Stepping up the pace in Key Population prevention programming in Kenya by establishing a Technical Support unit within Ministry of Health Government of Kenya: Experience from Kenya John Anthony1, Dr. George Githuka2, Bernard Ogwang3, Shem Kaosa4, Dr Seringo5, Parinita Bhattacharjee 1: Head Technical Support Unit: University of Manitoba 2: Program Manager: National STD AIDS Control Program, Ministry of health, Kenya 3: Technical Officer KP outreach: Technical Support Unit: University of Manitoba 4: Field Officer Monitoring and Evaluation: Technical Support Unit: University of Manitoba 5: Head: National STD AIDS Control Program, Ministry of health, Kenya 6: Senior Technical Advisor: University of Manitoba A

Kenya KP size estimates :Consensus report 2013 Female sex workers : 133,675 (this covers all the 7 regions in Kenya) Men who have sex with men : 21,759 (this covers all the 7 regions in Kenya) Injecting drug users : 18,327 (this covers all the 7 regions in Kenya) 2

HIV prevalence among KPs* PopulationHIV Prevalence MSMs (Men Having Sex With Men)18.2% FSWs (Female Sex Workers)29.3% IDUs (Injecting Drug Users)18.7% *Ministry of Health – NASCOP Consensus Report 2013

National Technical Support Unit- Kenya: Problem Statement – Adequate Funding: Inadequate monitoring Poor Program Quality – Interventions generally not led by Program Evidence: Little to no intervention reporting – Inadequate staffing: Existing Government staff at times prioritize program administration rather than hands on Tech Support to partners (due to time, skills constraints) – Duplications/ Overlaps – Little to none program standards/ guidelines

Program management: Strategic in-sourcing for quality assurance GoK recognized that it would benefit from taking advantage of technical capacity available with institutions with appropriate skills, flexibility & capacity. Usually, the Government tries to do it all! Inputs into policy/ guideline development Issuing guidelines, policy and planning Funds release, administration, implementation Developing appropriate monitoring tools Managing in- sourced units Supportive supervision and ‘feel on the street’ quality assurance Inputs into guideline development Issuing guidelines, policy and planning Funds release, administration, implementation Developing appropriate monitoring tools Managing in- sourced units Supportive supervision and ‘feel on the street’ quality assurance In-sourced supportGovernment Programme delivered

The role of quality assurance and supportive supervision units/mechanisms (TSU) 6 Role of government division Issuing guidelines/policiesAdministration Reviews and ensuring support structures deliver against mandate Funds flowsHandling public inquiries Role of TSU Technical inputs into guideline and module development Developing appropriate tools and MIS to monitor program Feet on the street supportive supervision Oversight of implementing partners (NGOs/CBOs) Strategic planning and ‘problem solving’ of emerging issues Implementation Quality assurance

Technical Support Unit: Kenya The unit was established by GoK - MoH in 2012 Team of 11 hired (technically sound on Key population issues) 5 officers were placed regionally to provide hand on support to the implementing partners Since no partner reporting mechanisms were in place, the same was initiated in early 2013 Mentoring and supportive supervision was initiated for implementing partners Field visits were done for 361 days in 29 counties in 80 partner locations coupled with 56 on site trainings (Jan 2014)

Key Results Map key populations implementing partners Develop a reporting mechanism keeping the county and federal sensitivities in place 5 regional trainings done (all 82 IPs) were trained. Reporting improved from near 0 to 95 % consistently. Data analysis done and shared with Government and IPs on program performance To improve data quality, field level tools were developed to capture outreach, program and clinic data applicable to all programs.

Key Results: Services Uptake General improvements in service uptake More Key populations are being met by their peer educators: MSMs: around 30 % every quarter. Similar increases in service uptake to around 20 % every quarter PWIDs: NSP has increased from 0.3 to 11 needles & syringes per person per month with general increases in number of PWIDs being met every quarter This is just a beginning!!!

Key lessons and conclusion Key Lessons – Supportive Government leadership and ownership – Defined roles and responsibilities (Govt: Administration, Procurements, Finance TSU: Technical support functions – Feet on the ground) – Co-located TSU within the Government Offices Conclusion – Adds extra hands to a department/ ministry – Improves speed and reduces turnaround times – Improves program efficiency and effectiveness – Provides in house technical and managerial talent

Team

Acknowledgements Key populations: FSWs, MSM/ MSW, PWIDs Ministry of Health: Government of Kenya National AIDS and STI Control Program: Government of Kenya National AIDS Control Council: Government of Kenya Bill and Melinda Gates Foundation PEPFAR: CDC and USAID GFATM Dutch Government UN Joint Team All Key Populations implementing partners in Kenya Technical Support Unit - University of Manitoba

Thank you