Roll out CD4 testing; Cryptococcal testing and treatment for AHD patients;

·      Mapping and optimization of the CD4 testing through the already existing mechanism to improve baseline CD4 testing. This has moved testing for CD4 from 50,359 to 96,964 leading to 92.5% increase.

·      Cryptococcal Meningitis testing among the PLHIV with a CD4 below 200 cells/mm³ has increased from 26,918 to 31,095.

·      Rationalization of the already existing treatment for cryptococcal meningitis this is to ensure that all the level 5 and 6 facilities are equipped to treat the disease.

·      CHAI in collaboration with the ministry of health, NASCOP, has worked on the inclusion of 5FC and AmBisome in quantification and have received product commitment for the products in COP 23. The use of this product will start in the second quarter of this year.

·      A clearly mapping of the spoke and hub model has been established for the management of complex AHD cases.

We still have CD4 POC lateral flow pending introduction. Evaluation planned to be done in the 1^st quarter of 2024 after which the role out will happen in 2^nd quarter of 2024

COVID Test and treat model : Upadting M&E tools to capture the data required to track Paxlovid roll out and uptake in 25 facilities;

51 facilities supplied with Paxlovid in 23 counties.

Integration of Covid-19 into lung health program being pursued.

Screening of COVID in collaboration with the NCD program;

Currently only the TB program has started bidirectional screening for TB and Covid 19. Through TIBU lite 4624 screened to TB and Covid, 197 Covid 19 cases identified.

There is reduced traction of covid 19 response due to WHO advisory declassifying COVID 19 as global health emergency.

Yet to have a patient initiated on Paxlovid.

Sustaining 95% of patients on 3HP

Uptake is above 90% for PLHIVs and 30% of Household contacts.

Adoption of 3HP among adults’ population PLHIVS and HIV-ve population. 

To increase level of allocation in the new areas eg RSSH- The measure will be indicated by how much money has been put due to your advocacy; influence and ability to pusuade difficult people and to what level have CHAI has managed to allocate funds to these new areas of interest

Development of GC7 funding request happened between February – October 2023 and was successfully submitted in August 2023

The interventions prioritized for RSSH were:

o  Laboratory System Strengthening including national and peripheral.

o  Human Resources for Health (HRH) and Quality of Care

o  Health Financing Systems

o  Community Systems Strengthening

o  Health Sector Planning and Governance for Integrated People-centred Services

o  RSSH Monitoring and Evaluation Systems

o  Health Products Management Systems (HPMS)

o  Program Management

     Currently in the grant making process . A team has been formed.   Submission is set for 15th April 2024.

Increase number of screened patients to 15%.

There is a 14% increment in number of patients screened from 2022 [4,121,686] to 2023[4,816,443].

This is to be accelerated to 20% in 2024

Establish one center of excellence and decentralization to the counties-Tharaka Nithi county is the target county in collaboration with the AHDP team

Initiated the setup in 2 counties Kajiado and Machakos.

For the period of Dec-January 15^th, 2024, in the 2 counties, out of the 780 children who presented with a severe diagnosis, 476 of them were screened for blood sugars (63%)

Expanding to 3 additional counties in 2024, Tharaka N., Nyeri & Nakuru

Increase number of screened patients to 15%.

There is a 14% increment in number of patients screened from 2022 [4,121,686] to 2023[4,816,443].

This is to be accelerated to 20% in 2024

Establish one center of excellence and decentralization to the counties-Tharaka Nithi county is the target county in collaboration with the AHDP team

Initiated the setup in 2 counties Kajiado and Machakos.

For the period of Dec-January 15^th, 2024, in the 2 counties, out of the 780 children who presented with a severe diagnosis, 476 of them were screened for blood sugars (63%)

Expanding to 3 additional counties in 2024, Tharaka N., Nyeri & Nakuru

Follow up with treatment coverage with the facilities which received the device (get the actual numbers treated).

Treatment coverage increased from 18% to 51.9%.

Under reporting due to transition to new updated tools

Ensure reporting tools reach all facilities in our focus counties

Focus counties reporting rate is at 69%; Kenya at 49% coverage.

Some tools are at the central level awaiting to be distributed. Still need for more tools to be printed and distributed

Ensure smooth transition by leveraging on MOH and partners to complement efforts

• procurement of supplies and commodities
• procurement of HPTs
• training of HCWs

USAID and their sub guarantees have trained TOTs and HCWs in 22 counties, procured 150 TA devices. Screening of clients with HPV through CIHEB. Procurement of HPV kits through NASCOP additional HPV kits through GF etc.

Snowball effect from CHAI’s investments into the  cancer space.

Increase portfolio of drugs from 23 to 50

Portfolio now at 34 drugs.

F&Q done for 10 adult cancers excluding paediatric cancers. MTRH and Kenyatta hospital are the only ones managing paediatrics and they did not provide any data.

Complete development of the pharmacy tool.

Inclusion of screening for cervical and breast cancer screening service statistics to be part of the dashboard.

Develop a consolidated M&E framework for assessing performance of NTD program

Catch up of children who missed their vaccination during the rota virus vaccine stock out in 2022

Supported MoH immunization program to conduct catch up vaccination efforts. Q1 coverage was 178%, Q3 84% coverage

Scale up defaulter tracking tool nationally

Supported the pilot of registers in 10 selected health facilities before the national rollout. We supported distribution of registers nationally. All immunizing health facilities have a defaulter tracing register.

Review of facility level screening in Kisii and Busia to inform scale up decision making

The OPD screening was reviewed, and results shared with the MoH for scale-up in all the 8000 immunizing HFs. The intervention showed 34% increase in HPV coverage. The MoH has made it a priority to implement the screening tool their workplan.

Roll out covid-19 routinization in all health facilities

The routinization process of COVID-19 vaccination was started and is still an ongoing process. The screening work in Busia and Kisii counties was part of the integration process. Further supported the MoH in conducting the health facility readiness assessment program to explore how facilities were ready for the COVID-routinization. This assessment report was shared and disseminated to key stakeholders.

Disaggregate 2% zero dose children to understand who they are and where they are

Access to KNBS (Census data) data to perform data analysis was a challenge.

Identify and vaccinate at least 5,000 zero dose children

ZD identified through a mix of strategies. In 2022, at least 180,338 ZD children were identified, in 2023, 19,355 more ZD children were identified (total ZD identified in 2023 was 199,693)

Increase coverage (MR1 – 88%, MR2 -65%, HPV1 – 65%)

We assisted the Ministry of Health in developing strategies for catch-up vaccination campaigns for Measles-Rubella (MR), along with initiatives for tracing defaulters and conducting outreach programs. By the third quarter of 2023, the coverage for the second dose of the MR vaccine had reached 61%.

Work with the HF team to improve allocation in the two (2) health facilities in Kiambu that have received Linda Mama funds

Supported healthcare facilities in enhancing revenue generation through the NHIF, focusing on the Linda Mama and EduAfya schemes. This involved providing training to healthcare workers and conducting monitoring and evaluation in these facilities. Collaborating with both the county and the facilities, we advocated for effective funding, including allocation for immunization programs. However, this objective was not completely met due to different priorities in the allocation and use of funds, which varied according to the priorities of different health facilities.

Scale up LMD work

Scale up was done from 3 counties in 2022 to 7 counties in 2023

Standardised operational integration of temperature sensitive products specifically oxytocin

Sensitization and baseline assessment was carried out and data analysis and dissemination is pending

Provision of oxytocin to all maternal facilities in three (3) counties

Beyond program vaccines mandate.

100% CC capacity extension to all immunizing facilities

CCOP deployed was carried out

Begin process to transition Chanjo to MoH

Initiated transition engagement process with the health directorate team. The discussion is ongoing.

Consolidate vaccines data to central repository

Click house is currently operational and automatically pulls data from KHIS. Other programs can also benefit from this.

Use GIS microplans to support HPV microplanning and scale up

Mapped distance from health facilities to schools to inform distance coverage for HPV outreaches. Additionally, we refined the distribution strategy for vaccines to determine the most efficient routes. Implementation on a larger scale is yet to be initiated.

Provide accessibility index mapping tool to help MoH identify and reach vulnerable groups

Formulated a plan for socio-economic index analysis, but access to data from the KNBS (census) is still pending

Dissemintation of the EDL to 47 counties;

Complete document yet to be implemented. Implementation plan is under GC7 application targeting all 47 counties targeting all service provider in all levels of care.

Initiate active screening of STI -specifically have 1000 tests for NG /CT;

Screening for NG/CT is done for key HIV population but not routinely for other PLWHIV and high risk general population groups. Syphilis screening is being done and plan is to scale it up to more routine testing using the Duo. 

Initiate updating of STI diagnostics algorithms;

Viral Hepatitis/STI TWG was established in Oct 2023 to put in place structures for STI management. Through this TWG(which CHAI is part of) discussions to be heard on the current testing strategies and potential changes. 

Increase visibility of diagnostic platforms with multiplexing capability across the CHAI programs

Managed to link with other programs on multiplexing capacity on the available DX devices.

LIS interoperability across programmatic areas(HIV/TB/Malaria)

Hospital management information system (Medboss/Bliss) integration with Labware LIMS (laboratory information systems) to enhance clinical-laboratory interface and improve quality of data generated, TAT and surveillance data in Level 4/5/6.

Increasing access of 60,000 units of AT across the domains;

The expansion of access to Assistive Technology (AT) devices is currently underway across various domains with the procurement process actively ongoing.

Scaling up rehabilitative services in the country.

We prioritized strengthening the governance, coordination, and human resource aspects of the program, and developed fundamental policy structures, including the Assistive Technology (AT) priority listing for effective supply chain interventions. Additionally, we dedicated efforts to understand the existing models of care and services at the national referral hospital, conducting a baseline survey to support the selection of beneficiary facilities and identify key project areas. Sub-committees have thoroughly reviewed the workplan, aligning activities with the Ministry of Health (MOH) and stakeholders. This phase also involved formulating domain-specific costed annual work plans and creating comprehensive national annual work plans with sequenced activities, alongside developing drafts for Monitoring and Evaluation, facility reporting tools, guidelines, and protocols tailored to specific project domains.

Upskilling HCWs; 25 to be trained on long term courses across the domains (10 physical, 10 audiology;5 speech and language)

Progressing towards our goal of upskilling healthcare workers (HCWs), we have initiated training for 20 individuals in long-term courses spanning various domains. Specifically, 10 individuals are undergoing training in physical health, 2 in audiology, and 8 are being trained in visual.

Intergrate play therapy at 10 service points by end of the year

Our current emphasis has been on formulating a comprehensive implementation plan to guide the entire process of integrating play therapy at designated service points as well as special needs schools. The development of this plan considers the entire patient continuum, with a specific focus on the identified cohort. This includes mapping out the pathway for early identification, screening, and implementing targeted interventions. The goal is to seamlessly incorporate play therapy into the existing framework at more than 10 service points by the end of the year.

Find other partners to support scaling increasing wheelchair units to more than 10K.

By involving a spectrum of partners, the project aims to create a robust ecosystem that addresses the multifaceted needs of individuals requiring assistive devices, contributing to a more inclusive and accessible environment.

Effective redeployment of all trained sub-specialists to the right facilities and right units and they are actively applying their newly acquired skills and making an impact.

All the 139 graduates redeployed rationally. However, one midwife is not supporting service delivery because she forfeited bonding and migrated abroad after graduation. Efforts are being made to recover the money

Rollout Hormonal IUD in 16 Counties and provide the method to 30,000 women

Reduce stock out of FP commodities from 30% to 40% to below 10%

Ensure government funds at least 50% of the contraceptive requirement in the budget in FY 2023/24

A report on the private sector supply chain for FP

Develop mentorship criteria, requirements, rollout plan and approach for National roll out

Finalize and disseminate national hypoxemia baseline assessment and develop county specific action plans for the clinical and engineering teams

Leverage existing data systems to allow more data visibility and use on pediatric indicators using DHIS

Increase the availability of affordable caffeine citrate in the public sector for the management of apnoea of prematurity

FIF legislation and operationalization in 5 counties

We supported and collaborated with AMREF and COG in the process of developing regulations to operationalize FIF in some counties. However, the health reforms slowed down this process.

Strengthen B&R function to better support teams respond timely on their budgets/ spends.

KE-Finance Optimizations with respect to:

• Implementing functional B&R Dashboards (2023 July Deadline).
• Meeting Attendance Registration module and MOH Bulk Payments.
• Fuel Cards Advances Management Module & Fuel/ Debit Card options.
• Leave Dashboard improvements- to also cover field staff and global staff.
• Staff Profile Improvements (to capture HR Data & documents).

Support all staff in strengthening our Internal Control Mechanism.

Creating visibility for the counties in terms of available funds.

This was carried out in 3 counties namely: Siaya, Kiambu and Kajiado in 20 facilities each.

Supported the facilities to optimise revenue raising through NHIF (Linda Mama and EduAfya schemes). We conducted HCW  trainings, developed tracking tools and a dashboard that created visibility for these facilities and the counties. The dashboard outlined the revenues claimed, revenues reimbursed by NHIF and the utilization of the respective AIE’s.

Supporting domestic resource mobilisation to support immunisation program service delivery activities

This was carried out in 3 counties in 20 facilities each across the various sub counties

Immunization outreaches have routinely been supported by partners. Over the years, these funds have greatly reduced, and this meant that facilities had to look for other means of improving coverage by allocating resources to outreaches. We worked with facility in-charges to demonstrate the possibility of improving coverage of HPV vaccinations of girls between 10-14 years of age whilst raising resources. This would be done through the Edu Afya scheme.

Tracking utilisation of funds available specifically towards availability essential commodities

This was carried out in 3 counties in 20 facilities each across the various sub counties

We worked with the county and the facilities to advocate for prudent and efficient allocation and use of the resources available. We also looked at other sources of funds available to the facilities such as capitation money from NHIF, deliveries done through the supa cover (national scheme), DANIDA and county allocations.  The trackers we developed outlined the various vote heads where money is allocated in majority of PHC facilities as well as the gaps therein.   

Initiate establishing routine STI testing in collaboration with diagnostics team

·      STI/VH TWG started

·      The focus areas have been cut out to be NG, CT, Syphilis and HBV

·      STI indicators incorporated in to the SQA/DQA and KENPHIA. This will help the program understand the prevalence better.

The year 2022 just focused on setting up the program. 2023 will focus on look into policy document, algorithms review, quantification and forecasting of STI commodities