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«ANNUAL REPORT OUR LEARNINGS 2012-2013 © December 2013 by CHS. All rights reserved. This report was made possible through the generous support of ...»

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© December 2013 by CHS. All rights reserved.

This report was made possible through the generous support of PEPFAR through the Centers

for Disease Control and Prevention (CDC) and the American people through the United States

Agency for International Development (USAID). The contents of this report are solely the

responsibility of the authors and do not necessarily reflect the official views of USAID or CDC.

For more information on CHS, call +254-020-271 0077; or send an e-mail to: info@chskenya.org

Compiled and written by:

Susan Waweru


Dr. Fridah Njogu - Ndongwe, Dr. Symon Wambugu, Dr. Angela Mc’Ligeyo, Lulu Ndapatani, Dinah Mamai, Kennedy Muthoka, Francis Mbate, Rachel Muinde,

Edited by:

Dr Paul Wekesa Janice Njoroge Design and Layout James Ngechu SOLUTIONS SULUHISHO Contents List of Acronyms

About CHS

Word from the CEO

Our New Solutions

HIV Testing And Counselling (HTC) Solutions

Tuberculosis (TB) Solutions

Solutions For Opportunistic Infections

Health Solutions For Mothers and Babies

Reproductive Health Solutions

Paediatric Solutions

Pharmacy Solutions

Laboratory Solutions

Capacity Building Solutions

Monitoring and Evaluation Solutions

Community Health Solutions

Health Systems Strengthening Solutions

Management Solutions for Health

Centres of Excellence

Do, Document and Disseminate

List of Acronyms

–  –  –

About CHS Centre for Health Solutions – Kenya (CHS) is an indigenous, not-for-profit organisation with in-depth understanding of the local context, utilization of local expertise as well as strategic partnerships to ensure the implementation of evidence informed solutions and interventions to existing and emerging public health concerns.

Vision A world of healthy families through universal access to health interventions and services.

Mission To optimize delivery and use of health interventions to communities through evidence-informed solutions, innovations and research to address existing and emerging public health needs.

Our Approach With a commitment to improving health outcomes, CHS works in partnership with government, donors, other stakeholders and local communities to complement and synergize the delivery of sustainable health services.

CHS works closely with the Ministry of Health to support the implementation of better quality services in Kenya through sustainable health solutions and the effective and efficient utilisation of limited resources. CHS aligns its work to national and international public health priorities in order to support the achievement of local and international goals and objectives through innovative health solutions that address existing and emerging public health needs.

Locally, CHS work is aligned to the 2nd National Health Sector Strategic Plan (NHSSP II) and the 3rd Kenya National AIDS Strategic Plan (KNASP III) and our work is informed by national guidelines from the Ministry of Health, such as those described by the National AIDS and STI Control Program (NASCOP) and the Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) Internationally, CHS work is aligned to contribute to the achievement of the Millennium Development Goals (MDGs) and the Global Health Initiative (GHI) goals.

–  –  –

Dr. Richard Ayah Dr. Paul Wekesa, Chief Executive Officer, Centre for Health Solutions - Kenya (CHS) Word from the CEO 2013 has been a phenomenal year for CHS! This being our third anniversary, we have continued to strengthen existing and establish new partnerships to ensure access to quality health services for the most vulnerable in the community.

We have continued to strengthen our brand as well as further improve our organisational systems to ensure optimisation of existing resources for maximal value. This has been demonstrated by improvements to our website, optimisation of the Navision system, embracing the use of mobile payment solutions as well as e-banking to improve efficiencies; enabling us to increase our investments to reach those for whom we exist - our patients and their families, our health workers and the society at large.

This year, we are proud to have won the USAID funded Accelerating Progress Against Tuberculosis award to reduce the burden of all forms of tuberculosis (TB) across Kenya. This five year activity will support the leadership role of the Ministry of Health’s Division of Leprosy Tuberculosis and Lung Disease and focus on the development and scale up of new TB programs while strengthening existing programs through local adaptation of evidence informed interventions.

We have also established a new partnership with Abt Associates for a project funded by USAID to support the implementation of a strong, unified National Health Information System (NHIS).

With these two grants added onto our portfolio, we have grown from an annual budget of US$ 6M in the previous financial year to US$ 12M in 2013 and from programme implementation in Central Kenya to national reach across all of Kenya’s 47 Counties.

CHS continues to work hand in hand with the evolving county health structures to support the realisation of the dream set forth in Kenya’s Constitution and Vision 2030. We have supported the development of county health strategies and established new sub agreements with the counties. CHS also hosted the 2013 Annual Stakeholders Meeting with the theme ‘Ownership towards sustainable efficient and universal health solutions’ in Nyeri.

Our sincere gratitude goes out to the beneficiaries of our programs and our partners, particularly the United States Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC) through PEPFAR and the Government of Kenya through the Ministry of Health for their demonstrated trust in CHS’s capacity.

I wish to thank CHS staff, management and the board for their good work, commitment and dedication towards the realisation of our vision and look forward to reaching even greater heights in the coming year.


Our New Solutions CHS envisions continuous commitment to promoting the quality of health and thus seeks to keep building

partnerships to further this goal. In the year 2013, CHS added two grants to its portfolio:

Funded by USAID, Tuberculosis Accelerated Response and Care (TB ARC) is a five-year activity that seeks to expand access to quality-assured TB services in all Counties and for all forms of TB, through the identification and implementation of evidence-based interventions that support and/or complement the activities of the DLTLD and increase the proportion of TB cases identified and treated over a period of five years. This activity marks an important milestone in CHS’s contribution towards achieving zero TB Deaths, Zero New TB Infections and Zero Suffering (zero stigma).

Funded by USAID through Abt Associates, AfyaInfo is a five-year project that responds to needs identified by the Government of Kenya for a strong, unified National Health Information System (NHIS).

In this program, CHS has the mandate to undertake capacity building of Health Information System (HIS) users in Kenya, develop a quality assurance model for HIS trainings and provide mentorship and support to data managers.

HIV Testing And Counselling (HTC) Solutions One of the major drawbacks to HIV care and treatment is limited access to testing and treatment facilities, demonstrated by inaccessibility to such centres or limitations in handling a high number of clients where they exist. CHS seeks to overcome this barrier by increasing the capacity of facilities to promote the uptake of HIV testing and counselling (HTC).

This has been done through supporting Comprehensive Care Centres (CCCs) at various health facilities with infrastructure repairs, staffing, creating linkages with communities through the Ministry of Health’s Community Health Strategy, training and mentorship of health facility staff, creation of quality assurance committees and the introduction of HTC services at major points of care within facilities.

Interventions to ensure HTC services are available at all service delivery points within facilities means that more individuals can be reached and patients no longer have to wait long hours to access HTC services.

CHS has been introducing re-testing guidelines at facilities, significantly improving care and treatment efforts. The World Health Organisation (WHO) HIV re-testing guidelines adopted in 2010 recommend annual re-testing of the general population and re-testing of HIV negative clients in cases of indeterminate results, generalised epidemics and risk.

HTC uptake has increased significantly and in the past year, CHS surpassed its annual target for HIV testing and counselling. 256,591 individuals (including 34,437 children) were received on HIV testing compared to the targeted 178,077 individuals.

CHS implemented a rapid results initiative (RRI) between July and August 2013, to address the shortfall in targeted HTC service uptake for the first half of the year.

An extra 18 HTC counsellors were recruited to offer support at selected high volume facilities and HTC was offered at all service delivery points. The RRI yielded exceptional results with 52,639 clients having received HIV testing and counselling services compared to the targeted 35,625. The RRI targets were surpassed by 47.8% and this to a significant level, contributed to the surpassed annual targets for HTC service uptake.

78% of those found HIV positive have been enrolled into care at CHS supported facilities Trainings to build the capacity of health workers to provide HTC services were conducted including continuous medical education (CME) at facility level. 48 health workers were trained using the national HTC curriculum to promote better service outcomes while 68 health workers trained in HTC the previous year went through observed practice.

In a bid to promote greater commitment towards HTC outcomes, CHS is working towards creating ownership of HTC by Ministry of Health staff through encouraging increased participation of health workers.

A sensitisation activity targeting 30 health workers including medical and clinical officer interns was conducted at Gatundu District Hospital to create more awareness on HTC and thereby scale up its uptake across inpatient departments.

CHS strengthened quality assurance (QA) systems for HTC through support supervision at various health facilities in conjunction with the District Health Management Teams (DHMTs). This was aimed at promoting quality service delivery across health facilities that CHS supports through enhancing efficiency. HTC supervision was carried out in Ruiru, Muranga North, Gatundu, Muranga South, Thika and Kangema districts.

Family Approach to HTC The family approach to HTC that involves incorporating family members of affected persons into care, such that they are also offered HIV testing services has had a significant contribution to the growing HTC numbers. Men are encouraged to accompany their wives when attending antenatal clinics and this ensures that they are tested for HIV together.

The testing of children was scaled up through identification of paediatric entry points and placement of counsellors at those points.

–  –  –

In September 2012, CHS began a system strengthening journey at Nyeri Provincial General Hospital (PGH), to improve the hospital’s CCC. Challenges ranging from low staffing, poor facilities, overcrowding and client privacy concerns curtailed care and treatment efforts at the hospital.

–  –  –

HIV testing and counselling rooms during repair and at handover to Dr. Silas Njoroge, Medical Superintendent, Nyeri PGH Rush Nderitu is a Peer Educator who supports ART adherence and follow up of clients at CHS supported Warazo Health Centre in Central Kenya Antiretroviral Therapy CHS has been instrumental in promoting the adoption of the revised national guidelines for anti-retroviral therapy (ART) across facilities that it supports. The guidelines seek to promote effective and more standardised ART for better HIV treatment outcomes. They call for earlier initiation of ART and improved criteria for ART switching, effective and feasible treatment regimens, optimal management of mother and child health for prevention of mother to child transmission of HIV (PMTCT), management of HIV exposed infants (HEI), management of TB/HIV co-infections and common chronic non-communicable conditions.

Through day-long sensitisations and CME, CHS has equipped health workers with the necessary knowledge and skills to implement the ART guidelines. Special emphasis was given on reducing non-standard regimen across facilities through guiding health workers on the new standardised treatment regimens as provided in the revised guidelines. This means that ART is now based on standardised drug combinations in the first-line and second-line regimen as per national guidelines. The guidelines seek to promote the use of the most potent, effective and feasible treatment regimens applicable to the majority of the population.

ART is now based on standardised drug combinations in the first-line and second-line regimen Tuberculosis (TB) Solutions According to the WHO Global TB report of 2012, Kenya was ranked 15th among the 22 high TB incidence burden countries. CHS continues to support the strengthening of TB health systems towards attaining the Global Plan to Stop TB by reversing the incidence of TB by 2015.

Tuberculosis Accelerated Response and Care (TB ARC) In June 2013, CHS and partners kicked off the five year, USAID funded Tuberculosis Accelerated Response and Care activity that seeks to expand access to quality-assured TB services across Kenya’s 47 Counties for all forms of TB. This will be done through the identification and implementation of evidence-based interventions that support the activities of the DLTLD and increase the proportion of TB cases identified and treated.

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