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Support for Provincial and District Health Teams in Kenya Lessons Learned and Promising Practices. Dr Mark Hawken , Maputo, 11 August 2010. Outline of presentation . Introduction to current ICAP program Transition strategy Accomplishments at provincial and district level
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Support for Provincial and District Health Teams in KenyaLessons Learned and Promising Practices Dr Mark Hawken, Maputo, 11 August 2010
Outline of presentation • Introduction to current ICAP program • Transition strategy • Accomplishments at provincial and district level • Future plans
ICAP-Kenya supports facilities in Central, Nyanza and Eastern Provinces • Central Province facilities supported under Track 1 funding
ICAP Program • Track 1 program began in April 2006 • Support Care and Treatment in 51 (GOK) facilities and 46 PMTCT sites • Capacity building of national, provincial and district teams has been main focus of program • Support for clinical services including laboratory and pharmacy , adherence and psychosocial support , TB/HIV integration, pediatric care and early infant diagnosis, infrastructure improvement , human resources, linkages within and between facility and community and monitoring and evaluation • Through sub agreements with the provincial office, DHMTs and some larger facilities
Provincial level support • Quarterly meetings/updates with the PHMT • Joint planning for training and implementation • Support the employment of additional HCW • Support for 6 roving accountants to support facility administrators and accountant • Innovative support through: • roving health records officers to support the facility HRIO with record keeping and reporting • roving IT Specialist • Supervision of the DHMT
district level support • Annual planning of ART scale-up: identification of sites for scale-up • Training HCW identified by the DHMT on HIV services • Joint baseline site assessment • Intensive on-site clinical mentorship • Quarterly joint supportive supervision • Support for funds management • Training of District AIDS/ STI Coordinators on HIV management • Training of DHRIO to support data management, data dissemination/data feedback to facilities, mentorship of facilities on data systems
Clinical systems mentorship • Currently ICAP program officers provide clinical mentorship to district and facility staff • Residential mentorship established at one district hospital where HCW from lower-level facilities receive one week long practicum in the HIV clinic, led by hospital mentors • Identifying district mentors – District RCO, DASCO and other specialists to train as TOTs and mentor HCW and continue mentorship through GoK supervision structures
Quality of care monitoring • ICAP has established a quality team led by quality assessment coordinator, collaborating with ICAP program and M&E officers and district DHMT (including RCO, DASCO and district HRIO) • Team, identified as a District Quality of Care team, will move around facilities conducting standards of care (SOC) assessment with facility staff 6-monthly and developing strategies to improve areas of weakness
District support for hmis • Support for training of DHRIO and HRIO – didactic and on-job mentorship • Support for mentorship of HRIO using a structured mentorship tool, which includes a set list of tasks, skills and understanding of tools • Support for installation of electronic data systems at over 10 facilities with follow-up mentorship of HRIOs • Roving HRIOs providing mentorship to facilities in four districts • Roving Data Entry Clerk computerizing patient level data at low volume facilities in four districts • Data feedback to facility MDTs
challenges • Human resource (recruitment, deployment, retention) • Infrastructure limitations • Dual MoH systems (MoPHS and MoMS) • No permanent authority from central government for provincial medical office to receive external funds • Limited sense of ownership at some facilities • Weak linkages and integration of services • Inability to maintain optimal burn rates due to management challenges
Acknowledgements • NASCOP /MOH • PHMT, DMOH and MOH Hospitals • CDC • KEMRI • APHIA II • Clinton Foundation • JKUAT • Other NGOs • CBO