Kenya FY 2006 Country Operational Plan (COP)


KENYA

Project Title: Kenya FY 2006 Country Operational Plan (COP)

Budget Summary:

 
Field Programs Funding by Account
Central Programs Funding by Account
 
 
Notified as of May 2006
Current Notification August 2006
Current Notification August 2006
 
Implementing Agency

GAP

GHAI

Subtotal:
Field Programs Funding by Account

GHAI

GAP

New Subtotal: Field Programs Funding by Account

GHAI Central Programs

Total Dollars Allocated: Field & Central Funding

DOD

-

8,395,000

8,395,000

-

-

8,395,000

-

8,395,000

DOL

-

-

-

-

-

-

-

-

HHS

8,121,000

49,200,482

57,321,482

417,500

-

57,738,982

15,197,120

72,936,102

Peace Corps

-

677,582

677,582

-

-

677,582

-

677,582

State

-

967,550

967,550

-

-

967,550

-

967,550

USAID

-

116,021,886

116,021,886

270,000

-

116,291,886

9,001,759

125,293,645

TOTAL Approved

8,121,000

175,262,500

183,383,500

687,500

-

184,071,000

24,198,879

208,269,879

HIV/AIDS Epidemic in Kenya:

Adult HIV Prevalence Rate: 6.1% [5.2-7.0%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 1,300,000 [1,100,000-1,500,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 1,100,000 [890,000-1,300,000] (UNAIDS 2006)

Country Results and Projections to Achieve 2-7-10 Goals:

Kenya Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
End of FY 2004* 172,200 17,100
End of FY 2005** 397,000 44,700
End of FY 2006*** 348,340 69,500
End of FY 2007*** 571,000 112,000

*Results. "Engendering Bold Leadership: The President's Emergency Plan for AIDS Relief." First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005
**Results. "Action Today, a Foundation for Tomorrow: The President's Emergency Plan for AIDS Relief." Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February, 2006
***Projections from FY 2006 Country Operational Plan

Program Description:

Kenya has a severe generalized epidemic with an estimated adult HIV prevalence of 76.1% [5.2-7.0%] (UNAIDS 2006), translating into 1.3 million infected adults between the ages of 15 and 49. Another 100,000 adults over 50 and an equal number of children under 15 are also infected. While the rate of new infections has decreased, the relatively recent advent of treatment has not yet significantly affected mortality rates, and an estimated 150,000 Kenyans died of AIDS in 2004. Deaths to date have left 650,000 children orphaned by AIDS. The Kenyan epidemic varies significantly from region to region, with Nyanza Province in Western Kenyan affected by prevalence rates approximating those in some Southern Africa nations, and women are nearly twice as likely as men to be infected.

The vast majority of HIV transmission in Kenya occurs through heterosexual contact but certain populations require special prevention interventions. These include intravenous drug users, uniformed personnel, HIV-infected partners in discordant couples, men who have sex with men, long-distance transport workers, and male and female commercial sex workers. The Emergency Plan�s (EP) activities and funding is carefully and strategically targeted to the following interventions in support of country-level and global 2-7-10 targets.

Prevention: $ 41,051,832 as of August 2006 ($30,864,350 Field and $10,187,482 Central) (21.9% of prevention, care, and treatment budget)

The Emergency Plan prevention portfolio for Kenya includes medical and technical interventions to improve blood safety, reduce occupational exposure through safer medical injection, and to prevent of mother-to-child transmission (PMTCT). The longer-standing sexual transmission interventions include abstinence and be faithful programs (AB) and other prevention activities (OP).

FY 2006 funds of nearly $11M available for PMTCT will enable some 700 Emergency Plan-supported sites to provide HIV testing and counseling, including provision of test results, to over 540,000 pregnant women in 2006. Of those who are HIV-positive, 32,000 will receive a full course of prophylaxis to interrupt vertical transmission. In an increasing number of cases, more efficacious regimens including AZT will be utilized. Based on models for quantifying infections averted by implementing the four elements of PMTCT, the USG team anticipates that at least 6,400 fewer infants will be infected as a result of the EP�s interventions next year.

The six regional blood transfusion centers and four satellite centers are expected to collect 100,000 safe units of blood, catering for some two-thirds of national demand, in large part due to central FY 2006 funding that is supporting implementation. These efforts are building on early investments made after the tragic US Embassy bomb blast in 1998; U.S. Agency for International Development (USAID) and the Centers for Disease Control (CDC) have helped the Government of Kenya build a national blood transfusion system that � with more recent Emergency Plan investments � is a model for East Africa. Safe injection practices will be implemented in over 100 sites, 400 key staff will be trained in injection safety in priority districts, and the Government of Kenya (GOK) will continue to complement USG efforts with significant procurement of auto-disable syringes.

The more visible elements of the prevention portfolio involve efforts to interrupt sexual transmission. The USG team will also undertake two important new initiatives in Nyanza Province, which has the highest prevalence rate in the nation. With FY 2006 funds, the national OP program will train 18,000 people to reach 900,000 of their fellow Kenyans with important prevention information, and will undertake pilot projects in high-prevalence Nyanza Province. Abstinence and be faithful activities are carried out by 30 prime partners. FY 2006 funds will support interventions ranging from a continuation of the highly successful and extremely popular �Nime Chill� (�I�m chilling� or �I�m abstaining�) mass media campaign targeting young people countrywide to highly personalized �True Love Waits� and �I Choose Life� programs that directly reach individual young people with skills and messages to promote abstinence to prevent infection. Regular meetings of all AB partners will continue to assure that mass media and interpersonal interventions are coordinated and mutually reinforcing.

Also with FY 2006 funding, at least two AB efforts will incorporate evidence-based approaches for alcohol prevention into existing programs. The EP will work with the Ministry of Education, Science and Technology and our implementing partners to develop a teacher training syllabus on HIV and a standardized core training curriculum for community groups undertaking AB work. In both instances, USG will be sure that these new resources thoroughly and accurately reflect the ways in which alcohol (and other substance) misuse and abuse can increase risk of infection and how abstaining from substance use can reduce risks of infection.

In the May notification, an additional $1,400,000 was allocated for prevention activities. The additional funds will support significant strengthening of technical prevention interventions in blood and injection safety, supporting more than 10 additional sites involved in safe blood work, and a greater than 200% increase in the number of individuals trained in safe injection practices.

In August 2006, an additional $687,500 was allocated for prevention activities. These additional funds will expand existing activities to reach more women in need of PMTCT services and people who engage in high-risk activities.

Principal Partners: American Association of Blood Banks, Community Housing Foundation, John Snow, Inc., Academy for Educational Development, Adventist Development and Relief Agency, American International Health Alliance, Centre for British Teachers, Family Health International, Hope Worldwide, Impact Research and Development Organization, Institute of Tropical Medicine, International Rescue Committee, Kenya AIDS NGO Consortium, Kenya Medical Research Institute, Live With Hope Centre, Ministry of Education, Science and Technology- Kenya, National AIDS & STD Control Program, Population Council, Program for Appropriate Technology in Health, Salesian Mission, Samaritan's Purse, World Relief Corporation, World Vision Kenya, American Federation of Teachers - Educational Foundation, EngenderHealth, African Medical and Research Foundation, CARE International, Indiana University School of Medicine, International Medical Corps, Internews, JHPIEGO, Network of AIDS Researchers in East and Southern Africa, Pathfinder International, United Nations Children's Fund, University of Nairobi, American Association of Blood Banks, and the National Blood Transfusion Service.

Care: $ 56,313,648 as of August 2006 ($52,707,931 Field and $3,605,717 Central) (30.1% of prevention, care, and treatment budget)

Kenya�s care and mitigation efforts include counseling and testing (CT) that is integrally linked to both prevention and treatment, tuberculosis (TB)/HIV programs to identify and care for those who are co-infected, support for orphans and vulnerable children (OVC), community-support services to strengthen households affected by AIDS, and health services that complement anti-retroviral treatment (ART) by intervening to prevent/treat opportunistic infections (OI) or offering end-of-life care when treatment fails or is unavailable.

With strong U.S. technical and financial support, Kenya continues to provide global leadership in expanding counseling and testing services beyond traditional voluntary counseling and testing (VCT). FY 2006 funded CT efforts are expected to help over 500,000 Kenyans learn their HIV status. Well over 200,000 of those individuals will learn their status in medical settings as the EP expands availability of � and expectations for � diagnostic testing of hospital inpatients and TB suspects/patients. Innovations utilizing FY 2006 funding will include door-to-door testing, expanded mobile testing, testing of family members of active TB patients and other HIV-positive patients, and self-testing for health workers. CT activities will be undergirded by funds allocated to the laboratory infrastructure program area for purchase of a buffer stock of test kits to guard against interruption of this important service.

In FY 2006, OVC programs are funded from country and central budgets and awarded to eight partners. As noted under Treatment below, the USG is placing a special and expanded priority on pediatric treatment in FY 2006 and subsequent years. At least $8.5 million of FY 2006 treatment resources will care for OVC. Working closely with the Department of Children�s Services, the US team in Kenya is challenging all Emergency Plan implementing partners to offer more robust responses that seek to ensure that children benefit from all six GOK priority OVC services: health, nutrition, education, protection, psychosocial support, and shelter. This will result in a transitory dip in the total number of orphans the Plan serves, but the USG is confident that this approach � which will reach at least 130,000 new OVC next year � is ultimately in the best interest of every Kenyan child orphaned or made vulnerable by AIDS.

Palliative care, particularly clinical care other than ART and hospice care is funded within the overall care budget. Wider use of cotrimoxazole, improved linkages between community and clinic settings, and improved availability of medications to treat OI will together reach some 240,000 Kenyans (including 48,000 children). Government of Kenya nutritionists will be trained about the interaction between nutrition and HIV in the clinical context, including the impact of poor nutrition on disease progression, the role of diet and micronutrients in improving treatment outcomes, and options for nutritional support.

Efforts to improve home-based care will continue to expand with a special emphasis on promoting consistent implementation of the sound guidelines promulgated by the Ministry of Health and wider availability of better equipped HBC kits. With FY 2006 funds, the USG intends to provide home-based case to 115,000 people living with HIV or AIDS (PLWHA), nearly one in ten of the total infected population.

The Plan�s TB/HIV programs will provide TB treatment and cotrimoxazole prophylaxis to at least 70,000 co-infected Kenyans utilizing FY 2006 funds. In some parts of the country, over 90 percent of TB patients are also HIV-positive, so the EP will aggressively promote diagnostic HIV testing in TB care settings to identify and refer as many individuals as possible to care and treatment. The Uniformed Services program will increase emphasis on TB among the military, in prisons, and other institutional settings where both guards and inmates are at increased risk. Additionally this year, the focus will expand to include TB centers in mission hospitals and national scale up of diagnostic CT.

In the May 2006 notification, $9,405,000 was allocated for care activities. The additional funds will support a 30 percent increase in the number of people with HIV who are treated for TB, a 22 percent increase in the number of orphans assisted by USG-supported programs, and a 31 percent increase in the number of Kenyans who learn their HIV status through USG-supported counseling and testing programs. In August 2006, $20,000 was reprogrammed from care activities to treatment activities to address the increased number of people who are ART-eligible.

Principal Partners: Community Housing Foundation, Academy for Educational Development, Children of God Relief Institute, EngenderHealth, Hope Worldwide, International Medical Corps, International Rescue Committee, Internews, JHPIEGO, Kenya Medical Research Institute, Live With Hope Centre, Liverpool VCT and Care, National AIDS & STD Control Program, Population Council, Tenwek Hospital, Associazione Volontari per il Servizio Internazionale, CARE International, Catholic Relief Services, Christian Aid, Christian Children�s Fund, Inc., Family Health International, Kenya Medical Research Institute, PLAN International, Samoei Community Response to OVC, The Futures Group International, World Concern World Vision Kenya, Africa Inland Church Litein Hospital, African Medical and Research Foundation, Columbia University Mailman School of Public Health, Eastern Deanery AIDS Relief Program, Indiana University School of Medicine, James Finlay (K) Ltd., Kapkatet District Hospital, Kapsabet District Hospital, Kenya Rural Enterprise Program, Kericho District Hospital, Kilgoris District Hospital, Longisa District Hospital, Mildmay International, Nandi Hills District Hospital, National AIDS & STD Control Program, New York University, Unilever Tea Kenya, University of California at San Francisco, University of Manitoba, University of Nairobi, University of Washington, Working Capital Fund, Eastern Deanery AIDS Relief Program, International Medical Corps, John Snow, Inc., and the Program for Appropriate Technology in Health (PATH).

Treatment: $89,885,396 as of August 2006 ($79,479,716 Field and $10,405,680 Central) (48.0% of prevention, care, and treatment budget)

There has been dramatic expansion of access to ART in Kenya with the number of people on ARV more than doubling in just one year from 24,000 in September 2004 to 50,000 in September 2005. In just three years, ART has shifted from a peripheral interest to the very heart of all that the EP does for AIDS. The FY 2006 Emergency Plan anti-retroviral treatment (ART) budget exceeds total funding available to all USG agencies for all HIV activities in Kenya in 2003. The combined country and central-allocated budget of for ARV drugs, ART and laboratory infrastructure will make it possible for the USG to contribute to continuous, high-quality treatment for over 100,000 Kenyans.

This further scale up will be closely coordinated through the National AIDS and STI Control Programme (NASCOP) within the Ministry of Health. Consistent with Kenya�s Five Year Strategy for the Emergency Plan, USG inputs include assistance with planning and development of strategies, policies and guidelines; support for centralized activities such as drug procurement and delivery, training, and enhancement of laboratory capacity; direct support to 50% of the 210 sites providing ART in Kenya; and indirect support to nearly all sites providing ART in Kenya through collaboration with NASCOP. It is expected that a combined total of 112,000 Kenyans will be on ART through downstream and upstream Emergency Plan support by September 30, 2007.

A key USG effort with FY 2006 funding is to strengthen support for health systems. Support provided by larger partners will strengthen sites within the region as well as the relationships between those sites, improve regional functions such as quality assurance, and the supervision of those sites as a network. Networks are now well defined in all regions and are overseen by NASCOP designees known as Provincial ART Officers (PARTOs). PARTOs, most of whom are physicians, determine which sites become treatment centers, provide supervision, work to strengthen treatment networks, and conduct periodic meetings where health care providers can share experiences and receive continuing medical education.

A final critical focus utilizing FY 2006 funds is pediatric treatment. A national curriculum for pediatric treatment has been developed, over 300 providers have received classroom training, many providers have received practical training, access to diagnostic testing for infants is expanding, and pediatric formulations of ARV are available, setting the stage for rapid scale up of treatment for children. The EP expects to treat at least 18,000 HIV-infected children with these monies.

In the May 2006 notification, an additional $16,612,500 was allocated for treatment activities. The increased funding will be used to procure anti-retroviral drugs and support treatment costs for an additional 12,100 Kenyans. This is a nearly 24 percent increase in the number who could otherwise have started treatment. In August 2006, an additional $20,000 was reprogrammed to treatment activities to help address the increased number of people who are ART-eligible. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Principal Partners: American Society of Clinical Pathology, John Snow, Inc., Kenya Medical Supplies Agency, Mission for Essential Drugs and Supplies, Africa Inland Church Litein Hospital, African Medical and Research Foundation, Catholic Relief Services, Children of God Relief Institute, Community Housing Foundation, Eastern Deanery AIDS Relief Program, Family Health International, Indiana University School of Medicine, International Rescue Committee, Internews, IntraHealth International, Inc., James Finlay (K) Ltd., JHPIEGO, Kapkatet District Hospital, Kapsabet District Hospital, Kenya Medical Research Institute, Kericho District Hospital, Kilgoris District Hospital, Liverpool VCT and Care, Longisa District Hospital, Mildmay International, Mission for Essential Drugs and Supplies, Nandi Hills District Hospital National AIDS & STD Control Program, New York University, Population Council, Unilever Tea Kenya, University of California at San Francisco, University of Manitoba, University of Nairobi, and the University of Washington.

Other Costs: $21,019,003 as of August 2006

Resources invested in Other Costs primarily fulfill the Plan�s commitment to effective management and monitoring of the substantial American investment in the response to AIDS in Kenya. These efforts are also directly related to the �Three Ones� to which the American Government and other donors have committed.

FY 2006 funds will support the Strategic information (SI) program including targeted allocations to increase the capacity of both the Ministry of Health and the National AIDS Control Council to implement the one monitoring and evaluation framework called for in the Three Ones, and the USG team is philosophically and practically committed to assuring that the data collected from our programs strengthens the national system. The Plan will undertake an AIDS Indicator Survey (AIS) to assess the behavioral effects of the expanding response to HIV/AIDS in Kenya and will continue our support to the already strong annual surveillance efforts conducted in antenatal clinics and among sexually transmitted infections (STI) patients.

Modest FY 2006 financial investments in policy analysis and systems strengthening focus on efforts that have proven themselves or that hold great promise. The Plan will continue to support networks of PLWHA � including positive teachers, religious leaders, Muslim women, and ART patients � so that they can provide mutual support to one another but, perhaps more importantly in the long run, so they can become effective participants in the policy councils of their nation to promote accountability, efficiency, and transparency in HIV/AIDS programs. To date, USG personnel have invested hundreds, if not thousands, of hours in trying to assure that Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) resources � one third of which come from American taxpayers � are used wisely and efficiently in Kenya. In 2006 we will join with our host government, other donors and the GFATM Secretariat to devise the optimal administrative structure(s) to support GFATM planning, procurement, and programming.

The combined pressures of budgetary earmarks, the desire to maximize funding for programs and security concerns about the overall size of the official American presence in Kenya resulted in less than 5% of the combined total being budgeted for management and staffing costs.

In the May 2006 notification, an additional $3,702,000 was allocated for strategic information, policy analysis and systems-strengthening activities, and management and staffing activities. The additional funds will enable the strong Kenya model for coordination to be shared with other focus countries, more than double the number of individuals trained to reduce HIV-related stigma and discrimination, and support capacity building for 14 additional local Government agencies and indigenous community based organizations (CBO) and faith based organizations (FBO) for a sustained response to HIV/AIDS. In August 2006, there was no change in the amount of funding allocated for other costs.

Principal Partners: Academy for Educational Development, American Federation of Teachers- Educational Foundation, ABT Associates, Association of Schools of Public Health, Family Health International, Kenya Medical Research Institute, Macro International, Mission for Essential Drugs and Supplies, National AIDS & STD Control Program, University of Kwazulu-Natal, HEARD Mobile Task Team, and the University of North Carolina.

Other Donors, Global Fund Activities, Coordination Mechanisms:

The United States is the predominant donor for HIV/AIDS interventions in Kenya, providing $145 million in 2004 for care, treatment and prevention services. The United Kingdom�s Department for International Development is the next largest bilateral donor and will expend $15 million in direct HIV/AIDS programming in Kenya in 2005. Other donors/lenders active in the response to AIDS in Kenya include the Japanese International Cooperation Agency, Germany�s GTZ, and the World Bank.

GFATM has approved HIV grants for Kenya totaling nearly $130 million, with approximately 31% expended as of September 30, 2005. The United States participates in the GFATM Country Coordinating Mechanism and all relevant Interagency Coordinating Committees (ICCs) dealing with HIV and other health issues. USG technical staff also works closely with both the multi-sectoral National AIDS Coordinating Council (NACC) and NASCOP.

The addition of interagency technical teams (ITTs) to inform and guide development of our 2006 Country Operational Plan through representation from key host government agencies and the donor community greatly enhanced the extent to which our plans are coordinated with the efforts of others. We are actively planning to incorporate ITTs as contributors to year-round implementation, assessment, and continuous improvement of the Emergency Plan program in Kenya.

As noted above, we and other donors are vitally interested in assuring that Kenya receives maximum resources from the GFATM and that it has the capacity to use those resources rapidly and effectively. For that reason, our 2006 efforts will include increased focus and resources on defining the best systems for planning and using these important funds to prevent new infections and prolong the lives of Kenyans already infected with HIV.

Program Contact: Ambassador William Bellamy and Interagency Emergency Plan Coordinator, Warren Buckingham

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: Kenya

August 2006 Operational Plan Main Page

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