Activity: Community Feedback meeting

Venue: Aberdare County Club- Nyeri

Date: 14/03/2019-16/03/2019

DAY 1

1. Registration

2. Opening Remarks and Introductions

3. Expectations

4. Objectives of the meeting

5. Updates from KP KCM Representative and OIG Audit Report

6. Introduction to KCM Secretariat

7. Global Fund Implementation status: Performance, Rating and catch-up plans

8. Key concerns

9. Action Points

1. Registration

The registration process was initiated as soon as delegates presented themselves to the

meeting facility. It was a straight forward activity and it was completed on time.

2. Opening Remarks and Introductions

The meeting was called to order by Rosemary Kasiva, who thanked everyone for availing

themselves and apologized for starting the meeting slightly late.

Everyone present was requested to introduce themselves using the following criteria:

- Name

- Network representing

- Identity/ Pronoun.

The participants were drawn from the network members dealing with key population.

3. EXPECTATIONS

I. Update from the secretariat from the red cross

II. Learn more of the KCM , where we are, when elections will be made – Process and

Procedures

III. Global fund – Support for MAT networks

IV. Learn how sex workers can directly be engaged by the global fund

V. Find out status of the groups of sex workers who were to be funded, and if they

are funded or not

VI. Feedback concerning sex workers programming (Directed to red cross)

VII. Engagements involving the trans community

VIII. Concerns about the KPS Groups not being involved, what is the current status

IX. Hear from the Global fund: what does advocacy and activism mean according to

Red cross

X. A common information resource on how we are working together as KPs

XI. Want to interact with us and ask questions

XII. Transition (clarity on the programs being dropped and translation mechanism)

a. Purpose and Objective

- Areas to be scaled up or down, enable directing and offering guidance to the process

of the global fund

- Guide and give support the GF Programing in Kenya

4. Objectives of the meeting

I. Update constituency members on GF/KCM operations, OIG report, SR selection

process and GF replenishment

II. Share Overall experiences and achievements in relation to GF grants

III. Review 2018/2019 constituency work plan implementation progress

IV. Develop Constituency Annual Plan for 2019/2020

V. Discuss Strategies to strengthen and sustain GF Programming in Kenya

5. Updates from KP KCM Representative and OIG Audit Report

The Global Fund: Purpose

“To dramatically increase resources to fight three of the world's most devastating diseases

and to direct those resources to areas of greatest need.”

Updates:

- OIG Audit report published and discussed during special KCM management

Committee meeting held on 25th Jan,2019

- Award of additional funding of US$ 8,661,734 for LLINs through portfolio

optimization.

- Grant revision process to commence to include the additional funds in the KEN-M-

TNT grant.

- Revised documents are expected to be submitted to GF before 28th February, 2019.

- SR Selection process /outcome/ appeals review process

- Preparations for GF 6th Replenishment currently ongoing-PRs /SRs to improve on

absorption and ensure prudent use of funds, document success stories realized

during NFM /Current Grant.

- Need for National and County Governments to demonstrate domestic support to

HIV, TB/HIV Programmes in line with UHC agenda.

- Pledge made to GF by the Government of Kenya during 5th Replenishment fully

honored.

- Consultations ongoing for the amount to be pledged during the 6th Replenishment

OIG Audit Report

The Global Fund OIG Team conducted audit in June, 2018. The Audit covered the period Jan

2016 to December, 2017.

21 health facilities, ten bed net distribution points, five KEMSA warehouses, five key

population groups in ten counties and KCM Secretariat visited during the Audit Period.

Specifically, the audit assessed the efficiency and effectiveness of the:

I. Design and implementation of the programs to deliver quality services to intended

beneficiaries.

II. Procurement and supply chain processes and systems in ensuring availability of

quality assured medicines and health products to patients.

III. Grant implementation arrangements in the context of devolution including

governance, oversight and coordination to ensure sustainability.

IV. Adequacy and effectiveness of frameworks in place to measure grant performance.

Key Achievements:

- Significant progress made in the fight against the three diseases:

- Increased government financial commitment to the three diseases:

- Functional in-country procurement and supply chain systems and processes, with

KEMSA, able to procure quality assured medicines at cheaper rates than

international reference prices.

Key Issues and Risks

Improvement required in quality of services: A number of qualities of service issues to be

addressed

- Case notification targets for TB not met for the last three consecutive years.

- TB treatment coverage remains low (45%).

- Inconsistencies in compliance with national guidelines for HIV testing and counselling

services.

- Inconsistencies in measurement of outcome and reporting of data

Challenges in programming and implementation of interventions for key populations:

- Outdated bio-behavioral data informing current KP programs.

- New national survey (2017) suspended due to lack of consensus on use of

biometrics.

- The “in and out of school” AGYW behavioral interventions for 10-17-year Old’s,

piloted in Turkana, have not been effectively implemented.

Delayed engagement of service providers by PR since January 2018, with no

commencement of AGYW interventions

There is limited visibility on donor activities which results to duplication. Duplication in

programs supported by GF and other health partners, due to limited information sharing at

the central and county level:

- GF and two other development partners provide resources to the same

implementers for the same interventions for MSM and PWID in same five counties.

- The implementers report the same results to both donors, which leads to over-

reporting at the national level.

Need to adapt Global Fund’s risk mitigation measures and assurance:

The country is working on devolving grant implementation to counties, which will

significantly change the risk exposure of Global Fund grants. Existing GF Country Team

structure and assurance arrangements, as well as in-country oversight mechanisms by the

PR, were designed based on the national implementation arrangement. Risk mitigation

measures will therefore have to be adapted to respond to changes in implementation

arrangements

Rating the Global Fund Performance per the 4 Objectives

Objective 1: Design and implementation of the programs to deliver quality services to

intended beneficiaries: Partially effective.

Objective 2: Procurement and supply chain processes and systems in ensuring availability of

quality assured medicines and health products to patients: Effective.

Objective 3: Grant implementation arrangements in the context of devolution including

governance, oversight and coordination to ensure sustainability: Partially effective.

Objective 4: Adequacy and effectiveness of frameworks in place to measure grant

performance: Partially effective.

Summary of Agreed Management Actions

Development of an action plan for implementation of the TB strategic initiatives, including

- Implementation arrangements for expansion of TB case detection and reporting in

the private sector

- Interventions for improving and monitoring active case findings at facility and

communities

- A challenge fund to pay for performance initiatives.

Next Step

To take note of OIG recommendations and timelines for timely follow-up.

To share road map and update KCM on the progress made on implementation of OIG

recommendations (PRs, Programs, CoG, and KCM Secretariat)

- Share template

- Include clear indicators/milestones to demonstrate progress

Reports/roadmaps shared with ICCs, Oversight Committee and Management

Committee and thereafter presented to KCM on 14 March, 2019.

Management Committee to monitor progress on implementation of roadmaps

Management response to state facts and actions, and reassure the public

6. Introduction to KCM Secretariat

KCM is comprised of 23 Principal members and 23 Alternate members;

KCM constitution has been amended to bring on board a representative of adolescents and

young persons, additional slot for key populations, and three slots for County Governments.

Current Total KCM membership is - 23 members.

Constituency/KCM Membership

Members

National Government 5

County Government 3

Non-Government Organisations

1

Faith Based Organisations 2

Persons Infected/affected by the disease

3

Bilateral Development Partners

2

Multilateral Development Partners

2

Private Sector 2

Key Population 2

Adolescents and Youth 1

KCM Mandate

-To mobilize funds from The Global Fund for HIV/AIDS, Tuberculosis and Malaria

programmes through coordinating submission of Country Funding Application and to

coordinate stakeholder engagement and provide oversight over the implementation of

approved Global Fund Grants.

Roles of KCM

- Coordinate the development and submission of Country proposals/funding requests

- Nominate Principal Recipients

- Oversee implementation of the approved Grants and submit requests for continued

funding

- Approve any re-programming and submit requests for continued funding

- Ensure linkages and consistency between Global Fund grants and other Country

health and development programs/constituencies

Principal Recipients

The Principal Recipient is the institution with whom the Grant Agreement is signed and is

the one legally responsible for the execution of the contract with the Global Fund and Sub-

recipients (SRs/SSRs)

Current Principal Recipients

- The National Treasury (TB, Malaria and HIV/AIDS)

- AMREF Health Africa – (TB & Malaria – for CSOs)

- Kenya Red Cross Society (HIV/AIDS – for CSOs)

Global Fund New Grant components

- On 15th December, 2017 Kenya signed new Grants amount totaling to USD 380

Million to support HIV, TB and Malaria for the period January 2018 to June 2021.

Component allocation is as below;

- HIV= Ksh 25 billion (TNT, 17.9 billion, KRCS=KShs 7.1 billion)

- Malaria Ksh 6.7 Billion (TNT 5.4 billion, Amref Health Africa, KShs 1.3 billion)

- Tuberculosis = KShs 6.3 billion (TNT KShs 3.0 billion, Amref Health Africa, KShs 3.3

billion)

KCM Governance & Oversight

KCM has up-to-date Governance Documents which include; Constitution, Conflict of

Interest, Oversight Plan and Standard Operating Procedures.

KCM is supported by 2 Committees; Management Committee and Oversight Committee,

which meet quarterly.

KCM has a functional website from which various reports and documents can be found:

www.globalfundkcm.or.ke

7. Global Fund Implementation status: Performance, Rating and catch-up plans

1. The National Treasury (TB, Malaria and HIV/AIDS)

The National Treasury is the state PR under GF, managing three grants; HIV, TB and Malaria.

The grants started in January 2018 and will end in June 2021.

Support under the HIV grant

The grant supports the following;

Procurements and distribution of HIV commodities. (ARVs, HIV test kits, Male

condoms, Lubricants, Hepatitis B screening and vaccine, Hepatitis C Screening, STI

drugs, Methadone, Naloxone, Naltrexone, Buprenorphine and lab commodities).

Trainings - ART guidelines, human rights, HIV testing services, PMTCT, school

teachers on psychological support, Key population programming, play therapy and

caregivers among others

Advocacy forums – CHMT, law enforcers, network of people living with HIV, KPs,

Insurance companies, Judiciary, National assembly members.

Printing of data collection and reporting tools

Mass media campaigns

PrEP - GF is supporting review meetings, Community outreach and linkage in 5

counties, development of PrEP tools and procurement of ARVs for PrEP.

Creation of awareness of the HIV tribunal human rights and law Targeting networks

for persons living with HIV, KPs, vulnerable groups and general population in

selected counties

Continued support for Monitoring of Adverse Drug Reaction in 8 hospitals and Drug

resistance surveillance

Consultative forum for the adolescents at Various level – National and County

Support for the National call centre and SMS notification to support counties in

management of complicated cases

Support under the HIV grant for KPs

Annual stakeholders review

Sensitization of PWIDs on national guidelines for prevention and management of

viral hepatitis

Development of communication materials for KP program done. Printing has been

initiated.

Annual peer convention conducted in 2018

Training on various aspects of KP programming conducted in 2018

Onsite support for the KP site

Quarterly TWGs at the National level

Achievements

The HIV estimates 2018 show that prevalence of HIV is on a downward trend.

Reviewed the ART guideline and launched it in 2018 to allow transition process to

commence.

Conducted and completed the data quality assessment including discussion with the

counties on measures to improve service and data quality.

Challenges

The transition process has been slow and experienced low stocks of some of the HIV

commodities.

Slow start of the grants implementation due to GF and GOK requirements

Support under the TB grant

The support under the TB grant includes the following;

Procurement and distribution of drugs for TB including multi drug resistance TB, lab

commodities, and nutritional supplements. They have been initiated and at various

stages of procurement.

County and national TB data review and cohort analysis meetings

Trainings – Second line Drug Susceptibility Testing (DST), HCW training on MDR TB

detection and diagnosis, Infection prevention control.

Provision of NHIF to MDR TB patients

Support activities around active case finding of missing TB cases

Printing of data collection and reporting tools.

Mass media campaigns and advocacy forums

Achievements

The MDR TB patients are being supported for NHIF. This allows them to get services

other that TB in NHIF accredited facilities.

The program has reached more than 1000 MDR TB patients on treatment.

Challenges

Stock out of cartridges for gene xpert machines

Support under the Malaria grant

GF support includes;

The procurement of LLINs, Anti-malaria’s, and Rapid test kits etc. The procurement

process has been initiated and is at an advanced stage.

Trainings – Such as malaria case management, quality assurance, microscopy among

others and Review meetings for the pharmacists and lab personnel.

Printing of tools , manuals and guidelines

Mass media campaigns to create awareness

Support quality of care surveys (inpatient, outpatient and private sector)

Achievements

Malaria prevalence has reduced from 11% to 8% and GF has played an important role such

as the distribution of LLINs.

Challenges

There is delayed procurement of training firms to conduct case management trainings

under the grant.

2. AMREF Health Africa(TB & Malaria – for CSOs)

Malaria Grant

The objective of the grant is to contribute towards the national goal of reducing the

morbidity and mortality attributable to malaria in the various epidemiological zones by 2/3

of the 2015 levels by 2020

Project implementation period:

Oct 2012 to September 2015 (Round 10)

October 1st 2015 – December 31st 2017 (NFM) Budget: USD12,155,880

January 2018 – June 2021 Budget USD 13,240, 138

Effects of the intervention:

Contributed to reduction in prevalence of malaria in the lake endemic region from

38% in 2010 to 27% in 2015 (KMIS 2015). In the coast endemic region where there is

no CCMM, the prevalence increased from 4% to 8% during the same period.

There has been a significant improvement in the health seeking behavior among the

communities served with CHVs

There is change of attitude among HCWs towards the CHVs. HCWs continue to

embrace the efforts of CHVs at level one.

Reduction in the workload at the primary facilities by about 30 – 40%

During the health care workers’ industrial action in April to November 2017, CHVs

were the main source of healthcare for many community members.

Challenges

Prolonged SR selection process that delayed start of activities.

Some of the CUs still reporting stock-outs of commodities.

Roll out of school health activities in coast malaria endemic counties delayed due to

a circular from Ministry of Education prohibiting any activities in schools during the

3rd school term.

TB Grant

The main goal is to accelerate reduction of TB Leprosy and Lung disease burden through

provision of people-centred universally accessible, acceptable and affordable quality

services in Kenya.

Coverage:

47 Counties

Project implementation period:

1st January 2018 to 30th June 2021

Total Budget = 32,651,550

Planned Activities

Follow up on implementation of the action plans developed during trainings.

Adaptation of CAPR tool to include TB and Malaria for CSO reporting.

High Level Engagement of National and County Legislators through community led

social mobilization campaigns in 10 counties to include domestic resource

mobilization for health

Media engagement and Mobilization for county champions

Sensitization of 30 community champions (HIV, TB and Malaria ) on the diseases

CSOs review meeting for the CSOs leaders/ representatives

3. Kenya Red Cross Society (HIV/AIDS – for CSOs)

PWIDS Program:

-It’s a continuous program; no new activities are being implemented.

- The activities are being implemented in Mombasa, Nairobi, Kilifi, Kwale,

-Kenya Red Cross Society is procuring NSP kits for the PWIDs.

-On methadone they are providing referrals and follow ups for the clients.

-This year, KRCS is planning to capacity build the MAT networks so that they can continue

implementing the activities.

-The targets in the PWIDs Program were not increasing due to the same clients are

graduating to Methadone.

Female Sex Workers:

-KRCS is targeting 3300 female sex workers in the country.

-The targets are not increasing because Global Fund is meant to fill the gaps after PEPFAR

funding. Some female sex workers activities have been implemented by PEPFAR

-Global fund should include the young FSW into their programs

- No scale up to new counties apart from Laikipia.

-There is allocation for capacity building for the FSW networks.

MSM Program

-There were additional targets for the MSM networks to receive the GF funds. This is

because the size estimates of MSMs increased during modeling process conducted by

Global Fund hence increasing their numbers.

- The funds were to intervene even at the grassroots level.

-Global Fund is helping the MSMs carry out capacity building activities to strengthen the

networks.

-The program is focusing on how to include the young MSMs.

Human Rights

-It’s a new program and it’s yet to be implemented.

-Global Fund is planning to train people on know your rights.

-Also train the paralegals and pro bono lawyers so that they can help in cases filed.

-Liaise with HIV Tribunal so that the key population can access justice.

- KRCS is in a consultation process with the government since its implementing on the same

that is NACC and KELIN. The grant should fill the gaps existing in the implementation

process.

8. Key concerns

-Lack of Lubricants

The government stated in their response that the unavailability of the said commodity was

as a result of the procurement process which has resulted in unforeseen delays. The

Government promised to avail the lubricants in the coming months as the process is being

resolved. It has re-advertised the lubricants tendering process.

- STI Drugs being unavailable

The government stated that STI drugs were supposed to be supplied to the DICES and they

would not meet every facilities demand.

The delivery of expired STI Drugs, it was agreed would be investigated by the government to

ensure it doesn’t happen again. Global Fund will follow up with KEMSA to ensure that the

drugs supplied are not expired.

The government will also provide a list of STI Drugs that facilities are meant to receive from

KEMSA.

- Lack of TB Funding for KPs

It was noted that KPs don’t access the TB funding. The community is not involved in TB

Programming. A lot need to be done so that they can make the process consultative.

- NSP Kits

There was shortage of NSP Kits which are used by PWIDs. The government is procuring the

kits so that they can be available for the community. In addition, the government will be

procuring Naloxone for the first time. This will help to fight overdose.

- Engagement with TRANS* Community

The government should involve the Trans* community directly in their activities eg buying

hormones. They attend the meetings but nothing has been implemented. There is need to

sensitize the government on the existence of Trans* in the country and creating forms for

them to create awareness.

KP Consortium should help to lobby/advocate to the government to have Trans*

programmes and have Trans* module because their need are different from MSMs.

- It was suggested that the PRs should help the community create back the good

relationship with NASCOP since its affecting key population programming.

9. Action Points:

Recommendations to Global Fund as per group:

FSW:

1. Engagement for SW organizations in areas that have not been engaged eg Laikipia. GF

should work with networks that have not been reached before

2. Hold dialogues with key population, GF and the government on how to engage the

young FSW.

MSM

3. Advocacy

4. Supply lubricants

5. Have clear guidelines on how the STI drugs should be distributed

6. Always consult the MSMs before implementing

TRANS*

7. Fund Trans* programming targeting 4000 trans people

8. Establish transgender friendly comprehensive health facilities.

9. Carry out a mapping activity for the transgender

10. Training the law enforcement around Trans* issues

PWIDs

11. Capacity build the PWIDs/PWUDs networks

12. Scale up methadone to reach new areas and take home dose options

13. Provision of commodities eg KIT 1

14. Sensitization on Hepatitis B & C screening and treatment

15. Overdose Management and Naloxone Roll Out

DAY 2

KP CONSORTIUM PRESENTATION:

KP Consortium had a presentation about the Key Population Investment Fund (IKPF) CDC

Grant.

KP Consortium will be a sub-awardee of Impact Research Development Organization which

has been awarded as the prime recipient of Key Population Investment Fund (KPIF).

Key Population Investment Fund (KPIF) aims at scaling up quality KP Led Community

approaches to HIV/AIDS Prevention, care and treatment programs and address social and

structural factors including stigma, discrimination, violence and human rights violations that

negatively impact KPS’ access to and retention in the programs.

The fund will help to support the implementation of advocacy and messaging under KPIF

program. The grant will be running from 1st April 2019 to 30th September 2019. Some of

the activities KP Consortium is planning to undertake include the following:

1. U=U (Undetectable= (Untransmittable)Messaging

2. Social network strategies for Key population-case identification

3. PrEP Communication materials for the key population.

ACTION POINTS:

1. KCM election. The participants agreed on the way forward on how the election

process to be done and the Key Population Consortium to take the lead in the

planning of the election process, the networks were encouraged to plan for the

meeting to identify the representative to participate in the election process.

2. The organization were requested to include the transport allowances in their work

plan so as to facilitate for their own transport when attending the meetings, this is

due to the amount given through the GF is not enough bearing in mind the distance

coming Mombasa and Kisumu.

3. The consortium should always update the network members on the ICC Meeting

happenings: dates and venue since this is where major issues are tackled before

taken to KCM.

4. Key population led organizations and networks were requested to be vibrant, open

minded and apply for other funding eg Malaria and TB when the grant proposal are

called out since the key populations are also affected by malaria and TB.

5. KP Consortium should facilitate a meeting between the networks members and the

HIV Tribunal to understand more on the involvement of key population in the

tribunal. In addition, set up a meeting with representatives from Malaria and TB

with the community since they are among the issues affecting the key population.

6. The Consortium agree to plan for Capacity building for the KCM key populations

process and induction for better understanding of their KCM mandate.

7. Capacity building for SR and Networks for Global fund process and engagement for

the next funding model.

8. Human Rights support from PR1 and PR2 – this is a key area which the key

population network would like the to learn and to gain knowledge on the human

rights

Kenya Coordinating Mechanism Constituency Feedback Work plan 2019 Key Population Constituency Work plan

Activity Responsible 2019

Jan-Mar

Apr-June

July-Sept

Oct-Dec

1

Desk review and Disseminate information on Global Fund grants during the annual general meeting of Key Population Consortium Njane & Taib

X

2

Package and Provide feedback on GF grants during Review Meeting and Quarterly Review Feedback meeting. Njane & Taib

X X X X

3

Disseminate information on GF grants through the E- platform - Google Group platform Watts App networks groups and Through The keyP consortium Website Njane & Taib

X X X

4

Maintaining a vibrant Key Population Consortium mailing list to networks and Community Groups through the KP consortium Secretariat for updates and discussions

Rosemary & Ishmael

X X X X

5 Develop messages, Validate and to be disseminated to the Key Population Networks and Groups

Rosemary & Ishmael

X X X X

6 Participate in the Key Populations TWG National and County levels

Rosemary & Njane Taib & Ishmael

X X X X

7

Capacity Building to the Networks on Global Fund

Rosemary & Njane Taib & Ishmael

X X X X

8 Planning and implementation of the Constituency Feedback Meetings

Rosemary & Njane Taib & Ishmael X

X

9 Capacity Building for KCM members – Member and alternate of Key Populations Njane & Taib