Support for Provincial and District Health Teams in Kenya Lessons Learned and Promising Practices Dr Mark Hawken, Maputo, 11 August 2010

O UTLINE OF PRESENTATION Introduction to current ICAP program Transition strategy Accomplishments at provincial and district level Future plans

ICAP-Kenya supports facilities in Central, Nyanza and Eastern Provinces Central Province facilities supported under Track 1 funding

ICAP P ROGRAM Track 1 program began in April 2006 Support Care and Treatment in 51 (GOK) facilities and 46 PMTCT sites Capacity building of national, provincial and district teams has been main focus of program Support for clinical services including laboratory and pharmacy, adherence and psychosocial support, TB/HIV integration, pediatric care and early infant diagnosis, infrastructure improvement, human resources, linkages within and between facility and community and monitoring and evaluation Through sub agreements with the provincial office, DHMTs and some larger facilities

C UMULATIVE NUMBER ON ART IN CENTRAL PROVINCE

T RANSITION STRATEGY Support GOK to continue to implement HIV prevention, care and treatment services Phased transition to CHS for support of districts in Central Province over the next 18 months Formation of local NGO (Centre for Health Solutions) Capacity building of GOK at national, provincial and district levels level Support for Continuous Quality Improvement Continued HSS activities Technical assistance to GoK structures

P ROVINCIAL LEVEL SUPPORT Quarterly meetings/updates with the PHMT Joint planning for training and implementation Support the employment of additional HCW Support for 6 roving accountants to support facility administrators and accountant Innovative support through:  roving health records officers to support the facility HRIO with record keeping and reporting  roving IT Specialist Supervision of the DHMT

DISTRICT LEVEL SUPPORT Annual planning of ART scale-up: identification of sites for scale-up Training HCW identified by the DHMT on HIV services Joint baseline site assessment Intensive on-site clinical mentorship Quarterly joint supportive supervision Support for funds management Training of District AIDS/ STI Coordinators on HIV management Training of DHRIO to support data management, data dissemination/data feedback to facilities, mentorship of facilities on data systems

C LINICAL SYSTEMS MENTORSHIP Currently ICAP program officers provide clinical mentorship to district and facility staff Residential mentorship established at one district hospital where HCW from lower-level facilities receive one week long practicum in the HIV clinic, led by hospital mentors Identifying district mentors – District RCO, DASCO and other specialists to train as TOTs and mentor HCW and continue mentorship through GoK supervision structures

Q UALITY OF CARE MONITORING ICAP has established a quality team led by quality assessment coordinator, collaborating with ICAP program and M&E officers and district DHMT (including RCO, DASCO and district HRIO) Team, identified as a District Quality of Care team, will move around facilities conducting standards of care (SOC) assessment with facility staff 6-monthly and developing strategies to improve areas of weakness

D ISTRICT SUPPORT FOR HMIS Support for training of DHRIO and HRIO – didactic and on- job mentorship Support for mentorship of HRIO using a structured mentorship tool, which includes a set list of tasks, skills and understanding of tools Support for installation of electronic data systems at over 10 facilities with follow-up mentorship of HRIOs Roving HRIOs providing mentorship to facilities in four districts Roving Data Entry Clerk computerizing patient level data at low volume facilities in four districts Data feedback to facility MDTs

CHALLENGES Human resource (recruitment, deployment, retention) Infrastructure limitations Dual MoH systems (MoPHS and MoMS) No permanent authority from central government for provincial medical office to receive external funds Limited sense of ownership at some facilities Weak linkages and integration of services Inability to maintain optimal burn rates due to management challenges

N EXT STEPS New NGO registered and due to start implementing in September 2010 to continue providing site support and continued capacity building to GOK partner in a phased approach in 4 districts initially Local NGO (Centre For Health Solutions) National technical support for technical working groups Technical support and supervisory role for CHS Continuing implementation in Eastern and Nyanza Provinces Continuing technical role for ICAP

A CKNOWLEDGEMENTS » NASCOP /MOH » PHMT, DMOH and MOH Hospitals » CDC » KEMRI » APHIA II » Clinton Foundation » JKUAT » Other NGOs » CBO