Preventing mother-to-child transmission of HIV in Western Kenya: operational issues

To improve uptake in a program to prevent mother-to-child HIV transmission and describe lessons relevant for prevention of mother-to-child transmission programs in resource-poor settings. Implementation of a pilot project that evaluates approaches to increase program uptake at health facility level at New Nyanza Provincial General Hospital, a public hospital in western Kenya, an area with high HIV prevalence. Client flow was revised to integrate counseling, HIV testing, and dispensing of single-dose nevirapine into routine antenatal services. The number of facilities providing PMCT services was expanded to increase district-wide coverage. Main outcome measures were uptake of counseling, HIV testing, nevirapine, and estimated program impact. Uptake of counseling and testing improved from 55 to 68% (P <0.001), nevirapine uptake from 57% to 70% (P <0.001), and estimated program impact from 15% to 23% (P = 0.03). Aggregate reports compare well with computer-entered data. Addressing institutional factors can improve uptake, but expected program impact remains low for several reasons, including relatively low efficacy of the intervention and missed opportunities in the labor roo

Developing a Nursing Database System in Kenya

Objective: To describe the development, initial findings, and implications of a national nursing workforce database system in Kenya. Principal Findings: Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya’s most qualified. Conclusions: The Kenya nursing database is a first step toward facilitating evidencebased decisionmaking inHRH. This database is unique to developing countries in sub- Saharan Africa. Establishing an electronic workforce database requires long-term investment and sustained support by national and global stakeholders