MDG
MgSO4
MNH
MNCH
MOH
MOPHS
MTEF
NASCOP
NGO
NMR
ORT
PATH
PMTCT
PPH
PPP
SOPO
TT
U5MR
UN
UNICEF
USAID
WHO
FTP
GTZ
HENNET
HII
HMIS
IEC
IMR
IPT
JHPIEGO
JICA
KDHS
KEMRI
LLITN
MCHIP
ACT
AOP
AMREF
BCC
DCAH
DFID
DHP
EHS
FCI
FHI
Artemisinin Combination Therapy
Annual Operative Plan
African Medical Research Foundation
Behaviour Change Communication
Division of Child and Adolescent Health
Department for International Development
Division of Health Promotion
Essential Health Services DFID Technical Assistance Project
Family Care International
Family Health International
File Transfer Protocol
German Technical Cooperation Agency
Health NGO Network
High Impact Interventions
Health Management Information System
Information Education and Communication
Infant Mortality Rate
Intermittent Presumptive Treatment
Johns Hopkins Program for International Education in Gynecology and Obstetrics
Japan International Cooperation Agency
Kenya Demographic and Health Survey
Kenya Medical Research Institute
Long Lasting Insecticide Treated Net
Maternal and Child Health Integrated Program
Millennium Development Goal
Magnesium Sulphate
Maternal and Neonatal Health
Maternal Neonatal and Child Health
Ministry of Health
Ministry of Public Health and Sanitation
Medium Term Expenditure Framework
National AIDS Control Program
Non Government Organization
Neonatal Mortality Rate
Oral Rehydration Therapy
Program for Appropriate Technology in Health
Prevention of Mother to Child Transmission
Post partum haemorrhage
Public Private Partnership
Hand Washing Campaign
Tetanus Toxoid
Under Five Mortality Rate
United Nations
United Nations Children’s Fund
United States Agency for International Development
World Health Organization
2

With only six years left to the Millennium Development Goal (MDG) date, there has been reduction in infant and under five mortality. However, maternal and newborn health indicators in Kenya have generally stagnated or show very marginal improvement. The recently released KDHS revealed the following:

Reduction in Infant Mortality from 77 to 52/1000

Reduction in Under Five Mortality from 115 to 74/1000

Newborn mortality rate has reduced from 33 to 31/1000

Delivery by a health care professional has increased from 42 to 44%

Delivery in a health facility increased from 40 to 43% but with some regions reporting only
17% delivery in a health facility

FP contraceptive prevalence rate has increased from 39 to 46%
 Maternal mortality ratio has decreased from 414 to 410/ 100 000
 Breastfeeding coverage
These changes are still way below the National as well as the MDG targets. Kenya therefore like other sub Saharan Africa countries has to put in place strategies to accelerate the reduction in maternal, newborn and child morbidity and mortality. With NMR contributing over 60% of IMR, we know that if this is addressed, we will be able to attain MDG 4. However issues of the newborn cannot be addressed separately as they are intrinsically entwined with pregnancy, labour, delivery and postpartum care. Hence addressing maternity care automatically translates to improved newborn health.
Many stakeholders are expressing greater interest in investing in Maternal and Newborn health.
Key policy documents have been developed including the National MNH Road Map which is almost finalized , the Child Survival and Development Strategy and the Infant and Young Child Feeding
Strategy and the National MNH Road Map. These key policy documents clearly outline the broad strategies and priority actions necessary to accelerate the reduction in maternal and newborn morbidity and mortality. The priority interventions therefore need to be adapted by the districts and included in the Annual Operational Plans.
3

Justification for the Retreat:
The need for this workshop was muted out of the concerns emanating from the results of the KDHS
2008/9 and the AOP 4 (2008-2009) review which revealed little progress in attaining MDG 1
(nutrition), 4 & 5. At the same time it was clear that there was a need to integrate the maternal, neonatal and child Health (MNCH) - Cohort 1 &2 for better progress in MNCH in Kenya.
The main Objectives of the retreat were:
1.
To bring together MNH stakeholders for updating on the status of MNH in Kenya and what different partners are doing to date
2.
To identify key priority actions to be incorporated into the AOP6 for the purpose of accelerating the attainment of MDGs 4& 5
3.
To obtain stakeholder buy in and resource mobilisation for implementation of identified priority actions
Expected Outcomes of the meeting were as follows:
1.
The situation of maternal, newborn, child survival and nutrition Kenya is reviewed
2.
The activities to expedite progress in acceleration of the implementation of the MNH Road map, Child Survival and Development Strategy and nutrition strategies are identified.
3.
The actions and commitments to implement the identified activities and strategies are clearly spelled out with timeline.
The format of the meeting comprised targeted presentations in plenary followed by group discussions.
Participants
The workshop brought together stakeholders in Maternal, Newborn and Child health from policy,
Implementation and Partners levels. They included: the Director of Public Health and Sanitation,
Provincial heads, representatives from the development partners (DFID, GTZ, JICA, USAID), the UN agencies (WHO, UNICEF), NGOs (Save the Children, AMREF, HENNET, FHI, JHPIEGO, FCI, PATH,
Capacity project, Clinton Foundation, MCHIP, World Vision, Micronutrient Initiative, PSI),heads and programme managers of technical divisions of the MOPHS (DRH, DCAH, HMIS, Nutrition, Health promotion, NASCOP, Community Strategy), EHS, The White Ribbon Alliance, Training Institutions
4

(Moi Teaching and referral hospital, University of Nairobi, Aga Khan University hospital), CHAK,
Catholic Health Commission, KEMRI Wellcomme, CIFF, and The Nairobi City Council Health services, among others. The complete list of participants is attached.
Figure 1: Section of participants to MNCH retreat
The first 2 sessions reviewed the global, regional and national situation analysis on MNCH and nutrition. These were presented by the following;
 Global and Regional Situational Analysis: o Maternal Health: Dr. Joyce Lavussa WHO o Neonatal and Child Health: Dr. Sanjiv Kumar UNICEF
 Situational Analysis Kenya: o Maternal Health: Dr. Isaack Bashir o Neonatal and Child Health: Dr. Annah Wamae o Nutrition in Achieving MNC Survival Goals: Ms. Grace Gichohi
Key points from these presentations were that:

Sub-Saharan countries are lagging behind other regions in progress towards MDG 1, 4 and 5 targets.
5


Worldwide, 536 000 women loose their life during pregnancy and childbirth every year. The world map below indicates the magnitude of the maternal mortality ratio. Maternal mortality ratio is by far the highest in Sub-Saharan Africa, where 1 in 23 women faces life time risk of dying, when compared to 1 in 2300 in Europe"
 Children living in Africa have a much higher chance of dying before the age of five, and among those, it are the children of the poorest families who will suffer most. Of these 1 in 4 deaths occur during the neonatal period
 There is no sub-Saharan country among the 63 on track for attainment of MDG 1, with 54% of childhood mortality being associated with under nutrition.
Results of the 2008 Kenya Demographic and Health Survey (KDHS) indicate that:

All maternal health indicators remain poor. Kenya is 14 th in the list of the worst 20 countries that contribute the highest numbers of maternal deaths

Child Survival has improved but is being pulled back by the high newborn deaths. (In 2008
DHS, neonatal mortality has increase to 60% of the IMR, up from 45% in 2003).

Nutritional indicators have also largely remained unchanged over the last decade.
Available strategies were reviewed and outlined by;

The Maternal and Newborn Health as outlined in the National Roadmap which is adapted from the African Union Road Map: Dr. Shiphrah Kuria, DRH

The Child survival and Development Strategy: Dr. Annah Wamae DCAH
 The Nutrition and Infant and Young Child Feeding strategy: Ms. Grace Gichohi, DN
 The Community Strategy: Dr. James Mwitari, Division of Community Health Services.
Discussion following the presentations focused on the need to rally other players from different sectors e.g. Ministry of Education, Gender, Agriculture, Social services, Youth, Roads, Transport and Communication, Finance, Office of the president etc, since reduction of MNC morbidity and mortality goes beyond the health sector.
The operations research component and health financing issues need to be highlighted strongly in all the MNCH and nutrition strategies.
6

The use of local best practices that are cost effective in reducing maternal, newborn, and child morbidity and mortality needs to be scaled up.
Figure 2: A Group work session
Participants in 5 groups identified the problems /bottlenecks slowing Kenya’s progress towards attaining the MNCH and nutrition targets.
The groups looked at: 1) commodities; 2) Monitoring of data flow/ HMIS, 3) Communication for behavior change, 4) Human resources, 5) Referral and quality assurance
Group 1: Commodities for MNCH

Challenges were identified as inadequate financial allocations and delays in disbursement of procurement funds, Inadequate capacity of human resources for logistics management,
Unavailability of reporting tools and poor reporting , Push system is a challenge leading to mal-distribution of commodities , Delayed deliveries of commodities

It was proposed that: concerned departments and divisions to advocate for adequate funding allocation in the MTEF process, Capacity strengthening be done at all levels on logistic management, and beaurocratic and legal delays be addressed
7


There is need for divisions working in MNCH to engage with and participate in the commodities and supplies ICC
Group 2: Monitoring of data flow/ HMIS
 Key challenges included: incomplete data in 50 -70% of districts, multiplicity of reporting tools, low numbers of records officers/ skilled HMIS personnel, and low capacity for utilisation of data
 Suggested interventions included- Capacity building for data management, harmonisation of tools, prioritisation of key indicators and supportive supervision.
 It was proposed that the private sector and FBOs be encouraged to submit their data to the district, provincial and central level
Group 3: Communication for behaviour change

Challenges include: poor articulation/ understanding of the community strategy, communication strategies not user friendly, low participation of communities in design , development and dissemination of messages, demand created when services are not yet available.

To address this, capacity building for IEC/BCC, Strengthen linkages at all levels, and all partners need to work in synergy

There is need to avoid demand creation without commensurate services being in place
Group 4: Human resources for MNCH
 Challenges noted include: HRH coverage and poor deployment of available staff; this is augmented by deficient competencies in MNCH, lack of harmonised guidelines, and inadequate facilitative supervision. Poor staff attitudes have also been noted to affect quality of service provision
 Short term measures to address these include: Onsite training / mentoring for higher level facilities (level 4 and above), Revitalise or strengthen rural health facilities for the lower level, rational and equitable distribution of available staff, and integrated MNCH facilitative supervision
8


The government under the economic stimulus package is set to deploy 20 additional nurses per constituency. The USAID is also supporting contract hiring of health workers for hard to reach areas.
Group 5: Other health systems challenge s (Referrals, Q/A)
 Challenges included: lack of collaboration with other key ministries (transport, roads, security, etc); lack of community based referral systems, deficient communication and feedback mechanisms, deficient competencies in management of referral systems
 Suggested measures to address this included: Strengthening community referral systems, review GOK referral management system and strengthen linkages with other sectors
 With regard to quality of care there is no standardised quality improvement system or tools in place. Short term measures to address this include revitalisation of Quality Management committees, audits, and COPE (client-oriented, provider-efficient services).
Figure 3: Thank God its break time
9

Day 2:
In this session, the good practices from global experience and some countries that have made a good progress in maternal, newborn and child survival were highlighted and discussed.
Accelerating Child Survival and Development- Malawi Mr. Humphreys Nsona, National IMCI/ACSD
Coordinator, MOH Malawi
Malawi has been able to accelerate child survival and development (and overshoot their MDG targets) by investing in simple cost effective interventions. Malawi’s package of services emphasized community participation, selected outreach / facility based interventions, as well as individual oriented curative services. The country has an established community structure that supports a cadre of staff that is able to provide simple and safe basic promotive and curative care for the most important causes of child morbidity, such as acute malnutrition, malaria, pneumonia and diarrhoea to save lives in the interim, while referring more complicated cases of pneumonia, sepsis.
Operationalising of the Child Survival and Development Strategy Dr. Vincent Orinda, UNICEF
Evidence based High Impact Interventions (HII) to operationalise child survival and developments as outlined in the Lancet series were disseminated. These include both preventive and treatment as summarized below:
Preventive
 Breastfeeding
 Insecticide-treated materials
 Complementary feeding
 Water, sanitation, hygiene
 Hib vaccine
 Zinc
 Vitamin A
 Antenatal steroids
 Newborn temperature management
 Tetanus toxoid
 Nevirapine and replacement feeding
 Antibiotics for premature rupture of membranes
 Clean delivery
 Measles vaccine
 Antimalarial intermittent preventive treatment in pregnancy 10
Treatment
 Oral rehydration therapy
 Antibiotics for pneumonia
 Antimalarials
 Antibiotics for sepsis
 Newborn resuscitation
 Antibiotics for dysentery
 Zinc
 Vitamin A

To operationalise this, the country needs to prioritise their interventions and to ensure that the government leads the process.
Overview of Best Practices in preventing maternal mortality – Dr. Nancy Kidula, WHO
Success stories to reduce maternal mortalities in various countries covering Skilled Birth
Attendance, Family Planning, Transport, advocacy, multi-sectoral approach were also shared. These included simple, cost effective interventions such as: increased numbers and coverage of skilled birth attendants as in the case of Thailand, Sri Lanka and Malaysia; Increased advocacy for MNH by
White Ribbon Alliance; and strengthening community initiatives as in Eritrea.
Reducing Maternal Mortality by Focusing in PPH Prevention - Dr. Marsden Solomon, KOGS
The KOGS also shared the concept paper for reducing maternal mortality by focusing on prevention of PPH. There following areas need to be strengthened

Intensify Advocacy for prevention and reduction of complication rates of PPH

Strengthen the health systems targeting the delivery of services-both public and private sector involved in the prevention of PPH

Improve the PPP[Public –Private partnerships ]

Improve the linkages with other line ministries

Strengthen community based services –including referrals with regards to prevention and
/or reduce the complications rates of PPH
This session reviewed, discussed and identified the good practices from Kenyan experience that have the potential to accelerate our progress in maternal, newborn and child survival.
Experiences from Kenya included:

Child- Mother Health and Nutrition weeks (Malezi Bora) initiative presented by: Mr. Crispine
Ndeda, DCAH. Malezi Bora has been cited as a success story in the region. This focuses on increasing the utilization and improving the delivery of routine evidence based health and nutrition services for children, expectant women and lactating mothers and women of
11

reproductive age in Kenya. The importance on focussing on a smaller package of high impact interventions during outreaches was highlighted
 AMREF BUSIA Child survival project presented by Angela Nguku, AMREF. This project utilizes community structures, innovative BCC approaches, advocacy and capacity building to increase access to and utilization of maternal and newborn services, reduce malaria incidence in pregnant women and under 5s, and reduce neonatal HIV infections
 The Family Care International (FCI) project in Yatta presented by: Angela Mutunga, FCI. This project aims at Increasing Community Participation in Health Systems Strengthening for
Improved Maternal health by increasing community participation in maternal health service delivery, engaging community leaders in increasing service utilisation, and strengthening health facility management for improved maternal health.
In summary, the role of advocacy at all levels for improvement of MNCH was highlighted. Key elements of success included: strong leadership, good coordination across sectors, strong emphasis on community involvement, adequate resources, monitoring and evaluation including facilitative supervision.
Participants were divided into 6 groups to identify the priority High Impact interventions required to accelerate progress towards attainment of MNCH and nutrition targets both at community and facility level. The results of these discussions are highlighted below:
12

Community- L1

Demand creation for early
 initiation of ANC
Individualised birth plan and
Emergency preparedness

Community actions to promote skilled care
Facility level- L2, L3, L4

Four timely focused ANC visits with a focus on: o Individualised Birth Plan and Emergency Preparedness o Prevention and management of pregnancy complications
( IPT, iron and folate, TT, PMTCT, MgSO4, micronutrients)

Emergency Obstetric Care- Administer IV oxytocin, IV antibiotics,
Magnesium sulphate, Manual removal of placenta, removal of retained POCs, Assisted delivery, Blood transfusion, and caesarean section

Active management of third stage labour

Monitoring labour using partograph

Skilled attendance within first 24-48 hours after delivery

PNC

Long acting and permanent FP methods

Conduct maternal and perinatal death reviews

BCC for FP, PNC, Newborn and child care practices

BCC to promote skilled attendance with first 24-48 hours after delivery

Hygienic cord care

Newborn temperature management

Hand washing with soap by caregiver

Early initiation and EBF

Complementary feeding

Vitamin A

Immunization

LLITN

ORT and Zinc

Safe drinking water

Hand washing with soap by caregiver

Temperature management

Antibiotics for neonatal infections

Newborn resuscitation

ARV prophylaxis

Early initiation and EBF

Complementary feeding

Vitamin A

Immunization

LLITN

ORT and Zinc

ACT

Antibiotics for childhood pneumonia

Early Infant Diagnosis of HIV

ART
Summary – The discussions highlighted that the existing challenges are already known and a paradigm shift in addressing them is required. The discussions highlighted the lack of scaling up of recommendations from pilot studies that have shown positive results. Possible approaches include: establishing structures to ensure that allocated funds reach the lower levels, improving the quality of care provided at all levels (including, addressing the attitude of the workers, privacy, and sensitivity to gender-cultural issues to include ensuring the availability of female attendants in cultural sensitive regions), and devising innovative and cost effective approaches of implementing key strategies.
13

The role of Communication in achieving MNCH goals – Dr. Salim Hussein, DHP, MOPHS
These were defined as follows:
1.
Educate families through social mobilization to adopt and sustain desirable behavior
2.
Create demand, provide supplies and educate and motivate families to use these
3.
Create demand to avail services, provision of quality services and educate families, social mobilization to avail services
4.
Families identify danger signs early and know where to go.
Malezi Bora and Hand washing (SOPO) are among the MNCH initiatives that have had an intensive health promotion component.
The role of HMIS in achieving Maternal, Neonatal, Child health and Nutrition goals – Mr. Pepela
Wanjala, HMIS MOPHS
HMIS is focusing on harmonising and standardising health sector indicators, supplying harmonised summary tools to the facilities, and training service providers on use of these tools. The file transfer protocol (FTP) system has been set up at AFYA house which collates all data from districts and provinces, and can be used for analysis and generation of graphs etc Data generated can be easily retrieved and utilized for planning and resource allocation.
It was reported that HMIS is in the process of finalizing and adoption of the Community Health
Information systems tools for national roll out.
Challenges with HMIS include inadequate human resources, and limited financial allocation.
The last group work session reviewed key action points needed to accelerate high impact interventions for maternal, neonatal and child survival and development (MNCSD) and how they would be monitored. The groups included;
Partnership, coordination and leadership and advocacy for accelerated MNCSD
It was noted that there was lack of leadership and coordination by MOPHS and MOMS was an issue, hence the need for strong leadership and advocacy, to ensure that the acceleration of
MNCSD is put high on the government’s agenda. Partners were also not willing to move away from
14

their own agenda which would sometimes not be in line with the government agenda. One of the ways this could be done is by establishing a “working group” of MNCH and child survival that would feed to the various ICCs. This working group would also coordinate the inputs of various Ministries that have a stake in the MNCSD agenda. Provinces and districts also need to be empowered to better coordinate and/or reactivate the stakeholder coordinating groups to strengthen programming. The roles of the NGOs and partners need to be clearly defined. Mapping of who is doing what and where they are located in the provinces and districts was noted as a priority for resource planning and mobilisation.
Resource allocation
The government and partners should honour their commitments to resource allocations to enable programming to continue. There should also be transparency and disclosure by stakeholders so that the resource envelop is known. This is one of the key SWAP objectives.
Synergy among partners
All Partners need to be oriented on the HII so that they include them in their planning processes. Joint planning, monitoring and evaluation would be strengthened. The district stakeholders’ forum can be an avenue for this
Acceleration at the community level
Acceleration of MNCH at community level can be done through strengthening Community involvement and participation as well as outreach activities. Efforts should be made to scale up the community maternal and newborn guidelines.
Commodities and supplies
The government needs to take the lead in coordinating a streamlined procurement and distribution system and also put in more resources for procuring MNCSD supplies and commodities. The roll-out of the pull distribution system needs to be countrywide. Stock monitoring needs to be strengthened
Monitoring and evaluation
15

One of the key steps to strengthen the M&E would be to establish an M&E working group with clear terms of reference. Quality Assurance Teams would also be established and institutionalized with clear guidelines on standard operating procedures, DQA and evidence of use. There was also need to review and revise the current MNCSD supervisory tools. Reporting should be based on
District denominators obtained from Central Bureau of Statistics at the national level. This would provide a standardized figure and hence a better picture of progress being made.
In his concluding remarks, the DPHS outlined the components of the Economic Stimulus Package which aims at upgrading the infrastructure of health facilities, increasing the number of human resources by 20 health workers per constituency, and yearly procurement of drugs amounting to
KSH one billion with the higher proportion of about KSH 700 million allocated to drugs and the balance to vaccines.
He outlined the establishment and operationalisation of the HSSF (as performance based financing) to facilitate disbursement of funds especially to level 2 and 3 facilities.
Calling on the stakeholders’ to make a deliberate and concerted effort to ensure that the interventions identified during the meeting are implemented, the DPHS reaffirmed the commitment of his office and the Minister’s in improving the MNCH indicators. As a follow-up step, he called for a meeting in September 2010 to assess the progress being made to accelerating progress towards MDG 1, 4, 5 and 6.
Figure 4: Dr Shariff- DPHS makes his remarks
16

This is outlined in the attached communiqué.
ACCELERATION OF MATERNAL, NEWBORN AND CHILD SURVIVAL IN KENYA
Setting a national agenda-March 2010
Background
Kenya has recently registered encouraging improvements in child survival indicators over the period 2003-2008/9. On the other hand, we hardly made any progress with maternal neonatal health and nutrition indicators over the same period. The preliminary Kenya Demographic Health
Survey (KDHS) 2008/9 showed reductions in Infant Mortality Rate (IMR) from 77 per 1000 live births in 2003 (KDHS 2003) to 52 per 1000 live births in 2008/9. The Under Five Mortality Rate reduced from 115 to 74 per 1000 live births over the same period of time. It is thought that the improvements seen in child survival during that period could be explained by the scale up of high impact evidence based interventions such as Insecticide Treated Nets (ITNs), Artemisinin
Combination Therapy (ACTs) and Vitamin A supplementation
The neonatal mortality rate only reduced marginally from 33 to 31 per 1000 live births between 2003 and 2008/9. Only 43 percent of women were delivering in health facilities by 2008/9
(KDHS, 2008/09). Over the same period exclusive breastfeeding rates, 0-5 months, increased from
13% to 32% and at 6 months from 3% to 13%. However this was noted to be still way below the target. Nutrition related indicators continue to show significant regional disparities with the arid and semi arid areas showing high levels of stunting. The national average distances to domestic water points have increased to 25-30 km against the normal of 7 kms. This has had a corresponding effect on the quantity of water available for domestic use with the average down to less than 5 litres per day compared to the recommended 5-10 litres per day (KFSSG 2009). Only 42 percent of the population has access to a safe drinking water supply and 46 percent has safe sanitation in
2007 1 while handwashing is very low despite their importance in the prevention of diarrhoea and neonatal sepsis.
1 2007 WHO UNICEF Joint Monitoring Program
17

Setting the Agenda for Accelerating Maternal, Newborn and Child survival
A national stakeholder’s workshop on acceleration of maternal, newborn and child survival was convened by the Ministry of Public Health and Sanitation in March 2010. The workshop achieved consensus on the following outcomes:
1.
Prioritization of selected high impact interventions for maternal, newborn and child survival and,
2.
Identification of cardinal actions, commitments and timelines which stakeholders will implement towards the acceleration of maternal, newborn and child survival.
Community- L1

Demand creation for early initiation of ANC

Individualised birth plan and
Emergency preparedness
Facility level- L2, L3, L4

Four timely focused ANC visits with a focus on: o Individualised Birth Plan and Emergency Preparedness o Prevention and management of pregnancy complications
( IPT, iron and folate, TT, PMTCT, MgSO4, micronutrients)

Community actions to promote skilled care

BCC for FP, PNC, Newborn and child care practices

BCC to promote skilled attendance with first 24-48 hours after delivery

Hygienic cord care

Newborn temperature management

Hand washing with soap by caregiver

Early initiation and EBF

Complementary feeding

Vitamin A

Immunization

LLITN

ORT and Zinc

Safe drinking water

Emergency Obstetric Care- Administer IV oxytocin, IV antibiotics,
Magnesium sulphate, Manual removal of placenta, removal of retained POCs, Assisted delivery, Blood transfusion, and caesarean section

Active management of third stage labour

Monitoring labour using partograph

Skilled attendance within first 24-48 hours after delivery

PNC

Long acting and permanent FP methods

Conduct maternal and perinatal death reviews

Hand washing with soap by caregiver

Temperature management

Antibiotics for neonatal infections

Newborn resuscitation

ARV prophylaxis

Early initiation and EBF

Complementary feeding

Vitamin A

Immunization

LLITN

ORT and Zinc

ACT

Antibiotics for childhood pneumonia

Early Infant Diagnosis of HIV
18


ART
1.
The Director PHS will issue a twice yearly bulletin to all stakeholders on new developments in the health sector such as the Community Strategy, HSSF, HRH, and Infrastructure
Development e.t.c.
2.
The Director PHS will convene national annual forum to review progress in accelerating
MNC survival just before commencement of AOP process.
3.
The Director PHS will issue a bulletin outlining the cardinal actions, commitments and timelines for acceleration of Maternal, Newborn and Child survival to all stakeholders in the health sector as well as in other sectors 1 week after the national annual review forum for accelerating MNC survival.
4.
Programme managers in the Ministry of PHS and partners will include high priority MNC
Child survival in all quarterly Interagency Coordinating Committee meeting agendas including Commodity and Supplies ICC.
5.
The heads of Reproductive Health, Child Health, Nutrition, Hygiene and Sanitation will conduct partner mapping for MNCH for resource identification and targeting.
6.
The heads of Reproductive Health, Child Health, Nutrition, Hygiene and Sanitation will finalize the MNC survival Road Map using multi-sectoral engagement to clarify roles and responsibilities.
7.
The Director PHS will develop RRI schedule based on high impact interventions for MNC survival by end of May 2010. The director will build leadership and management capacity for MNCH (RRI) at national, provincial and district levels.
8.
The head of HMIS will review AOP monitoring indicators to include priority high impact interventions (HII).
1.
The Provincial Directors will convene quarterly Provincial Health Stakeholder forum focusing on acceleration of MNC survival.
19

2.
The Provincial Directors will prioritise selected high impact interventions outlined above in the AOP 6 process before end of April 2010.
3.
The Provincial Directors will conduct partner mapping for MNCH for resource identification and targeting.
4.
The Provincial Directors will initiate onsite supportive supervision in the provincial hospital and provincial management level.
5.
PHMTs will participate in supportive supervision and monitoring of district and other lower levels.
1.
The DMOs will convene quarterly District Health Stakeholder forum focusing on acceleration of MNC survival.
2.
The DMOs will prioritise selected high impact interventions outlined above in the AOP 6 process before end of April 2010.
3.
The DMOs will conduct partner mapping for MNCH for resource identification and targeting.
4.
The DMOs will initiate onsite support supervision in the District hospital and District management level.
5.
DHMTs will participate in supportive supervision and monitoring of health centres, dispensaries and community while specifically focussing on completeness of HMIS at all levels.
6.
DHMT, District Accountant and District Internal Auditor will monitor the implementation of
HSSF at level 1, 2, and 3.
7.
Strengthen FTP HMIS
1.
The facility I/C will initiate onsite supportive supervision in their respective facilities.
2.
I/C to coordinate Planning and implementation of selected priority high impact interventions for the level of care as shown in table 1 above.
3.
I/C will oversee HSSF implementation at Level 2 and 3
4.
I/C will maintain up to date HMIS and up load to central server through file transfer protocols.
20

1.
The CHEW will coordinate planning and implementation of priority high interventions at the community as shown in table 1 above.
2.
CHEWs to initiate onsite supportive supervision at the community level.
21

1
2
List of participants
Name
Dr. S K Sharif
Absalom Ingabo
Ministry/
Organization
MOPHS
MOPHS
3 Angela Njiru
4 Annie Gituto
MOPHS
MOPHS
5 Dr. Bashir M Issak MOPHS
Carolyn C
6 Kenduiwa MOPHS
7 Crispin Ndedda MOPHS
8 Dr. Annah Wamae MOPHS
9 Dr. Wago D Ejersa MOPHS
10 Grace Gichohi MOPHS
Title/Department
Director, Medical
Services
PCO Western
Health
Prog Manager
Head DRH
Telephone
Email
0733 813449 sksharif@africaonline.co.ke
0722 865183 ingaboabsalom@yahoo.com
0722 605 687 wangainjiru@yahoo.com
pmonairobi@yahoo.com
0722 370 122
0722 - 318 084 wangmaina78@yahoo.com drbashiri@yahoo.com
Nutritionist - PGH Nakuru 0724 - 754 682 chepck@yahoo.ocm
DCAH 0722 645 384 ndedda@yahoo.com
Head, DCAH
PDCHS - Rift Valley
Div of Nutrition
0722 674 681
0720 846127
0721 971 572 dchildhealth@swiftkenya.com pmorvp@yahoo.com gichohigrace@yahoo.com
11 Grace Wasike
12 Judith Karia
MOPHS
MOPHS
13 Dr. Osman Warfa MOPHS
14 Rachel Randu MOPHS
Prog Officer - DCAH
Dept of Health
Promotion
PDPHS
District Clinical Officer
0720 55 4171
0723 586 832 /
0734 242215 grewasike@gmail.com
020 2721507 newnessnew@yahoo.com
0726 - 846809 owarfa@yahoo.com randurachel@yahoo.com
15
16
Raphael K Njue
Dr. Salim Hussein
MOPHS
MOPHS
PCO Eastern Province
Head, Division of Health
Promotion
DRH - Prog Officer
0722 459 414 njueraphael@yahoo.com saalhu@yahoo.com
17 Sellina Cherutich MOPHS
Dr. Shiphrah N
18 Kuria MOPHS - DRH Prog Manager
0721 884338 siematur@yahoo.com
0722 300279 shiphonk@yahoo.com
19 Esther Oloo MOPHS - Nakuru DNO 0722 327 937 swaknku@yahoo.com
0722 922
466/0733 709
388/057 2023
176 ngwallacharles@yahoo.com 20 Charles Ngwalla MOPHS - Nyanza PCO/Rep PDPHS Nyanza
21
Dr. Jennifer
Othigo MOPHS & MOMS RH Coordinator 0722 411 545 mj_othigo@yahoo.com.au
22

22 Dr. Alfred Owiti
Lydia Njuki
23
24
25
26
Mwangi
Evangeline K
Mugo
Patrick O Kamo
William Macharia
MOMS
MOMS
MOMS
MOMS - Nyanza Rep PDMS - Nyanza
AKU
Prov Dentist - Nairobi 0722 797266 aowiti@yahoo.com
0722 28 47 22/
SACCO PGH Nakuru
Nursing Council of Kenya
0734-284722 ladimwa@yahoo.com
0723 703 137 evangelinemugoh@yahoo.co
m
Prog Officer
0721 546 843 plokamo2007@yahoo.com
0733
627077/36620
40 william.macharia@aku-edu.
27 Peter Ofware
28 Angela Nguku
29
Dr. Gathari
Ndirangu
30 Titus Munene
AMREF
AMREF/WRA
Capacity/DRH
Catholic Health
Commission
(KEC)
Prog Manager
Prog coordinator
RH Technical Advisor
Training and Nursing
Services Manager
0720 337856
0722 365434
0720 102 602
0722
980431/020-
4443133 peter.ofware@amref.org angela.nguku@amref.org gndirangu@intrahealth.org tmaeti@catholicchurch.or.ke
31 Joseph Oyongo
32 Henry Kilonzo
33 Rosemary Kihoto
34 Allan Govoga
CHAK
CIFF
Clinton
Foundation
DCAH/MOPHS
35 Tony Daly
36
Dr. Margaret
Meme
37
Dr. Paul
Dielemans
DFID
DRH/MOPHS
EHS
38 Angela Mutunga FCI Kenya
Dr. Marsden
39 Solomon FHI
40 Dr. Klaus Hornetz GDC/GTZ
41 Cynthia Macharia GDC/KFW
42 Maisori Thorm
43 Dr. Patricia Odero GTZ
HENNET 44 Allan Oginga
GTZ
Training Officer 0722 487 138 jmoyongo@chak.or.ke
Monitoring & Evaluation 0721 294 576 henry@ciff.org
Prog. Manager-
Paediatric 0727 494 715 rkihoto@clintonfoundation.or
g
Prog Officer - DCAH
Reg Maternal Health
Advisor
0722 235670 allangovogah@yahoo.com
0735 22 6313 a-daly@dfid.gov.uk
Prog Manager - Gender 0722 849835 magmeme2004@yahoo.com
MNHTA
CD
Reg. Medical Advisor
(RH)
0723-774963 pdielemans@liverpoolvct.org
0724 975 955/
443204/3167 amutunga@fcimail.org
0722 736 813 msolomon@fhi.org
0724 260 287 klaus.hornetz@gtz.de Director
Prog officer
Health Sector
Component Head
0722 279 802 cynthia.macharia@
0717
491147/272
5684 thorm.maisori@gtz.de / thorm.maisori@hotmail.com
0721 316 457-
2725684 patricia.odero@gtz.de
0720 677 577 hennet.advocacy@amref.org Advocacy & Comms
23

45 Dr. Kazuko Kumon JICA
46 Yamiko Nakahara JICA
47 Mike English
KEMRI-
WELCOME
48
Dr. Chris
Wanyoike MI
49 Humphreys Nsona MOH- Malawi
50 Peter Gisore
51
Dr. Ambrose
Misore
Moi University
PATH
52 Janet Shauri
53
Wanjiru
Mathenge
54
55
Catherine
Fitzgiblon
Metasebia Gizaw
Balcha
PATH
PSI - Kenya
SCF-UK
SCF-UK
56 Fredrick Donde
57 Martin Ocholi
UNICEF
UNICEF
58 Ruth Situma UNICEF
59 Dr. Grace Miheso UNICEF
60 Dr. Sanjiv Kumar UNICEF
61
Dr. Kennedy
Ongwae UNICEF
61 Dr. Vincent Orinda UNICEF
62 Dr. Juan Ortiz UNICEF
63 Doris Kamawera UNICEF
64
Dr. Blasio Osogo
Omuga
University of
Nairobi
65
Dr. Sheila
Macharia USAID Kenya
66 Lilian Mutea USAID Kenya
USAID MCHIP 67 Nancy Koskei
PFA
Prog Quality Director
Health
WASH
Communication for
Development kumon.kazuko@jica.jp
PFA
Senior Researcher nakahara.yumiko@jica.go.jp
0722 628700
Country Director 0729 110200 cwanyoike@micronutrient.org
+265 999 510
272; +265 1759
563 hnsona@gmail.com IMCI/ACSD
Researcher/Lecturer
Neonatoglogist 0725 619 549 gisore2007@yahoo.com
0722 810411 amisore@path.org PD
Prog Officer 0713 786382 jshauri@path.org
CS Programme Manager 0722 968209 wmathenge@psikenya.org
0733 988004 c.fitzgibbon@scuk.or.ke
0737 148793 m.balcha@savethechildren.or
g.uk
0722 711940 fdonde@unicef.org
0733 731216 /
7622171 mochali@unicef.org
Nutrition Specialist
Health Specialist
Chief, CSD
Health Specialist
Consultant
Dep Representative
Program Assistant
Lecturer
Senior Health Advisor
Prog Management
Specialist- MCH/FP/RH
Programme Advisor
24
0722 742865
0722 711 466
0724 255541
0733 554139
0717 592 887
0722 448484
0722 256080 rsituma@unicef.org gmiheso@unicef.org ksanjiv@unicef.org kongwae@unicef.org orinda2006@unicef.org
0722 52 9714 jortiz@unicef.org dkamawera@unicef.org mitenga@yahoo.com
0713 601472 smacharia@usaid.gov
0722 676753 /
86224 33 lmutea@usaid.org
0720 740 977 /
3751882/84 nkoskei@jhpiego.net

68
Dr. Assumpta
Muriithi WHO
69 Dr. Christine Kisia WHO
70 Dr. Rex Mpazanje WHO
71 Dr. Joyce Lavussa WHO
72 Janet Kagai WHO
CAH/NUT
Health Promotions
Officer
Technical Officer
NPO/FRH
Prog Assistant
73 Dr. Nancy Kidula WHO MPO/MPS
74 Dr. Kibet Sergon WHO
75 Mary Kihara
World Vision
Kenya
EPI
Health
Figure 5: Dr Sanjiv (UNICEF and Dr Mpazanje (WHO)
0723 412 992 muriithia@ke.afro.who.int
0721 213969 kisiac@ke.afro.who.int
0736 416660/
2717902 mpazanjer@ke.afro.who.int
0722 785 941 lavussaj@ke.afro.who.int
0722 750
234/2717902 kagaij@ke.afro.who.int
0733 614087/
2717902 kidulan@ke.afro.who.int
0722 659 568 sergonk@ke.afro.who.int
0722 572 881 mary_kihara@wvi.org / mjwkihara@yahoo.com
25

A G E N D
1730 – 1830 Arrival and Registration
Chair: Dr. Isaack Bashir Facilitator: Dr. Rex Mpasanje
08:15 – 09:00 Welcome and Introduction: Dr. Isaack Bashir
 Opening remarks
 Objectives, agenda of the meeting
09:00 – 10:50 Session 1:
Outcome: Participants are updated on and discuss the situation of Maternal, newborn and child survival in Kenya, in East and South Africa region and global and identify areas which need priority attention in Kenya

Global and Regional Situational Analysis: o Maternal Health: Dr. Joyce Lavussa WHO (10 mins) o Neonatal and Child Health: Dr. Sanjiv Kumar UNICEF (10 mins)

Situational Analysis Kenya: o Maternal Health: Dr. Isaack Bashir (15 mins) o Neonatal and Child Health: Dr. Annah Wamae (15 mins)

Nutrition in Achieving MNC Survival Goals: Ms. Grace Gichohi (15 mins)

Role of Communication in achieving MNC goals: Dr. Salim (10 mins)

HMIS and Reporting on MNCH : Mr. Pepela Wanjala (10 mins)
Discussion (20 mins)
10:50 – 11:10 Tea/Coffee
11:10 – 13:00 Session 2: Overview of Strategies in Kenya
Outcome: An overview of strategies in Kenya is presented and discussed. The priority interventions for scale up are identified
(15 minutes each)

Child Survival and Development Strategy: Dr. Annah Wamae

Maternal Neonatal Health Roadmap (Draft): Dr. S. Kuria

Infant and Young Child Feeding Strategy : Ms. Grace Gichohi
Discussion (20 mins)
26

13:00 – 14:00
14: 00 – 15:30
15:30 – 16:00
16:00 – 17:30

The Role of the Community Strategy in the Attainment of MDG 1, 4 and 5: Dr.
Odondi
Discussion (30 mins)
Lunch
Session 3: Group Work
Outcome: The participants in five groups discuss what can be done to address the problems/bottlenecks preventing us making progress towards the targets in
maternal, newborn, child health and nutrition
Briefing on Group Work (Annex I)
Tea/Coffee
Session 4: Group Presentation and Discussion
Chair: Dr. Jennifer Othigo Facilitator: Dr. Vincent Orinda
08:30 – 08:40
08:40 – 10:30
Feedback from Day 1
Session 5: Learning from Global and Regional Good Practices
Outcome: The participants review, discuss and identify the good practices from global experience and some countries that have made a good progress in maternal, newborn and child survival.

Accelerating Progress Towards MDG 4 and 5: Mr. Humphreys Nsona, National
IMCI/ACSD Coordinator, MOH Malawi

Overview of the Best Practices in Maternal Health: Dr. Nancy Kidula, WHO

Operationalising of the Child Survival and Development Strategy: Dr. Vincent

Orinda
Reducing Maternal Mortality by Focusing in PPH Prevention: KOGS Dr.
Marsden Solomon
10:30 – 11:00
Discussion
Tea/Coffee
27

11:00 – 13:00 Session 6: Learning from Experience in Kenya
Outcome: The participants review, discuss and identify the good practices from
Kenyan experience that have the potential to accelerate our progress in maternal, newborn and child survival.

The Role of the Community Strategy in the Attainment of MDG 1, 4 and 5

Malezi Bora: Crispine Ndeda, DCH

Systems Strengthening at Community Level: Angela Mutunga Country Director
Family Care International

Busia Community Maternal Newborn Health Project: John Nduba AMREF

Role of Communication in achieving MNC goals: Dr. Salim
Discussion

Role of HMIS in achieving MNC and nutrition goals
Discussion
Lunch 13:00 – 14:00
14:00 – 15:30 Session 7: Group Work
Outcome: The groups break into the maternal and child health cohorts and discuss two to three priority interventions needed to accelerate the scale up of MNC and nutrition
Tea/Coffee 15:30 – 16:00
16:00 – 17:30 Session 8: Group Presentation and Discussion
08:00 – 08:10
08:10 – 09:30
09:30 – 09:40
09.40 – 09.50
Chair: Dr. SK Sharif Facilitator: Dr. Vincent Orinda
Session 9 Remarks from Dr. SK Sharif, Director MOPHS
Presentation of group work
Discussion
Role of HMIS in achieving MNC and nutrition goals: Pepela Wanjala
Discussion
28

09:50 – 12:30
12:30 – 13:30
13:30 – 14:30
14:30
Session 10: Group work 3
Outcome: Groups to review key action points needed to accelerate high impact interventions for Maternal, Neonatal and Child Survival and Development
(MNCSD)and how they will be monitored
Groups
1.
Leadership and advocacy for accelerated MNCSD
2.
Partnership and coordinating mechanism for improving MNCSD
3.
Synergy among programs for accelerating HII
4.
Acceleration of MNCS at community level
5.
Commodities and supplies
6.
Monitoring and evaluation a.
Identify core indicators based on priority HII b.
Include how to provide integrated supportive supervision c.
Assessing district performance
Presentation of group work and discussion
Tea/Coffee during group work
Session 10: Way Forward and Concluding

Summary of priority interventions

Statement of commitment for accelerating MNCH and nutrition

Way forward

Closing remarks
Lunch
Departure for Nairobi
29