MDG 4, 5 & 6 Joint Programme: Concept Note Narrative
I. Title: Support to Achieving Millennium Development Goals (MDG) 4 and 5 & 6 in Kenya
II. Programme Summary
The objective of this joint programme is to contribute to decreasing infant and maternal mortality in
Kenya. This will be achieved through supporting the Beyond Zero campaign which aims at
controlling HIV and promoting maternal and newborn and child health in Kenya.
III. Background
Over 5,500 women in Kenya die annually due to pregnancy and birth related complications. In
2012 alone, over 100,000 children below age five died before their first birthday. In the same year,
there were over 13,000 new HIV infections among children, of whom 62% did not access lifesaving medication1. The health of mothers and children, particularly newborns is closely linked.
Research has shown that if a mother dies, her child is ten times more likely to die before the age of
five than a child whose mother survives. Poor nutrition, preventable diseases such as malaria or
HIV and AIDS and poor access to ante-natal care contribute significantly to pregnancy related
complications.
IV. Status of Implementation of MDGs in Kenya
Kenya has made tremendous efforts in implementing the MDGs since the process started in
September, 2002. While the country is on course to achieve universal primary education, other
MDGs are still lagging behind such as MDG 4 and 5 on reduction of child mortality and
improvement of maternal health. The MMR has remained high at 488 per 100,000 live births,
skilled birth attendance at 44%, contraceptive prevalence rate (CPR) at 46% (KDHS 2008/9) 2 and a
higher unmet need for Family Planning among the women living with HIV at 52%, double that of
the general population. Maternal mortality ratios however differ by regions with northern arid lands
having a maternal mortality ratio in excess of 1000 per 100,000 live births while the central region
is well below 300. On the other hand, childhood mortality levels are decreasing in the country.
According to the KDHS 2008-09, the infant mortality rate was 52 deaths per 1,000 live births,
down from 77 deaths per 1,000 in 2003. The under-five mortality rate was 74 deaths per 1,000 live
births compared to 115 in 2003. Still, this means that one in every 13 children in Kenya dies before
his or her fifth birthday. Furthermore, achievement of gender equality and empowerment of women
(MDG3) continues to be a priority towards mitigating the impact and spread of HIV and AIDs.
The UNAIDS Global Plan of Action towards elimination of new HIV infections among children
(eMTCT) by 2015 and Keeping Mothers Alive (KMA) , 2011-20153, focuses on reaching pregnant
women living with HIV and their children to assure prevention, treatment , care and support. Some
of the strategies towards realizing this goal include: Ensuring that pregnant women and their
children have access to quality lifesaving HIV prevention and treatment services; recognizing the
interconnectedness of HIV, maternal health, newborn, child health and family planning
programmes in improving health outcomes as well working towards strengthening accountabilities
for results through stronger partnerships amongst global and national leaders.
1
Countdown to 2015: Accountability for Maternal, Newborn and Child Survival, 2013 Update Commission on Information and
Accountability for Women and Children’s Health
2 Government of Kenya , KDHS 2008/9
3 Global Plan of Action towards elimination of new HIV infections among children (eMTCT) by 2015 and Keeping Mothers Alive
(KMA) , 2011-2015, UNAIDS, 2011
In Kenya, the eMTCT Framework4 recognizes that in order to promote a sense of urgency, political
advocacy and commitment to eMTCT and KMA, as a national campaign is imperative. As a result,
the campaign was launched under the leadership of the Ministry of Health and is to be anchored
within the national political systems, devolved governance structures right down to the community
level. Most importantly, the framework notes that in order to strengthen accountability, there is
need to have a champion from a high level political office.
The national champion will work closely with county level champions to ensure that eMTCT and
KMA agenda remains prioritized throughout the country. Subsequently, the First Lady’s office has
been identified as the national champion as strategically positioned in catalyzing high impact
interventions towards a HIV free generation. The First lady committed during the 2013
Organizations of First Ladies against HIV and AIDS in Africa meeting held in Addis Ababa to
champion the campaign to eliminate new HIV infections among children and keep their mothers
alive. In December 2013, the First Lady launched a five year strategic framework to accelerate
progress in HIV control and promotion of maternal, newborn and child health in Kenya. 5
V. UN Engagement
The Joint UN eMTCT Technical Working Group coordinates UN efforts on prevention of mother
to child transmission and gives coherent approach to the government and CSO partners. The group
use eMTCT as a pathfinder for driving HIV service delivery out of isolation into an integrated
model to sustain gains in maternal and child health.
VI. UNDP Support to the Beyond Zero Campaign
UNDP’s core mandate and strengths allow it to make unique and invaluable contributions to
national health. UNDP recognizes the value of both stand-alone programming specifically
designed to improve HIV and health outcomes and integration of HIV and health sensitivity into
other areas of work.
First, UNDP helps the country to mainstream attention to HIV and health into action on gender,
poverty and the broader effort to achieve and sustain the Millennium Development Goals. For
example, UNDP works with the government and national partners to understand the social and
economic factors that play a crucial role in driving health and disease, and to respond to such
dynamics with appropriate policies and programmes outside the health sector. UNDP also
promotes specific action on the needs and rights of women and girls as they relate to HIV.
Second, UNDP works with partners to address the interactions between governance, human rights
and health responses. Sometimes this is done through focused or specialized programmes, such as
promoting attention to the role of the law and legal environments in facilitating stronger HIV
responses, including the use of flexibilities in intellectual property law to lower the cost of drugs
and diagnostics. UNDP also works to empower and include marginalized populations who are
disproportionately affected by HIV, such as sex workers, men who have sex with men and people
living with HIV. Beyond these focused efforts, UNDP plays a key role in ensuring attention to
HIV and health within broader governance and rights initiatives, including support to local action
on MDGs, strengthening of national human rights institutions and increasing access to justice for
marginalized populations.
Beyond Zero Campaign resonates and is situated well in the above articulated core mandates of
UNDP. Capacity building is at the core of UNDPs programming work and is also a basis for the
capacity support to the Campaign.
4
MOH, eMTCT Framework, 2012-2015
`NACC, Strategic Framework for Engagement of the First Lady in HIV Control and Promotion ok Maternal, Newborn and Child
Health in Kenya, 2013-2017
5
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VII.
Joint Programme Results
The Joint Programme is closely linked with the nationwide policies contained in the Kenya eMTCT
Framework in which goals and strategies are put in place with a view to improving
Mother-infant health.
This Joint Programme will further support and take place in the context of the country’s new AIDS
Strategic Framework 2014/15-2018/196 which sets ambitious targets for both the national and
county governments to accomplish an end in AIDS.
Furthermore, the Joint Programme is based on the United Nations Development Assistance
Framework (UNDAF) for 2014-20187, SR 2 on Human Capital. These interventions will be
instrumental in supporting the efforts undertaken by the national authorities to continue working on
MDG 4 MGD 5 and MDG 6.
The programme is an innovative initiative as detailed hereunder:
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It will accelerate implementation of relevant policies and programs to increase access to HIV
prevention, care and treatment services, maternal and child health interventions
Influence investments through advocacy for allocation of resources and strategic investment in
high impact interventions to promote maternal and child health, HIV control and strengthening
of health systems to enhance service delivery
Mobilization of men as clients, partners and agents of change in promoting uptake of HIV,
maternal and child health services at family and community level
Mobilization of communities to address barriers to accessing HIV, maternal and child health
services
Leadership, coordination, accountability and recognition to accelerate the attainment of HIV,
maternal and Child health targets
As pointed out, Kenya’s infant & maternal mortality needs to be addressed from a multisector
perspective. To that end, the UN Country Team in Kenya, based on an inter-agency approach, has
designed interventions that complement each other to support achieving the expected results.
The macro objective of this joint program is to contribute to decreasing infant and maternal
mortality in Kenya. This will be achieved through supporting the Beyond Zero campaign which
aims at controlling HIV and promoting maternal and newborn and child health in Kenya.
Five outcomes of this joint programme have been designed as follows;
1. Increased awareness and sense of urgency among leaders on the need to rapidly scale up
high impact interventions for HIV control, maternal and child health
2. National and county leadership sensitized to progressively allocate sufficient resources for
HIV, maternal and child health programs
3. Increased support and participation of men in HIV control, maternal and child health at
family and community level
4. Increased uptake and utilization of HIV, maternal and child health services
5. Institutionalized culture of accountability for results among leaders on their commitment
towards meeting HIV, maternal and child health targets
6
7
NACC, Kenya AIDS Strategic Framework, 2014/15-2018/19
United Nations; United Nations Development Assistance Framework for Kenya, 2014-2018
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VIII.
Joint Programme Design and Implementation Plan
The design of this joint programme is the result of inter-agency work with the active presence of
representatives from national institutions and with the national coordination of the Ministry for
Health through the National AIDS Control Council (NACC). NACC is the counterpart for the
cooperation HIV & AIDS activities of the agencies and programmes of the UN System in Kenya.
The activities of the Joint Programme have been defined taking into account the causes of infant
and maternal mortality in the country, the programmes and polices already undertaken by the
national authorities on this issue and the comparative advantages of each participating agency. The
direct involvement of two agencies is justified by the principle focus on Capacity Development
(UNDP) and of the other on reproductive health rights and programmes for women and girls
(UNFPA).
The programme will be implemented through an inter-agency and inter-sector mechanism with
broad-based participation by concerned national institutions. The main national partner for this
activity will be the NACC. To promote coordination and in support of the Resident Coordinator,
the lead agency on behalf of the UN System will be UNDP.
IX. Monitoring and Evaluation
Monitoring and evaluation activities for the joint programme will be aligned with the UNDAF
monitoring and evaluation plan. Indicators for impact, outcome and processes will be put in place
to monitor and evaluate the joint programme’s outcomes and products. These indicators will be
obtained from quantitative and qualitative information. The monitoring process will take place
throughout the programme
X. Institutional Arrangements and Management Plan
This Joint Programme is implemented as part of the United Nations Development Assistance
Framework (UNDAF) for 2014-2018 which includes Infant and Maternal Health as well as HIV
priority areas for cooperation. As a strategy to reach dialogue, planning, implementation, follow-up
and evaluation in this area an Inter-Agency eMTCT Group was established, which has been
working jointly for over two years now. This inter-agency group has obtained important analytical
results, which were instrumental in identifying joint programming opportunities and facilitating the
design of this joint programme. Furthermore, the UN System in Kenya is experienced in
undertaking articulated local projects as a result of interagency cooperation. As a lead agency to
support the coordination of this joint programme, UNDP will report to the interagency group,
United Nations Country Team, and Resident Coordinator to provide progress overviews on behalf
of the UN System.
The main national institutions connected with this programme, under the coordination of the
Ministry for Health is the NACC. Also envisaged is the active participation of local institutions,
particularly at the county level.
The participating UN agencies are UNDP and UNFPA. The Coordination Committee, composed of
the members of the Inter-Agency on eMTCT and members of the participating national institutions,
will be in charge of coordinating programme implementation and monitoring/evaluation based on
the joint results matrix. As the lead agency UNDP will provide programme overviews to the group.
Programme finance will be disbursed by UNDP. Once approved, a Memorandum of Understanding
will be signed between UNDP, as Managing Agent, and all participating UN System agencies that
may wish to participate starting with UNFPA, to support funds transfer.
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XI. RESULTS AND RESOURCES FRAMEWORK:
Intended Outcome as stated in the Country Programme Results and Resource Framework: Democratic participation and human rights & Devolution
and Accountability
Outcome indicators as stated in the Country Programme Results and Resources Framework, including baseline and targets:
Indicators:
% of high burdened counties supported whose plans and budgets address HIV and AIDS
# no. of laws, programme and initiatives supported to address legal barriers hindering access to HIV and AIDS services
Baselines: 3 high burdened counties ; Practices are hindering access
Target: x no. of laws ; 50% of high burdened counties have HIV and AIDS plans and budgets
Applicable Key Result Area: Transformational Governance / Democratic Governance
Partnership Strategy
Partnerships will be formalized with selected national and county partners and will include but not limited to; Ministry of Health, Ministry of Devolution
and planning, NASCOP, Council of Governors, Office of the First Lady, UNFPA, Joint UN Programme on AIDS, NEPHAK and other networks of
PLHIV.
Project title : Joint Programme MDG 4, 5 & 6 ID: 00092467 ( Award: 00084484)
INTENDED OUTPUTS
OUTPUT
TARGETS INDICATIVE ACTIVITIES
RESPONSIBLE PARTIES INPUTS
FOR (YEARS)
Outcome area 1: Poverty eradication and achievement of the MDGs
Output 1.
Leadership and
Governance for HIV and AIDS
response strengthened at the
national and County levels
Targets (2014)
1.1 Support establishment, equipping, NACC, CoG,
85,000
16 BZ clinics launched in 16 operations and staffing of Beyond Zero County Governments, UNJT
secretariats.
counties
CSOs (e.g.
NEPHAK,)
1 consultancy to support
Health care providers, Media
beyond
zero
completed
campaign
1 leadership summit held
1.2. Phase II Consultancy to support the
Beyond Zero Campaign
35,000
INTENDED OUTPUTS
Baseline
The NACC is supporting the beyond
Zero Campaign initiative in line with
the 2030 Prevention Revolution
Road Map
Indicator:
No. of clinics launched
Consultancy to support beyond zero
campaign completed
Leadership summit held
OUTPUT
TARGETS INDICATIVE ACTIVITIES
FOR (YEARS)
RESPONSIBLE PARTIES
INPUTS
1.3 Support branding, IEC materials and
other stationeries
15,000
1.4 Hold
meetings.
management
10,000
1.5 Support media events, publicity and
publications.
10,000
NSC,
TAT
1.6 Leadership Summit preparations
1.7 Support Launching of Beyond Zero
Mobile Clinics.
30,000
15,000
200,000
TOTAL
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XII. Annual Work Plan 2015
EXPECTED OUTPUTS
PLANNED ACTIVITIES
And baseline, indicators List
activity
results
including annual targets
associated actions
TIME FRAME
and Q1
Q2
Q3
Support
establishment,
Output 1.
Leadership 1.1
and Governance for HIV equipping, operations and staffing
and
AIDS
response of Beyond Zero secretariats
strengthened
at
the
national and County levels
Baseline
The NACC is supporting the
beyond Zero Campaign
initiative in line with the
2030 Prevention Revolution
Road Map
X
Q4
X
RESPONSIBLE
PARTY
NACC
PLANNED BUDGET
Funding
Budget Description
Source
UNDP/UNFPA
Office Equipment
4 laptops
4 tables and chairs
Office accessories x
months
Telephone costs x
months
Office space x
months
Operations costs x
months
Amount
4
85,000
4
4
4
Indicator:
1.2. Phase II Consultancy to
No. of clinics launched
support the Beyond Zero Campaign
X
X
NACC
UNDP/UNFPA
Consultancy to support 1.3 Support branding, IEC
beyond
zero
campaign materials and other stationeries
completed
Individual
contract
35,000
(IC) * 4 Months
Branding
(assorted)
NACC
Leadership summit held
7
UNDP/UNFPA
materials
20 street banners
20 roll-up banner
stationery
15,000
EXPECTED OUTPUTS
PLANNED ACTIVITIES
And baseline, indicators List
activity
results
including annual targets
associated actions
1.4
Hold
NSC,
management meetings.
TIME FRAME
and Q1
Q2
Q3
Q4
RESPONSIBLE
PARTY
PLANNED BUDGET
Funding
Budget Description
Source
Amount
TAT
X
NACC
UNDP/UNFPA
3 NSC Meetings
Venue
and
refreshments
10,000
4 TAT meetings
Refreshments
1.5 Support media events,
publicity and publications.
X
1.6
Leadership
preparations
NACC
UNDP/UNFPA
12 Radio spots
4 Radio talks
10,000
4
publications
(newsletter)
NACC
UNDP/UNFPA
6 planning meetings
3 media supplements
Summit
X
8
30,000
EXPECTED OUTPUTS
PLANNED ACTIVITIES
And baseline, indicators List
activity
results
including annual targets
associated actions
TIME FRAME
and
Q1
RESPONSIBLE
PARTY
Q2
Q3
Q4
PLANNED BUDGET
Funding
Source
Budget Description
UNDP/UNFPA
16 preparatory visits
and community liaison
activities
for
the 15,000
launch of the mobile
clinics
Amount
1.7 Support Launching of
Beyond Zero Mobile Clinics.
X
X
TOTAL
NACC
200,000
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ACRONYMS
AIDS
CPD
CPR
CSO
CoG
eMTCT
GBV
GOK
HIV
KDHS
KMA
MDGS
MMR
MOH
NACC
NASCOP
NEPHAK
NSC
PLHIV
TAT
WLHIV
UNAIDS
UNDAF
UNDP
UNFPA
Acquired Immuno-Deficiency syndrome
Country Programme Document
Contraceptive Prevalence Rate
Civil Society Organisation
Council of Governors
Elimination of Mother to child Transmission of HIV
Gender Based violence
Government of Kenya
Human Immuno-deficiency Virus
Kenya Demographic and Health Survey
Keeping Mothers Alive
Millennium Development Goals
Maternal Mortality Ratio
Ministry of Health
National AIDS Control Council
National AIDS and STI Control Programme
National Empowerment Network for PLHIV in Kenya
National Steering committee
Persons Living with HIV
Technical Advisory Team
Women Living with HIV
United Nations Joint Programme on HIV and AIDS
United Nations Development Assistance Framework
United Nations Development Framework
United Nations Population Fund
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