Kenya
Home to modern cities such as Nairobi and ancient anthropological sites in the Rift Valley, Kenya is a major economic and cultural force in East Africa. However, the country also faces such challenges as an understaffed health care system and the HIV/AIDS epidemic.
Kenya’s health care worker shortage is critical—there are not enough doctors, nurses and other trained providers in place to run the basic health services, let alone HIV/AIDS-specific services. Through USAID’s Capacity Project, IntraHealth and partners helped the Ministry of Health and health sector leaders to design, implement and evaluate an Emergency Hiring Plan, which expanded access to treatment and care through the rapid hiring, training and deployment of 830 health workers at nearly 200 facilities. The Capacity Project is currently helping the Ministry of Health develop a long-term human capacity building strategy for health care.
This work includes:
- Adopting rapid recruitment and deployment approaches that cut the Ministry of Health’s hiring process time in half
- Mapping out human resources needs to respond to tuberculosis infection (a frequent and deadly HIV/AIDS co-infection)
- Improving the work climate to strengthen health care workers’ performance and retention
- Addressing the special needs of health care workers with HIV.
IntraHealth is also providing assistance in training and performance improvement to the AIDS, Population and Health Integrated Assistance (APHIA II) program in North Eastern province. The program is working to strengthen integrated delivery of HIV/AIDS/tuberculosis and reproductive health/family planning services with a special focus on the region’s hard-to-reach pastoralist populations.
IntraHealth previously worked in Kenya through three other USAID projects: PRIME II (1999–2004), AMKENI (2001–2006) and ACQUIRE (2004–2006). These projects worked to:
- Increase access to sustainable, comprehensive reproductive health, family planning and child survival services, including HIV/AIDS-related services
- Improve the quality of these services
- Promote healthy behaviors among people
- Strengthen human resources for health in the private sector to deliver key services, including:
- Prevention of mother-to-child transmission of HIV (PMTCT)
- Voluntary HIV counseling and testing
- Postabortion care.
Strong results from these projects include increased availability and use of a wider range of family planning options and an increase in overall family planning use. Health facilities that offer safe motherhood services rose from 64 to 90 and normal deliveries at these facilities went from 15,100 in 2001 to 27,700 in 2005. Between 2003 and 2005 infant mortality declined by 45% at AMKENI-supported facilities and 225,480 clients received HIV testing and counseling.
AMKENI piloted a reproductive health training and supervision system successfully in local health facilities in two districts and introduced the system in all ten provinces. This approach to health care services development was so successful that several village health committees have adapted it to other community health concerns, such as malaria.
ACQUIRE supported the training of 248 PMTCT providers in 174 facilities, 33 voluntary counseling and testing providers in 14 facilities, 142 primary care assessment providers in 155 facilities and 212 family planning providers in 201 facilities. The project also helped train 225 community members in postabortion care advocacy, reaching 1,467 people with information about reproductive health issues. The project helped facilities develop supportive supervision plans, leading to improvements in infection control practices and data management and reporting. These improvements in reporting helped private health care providers work better with the Ministry of Health, including success in solving supply problems.
Donors/Projects: USAID (Capacity Project, APHIA II: North Eastern Province, AMKENI, ACQUIRE)
Partners, Capacity Project: JHPIEGO, Management Sciences for Health, Deloitte and Touche—Kenya
Partners, APHIA II: North Eastern Province: Pathfinder International (lead)
Partners, AMKENI: EngenderHealth (lead)
Partners, ACQUIRE Project: EngenderHealth (lead)
Selected health statistics for Kenya (WHO, accessed July 2008):
Life expectancy, in years (m/f): 52,55
Probability of dying under 5 years of age (per 1000 live births): 121
Adult prevalence of HIV/AIDS: 7.4%
Maternal mortality (per 100,000 live births): 1,000