Transcript Priority Issues and Strategic Information Needs for Kenya in scaling

Priority Issues and Strategic
Information Needs for Kenya
in scaling up ART
Priority Issues
• Political Will
– Managing the process of ART implementation
according to strategic plan
• Policy
– Eligibility criteria
– Financing all components of the ART
Programme
• Role of cost recovery vs. cost sharing
• Determining “who will pay” and affordability or a
waiver system
Priority Issues
• Infrastructure:
– Existing pool of HR in relation to workload
– Provision of comprehensive HIV/AIDS services
– Mechanism for drug procurement and logistics
management
• Community preparedness strategy
– Addressing misconceptions
– Adherence
– Equity (only 50% of eligible have access by 2008)
Strategic Information Needs:
HIV/AIDS Services
• To what extent are people who need VCT
and OI management receiving the
services
• What is the flow of patients in and out of
the system:
– how patients would access ART
– how would drugs be administered
– How would patient treatment be monitored
Strategic Information Needs:
Financing
• What are financing sources and length of
commitment
• To what extent will there be full cost
recovery/sharing in the public sector
• How will the waiver system work
• How prevalence rates relate to income
groups
Strategic Information Needs:
Eligibility
• Information on those eligible for ART
(those falling within AIDS case definition)
• What are the national eligibility criteria for
those eligible who will receive ART
Strategic Information Needs:
Community Preparedness
• Mapping of existing NGOs and their
capacity and services they provide
• What conduits of information about HIV
and ART to community exist
• Baseline of KAP on HIV and ART
• Access and adherence perceptions within
the community
Strategic Information Needs:
Infrastructure and Logistics
• Information that will help to look for
strategies to reinforce the existing pool
and expand HR
• What is capacity of existing ARV drug
supply chains to help scale up
• What is the capacity of laboratory services
to monitor patients
Strategic Information Needs:
Information Systems and M&E
• What is your basic essential data that you need
(patient, drug, cost etc)
• For program M&E, how much can you get from
individual patient M&E and how much is
required from external sources
• How will patient, drug etc data be collected,
linked, transmitted and aggregated
– role of technology??
• Need a centralized data bank for all data
First Steps: M&E System
• Use ARV Task Force to:
– Develop patient workflow including access and
referral to services, drug flow and access, access to
lab services
– Determine essential data to collect for programme
– Determine mechanisms for collecting and linking
patient and drug information at the point of care and
drug dispensing, sending up disaggregated data but
retaining capacity for site to receive or retain data
useful for own decision making
Steps Already Taken or In the
Workplan
• Situational assessment for scaling up ART
at 15 sites just completed
– Gaps identified in infrastructure, staff numbers
and training, drug logistics, lab capacity,
comprehensive HIV/AIDS services,
management practices
– For each site, operational planning has been
conducted for 15 sites to upgrade capacity to
reach minimum standards for provision of
ART
Steps Already Taken or In the
Workplan
• Plans for development of:
– Eligibility criteria
– Financing strategy, including waiver system
– Developing LMIS
– Medium term HR plans for ART linked in with
national HR plans
– Communication strategy
– Community preparedness strategy
First Steps: M&E System
• Identify basic minimum information needs for
programme monitoring (national) at each level
and frequency of data
• How will this information be collected according
to the workflow (who has responsibility at each
level, what role if any does technology play)
• Develop SOPs for information collection,
transmission taking into account issues of
confidentiality
• How much will this cost and who will pay
First Steps: M&E System
• Identify data requirements outside the
program that are needed to M&E
aggregate programme impact (e.g.
timeliness of mortality data, including
cause of mortality, HIV prevalence data)
• Determine how to link ART and other HIV
related data at the hospital or site and
looking at national trends (e.g. hospital
bed utilization)
Items to Add to Workplan
• Standardize M&E tools, framework and
approach across all ART programs
• Identify questions that can be answered by
OR and develop inventory of OR initiatives
ongoing
• Establish national research agenda by
priority areas