Kenya FY 2007 Country Operational Plan (COP)


KENYA

Project Title: Kenya Fiscal Year 2007 Country Operational Plan (COP)

Budget Summary:

  Field Programs Funding by Account  Central Programs Funding by Account  
   Notified as of March 2007 Notified as of June 2007 Notified as of November 2006   
Implementing Agency GAP GHAI Subtotal: Field Programs Funding GAP GHAI New Subtotal: Field Programs Funding GHAI Central Programs Total Dollars Allocated: Field & Central Funding
DOD 0 12,062,275 12,062,275 0 13,527,275 13,527,275 0 13,527,275
DOL 0 0 0 0 0 0 0 0
HHS 8,121,000 65,103,098 73,224,098 8,121,000 92,758,098 100,879,098 14,805,680 115,684,778
Peace Corps 0 1,364,500 1,364,500 0 1,364,500 1,364,500 0 1,364,500
State 0 1,098,700 1,098,700 0 1,673,700 1,673,700 0 1,673,700
USAID 0 179,967,089 179,967,089 0 228,594,427 228,594,427 7,284,502 235,878,929
TOTAL Approved 8,121,000 259,595,662 267,716,662 8,121,000 337,918,000 346,039,000 22,090,182 368,129,182

HIV/AIDS Epidemic in Kenya
Estimated Population: 34,256,000*
HIV Prevalence rate*: 6.1%*�
# of HIV infected: 1,300,000*
Estimated # of OVCs: 1,100,000*�
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
Prevalence is in adults only (15-49 years)
Orphans aged 0-17 due to AIDS

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

Kenya

Total # Individuals Receiving Care & Support

Total # Individuals Receiving ART

End Fiscal Year 2004*

172,200

  17,100

End Fiscal Year 2005**

397,000

44,700

End Fiscal Year 2006***

546,000

  97,800

End Fiscal Year 2007****

598,480

111,400

End Fiscal Year 2008****

697,661

169,260

*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
***Results. �Power of Partnerships: The President�s Emergency Plan for AIDS Relief.� Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February, 2007
****Fiscal year 2007 Country Operational Plan targets


Program Description/Country Context

Kenya has a severe generalized epidemic with estimated adult HIV prevalence of 6.1% (UNAIDS, 2006), translating into 1.2 million HIV-positive Kenyans over age 15 and approximately 150,000 infected children under 15. While the rate of new infections has decreased, the relatively recent advent of treatment has not yet significantly affected mortality rates. An estimated 140,000 Kenyans died of AIDS in 2005. Deaths to date have left 1.1 million children orphaned by AIDS. The Kenyan epidemic varies significantly from region to region, with Nyanza Province affected by prevalence rates approximating those in some Southern African nations. 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 individuals, sexual partners in HIV-discordant relationships, men who have sex with men, long-distance transport workers, and people in prostitution.

Additional Funding: In June 2007, an additional $60,000,000 was allocated to enable increased coverage in PMTCT, CT and TB/HIV. The added funding will support testing of all pregnant women to ensure national access to PMTCT, increased access to counseling and testing, including the launch of a national testing campaign, and increased integration of expanded prevention activities throughout all program areas. Through the technical working group (TWG) process, $5,000,000 of the additional funds were identified to support new medical male circumcision (MC) activities in Kenya.

Emergency Plan funding is carefully and strategically targeted to the following interventions in support of country-level and global 2-7-10 targets:

Prevention: $72,449,385 ($63,629,700 Field and $8,819,685 Central) (22.0% of prevention, care, and treatment budget)

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

Fiscal year 2007 funding for PMTCT will enable Emergency Plan-supported sites to provide HIV testing and counseling, including provision of test results, to pregnant women. Women who test positive will receive a full course of prophylaxis to interrupt vertical transmission; more efficacious regimens, including AZT, also will be utilized with increasing frequency.

While our base budget levels are relatively modest, the benefits of improved blood safety and injection practices will be significant. Building upon early investments made after the tragic U.S. Embassy bomb blast in 1998, USAID and CDC have helped the Government of Kenya build a national blood transfusion system which, with more recent Emergency Plan investments, has become a model for East Africa. Safe injection practices will be scaled up in additional provinces, key staff will be trained in injection safety in priority districts, and the Government of Kenya 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. In fiscal year 2007, new initiatives will be expanded to Nyanza province, which has the highest prevalence in the nation. The national C&OP program will train health workers and community members to reach their fellow Kenyans with important prevention information. In addition, the Emergency Plan will support pilot projects in high-prevalence provinces that respond to unpublicized demand building on research into the effectiveness of medical male circumcision, and intervene with people in prostitution in efforts to give them skills and capacities to move to alternate employment.

AB programs will be continued and reinvigorated through a public-private partnership � the highly successful and extremely popular �Nime Chill� (�I�m chilling� or �I�m abstaining�) mass media campaign, as well as the highly personalized �True Love Waits� and �I Choose Life� programs, which reach individual young people with skills and messages that promote abstinence to prevent infection. Longstanding and proven work with the Kenya Girl Guides Association is being expanded to work with Boy Scouts. Regular meetings of all AB partners will continue to ensure that mass media and interpersonal interventions are coordinated and mutually reinforcing.

Fiscal year 2007 represents the first opportunity to fully embrace recommendations from the 2005 Emergency Plan meeting on the role of alcohol in HIV transmission. Many of our AB efforts this year will incorporate evidence-based approaches for alcohol prevention into existing programs. The USG will continue to work with the Ministry of Education, Science and Technology and implementing partners in order to develop a teacher training syllabus on HIV and a standardized core training curriculum for community groups undertaking AB work. In both instances, these new resources will thoroughly and accurately reflect the ways in which alcohol (and other substance) misuse and abuse can increase risk of HIV infection and how abstaining from substance use can reduce risks of infection.

Principal Partners: African Medical and Research Foundation, Network of AIDS Researchers in East and Southern Africa, Community Housing Foundation, Hope Worldwide, Impact Research and Development Organization, Institute of Tropical Medicine, Live with Hope Centre, Population Council, and American Federation of Teachers � Educational Foundation.

Care: $90,424,817 ($87,560,000 Field and $2,864,817 Central) (27.4% of prevention, care and treatment budget)

Kenya�s care and mitigation efforts include counseling and testing (CT), which are integrally linked to prevention and treatment programs; 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 (OIs), prevent transmission of HIV by those who are in care, and/or offer end-of-life care when treatment fails or is unavailable.

With strong USG technical and financial support, Kenya continues to provide global leadership in expanding CT services beyond traditional voluntary counseling and testing (VCT). Fiscal year 2007 CT efforts are expected to help increasing numbers of Kenyans learn their HIV status. More than half of all tested individuals will learn their status in medical settings, as availability of � and expectations for � diagnostic testing of hospital inpatients and suspected TB patients continues to become the standard of practice. Innovations in 2007 will include door-to-door testing, expanded mobile testing, testing of family members of ART patients, and self-testing for health workers. CT activities will be undergirded by funds that have been allocated to the laboratory infrastructure program area for purchase of expanded stocks of test kits.

OVC funding will be committed to hiring experienced adult patients to enhance continuity of clinical care for children. As noted under �Treatment� below, the USG will place a special priority on pediatric treatment in fiscal year 2007 and subsequent years. Working closely with the Department of Children�s Services, the USG team will require all Emergency Plan implementing partners to offer robust responses to all six Government of Kenya high priority OVC services: health, nutrition, education, protection, psychosocial support, and shelter.

In fiscal year 2007, palliative care, particularly clinical care (other than ART) and hospice care, will focus on wider use of cotrimoxazole, improved linkages between community and clinic settings, and improved availability of medications to treat OIs. Government of Kenya nutritionists will be trained regarding the interaction between nutrition and HIV in the clinical context, including the impact of poor nutrition upon 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 upon promoting consistent implementation of the sound guidelines promulgated by the Ministry of Health, as well as wider availability of better equipped home-based care kits. Uganda�s successful �basic care package� will be replicated for people living with HIV/AIDS (PLWHA).

TB/HIV programs will provide TB treatment and cotrimoxazole prophylaxis to co-infected Kenyans. In some parts of the country, over 90 percent of TB patients are also HIV-positive. Diagnostic HIV testing in TB care settings has become the standard of care to identify and refer as many individuals as possible to care and treatment. The Uniformed Services program will increase emphasis upon TB among military personnel and in prisons, as well as in other institutional settings in which both guards and inmates are at increased risk. In fiscal year 2007, the TB/HIV programs will continue expansion to include TB centers in mission hospitals, national scale up of diagnostic CT, and rollout of additional TB sites where ART is offered.

Principal Partners: Academy for Educational Development, Children of God Relief Institute, Kenya Rural Enterprise Program, Liverpool VCT, Mildmay International, University of Nairobi, JHPIEGO, EngenderHealth, Family Health International, Pathfinder International, Program for Appropriate Technology in Health, Samoei Community Response to OVC, and Internews.

Treatment: $167,064,980 ($156,659,300 Field and $10,405,680 Central) (50.6% of prevention, care, and treatment budget)

Dramatic expansion of access to ART in Kenya continues; in just three years, ART has shifted from a peripheral interest to the very heart of the USG�s HIV/AIDS interventions. The combined budget for ARV drugs, ART, and laboratory infrastructure will make it possible for Kenya to contribute to the provision of continuous, high-quality treatment. Treatment priorities include: (1) expanded procurement of generic ARVs; (2) increased funding for pediatric formulations; and (3) accommodation of maturing treatment profiles by increasing the percentage of drug procurement committed to second-line regimens.

Treatment efforts will be coordinated closely, through the Ministry of Health�s National AIDS and STI Control Programme (NASCOP). Consistent with Kenya�s 5-Year Strategy for the Emergency Plan, USG support will 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 some of the many sites that will provide ART in Kenya; and indirect support to nearly all sites providing ART in Kenya.

Strengthened support for Kenya�s health systems will be a continuing priority. Networks are now well defined in all regions and are overseen by NASCOP 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 at which health care providers can share experiences and receive continuing medical education. In fiscal year 2007, the nationwide scale-up of ART services will ensure that more HIV tests are performed, many of which are supported under laboratory services. Investments in this area prioritize procurement and human resources in order to expand laboratory services in Kenya, with an increasing number of facilities receiving quality assurance and training for personnel.

Turning our earlier investments in pediatric treatment support into greatly increased numbers of children on ART will be a top priority. Treatment programs will be expected to establish Prevention with Positives (PwP) programs. Clinicians will be involved in the multi-country PwP demonstration project, patients will be employed and trained to facilitate prevention support groups, and HIV-positive children will receive age-appropriate HIV prevention interventions linked to their clinical care.

Principal Partners: Management Sciences for Health, Catholic Relief Services, Columbia University Mailman School of Public Health, Eastern Deanery AIDS Relief Program, Indiana University School of Medicine, National AIDS & STD Control Programme, University of California at San Francisco, University of Nairobi, University of Washington, and Kenya Medical Research Institute/Walter Reed Project South Rift Valley Province HIV Program.

Other Costs: $38,190,000

Resources invested in Other Costs primarily fulfill the Emergency Plan�s commitment to effectively manage and monitor the substantial USG investment in the response to AIDS in Kenya. These efforts also are related directly to the �Three Ones,� to which the USG and other supporters are committed.

Funding for strategic information (SI) ensures responsible stewardship of programs and funding. The SI program includes targeting allocations to increase the capacity of both the Ministry of Health and the National AIDS Control Council (NACC), in order to implement the single monitoring and evaluation framework called for in the Three Ones. The USG team is committed to ensuring that data collected from programs strengthen the national system. Plans are underway for an AIDS Indicator Survey to assess the behavioral effects of the expanding response to HIV/AIDS in Kenya, and support will continue for the already-strong annual surveillance efforts conducted in antenatal clinics and among STI patients.

Principal Partners: ABT Associates, Family Health International, Kenya Medical Research Institute, Macro International, National AIDS & STD Control Program, US Centers for Disease Control and Prevention, EngenderHealth, Pathfinder International, and JHPIEGO.

In fiscal year 2007, modest investment in systems strengthening and policy analysis focuses upon efforts that have proven to be effective or hold great promise. The USG team will continue to support networks of PLWHA � including HIV-positive teachers, religious leaders, Muslim women, and ART patients � so they can provide mutual support to one another and become effective participants in the policy councils of their nation, in order to promote accountability, efficiency, and transparency in HIV/AIDS programs. To date, USG personnel have invested considerable time in working to ensure that Global Fund resources are used wisely and efficiently in Kenya. In fiscal year 2007, the USG will join with the host government, other supporters, and the Global Fund Secretariat, to implement revised administrative structures that support Global Fund planning, procurement, and programming and equip PLWHA and civil society representatives to effectively participate in the Country Coordinating Mechanism (CCM).

Principal Partners: Academy for Educational Development, Community Housing Foundation, Internews, Kenya Medical Training College, Population Reference Bureau, The Futures Group International, and IntraHealth International, Inc.

Other Donors, Global Fund Activities, Coordination Mechanisms:

The USG is the predominant supporter of HIV/AIDS interventions in Kenya. The United Kingdom�s Department for International Development is the next largest bilateral donor. Other donors/lenders active in the response to AIDS in Kenya include the Japanese International Cooperation Agency, Germany�s GTZ, and the World Bank.

The Global Fund has approved HIV grants totaling nearly $130 million, with approximately $29 million disbursed to the Government of Kenya as of September 30, 2006. The USG participates in the Global Fund CCM and all relevant Interagency Coordinating Committees (ICCs) dealing with HIV and other health issues. USG technical staff members also work closely with both the multi-sectoral NACC and NASCOP.

The addition of interagency technical teams (ITTs), including representatives from key host government agencies and the donor community, greatly enhanced the extent to which USG plans are coordinated with the efforts of others. The USG team is actively planning to incorporate ITTs as contributors to year-round implementation, assessment, and continuous improvement of the Emergency Plan program in Kenya.

It is critical that the Emergency Plan redouble its donor coordination and public diplomacy efforts. As HIV/AIDS cannot possibly be the exclusive purview of USG, the USG will encourage the Government of Kenya and other donors to continue to contribute resources in order to reach national scale with prevention, care, and treatment services.

The Emergency Plan and other supporters are vitally interested in ensuring that Kenya receives anticipated grants from the Global Fund and that it has the capacity to use Global Fund resources rapidly and effectively. For that reason, fiscal year 2007 efforts will include expanded focus and resources to define the best systems for planning and use of Global Fund funding, to prevent new infections and prolong the lives of Kenyans who already are infected with HIV. A key priority for 2007 will be equipping PLWHA and civil society representatives to be optimally effective participants in the CCM.

Program Contact: Ambassador Michael Ranneberger and Emergency Plan Country Coordinator Warren Buckingham

Time Frame: Fiscal year 2007 � fiscal year 2008

Approved Funding by Program Area: Kenya

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