Support for Provincial and District
Health Teams in Kenya
Lessons Learned and Promising Practices
Dr Mark Hawken,
Maputo, 11 August 2010
OUTLINE OF PRESENTATION
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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 PROGRAM
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Track 1 program began in April 2006
Support Care and Treatment in 51 (GOK) facilities and 46 PMTCT
sites
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Capacity building of national, provincial and district teams has been
main focus of program
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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
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Through sub agreements with the provincial office, DHMTs and
some larger facilities
CUMULATIVE NUMBER ON ART IN CENTRAL
PROVINCE
TRANSITION STRATEGY
Technical
assistance to
GoK structures
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
• 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
PROVINCIAL LEVEL SUPPORT
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Quarterly meetings/updates with the PHMT
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Innovative support through:
Joint planning for training and implementation
Support the employment of additional HCW
Support for 6 roving accountants to support facility
administrators and accountant
 roving health records officers to support the facility
HRIO with record keeping and reporting
 roving IT Specialist
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Supervision of the DHMT
DISTRICT LEVEL SUPPORT
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Annual planning of ART scale-up: identification of sites for scale-up
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Support for funds management
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Training of District AIDS/ STI Coordinators on HIV management
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Training of DHRIO to support data management, data
Training HCW identified by the DHMT on HIV services
Joint baseline site assessment
Intensive on-site clinical mentorship
Quarterly joint supportive supervision
dissemination/data feedback to facilities, mentorship of facilities on
data systems
CLINICAL 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
QUALITY OF CARE
MONITORING
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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)
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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
DISTRICT SUPPORT FOR HMIS
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Support for training of DHRIO and HRIO – didactic and onjob mentorship
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Support for mentorship of HRIO using a structured mentorship
tool, which includes a set list of tasks, skills and understanding
of tools
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Support for installation of electronic data systems at over 10
facilities with follow-up mentorship of HRIOs
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Roving HRIOs providing mentorship to facilities in four
districts
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Roving Data Entry Clerk computerizing patient level data at
low volume facilities in four districts
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Data feedback to facility MDTs
CHALLENGES
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Human resource (recruitment, deployment,
retention)
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Infrastructure limitations
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Limited sense of ownership at some facilities
Dual MoH systems (MoPHS and MoMS)
No permanent authority from central government for
provincial medical office to receive external funds
Weak linkages and integration of services
Inability to maintain optimal burn rates due to
management challenges
NEXT STEPS
Local NGO (Centre For Health Solutions)
• 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
Continuing technical role for ICAP
• National technical support for technical working
groups
• Technical support and supervisory role for CHS
• Continuing implementation in Eastern and Nyanza
Provinces
ACKNOWLEDGEMENTS
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NASCOP /MOH
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PHMT, DMOH and MOH Hospitals
CDC
KEMRI
APHIA II
Clinton Foundation
JKUAT
Other NGOs
CBO