the Ministry of Health. Hospital (now Busia County Referral Hospital), and The peak of HIV prevalence in the County was in the by then HIV accounted for 50% of the in-patients. year 1999/2000 when it reached 14%. From 1999, when the then President H.E. Daniel As years went by, other partners came in to Toroitich Moi declared HIV and AIDS a national compliment the government’s HIV response in the disaster and constituted the National AIDS Control County. MSF was the first partner to offer treatment Council to coordinate the multi–sectoral HIV
17 Table1.1: Population descriptions by age cohort
Description Population Target Population estimates 2013 2014 2015 2016 2017
1 Total population 823,504 843,000 864,343 886,224 908,658
2 Total number of households 164,701 168,600 172,869 177,245 181,732
3 Children under 1 year (12 months) 3.587999% 29,547 30,247 31,013 31,798 32,603
4 Children under 5 years (60 months) 17.47671% 143,921 147,329 151,059 154,883 158,804
5 Under 15 year population 47.13468% 388,156 397,345 407,405 417,719 428,293
6 Women of child bearing age (15 – 49 years) 26.35765% 217,056 222,195 227,821 233,588 239,501
7 Estimated number of pregnant women 3.587999% 29,547 30,247 31,013 31,798 32,603
8 Estimated number of deliveries 3.587999% 29,547 30,247 31,013 31,798 32,603
9 Estimated live births 3.587999% 29,547 30,247 31,013 31,798 32,603
10 Total number of adolescents (15-24) 20.12419% 165,724 169,647 173,942 178,345 182,860
11 Adults (25-59) 27.38574% 225,522 230,862 236,707 242,699 248,843
12 Elderly (60+) 5.30286% 43,669 44,703 45,835 46,995 48,185
Source: Exploring Kenya’s Inequality-Busia County KNBS 2013
response in the Country, Busia County has been Despite devolving the functions of the larger Ministry relying on the National AIDS Strategic Plans (KNASP of Health, NACC in the fulfillment of its national I, KNASP II and KNASP III) which were formulated mandate to coordinate HIV response through by NACC and partners. These policy documents policy formulation and resource mobilization, ensured the County (District) had HIV response came up with the Kenya AIDS Strategic Framework resources mobilized and response coordinated in a (KASF)2014/2015-2018/2019, which provides uniform manner through major programs like the guidance to the country on HIV response. However, KHADREP and TOWA which came to an end in 2013. the 47 Counties needed to formulate county specific HIV and AIDS plans.This is the premise of formulating With the emergence of Kenya’s New Constitution this County HIV Strategic Plan (CASP). 2010, the country adopted the devolved system of governance with health services, including HIV response, being devolved in all the 47 Counties in Kenya.
18 CHAPTER 2
Situational Analysis
2.1 HIV Epidemiology in Busia County approximately 843,001 in 2014 with an adult HIV prevalence of 6.8% (KAIS II). The HIV prevalence 2.1.1 HIV burden in Busia County among women in Busia County is higher (8.4%) According to the World Health Organization, Kenya than that of men (5.1%). Over the years, the women faces a severe, generalized HIV and AIDS epidemic living in the county have been more vulnerable to HIV that continues to have a devastating impact on all infection than the men. Despite the huge importance sectors of the society. National estimates indicate of HIV testing as a way to increase prevention and that the adult HIV prevalence rate in 2003 was 6.7%. treatment, about 43% of people in Busia County had Since 2006, the epidemic has remained stable with never tested for HIV by 2009. an adult prevalence rate of 6.0% (KDHS 2003, KAIS It is estimated that about 44,326 are living with HIV in 2007, 2008 and 2012). the county (Kenya County HIV Profiles, 2014, NASCOP Busia County had a projected population of SI Unit, 2014 and KAIS II).
Source: KDHS, KAIS, Kenya County HIV Profiles, 2014
2.1.2 Administrative regions HIV burden There are variations in the number of PLHIV in the different sub-counties of Busia County. Matayos, Butula and Bunyala sub-counties have the highest numbers of PLHIV in the county, while Nambale has the lowest estimates.
19 SUB COUNTY ESTIMATED ADULTS ESTIMATED CHILDREN LIVING WITH HIV LIVING WITH HIV LIVING WITH HIV
BUNYALA 6536 766 7302
BUTULA 7419 870 8289
MATAYOS 10512 1232 11744
TESO NORTH 3365 394 3759
NAMBALE 2484 291 2775
SAMIA 5126 601 5727
TESO SOUTH 4233 496 4729
BUSIA COUNTY 39,675 4651 44,326
Source; NASCOP SI Unit, 2014
These variations provide for a platform to generate There were about 2,152 pregnant women living specific interventions targeted for each region and with HIV in Busia County in 2014. According to DHIS also the need to provide targeted approaches in 2013 data, Kenya had an estimated 12,940 new HIV reducing new HIV infections per population category. infections among children with Busia County ranked 21st in the country with 58 new infections. A key component of these new infections is that while 84% 2.2 HIV Transmission of pregnant women attend clinic at least once, only In the KDHS 2014 Survey on knowledge of HIV 41% of pregnant women attend the recommended prevention methods by county, 81.8% of women and four antenatal visits in Busia County and only 62% 96.3% of men in Busia County know that HIV can deliver in a health facility (DHIS 2013). be prevented by using condoms. This is above the national figure of 79.8% and 87.6% for women and men respectively. Whereas it has been documented that consistent and proper use of condoms can 2.3 ART Uptake and Coverage reduce the risk of HIV and other sexually transmitted As at the end of 2014, Busia County had 28,660 clients infections by more than 90%, low condom use in Busia enrolled in HIV comprehensive care clinics of whom County is a major factor in any new HIV infections 26,460 were on HAART. The sub-county breakdown is and also on the adult HIV prevalence of 6.8% (Kenya as shown in the table below: HIV and AIDS Profile, 2014) that places Busia County among the ten counties that account for 65% of the prevalence nationally.
20 Table 2.3: PLHIV distribution by age and care per sub-county
ORGANIZATION PAEDIATRICS ADULTS ON TOTAL ON CARE PAEDIATRICS TOTAL ON ARVS TOTAL ON ARVS UNIT ON CARE CARE ON ARVS MATAYOS 517 6830 7347 487 6225 6712 BUTULA 409 4614 5023 366 4054 4420 BUNYALA 327 3935 4262 318 3676 3994 SAMIA 276 3866 4142 260 3678 3938 TESO NORTH 234 2168 2402 221 2067 2288 TESO SOUTH 283 3084 3367 263 2782 3045 NAMBALE 145 1794 1939 136 1676 1812 BUSIA COUNTY 2191 26291 28482 2051 24158 26209 TOTALS
Source; DHIS data as at February 2016
2.4 SWOT Analysis
In light of the HIV prevalence in the county, new This is due to the declaration of HIV and AIDS infections rates, ART uptake and interventions as a national disaster in 1999 and the various to tame the HIV scourge in the county, it is vital to educational and sensitization campaigns that know that there are various strengths, weaknesses, followed. opportunities and threats to the efforts towards • CBOs - There is a strong presence of attaining the goals of this plan. Community Based Organizations carrying out HIV programmatic activities in all the 7 sub- 2.4.1 Strengths counties. This has further helped in scaling up treatment and preventative measures. There are strengths in Busia County that will help towards the realizations of the BCASP 2014/15 – • The Department of Education has played a 2018/19 objectives: role of ensuring there are active health clubs in schools all over the county to educate both • Devolution - The County Government, and students and pupils and also increase their devolved functions, according to the Kenya involvement in preventative measures while at Constitution (2010) have created an increased a young age. impetus in attaining the goals of this plan. The devolution of structures related to HIV and AIDS • Members of KPs have organized groups that prevention and treatment to the county level has made it easier to involve them in key have presented an opportunity for increased strategies affecting them. In addition there are involvement of the health professionals within strong PLHIV networks in the county. the county. • The county boasts of a wide availability of health • Receptive community - The county is fortunate facilities in all the sub-counties that makes to have a community that is well aware of the access to HIV and AIDS services easier. - The HIV scourge and the implications of HIV and National AIDS Control Program (NASCOP) has AIDS to the socio-economic being of the people. made it possible to have a consistent availability of ARVs for PLHIV in the county.
21 • The county has skilled personnel to handle This has led to unavailability of some services the preventative and curative aspects of HIV in many health facilities. and AIDS epidemic. - There is a high uptake • Inadequate and unreliable supply of some HIV of primary healthcare services in the health commodities like female condoms and test kits facilities in the county which is a further boost have slowed down HIV preventative efforts in to the preventative strategies for HIV and AIDS. the county. The construction of a Kenya Medical Training • There is inadequate dissemination of HIV College (KMTC) campus in Busia will further research findings relevant to the county despite add to the pool of trained health professionals. there being research done at various levels. These findings and results are key to shaping the direction of the fight against HIV in the 2.4.2 Weaknesses county by defining where and how resources should be allocated. The following are the major weaknesses witnessed in the county: • The absence of a county institutional research and ethics committee has hindered the uptake • There is a high HIV stigma among the of research focused on HIV and AIDS in the professional classes especially health workers county. This in turn means that it is impossible which has hindered the efforts to prevent the to fully involve health professionals and other scourge from spreading in the county. stakeholders in shaping the HIV agenda in the • Despite being organized into groups, there is county through an evidence-based approach. a negative attitude towards service delivery to • Weak monitoring and evaluation structures KPs. Due to this, efforts to reach more of these in the county have resulted in the inability to groups are hindered. adequately quantify the impact of various • Poor correlation between knowledge of HIV interventions put in place against the scourge prevention and practices in the county. Moreover, it has created a • The presence of some cultural practices that duplication of roles and interventions for encourage the spread of HIV by encouraging various stakeholders and partners. indulgence in promiscuous sexual behaviour, • There are inadequate reporting tools leading e.g. wife inheritance and the popular “disco to a gap in the quality of data obtained from matangas” in many funerals in the county. health facilities. • The over-emphasis on curative as opposed to • The lack of a County AIDS Control Act has preventive interventions have denied resources hindered efforts to lobby for funding both from to measures and interventions meant to scale at the county level and from other development down the spread of HIV in the county. partners, resulting in underfunding in the fight • High poverty levels in the county have made against HIV in the county. There is weak multi access to health services low. sectoral coordination of HIV control activities with several stakeholders and development • There is only one reference laboratory serving partners engaged in duplicate activities in a large population thereby impacting negatively various parts of the county. on the uptake of testing and care services because its resources are stretched. • Lack of office space and logistical support. • While there is availability of skilled staff in the county, their numbers are inadequate.
22 2.4.3 Opportunities 2.4.4 Threats The following are opportunities in the county for the The following are threats to the realization of the successful implementation of the goals of this plan, goals of this strategic plan: if fully tapped and utilized: • Donor fatigue - The HIV response in the country • The presence of vernacular media houses will and county, both preventative and treatment, is increase access to information on treatment heavily donor-dependent. Much of this funding and preventative measures on HIV and AIDS in and resource allocation in the county by donors the county. is time and intervention-dependent with the • The patronage of the County First Lady in the donors funding various projects in specific Beyond Zero Campaign. regions of the county, if not the whole. • The establishment of the regional East African • Emergent health problems - Emergence of Public Health Laboratory (EAPHL) in Busia new health problems such as cancer with a County Referral Hospital will increase uptake possible shift of focus from HIV means that and presence of laboratory services in the some stakeholders may shift their resources county. from HIV to these health problems thereby • The presence of Alupe KEMRI research increasing the funding gap for this plan. laboratory will open avenues for research on • Migrant population – The [presence of two HIV in the county. major border towns (Malaba and Busia) with • The presence of highly trained Alupe KEMRI significant key and migrant populations. research staff creates a channel for mentorship • Substance abuse - A high level of alcohol and training in clinical research which is key to and substance abuse in the county has led the interventions of this plan. to decreased health and wellness outcomes • The opening of new health facilities will of PLHIV as well as creating a platform for increase uptake of HIV and AIDS services hence increasing new infections through engaging in enabling the county meet the goals of Strategic unprotected sex. Direction Two: Improving health outcomes and • Religious and cultural beliefs - Traditional wellness of all people living with HIV. healers and religious leaders interfere with • The presence of cross-border committees with health seeking behaviour of PLHIV. Condom Uganda creates opportunities for linkages in use and adherence to treatment regimens addressing various health challenges arising and doses are some of the most affected from the interactions of populations between components. the two countries. • Home deliveries - There is a high rate of home • Support from IGAD Regional AIDS Partnership deliveries (40%) compared to pregnant women Program (IRAPP) and Cross-Border Health attending the first ANC visit. Moreover, 58% of Integrated Partnership Project (CB-HIPP) HIV positive pregnant women in the county do offers an opportunity for partnerships with not deliver in a health facility (Kenya County other stakeholders to share experiences and HIV Profiles, 2014). These facts hinder effective work together in matters HIV and AIDS in the elimination of mother-to-child Transmission region. (eMTCT) interventions. • Availability of HIV defaulter tracing mechanisms • Partners’ accountability - There is a lack of will ensure the retention of more PLHIV in care accountability by some partners in the county and treatment. when executing their mandate.
23 Key results, research findings and interventions • Partner distribution - While we appreciate that applied by some partners are not in tune with different partners have different needs and the various plans in the county, while some do focus areas, the distribution of partners in the not provide feedback on these components in county is not even due to this phenomenon. This the process of executing these interventions or has led to concentration of certain services in a even at exit. particular region based on what and where the • National guidelines - Some partners do not partner is supporting. adhere to the national guidelines and therefore there exists a disparity in handling PLHIV in different regions supported by different partners in the county. It therefore becomes challenging to offer continuity of services, in the event the partner exits.
24 CHAPTER 3
Rationale, Strategic Plan Development Process and the Guiding Principles
3.1 Rationale 3.2 Process of developing the Busia County AIDS Strategic Plan Since the year 2000, Kenya has developed three successive national strategic plans for the HIV This strategic plan was developed through an in-depth response, which laid out specific results and analysis of available data and a highly participatory strategies for delivering HIV services countrywide. process involving a wide range of stakeholders For the period 2015 to 2019, there is a shift to the drawn from Busia County Government, Civil Society development of county specific plans to take into Organizations, Faith Based Organizations, Networks account the devolution of most health services to of People Living with HIV, Youth and Key Populations, county governments. It is on this background that the private sector and the Busia County Assembly. Busia County has moved to develop a strategic plan The following were key aspects of the BCASP that is relevant to its local HIV situation, addressing development process: key drivers of the epidemic in the area. The BCASP has been developed to guide the delivery of HIV 3.2.1 Training of the 5 Busia County Technical services for the period 2015-2019 in the county. The Team on KASF: 28th- 29th April 2015 document defines the results to be achieved during its life and offers strategic guidance to stakeholders The goal of training was to prepare the TWG members on the coordination and implementation of the HIV for the task of drafting the document as well as response. The strategic plan is therefore a guide sensitizing other stakeholders on the development for coordination and implementation of the HIV of the document. response, and a resource mobilization, allocation and accountability tool. It ensures that the HIV 3.2.2 Sensitization of 40 Busia County response remains multi-sectoral and seeks to create Stakeholders: 24th - 25th June 2015 an enabling environment for stakeholders to play The purpose of the training was to engage the Busia their roles synergistically to achieve common results County stakeholders to enhance commitment, ensuring flexibility to address the micro effects of the sustainability and ownership of the Busia County- epidemic at community level. specific HIV response, with an aim of realizing the
25 four overarching national objectives of the KASF. The c) Multi-sectoral accountability five Busia County Technical Team Members provided The strategic plan provides guidance for technical support while the KASF Dissemination Task interventions and results for which many Force Members from NACC headquarters reinforced sectors are responsible and accountability highly technical areas beyond the scope of the Busia mechanisms will be established through County Technical Team. the NACC in order to increase resources and results. 3.2.3 Establishment BCASP Technical Task d) County ownership and partnership Force All HIV stakeholders including the The BCASP Technical Task Force comprising seven governments, development partners, civil members was established by the forty Busia County society organizations, people living with HIV stakeholders and tasked to draft the Busia County and the community shall align their efforts AIDS Strategic Plan 2015-2019 towards the results envisioned. The BCASP Technical Task Force elected a chairman e) Rights-based and gender transformative and a secretary to lead the team. The team tasked approaches each member to work on an identified priority area For the BCASP to succeed the rights of those then table reports during the subsequent meeting who are socially excluded, marginalized and for review by all members. vulnerable must be protected. The BCASP has taken care of this fact and a rights-based 3.3 The BCASP guiding principles approach is recommended. a) Results-based planning and delivery of the f) Efficiency, effectiveness and innovation BCASP All HIV programs shall be linked to the Due to limited resources available as a result BCASP and shall demonstrate contribution of declining donor support, the BCASP seeks towards the envisioned results . to explore and operationalize sustainable b) Evidence-based, high impact and scalable domestic financing through improved efficiency interventions Preferential interventions shall in service delivery and innovative approaches be those that are of high value, and scalable aimed at achieving more at reduced cost ones that are informed by evidence. without compromising on quality. CHAPTER 4
Vision, Mission, Goals, Objectives & County Strategic Direction
Vision A County free of HIV infections, stigma and AIDS-related deaths.
Goal: 2 To contribute to achieving Vision 2030 through universal access to comprehensive HIV prevention, treatment and care.
Objectives To reduce new HIV infections by 75% To reduce AIDS related mortality by 25% To reduce HIV related stigma and discrimination by 50% To increase domestic financing of the HIV response to 50%
27 4.4 Strategic Directions geographical areas with higher HIV prevalence. KPs include sex workers and their clients, men who have sex with men, and people who inject drugs. In 4.4.1 Strategic Direction 1: Reducing New HIV addition, we have vulnerable populations like street Infections families, prisoners, adolescents, persons in unstable Busia County had a projected population of 843,001 families due to GBV, low income women, Boda boda in 2014 with an adult HIV prevalence of 6.8%(KAIS II). operators as well as long distance truck drivers. The HIV prevalence among women in Busia County is higher (8.4%) than that of men (5.1%). Over the years, Key intervention the women living in the county have been more vulnerable to HIV infection than the men. Despite the i) Granulate the HIV epidemic to intensify HIV huge importance of HIV testing as a way of increasing prevention efforts to priority geographies and prevention and treatment, about 43%of the people in populations. Busia County had never tested for HIV by 2009.It is ii) Intervention Area 2: Adapt and scale up effective estimated that about 44,326 people are living with evidence-based combination prevention. HIV in the county (Kenya County HIV Profiles, 2014, iii) Intervention Area 3: Maximize efficiency in NASCOP SI Unit, 2014 and KAIS II). service delivery through integration. Some of the key drivers of the epidemic include iv) Intervention Area 4: Leverage opportunities poverty particularly among women and youths, through creation of synergies with other actors. cultural and social practices like “disco matanga”, sex work, stigma, social exclusion and gender based violence in families. Others include substance abuse These interventions are in three broad categories: particularly among the youths and low condom use. behavioural, biomedical and structural. The interventions in this strategic direction focus on ways of reducing new HIV infections. Expected results: Innovative approaches should be used to ensure • Reduced annual new HIV infections among the interventions reach the KPs and also target adults by 75%. • Reduced HIV transmission rates from mother- to-child from 14% to less than 5%
28 STRATEGIC DIRECTION 1: REDUCING NEW HIV INFECTIONS
KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra Respon- Objective Results Popu- phical sibility Biomedical Behavioural Structural lation Areas by county /Sub- County Reduce a. Reduced 1.Conduct Carry out Incorporate General All the sub County new HIV annual social awareness HIV prevention population counties: Depa- infections new HIV behaviour campaigns on and mitigation Matayos , rtment of by 75% infections change HIV prevention in community KPs Bunyala, Health among communi- among target health Samia, adults by cation (SBCC) populations( strategy. Adoles Butula, Partners 75% KPs and cents Teso vulnerable South, Teso CSOs populations). CHVs North and Nambale NACC Develop and CHEWs distribute IEC NASCOP materials. CHCs Develop mass media messages for radio and TV spots.Life skills education among adolescents in and out of school.
Carry out stigma reduction campaigns. Carry out awareness campaigns on drugs and substance abuse. Carry out condom promotion campaigns Reduced 2. Provision of Procure and KPs All seven MOH, annual condoms and distribute Adolescents sub- County new HIV lubricants adequate male (12 – 17 counties Depart- infections and female years ) ment of among condoms. Young Health adults Aadults (18- Partners by 75% Procure and 24 years) CSOs distribute NACC adequate NASCOP lubricants for MSM.
Procurement and placement of condom dispensers in strategic places.
29 KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra Respon- Objective Results Biomedical Behavioural Structural Popu- phical sibility lation Areas by county /Sub- County Reduce Reduced 4. Voluntary Provision and Capacity Uncircu- All seven NASCOP, new HIV annual Medical Male strengthening building of mcised men sub- NACC, infections new HIV Circumcision of VMMC healthcare above 10 counties Partners. , by 75% infections (VMMC) services workers in years CSOs, Busia among VMMC. County adults Govt- by 75% Procurement Dept of of VMMC Health and supplies and Sanitation equipment.
Integration of VMMC services in routine services.
Scale up facilities offering VMMC.
Reduced 5. Positive Support All PLHIV All seven MOH, annual Health formation of sub- County new HIV Dignity and PLHIV support counties Department infections Prevention groups. of among (PHDP) Health adults Train peer Partners by 75% educators on CSOs CPWP. NACC NASCOP Capacity building of health workers on clinical PWP.
Provide PWP IEC materials.
Monitor and evaluate PWP services.
Provision of ARVs.
30 KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra Respon- Objective Results Popu- phical sibility lation Areas by Biomedical Behavioural Structural county /Sub- County Reduce Reduced 7. Blood Screening all Carry out Ensure County All seven MOH, new HIV annual safety blood donated. blood donor availability Referral sub- County infections new HIV campaigns of safe blood Hospital counties Department by 75% infections targeting adults in all major of among and youths. facilities. All seven Health adults sub- Partners by 75% Introduce counties CSOs donor hospitals NACC notification NASCOP of HIV results at blood collection points. Implement quality assurance in injections safety to eliminate HIV transmission in healthcare settings.
8. STI Screening and Carry out public Train KPs All seven MOH, prevention treatment of education on healthcare sub- County and treatment STIs. STI prevention workers in STI Adolescents counties Department and control management. of targeting KPs Health and vulnerable Provision Partners groups. of STI CSOs commodities. NACC NASCOP Establish youth friendly centres.
9. Workplace Ensure all All county All seven MOH, HIVprevention Busia county departments sub- County departments and the counties Department and the private of private sector sector Health establish Partners vibrant AIDS CSOs Coordinating NACC Units (ACUs). NASCOP
Address workplace HIV stigma and discrimination.
Domesticate HIV workplace policy and guidelines.
31 KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra- Respon- Objective Results Popu- phical sibility lation Areas by county /Sub- County Reduce Reduced 10. Medical Screening and Carry out public Improve the All existing All seven MOH new HIV annual waste and IPC treatment of education on disposal of health sub- County infections new HIV management STIs STI prevention medical waste facilities counties Department by 75% infections and control at all levels of among targeting KPs of the health Health adults and vulnerable system. Partners by 75% groups. CSOs Improve the NACC availability NASCOP of and accessibility of appropriate IPC equipment and infrastructure in all healthcare settings.
11. Train staff on All pregnant All seven MOH, Elimination eMTCT. women sub- County of mother- counties Department to-child Train CHVs on of transmission Community Health of HIV eMTCT. Partners (eMTCT) CSOs )Integration NACC eMTCT NASCOP with MNCH services.
Provision of eMTCT services.
Train and station mentor mothers in all facilities.
Scale up EID services in all health facilities.
Carry out cervical cancer screening.
Enhance male involvement in eMTCT.
32 4.4.2 Strategic Direction 2: Care and treatment coverageThe system is further characterized by inadequate integration of screening, prophylaxis and management of co-infections and Improving Health Outcomes and Wellness of all co-morbidities contributing to loss of clients enrolled PLHIV on ART. The PLHIV continue experiencing stigma This strategic direction strives to achieve timely leading to lack of disclosure and therefore poor linkage to care for people who have been diagnosed adherence especially among KPs. Lower coverage of with HIV and to increase coverage of care and ART among children and adolescents imply retention treatment by maximizing retention in the cascade of of a heavy reservoir of HIV in the general population. care by scaling up interventions to improve quality of Quality of care and treatment services and viral care and health outcomes. suppression There is limited use of electronic The health system in Busia County faces varied medical records (with only 8 EMR sites in Busia challenges in the delivery and promotion of services County) and evidence based interventions at facility ranging from identification, linkages to care, levels and a generalized weak infrastructure in retention and viral suppression. There is inadequate the monitoring of viral load of patients. Similarly, and unequal access to health services and human improper coordination between health and other resource. Additionally, services to PLHIV are sectors such as education, legal and social services characterized by poor referral and tracking, weak lowers quality of care delivered to clients. commodity and supply chain as well as inadequate skills and infrastructure for information management Expected results systems. • 90% increase in linkage to care within 3 months after HIV diagnosis Key intervention areas: • 90% increase of ART coverage Diagnosis and linkage to care: Late HIV diagnosis • 90% increment on ART retention at 12 months and meaningful linkage to care remains a generalized challenge. On the other hand, legal barriers, stigma • 90% increment in viral suppression among and negative service providers’ attitudes reduce children, adolescents and adults. access to care by the KPs.
33 STRATEGIC DIRECTION2:IMPROVING HEALTH OUTCOMES AND WELLNESS OF ALL PLHIV
KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra Respon- Objective Results Popu- phical sibility Biomedical Behavioural Structural lation Areas by county /Sub- County Reduce 1. 90% General ART Treatment Advocacy for Build All seven Department AIDS related increase in care literacy that harmonization capacities Number sub-counties of Health and mortality by linkage to is age and of ART of health care of capacity Sanitation 25% care within 3 population treatment and service building months after specific and referral providers to workshops Development HIV diagnosis appropriate. strategies and monitor conducted partners tools for Cross quality Border of care and Mobile utilize care Implementing Populations, data for partners decision Intensify making advocacy for improved Upscale nutrition trainings among PLHIV in PwP to increase uptake of ART service outcomes Contin- - Number All seven Department uously of capacity sub-counties of Health and Improve building Sanitation patient Health care management providers Development system and PLHIV CSOs partners infrastructure / support groups Implementing General partners population, Health care providers
-Number of Adherence to adherence to Integration of Enhancement All seven Department participants ART by ART by Prevention with of defaulter sub-counties of Health and trained PLHIV, PLHIV, Positives (PwP) tracking Sanitation initiation of initiation of services, tools and ART ART Adequately mechanisms Development treatment treatment advocate for partners protocols and protocols and timely Cross border Cross border enrolment Implementing coordination coordination in ART.Sensitize partners of HIV of HIV communities interventions, interventions, and (MNCH model households of care) against HIV-related stigmatization and discrimination of PLHIV and OVC
34 KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra- Respon- Objective Results Popu- phical sibility STRATEGIC DIRECTION2:IMPROVING HEALTH OUTCOMES AND WELLNESS OF ALL PLHIV lation Areas by KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra Respon- county/ Objective Results Popu- phical sibility Sub- Biomedical Behavioural Structural lation Areas by County county Reduce 1. 90% Adherence to Provide Promote Strengthen -Number of All seven Department /Sub- AIDS related increase in ART by integrated appropriate facility and participants sub-counties of Health and County mortality by linkage to PLHIV, ART youth age-specific community trained Sanitation 25% care within 3 initiation of friendly treatment linkages with Reduce 1. 90% General ART Treatment Advocacy for Build All seven Department months after ART services, literacy, inter- and Development AIDS related increase in care literacy that harmonization capacities Number sub-counties of Health and HIV diagnosis treatment Adequately Intensify intra-facility partners mortality by linkage to is age and of ART of health care of capacity Sanitation protocols and provide and advocacy for referral 25% care within 3 population treatment and service building Cross border dispense ARV youth protocols Implementing months after specific and referral providers to workshops Development coordination drugs friendly and linkage partners HIV diagnosis appropriate. strategies and monitor conducted partners of HIV Scale-up services, strategies. tools for Cross quality interventions, prevention Sensitize Border of care and interventions communities Mobile utilize care Implementing for TB, on importance Populations, data for partners OIs and other of timely decision Co- enrolment and Intensify making morbidities, acceptance of advocacy for water and ART, improved Upscale sanitation Utilize peer nutrition trainings related mobilization among PLHIV in PwP to diseases, for enrolment increase vaccination and uptake of ART for retention in care service preventable and outcomes diseases extend flexible Contin- - Number All seven Department Provide and timings uously of capacity sub-counties of Health and appropriately for care, Scale Improve building Sanitation dispense up patient Health care Pre-ART education management providers Development services to programs for system and PLHIV CSOs partners deserving HIV and infrastructure / support clients treatment groups Implementing literacy General partners adherence and population, retention, Health care Utilize CSOs providers communities and PLHIV -Number of Adherence to adherence to Integration of Enhancement All seven Department 1.Reduce 1.Increased Adherence to Empower care Ensure the Care Givers, Department participants ART by ART by Prevention with of defaulter sub-counties of Health and AIDS linkage to ART by givers identified Parents, of Health and trained PLHIV, PLHIV, Positives (PwP) tracking Sanitation related care PLHIV, with HIV gaps in HIV Teachers, Sanitation initiation of initiation of services, tools and mortality within 3 initiation of education prevention Youths, ART ART Adequately mechanisms Development by 25% months of ART and treatment and Development treatment treatment advocate for partners 2.Reduce HIV HIV treatment literacy treatment partners protocols and protocols and timely related diagnosis to protocols and Utilize youth cascade are Cross border Cross border enrolment Implementing stigma and 90% for Cross border friendly addressed Implementing coordination coordination in ART.Sensitize discrimi- children, coordination technology and immediately.s partners partners of HIV of HIV communities nation by adolescents of HIV social interventions, interventions, and 50% and adults. interventions, media to (MNCH model households facilitate of care) against 2.Increased retention and HIV-related ART adherence eg stigmatization Coverage WhattsApp, and to 90% for Facebook discrimination children , Sensitize of adolescents service PLHIV and OVC and providers to adults reduce HIV-related stigma and discrimination to increase access to care and treatment KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra- Respon- Objective Results Popu- phical sibility lation Areas by county/ Sub- County 1.Reduce 1.Increased Adherence to Empower care HIV related Care Givers, Parents, All seven Department AIDS linkage to ART by givers health Parents, Teachers, sub-counties of health and related care PLHIV, with HIV education Teachers, FBO sanitation mortality within 3 initiation of education of parents, Youths leaders. by 25% months of ART and treatment guardians or 2.Reduce HIV HIV treatment literacy other care MoEST related diagnosis to protocols and Utilize youth givers such as stigma and 90% for Cross border friendly teachers. discrimi- children, coordination technology Advocacy for Development nation by adolescents of HIV and social harmonization partners 50% and adults. interventions, media to of ART Implementing facilitate treatment and partners 2.Increased retention and referral ART adherence eg strategies and Coverage WhattsApp, tools for Cross to 90% for Facebook Border children , Sensitize Mobile adolescents service Populations, and providers to Intensify adults reduce advocacy for HIV-related improved stigma nutrition and among PLHIV discrimination to increase Strengthen access to care peer support and treatment and networks of adolescents living with HIV Build capacities of health care service providers to monitor quality of care and utilize care data for decision making, Upscale training Integrate Department in PwP to HIV testing, of Health and increase care and Sanitation uptake of ART treatment service services into Development outcomes maternal, partners Adequately train neonatal and Health care child health Implementing providers settings and partners and community services members in (MNCH adherence model of support, Scale care). up training of PLHIV in peer support strategies eg mentor mothers, Cascade home and community based model of care for HIV patients and elderly, KASF CASP Key Activity Sub-Activity/ Intervention Target Geogra- Respon- Objective Results Popu- phical sibility lation Areas by county/ Sub- County 1.Reduce 1.Increased Adherence to Empower care Upscale training Scale up Youths, All the 7 sub Department AIDS linkage to ART by givers in PwP to integrated Health Care counties of Health and related care PLHIV, with HIV increase youth friendly Workers, Sanitation mortality within 3 initiation of education uptake of ART services teachers by 25% months of ART and treatment service including MoEST 2.Reduce HIV HIV treatment literacy outcomes training related diagnosis to protocols and Utilize youth Adequately train health Department stigma and 90% for Cross border friendly Health care workers, peer of Youth discrimi- children, coordination technology providers educators nation by adolescents of HIV and social and community and teachers Development 50% and adults. interventions, media to members in in the partners facilitate adherence Adolescent 2.Increased retention and support, Scale Package Of ART adherence eg up training of Care(APOC). Implementing Coverage WhattsApp, PLHIV in peer partners to 90% for Facebook support Health Care All the 7 sub MOH, children , Sensitize strategies eg Workers, counties County adolescents service mentor Peer Department and providers to mothers, Educators. of adults reduce Cascade Health HIV-related home and Partners stigma community CSOs and based model NACC discrimination of care for HIV NASCOP to increase patients and access to care elderly, and treatment Utilize youth All the 7 sub Department friendly counties of Health and technology, Sanitation social media Department such as of Youth WhatsApp Development groups, partners Facebook closed groups Implementing for education, partners recruitment and retention in care. 1.Reduce 1.Increased Utilize peer support support AIDS linkage to to peer groups groups related care mobilization Key and Key and mortality within 3 for enrolment Vulnerable Vulnerable by 25% months of and retention in populations populations, HIV care and extend General Health care 2.Reduce HIV diagnosis to flexible timings population providers related 90% for for care. Cross PLHIV CSOs stigma and children, boarder Department discrimination adolescents mobile of Health and by and adults. Populations Sanitation 50% Health care Department providers of Youth Drop Inn Development Centers partners managers Implementing partners
37 4.4.3 Strategic Direction 3: strategic plan calls for the mainstreaming of gender and human rights in all aspects of the response planning and service delivery. Using a Human Rights Based Approach to Facilitate Access to Services for PLHIV, Key Populations and Other Priority Groups The strategic plan therefore calls for the exploration of effective and appropriate responses to stigma, A number of PLHIV have reported discrimination discrimination and gender-based violence in order to by health workers through disclosure of their sero- have interventions that facilitate access to services status without their consent in Busia County. PLHIV for vulnerable groups and KPs. and KPs face stigma and discrimination in their families, communities and in various service delivery points in the county due to lack of a protective legal Key interventions areas and policy framework. • Address issues that hinder access to HIV, SRH Sexual and gender violence increases biological and rights information and services in public vulnerability to HIV and reduces the ability to and private entities. negotiate for safer sex. These forms of violence • Ensure availability of laws and policies for are widespread in the county and in most cases the protection and promotion of the rights of are directed at women and young girls, with many priority groups, KPs and people living with HIV. such incidents reported in Nambale and Butula sub- • Reduce and monitor stigma and discrimination, counties in the last three years. The reporting rate social exclusion and gender-based violence. in these two sub-counties is high due to increased awareness created by CSOs. The reporting rate • Improve access to legal and social justice and is low in the other sub-counties due to lack of protection from stigma and discrimination in awareness on what needs to be done, hence the the public and private sectors. need for stakeholders to seriously address the issue. Twenty percent of the girls aged 15-20 report their Expected results first sexual intercourse to have been forced and yet few receive treatment. Gender inequalities and • Reduced self-reported stigma and cultural practices such as wife inheritance, sexual discrimination related to HIV and AIDS by 50%. and gender-based violence, early marriages and • Reduced levels of sexual and gender-based high school dropout limit effective HIV prevention in violence for PLHIV, KPs, women, men, girls the county. and boys by 50%. Complaints of female sex workers being harassed by • Increased protection of human rights and law enforcement agencies particularly the police are improved access to justice for PLHIV, KPs and rampant in the county, while men who have sex with other priority groups. men are discriminated upon in almost every corner of the society including in their own families. The
38 STRATEGIC DIRECTION 3: USING A HUMAN RIGHTS BASED APPROACH TO FACILITATE ACCESS TO SERVICES FOR PLHIV, KPS AND OTHER PRIORITY GROUPS KASF CASP Key Activity Sub-Activity/ Target Geogra Responsibility Objective Results Intervention Population -phical Areas by county/Sub- County Reduce a)Increased Remove Train peer educators Key and All the 7 sub- County Director of HIV related protection barriers to among KPs to enhance Vulnerable counties Health Services stigma and of human access of HIV, uptake of services. populations discrimi- rights and SRH and rights Health care County Government nation by improved information providers 50% access to and services PLHIV, CSOs County Dept of health justice for in public and and sanitation, NACC, PLHIV, key private entities NASCOP, Partners, populations and other priority groups including , women, boys and girls. b)Increase access to services by PLHIV, Key and vulnerable populations, and other priority groups, c)Reduced Sensitize health Key and All the 7 sub- County Director of self-reported workers to reduce Vulnerable counties Health stigma and stigmatizing attitudes in populations, discrim- healthcare settings. Health care ination providers related to HIV Support and AIDS by groups 50% Private, Public and informal sector CSOs
Develop and General All the 7 sub- disseminate population population(15+ counties specific and user years) friendly information.
d)Reduced Reduce and Establish GBV recovery GBV centres All the 7 sub- levels of monitor centres for sexual counties sexual and stigma and violence victims. gender- discrimi- Sensitize school Board All the 7 sub- MoEST based nation, social management boards, members counties violence for exclusion and teachers, students and Kenya Red Cross PLHIV, gender pupils on SGBV Key based violence. FBOs Populations, women , men boys and girls by 50%
39 KASF CASP Key Activity Sub-Activity/ Target Geogra- Respon- Objective Results Intervention Population phical sibility Areas by county/ Sub- County Reduce a)Increased Reduce and Mentor health Health club All the 7 sub- MoEST HIV related protection monitor club patrons patrons counties stigma and of human stigma and in schools Kenya Red Cross discrimination rights and discrimi- on handling by 50% improved nation, social adolescents FBOs access to exclusion and living with HIV. justice for gender PLHIV, key based populations violence and other priority groups including , women, boys and girls.
b)Increase access to services by PLHIV, Key and vulnerable populations, and other priority groups, c)Reduced self-reported stigma and discrimination related to HIV and AIDS by 50% Remove Remove Sensitize Health club All the 7 sub- MoEST barriers to barriers to school patrons counties access of access of management Kenya Red Cross HIV,SRH HIV,SRH boards, and rights and rights teachers, FBOs information information pupils, and services in and services students and public in public the rest of and private and private the school entities entities fraternity on stigma and discrimination reduction Improve access Improve Enroleligible OVC All the 7 sub- Social to legal access to OVC into counties ServicesDepartment and social legal the social justice and and social protection protection from justice and programmes stigma and protection and provide discrimination from stigma HIV services. in the public and discrimi- Implement Vulnerable Number of County Government… and private nation in structural women peer support Partners, Partners, sector. the public interventions and networks Private-Public- and private that empower established informal sectors, sector. vulnerable FBOs, CSOs, FBOs, populations NEPHAK, FBOs, especially NACC, NASCOP . women.
40 KASF CASP Key Activity Sub-Activity/ Target Geogra- Respon- Objective Results Intervention Population phical sibility Areas by county/ Sub- County Reduce Improve access Remove Integrate HIV Religious All the 7 sub- County Government… HIV related to legal and barriers to information leaders counties Partners, Partners, stigma and social justice access of and encourage Private-Public- discrimination and HIV,SRH service uptake informal sectors, by 50% protection from and rights in religious FBOs, CSOs, FBOs, stigma information teachings. NEPHAK, FBOs, and discrimi- and services NACC, NASCOP . nation in in public the public and and private private entities sector. Remove Recommend Religious All the 7 sub- barriers to and emphasize leaders counties access of confirmation HIV,SRH of faith healing and rights claims through information scientific tests. and services Promote Religious All the 7 sub- in public acceptance of leaders counties and private KPs as part of entities the community for increased service uptake. Enhance male CSO leaders All the 7 sub- involvement in counties HIV, sexual and reproductive health programmes and also offer them services. Develop CSOs All the 7 sub- community counties groups and forums, and utilize persons living positively to campaign against HIV-related stigma and discrimination. Sensitize CSO leaders All the 7 sub- communities counties on legal issues, rights and gender.
41 KASF CASP Key Activity Sub-Activity/ Target Geogra- Respon- Objective Results Intervention Population phical sibility Areas by county/Sub- County Reduce Improve Remove Sensitize the 500 CSOs All the 7 sub- County HIV related access to barriers to community on harmful counties Government… stigma and legal and access of gender norms, negative Partners, discrimination social justice HIV,SRH stereotypes and Partners, by 50% and and rights concept of masculinity. Private-Public- protection information informal from stigma and services in sectors, FBOs, and discrimi- public CSOs, FBOs, nation in and private NEPHAK, the public and entities FBOs, NACC, private NASCOP sector. Facilitate campaigns CSO leaders All the 7 sub- Department to reduce stigma and counties of Health and discrimination, reduce Sanitation gender violence and Department of promote uptake of HIV Youth services and preventive Development interventions. partners Implementing partners Improve the Sensitize healthcare Management staff All the 7 sub- County Director legal and policy workers, on their own counties of Health environment rights, attitudes and Clinical Staff Services for the tools necessary to protection of ensure patient/client Support Staff Office of the PLHIV, KPs rights are upheld. Governor and other Sensitize law and policy All the 7 sub- priority groups CEC makers on the need to counties including enact laws, regulations women, Office of the and policies that adolescents, Speaker prohibit discrimination girls and boys. and support access Key CSOs to HIV prevention, treatment, care and
support. Review existing laws MCAs and County All the 7 sub- Office of the and policies to ensure Executives counties Governor they impact positively CEC on the HIV response. Office of the Speaker Sensitize law makers All the 7 sub- Office of the and law enforcement counties Governor, agencies on HIV and CECs, the consequences of Office of the enactment of laws in speaker the provision of HIV services to priority groups Facilitate discussion MCAs and County All the 7 sub- and negotiation among Executives counties providers, those who access the service and law enforcement agencies to address law enforcement practices that impede HIV prevention, treatment, care and support.
42 KASF CASP Key Activity Sub-Activity/ Target Geogra- Respon- Objective Results Intervention Population phical sibility Areas by county/Sub- County Reduce Increased Improve Hold the County County review All the 7 sub- Office of the National and Government accountable meetings across the counties Governor, CECs, HIV related protection of County to its constitutional and 10 departments Office of the stigma and human rights Legal and policy statutory obligations. speaker environment discrimination Implement programmes CSO leaders and All the 7 sub- and improved for protection that uphold the rights of County Government counties by 50% and promotion access to priority populations. of the rights of justice priority and Facilitate access to justice CSO leaders All the 7 sub- key populations in cases of rights violation. counties for PLHIV,Key and PLHIV Undertake legal literacy CSO leaders All the 7 sub- populations programmes to teach counties those who are living with or and other are affected by HIV about priority groups human rights and the laws relevant to HIV. including Conduct Conduct a HIV stigma Public and private All the 7 sub- ICC (HIV) women, boys monitoring index survey including in institutions counties and girls. and evaluation healthcare settings and for stigma and communities. discrimination Conduct a baseline survey Public and private All the 7 sub- ICC (HIV) and GBV to document the magnitude institutions counties and nature of human rights violations in the context of HIV. Conduct a baseline survey Public and private All the 7 sub- ICC (HIV) to document the magnitude institutions counties and nature of gender disparities in the context of HIV. Implementation of Public and private All the 7 sub- ICC (HIV) programmes aimed at institutions counties reducing stigma and CSOs discrimination against priority populations.
43 4.4.4 Strategic Direction 4: • Strengthen health service delivery system at Strengthening Integration of Community and county and sub-county levels to deliver HIV Health Systems services, integrated in the essential health package
The 2010 Constitution and Sessional Paper No. 47 of • Improve access to and rational use of essential 2012 on universal healthcare provides for provision products and technologies for HIV prevention, of universal health coverage for all citizens. Though treatment and care services various milestones have been made, there are • Strengthen community service delivery still issues to be addressed to achieve universal systems at county and sub-county levels for healthcare as seen from KNASP III, ETR and KHSSP the provision of HIV prevention, treatment and 2014. care services. The issues raised, though not limited to, are as follows lack of adequate qualified personnel, Expected results inadequate funding, weak and uncoordinated referral • Improved healthcare workforce for the HIV and linkages, low staff morale, lack of integrated response by 40% health services, stock out of commodities , weak and uncoordinated linkages between public and private • Increased number of health facilities ready sector entities, governance and leadership and to offer KEPH-defined HIV and AIDS services skewed distribution of healthcare workers from 51% to 90% • Strengthened HIV commodity management Key intervention areas through effective and efficient management of medicine and medical products • Provide a qualified, motivated and adequately • Strengthened community level AIDS staffed workforce at county and sub-counties to competency deliver HIV services, integrated in the essential health package
44 STRATEGIC DIRECTION 4: STRENGTHENING INTEGRATION OF COMMUNITY AND HEALTH SYSTEMS
KASF Objec- CASP Re- Key Activity Sub-Activity/ Inter- Target Popu- Geographical Responsibility tive sults vention lation Areas by coun- ty/Sub- County a)Reduce new Improve health Provide a Recruitment of enough Health work- All 7 sub-coun- MOH, County Govern- HIV infections workforce for qualified , skilled healthcare staff ers,community ties ment Departments, by 50% HIV response motivated and at all levels. units,CSOs Development part- b) Reduce by 20% adequately ners and CSOs. AIDS related staffed workforce mortality by at the county and 25% sub-counties c) Reduce to deliver HIV related HIV services, stigma and integrated in the discrimination essential health by 30% package
Capacity building of Management All the 7 healthcare workers staff sub-counties in HIV and AIDS management. Clinical offi- cers
Support Staff
Create avenues for Management All the 7 staff motivation, staff sub-counties e.g. in-service training, certificates Clinical of recognition and officers improving the working environment. Support Staff
Put in place healthcare MCA All 7 sub-coun- Office of the Governor workers retention ties policy. County CECs Executives
Correct placement of Management County Director of Health and staff based on their staff Sanitation skills and competences, e.g. CCC staff being CHMT CHMT rotated to OP. Training of health Management All 7 sub- CEC Health managers in HR staff counties matters.
45 KASF CASP Key Activity Sub-Activity/ Target Geographical Responsibility Objective Results Intervention Population Areas by county/Sub- County a)Reduce new Improve health Strengthen Need to integrate all Health workers, All 7 sub- County Government, HIV infections workforce for health service health services in the community counties dept of Health and by 50% HIV response delivery system county. units, CSOs Sanitation, Partners b) Reduce by 20% at county and Public service board, AIDS related sub-county Private sector, mortality by levels to deliver 25% HIV services, c) Reduce integrated in the HIV related essential health stigma and package discrimination by 30% Adoption and Health workers, All 7 sub- implementation of community counties Kenya HIV quality units, CSOs improvement framework as well as implementation of health workforce interventions that improve HIV technical skills and competencies. Develop strategies All 7 sub- for availability of counties comprehensive HIV services more accessible to KPs. Strengthen referrals All 7 sub- and linkages counties between public and private facilities and community.
Improve on health All 7 sub- facilities infrastructure counties to be able to meet basic standards for HIV service provision. Improve access Provision of HIV and All 7 sub- to and rational AIDs commodities counties use of essential based on the products and consumption rates in technologies for the sub-counties. HIV prevention, Conduct regular data All 7 sub- treatment and review meetings. counties care services Capacity building Management All 7 sub- of healthcare staff staff counties on commodity management. Clinical Officers
Support staff
46 KASF Objec- CASP Re- Key Activity Sub-Activity/ Inter- Target Popu- Geographical Responsibility tive sults vention lation Areas by coun- ty/Sub- County a)Reduce new Improve health Strengthen health Need to integrate all Health workers, All 7 sub- County Government, HIV infections workforce for service delivery health services in the community counties dept of Health and by 50% HIV response system at county county. units,CSOs Sanitation, Partners b) Reduce by 20% and sub-county Public service board, AIDS related levels to deliver HIV Private sector mortality by services, integrated 25% in the essential c) Reduce HIV health package related stigma • Provide baselines Adoption and All 7 sub- and discrimi- per sub county on implementation of counties nation by 30% integrated health Kenya HIV quality services improvement • Provide or framework as well improve road and as implementation electricity networks of health workforce to ease access to interventions integrated health that improve HIV services technical skills and • Avail adequate competencies. ambulances and Develop strategies All 7 sub- allied equipment for availability of counties to enhance timely comprehensive response to HIV services more services. accessible to KPs. • Formulate responsibilities, Strengthen referrals All 7 sub- duties and stipend and linkages counties scales (job groups) between public and for CHWs and CHVs private facilities and • Set up health community. insurance schemes Improve on health All 7 sub- s to sustain and facilities infrastructure counties provide health to be able to meet insurance cover basic standards for HIV to the PLHIV, poor service provision. families and elderly including OVC • Set and scale- up timeliness for service integrations per sub county Improve access to Provision of HIV and All 7 sub- and rational use of AIDs commodities counties essential products based on the and technologies consumption rates in for HIV prevention, the sub-counties. treatment and care Conduct regular data Health managers All 7 sub- services review meetings. counties Clinical Officers
47 KASF Objec- CASP Re- Key Activity Sub-Activity/ Inter- Target Popu- Geographical Responsibility tive sults vention lation Areas by coun- ty/Sub- County a)Reduce new Improve health Capacity building Capacity building Management All 7 sub- County Government, HIV infections workforce for of staff in MOH of healthcare staff staff counties dept of Health and by 50% HIV response on commodity on commodity Sanitation, Partners b) Reduce by 20% management management. Clinical Public service board, AIDS related Officers Private sector mortality by 25% Support staff c) Reduce HIV related Support the county Commodity All 7 sub- stigma and commodity technical TWG counties discrimination working group. by 30% Establish a Pharmacists All 7 sub- pharmaceutical counties management information system ( PMIS). Strengthen Capacity build and County All 7 sub- community empower communities departmental counties service delivery and workplaces to take heads systems at county charge of their health. and sub-county CSOs levels for the provision of HIV prevention, treatment and care services. Improve the Engage and motivate CHVs All 7 sub- legal and policy CHVs. counties environment for Strengthen governance County All the 7 sub- the protection and leadership for departmental counties of PLHIV, community and heads KPs and other workplace health priority groups actions at all levels. CSOs including women, adolescents, girls and boys. Strengthen Public County All the 7 sub- Private Partnerships Departmental counties heads
CSOs
Implementation of Public and All the 7 sub- ICC (HIV) programmes aimed at private counties reducing stigma and institutions CSOs discrimination against priority populations.
48 4.4.5 Strategic Direction 5:
Strengthening Research, Innovation and Despite these, the county lack own research agenda, Information Management to meet BCASP Goal budget allocation and M&E units to coordinate research, The county can partner with KEMRI at Alupe and development partners in establishing her This direction targets intervention areas in own research agenda resourcing and implementing an HIV research agenda informed by BCASP and increase evidence- Busia County lack own policies and regulations that based planning, programming and policy changes. address research, surveys and studies including The above targeting is expected by 2019 to have information management, consequently there isn’t delivered increased evidence-based planning, any Research, and innovation bank owned by the programming and policy changes by 50%, increased county. The Situation Room in the County is handy implementation of research on the identified BCASP provided all research, innovation and information related HIV priorities by 50% and increased capacity is regularly fed into the system. The county has not to conduct HIV research at County level by 10%. established research and innovation division thus lack mandate to regulate and or own any research The country has a worldwide record and leadership work. This fuels overdependence on National and in HIV related biomedical, behavioural and structural International research and innovations yet the county research by partnering on preventive efficacy has very high research and innovation opportunities treatment, PrEP and Prevention of Mother-to-Child emanating from her common international Transmission of HIV including discovery of broadly boundaries, huge water bodies like Lake Victoria and neutralizing antibodies for HIV vaccine development, allied Islands. epidemiology and other studies that determined risk factors to HIV acquisition and modes of transmission. Key intervention areas The biomedical study revelations that safe Medical Male Circumcision reduces HIV acquisition in males 1. Resource and implement an HIV research by 60% remains a landmark achievement in Kenya agenda informed by KASF and the world. 2. Increase evidence - based planning, programming and policy changes The other studies in the country on socio-behavioural and epidemiology of KPs such as MSM, Sex Workers, Expected results and PWIDs revealed the incidence and risk factors 1. Increased evidence based planning fueling HIV transmission. Similarly, evaluations of programing and policy changes by 10% structural interventions such as the impact of cash 2. Increased implementation of research on the transfer among adolescents have provided vital identified KASF-related HIV priorities by 10% information in HIV response. However it is notable that efficient translation of key research findings 3. Increased capacity to conduct HIV research at into policies and practices remain weak at the policy County levels by 10% formulation levels, thus delay on actualizing HIV response. In a nutshell, research is dependent on donor funding and often not harmonized with the national and county HIV research priorities.
49 STRATEGIC DIRECTION 5: STRENGTHENING RESEARCH, INNOVATION AND INFORMATION MANAGEMENT TO MEET BCASP GOALS KASF CASP Results Key Activity Sub-Activity/ Target Geographical Responsibility Objective Intervention Population Areas by county/Sub- County Reduce new Increased Implementation Evaluate the National All 7 sub MOH, CountyDept HIV infections evidence based of high impact effectiveness Government counties of health and by 75% planning , research of structural County sanitation, SCHMT, Reduce programing and priorities, interventions, e.g. Government CHMT, CSOs NACC, AIDS related policy changes innovative interventions dealing Universities NASCOP, Partners, mortality by by 50% programming with cross-border KEMRI County government, 25% and capability population adherence Research bodies CHRIO, Reduce and capacity to HIV and TB, service CSO, FBOs. HIV related strengthening integration of TB and Development stigma and to conduct eMTCT services. Partners. discrimination research by 50% Evaluate the impact Increase of scaling treatment domestic on HIV acquisition and financing of he morbidity at individual HIV response to and community levels. by at least 10%
Determine the impact of stigma and GBV reduction interventions onthe uptake of HIV care.
Determine the impact of new technologies and programs in HIV care.
Increased Behavioural Determine socio- All the 7 sub- MOH, CountyDept implementation research behavioural, cultural counties of health and of research priorities and gender- sanitation, SCHMT, on identified related factors as CHMT, CSOs , BCASP–related determinants of : NACC, NASCOP, HIV priorities by care & treatment Partners, County 50% outcomes and government, CHRIO, adherence to HIV/TB treatment; loss of follow up, defaulting and retention to HIV/TB treatment; morbidity and mortality; the effects of HIV stigma, its determinants and how to reduce it. Determine the factors contributing to high HIV prevalence among the fishing communities in Bunyala and Samia sub-counties. Determine the effectiveness of HIV interventions among the fishing communities in Bunyala and Samia.
50 STRATEGIC DIRECTION 5: STRENGTHENING RESEARCH, INNOVATION AND KASF CASP Results Key Activity Sub-Activity/ Target Geographical Responsibility INFORMATION MANAGEMENT TO MEET BCASP GOALS Objective Intervention Population Areas by KASF CASP Results Key Activity Sub-Activity/ Target Geographical Responsibility county/Sub- Objective Intervention Population Areas by County county/Sub- Reduce new *Increased Biomedical Determine the impact of National All 7 sub- KEMRI HIV infections evidence -based research the Gene Expert on HIV/ Government counties County Partners by 75% planning, priorities TB treatment outcomes. County Reduce new Increased Implementation Evaluate the National All 7 sub MOH, CountyDept Reduce programing and Government HIV infections evidence based of high impact effectiveness Government counties of health and AIDS related policy changes Universities Analysis Create and maintain a All 7 sub- NACC decentralized by 75% planning , research of structural County sanitation, SCHMT, mortality by by 50% KEMRI HIV research and best counties structures Reduce programing and priorities, interventions, e.g. Government CHMT, CSOs NACC, 25% *Increased Research bodies practices data base. AIDS related policy changes innovative interventions dealing Universities NASCOP, Partners, Reduce implimentation CSO, FBOs. mortality by by 50% programming with cross-border KEMRI County government, HIV related of reserach on Development 25% and capability population adherence Research bodies CHRIO, stigma and the identified Partners. Reduce and capacity to HIV and TB, service CSO, FBOs. discrimination KASF-related County HIV Develop county HIV 10 Policy makers All 7 sub- NACC HIV related strengthening integration of TB and Development by 50% HIV priorities by research research agenda through and researchers counties stigma and to conduct eMTCT services. Partners. Increase 50% agenda a consultative process to County Government discrimination research domestic *Increased complement the health by 50% Evaluate the impact financing of he Capacity to research agenda. Partners Increase of scaling treatment HIV response to conduct HIV domestic on HIV acquisition and by at least 10% research at Strengthen synergies financing of he morbidity at individual county levels by between HIV research HIV response to and community levels. 10% by at least 10% and other health research areas such as Determine the impact TB and SRH. of stigma and GBV reduction interventions Implement Develop and invest 10 researchers All 7 sub- NACC onthe uptake of HIV the research in-capacity for HIV counties care. agenda in the research and peer review County Government county publication. Determine the impact Partners of new technologies Strengthen co-ordination and programs in HIV and tracking of HIV care. research.
Increased Behavioural Determine socio- All the 7 sub- MOH, CountyDept Establish a County implementation research behavioural, cultural counties of health and Research Ethics Review of research priorities and gender- sanitation, SCHMT, Committee. on identified related factors as CHMT, CSOs , BCASP–related determinants of : NACC, NASCOP, Strengthen ethics review HIV priorities by care & treatment Partners, County committees to facilitate 50% outcomes and government, CHRIO, high quality HIV-related adherence to HIV/TB studies through: treatment; fast track mechanism; loss of follow up, quality assurance; defaulting and complex biomedical trial retention to HIV/TB designs; treatment; KPS; morbidity and adolescents; ethics and mortality; sensitivities. the effects of HIV stigma, its Create and strengthen determinants and how county HIV research to reduce it. capacities including Determine the factors epidemiologic contributing to high HIV surveillance, good prevalence among the laboratory and clinical fishing communities practice and ethics. in Bunyala and Samia sub-counties. Determine the effectiveness of HIV interventions among the fishing communities in Bunyala and Samia.
51 KASF CASP Results Key Activity Sub-Activity/ Target Geographical Responsibility Objective Intervention Population Areas by county/Sub- County Reduce new *Increased Resource the Develop and align HIV National All 7 sub- MOH, CountyDept of HIV infections evidence -based HIV agenda research financing Government counties health and sanitation, by 75% planning, strategy with the existing County SCHMT, CHMT, CSOs Reduce programing and health laws, policies and Government NACC, NASCOP, AIDS related policy changes regulations in the county. Universities Partners, County mortality by by 50% KEMRI government, CHRIO, 25% *Increased Integrate research Research bodies Reduce implimentation funding in BCASP funding CSO, FBOs. HIV related of reserach on priorities and develop a Development stigma and the identified resource mobilization Partners discrimination KASF-related plan. by 50% HIV priorities by Increase 50% Advocate for 20% of domestic *Increased health research budget financing of he Capacity to for HIV/TB HIV response to conduct HIV by at least 10% research at county levels by 10% Increase HIV information Establish a county multi- All 7 sub- evidence-based portal for Busia sectoral interactive web- counties planning, County. based HIV/AIDS research programming hub with geographic and policy mapping of research changes on HIV, TB and SRH research.
Develop and disseminate regular paper reviews of key research findings, local innovations, systematic reviews and their policy, funding and practice implications.
Reviews of Publish systematic All 7 sub- research reviews of research on counties the BCASP priorities and draft research briefs biennially.
Invest in capacity development for research reviews and collation.
Resource the Develop and align HIV All 7 sub- HIV agenda research financing counties strategy with the existing health laws, policies and regulations in the county.
Integrate research funding in BCASP funding priorities and develop a resource mobilization plan.
Advocate for 20% of the health research budget for HIV/TB
52 KASF CASP Results Key Activity Sub-Activity/ Target Geographical Responsibility 4.4.6 Strategic Direction 6: The existing County M&E requires strengthening so Objective Intervention Population Areas by as to flex and respond to data needs by the National county/Sub- County Promote Utilization of Strategic Information for and County governments, and facilitate generation of Reduce new *Increased Resource the Develop and align HIV National All 7 sub- MOH, CountyDept of Research, Monitoring and Evaluation to Enhance high quality and timely strategic information for HIV HIV infections evidence -based HIV agenda research financing Government counties health and sanitation, Programming response at all levels. by 75% planning, strategy with the existing County SCHMT, CHMT, CSOs Reduce programing and health laws, policies and Government NACC, NASCOP, AIDS related policy changes regulations in the county. Universities Partners, County Competent HIV response is dependent and influenced mortality by by 50% KEMRI government, CHRIO, The other core M&E challenge is over dependence on 25% *Increased Integrate research Research bodies by timely availing of data for effective evidence based donor for external funding that often results in delays Reduce implimentation funding in BCASP funding CSO, FBOs. HIV related of reserach on priorities and develop a Development informed decision making thus need for strengthened or partial implementation of planned M&E activities stigma and the identified resource mobilization Partners M&E capacity. Kenya’s Constitution (2010) requires such as population based surveys hence the need discrimination KASF-related plan. by 50% HIV priorities by people’s participation in decision making and to strengthen sustainable M&E activities both at the Increase 50% Advocate for 20% of transparent accountability and stewardship. The domestic *Increased health research budget National and County levels. financing of he Capacity to for HIV/TB M&E of national and county multi-sectoral response HIV response to conduct HIV to HIV and AIDS rely on a variety of systems, namely; by at least 10% research at Key intervention areas county levels by data sources, routine and periodic collection and 10% collation systems that are supported and maintained The county envisages the following as key priority Increase HIV information Establish a county multi- All 7 sub- evidence-based portal for Busia sectoral interactive web- counties by stakeholders. areas for this SD: planning, County. based HIV/AIDS research programming hub with geographic - Establish and build M&E systems to ensure and policy mapping of research The main challenges facing M&E in the county are availability of strategic information to inform changes on HIV, TB and SRH research. a strategic approach on coordination, ownership HIV response in the county and meaningful use of data for decision making and - Strengthening M&E capacity in the county by Develop and disseminate planning among stakeholders at different levels and establishing a County M&E Unit, which is fully regular paper reviews of sectors. Similarly, the M&E gap in programmatic data key research findings, equipped and having M&E specialists. local innovations, availability for routine monitoring of programmes systematic reviews and and sentinel surveillance that enable modeling their policy, funding and Expected results practice implications. trend-analysis are non-sensitive thus cannot detect emerging issues in HIV response. • Increased availability of strategic information Reviews of Publish systematic All 7 sub- research reviews of research on counties to inform HIV response in Busia County the BCASP priorities and draft research briefs The analytical capacity at the county level remains • Planned evaluations, reviews and surveys biennially. weak thus requires strengthening to enable re- implemented and timely disseminated results Invest in capacity address of the needs of strategic data. The county • Established M&E information hubs at the county development for research therefore needs to establish, recognize and own reviews and collation. level that provide comprehensive information efficient M&E systems that are linked to surveys, package on key BCASP indicators for decision Resource the Develop and align HIV All 7 sub- studies and programmatic data sources. making HIV agenda research financing counties strategy with the existing health laws, policies and regulations in the county.
Integrate research funding in BCASP funding priorities and develop a resource mobilization plan.
Advocate for 20% of the health research budget for HIV/TB
53 STRATEGIC DIRECTION6: PROMOTE UTILIZATION OF STRATEGIC INFORMATION FOR RESEARCH, MONITORING AND EVALUATION TO ENHANCE PROGRAMMING KASF Objective CASP Results Key Activity Sub-Activity/ Target Geographical Respon- Intervention Population Areas by sibility county/Sub- County Reduce new HIV Increased Strengthening Align the county CHRIO All the 7 sub County HIV ICC infections by 75% availability M&E capacity M&E system to the counties. MOH, Reduce AIDS of strategic to effectively new governance CASCO CountyDept related mortality information track the BCASP structure. of health and by 25% to inform HIV performance and NACC sanitation, Reduce response in Busia HIV epidemics in SCHMT, CHMT, HIV related County the county. CSOs , NACC, stigma and NASCOP, discrimination by Partners, County 50% government, Increase CHRIO, domestic financing of he HIV response to by at least 10% Planned Behavioural Conduct national 200 PLHIV All the 7 sub- evaluations, research priorities and Busia counties reviews and County M&E surveys engagements. implemented and timely disseminated Conduct All 7 sub- results M&E capacity counties assessment and capacity development in the county. Strengthen All 7 sub- functional multi- counties sectoral HIV M&E coordination structure and partnerships in the county. Develop, print 100 health All 7 sub - & disseminate facilities counties comprehensive HIV M&E systems guidelines, tools and standard operating procedures. Put in place County County level sustainable Assembly financing for HIV All 7 sub- M&E planned Partners counties activities. CSOs
CHMT
SCHMT
NACC KASF Objective CASP Results Key Activity Sub-Activity/ Target Geographical Respon- Intervention Population Areas by sibility county/Sub- County Reduce new HIV Planned Ensure a Strengthen 300 health All 7 sub- County infections by 75% evaluations, harmonized, HIV M&E data workers counties Government Reduce AIDS reviews and timely and management in related mortality surveys comprehensive the county. Partners by 25% implemented routine and Harmonize and Reduce and timely non–routine create linkages HIV related disseminated monitoring between data stigma and results systems to provide collection tools discrimination by quality HIV data in and databases. 50% the county. Increase Conduct periodic 100 health All 7 sub- domestic data quality audits facilities counties financing of he and verification. HIV response to Conduct M&E 100 health All 7 sub - by at least 10% supervision. facilities counties Scale up coverage of ongoing HIV programme surveillance and surveys. Honor global, national and county HIV reporting obligations. Strengthen routine and non-routine HIV information systems. Established an Establish multi- Establish a Partners County level County HIV ICC M&E information sectoral and multi-sectoral Department hub at the county integrated real- HIV programming of Health and All 7 sub BCASP level that provides time system web-based data Sanitation counties Monitoring Unit comprehensive management information system. NACC package on key NASCOP BCASP indicators for decision County making. Government
Public sector
HIV platform to Promote data Partners , County level County HIV ICC provide updates demand and use department and All 7 sub and BCASP on HIV epidemic of HIV strategic of health and counties monitoring unit response information to sanitation, accountability inform policy and NACC, programming. NASCOP, County government , public sector
55 KASF Objective CASP Results Key Activity Sub-Activity/ Target Geographical Respon- Intervention Population Areas by sibility county/Sub- County Reduce new HIV Established an HIV platform to Develop and Partners County level County HIV ICC, infections by 75% M&E information provide updates implement the Department Reduce AIDS hub at the county on HIV epidemic BCASP evaluation of Health and All 7 sub CHMT, related mortality level that provides response agenda. Sanitation counties by 25% comprehensive accountability County Reduce information NACC Assembly Health HIV related package on key Committee stigma and BCASP indicators NASCOP discrimination by for decision County BCASP 50% making. Government Monitoring nit Increase Public sector domestic Create and Partners County level CHRIO financing of he strengthen the HIV response to M&E information Department NACC by at least 10% hub at county of Health and level. Sanitation
NACC
NASCOP
County Government Public sector Align the county Partners County level County HIV ICC M&E system to the ‘Three Ones Department Principle’ of Health and Sanitation
NACC
NASCOP
County Government Public sector
4.4.7 Strategic Direction 7: middle income country. This will have implications Increasing Domestic Financing for on Kenya’s requirements for counterpart financing, Sustainable HIV Response terms for commodities and drugs, existing and future financing agreements. The dwindling resources available for HIV programming call for smarter investments of every Currently , the existing funding allocation for HIV shilling where it will have the greatest impact and in programing by the county government remains the most efficient way. Globally the unprecedented unknown. However Busia County is setting global support towards universal access to HIV mechanisms to identify HIV resourcing gaps prevention and treatment has evolved into an agenda shared responsibility and commitment to Expected results end the AIDS epidemic and achieve universal health coverage. Increased domestic financing for HIV response to 20% Kenya’s economy has been rebased making it a
56 STRATEGIC DIRECTION7: INCREASING DOMESTIC FINANCING FOR SUSTAINABLE HIV RESPONSE
KASF CASP Key Activity Sub-Activity/ Target Geographical Respon- Objective Results Intervention Population Areas by sibility county/Sub- County Increase Increased Ensure policy County Domestic County Assembly County Assembly County domestic domestic on County HIV Financing Health Committee Assembly financing financing for financing is put bill policy of the HIV HIV response in place developed and CEC response to to 50% implemented. 50% Governor
Undertake periodic review of the spending plans. Development/ Review of guidelines on quality assurance, quality control, quality improvement and monitoring of HIV service delivery. Promote Set up a HIV County Assembly County County innovative and investment unit Health Committee Assembly sustainable with a clear domestic HIV management Governor’s financing structure within office options. MoH. County HIV ICC Establish a trust fund
All contracts in Contractors, County County the county to private and Assembly include a sum informal sector of 2% of the Governor’s contract towards office HIV and AIDS program. County HIV ICC Engage the County Assembly County County county budget Health Committee Assembly allocation committee to Governor’s consider 1% office of the county budget for HIV County HIV response as an ICC added parameter or consideration in resource allocation. Lobbying with Development County County HIV the development partners ICC partners to fund BCASP Conduct county expenditure tracking survey.
57 KASF CASP Key Activity Sub-Activity/ Target Geographical Respon- Objective Results Intervention Population Areas by sibility county/Sub- County Increase Increased Align HIV Conduct county County County County domestic domestic resources/ expenditure Government Government financing financing for investments to tracking survey. department of the HIV HIV response strategic plan Organize Development County County response to to 50% priorities adevelopment partners Government 50% partners HIV forum County HIV to facilitate ICC alignment of their activities with BCASP. Conduct a stakeholder analysis/ mapping. Facilitate quantification of county resource needs through relevant information on county support. Implement a Partners County HIV partnership ICC accountability Department framework of Health and BCASP to ensure Sanitation Monitoring alignment of Unit resources to the Public, private BCASP priorities. and informal sectors
Conduct annual CSOs review meetings to give feedback Development of development partners partners’ contribution towards BCASP implementation.
58 4.4..8 Strategic Direction 8: Key interventions areas - Build and sustain high-level political Promoting Accountable Leadership for Delivery commitment for strengthened county of the BCASP Results by All Sectors and Actors ownership of the HIV response The Constitution of Kenya 2010 provides the - Entrench good governance and strengthen environment for the national HIV and AIDS response. multi-sector and multi-partner accountability to delivery of BCASP results Articles 10(2) and 73 define the fundamentals of good governance and leadership while Article 21 - Establish a functional HIV coordination (3) assigns all public institutions responsibility to mechanism at the county level address the needs of vulnerable groups within the society. In this case, the vulnerable groups include those infected and affected by HIV and AIDS. Expected results Similarly, the County Government Act, 2012 describe - Good governance practices and accountable the roles of county governments in planning, leadership entrenched for the multi-sectoral prioritization, Implementation, monitoring, resource HIV and AIDS response at all levels. allocation and budgeting for programmes and - Effective and well-functioning stakeholder interventions under the devolved governance. Health coordination and accountability mechanisms in is a devolved function; thus, the county governments place and fully operationalized. are obliged to guarantee residents access quality - An enabling policy, legal and regulatory health care services. Delivery of quality HIV and AIDS framework for the multi-sectoral HIV and AIDS related services; prevention, care, treatment and response strengthened and fully aligned to the mitigation of related impact are Constitution of Kenya 2010. provided for in the Busia County development plans. STRATEGIC DIRECTION8: PROMOTING ACCOUNTABLE LEADERSHIP FOR DELIVERY OF THE BCASP RESULTS BY ALL SECTORS AND ACTORS KASF CASP Results Key Activity Sub-Activity/ Target Geographical Respon- Objective Intervention Population Areas by sibility county/Sub- County
*Increase Good Provide policies Develop policies that County Assembly All the 7 sub NACC and First domestic governance and strengthen enhance accountability counties. Lady’s Office Financing practice governance and good governance of County line respectively of the HIV and accountable systems resources for multi-sectoral departments response to leadership HIV/AIDS response. 50%, entrenched for Private and * Reduce the multi- informal sectors new HIV sectoral HIV and infections by AIDS 75% *Reduce response at all HIV related levels stigma and Effective and Develop and implement County Assembly County HIV ICC discrimination well-functional systems that strengthen by 50%, * stakeholder co- good governance of the HIV County line Governor’s office Reduce ordination response. departments AIDS related and mortality by accountability Private and 25% mechanisms in informal sectors place and fully operationalized Build capacity of partners County Assembly County HIV ICC at county level. for resource management An enabling and accountability through County line Governor’s office policy, legal institutionalized technical departments and regulatory support mechanisms. Private and framework Build and Advocate for political informal sectors for the multi- sustain high- goodwill at the two arms sectoral level political of county government HIV and AIDS commitment. (executive and legislature). response strengthened Stakeholder Establish a HIV inter- Networks of faith County HIV ICC and fully aligned accountability agency coordinating and communities, to the other relevant committees civil society, key Governor’s office constitution of for monitoring of the HIV populations and Kenya response. persons living with HIV Build capacity of County HIV ICC stakeholders to promote strong accountable Governor’s office institutions that hold duty bearers accountable for the HIV response. Development Hold the development County Assembly County HIV ICC partners partners HIV forum focusing accountability on alignment to BCASP County line Governor’s office priorities. departments
Private and informal sectors
60 KASF CASP Results Key Activity Sub-Activity/ Target Geographical Respon- Objective Intervention Population Areas by sibility county/Sub- County *Increase *Good Implementing Develop and implement a County Assembly All the 7 sub County HIV ICC domestic governance partners partnership accountability counties Financing practices and accountability mechanism based on targets County line Governor’s office of the HIV accountable and results. departments response to leadership 50%, entrenched Private and * Reduce for the multi- informal sectors new HIV sectoralHIV and infections by AIDS response Private sector Review reporting County Assembly County HIV ICC 75% *Reduce at all levels. accountability mechanisms to capture HIV related * Effective and private sector contribution to County line Governor’s office stigma and well-functioning the HIV response. departments discrimination stakeholder by 50%, * coordination and Private and Reduce accountability informal sectors AIDS related mechanisms in mortality by place and fully 25% operationalized. Multi-sectoral Facilitate target setting and County Assembly County HIV ICC * An enabling accountability align sector reporting of policy, legal and results against targets. County line Governor’s office regulatory departments framework for the multi- Private and sectoral HIV and informal sectors AIDS response strengthened BCASP Establish a BCASP County Assembly County HIV ICC and fully governance monitoring committee to aligned to the oversee tracking of progress County line Governor’s office Constitution of towards results. departments Kenya 2010. Private and informal sectors
61 CHAPTER 5
Implementation Arrangements
5.1 HIV Coordination Structure for BCASP Delivery – County Level The multi-sectoral county response will be managed by various structures at different levels.Each level will be mandated with diffrent tasks and roles in the delivery of the stategic plan.The coordination infrastructure of the BCASP will be an all-inclusive one. This infrastructure will be coordinated at different levels as shown in the organogram below
62 County Government {Governor}
County Executive Committee {Governor}(Governor)
County HIV Committee {Co-Chairs: Health CEC, Director of Health}
{
County HIV County HIV ICC {all HIV County Coordination Unit County Partners in the County & BCASP {NACC} HealthManagement Health stakeholder forum Monitoring TeamTeam members Committee
Sub-County AIDS Committees
Sub-Committees by Strategic Sub-Committees Stakeholder working Direction {SD 1-5} + Public Sector 1. Resourcing groups {CSO, FBOs, Youth, Working Group PLHIV 2. HIV InvestmentCriteria
5.2 Stakeholder Management and • Effective reporting on program progress and Accountability activities to an agency under the leadership of the County Government The fight against HIV and AIDS in Busia County like in the rest of the country is heavily dependent on support • Civil society tracking of policy and public sector from foreign government agencies and private service delivery initiatives like the Bill and Melinda Gates Foundation. • Continuous monitoring of County Government This has been accompanied by enhanced civil society commitment and compliance to national involvement and influence. commitments; and finally • Fiduciary discipline and openness in use of Accountability covers a range of issues funds regardless of the source. and situations ranging from: • Effective coordination to ensure the safeguarding of the Busia community interest in HIV program design
63 The framework for accountability for the county HIV/ • Integration of HIV and AIDS services in routine AIDS response is this County Strategic Plan sets out healthcare services in all health facilities in the the Busia County strategic priorities and resource county. allocations that reflect the unique aspects of the • Entrenchment of the HIV and AIDS budget epidemic in this region. It specifies the institutional allocation in the county budget. and organizational roles and frameworks through • Enacting of favourable legislation and policies at which these county priority interventions will county level to guide the HIV and AIDS response. be managed and implemented. This it does by specifying the outcomes and outputs for which • Building of strong community structures which various implementers are to be accountable, and the will continue to carry on HIV programming. monitoring indicators through which such program • A strong multi-sectoral response to HIV and accountability can be established. AIDS. • Good coordination mechanism of HIV response 5.3 Sustainability at the county level. The gains achieved by this BCASP have to be sustained • Building of technical capacity at county level to over a long time to eventually be able to realize the review and develop subsequent strategic plans goal of getting to zero. Sustainability of this strategic at the end of term for this current one. plan will therefore be achieved through: • Aligning of all government departments and • Capacity building of healthcare providers in HIV the private sector in the county to support HIV prevention, care and treatment in the county; response activities. these healthcare workers will continue to • Meaningful involvement of people living with offer quality services even after the end of the HIV(MIPA). lifespan of the BCASP.
64 CHAPTER 6
Research, Monitoring and Evaluation of the Plan
The Busia County AIDS Strategic Plan is a five All stakeholders are expected to enhance capacity year strategy premised on achievement of set building of CSOs, PSOs and health workers. objectives, increased linkage to care, ART coverage The leadership of Busia County Department of and retention including viral load suppression in all Health and Sanitation is expected to champion PLHIV respectively. It is aligned to the Constitution supportive supervision, capacity building of HIV of Kenya (2010) and relevant international statutes, program managers, planners and service providers protocols and policies. This strategy therefore including data ownership and utilization for decision demands evidence based and factual reporting by all making. Similarly, the same leadership is expected to stakeholders engaged in multi-sectoral HIV response constitute a BCASP Monitoring Committee charged at all levels using all GoK validated reporting tools, with delivery of results. The figure below summarizes languages and timeliness including set targets. the hierarchy of reporting mechanism in the multi- Each stakeholder shall comply with the ‘Three ONES sectoral HIV response in Busia County and how it Principles’ in which the NACC and NASCOP will take will fit and inform the country and world for decision lead in respective strategic directions. making processe
65 lance il e urv S
urveys, urveys,
S ounty ounty stimates stimates C E
valuationsMid and and valuationsMid E erm T
BCASP End Evaluation Program
ector
S rivate
P ystem S County (SCACCS) (SCACCS) County -
NACC Sub NACC nified M&E M&E nified ociety ociety U
S
rganisations ivil C O NACC NACC
Community /BENEFICIARIES Community
nits U
Committee HIV County munity HIS m B o C C (CHEWs/CHW)
(DHIS) H o Facilities -
ountyM ub S C Health
Figure 6.1: Busia County HIV & AIDS response data flow chart
66 CHAPTER 7
Risk and Mitigation Plan
Risk Category Risk Name Status Proba- Impact Risk Response Respon- When bility (1-5) (1-5) Average sibility Score Technological • Personnel lack Active- risk is 3/5 4/5 3.5/5 Mitigate- CEC Health Continuous capacity and skills being actively Budget to use equipment. monitored money for • Inadequate training and equipment. pro- curement of equipment
Political Inconsistent Passive risk 2.5/5 3/5 3/5 Reduce – CEC Health Continuous and insufficient - its being CSOs and political good will. actively By constantly FBOs monitored engaging the political class. Sensitize the public to demand accountability from elected leaders for their rights.
Operational Inconsistent Active- 4.5/5 5/5 4.5/5 Reduce- CEC Health Continuous and inadequate being Improved AMPATH- supply of HIV monitored planning and PLUS. commodities. procurement APHIA-PLUS of PSI-Kenya commodities based on target population. Special emergency fund for HIV commodities.
67 Risk Category Risk Name Status Proba- Impact Risk Response Respon- When bility (1-5) (1-5) Average sibility Score Legislation Absence of a Active 5/5 4/5 4.5/5 Initiate and CEC Health Year 1 legislation to lobby for CSOs demand the support for an Key commitment of HIV Act populations resources for HIV response and to protect KPs and vulnerable groups. Environmental •Hard to reach Passive 2/5 2/5 2/5 Mitigate- CEC Health Continuous areas. Procure CSOs and •Unfavourable transport FBOs weather facilities for conditions. special areas. Improve existing facilities for adverse weather services.
Social • Stigma Active 4/5 4/5 4/5 Mitigate- CSOs Continuous •Discrimination Enhance MoEST • Social exclusion campaigns to Social • GBV reduce social Services drivers of HIV. FBOs
Economical • Poverty Active 3/5 3/5 3/5 Mitigate– Governor’s Continuous • Inadequate Poverty office funds in the alleviation Partners county HIV measures CSOs and response among FBOs women, youths and other vulnerable groups. Prioritize activities.
Inadequate Active 2/5 3/5 2.5/5 Forward CEC Health resources vs planning. many health priorities.
68 Risk Category Risk Name Status Proba- Impact Risk Response Respon- When bility (1-5) (1-5) Average sibility Score Organizational / Inadequate staff Active 2/5 4/5 3/5 Reduce – County Continuous human factors Hire adequate Director of staff Health
Insufficient task Passive 3/5 3/5 3/5 Increased skills trainings. Place supervisory staff based on qualifications
Poor leadership Passive 2/5 3/5 2.5/5 Reduce- Promote good governance and leadership. Demand accountability from all partners and stakeholders. Ineffective Active 2/5 2.5/5 2.25/5 . Capacity County community development Government systems in service of CSOs and NACC delivery FBOs. Development Financial partners support to CSOs.
Conflicts and Active 2/5 3/5 2.5/5 Reduce- NACC duplication of Improve on activities by CSOs coordination and M&E. Strategic/ High cost Active 4/5 3/5 3.5/5 Maximizing County Continuous commercial implementing the efficiency Director of strategy through Health integration Partners and CSOs prioritization of interventions.
69 Annexes
Annex 1: Results Framework
NASCO
NACC
CSOs
Partners
Health
of
Department Department
County
Partners
Development Development
ernment ernment
- Gov County
bility
- Responsi
1,749,326
tive)
- cumula
Target Target
Term Term
End-
744,054
1,749,326
1,749,326
874,633
Target
Term Term
Mid-
372,027
1,749,326
874,633
Source
line and and line
- Base
done. done.
campaigns campaigns
awareness awareness
KAIS KAIS
KDHS, KDHS,
No. of of No.
tors
- Indica
skills messages skills
reached with life life with reached
adolescents adolescents
No. of of No.
population population
general general
women and and women
adolescents, adolescents,
targeting targeting
BCC messages messages BCC
aired with key key with aired
media programs programs media
No. of mass mass of No.
distributed
developed and and developed
eral population population eral
- gen and women
adolescents, adolescents,
terials targeting targeting terials
- ma IEC of No.
health strategy. ( strategy. health
in community community in
and mitigation mitigation and
HIV prevention prevention HIV
Incorporate Incorporate
Structural
CHVs)
health strategy( strategy( health
in community community in
and mitigation mitigation and
HIV prevention prevention HIV
Incorporate Incorporate
Behavioural
Sub-Activity/Intervention
and out of school of out and
adolescents in in adolescents
education among among education
Life skills skills Life
population)
general general
women and and women
adolescents, adolescents,
and TV spots( spots( TV and
messages; radio radio messages;
mass media media mass
Develop Develop
population)
general general
women and women
adolescents, adolescents,
materials(
distribute IEC IEC distribute
Develop and and Develop
groups)
vulnerable vulnerable
KPs and and and and KPs
populations( populations(
among target target among
HIV prevention prevention HIV
campaigns on on campaigns
awareness awareness
Carry out out Carry
Biomedical
STRATEGIC DIRECTION 1: REDUCING NEW HIV INFECTIONS HIV NEW REDUCING 1: DIRECTION STRATEGIC
SBCC
1.Conduct 1.Conduct
Activity
Key Key
75%
adults by by adults
among among
infections infections
new HIV HIV new
annual annual
1. Reduced Reduced 1.
Results
CASP CASP
75%
infections by by infections
new HIV HIV new
Reduce Reduce
jective
- Ob KASF
70
NASCO
NACC
CSOs
Partners
Health
of
Department Department
County
bility
- Responsi
demand
condom on on condom
accessing accessing
population population
general general
100 % of of % 100
12,596
mulative)
- cu Target
End-Term End-Term
demand
doms on on doms
- Con
accessing accessing
lation lation
- Popu
general general
80% of of 80%
6 ,298 6
Target
Term Term
Mid-
2014
KDHS KDHS
Source
line and and line
- Base
distributed
and and
procured procured
condoms condoms
female female
tage of of tage
percent-
distributed distributed
and and
procured procured
condoms condoms
male male
tage of of tage
percent-
population
general general
targeting targeting
done done
campaigns campaigns
promotion promotion
condom condom
tage of of tage
percent-
population
general general
reaching reaching
done done
campaigns campaigns
awareness awareness
HIV stigma stigma HIV
No. of anti anti of No.
tors
- Indica
population
the general general the
done targeting targeting done
campaigns campaigns
awareness awareness
abuse abuse
and substance substance and
No. of drugs drugs of No.
targeting youths targeting
campaigns campaigns done
awareness awareness
abuse abuse
and substance substance and
No. of drugs drugs of No.
Structural
population
and general general and
to the KPs KPs the to
campaigns campaigns
promotion promotion
condom condom
Carry out out Carry
CHVs)
health strategy( strategy( health
in community community in
and mitigation mitigation and
HIV prevention prevention HIV
Incorporate Incorporate
Behavioural
Sub-Activity/Intervention
condoms. condoms.
female female
male and and male
adequate adequate
distribute distribute
Procure and and Procure
population)
and general general and
, the youth youth the ,
abuse(KPs abuse(KPs
substance substance
on drugs and and drugs on
campaigns campaigns
awareness awareness
Carry out out Carry
population)
general general
campaigns(
reduction reduction
stigma stigma
Carry out out Carry
Biomedical
lubricants
condoms and and condoms
2. Provision of of Provision 2.
75%
among adults by by adults among
new HIV infections infections HIV new
. Reduced annual annual Reduced .
Key Activity Key
75%
adults by by adults
among among
infections infections
new HIV HIV new
annual annual
. Reduced Reduced .
Results
CASP CASP
75%
adults by by adults
among among
infections
new HIV HIV new
annual annual
1. Reduced Reduced 1.
Objective KASF KASF
71
NASCO
NACC
CSOs
Partners
Health
of
Department Department
County
bility
- Responsi
744,054
scents-
Adole-
KPs -6 ,298 ,298 -6 KPs
1,574,394 1,574,394
lation-
Popu-
General General
80%
mulative)
- cu Target
End-Term End-Term
372,027
scents-
Adole-
-3,149 -3,149
KPs KPs
787,197 787,197
lation: lation:
Popu-
General General
40%
Target
Term Term
Mid-
2014
KDHS KDHS
Source
line and and line
- Base
services
treatment treatment
care and and care
clients for for clients
positive positive
to HIV HIV to
offered offered
linkages linkages
No. of of No.
PITC
offering offering
facilities facilities
No. of of No.
services
HTC HTC
offering offering
facilities facilities
health health
No. of of No.
supplied
logistics logistics
testing testing
No. of HIV HIV of No.
CT
built in HIV HIV in built
capacity capacity
workers workers
health health
tage of of tage
percent-
tors
- Indica
services services
treatment treatment
HIV care and and care HIV
clients to to clients
of all positive positive all of
Ensure linkage linkage Ensure
based PITC based
Scale up facility facility up Scale
health facilities health
services in all all in services
Provision of HTC HTC of Provision
testing logistics testing
Provision of HIV HIV of Provision
testing
counseling and and counseling
workers in HIV HIV in workers
healthcare healthcare
building of of building
Capacity Capacity
population
and general general and
to the KPs KPs the to
campaigns campaigns
promotion promotion
condom condom
Carry out out Carry
Sub-Activity/Intervention
areas
geographical geographical
hard to reach reach to hard
to KPs and and KPs to
HTC services services HTC
outreach outreach
Conduct Conduct
and testing and
3. HIV counseling counseling HIV 3.
Key Activity Key
75%
adults by by adults
among among
infections infections
new HIV HIV new
annual annual
1. Reduced Reduced 1.
Results
CASP CASP
by 75% by
infections infections
new HIV HIV new
Reduce Reduce
Objective KASF KASF
72
NASCO
NACC
CSOs
Partners
Health
of
Department Department
County
bility
- Responsi
744,054
scents-
Adole-
KPs -6 ,298 ,298 -6 KPs
1,574,394 1,574,394
lation-
Popu-
General General
mulative)
- cu Target
End-Term End-Term
372,027
scents-
Adole-
-3,149 -3,149
KPs KPs
787,197 787,197
lation: lation:
Popu-
General General
Target
Term Term
Mid-
2014
KDHS KDHS
Source
line and and line
- Base
services
treatment treatment
care and and care
clients for for clients
positive positive
to HIV HIV to
offered offered
linkages linkages
No. of of No.
tors
- Indica
workers on PEP on workers
Train healthcare healthcare Train
ARVs
Provision of of Provision
services
evaluate PWP PWP evaluate
Monitor and and Monitor
materials materials
Provide PWP IEC IEC PWP Provide
on clinical PWP clinical on
health workers workers health
building of of building
Capacity Capacity
CPWP
educators on on educators
Train peer peer Train
groups
PLHIV support support PLHIV
formation of of formation
Support Support
VMMC
facilities offering offering facilities
Scale up up Scale
services
in routine routine in
VMMC services services VMMC
Integration of of Integration
and equipment and
VMMC supplies supplies VMMC
Procurement of of Procurement
VMMC
workers in in workers
healthcare healthcare
building of of building
Capacity Capacity
population
and general general and
to the KPs KPs the to
campaigns campaigns
promotion promotion
condom condom
Carry out out Carry
Sub-Activity/Intervention
services
of VMMC VMMC of
Provision Provision
hylaxis
Prop-
6. Post Exposure Exposure Post 6.
Prevention (PHDP) Prevention
Dignity and and Dignity
5. Positive Health Health Positive 5.
Circum-cision
Medical Male Male Medical
4. Voluntary Voluntary 4.
Key Activity Key
75%
adults by by adults
among among
infections infections
new HIV HIV new
annual annual
1. Reduced Reduced 1.
Results
CASP CASP
by 75% by
infections infections
new HIV HIV new
Reduce Reduce
Objective KASF KASF
73 Responsi - bility County Department of Health Partners CSOs NACC NASCO End-Term End-Term cu - Target mulative) General General Popu- lation- 1,574,394 -6 ,298 KPs Adole- scents- 744,054 Mid- Term Target General General Popu- lation: 787,197 KPs -3,149 Adole- scents- 372,027 Base - line and Source KDHS 2014 - Indica tors No. of linkages offered HIV to positive clients for and care treatment services Scale up PEP Scale in all services facilities Sensitize the on community PEP of post Provision services rape SGBV Establish centres recovery Avail PEP drugs Avail and logistics Ensure Ensure of availability in all blood safe major facilities donor Introduce of notification at HIV results collection blood points Implement quality in assurance injection safety HIV eliminate to transmission in healthcare settings Train healthcare healthcare Train in STI workers management of STI Provision commodities youth Establish centres friendly Carry out condom promotion campaigns the KPs to and general population Carry out donor blood campaigns adults targeting Carry out public on education STI prevention and control KPs targeting and vulnerable groups Sub-Activity/Intervention Provision Provision of VMMC services Screening Screening of all blood donated Screening and Screening treatment of STIs 6. Post Exposure Exposure 6. Post Prop-hylaxis 7.Blood safety 7.Blood Key Activity Key 8.STIprevention 8.STIprevention and treatment CASP CASP Results 1. Reduced 1. Reduced annual HIV new infections among adults by 75% KASF Objective Reduce HIV new infections by 75%
74
NASCO
NACC
CSOs
Partners
Health
of
Department Department
County
bility
- Responsi
744,054
scents-
Adole-
KPs -6 ,298 ,298 -6 KPs
1,574,394 1,574,394
lation-
Popu-
General General
mulative)
- cu Target
End-Term End-Term
372,027
scents-
Adole-
-3,149 -3,149
KPs KPs
787,197 787,197
lation: lation:
Popu-
General General
Target
Term Term
Mid-
2014
KDHS KDHS
Source
line and and line
- Base
services
treatment treatment
care and and care
clients for for clients
positive positive
to HIV HIV to
offered offered
linkages linkages
No. of of No.
tors
- Indica
eMTCT services eMTCT
Provision of of Provision
MNCH services MNCH
eMTCT with with eMTCT
Integrate Integrate
eMTCT
community community
Train CHVs on on CHVs Train
eMTCT
Train staff on on staff Train
settings
in all healthcare healthcare all in
infrastructure infrastructure
equipment and and equipment
appropriate IPC IPC appropriate
accessibility of of accessibility
of and and of
availability availability
Improve Improve
health system health
all levels of the the of levels all
medical waste at at waste medical
disposal of of disposal
Improve Improve
and guidelines and
workplace policy policy workplace
Domesticate HIV HIV Domesticate
discrimination
stigma and and stigma
workplace HIV HIV workplace
Address Address
ACUs
establish vibrant vibrant establish
departments departments
Busia County County Busia
Ensure all all Ensure
population
and general general and
to the KPs KPs the to
campaigns campaigns
promotion promotion
condom condom
Carry out out Carry
Sub-Activity/Intervention
of STIs of
treatment treatment
Screening and and Screening
HIV
transmission of of transmission
mother-to-child mother-to-child
11. Elimination of of Elimination 11.
management
waste and IPC IPC and waste
10. Medical Medical 10.
HIVprevention
9. Workplace Workplace 9.
and treatment and
8.STIprevention 8.STIprevention
Key Activity Key
75%
adults by by adults
among among
infections infections
new HIV HIV new
annual annual
1. Reduced Reduced 1.
Results
CASP CASP
by 75% by
infections infections
new HIV HIV new
Reduce Reduce
Objective KASF KASF
75 Responsi - bility County Department of Health Partners CSOs NACC NASCO End-Term End-Term cu - Target mulative) General General Popu- lation- 1,574,394 -6 ,298 KPs Adole- scents- 744,054 Mid- Term Target General General Popu- lation: 787,197 KPs -3,149 Adole- scents- 372,027 Base - line and Source KDHS 201 - Indica tors No. of linkages offered HIV to positive clients for and care treatment services Scale up EID Scale in all services health facilities Carry out cancer cervical screening male Enhance in involvement eMTCT Train and station and station Train mothers mentor in all facilities Carry out condom promotion campaigns the KPs to and general population Sub-Activity/Intervention Screening and Screening treatment of STIs 11. Elimination of mother-to-child of transmission HIV Key Activity Key CASP CASP Results 1. Reduced 1. Reduced annual HIV new infections among adults by 75% KASF Objective Reduce HIV new infections by 75%
76 Responsi - bility Department of Health and Sanitation, Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 300 300 2 Mid-Term Mid-Term Target 200 200 2 Base - line and Source KDHS Indicators No. of capacity No. of capacity - building work shops conducted No. of partici - pants trained No. of treatment materials literacy available No. of capacity No. of capacity - building work shops conducted No. of partici - pants trained No. of defaulter No. of defaulter tools tracking enhanced Structural Continuous - improve ly patient management and system infrastructure Enhancement Enhancement of defaulter tracking and tools mechanisms Behavioural Incorporate Incorporate HIV prevention and mitigation in community health strategy( CHVs) Sub-Activity/Intervention Biomedical Treatment literacy literacy Treatment that is age and population specific and appropriate Key Activity Key General ART General care STRATEGIC DIRECTION 2: IMPROVING HEALTH OUTCOMES AND WELLNESS OF ALL PLHIV AND WELLNESS OUTCOMES HEALTH 2: IMPROVING DIRECTION STRATEGIC CASP Re - CASP sults 1. 90% in increase linkage to within 3 care months after HIV diagnosis KASF Objective Reduce AIDS Reduce mortality related by 25%
77 Responsi - bility Department of Health and Sanitation MoEST Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation, Development partners Implementing partners End- Term Target cumu - lative) 1 80 21 1 Mid-Term Mid-Term Target 1 50 15 1 Base - line and Source KDHS Indicators No. of meetings conducted No. of linkage strategies developed No. of peer support and networks established No. of peer support and networks strengthened No. of gaps identified and addressed No. of health educations conducted No. of participants attending Strengthen Strengthen and facility community linkages with and inter- intra-facility referral protocols and linkage strategies Ensure the Ensure identified gaps in HIV prevention and treatment are cascade addressed immediately Incorporate Incorporate HIV prevention and mitigation in community health strategy( CHVs Strengthen Strengthen peer support and networks of adolescents living with HIV HIV related HIV related health education of parents, or guardians other care such as givers teachers Sub-Activity/Intervention Treatment literacy literacy Treatment that is age and population specific and appropriate Key Activity Key General ART General care Reduce Reduce AIDS related by mortality 25% CASP Re - CASP sults KASF Objective AIDS Reduce mortality related by 25%
78 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation MoEST De - partment of Youth Development partners Implementing partners End- Term Target cumu - lative) 80 600 Mid-Term Mid-Term Target 60 400 Base - line and Source KDHS Indicators No. of capacity No. of capacity building workshops conducted No. of trainings No. of trainings for conducted health care workers educators Peer in and teachers APOC No. of healthcare trained workers in APOC No. of peer trained educators in APOC No. of teachers in APOC trained Integrate HIV Integrate care testing, and treatment into services maternal, and neonatal child health settings and services (MNCH model of care) Scale up Scale integrated friendly youth services including health training peer workers, and educators in teachers the APOC Incorporate Incorporate HIV prevention and mitigation in community health strategy( CHVs Sub-Activity/Intervention Treatment literacy literacy Treatment that is age and population specific and appropriate Key Activity Key General ART General care Reduce Reduce AIDS related by mortality 25% CASP Re - CASP sults KASF Objective AIDS Reduce mortality related by 25%
79 Responsi - bility Department of Health and Sanitation Department of Youth Development partners Implementing partners Department of Health and Sanitation Department of Youth Development partners Implementing partners Department of health and sanitation, Fisheries department, De - NACADA, and velopment implementing partners End- Term Target cumu - lative) 10 300 6 Mid-Term Mid-Term Target 5 200 2 Base - line and Source KDHS Indicators No. of social media platforms and created being used No. of youth care accessing social through media No. of peer educators reached No. of peer educators in care retained No. of services No. of services in DICE offered No. of DICEs established Scale up Scale integrated friendly youth services including health training peer workers, and educators in teachers the APOC Integrate Integrate services care in drop-in centres including the fishing communities the along beaches Utilize youth Utilize youth friendly technology, social media education, for recruitment and retention e.g. in care WhatsApp groups, Facebook groups closed Utilize peer peer to mobilization enrolment for in and retention and extend care timings flexible care for Sub-Activity/Intervention Treatment literacy literacy Treatment that is age and population specific and appropriate Key Activity Key General ART General care Reduce Reduce AIDS related by mortality 25% CASP Re - CASP sults KASF Objective AIDS Reduce mortality related by 25%
80 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 300 300 80 Mid-Term Mid-Term Target 200 200 60 Base - line and Source KDHS Indicators No. of alcohol No. of alcohol and drug dependence outreaches conducted No. of trainings No. of trainings conducted No. of healthcare workers attending No. of screening No. of screening and diagnostic equipments procured No. of dispensaries with provided and screening diagnostic equipment Integrate Integrate alcohol and drug dependence reduction in strategies service care Decentralize Decentralize availability of screening and diagnostic equipment HIV, TB, for nutrition, other opportunistic by infections the expanding to services dispensaries Utilize peer peer to mobilization enrolment for in and retention and extend care timings flexible care for Sub-Activity/Intervention Treatment literacy literacy Treatment that is age and population specific and appropriate Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key General ART General care 2. General ART 2. General Care Reduce Reduce AIDS related by mortality 25% CASP Re - CASP sults Increase ART Increase to coverage and 90% care treatment and reduce in the loss the cascade of care KASF Objective AIDS Reduce mortality related by 25%
81 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 80 1 80 Mid-Term Mid-Term Target 60 1 60 Base - line and Source KDHS Indicators No. of preventions activities conducted No. of communities with the reached interventions No. of hotlines set up No. of PLHIV on accessing transit services No. of campaigns conducted No. of participants through reached the campaigns Scale-up Scale-up prevention interventions TB, OIs for and other co- morbidities, and water sanitation related diseases, vaccinations for preventable diseases Set up a hotline for PLHIV in who transit need services of a clinician of or refill and ARVs other related drugs Utilize peer peer to mobilization enrolment for in and retention and extend care timings flexible care for Carry out campaigns on the value of disclosure in improving treatment outcomes Sub-Activity/Intervention Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key General ART General care 2.Pre-ART 2.Pre-ART services Increase ART Increase to coverage and 90% care treatment and reduce in the loss the cascade of care CASP Re - CASP sults KASF Objective AIDS Reduce mortality related by 25%
82 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 80 500 10 Mid-Term Mid-Term Target 60 300 5 Base - line and Source KDHS Indicators No. of PLHIV care accessing at and treatment the community level No. of CSOs and communities used No. of PLHIV reached No. of social media platforms and created being used No. of youth care accessing social through media
Integrate and Integrate decentralize HIV service delivery models and increase care to access and treatment at the community level Utilize peer peer to mobilization enrolment for in and retention and extend care timings flexible care for Utilize the Civil Society and communities, especially PLHIV to enhance treatment patient literacy, empowerment, psychosocial and adherence support and disclosure Utilize youth Utilize youth friendly and technology social media facilitate to and retention e.g. adherence WhatsApp, Facebook Sub-Activity/Intervention Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key General ART General care Increase ART Increase to coverage and 90% care treatment and reduce in the loss the cascade of care CASP Re - CASP sults KASF Objective AIDS Reduce mortality related by 25%
83 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 1200 21 300 6 Mid-Term Mid-Term Target 800 15 200 3 Base - line and Source KDHS Indicators No. of trainings No. of trainings conducted No. of caregivers empowered No. of PSSG for for No. of PSSG adolescents No. of trainings No. of trainings conducted No. of teachers trained No. of school going children/ reached students No. of drop No. of drop in centres established/ up scaled No. of peer trained educators No. of peers through reached peer education Empower care care Empower with givers HIV education and treatment literacy Integrate Integrate and HIV care into treatment friendly youth services Education Education sector programs HIV and for treatment literacy, adherence and retention should be ups scaled Utilize youth Utilize youth friendly and technology social media facilitate to and retention e.g. adherence WhatsApp, Facebook Scale up key up key Scale population HIV friendly and care treatment services peer through mobilization and support Sub-Activity/Intervention Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key General ART General care Increase ART Increase to coverage and 90% care treatment and reduce in the loss the cascade of care CASP Re - CASP sults KASF Objective AIDS Reduce mortality related by 25%
84 Responsi - bility Department of Health and Sanitation Development partners Implementing partners IGAD Department of Health and Sanitation Development partners Implementing partners IGAD Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 1 1 1 Mid-Term Mid-Term Target 1 1 1 Base - line and Source KDHS Indicators No. of meetings conducted No. of protocols harmonized No. of set committees up - Advocate Advocate the for harmonization of HIV treatment with protocols neighbouring countries Set up a border cross committee coordinate to cutting cross components of HIV and TB services Scale up key up key Scale population HIV friendly and care treatment services peer through mobilization and support Institute Institute strategies eliminate to that practices barriers create service to provision migrant to populations or from foreigners neighbouring countries Sub-Activity/Intervention Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key General ART General care Increase ART Increase to coverage and 90% care treatment and reduce in the loss the cascade of care CASP Re - CASP sults KASF Objective AIDS Reduce mortality related by 25%
85 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 300 80 300 30 Mid-Term Mid-Term Target 200 60 200 20 Base - line and Source KDHS Indicators No. of sensitization meetings conducted No. of service providers reached No. of nutritional support provided 30 EMR sites No. of capacity No. of capacity buildings conducted No. of service providers reached No. of EMR sites No. of EMR sites established Set up a border cross committee coordinate to cutting cross components of HIV and TB services Build the capacity of service providers monitor to quality of care and utilize data care decision for making Continuous quality improvement initiatives use through of electronic medical records systems Sensitize service to providers HIV reduce and stigma discrimination increase to care to access and treatment Support for Support for nutritional management BMI ≤ with low 18.5 Sub-Activity/Intervention Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key General ART General care Improve quality Improve and of care monitoring treatment outcomes Increase ART Increase to coverage and 90% care treatment and reduce in the loss the cascade of care CASP Re - CASP sults KASF Objective AIDS Reduce mortality related by 25% 3. Improve quality 3. Improve and of care health outcomes
86 Responsi- bility
Department of Health and Sanitation
Development partners
Implementing partners
Department of Health and Sanitation
Development partners
Implementing partners
Department of Health and Sanitation
Development partners
Implementing partners
Department of Health and Sanitation
Development partners
Implementing partners
End- Term Term Target Target cumu- lative) 1
80
80
300
Mid-Term Mid-Term Target
1
60
60
200
Base- line and Source
KDHS
Indicators
No. of EMR sites established
No. of HIV commodities procured
No. of service delivery sites
No. of quality assurance conducted
No. of technical working groups created
Utilize cohort analysis analysis to monitor patient outcomes and by extension quality of care
Ensure Ensure continuous availability of HIV commodities at the point of service delivery
Carry out periodic quality assurance activities such as Site Improvement assessments and data quality audits Strengthen mentorship and clinical technical working groups groups to monitor quality
Support for nutritional management with BMI low ≤ 18.5
Sub-Activity/Intervention
Cascade integrated HIV trainings for afor skilled and competent workforce competent workforce through through innovative methods and technologies
Key Activity
Improve qualityImprove of care and of care monitoring treatment outcomes
CASP Re- sults
Increase ART coverage to coverage 90% and care treatment and reduce and reduce the in loss the cascade of care
KASF Objective
3. Improve quality3. Improve of care andof care health outcomes
87 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 1 1 300 30 Mid-Term Mid-Term Target 1 1 200 20 Base - line and Source KDHS Indicators No. of hotline set up services No. of policies created No. of laboratory No. of laboratory trained staff No. of health facilities networked No. of systems No. of systems put in place Set up a hotline for service to providers on consult challenging cases clinical Create a policy Create environment that will enable support of PLHV patients who need cancer and treatment OIs Strengthen Strengthen laboratory networking TB/ HIV for diagnosis and treatment monitoring Put in place Put in place systems assure to quality and for monitoring adherence laboratory to protocols Support for Support for nutritional management BMI ≤ with low 18.5 Sub-Activity/Intervention Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key Improve quality Improve and of care monitoring treatment outcomes Improve Improve laboratory capacity ncrease ART ncrease to coverage and 90% care treatment and reduce in the loss the cascade of care CASP Re - CASP sults KASF Objective quality 3. Improve and of care health outcomes
88 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 80 30 44,326 Mid-Term Mid-Term Target 60 20 30000 Base - line and Source KDHS Indicators No. of service No. of service charters introduced No. of trainings No. of trainings conducted No. of mentor mothers the attending training No. of PLHIV through reached mothers mentor No. of PHDP outreaches conducted No. of PHDP trainings conducted No. of PLHIV on PHDP trained No. of PLHIV reached Put in place Put in place mechanisms reduce to turn-around time for and results feedback Promote Promote PHDP Support for Support for nutritional management BMI ≤ with low 18.5 Scale up use Scale of PLHIV peer support such strategies as mentor mothers Sub-Activity/Intervention Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key 11. Elimination of mother- to-child transmission of HIV Increase Increase community based adherence support Increase ART Increase to coverage and 90% care treatment and reduce in the loss the cascade of care CASP Re - CASP sults KASF Objective quality 3. Improve and of care health outcomes
89 Responsi - bility Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners Department of Health and Sanitation Development partners Implementing partners End- Term Target cumu - lative) 30 2 300 Mid-Term Mid-Term Target 20 1 200 Base - line and Source KDHS Indicators No. of care No. of care trained givers No. of households visited No. of web No. of web based and mobile technology launched up No. of follow made No. of outreaches conducted No. of participants attending Scale up Scale home and community based model HIV for of care patients Use innovative Use innovative and mobile web-based technology increase to adherence up and follow options Promote Promote age and population specific treatment in education community and facility based settings Scale up use Scale of PLHIV peer support such strategies as mentor mothers Sub-Activity/Intervention Cascade integrated integrated Cascade HIV trainings and a skilled for workforce competent innovative through methods and technologies Key Activity Key Increase Increase community based adherence support Increase ART Increase to coverage and 90% care treatment and reduce in the loss the cascade of care CASP Re - CASP sults KASF Objective barriers Remove of HIV, access to SRH and rights information to in and services and public private entities
90 County Director County Director of Health and Sanitation County Government AMPATH-PLUS APHIA-PLUS FHI Red Cross Kenya IOM LVCT Other partners of County Director Health Department of Health and Sanitation Development partners Implementing partners Responsibility 600 Centers established TBD 1,828,949 600 Centers established End-Term End-Term Targets 3000 Peer educators trained TBD 914,475 TBD Mid- Term Targets Baseline & Source 300 TBD TBD TBD TBD TBD TBD TBD Indicators Sub-Activity/ Number of health sensitized on workers in reduction stigma setting. health care Number of IEC materials and on SRH developed in all the 7 distributed sub counties. Number of GBV for centers recovery victims violence sexual established Number of Peer Number of Peer among KPs educators enhance to trained of Services uptake PLHIV, KPS AND OTHER PRIORITY GROUPS PLHIV, KPS AND OTHER Key Activity Key Remove barriers barriers Remove of HIV, access to SRH and rights and information in public services entities and private CASP Results CASP Remove Remove to barriers of HIV, access SRH and rights information to and services and in private public entities STRATEGIC DIRECTION 3: USING A HUMAN RIGHTS BASED APPROACH TO FACILITATE ACCESS TO SERVICES FOR SERVICES FOR TO ACCESS FACILITATE TO 3: USING A HUMAN RIGHTS BASED APPROACH DIRECTION STRATEGIC KASF Objective An enabling and policy legal environmentne a robust for cessary at HIV response thenational and to levels county access ensure by toservices living with persons HIV
91 MoEST Red Cross Kenya FBOs Social Service Sector Social Service Sector Responsibility 1200 School boards trained SGBV TBD TBD TBD TBD End-Term End-Term Targets 600 school boards on trained SGBV TBD TBD TBD TBD Mid- Term Targets Baseline & Source TBD TBD TBD TBD 100 school management boards TBD TBD TBD TBD a) Number of school management boards ,sensitized on SGBV b) Number of teachers sensitized on SGBV c) Number of pupils sensitized on SGBV Indicators Sub-Activity/ Mentor health club Mentor in schools on patrons handling adolescents living with HIV Sensitize school management boards, pupils, teachers, and other students school fraternity and on stigma discrimination reduction into OVC eligible Enrol the social protection and provide progammes HIV services structural Implement that interventions vulnerable empower populations especially women Sensitize school management boards, and students teachers, pupils on SGBV Key Activity Key Remove barriers barriers Remove of HIV, access to SRH and rights and information in public services entities and private Remove Remove to barriers of HIV, access SRH and rights information to and services and in private public entities CASP Results CASP KASF Objective barriers Remove of HIV, access to SRH and rights to and information in private services and public entities
92 MoEST Red Cross Kenya FBOs Responsibility TBD TBD TBD TBD TBD TBD TBD TBD End-Term End-Term Targets TBD TBD TBD TBD TBD TBD TBD TBD Mid- Term Targets Baseline & Source TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD Indicators Sub-Activity/ Recommend and Recommend emphasize confirmation healing claims of faith tests. scientific through acceptance Promote as part of the of KPs increased for community uptake service male Enhance in HIV, involvement and reproductive sexual health programmes them and also offer services community Develop and forums, groups and utilize persons to living positively against campaign and stigma HIV-related discrimination Sensitize communities rights issues, on legal and gender Sensitize the community on harmful gender norms, negative and concept stereotypes of masculinity campaigns Facilitate and stigma reduce to discrimination, reduce and gender violence of HIV uptake promote and preventive services interventions Integrate HIV Integrate and information service encourage in religious uptake teachings Key Activity Key Remove barriers barriers Remove of HIV, access to SRH and rights and information in public services entities and private Remove Remove to barriers of HIV, access SRH and rights information to and services and in private public entities CASP Results CASP KASF Objective barriers Remove of HIV, access to SRH and rights to and information in private services and public entities
93 County Director of County Director Health Services of the Office Governor CECs of the Office Speaker CSOs Key of the Office Governor CECs, of the Office Speaker Responsibility TBD 200 End-Term End-Term Targets TBD 100 Mid- Term Targets Baseline & Source TBD Number of healthcare workers sensitized on rights their own , attitudes and necessary tools ensure to patient /client rights are upheld Number of law and policy makers sensitized on the need to enact laws ,regulations and policies that prohibit discrimination and support HIV to access prevention, care treatment, and support. Indicators Sub-Activity/ Sensitize healthcare Sensitize healthcare on their own workers, rights, attitudes and to necessary tools patient/client ensure upheld rights are Sensitize law and policy on the need to makers enact laws, regulations and policies that prohibit discrimination and HIV to support access treatment, prevention, and support. care laws and existing Review they ensure policies to on the impact positively HIV response Key Activity Key and legal Improve policy environment protection for of PLHIV, and other KPs priority groups including women, girls adolescents, and boys Remove Remove to barriers of HIV, access SRH and rights information to and services and in private public entities CASP Results CASP KASF Objective barriers Remove of HIV, access to SRH and rights to and information in private services and public entities
94 Office of the Office Governor CECs, of the Office Speaker Responsibility 200 TBD TBD 500 500 End-Term End-Term Targets 100 TBD TBD 250 250 Mid- Term Targets Baseline & Source TBD TBD TBD TBD TBD Number of programs to supported implement upholding the rights of priority populations . Number of literacy legal programs that supported, PLHIV or teach those affected about human rights . Number of law and law makers enforcement agencies sensitized on HIV consequences of enactment of laws on the of provision to HIV services priority groups. Indicators Sub-Activity/ Facilitate discussion discussion Facilitate and negotiation among those who providers, the service access and law enforcement law address agencies to practices enforcement that impede HIV treatment, prevention, and support care Hold the County Governmentaccountable their constitutional to obligations and statutory programmes Implement that uphold the rights of priority populations to access Facilitate of rights in cases justice violation literacy legal Undertake teach to programmes living with those who are by HIV about or affected human rights and the HIV to laws relevant Sensitize law makers Sensitize law makers and law enforcement agencies on HIV and of the consequences enactment of laws in the of HIV services provision priority groups to Key Activity Key Improve legal and legal Improve policy environment protection for of PLHIV, and other KPs priority groups including women, girls adolescents, and boys Remove Remove to barriers of HIV, access SRH and rights information to and services and in private public entities CASP Results CASP KASF Objective Remove barriers barriers Remove of HIV, access to SRH and rights to and information in private services and public entities
95 ICC (HIV) ICC (HIV) ICC (HIV) ICC (HIV) CSOs Responsibility 500 End-Term End-Term Targets 250 Mid- Term Targets Baseline & Source TBD Conduct baseline survey document to the magnitude of and nature human rights violations in the of HIV context Number of baseline surveys supported documenting the magnitude and nature of gender disparities in of the context HIV Number of Programmes to supported implement activities reducing and stigma discrimination priority against populations. Number of HIV stigma surveys index conducted. Indicators Sub-Activity/ Conduct baseline document the to survey of magnitude and nature gender disparities in the of HIV context of Implementation aimed at programmes and stigma reducing discrimination against priority populations Conduct monitoring and Conduct monitoring stigma for evaluation and discrimination GBV Key Activity Key Conduct HIV index stigma including survey in health care settings and communities Remove Remove to barriers of HIV, access SRH and rights information to and services and in private public entities CASP Results CASP KASF Objective barriers Remove of HIV, access to SRH and rights to and information in private services and public entities
96 Department of Health and San - itation Development partners Implementing partners County Director County Director of Health County Director County Director and of Fealth Sanitation County Government AMPATH-PLUS APHIA-PLUS FHI Red Cross Kenya IOM LVCT Other partners Responsibility TBD 1,828,949 600 Health Workers trained End- Term Targets 1000 Peer 1000 Peer educators trained among KPs 200 GBV recovery centers established 914,475 Mid-Term Mid-Term Targets TBD 500 Peer 500 Peer educators trained among KPs TBD TBD 300 Health workers trained Baseline & Source 500 Peer edu - 500 Peer trained cators among KPs TBD TBD Number of health workers sensitized reduce to stigmatizing attitudes in health care settings Indicators Number of - peer educa trained tors enhance to of uptake services among KPs. Sub-Activity/ Number of GBV recovery Number of GBV recovery violence sexual for centers victims established. Number of population specific and user friendly HIV to related information and released. developed Sensitize health workers stigmatizing reduce to attitudes settings in healthcare Train peer educators peer educators Train enhance to among KPs of services. uptake Remove barriers to to barriers Remove of HIV, SRH access and rights information in public and services entities and private Key Activity Key CASP Results CASP 80% of the community community the 80% of with a key reached HIV message STRATEGIC DIRECTION 4: STRENGTHENING INTEGRATION OF COMMUNITY AND HEALTH SYSTEMS SYSTEMS AND HEALTH OF COMMUNITY INTEGRATION 4: STRENGTHENING DIRECTION STRATEGIC An enabling and policy legal environmentnecessary HIV a robust for at the response national and county access ensure to levels by persons toservices living with HIV KASF Objective
97 Responsibility - County Govern ment Department of Health and San - itation KEMRI Development Partners NACC NASCOP Universities 10 policy makers 10 policy makers and researchers the constituting research county team for Advocate 20% of health budget research HIV/TB for End Term End Term Target 500 people 500 people to targeted in participate implementation research 200 PLHIV in this involved research Advocate for for Advocate 10% of health budget research HIV/TB for Mid Term Mid Term Target 100 in PLHIV involved this research - 4 Studies conduct determine ed to the impact of the Gene Expert on HIV/TB treatment Baseline & Source 250 people 250 people to targeted in participate implementation research 2 Studies to conducted the determine impact of the Gene Expert on HIV/TB treatment Indicators Number of HIVresearch Number of HIVresearch strategies financing and developed aligned with disseminated health laws, the existing in policies and regulations the County Number of evaluations Number of evaluations on structural conducted e.g. cross- interventions population boarder HIV and TB, to adherence of TB integration service services. and eMTCT Number of Behavioural to supported Research social cultural determine factors and gender related of Care as determinants outcomes and Treatment HIV/TB to and adherence treatment. Number of studies determine to conducted the impact of Gene Expert on HIV/TB treatment outcomes. Number of County agenda HIV research and ,developed supported through disseminated process consultative Develop and align HIV Develop financing research with the strategy health existing laws, policies and in the regulations county Implementation of Implementation priorities research the Evaluate effectiveness of structural e.g. interventions, dealing interventions with cross-border population adherence HIV and TB, service to of TB and integration services eMTCT Behavioural priorities research determine like socio-behavioural, and gender- cultural as factors related of determinants & treatment care and outcomes HIV/TB to adherence treatment the impact Determine of the Gene Expert on HIV/TB treatment outcomes HIV county Develop agenda research a consultative through process Key Activity Key Resource the HIV Resource agenda in the County Reduce HIV Reduce and stigma related discrimination by 50% AIDS related Reduce by 25% mortality County HIV research agenda developed Increased evidence evidence Increased based planning , and programing policy changes by 50% CASP Results CASP STRATEGIC DIRECTION 5: STRENGTHENING RESEARCH, INNOVATION AND INFORMATION MANAGEMENT TO MEET BCASPGOALS MEET BCASPGOALS TO MANAGEMENT AND INFORMATION RESEARCH, INNOVATION 5: STRENGTHENING DIRECTION STRATEGIC KASF Objective Identification and Identification of implementation high impact research priorities, innovative and programming and capacity capability to strengthening research conduct
98 Responsibility - County Govern ment Department of Health and San - itation KEMRI Development Partners NACC NASCOP Universities End Term End Term Target Four quarterly quarterly Four paper reviews research of key local findings, sys - innovations, reviews tematic and developed disseminated. research Draft briefs biennially Mid Term Mid Term Target Four quarterly pa - quarterly Four of key per reviews findings, research - innova local tions, systematic developed reviews and disseminated Baseline & Source 2 Studies to conducted the determine impact of the Gene Expert on HIV/TB treatment Indicators Number of established HIV Number of established Busia for portal information County Number of Systemic Number of Systemic of Reviews Research on the BCASP research priorities published and disseminated. Establish HIV Establish for portal information Busia County Key Activity Key Publish systematic Publish systematic on of research reviews priorities the BCASP research and draft briefs biennially Establish evidence- Establish based planning, and programming policy development CASP Results CASP KASF Objective and Identification of implementation high impact research priorities, innovative and programming and capacity capability to strengthening research conduct
99 County HIV ICC County HIV ICC County HIV ICC, NACC Department of Health and Sanitation County HIV ICC Responsi - bility 1 400 1 2 8 M&E Capacity - Assess ments 2 End Term Target 1 200 1 1 4 M&E Capacity Assessments 1 Mid Term Mid Term Target 400 400 1 0 Baseline & Source 0 Indicators Number of sustainable Number of sustainable financing mechanisms activities HIV related for in the put in place County. Number of Comprehensive HIV M&E system guidelines, tools, and standard procedures operating and developed,printed disseminated. Number of M&E Capacity assessment and Capacity done in development the County Number of functional HIV multi- sectoral M&E Coordination and structure partnerships in the strengthened County No. of Busia County M&E engagement conducted No. ofCounty HIV M&E new aligned to System structure governance Put in place Put in place financing sustainable HIV M&E planned for activities Develop, print Develop, & disseminate comprehensive HIV M&E systems and guidelines, tools operating standard procedures Conduct M&E assessment capacity and capacity at the development county functional Strengthen HIV multi-sectoral M&E co-ordination and structure at the partnerships county Conduct National and M&E Busia county engagements Align the Busia county Align the Busia county the to M&E system governance new structure PROGRAMMING Strengthening M&E Strengthening effectively to capacity the BCASP track and HIV performance epidemics at Busia county Key Activity Key Planned evaluations, Planned evaluations, and surveys reviews and implemented disseminated timely results Increased availability availability Increased of strategic inform to information in Busia HIV response County CASP Results CASP STRATEGIC DIRECTION 6: PROMOTE UTILIZATION OF STRATEGIC INFORMATION FOR RESEARCH, MONITORING AND EVALUATION TO ENHANCE TO AND EVALUATION RESEARCH, MONITORING FOR INFORMATION OF STRATEGIC UTILIZATION 6: PROMOTE DIRECTION STRATEGIC To improve data data improve To demand, quality, and use of data access decision making for at the County and National levels KASF Objective
100 - County Gov ernment and Partners County HIV ICC, NACC Department of Health and Sanitation County HIV ICC County HIV ICC Moni - BCASP Unit toring Responsi - bility 400 400 400 1 End Term Target 200 200 200 1 Mid Term Mid Term Target Baseline & Source 400 Indicators Number of County activities that supported harmonization facilitate and linkages between tools collection data and database Number of Periodic quality audits and data conducted verifications within the county. Number of M&E Supervisions conducted Number of activities ,facilitating conducted up Coverage the scaling of ongoing HIV Surveillance programs and Surveys. Number of activities the done that facilitates HIV national and global obligations. reporting Number of activities that enhance conducted routine strengthened HIV and non routine in systems information the county. Number of multi- l HIV sectoral programming data web-based management systems established Number of activities towards geared HIV M&E Strengthened management data by Busia supported County Government Harmonize and create Harmonize and create data linkages between and tools collection databases Conduct periodic data quality audits and verification Conduct M&E supervision up coverage Scale of ongoing HIV programme and surveillance surveys national Honor global, HIV and county obligations reporting routine Strengthen HIV and non-routine systems information a multi- Establish HIV sectoral programming data web-based management system Strengthen HIV M&E Strengthen management in data Busia County Establish multi- Establish and sectoral real-time integrated Ensure harmonized, Ensure and timely routine comprehensive and non–routine systems monitoring quality HIV provide to in Busia County data Key Activity Key Established M&E Established hubs information at the County that provide level comprehensive package information BCASP on key decision for indicators making Planned evaluations, Planned evaluations, and surveys reviews and implemented disseminated timely results CASP Results CASP KASF Objective data improve To demand, quality, and use of data access decision making for at the County and National levels
101 County HIV ICC Moni - BCASP Unit toring County HIV ICC CHMT County As - Health sembly Committee Moni - BCASP Unit toring CHRIO NACC County HIV ICC Responsi - bility 1 1 1 1 End Term Target 1 1 1 1 Mid Term Mid Term Target Baseline & Source 400 Indicators Number of BCASP Number of BCASP agenda Evaluation and developed disseminated. Number of M&E hubs Information and created . strengthened Number of activities Data that facilitate Demand and Use of HIV in information strategic decision making. Develop and Develop BCASP implement agenda evaluation and strengthen Create M&E information evel hubs at county Align the Busia County M&E system Ones the ‘Three to Principle’ Promote data demand data Promote and use of HIV information strategic policy and inform to programming HIV platform to to HIV platform HIV on updates provide epidemic response accountability Key Activity Key Established M&E Established hubs information at the County that provide level comprehensive package information BCASP on key decision for indicators making CASP Results CASP KASF Objective data improve To demand, quality, and use of data access decision making for at the County and National levels
102 County Government County Government Partners CEC County Government Partners CEC County Government Partners CEC County Assembly County Assembly office Governor’s County HIV ICC County Assembly office Governor’s County HIV ICC County assembly office Governor’s County HIV ICC Responsibility County Domestic Financing Bill policy developed - and imple mented 3 Reviews done 1 1 100% of all County departments funding HIV 500 CSOs funded by County on HIV related activities End Term End Term Target 1 Review done 1 Review 1 County Domestic Financing Bill in place Mid Term Mid Term Target 1 60% 250 CSOs funded by County on HIV related activities Indicators Number of reviews done on Number of reviews HIV spending by the county Number of HIV investment Units set up with a clear management structure within MOH Amount of funds generated Amount of funds generated financing domestic through Evidence of an established of an established Evidence HIV. fund for trust Percentage of County Percentage Department Government sum of ensuring 2% of total is set award they contracts fund HIV activities. aside to Number of engagement meetings held with County to Budget Committee of 1% allocation ensure government county total HIV. budget to Undertake periodic Undertake of the spending review plans Set up HIV unit with investment management a clear within MoH structure Establish a trust fund a trust Establish All contracts in the All contracts should include county a sum of 2% the HIV towards contract and AIDS program Engage the county budget committee consider to allocation budget 1% of county HIV as an added to for parameter in consideration allocation resource Promote innovative innovative Promote and sustainable HIV domestic financing options Ensure policy on Ensure County HIV financing is put in place Key Activity Key Increased domestic domestic Increased for HIV financing 50% to response CASP Results CASP STRATEGIC DIRECTION 7: INCREASING DOMESTIC FINANCING FOR SUSTAINABLE HIV RESPONSE SUSTAINABLE 7: INCREASING DOMESTIC FINANCING FOR DIRECTION STRATEGIC Increase domestic domestic Increase financing of the HIV 50% to response KASF Objective
103 Responsibility County Assembly County Assembly office Governor’s County HIV ICC County HIV ICC County Government County Government County HIV ICC 4 1 End Term End Term Target 4 1 4 4 1 Mid Term Mid Term Target 1 2 2 1 2 2 1 Indicators Number of annual county Number of annual county tracking expenditure done documenting surveys HIV spending Number of development Number of development successfully partners fund BCASP to lobbied Number of forums Number of forums targeting organized to partners development alignment with facilitate BCASP Number of stakeholder Number of stakeholder /mapping analysis conducted. Number of County need resource activities quantification done Number of partnership Number of partnership framework accountability ensure to implemented to alignment of resources BCASP Conduct annual expenditure county survey tracking Lobbying with the partners development fund BCASP to Organize Organize partners development facilitate to HIV forum alignment with BCASP Conduct a analysis/ stakeholder mapping Facilitate of quantification resource county needs through information relevant support on county Implement a Implement partnership accountability to framework alignment of ensure BCASP to resources priorities. Conduct annual meetings review feedback give to of development contribution partner’s BCASP towards implementation Promote innovative innovative Promote and sustainable HIV domestic financing options Key Activity Key Align HIV resources/ to investments plan strategic priorities Increased domestic domestic Increased for HIV financing 50% to response CASP Results CASP KASF Objective domestic Increase financing of the HIV 50% to response
104 Responsibility County HIV ICC office Governor’s County HIV ICC office Governor’s County HIV ICC office Governor’s County HIV ICC office Governor’s County HIV ICC office Governor’s End Target 4 4 1 1 1 Mid Target 2 2 1 1 1 Baseline and Source
Indicator Indicator
Number of reviews Number of reviews done on policies that accountability enhance of and good governance multi- for resources HIV response. sectoral Number of functional -agency Inter coordinating established committees of the monitoring for HIV response. Number of reviews Number of reviews done on HIV spending by the county Number of Capacity Building meetings done targeting development various on resource partners management and through accountability institutionalized support technical mechanisms Sub-Activity/In - tervention Develop/ policies Review that enhance and accountability of good governance multi- for resources HIV/AIDS sectoral response. Establish a HIV Establish inter-agency and coordinating other relevant for committees of the monitoring HIV response Develop and Develop systems implement good that strengthen of the governance HIV response Build capacity Build capacity of partners resource for management and accountability through institutionalized support technical mechanisms Advocate for for Advocate goodwill political arms of at the two government county and (executive legislature) Key Activity Key Provide policies Provide and strengthen governance systems Stakeholder Stakeholder accountability Build and sustain Build and sustain political high-level commitment CASP Results CASP STRATEGIC DIRECTION:8 PROMOTING ACCOUNTABLE LEADERSHIP FOR DELIVERY OF THE BCASP RESULTS BY ALL SECTORS AND ACTORS BY ALL SECTORS RESULTS DELIVERY OF THE BCASP LEADERSHIP FOR ACCOUNTABLE PROMOTING DIRECTION:8 STRATEGIC KASF Objective Promote good Promote governance by practices identifying, and developing nurturing effective and committed the HIV for leaders and AIDS response
105 County HIV ICC office Governor’s Responsibility County HIV ICC County HIV ICC office Governor’s County HIV ICC office Governor’s County HIV ICC office Governor’s County HIV ICC office Governor’s 4 End Target 4 4 4 4 2 Mid Target 40 Stake hold - 40 Stake trained ers 2 2 2 2 Baseline and Source 20 Stake hold - 20 Stake trained ers Indicator Indicator Number of partnership Number of partnership accountability accountability mechanisms developed and implemented and based on targets results.
Number of stake Number of stake through taken holders Capacity Building strong promote to institutions accountable that hold duty bearers the HIV for accountable response. Number of reviews Number of reviews done on reporting mechanisms capturing sector private the HIV to contribution response. Number of partners development on focusing HIV forums BCASP alignment to priorities. Number of meetings target facilitate held to setting and sector alignment. reporting Number of BCASP Number of BCASP committee monitoring and established oversee functioning to of progress the tracking results towards Build capacity of Build capacity to stakeholders strong promote accountable that institutions hold duty bearers the for accountable HIV response Sub-Activity/In - tervention Review reporting reporting Review mechanisms to private capture contribution sector the HIV response to Hold the development HIV partners on focusing forum BCASP alignment to priorities Facilitate target target Facilitate setting and align reporting sector against of results targets Develop and Develop a implement partnership accountability mechanism based and on targets results Establish a Establish monitoring BCASP to committee of tracking oversee towards progress results Stakeholder Stakeholder accountability Key Activity Key Private sector sector Private accountability Development Development partners accountability Multi-sectoral Multi-sectoral accountability Implementing Implementing partners accountability BCASP governance BCASP CASP Results CASP KASF Objective good Promote governance by practices identifying, and developing nurturing effective and committed the HIV for leaders and AIDS response
106 Annex 2:
Resources required for implementing BCASP (in USD Millions)
Strategic Specific BCASP % of resource 2014/15 2015/16 2016/17 2017/18 2018/19 Total Directions Intervention dedicated for Areas the strategy SD1 HIV prevention 25.00% 6.62 7.54 8.51 9.52 10.32 42.52
SD2 Treatment and care 54.00% 14.31 15.64 16.34 16.64 16.43 79.36
SD3 Social inclusion, 4.06% 1.08 1.40 1.74 2.11 2.51 8.83 human rights and gender SD4 Health systems 6.35% 1.68 1.52 1.25 1.12 0.59 6.16
Community systems 3.95% 1.05 0.94 0.77 0.70 0.36 3.82
SD7 & Leadership, gover- 3.94% 1.04 1.06 1.03 0.97 0.88 4.99 SD8 nance and resource allocation SD6 Monitoring and 1.84% 0.49 0.49 0.48 0.45 0.41 2.32 evaluation SD5 Research 0.49% 0.13 0.15 0.16 0.17 0.18 0.79
Supply chain man- 0.37% 0.10 0.11 0.12 0.13 0.14 0.60 agement Grand Total 100.00% 26.49 28.86 30.41 31.81 31.81 149.39
107 Annex 3: References& Operational Documents References 1. Busia County Health Strategic Plan 2014
2. Busia County Integrated Development Plan (2013- 2017)
3. HIV and AIDS Prevention and Control Act, 2006
4. KASF – Kenya AIDS Strategic Framework
5. KNBS (Kenya) 2008-2009 Kenya Demographic and Health Survey 2008-09 Preliminary report. Calverton, Maryland, KNBS, NACC, NASCOP, NPHLS, KMRI, ICF Macro September 2009
6. KNBS,(2009) Projections from Kenya 2009 Population and Housing Census, Nairobi:KNBS.
7. NACC (2014) EndTerm Review: Kenya National AIDS Strategic Plan 2009–2013.
8. NACC (2014) Establishing a Trust Fund to Ensure Sustainable Financing of HIV/AIDS in Kenya. NACC: Nairobi
9. NACC, NASCOP (2014) Kenya HIV Estimates Report. Nairobi, Kenya; 2014, Nairobi: NACC, NASCOP (NACC, NASCOP, 2014)
10. NACC, NASCOP, UNAIDS (2013) Kenya HIV Prevention Revolution Roadmap: Count Down to 2030, Nairobi, Kenya; 2014
11. NACC, UNAIDS (2014) Kenya HIV County Profiles, HIVand AIDS Responsein My County- My Responsibility. Nairobi, Kenya;2014
12. NACC; 2009. Kenya National AIDS Strategic Plan, 2009-2013-Delivering on universal access to services
13. NASCOP (2012). Guidelines for Prevention of Mother to Child Transmission (PMTCT) of HIV/AIDS in Kenya, 4th edition. (Update on current guidelines)
14. NASCOP (2013), Kenya AIDS Indicator Survey 2012. Nairobi: NASCOP (NASCOP,2009)
15. The Constitutionof Kenya, 2010
16. UNAIDS (2014) 90-90-90 An ambitious treatment target to help end the AIDS epidemic, UNAIDS Prevention Revolution Roadmap: Count Down to 2030, Nairobi, Kenya; 2014
11. NACC, UNAIDS (2014 )Kenya HIV County Profiles, HIV and AIDS Responsein My County- My Responsibility. Nairobi, Kenya; 2014
12. NACC; 2009. Kenya National AIDS Strategic Plan, 2009-2013-Delivering on universal access to services
13. NASCOP (2012). Guidelines for Prevention of Mother to Child Transmission (PMTCT) of HIV/AIDS in Kenya, 4th edition. (Update on current guidelines)
14. NASCOP (2013), Kenya AIDS Indicator Survey 2012. Nairobi: NASCOP (NASCOP,2009)
15. The Constitution of Kenya, 2010
16. UNAIDS (2014) 90-90-90 An ambitious treatment target to help end the AIDS epidemic, UNAIDS
108 Operational Documents 1. The Kenya HIV Prevention Roadmap 2. HIV program network 3. HIV estimates and County profiles 4. Kenya AIDs epidemic report 2012 5. Strategic Framework Towards Elimination of Mother to Child Transmission of HIV and Keeping Mothers Alive 2012-2015 6. A Strategic Framework for Engagement of the First Lady in HIV Control and Promotion of Maternal, Newborn and Child Health in Kenya 2013-2017 7. National Guidelines for HIV Testing and Counseling and Prevention with Positives 8. Guidelines on use of antiretroviral drugs in treating and preventing HIV, Rapid advice, 2014 9. Kenya Quality Model for Health 2009 10. Kenya HIV Quality Improvement Framework
Annex 4: List of Drafting and Technical Review Teams County Drafting Team
1. Steve G. Kathaka - NACC Regional HIV Coordinator (Team Leader) 2. Dr. Melsa Lutomia - County Director of Health 3. Dr. Festus Kigen - County AIDS and STI Coordinator 4. Wilfred Magoba - County HIV Coordinator 5. Dr. Allan Wafula - Deputy County Pharmacist 6. Nelson Andanje - County Health Promotion Officer 7. Napoleon Nyongesa – Sub-County HIV Coordinator, Teso North 8. Bruno Otsyula - Field Officer ADEO 9. Vicent Olouch - KENAPOTE 10. Bernard Bosire - County TB Coordinator
BCASP Technical Review Team
1. Elly Assurah - KEMRI-RCTP-SEARCH, Consultant 2. Steve G. Kathaka - NACC Regional HIV Coordinator 3. Bryan Okiya - NACC Program Officer, Strategy 4. Dr. Suzanne Waweru - Nairobi Hospital
109 110