Priority Issues and Strategic Information Needs for Kenya

in scaling up ART

Priority Issues

• Political Will– Managing the process of ART implementation

according to strategic plan

• Policy – Eligibility criteria– Financing all components of the ART

Programme• Role of cost recovery vs. cost sharing• Determining “who will pay” and affordability or a

waiver system

Priority Issues

• Infrastructure:– Existing pool of HR in relation to workload– Provision of comprehensive HIV/AIDS services– Mechanism for drug procurement and logistics

management

• Community preparedness strategy– Addressing misconceptions– Adherence– Equity (only 50% of eligible have access by 2008)

Strategic Information Needs: HIV/AIDS Services

• To what extent are people who need VCT and OI management receiving the services

• What is the flow of patients in and out of the system: – how patients would access ART– how would drugs be administered– How would patient treatment be monitored

Strategic Information Needs: Financing

• What are financing sources and length of commitment

• To what extent will there be full cost recovery/sharing in the public sector

• How will the waiver system work

• How prevalence rates relate to income groups

Strategic Information Needs: Eligibility

• Information on those eligible for ART (those falling within AIDS case definition)

• What are the national eligibility criteria for those eligible who will receive ART

Strategic Information Needs: Community Preparedness

• Mapping of existing NGOs and their capacity and services they provide

• What conduits of information about HIV and ART to community exist

• Baseline of KAP on HIV and ART

• Access and adherence perceptions within the community

Strategic Information Needs: Infrastructure and Logistics

• Information that will help to look for strategies to reinforce the existing pool and expand HR

• What is capacity of existing ARV drug supply chains to help scale up

• What is the capacity of laboratory services to monitor patients

Strategic Information Needs: Information Systems and M&E

• What is your basic essential data that you need (patient, drug, cost etc)

• For program M&E, how much can you get from individual patient M&E and how much is required from external sources

• How will patient, drug etc data be collected, linked, transmitted and aggregated – role of technology??

• Need a centralized data bank for all data

First Steps: M&E System

• Use ARV Task Force to:– Develop patient workflow including access and

referral to services, drug flow and access, access to lab services

– Determine essential data to collect for programme– Determine mechanisms for collecting and linking

patient and drug information at the point of care and drug dispensing, sending up disaggregated data but retaining capacity for site to receive or retain data useful for own decision making

Steps Already Taken or In the Workplan

• Situational assessment for scaling up ART at 15 sites just completed– Gaps identified in infrastructure, staff numbers

and training, drug logistics, lab capacity, comprehensive HIV/AIDS services, management practices

– For each site, operational planning has been conducted for 15 sites to upgrade capacity to reach minimum standards for provision of ART

Steps Already Taken or In the Workplan

• Plans for development of:– Eligibility criteria– Financing strategy, including waiver system– Developing LMIS– Medium term HR plans for ART linked in with

national HR plans– Communication strategy– Community preparedness strategy

First Steps: M&E System

• Identify basic minimum information needs for programme monitoring (national) at each level and frequency of data

• How will this information be collected according to the workflow (who has responsibility at each level, what role if any does technology play)

• Develop SOPs for information collection, transmission taking into account issues of confidentiality

• How much will this cost and who will pay

First Steps: M&E System

• Identify data requirements outside the program that are needed to M&E aggregate programme impact (e.g. timeliness of mortality data, including cause of mortality, HIV prevalence data)

• Determine how to link ART and other HIV related data at the hospital or site and looking at national trends (e.g. hospital bed utilization)

Items to Add to Workplan

• Standardize M&E tools, framework and approach across all ART programs

• Identify questions that can be answered by OR and develop inventory of OR initiatives ongoing

• Establish national research agenda by priority areas