Country support update: Kenya

COUNTRY CONTEXT

Population: 31 292 000
GDP par capita (Int$): 1 396
People living with HIV/AIDS: 1 800 000
People in need of ART: 280 000
Present ART: 11 000
3 by 5 Target for 2005: 140 000

The first WHO emergency 3 by 5 Assessment Mission took place in Kenya from October 6 to 11, 2003. The multi-partner Team found high-level support for the 3 by 5 Initiative as the Kenyan government had just declared HIV/AIDS to be a national disaster and is taking legal steps to treat HIV/AIDS in an emergency context.

STRENGTHS

Minister of Health of Kenya, Mrs.Charity Ngilu and Dr.LEE Jong-Wook, Director General of WHO
  • Strong political commitment. There is an HIV/AIDS cabinet committee chaired by the President.
  • A central Management Unit of 5 professionals in place.
  • A broad based ARV task force is in place.
  • Several ART clinics are already running. 30 further ART centres are preparing to begin operations.
  • Financial partners are willing to support ART scale up.
  • A group of trained medical professionals, unemployed because of cutbacks to healthcare, may be available.
  • The government has brought in legislation to make a climate conducive to produce ARVs in Kenya, where a drug manufacturing industry exists.
  • The government is also increasing efforts to pre-qualify drugs.
  • The private sector (including the Faith Based Organizations and other NGOs) is actively engaged in scaling up treatment through workplace-based treatment schemes.
  • A national health insurance scheme that covers HIV/AIDS treatment costs is being developed.
  • Professional medical associations are fully involved in the scale up of HIV/AIDS care and treatment, particularly in the training of the health care workers on the rational use of ART.

CHALLENGES

  • Life expectancy at birth dropped over the last ten years from 62 to 46 years.
  • The present staff, facilities and funds will only support 10 000 additional patients.
  • In staff alone, an additional 4 200 staff are needed for the scale up of the 3 by 5 target. 1 000 health workers will be trained by the end of 2003 with the 3 by 5 WHO support.
  • All quality assurance and delivery systems need to be upgraded and developed: drug management, monitoring and logistics systems, laboratory standards and testing guidelines.
  • Generic fixed dose combination recommended as the national regimen has not yet been certified by WHO.
  • Treatment literacy is very low amongst health workers and in communities.

EMERGENCY ACTIONS TO TAKE

  • A patient tracking system will be developed with WHO assistance in January 2004.
  • Immediate hiring and training of the new Country Emergency Team to assist and enable the emergency scale up:
    o Development of the national implementation plan.
    o Broker resources to fill the emergency gap.
    o Develop national standards, testing and tracking methods, and laboratory standards for immediate roll out.
    o Develop major training of health care workers and managers.
    o Orientation of stakeholders and community leaders in ART.
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