KNASP 2005/6-2009/10 Table of Contents Table of Contents......................................................................................................................i List of Tables and Figures.....................................................................................................iii LIST OF TABLES....................................................................................................................III LIST OF FIGURES..................................................................................................................III Foreword by His Excellency the President...........................................................................iv Acknowledgements.................................................................................................................vi Strategic Overview ………………………………………………………………………….vii Section One: Introduction to KNASP 2005/06-2009/10.......................................................1 1.1 BACKGROUND..........................................................................................................1 1.2 KENYA’S COMMITMENT TO THE “THREE ONES”.....................................................2 1.3 THE PURPOSE OF THE KNASP 2005/06-2009/10.....................................................3 1.4 TIME PERIOD FOR THE KNASP................................................................................3 1.5 STRATEGIC PLANNING PROCESS..............................................................................3 Section Two: HIV/AIDS in Kenya - Challenge and National Response.............................5 2.1 THE CHALLENGE OF HIV/AIDS IN KENYA..............................................................5 2.2 THE NATIONAL RESPONSE.......................................................................................7 Section Three: KNASP Core Principles..............................................................................10 3.1 INTRODUCTION.......................................................................................................10 3.2 MULTI-SECTORAL APPROACH...............................................................................10 3.3 TARGETING VULNERABLE GROUPS........................................................................13 3.4 FOCUS ON GENDER AND YOUTH.............................................................................15 3.5 FULL IMPLEMENTATION OF GIPA PRINCIPLES.......................................................16 3.6 EVIDENCE-BASED INTERVENTIONS........................................................................16 3.7 EMPOWERED/PARTICIPATORY APPROACH.............................................................16 3.8 SUPPORT TO REGIONAL AND INTERNATIONAL INITIATIVES...................................17 Section Four: The KNASP Strategic Vision........................................................................18 4.1 INTRODUCTION.......................................................................................................18 4.2 GOAL OF THE KNASP............................................................................................18 4.3 OVERALL PREVALENCE TARGET...........................................................................18 4.4 KNASP PRIORITY AREAS......................................................................................18 4.5 PRIORITY AREA 1: PREVENTION OF NEW INFECTIONS..........................................20 4.6 PRIORITY AREA 2: IMPROVEMENT OF THE QUALITY OF LIFE OF PEOPLE INFECTED AND AFFECTED BY HIV/AIDS...............................................................................24 4.7 PRIORITY AREA 3: MITIGATION OF SOCIAL AND ECONOMIC IMPACT...................27 4.8 MONITORING AND EVALUATION............................................................................29 4.9 PROVISION OF KNASP SUPPORT SERVICES...........................................................30 Section Five: Implementing the KNASP.............................................................................32 5.1 INTRODUCTION.......................................................................................................32 5.2 THE CHALLENGE OF IMPLEMENTING ONE NATIONAL STRATEGIC PLAN..............32 - i - KNASP 2005/6-2009/10 5.3 THE KNASP RESULTS FRAMEWORK.....................................................................33 5.4 INSTITUTIONAL ARRANGEMENTS FOR KNASP IMPLEMENTATION.......................34 Section Six: Financing the Strategy.....................................................................................37 6.1 INTRODUCTION.......................................................................................................37 6.2 BASIS FOR FINANCING ESTIMATES........................................................................37 6.3 KNASP FINANCING ESTIMATES............................................................................38 Annex A – Results Framework For KNASP 2005/06-2009/10..........................................40 Annex B - Preparation of the KNASP 2005/06-2009/10.....................................................64 Annex C - Summary of Achievements of KNASP 2000-2005............................................67 Annex D – NACC Institutional Framework.......................................................................69 Annex E – National HIV/AIDS M&E Model and Linkages..............................................70 Annex F – Distribution of Funding Requirements for 2005-10...............................................71 Annex G: Participating Organizations and Institutions . …………………..……72 - ii - KNASP 2005/6-2009/10 List of Tables and Figures List of Tables Table 1: Key Features of “One Agreed HIV/AIDS Action Framework”..................................2 Table 2: KNASP Mainstreaming Principles...........................................................................12 Table 3: Great Lakes Initiative on AIDS.................................................................................17 Table 4 - Target Statement: Prevention..................................................................................22 Table 5 - Target Statement: Improve Quality of Life of People Infected and Affected by HIV/AIDS.................................................................................................................................26 Table 6 - Target Statement: Mitigation of Socio-Economic Impact of HIV/AIDS..................28 Table 7: KNASP 2005-10 Estimated Financing Requirements (Ksh. millions)......................39 List of Figures Figure 1: HIV Prevalence by Age and Sex (KDHS 2003)........................................................5 Figure 2: KNASP Coordination Structures.............................................................................36 Figure 3: Estimated Financing Requirement and Available Resources.................................38 Figure 4: Key Steps in Developing the KNASP 2005/06-2009/10.........................................66 - iii - KNASP 2005/6-2009/10 Foreword by His Excellency the President HIV/AIDS continues to be a major challenge to our socio-economic development. Since the first case was discovered in 1984, it is estimated that over 1.5 million people have died due to AIDS-related illnesses, resulting into 1.8 million children left as orphans. It is also estimated that 1.4 million people are living with the HIV today. However, there is hope, as we have noted a decline in the HIV prevalence which reached a peak of 14 percent in 2000, and which has fallen to 7 percent in 2004, due to successful multi-sectoral responses including the fact that HIV/AIDS has now become everybody’s concern. The scale up in condom uptake, voluntary counselling and testing services, antiretroviral therapy, and increased co-ordination among stakeholders is expected to result into a further reduction in HIV prevalence. Despite this progress, enormous challenges remain. The rate of new infections is unacceptably high particularly among vulnerable groups including; young girls, individuals in HIV discordant relationships, commercial sex workers and their clients, migrant workers and injecting drug users. Equally critical is the availability of affordable treatment for those in need of antiretroviral therapy. Other challenges include the negative socio-economic impact that HIV/AIDS inflicts on society as evidenced by the cumulative number of orphans and other vulnerable children, widows and the elderly as well as high levels of poverty and unemployment in the country. My government has since declared total war against HIV/AIDS and established a Cabinet Committee on HIV/AIDS, which I chair. My government is committed to lead a multi-sectoral national response to HIV/AIDS and has mandated the National AIDS Control Council (NACC) as the national co- coordinating authority to provide the required leadership within the “Three Ones” principles, namely: • One agreed HIV/AIDS action framework that provides the basis for co- ordinating the work of all partners; • One national AIDS coordinating authority with a broad-based multi- sectoral mandate; and • One agreed upon country level monitoring and evaluation system. The Kenya National HIV/AIDS Strategic Plan (KNASP) 2005/06-2009/10 provides the action framework for HIV/AIDS and the context within which all stakeholders will develop their specific strategies, plans and budgets to make responses. Therefore, the purpose of KNASP is among other things, to provide clear and agreed vision, goal and targets for the national response over the next five years. - iv - KNASP 2005/6-2009/10 My Government supports fully the implementation of this Strategic Plan and is committed to reducing the HIV/AIDS prevalence to less than 5.5 percent during the plan period and to improve the quality of life for those infected and affected by HIV/AIDS. It is envisaged that the implementation of the activities outlined in this Strategic Plan will require a total of Ksh. 45 billion by 2010, which will be Ksh. 21 billion over and above the current level of Ksh. 24 billion. To ensure long-term sustainability of the HIV/AIDS programmes, the government will link the process of implementing KNASP to the Economic Recovery Strategy for Wealth and Employment Generation (2003-2007) and the Kenya Government budgetary cycle. This will enable Ministries to budget and allocate resources to HIV/AIDS programmes as spelt out in the results framework of KNASP 2005/06-2009/10. I also call upon our development partners to support the implementation of KNASP and allocate resources to the respective priority areas of the Plan. In conclusion, I appeal to all stakeholders to support the implementation of KNASP and build partnerships with one another so that we can achieve the goal of the Strategic Plan, namely “reduce the spread of HIV, improve the quality of life of those infected and affected and mitigate the socio-economic impact of the epidemic in Kenya”. TOTAL WAR AGAINST HIV/AIDS H.E MWAI KIBAKI, CGH, MP PRESIDENT OF THE REPUBLIC OF KENYA - v - KNASP 2005/6-2009/10 Acknowledgements The development of the Kenya National HIV/AIDS Strategic Plan (KNASP) covering the period 2005/06-2009/10 followed a participatory process in which many stakeholders took part. The stakeholders were drawn from a cross-section of public, private, civil society, faith-based organizations and international institutions. The process involved extensive nationwide consultations with stakeholder groups as well as joint HIV/AIDS programme review meetings. The Plan, whose theme is ‘A Call to Action’, operationalises the commitment of the Kenya Government and all stakeholders including development partners and civil society involved in the fight against the HIV/AIDS pandemic. The following stakeholders who were involved in the development of this strategic plan are acknowledged for having played tremendous individual and collective roles: • Development partners for having supported the preparation and production of this strategic plan including those who have already pledged to contribute substantial amount of resources towards the implementation of the proposed activities. • NGOs, civil society Faith Based organizations, CBOs, PLWAs, CACCs, research institutions and the private sector among others are thanked for having taken part in the preparation of this strategic plan including the identification of various problems and prioritisation of appropriate interventions. In addition these organisations are acknowledged for participating in the setting of realistic targets during the plan period and for their continued support for various HIV/AIDS activities in the country. • Various Government ministries and departments are acknowledged for having identified various constraints that need to be addressed and for supporting various sector specific HIV/AIDS activities including coordination of the national effort at all levels. The full names of the institutions and organisations that were involved in the preparation and development of this strategic plan are found in Annex G. - vi - KNASP 2005/6-2009/10 KNASP 2005/6 –2009/2010: A Strategic Overview Purpose of the KNASP is Provide an Action Framework for HIV/AIDS within which all HIV/AIDS interventions in Kenya take place. The KNASP is not intended to replace or duplicate sectoral HIV/AIDS strategies, nor does it include detailed operational or implementation plans, or detailed budgets, for specific interventions. Rather, the KNASP provides the framework and context within which such strategies, plans and budgets should be formulated, monitored and coordinated. Goal of the KNASP 2005/6 –2009/10 Reduce the spread of HIV, improve the quality of life of those infected and affected and mitigate the socio-economic impact of the epidemic in Kenya KNASP Priority Areas The Goal will be achieved by focusing on three Priority Areas: • Prevention of new infections: reducing the number of new HIV infections in both vulnerable groups and the general population; • Improvement of the quality of life of people infected and affected by HIV/AIDS: improving treatment and care, protection of rights and access to effective services for infected and affected people; and • Mitigation of the socio-economic impact of HIV/AIDS: adapting existing programmes and developing innovative responses to reduce the impact of the epidemic on communities, social services and economic productivity. KNASP Core Principles The following Core Principles underpin the strategy: • A multisectoral approach, which enhances advocacy, builds strategic partnerships and mainstreams HIV/AIDS within key sectors • Targeted interventions for those groups most vulnerable to infection and to the impact of HIV/AIDS • Recognition of the special needs of women and youth • Maximum engagement of people living with HIV/AIDS in the implementation of the strategy • Empowerment of all stakeholders to participate effectively in the national response • Interventions which are evidence-based - vii - KNASP 2005/6-2009/10 Abbreviations and Acronyms AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ARV Antiretroviral ART Antiretroviral Therapy BCC Behaviour Change Communication CACC Constituency AIDS Control Committee CBO Community Based Organisation CSW Commercial Sex Workers CT Counselling and Testing Services DP Development Partners DPM Directorate of Personnel Management DTC District Technical Committee ERS Economic Recovery Strategy FAO Food and Agricultural Organisation FBO Faith Based Organisation FGE Futures Group Europe FHI Family Health International GoK Government of Kenya HBC Home Based Care HIV Human Immuno-deficiency Virus ICASA International Conference on AIDS and STIs in Africa ICC Inter-agency Coordinating Committee (for HIV/AIDS) IDU Injecting Drug User IEC Information, Education and Communication IS Information System JAPR Joint HIV/AIDS Programme Review KEMRI Kenya Medical Research Institute KEMSA Kenya Medical Supplies Agency KDHS Kenya Demographic Health Survey KIRAC Kenya Inter-Religious AIDS Consortium KNASP Kenya National HIV/AIDS Strategic Plan KNHRC Kenya National Human Rights Commission M&E Monitoring and Evaluation MIS Management Information System MoA Ministry of Agriculture MoEST Ministry of Education, Science and Technology MoF Ministry of Finance MoH Ministry of Health - viii - KNASP 2005/6-2009/10 MoHA Ministry of Home Affairs MoJCA Ministry of Justice and Constitutional Affairs MoLF Ministry of Livestock and Fisheries MoLG Ministry of Local Government MoP Ministry of Planning MP Member of Parliament MTEF Medium Term Expenditure Framework NACC National AIDS Control Council NALEP National Agricultural and Livestock Extension Programme NASCOP National AIDS and STD Control Programme NASP National AIDS Strategic Plan NBTC National Blood Transfusion Centre NCPD National Council for Population and Development NCST National Council of Science and Technology NGO Non- Governmental Organisation OI Opportunistic Infection OVC Orphans and Vulnerable Children PACC Provincial AIDS Control Committee PEP Post Exposure Prophylaxis PLWHA People Living with HIV/AIDS PMCT Prevention of Mother to Child Transmission PSI Population Services International RTI Reproductive Tract Infection SME Small and Medium Enterprises STD Sexually Transmitted Disease STI Sexually Transmitted Infection TB Tuberculosis TA Technical assistance UNAIDS Joint United Nations Programme on HIV/AIDS UNICEF United Nations Children’s Fund UPE Universal Primary Education VCT Voluntary Counselling and Testing WB World Bank WFP World Food Programme - ix - KNASP 2005/6-2009/10 Section One: Introduction to KNASP 2005/06-2009/10 1.1 Background Kenya is implementing a successful multi-sectoral response to HIV/AIDS. Overall prevalence rates are falling, voluntary counselling and testing services are increasingly widely available, and a growing proportion of Kenyans are aware of their HIV status. The scale up of antiretroviral therapy (ART) is on-course. There is an increasing understanding and willingness to cooperate among stakeholders across Government, civil society, the private sector and development partners. But progress cannot be taken for granted; enormous challenges remain. The rate of new infections remains unacceptably high, and there are major differences in the risk of infection faced by different population groups. Particularly vulnerable to infection are young girls; individuals in HIV discordant relationships; commercial sex workers (CSW) and their clients; migrant workers; and injecting drug users (IDUs). Although access to ART is increasing, availability of affordable treatment still falls far short of the need. With rising cumulative deaths from AIDS, vulnerability to the impact of HIV/AIDS, particularly among orphans, vulnerable children, widows and the elderly is becoming increasingly apparent, exacerbated by high general poverty levels. The national response must be stepped up to meet these challenges. Advances in understanding, better national coordination and growing international support and resources have created an unprecedented opportunity to prevent new infection and reduce the impact of HIV/AIDS in Kenya. To grasp this opportunity and build an effective, enhanced national response, all stakeholders need to work together within a common action framework. The KNASP 2005/06-2009/10 provides that framework. The KNASP articulates a set of common targets and results agreed upon by all stakeholders. As such, the KNASP enables all partners, both national and international, to make best use of their individual and collective resources in support of an effective and efficient national response. Structure of KNASP 2005/06-2009/10 The KNASP 2005/06-2009/10 is structured as follows: Section 1 forms the introduction; Section 2 covers challenges and national response to HIV/AIDS; Section 3 sets out core strategic principles which underpin the KNASP 2005/06- 2009/10 and cut across all strategic interventions; Section 4 sets out the strategic vision of the KNASP 2005/06-2009/10 in terms of its goal, priority areas, targets and key strategies; Section 5 describes the KNASP 2005/06-2009/10 implementation framework including the results framework and structures for coordinating and monitoring implementation; Section 6 sets out the estimated financing requirements for the strategy; Annex A contains the detailed results framework for the first two years of the KNASP 2005/06-2009/10, which identifies key deliverables and milestones for the years 2005/6 and 2006/7; Annex B provides more information on the process of preparing the strategy; Annex C summarises achievements of the previous KNASP 2000-2005; Annex D is the NACC institutional framework; Annex E provides the National HIV/AIDS Monitoring and Evaluation Model and Linkages; Annex F provides information on the distribution of funding requirements by priority areas of intervention and Annex G outlines the names of organizations and institutions that were involved during different stages of preparing and developing the strategic plan. - 1 -