Political Engagement of Counties for Sustainable Health Programs
While meaningful engagement of county leadership is critical in fostering a conducive environment for county ownership and support of donor funded projects, it is often not given the emphasis it requires. CHS acknowledged the need for this and developed a system to engage counties to gain political support and ensure smooth and successful implementation of the PEPFAR-funded Tegemeza Project.
The project reached out to a broad array of parties that could potentially affect the work including County Health Management Teams, county executives, members of the county assemblies and public service boards. Specific officers within CHS have a mandate to build strategic relationships and partnerships with these offices.
Integration Approaches to Scale Up Identification of Children and Adolescents Living with HIV
In the last decade, there has been remarkable progress in the coverage of programs to prevent mother-to-child transmission of HIV (PMTCT), particularly with the implementation of lifelong combined antiretroviral therapy (ART) in pregnant women living with HIV. As a result, the number of new paediatric HIV infections among infants has dropped by 52% from 550,000 in 2001 to 260,000 in 2012 (CDC/USAID, 2015).
Even with this progress, an estimated 3.4 million children under the age of 15 years are living with HIV globally (CDC/USAID). Strategies to identify and test children at increased risk for HIV are critical. In Kenya, less than half of all children between 18 months and 19 years of age with a HIV-positive parent have ever been tested for HIV (NACC, 2016). Family testing as a strategy seeks to increase identification of children and adolescents through a family-centred approach to reach children and adolescents (0-19 years) with HIV testing services (HTS).
Through its flagship Tegemeza Project funded by PEPFAR through CDC, CHS sought to scale up the identification of children and adolescents through integration of HIV testing services across all service delivery points at three high volume facilities in Kiambu County.
Residential Mentorship Program
The Residential Mentorship Program aims at improving skills, knowledge and competency of health care workers. It is one of the flagship programs of the CHS TEGEMEZA project that seeks to implement and expand HIV prevention, care and treatment services in five counties of Central Kenya namely: Kiambu, Murang’a, Nyandarua, Nyeri and Laikipia.
A workforce with the right knowledge, skills and attitude is essential to provide high quality clinical care. Effective training, clinical mentorship and ongoing supportive supervision are critical to ensure consistent application of national treatment guidelines and the provision of high quality care.
The Residential Mentorship Program aims to provide practical off-site mentorship to ensure a competent and confident workforce at all levels of the health system. This is provided by Ministry of Health (MoH) staff in a public health facility, forming a shift in capacity building from being partner-led to MoH-led. The program is run at Murang’a County Hospital.
Learn more about the Residential Mentorship Program
Efforts To Improve MNCH in Kiambu County
CHS works in 29 health facilities in Kiambu County, contributing to reducing illness and death associated with pregnancy and child birth through scaling up Prevention of Mother to Child Transmission (PMTCT) services, supporting human resources for service delivery in facilities, training health care workers, strengthening community linkages and psychosocial support aimed at eliminating mother to child transmission of HIV.
This has been achieved through integration of ART services into the mother and child health clinics (MCH), employing clinical officers and nurses to support PMTCT service delivery, synchronization of HIV Exposed Infants (HEI) care with immunisation, peer education and psychosocial support by mentor mothers and defaulter identification and tracking mechanisms.
In the period January to September 2014, a total of 12,412 women were counselled and tested for HIV, 417 were identified HIV positive, 377 HIV infected women were provided ARVS to prevent MTCT and 400 infants were provided with Nevirapine prophylaxis.
Download the full brief on CHS MNCH Efforts in Kiambu County
Approach to HIV Testing and Counselling: Nyeri Provincial General Hospital
In September 2012, CHS began a system strengthening journey at Nyeri Provincial General Hospital (PGH), to improve the hospital’s comprehensive care centre (CCC). Challenges ranging from low staffing, poor facilities, overcrowding and client privacy concerns curtailed care and treatment efforts at the hospital.
CHS provided screens and furniture to create extra room thus enhancing privacy and reducing congestion. More counsellors were hired and through the establishment of a duty rota, their distribution to cover all out-patient clinics at the facility was made possible.
Continuous mentorship and regular supervision of counsellors and other health care staff has since played a great role in promoting HIV Testing and Counselling (HTC) uptake at the hospital from 12,347 individuals in October 2012 to 21,170 in September 2013 (71% increase). CHS has completed repairs of HTC rooms which will promote counselling and testing (C&T) operations.