Acceptability and sustainability of the WHO focused antenatal care package in Kenya

The objectives of this study were to assess the Kenyan Ministry of Health’s capacity to adapt focused antenatal care (ANC) at the service delivery level so that it can be sustained, and to examine the extent to which adaptation of the package has increased coverage and quality of key ANC services and the overall quality of care received by pregnant women. The study showed that focused ANC is acceptable to both clients and providers and the approach has also received tremendous support from both the government and health development partners. However, the sustainability of the focused ANC package is contingent upon availability of funding, availability of a minimum level of equipment and supplies, competent providers, and a clear policy direction. The study recommends further consultation with key actors (such as pre-service training institutions and professional bodies) to ensure institutionalization and standardization of focused ANC; community mobilization to create awareness about the new services being offered; reorganizing service delivery and client flow within clinics to reduce client waiting time; and training providers in the concept of focused ANC

Understanding the HIV/STI risks and prevention needs of men who have sex with men in Nairobi, Kenya

Despite increasing awareness of the role men who have sex with men (MSM) can play in the dynamics of HIV transmission in Africa, research on MSM in Kenya has been limited. In response to this gap, researchers from the Institute of African Studies at the University of Nairobi and the Horizons and FRONTIERS programs of the Population Council undertook a study of MSM in Nairobi. The overall goals of the study were to understand the extent to which MSM are at risk of HIV and other STIs, identify the factors associated with risk behaviors, and identify MSM sexual health needs in order to develop appropriate interventions. The ease with which this study recruited 500 men through snowball sampling suggests that the population of Kenyan MSM living in Nairobi is larger than is commonly believed. This situation, combined with the existence of risk behaviors, such as unprotected sex, among the study sample may have implications for the development of localized STI and HIV epidemics. The report recommends urgently needed interventions targeted to this population

The making of the Kenya sexual offenses act, 2006: Behind the scenes

Kenya’s enactment of the Sexual Offenses Bill in 2006 was a milestone in dealing with sexual offenses and gender-based violence. The bill is Kenya’s first legal recognition of the many sex crimes that occur in the country. Among other things, the law criminalizes deliberate transmission of HIV/AIDS and provides rape victims with free medical care and counseling in public institutions. Convicted rapists will now face a minimum sentence of ten years, while a maximum penalty will be life imprisonment. A retrospective study was conducted to document the process leading to the enactment of the law. The objective was to document the sexual offenses law-making process in Kenya, the influence of different actors, and how these interacted with contextual factors to influence the substantive content of the law as well as its enactment. This book explores the circumstances under which the law was formulated and passed, identifies actors and interest groups involved in the law-making process, explores how the law changed over time, and draws lessons learned that could be of interest to other countries intending to invoke similar actions

Understanding the HIV/STI prevention needs of men who have sex with men in Kenya

Understanding the sexual behaviors of populations who are vulnerable to HIV is an important component in the battle against AIDS. Yet policymakers in developing countries, particularly in Africa, have often overlooked men who have sex with men (MSM) as a vulnerable group because of stigmatization of homosexual behavior and denial of the existence of MSM and the role they may play in HIV transmission. A growing body of literature not only documents the presence of this population in Africa but also the importance of reaching them with information and services to prevent HIV and other sexually transmitted infections (STIs). In response to this gap, researchers from the Institute of African Studies at the University of Nairobi and the Horizons and FRONTIERS Programs of the Population Council undertook a study of MSM in Nairobi. The goals were to understand the extent to which MSM are at risk of HIV and other STIs, identify factors associated with risk behaviors, and determine their sexual health needs to develop appropriate interventions. As this research summary states, targeted interventions, such as confidential counseling and peer education are needed

An evaluation of Health Workers for Change in seven settings: a useful management and health system development tool

This paper presents the findings of a multi-centre study assessing the impact of Health Workers for Change (HWFC) workshops in seven different primary care sites, based on the common core protocol described in this paper. The paper discusses a common methodology used by the studies, consisting of a triangulation of qualitative and quantitative methods. Such methodologies are inherently complex as they require comparisons across systems, sites and procedures. The studies were conducted in six sites in Africa and one site in Argentina. Generally, the intervention resulted either in positive change or in no change, except in the area of staff relationships where conflicts were more frequent after the intervention than before. This may reflect a willingness to confront problems or contentious issues. Implementing the HWFC workshops improved provider-client relations, facility level functioning and aspects of staff interrelationships, and had some impact at the system level. All studies indicated that overall health system development is essential for improved service provision including quality of care. The findings also indicated that this intervention complemented and could assist health sector reform efforts and can play a role in sensitizing health workers to gender issues. The paper concludes with a discussion of the robustness of the methodology used in the studie

A review and evaluation of multi-sectoral response services (\u27one-stop centers\u27) for gender-based violence in Kenya and Zambia

An increasingly popular strategy for addressing sexual gender based violence (SGBV) is through the establishment of one-stop centers‘ (OSCs), which provide integrated, multi-disciplinary services in a single physical location. The goals of this assessment were two-fold: first, to assess the effectiveness of different OSC models in terms of health and legal outcomes for survivors, and the cost-effectiveness of these models; and second, to identify lessons learned in OSC implementation with recommendations for both start-up and scale-up. Findings from this study offer the first form of systematic evidence on the effectiveness of OSCs, which can guide national-level policymakers and program managers in introducing or adapting the OSC model in their countries

The impact of introducing new vaccines on the health system: case studies from six low- and middle-income countries.

OBJECTIVE: We aimed to explore the impacts of new vaccine introductions on immunization programmes and health systems in low- and middle-income countries. METHODS: We conducted case studies of seven vaccine introductions in six countries (Cameroon, PCV;Ethiopia, PCV; Guatemala, rotavirus; Kenya, PCV; Mali, Meningitis A; Mali, PCV; Rwanda, HPV). Inter-views were conducted with 261 national, regional and district key informants and questionnaires were completed with staff from 196 health facilities. Routine data from districts and health facilities were gathered on vaccination and antenatal service use. Data collection and analysis were structured around the World Health Organisation health system building blocks. FINDINGS: The new vaccines were viewed positively and seemed to integrate well into existing health systems. The introductions were found to have had no impact on many elements within the building blocks framework. Despite many key informants and facility respondents perceiving that the new vaccine introductions had increased coverage of other vaccines, the routine data showed no change. Positive effects perceived included enhanced credibility of the immunisation programme and strengthened health workers' skills through training. Negative effects reported included an increase in workload and stock outs of the new vaccine, which created a perception in the community that all vaccines were out of stock in a facility. Most effects were found within the vaccination programmes; very few were reported on the broader health systems. Effects were primarily reported to be temporary, around the time of introduction only. CONCLUSION: Although the new vaccine introductions were viewed as intrinsically positive, on the whole there was no evidence that they had any major impact, positive or negative, on the broader health systems

New pneumococcal conjugate vaccine introductions in four sub-Saharan African countries: a cross-country analysis of health systems\u2019 impacts

Background: Pneumonia is a main cause of under-five mortality in low-income settings. The pneumococcal conjugate vaccine (PCV) has been introduced in many countries as a tool in the disease\u2019s prevention. Although PCV\u2019s effectiveness has been established, less is known about the effects of introducing additional injectable vaccines into routine immunisation programmes, particularly in the context of resource-constrained settings. Objectives: To explore the effects of PCV introduction on the immunisation programmes and health systems in four low-income countries. Methods: This study was carried out in Cameroon, Ethiopia, Kenya and Mali. Three to four regions and nine to 10 districts were selected within each country. Semi-structured interviews were carried out at national, regional and district levels (n=173). Researcher-administered questionnaires were completed with facility staff (n=124). Routine data on monthly vaccination activities were collected at district and facility levels. Results: PCV was generally well integrated into existing routine immunisation. Little or no impact was found in most areas of the health systems. Some minor effects were found on immunisation programmes, particularly in areas with either planning activities or investments e.g. staff skills were strengthened and there were limited improvements in surveillance. Although health sector workers perceived increases in the coverage of other vaccines following the introduction of PCV, routine service data did not confirm this claim. No substantial impacts were seen in health system management, service delivery or performance. Conclusions: The introduction of PCV had marginal impacts on the Expanded Programme for Immunisation and little to none on broader health systems

Engaging men who have sex with men in operations research in Kenya

Research on men who have sex with men (MSM) in Africa is severely constrained. This paper examines the process of engaging MSM in research in a context where same-sex relationships are criminalised and socially stigmatised. Despite difficulties in researching MSM in Kenya, a convenient sample of 500 men was enrolled into a study aimed at understanding HIV/STI risks and prevention needs. Lessons drawn from this study highlight innovative methodological approaches and processes to working with and researching MSM in homophobic communities. Researchers willing to venture into MSM research in such contexts should be prepared to deal with among others, issues such as, seeking ethical approval for a study whose subjects are considered to engage in illegal activities, assuring study participants of their privacy and confidentiality and questioning of their own integrity. This study shows that despite difficulties, research of this kind can be carried out in Kenya