Written evidence submitted by AMREF
STRENGTHENING COORDINATION AND COMMUNITY
CAPACITY AND PARTICIPATION IN THE HIV AND AIDS RESPONSE: THE CASE
OF AMREF'S MAANISHA PROJECT IN KENYA
ACRONYMS
— NACC: National AIDS Control Council
— MoH: Ministry of Health
— M&E: Monitoring and evaluation
— CSOs: Civil Society Organisations
— MSM: Men who have sex with men
— IDU: Injecting drug user
— PLHIV: People Living With HIV/AIDs
— PMTCT: Prevention of Mother to Child
Transmission
— HCBC: Home and community-based Care
— PSOs: Private Sector Organisations
— GoK: Government of Kenya
— OVC: Orphans and vulnerable Children
ABOUT AMREF
1.1 AMREF is Africa's leading health development
organisation. AMREF's mission is to improve the health of disadvantaged
people in Africa as a means for them to escape poverty and improve
the quality of their lives. Founded in 1957 as the Flying Doctors
of East Africa, AMREF has since expanded and has a continental
and international reputation for delivering effective health programmes
and developing innovative models for health delivery in Africa.
In 2005, AMREF became the first African organisation to receive
the Gates Award for Global Health, in recognition of its extraordinary
contribution to improving health in Africa's poorest communities.
1.2 AMREF is a truly African organisation.
AMREF's headquarters are based in Nairobi, Kenya, and it has large,
multi-sectoral country programmes across Ethiopia, Kenya, South
Africa, Southern Sudan, Tanzania and Uganda. AMREF employs more
than 800 people, 97% of whom are African health and development
professionals. AMREF places African communities at the centre
of all its work, particularly children, young people, women of
reproductive age, and the health workforce in poor remote and
informal urban emergency settings. AMREF seeks to work effectively
in partnership with governments, communities and the private sector
across Africa.
SUMMARY
1.3 This paper describes problems of co-ordination
and the lack of community capacity and participation in Kenya's
HIV and AIDS response. It goes on to describe the Maanisha
project, co-funded by DFID and Sida, which was designed by
AMREF and its partners to address these gaps. Specifically, Maanisha
is strengthening efforts made by civil society organisations
(CSOs) and private sector organisations (PSOs) at the grassroots
in Kenya to reduce the incidence of HIV and AIDS and improve the
quality of life among those infected and affected. Maanisha
is recognised by the Government of Kenya and development partners
as a successful and replicable model of comprehensive HIV and
AIDS programming.
WHAT IS
THE PROBLEM?
1.4 The prevalence of HIV among adults aged
15-49 years in Kenya has risen from 5.3% in 1990 to 7.1% in 2007.
There are now more than 1.4 million PLHIV.[1]
The epidemic is marked by considerable gender and geographic disparities:
between 15-64 years, there are five females infected with HIV
for every three males infected. Out of the country's eight administrative
provinces, two have a prevalence well above the national average—Nyanza
province (14.9%) and Nairobi province (8.8%).[2]
By 2006, approximately 1.5 million people had died due to AIDS,
leaving a cumulative total of an estimated 1.7 million orphans
aged 0-17 years.[3]
There are about 150,000 children aged 0-14 years living with HIV
in Kenya. Between the years 1979-89 and 2006, Kenya witnessed
a decline in life expectancy from 61.9 years to 50.5 years,[4]
which has largely been attributed to the interplay between HIV
and AIDS and poverty.
1.5 Kenya's National AIDS Control Council
(NACC) is responsible for co-ordinating the country's HIV and
AIDS response and has led the formulation and implementation of
the National AIDS strategic plan (2005-06 to 2009-10) as well
as the new HIV and AIDS strategic plan (2009-10 to 2012-13). Kenya's
HIV and AIDS response has evolved from managing HIV and AIDS as
a purely medical problem, to recognising the public health significance
of the epidemic and applying a social model to HIV and AIDS programming.
This has meant a shift from largely health facility-based interventions
to a greater balance between health facility and community-based
interventions, and greater involvement of communities, including
beneficiaries, civil society and the private sector. The current
plan (2009-10 to 2012-13) advocates for a multi-sectoral and comprehensive
response encompassing: prevention, treatment, care and support;
mainstreaming of HIV in key sectors; community-based programming
in support of universal access and social transformation; and
effective stakeholder co-ordination.[5]
1.6 Two recent assessments carried out by
AMREF have highlighted important gaps in the HIV and AIDS response
in Kenya.[6],
[7]
These gaps are:
— Poor co-ordination and weak participation
of communities.
— Insufficient capacity of communities
to design and implement interventions to address HIV and AIDS
and inadequate resources for them to do so.
— Failure to address the underlying causes
of the high prevalence and negative impact of HIV among the most-at-risk
categories.
These gaps are set out in greater detail below:
Poor co-ordination and weak participation of communities
1.7 AMREF found that a third of CSOs in
Kenya were failing to follow national guidelines on HIV and AIDS
implementation, and only a minority had reported to the NACC or
used the harmonized HIV and AIDS indicators stipulated in Kenya's
national monitoring and evaluation framework.[8]
Linkages between CSOs and government structures in Kenya were
extremely weak and there was a clear disconnect between what CSOs
were doing and what the formal health system desired them to do.
Failure of CSOs to align their interventions with government policies
and guidelines was largely to lack of information and the poor
inclusion of CSOs in local government reviews and planning processes.
The assessments also highlighted the weaknesses of decentralised
NACC and MoH M&E and information systems: databases were found
to be incomplete, HIV and TB activities were inadequately integrated,
and key stakeholders were poorly involved in key planning processes.
Insufficient capacity
1.8 AMREF Kenya found that local CSOs lacked
sufficient organisational and technical capacity to design, implement
and monitor effective HIV and AIDS interventions. For example,
out of the 70 CSOs surveyed by AMREF in 2004, only 20% were found
to have elected leaders, 15% had annual plans to guide implementation,
53% had financial procedures in place, 22% used finances efficiently,
and only 68% had a constitution. AMREF also found considerable
funding and sustainability gaps among CSOs in Kenya, and inadequate
systems in place to track performance and resource utilisation,
making it difficult to assess the efficiency and effectiveness
of community interventions.
Poor quality services for the most at risk
1.9 AMREF's assessment also revealed a low
quality of HIV and AIDS services for the most-at-risk in Kenya,[9]
both in health facilities and in the community. For example, whilst
Kenya's training curriculum on home and community-based care (HCBC)
recommends 11 days of training, many CSOs were found to be training
caregivers for as little as three days and were also lacking the
appropriate HCBC kits. Health facilities were providing minimal
to no services to at-risk populations: less than 5% of health
facilities were effectively addressing the needs of IDUs and less
than 30% were addressing the needs of sex workers. Only a fifth
of the health facilities were offering specific youth friendly
services. Little was being done to address the underlying drivers
of the epidemic, including traditional/cultural practices, gender
inequalities, and violations of human and legal rights particularly
among women and girls, and high-risk sexual practices. AMREF found
that 50% of widows in the Lake Victoria Basin Region of Kenya
undergo sexual cleansing, a high risk sexual practice.
WHAT IS
THE MAANISHA
PROGRAMME DOING?
2.1 Maanisha is AMREF's community-focused
HIV and AIDS programme in Kenya, which aims for a sustained reduction
in HIV incidence and reduced HIV—related mortality and morbidity,
and the social protection of HIV infected and affected persons
in the country. "Maanisha" is a Swahili word
that means "giving meaning to". The programme
covers all districts in Nyanza, Western and Eastern provinces,
and the Lake Basin Districts of the Rift Valley province. The
project is being implemented in partnership with the NACC, MOH,
CSOs and PSOs. It is funded by the UK Department for International
Development (DFID) and the Swedish International Development Cooperation
Agency. The total cost of the programme is US$30 million for five
years (2007-12).
2.2 The specific objectives of Maanisha
are:
— To build the capacity and capabilities
of CSOs and PSOs to design and implement quality HIV and AIDS
interventions.
— To promote safer sexual behaviour and
practices among at risk and vulnerable groups.
— To strengthen facilitation, harmonization
and co-ordination mechanisms between CSOs and GOK structures.
— To support CSOs/PSOs to improve quality
of life for PLHIV, OVC, and widows/widowers through increased
access to quality treatment, care and support services.
— To develop and strengthen a knowledge
base for positively influencing policy and practice in HIV and
AIDS programming.
See Annex 1 for full conceptual framework.
DESCRIPTION OF
SPECIFIC INTERVENTIONS
Strengthening capacities of grassroots CSOs and
PSOs
2.3 Grassroots CSOs and PSOs in Kenya provide
important prevention, care and support services and ensure HIV
and AIDS interventions are accessible and acceptable, and relevant
to the needs of communities and households. Maanisha strengthens
the capacity of CSOs and PSOs in four provinces of Kenya to implement
HIV and AIDS interventions in two ways: grant making and capacity
strengthening (includes both technical capacity and organisational
strengthening). Organisations are strengthened in eight areas[10]
using the "Organisational Development and Systems Strengthening
(ODSS) approach", implemented by programme staff and NACC
staff via CSO mentoring (AMREF has also developed an ODSS manual
for grassroots CSOs). The mentoring programme for each organisation
is designed based on results from an ODSS scanning tool, which
establishes the capacity of CSOs and PSOs in all eight components
of the ODSS.
Strengthening co-ordination and harmonization
between government structures and CSOs
2.4 Maanisha applies three strategies
to strengthen co-ordination and harmonization: (a) strengthening
M&E and information systems; (b) enhancing co-ordination and
collaboration between NACC/MoH and CSOs; and (c) enhancing CSO
alignment to national standards. The first involves working with
NACC staff to strengthen district information management systems
and improve CSO input into the national HIV and AIDS M&E system.
It includes: mentoring CSOs on M&E; supporting CSOs to access
and utilise reporting tools aligned to the National M&E framework;
and supporting the strengthening of NACC databases. The second
strategy involves strengthening co-ordination fora at district
and provincial levels. It includes: lobbying NACC and other stakeholders
to initiate the fora; providing start-up funding and technical
support; and rallying players to recognise the leadership role
of the NACC. Maanisha also improves the involvement of
CSOs in local planning processes by strengthening networking capacity
among CSOs, sensitising them on participation in stakeholder fora,
and lobbying the NACC and MoH for the inclusion of CSOs in key
review and planning fora/processes. The third strategy—enhancing
alignment of CSO interventions to national standards, is achieved
via CSO mentoring, as well as the dissemination of national policies
and relevant guidelines to CSOs.
Grants scheme
2.5 Maanisha has implemented a grant
scheme targeting CSOs and PSOs. The scheme is closely linked to
the capacity building component, and constitutes what AMREF calls
the "Twin Approach". This approach ensures that
organisations receiving funding have the required organisational/management
and technical capacity to utilise these resources effectively.
The scheme consists of the following elements: demand creation,
capacity assessment of CSOs and PSOs, provision of grants, strengthening
of CSOs' and PSOs' financial management systems, and financial
mentoring & monitoring. Maanisha creates demand for
funding in two ways: the "call for applications" approach
(creating demand among CSOs and PSOs for resources and then calling
for applications); and the "proactive approach" (actively
seeking groups that target the most at risk populations, and then
building their capacity to apply and qualify for grants). 60%
of Maanisha's resources are allocated as grants to CSOs
and PSOs, and the grants range in size from USD 7000 to USD 20,000
per year. The Maanisha project implementation team receives,
records, and undertakes the initial review and assessment of submitted
applications. External regional and national technical committees
then review the applications before grants are disbursed to qualifying
organisations. When an application is successful, Maanisha
conducts capacity assessments for prospective CSOs and PSOs,
and financial management and systems strengthening training to
improve skills and understanding of financial management procedures
and reporting requirements before funds are released. The Maanisha
team then mentors and monitors CSOs and PSOs during quarterly
and "spot" visits, increasing their compliance with
contractual obligations, utilisation of funds according to approved
budgets and work plans, maintenance of records and realisation
of projects targets. Maanisha has developed and applied
a simplified financial management model—the Pot Model, to
guide CSO and PSO capacity strengthening in financial management.
Prevention of HIV infection
2.6 In order to prevent new HIV infections
and re-infections, Maanisha promotes the adoption of positive
sexual behaviour and practices especially among at risk populations
and special groups (eg youth, MSM, IDU, PLHIV) by funding and
building the capacity of CSOs/PSOs to implement the following
interventions: promotion of abstinence, being faithful and reduction
of number of sexual partners; condom promotion and distribution;
promotion and advocacy for expanded access to HIV counseling and
testing; information, education and communication; prevention
with positives; and promotion of male circumcision.
Care and support
2.7 The Maanisha project bridges
gaps in the continuum of care and support between the formal health
system and the community. It facilitates collaboration between
MoH officials (including district HIV and AIDS co-ordinators and
district home and community-based care co-ordinators) and CSOs/PSOs,
and provides CSO/PSOs with MoH approved home- and community-based
care guidelines, diaries, tally sheets, notebooks, referral forms,
and education and communication materials, as a means of aligning
their activities to the national HIV and AIDS strategy. The programme
has also enabled funded CSOs and PSOs to form or develop linkages
with support groups—an important part of the referral system,
where PLHIV can go for psychosocial and spiritual support. To
facilitate this, Maanisha distributes a community referral
tool to support groups, developed by the MoH, which is recognised
and accepted by health facilities. As part of strengthening the
referral system, CSOs and PSOs also support the transportation
of clients in need of medical attention to local health facilities.
2.8 The Maanisha programme also enhances
the capacity of communities to provide care and support by funding
CSOs and PSOs engaged in the provision of home and community-based
care, care and support for orphans and vulnerable children, and
support for PLHIV and widows. CSOs and PSOs are able to use these
funds not only to provide better direct care to beneficiaries,
but also to train home and community-based caregivers and counselors
to provide services to PLHIV, youth and other categories of most-at-risk
populations and special groups. In Kenya, home and community-based
care includes basic clinical care such as the identification of
adverse drug effects and referral, basic palliative care, nutritional
counseling and education, and psychological and emotional support
to PLHIV and their families. Consequently, funded CSOs and PSOs
also procure home and community-based care kits, and distribute
them to local caregivers. The programme also funds organisations
providing sustainable nutritional support to PLHIV, and those
that support orphans and vulnerable children to access formal
education, food and nutrition, social protection, medical care
and psychosocial support.
Mainstreaming of cross cutting issues
2.9 Addressing the underlying drivers of
the epidemic, including social and cultural factors, gender inequalities,
stigma and discrimination, legal and human rights violations,
participation of beneficiaries, poverty and food insecurity is
a key component of the Maanisha project. Maanisha addresses
these issues by engaging with communities, community leaders and
policy makers to create an enabling social, cultural and policy
environment for desired social and behaviour change. For example,
it funds CSOs to engage in prevention activities; trains CSOs
and community members on key underlying drivers of the epidemic,
especially on social cultural and gender analysis, and legal and
human rights; works with cultural leaders eg councils of elders
to help integrate principles of HIV and AIDS prevention, care,
and support in cultural practices and reduce harmful traditional
practices that result in spread of HIV and worsen its impact;
and links CSOs with microfinance institutions to enable them to
access funds and initiate sustainable income generating activities.
Knowledge Management
2.10 The Maanisha programme identifies
key lessons learned and best practices to influence future HIV
and AIDS programming, particularly in resource constrained settings.
The programme promotes replication of these practices among CSOs
and PSOs, and shares them with policy makers for incorporation
into national implementation frameworks.
ACHIEVEMENTS OF
MAANISHA
The key strengths and achievements of Maanisha
are as follows:
Using the ODSS to strengthen the capacity of grassroots
CSOs and PSOs
3.1 As of June 2009, Maanisha was
funding and mentoring 536 CSOs/PSOs, which in turn were reaching
more than 500,000 most-at-risk and vulnerable people with quality
prevention, care and support services. Based on before and after
training and mentoring assessments, funded organisations now have
improved management and governance (figure 1). Earlier assessments
based on a quasi-experimental study design[11]
revealed similar benefits in capacity enhancement of CSOs as a
result of the Maanisha intervention. In a recent client
satisfaction survey,[12]
86% of CSOs rated Maanisha as good to excellent with regards
to the effectiveness of capacity building, management of inquiries
and complaints, waiting time for grants, and treatment of clients
with respect/courtesy/fairness.
Figure 1
PERCENTAGE OF CSOs/PSOs SHOWING CAPACITY
GAPS BEFORE & AFTER TRAINING & MENTORING
The innovative grants scheme
3.2 Maanisha today funds 536 CSOs:
[as per funding round five] 85% are CBOs, 6.1% PSOs, 11% NGOs
and 3% are FBOs. Most of the grantees (85%) are grassroots organisations,
which have direct contact with targeted beneficiaries. The funded
CSOs are reaching diverse beneficiaries including at risk and
vulnerable populations (see Table 2 below).
Table 2
MAANISHA FUNDED
CSOs'/PSOs' BENEFICIARIES (ROUND 5)
|
| Target | # sub-grantees (CSOs & PSOs)
| # beneficiaries |
|
| OVC | 315 |
22,367 |
| Youth | 303
| 458,079 |
| Married couples | TBD
| TBD |
| PLHIV | 275
| 34,663 |
| Widows/widowers | 223
| 18,963 |
| PWD | 108 |
4,145 |
| CSW | 59 |
12,124 |
| Migrant people | 28
| — |
| IDU | 20 |
1,210 |
| Prisoners | 15
| 3,584 |
| MSM | 13 |
452 |
|
The funded organisations are implementing prevention, treatment,
care and support activities as outlined in table 3 below:
Table 3
ACTIVITIES IMPLEMENTED BY SUPPORTED CSOs/PSOs
|
| Intervention | # sub-grantees (CSOs & PSOs)
|
|
| HIV Testing and Counseling | 85
|
| Behaviour Change Communication | 270
|
| PMTCT support | 63
|
| Prevention with Positives | 22
|
| Home and Community-based Care (HCBC) | 246
|
| ART Adherence | 72
|
| Psychosocial Support | 107
|
| Food and Nutrition | 251
|
| OVC support | 315
|
|
Improved facilitation, co-ordination and harmonization
3.3 As of June 2009, Maanisha had strengthened
the capacity of 117 NACC structures, with 97% showing an increase
in knowledge and skills to support and supervise CSOs/PSOs. Today,
there is evidence of enhanced co-ordination between NACC/MoH and
CSOs, coupled with greater harmonization of CSO interventions
to national standards. Maanisha has helped shape the design
and rollout of the World Bank funded Total War against AIDS (TOWA)
project implemented by NACC in Kenya, including embedding the
capacity building of CSOs as a key component. Other specific recent
short-term outcomes include: 56% of Maanisha-supported
CSOs/PSOs in programme scale up areas are now assisted by NACC
staff (up from 22% at baseline in mid 2008); from January to June
2009, 40 CSOs/PSOs in pilot regions received specific support
from MoH staff, and 164 grantees (31%) participated in stakeholder
co-ordination/planning fora; and grantees reporting to NACC using
the national reporting tool has increased from 12% to 98%. There
are also strong signs of an emerging co-ordination model based
on regular joint stakeholders meetings, co-ordinated support to
CSOs, information sharing between key stakeholders, harmonization
of reporting tools, and involvement of key stakeholders in planning
and implementation processes, and synergy in resource mobilisation
and utilisation among key implementing partners.
Prevention of HIV infections and mainstreaming of underlying
factors
3.4 The Maanisha project has enhanced the ability
of 270 CSOs to design and implement HIV prevention interventions.
Specifically, the project has increased knowledge among trainers-of-trainers
(TOTs) on safer-sexual practices, who in turn have facilitated
the training of more than 20,000 peer educators and reached more
than one million people with specific prevention messages, including
over 300,000 young people in schools and 12,160 males on male
circumcision. Other key outputs and short-term outcomes include:
162,530 people trained on proper condom use; 10 voluntary and
counseling centres strengthened, which have provided services
to more than 26,250 people (including those with disabilities);
107,932 IEC materials distributed (4,218 of them in Braille);
2,916 CHWs trained to support counseling and testing, 2,783 CHWs
trained to support PMTCT; and 8,522 PLHIV reached with "prevention
with positives" (PwP) interventions. The Maanisha project
has also trained 9,884 PLHIV and 11,469 community members on human
rights advocacy during the period January to June 2009. Consequently,
878 cases of human rights violations have since been handled,
and 447 of the cases have been concluded (including cases concerning
widows recovering property lost through disinheritance after death
of their spouses).
Improving quality of life of PLHIV, OVCs, and widows/widowers
3.5 The project has supported 246 CSOs to provide HCBC,
and strengthened referral and linkage mechanisms between CSOs
and health facilities. It has also facilitated 72 CSOs to support
adherence to ART, 251 CSOs to offer nutritional support to PLHIV,
and 351 CSOs to offer OVC care and support. As a result of these
activities, the following outputs and short term outcomes have
been realised: 264 CHWs and 8.505 caregivers have been trained
in HCBC (and consequently 23,147 PLHIV have been provided with
quality HCBC services); 5,521 clients have been referred by CSOs/PSOs
to health facilities; farming initiatives by PLHIV support groups
have improved (21,553 PLHIV have been provided with sustainable
nutritional support); sustainable OVC support initiatives have
been developed by CSOs, which has meant that 27,139 OVCs have
accessed primary support, 2,222 have accessed HIV counseling and
testing, and 1,478 have accessed ART; and CSO training on adherence
support has meant that an additional 13,794 PLHIV have been supported
to adhere to ART.
Knowledge management
3.6 The project has developed and rolled out a knowledge
management strategy, orientated 149 CSOs/PSOs on knowledge management,
and identified and pursued key advocacy issues. As a result of
these efforts, CSOs have documented 362 human interest stories,
while project staff have documented two best practices and a paper
on "approaches for enhancing aid effectiveness among grassroots
CSOs". Today, many CSOs are also replicating prevention,
treatment, care and support interventions, learnt from other CSOs
during exchange visits and review meetings.
KEY LESSONS
LEARNED
3.7 The implementation of the Maanisha project
has demonstrated several key lessons for future HIV and AIDS programming.
The most important of these are:
— Grant-making to CSOs and PSOs should include a comprehensive
capacity building programme to enhance quality of interventions.
The capacity building programme should cover capacity needs assessment
prior to disbursement to reduce risk and inform the capacity building
process for each CSO and PSO.
— Involving government structures in the co-ordination
of HIV and AIDS efforts, including the training and mentoring
of CSOs and PSOs at a local level, significantly improves the
relationship between government structures and CSOs and PSOs.
It also increases the sustainability of capacity building efforts
at a local level and improves the co-ordination of interventions.
However, for this to happen, the capacity of government structures
must also be built and government personnel must be provided with
transport to enable them to visit CSOs and PSOs.
— It is important to invest in the strengthening of
co-ordination and harmonization mechanisms at provincial and district
levels to improve the HIV and AIDS programming environment. However,
to be effective, co-ordination efforts should involve key government
agencies as well as civil society, including grassroots CSOs;
and promote wide stakeholder involvement, information sharing,
leadership, harmonization of implementation and reporting frameworks,
and synergy in resource mobilisation and utilisation.
— Mainstreaming factors underlying the spread and impact
of HIV and AIDS across the programme is an effective way of creating
community behaviour change and enhancing the quality of care and
protection among at risk populations. Key underlying issues needed
to be addressed include: human and legal rights violations, gender
inequalities, and prevalent harmful socio-cultural practices.
— Door-to-door counselling and testing is a more effective
way of increasing access to HIV counseling and testing services.
Anecdotal evidence from CSOs/PSOs indicates that people prefer
mobile, door-to-door counselling and testing than static VCT centres.
— There are many innovative best practices being implemented
by CSOs/PSOs in Kenya. These are practices which if replicated
and scaled up would significantly enrich the national response
against HIV and AIDS. Consequently, AMREF in Kenya will work with
the NACC and other partners to promote knowledge management as
a significant component of HIV and AIDS programming.
— Peer-to-peer learning is an effective way to fast
track the replication of best practices. AMREF is supporting carefully
planned exchange visits between CSOs/PSOs, which in the future
will include exchange visits between CSOs/PSOs in "old"
Maanisha areas and scale up areas.
— It is possible to access hard-to-reach population
groups including sex workers, MSM, and prisoners with prevention,
treatment, care and support interventions by supporting those
CSOs/PSOs that include these groups in their membership, to design
and implement context specific interventions.
CONCLUSION
3.8 The Maanisha project demonstrates the important
role that civil society plays in improving the HIV and AIDS response
in Africa. In many African nations, civil society provides health
care services to more than half the population. Recognising their
role, building their capacity and co-ordinating their work at
a local level are essential. In Kenya, there remains work to be
done: the CSO response is poorly co-ordinated, communities have
weak capacity, minimal access to resources, and their participation
in HIV and AIDS mitigation is limited; the underlying factors
of high HIV prevalence among most-at-risk populations are also
poorly addressed. Governments across Africa must seek new ways
of engaging CSOs and better leveraging their work. Maanisha
provides an evidence-based, replicable model of comprehensive
HIV and AIDS programming, designed for resource poor settings,
which can significantly improve the effectiveness of national
HIV and AIDS responses.
1
National AIDS/STD Control Programme, Kenya Ministry of Health,
2008: http://www.aidskenya.org/. Back
2
National AIDS/STD Control Programme, Kenya Ministry of Health,
2008: http://www.aidskenya.org/. Back
3
UNGASS (2006), Country Report-Kenya: http://www.nacc.or.ke/2007/index.php Back
4
UNGASS (2006), Country Report-Kenya: http://www.nacc.or.ke/2007/index.php Back
5
Draft Kenya National AIDS Strategic Plan, 2009/10-2012/12): http://www.aidsportal.org/Article_Details.aspx?ID=10873. Back
6
AMREF (2004), HIV and AIDS Needs Assessment, Lake Victoria Basin
Region-Kenya. Back
7
AMREF (2005), Baseline Study on HIV and AIDS Knowledge, Attitude,
Behaviour and Practice in Western and Nyanza Provinces, Kenya. Back
8
AMREF (2005), Baseline Study on HIV and AIDS Knowledge, Attitude,
Behaviour and Practice in Western and Nyanza Provinces, Kenya. Back
9
Most-at-risk populations are those at higher risk of infection
and the negative social impacts of infection; they include: people
living with HIV, widows, orphans, sex workers, men who have sex
with men, injecting drug users, adolescents and youth, people
with disability, mobile populations such as long distance truck
drivers and fishermen. Back
10
The eight areas are: leadership, governance and strategy development;
financial management and budgeting; administration and human resources
management; networking and advocacy; community ownership and accountability;
project design and management; sustainability; and knowledge management. Back
11
AMREF, 2007. (http://www.amref.org/search/poster/) Back
12
AMREF, 2009. Client satisfaction survey. Back
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