Population and Health

Key Achievements

Reduce HIV transmission. USAID's program works through behavior change to reduce sexual transmission and encourage positive behavior change. USAID works with local groups, to establish interpersonal and peer counseling programs, communication campaigns, and Community Theater. For example, a project with the Kenya Girl Guides Association has provided more than 20,000 girls and young women with HIV/AIDS peer education and life skills training. One USAID project trained people living with HIV/AIDS in public speaking. They became eloquent advocates of self-risk perception, behavior change, and stigma reduction, speaking in schools, churches, and workplaces and on call-in radio programs.

Due to past support from USAID and other donors, Kenya is now poised for a rapid expansion of its program to prevent the mother-to-child transmission of HIV under the Presidential Initiative. USAID and CDC in Kenya have received funding to start scaling up PMCT activities in 2003-2004. By the end of that period, the number of health facilities providing PMCT services will have more than doubled. The Ministry of Health system, with it five regional blood transfusion centers built with USAID assistance, focused this year on quality assurance and blood donor mobilization. Almost 60,000 units of tested blood were collected in FY 2003.

Community-based HIV/AIDS care and support. The community-based care and support program works to improve the ability of local communities to identify their needs and to develop and carry out home-based care activities and support for people living with HIV/AIDS and their families. Combining food aid and health support, Title II contractors provided food assistance to people living in areas served by USAID's community-based program for people living with HIV/AIDS. The COPHIA project works through 29 local implementing partners to bring home-based care, ecumenical support, and orphan care to over 7,000 vulnerable households.

USAID supports several projects to identify and establish sustainable strategies to enable communities to cope with the needs of HIV-positive children and those orphaned by AIDS. USAID's Lea Toto project provides care within the community and family setting for 455 HIV-positive orphans, complemented by the support that Nyumbani gives to 91 institutionalized orphans.

Crosscutting HIV/AIDS activities. This year USAID worked with the Ministry of Health on a strategy to roll out VCT in public sector facilities. A key element in expanding VCT was the establishment of a VCT curriculum for training the increasing number of counselors needed. A national VCT communications campaign, aimed at encouraging young couples to learn their HIV status before making major life-course decisions, helped bring in more clients to VCT centers. In FY 2003, 67 USAID-supported sites served over 80,000 clients. With USAID assistance, the national AIDS committee worked to mainstream gender into its strategic plan.

USAID uses social marketing to promote products, health messages, and positive behavior change. Condom social marketing, used to prevent HIV transmission among those who are sexually active, expanded in 2003. Sales of socially marketed condoms grew 12% to almost 20 million, averting an estimated 45,000 new HIV cases and complementing the public sector distribution of almost 64 million free condoms. Social marketing sales also generated $1.5 million for local wholesalers and retailers. USAID used social marketing techniques to encourage abstinence (e.g., encouraging girls not to have sex with older men), reduce the number of sex partners, and reduce stigma.

With USAID support, the National TB Reference Laboratory began testing services in FY 2003 after a 4-year period of inactivity. USAID also funded a TB program in Nairobi and Mombasa, realizing that over 60% of TB cases reside in these urban areas.

Since AIDS is not just a health problem, USAID works in intersectoral programs in both the microfinance and democracy and governance sectors. USAID supports capacity development of local grassroots savings and credit organizations serving those affected by HIV/AIDS. Promoting democracy and governance and preventing HIV/AIDS require working with similar constituencies. USAID/Kenya promotes linkages throughout its program, beginning with the Kenyan Parliament.

Reproductive health and child survival. With USAID assistance, fertility in Kenya had fallen dramatically over the past 20 years, from 8.1 in the 1980s to 4.5 children per woman in 1995-97. Unfortunately, the latest Demographic and Health Survey shows that this decline has leveled off. Several factors probably accounted for reaching this plateau, such as decrease in education and communication activities as health programs increasingly focused on HIV/AIDS, and the unfavorable distribution of health services creating disparities in access and affordability. The problems of guaranteeing a predictable and sustainable contraceptive supply exist but are being addressed. Underlying these factors are the declining social and economic conditions in Kenya: half of the people in rural areas and a third of urban residents living in poverty.

USAID will analyze these data to see how it can improve these programs. USAID has begun to address some of these problems. It has started a set of activities to "re-introduce" the intrauterine contraceptive device (IUD) into the national program. This safe, cost-effective, and long-term method had fallen out of favor in Kenya. Advocacy and training activities have targeted policy makers and health care providers. In addition, USAID provided all of the IUDs in Kenya in FY 2003. USAID is also looking at missed opportunities within the health care system for discussing family planning. For example, a study in FY 2003 showed that VCT counselors, who see sexually active people every day, are also willing to discuss family planning. Sales of socially marketed contraceptives have been steadily increasing.

USAID continues to support public and private sector reproductive health activities. One project worked in 96 health facilities (80% government owned) in 10 districts, increasing the quality of care by training providers and upgrading facilities. The project also seeks to increase the utilization of ANC and delivery services since in Kenya less than half of all births are delivered in health facilities. The USAID program also increased demand for services and promoted healthier behavior through community-level interpersonal communications and national-level mass marketing.
Malaria is the biggest killer of young children in Kenya, resulting in about 26,000 deaths every year. Pregnant women living in endemic areas have an increased risk of severe anemia and a higher incidence of low birth weight. Increasing resistance to first line drugs, sub-standard drugs, inadequate case management, and poor surveillance further impede malaria control efforts.

USAID and DFID jointly support a project to socially market bednets, insecticide net treatment tablets, and oral and injectable contraceptives. In FY 2003, the project sold over 600,000 nets, and almost 400,000 tablets, well over FY 2002 levels. These prevented an estimated 1.9 million malaria episodes and 8,700 child deaths. Contraceptive sales were also up in FY 2003, supplying about 17% of all couple years of family planning protection in Kenya and averting an estimated 158,000 unwanted pregnancies. As sales of all products increased, the cost per unit sold dramatically decreased. USAID also worked with the national malaria control program to improve policy implementation.

Enabling Environment. USAID helped the MOH conduct the National Health Accounts study this year, to identify the constraints related to resource allocations. The NHA will help rationalize health spending and financing and improve strategically planning by estimating total health expenditures in the country and then disaggregating this information by source of funding, flow of funds to financing agents, and end uses of expenditures by providers and by categories of expenditure. The next phase of assistance will focus on financial management, the creation of a national social health insurance program and privatizing health commodity procurement and distribution.

Donor Relations. As the lead agency in health programming in Kenya, USAID has recognized how it can strengthen programming, improve communications and coordination with other agencies, and actively facilitate their participation. For example, USAID collaborated with other organizations in programming in important technical areas such as Roll Back Malaria, management of childhood illness (IMCI), and HIV/AIDS awareness. USAID-DFID collaboration is a good example. Both support PSI's work in HIV/AIDS, family planning, and malaria.