KANCO Annual report by McAbility

Annual Report 2019

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Proper Citation: KANCO Annual Report 2019 Copyright: 2019, KANCO Editorial Team Peter Kamau:

Deputy Executive Director and Head of Technical Services

Bernadette Nzisi: Communication and Documentation Advisor Jack Ndegwa:

Health Systems Strengthening Advisor

Charity Wachira:

Communication Officer

Gregory Onyango:

Monitoring and Evaluation Officer

Layout Design and Printing by Brandworld Communications Ltd Vinodeep Towers, Baricho Road, Nairobi Tel: +254 721 784 369 KANCO Regent Court, Off Argwings Kodhek Road, Opposite Nairobi Womenâ&#x20AC;&#x2122;s Hospital Block C, P. O. Box 69866 - 00400 Nairobi-Kenya Email: kanco@kanco.org |

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@KancoKE

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Table of Contents

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About us...................................................................................................................... 8 STATEMENT FROM THE BOARD OF GOVERNORS CHAIRPERSON ..................................... 9 STATEMENT FROM THE EXECUTIVE DIRECTOR.................................................................. 10 OUR PHILOSOPHY .................................................................................................................. 11

Our Milestones: �� 11 Our strategic Objectives: �� 11 2019 In A Snap Shot: �� 12 KANCO IN NUMBERS.............................................................................................................. 18 STRATEGIC DIRECTION 1: IMPROVING ACCESS TO HEALTH.............................................. 20 Strengthening the TB Response ��21 Global Fund TB Project ��22 Global Fund Malaria Project ..............................................................................................23 Improving Access to Services for Key Populations.............................................................25 Improving Access to Immunization Services.....................................................................28 Strengthening Grassroots Groups Engagements...............................................................34 Regional Meetings and Civil Society Engagements...........................................................34 STRATEGIC DIRECTION 2: HEALTH POLICY AND ADVOCACY............................................. 35 Health Policy Advocacy- GAVI-HSS Programe ...................................................................35 KANCO High Level Engagements ��36 County Engagement Activities ��37 Advancing the Right to food in Kenya ��38 Advancing the Right to food through the Universal Periodic Review (UPR) forum ��38 KANCO Health Campaigns ��41

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Abbreviations.............................................................................................................. 6

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STRATEGIC DIRECTION 3: INSTITUTIONAL SYSTEMS STRENGTHENING.......................45 Capacity Building for Adolescent Girls and Young Women Organizations......................... 45 Diversifying Partnerships................................................................................................. 46

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Capacity Building of stakeholder to support uptake of immunization............................... 46 Empowering CHVs through the LEAP Project.................................................................. 46 Strengthening Key Populations Engagements................................................................. 46 Brand Strengthening....................................................................................................... 47 Membership.................................................................................................................... 47 STRATEGIC DIRECTION 4: RESEARCH, LEARNING AND INNOVATION.............................48 Eastern Africa HIV and Harm Reduction Project End-line Evaluation................................ 48 Publication on the HIV and Harm Reduction Regional Project Milestones-Community and Implementing Partners Experiences.................................... 48 Mapping of CSO’s and GIS Coding and Appraisal of Health Facilities in 8 Counties. �� 49 FINANCIAL REPORT................................................................................................................50 OUR PARTNERS......................................................................................................................51

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ABBREVIATIONS ACF

Active Case Findings

ACSM

Advocacy Communication Social Mobilization

AIDS

Acquired Immune Deficiency Syndrome

AMPATH

Academic Model Providing Access to Healthcare

ANC

Antenatal Clinic

APRM

Africa Peer Review Mechanism

African Union

CCMM

Community Case Management of Malaria

CEC

County Executive Committees

CHV

Community Health Volunteers

CIDP

County Integrated Development Plans

CSO

Civil Society Organization

CSS

Community Systems Strengthening

COHA

Cost of Hunger Analysis

COG

Council of Governors

DHIS

Demographic Health Survey

DQA

Data Quality Audit

EAC

East African Community

EALA

East African Legislative Assembly

EANNASO

Eastern Africa National Networks AIDS Service Organizations

ECD

Early Childhood Development

ECOSOC

Economic and Social Council

FSW

Female Sex Workers

Hep C

Hepatatis C

GAVI

GAVI the Vaccine Alliance

HIV

Human Immunodeficiency Virus

HPV

Human Papilloma Virus

HSS

Health Systems Strengthening

ICF

Intensive Case Findings

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Injecting Drug Users

Key Populations

KEMSA

Kenya Mesdical Supplies Autho

MAT

Medically Assisted Therapy

MCA

Members of the County Assembly

MDR TB

Multi-Drug Resistant Tuber Closis

MOH

Ministry of Health

Member of Parliament

MSM

Men who have Sex with Men

MTP

Medium Term Plan

NACC

National AIDS Control Council

NASCOP

National AIDs and STI Control Programme

NEPAD

New Partnerships for Africaâ&#x20AC;&#x2122;s Development

NHIF

National Hospital and Insurance Fund

NVIP

National Vaccines and Immunization Programe

PEP

Post exposure Phrophilasis

Prep

Pre Exposure Prophilaxis

PWUDs

People Who Use Drugs

SUN CSA

Scaling Up Nutrition Civil Society Alliance

SCTLC SDGs

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IDU

Sub-County TB and Leprosy Coordinator Sustainable Development Goals

SRHR

Sexual Reproductive Health and Rights

STI

Sexually Transmitted Infections

Tuberculosis

TB ARC

Accelerated Response and Care

TWG

Technical Working Groups

UHC

Universal Health Coverage

UNAIDS

United Nations joint Programe on AIDS

UPR

Universal Periodic Review

USAID

United States Agency for International Development

WHO

World Health Organization

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KANCO

A Membership Organization with Over 30 years of Health and Advocacy programming.

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ABOUT US KANCO is a premier membership organization established in the early 1990s in Kenya. Its membership includes Non-Governmental Organizations (NGOs),Community Based Organizations (CBOs), Faith Based Organizations (FBOs), Network Organizations and learning institutions that have a focus on health advocacy and/or implementing health programs, towards improving the health and well-Being of communities. This is steered through capacity building and innovative Leadership through the four organizational strategies; policy and advocacy; improving access to health; strengthening KANCO as an institution and developing a strong unified membership and research, learning and innovation. Over the years KANCO has horned operations at the national, regional and global level, with advocacy partnership pushing for access to people centred and sustainable health services, towards the realization of healthy people and empowered communities.

Vision Healthy people, empowered communities.

Mission To improve the health and wellbeing among communities through capacity building and promotion of innovative leadership

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Policy and Advocacy, Institutional Strengthening and Development of a strong and Unified Membership and Research Learning and Innovation. Our achievements and lessons learnt will be eye openers for the next frontier, of the next strategic planning period. We observed growth in the programmatic base, with the projects seeking to go over and beyond the project mandate to achieve the overall vision of the organization; realization of a healthy and empowered communities.

On behalf of the board I am happy to report that 2019 as another great year for the KANCO as a Consortium. We wish to commend the work done by the secretariat and the over 1200 CSO members towards improving the health outcomes of the people of Kenya, the region and globally. We have been following closely on the consortiumâ&#x20AC;&#x2122;s delivery of the four strategic objectives for the period 2016-2020. With 2019 being near the end of the strategic plan period, we are pleased to have seen the commendable efforts and results across the four pillars: Improving access to health, Health

In terms of utilization of resources, we reiterate our confidence in the use of the resources entrusted to the organization, as we have noted the deliberate efforts to maximize the value for money, through conscious and concerted efforts to involve the beneficiaries in the programming, to maximize impact and to steer the organization into the next level. 2020 being the final year of the strategic plan. It will be an important period for the consortium to introspect and evaluate its achievements, opportunities, challenges and how to create long lasting impact in the next strategic period. As a board, we continue to register our confidence in KANCOâ&#x20AC;&#x2122;s management and leadership and look forward to strong partnerships towards reaching greater milestones. Board Chairperson, KANCO Fr. Firminus Shirima

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STATEMENT FROM THE BOARD OF GOVERNORS CHAIRPERSON

STATEMENT FROM THE EXECUTIVE DIRECTOR

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52 Through national and regional thematic health technical working groups, KANCO took leadership and continued to champion health causes for the general and key populations. Notably, KANCO was part of Regional TWG championing harmonization of the Sexual Reproductive Health and Rights bill in the region through the East Africa Legislative Assembly to improve access to Sexual Reproductive Health and Rights (SRHR) services for the youth as well as the key and general population.

In 2019, KANCO was deliberate on partnerships and influence for greater impact in the realization of its vision of healthy people and empowered communities. Our advocacy, community and health system engagements impacted the health - policy systems and domains at national, regional and global level. We are a stronger and better focused organization. We expandÂed the scope and geographical coverage in our programming and ventured into new areas; focusing on young people, adolescents and young women, while maintaining our traditional niche in TB, HIV, Immunization, ECD and Nutrition. In 2019, we were deliberate and continued to implement our 3-S Strategy. Being Small, Smart and Strategic. We made several policy wins, topped by the adoption of the East African Community Regional Policy on Alcohol, Drugs and Other Substance, a cause we birthed and championed under the regional HIV and Harm reduction Project supported by the Global Fund.

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KANCO undertook joined campaigns with partners towards realization of shared health goals. On the Global Fund replenishment, KANCO through multi-stakeholder engagements and advocacy played an instrumental role in Kenyaâ&#x20AC;&#x2122;s pledge of US$6 million in the Sixth Replenishment, in addition to the overall raising of US$14 Billion target to Step up the Fight against AIDS, TB and Malaria. We also saw our reach and influence expand in the region, through the ACTION Africa partnership, coordinating our efforts towards Domestic Resource Mobilization for health and holding regional governments accountable, towards strengthened health response in the region. As we move into 2020, we hope to continue what we started in 2019, remaining small, smart and strategic. Further, being the final year of our strategic plan (2016-2020), we are keen to reflect on our achievements and challenges, to inform the incoming phase. We remain highly appreciative of our partners and members who are key to our success. We are convinced that together, we will continue to achieve great things. Executive Director, KANCO Allan Ragi

OUR PHILOSOPHY

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Knowledgeable and powered communitoes leading an effective health response

Im p r o vin g

Existence of supportive health policy and legal environment

Evidence based strategic programing

th eal oH st es cc

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Stengthened Instutional capacity to coordinate an effective health response

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OUR MILESTONES:  More than three decades of health programming  Strategic and regional global partnerships  Extensive and diverse membership  Regional Programming and technical support

OUR STRATEGIC OBJECTIVES:  Improving Access to health  Health Policy and advocacy  Institutional strengthening and developing a strong unified membership  Research learning and innovation

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2019 IN A SNAP SHOT:

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H.E President Uhuru Kenyatta officiating the launch of the HPV Vaccine in Kenya

KANCO Executive Director and the CEO Kenya NGO Board Franklin Mutuma Nkanata during a courtesy visit to KANCO

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KANCO team led by the Executive Director Allan Ragi, during an immunization grassroots sensitization meeting for the Samburu Council of Elders

World AIDS day celebrations in Kakamega County one of the counties where KANCO partnered to mark the 2019 Celebrations

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KANCO, GAVI-High Level Mission (HLM) delegation and Parliamentary Health Committee led by Hon Sabina Chege, discussing immunization financing during the GAVI-HLM to Kenya.

KANCO and GAVI-HLM delegation meeting with the Council of Governors during the GAVI-HLM delegation visit to Kenya

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Launch of the catastrophic cost of TB study in Kenya.

The CS Health Sicily Kariuki and the First Lady Kiambu County H. E Susan Waititu, during the Launch new patient centered TB prevention strategy

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KANCO, GAVI-HLM delegation representatives and the Parliamentary Health Committee after an engagement in parliament

Member of Parliament engagement on immunization financing and Legislation hosted by KANCO

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Community Health Volunteers working in the Informal Health Settlement in Nairobi County to ensure every child receives lifesaving vaccines.

KANCO leadership team receives an award of financial prudence during the Consortiumâ&#x20AC;&#x2122;s 2019 Stakeholders forum.

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KANCO IN NUMBERS

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5,455,515

24,420

60,377

39,130

Individuals reached with health messages

Households reached through community outreaches

Suspected malaria cases that received a parasitological test in the community

Confirmed malaria cases that received first - line treatment in the community by CHVs

200

5,683

16,512

308

Schools reached with Malaria interventions

FSWs reached with comprehensive care package

Quarterly contacts made with FSWs in the provision of comprehensive care package

MSMs provided with comprehensive care package

935

3,255

38,459

323

Contacts made with MSM in the provision of comprehensive care package

CHWs supported

People screened for TB

TB cases linked to treatment

253

180

808

Policy makers engaged

National high level policy champions groomed

Community grassroots champions supported

CSOs provided with technical support and capacity building

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â&#x20AC;&#x153;In 2019. We expanded the scope and geographical coverage in our programming and ventured into new areas; focus on young people, adolescents and young women, while maintaining our traditional niche in TB, HIV, Immunization, ECD and Nutritionâ&#x20AC;?.

Allan Ragi

EXECUTIVE DIRECTOR , KANCO

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STRATEGIC DIRECTION 1: IMPROVING ACCESS TO HEALTH Over the three decades of KANCOâ&#x20AC;&#x2122;s programing, improving access to health has been one of its key objectives. The efforts span broadly addressing access to treatment for both communicable and noncommunicable diseases in line with its strategic objective and goals. Under this pillar KANCO continued to engage to enhance not just access to health services but enhancing the quality of care and treatment both in the general population and among the marginalized communities. Community participation remained at the heart of this pillar, driven by the need to realize people centred services and promote community ownership of health at all levels. KANCO continued to increase support to institutional and leadership strengthening, increased social cohesion and gender equality and strengthening capacity of CSOs to mobilise resources.

Nutrition Officer KANCO Esther Kagure supporting weight taking during the immunization and child health drive supported by KANCO during the world immunization week

KANCO implemented several interventions under the strategic objective improve access to health including: Global Fund -TB, the GAVI-health systems strengthening project (GAVI-HSS), linkages, Pwani Lishe Bora project, GF-Malaria, GF-HIV, ongoing support for the Eastern Africa region on harm reduction services and TB-ARC II, whose progress is highlighted below:

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STRENGTHENING THE TB RESPONSE 21

Launch of the new patient centered TB prevention strategy

Tuberculosis remains a public health concern globally and nationally. Kenya is listed among the 30 high TB burden countries (WHO, 2017) with a triple burden of TB, TB/HIV and MDR TB with TB as the fourth (4th) leading cause of death. In 2019 Kenya reported and treated 96,434 TB patients, among them 10,087 children and 669 Multiple Drug Resistant (MDR) TB cases. Though TB diagnosis, treatment and nutritional support for TB are offered free in all government and faith-based health facilities, 40% of the TB cases are missed annually. The year 2019 saw the launch of the National Strategic Plan for Tuberculosis, Leprosy and Lung Disease 2019-2023; this strategic plan laid emphasis on the patient centred approach to TB prevention, diagnosis, treatment and care. It further made calls for the elimination of fees associated with diagnostic testing for TB, including chest radiography services. This was in line in line with His Excellency President Uhuru Kenyatta commitment to diagnose and cure at least 597,000 people with TB by the year 2023, including 55,000 children, 542,000 adults and 4,500 people with MDR TB in addition to providing TB Preventive Therapy to at least 900,000 Kenyans at risk. This year we lauched the ‘Mulika TB Maliza TB’ initiative to mobilize and increase resources for TB prevention, treatment and care. The initiative was piloted in Kiambu County envisaging that by the year 2025, all the counties will be covered towards finding all the missed cases and put those on treatment as per the national call for ‘Mulika TB, Maliza TB.’

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Former First Lady Kiambu county H.E Susan Waititu, signing on the commitment to end TB, during the Launch of the Maliza TB Mulika TB initiative

GLOBAL FUND TB PROJECT With the support of the Global Fund through Amref Health Africa, KANCO continued to implement the Global Fund TB project through active contact screening and screening of household of children under 5 years and tracing of TB treatment defaulters, building the capacity of communities to effectively respond to TB The project covered 5 counties: Kwale, Bungoma, Kitui, Machakos and Mombasa Counties. Further through the grant KANCO engaged CSOs and TB Champions to advocate for accountability and increased resources for TB at the national and county levels in Kwale and Mombasa Counties. In 2019 guided by the Active Case Finding (ACF) strategy recommended by WHO to find the missing cases, the project continued to engage towards reaching people with latent TB. Under the project, KANCO conducted a series of training for community health volunteers (CHVs) to support finding the missing cases as well as support supervision activities for the project implementing regions by the head office staff.

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40,097 presumptive TB cases identified. 2,645 New TB cases identified

Under 5 Years

Contact Tracing 5,394 bacteriologically confirmed patients whose households were visited and contact screening done. 17,707 household’s members screened. 306 new TB cases identified

Treatment Interrupters

130 presumptive under 5 years household members referred. 562 household’s members screened. 29 new TB cases identified

Meetings, Trainings, Sensitizations and Engagements.

500 treatment interrupters physically traced, referred back to treatment.

13 sensitization meetings on community TB conducted.

64 Sensitization of PLHIV and CHVs on active TB case Finding, HIV testing, Isoniazid, human rights and patients right for demand creation.

642 of CHVs sensitized on Community TB

Working with the informal health service providers to find and treat TB For the better part of 2019, KANCO with the support of USAID through the Centre for Health Solutions (CHS) under the TB ARC II project, continued to work with informal health service providers and linking presumptive TB cases to formal health facilities in 35 counties. Further under the project, KANCO participated in the review of the National Tuberculosis Leprosy, and Lung Diseases Programe and Advocacy Communication and Social Mobilization (ACSM) towards improving community action on TB. KANCO also participated in the review and development of training slides for the CHV’s in relation to TB work in line with the community strategy together with other partners.

Global Fund Malaria Project The fight against malaria is one of the biggest public health successes of the 21st century. It’s among the deadliest diseases in human history. Pregnant women and children under age 5 are most at risk, because of their weakened immune systems. Through the Global Fund and Amref Health Africa as the Principle Recipient, KANCO continued to support the Malaria program in Bungoma County, supporting three Counties namely; Baringo, Elgeyo Marakwet and Nandi with Health Facilities Support Supervision and Malaria Routine Data Quality Audit. In the year 2019, through Community Case Management of uncomplicated Malaria, KANCO contributed in the management of suspected malaria cases in line with the Kenya Malaria Treatment Guidelines supporting 1,020 CHVs to undertake home testing and treatment of malaria 60,377 suspected malaria cases received a parasitological test and 39,130 confirmed malaria cases received first-line antimalarial treatment in the community. Additionally, a total of 5,452 suspected malaria cases were referred by the CHVs to the various link facilities to receive a parasitological test.

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Support for Monthly Facility Based ACF meetings

In 2019, biannual Community Units Link Facility Support Supervision was done and 1,020 CHVs provided with supervision feedback to sharpen their skills on Commuity Case Managenent & Malaria (CCMM), Malaria Routine data quality audit was also done in four counties namely Baringo, Bungoma, Elgeyo Marakwet and Nandi Counties.

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Photo on Link Facility Support supervision feedback and group photo after CU supervision

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Malaria Prevention using school champions School health intervention has proven to be an effective strategy for Malaria Prevention in the community, in the year 2019, in 200 Primary School pupils in Bungoma County championed malaria messaging in schools and served as link to teaching malaria prevention through promotion of net use in the community.

Group photo after a school health review meeting in Sirisia Sub County, Bungoma County

Improving Access to Services for Key Populations The Key Populations (KP) program at KANCO focused on a number of strategic activities that are in line with the four organizational objectives. In regard to accessing harm reduction sciences, KANCO engaged in a series of activities towards strengthening access to service for key populations:

Strengthening Uptake of Medically Assisted Therapy (MAT) Programs in the Region Injecting drug use has become a major factor for HIV transmission in Eastern Africa. 2019 National Kampala Place Study Estimated (KPSE) study indicated in Uganda revealed that Injecting drug use is a growing problem with an estimated 11,034 of people who inject drugs. The 2018 KPSE there were 18,000 people who inject drugs in Uganda with 17 % HIV prevalence and underlying mental health problems. Programmatic data from various sites and organizations consistently shows a higher prevalence of HIV among PWIDs compared to that in the general population 45% vs. 7.3% respectively. Although the Government of Uganda has acknowledged the existence of injecting drug use, the HIV and drug treatment response is limited to private hospitals and a public mental health facility. Other barriers to HIV and drug treatment services include: high cost, negative provider attitudes and skills, stigma and discrimination, and criminalization of drug use. The introduction of MAT program in Kampala as the pilot district is now seen as the only hope to the communities that have suffered over the years. â&#x20AC;&#x153;We are now confident that MAT will change our lives and those of our peersâ&#x20AC;? A peer educator remarked in a community engagement during one of

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the site visits. However, it was noted that Harm reduction services were non-existent. No research has been conducted on Hepatitis C (Hep C) but the regional estimates by the University of South Wales show that the prevalence is about 40% in EAC region. To promote a common understanding on the effectiveness, efficacy and challenges of Medically Assisted Therapy Programe, the infectious Diseases Institute (IDI) at Makerere University, Uganda requested for the technical support of KANCO and NASCOP to facilitate buy in by stakeholders and provide insights for start-up of a MAT centre in Uganda in 2019 and 2020. Going forward in 2020, KANCO and NASCOP will guide the establishment of a Medically Assisted Therapy (MAT) centre at Butabika National Referral hospital. The first phase of the technical support entailed establishing the coordination structure and road map for MAT; developing formal technical guidelines, Standard Operating Procedures (SOPs), Monitoring and Evaluation (M&E) tools and training packages, conducting site readiness assessments as well as procurement and setting up the MAT centre in line with the WHO guidelines. The second phase will focus on operationalization of the MAT Centre through clinical and CSO provider capacity building and demand creation for MAT within the community to facilitate easy health care access for People Who Use Drugs (PWUD) in need. The last phase will focus on developing analytical and technical writing skills of MAT programme implementers for identification of best practices and lessons learnt to guide policy and decision making for MAT scale up. These shall be disseminated and documented through conference abstracts and annual MAT workshop that will bring all concerned stakeholders from national to community levels.

Strengthening the Response to Drug Addiction and Harm Reduction in the Region.

Staff of HDI Rwanda and CSOs partners including GIZ, IMRO, RNGOF, AJPRODHO Jijukirwa and KANCO, Implementing Harm Reduction in Rwanda. Health Development Initiative (HDI) contracted KANCO and NASCOP to conduct a comprehensive training on drug addiction and harm reduction. The training sought to equip participants with knowledge

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From the training it was recommended that HDI pitches the harm reduction agenda on areas that would attract political support like Elimination of Hepatitis C, Hepatocellular cancers and Universal Health coverage (UHC) starting small with the current limited resources while mobilizing more resources for advocacy. They were further advised to use the already existing good will with the law enforcers to advocate for tolerance for harm reduction interventions and services targeting People Who Inject Drugs (PWIDs).

Serving KPs through the Drop in Centre Model

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and skills enabling them to set up and manage harm reduction programmes. The training participants included; HDI Rwanda and other CSOs partners including GIZ, IMRO, RNGOF, AJPRODHO .

KANCO through the Drop in Centres (DIC) model continued to offer health services to key population providing key populations friendly services through the DICs in Kakamega, Mariakani and Kajiado. The three facilities offered Post-Exposure Prophylaxis (PEP) and Sexuall transmitted Infections (STI’s) activities such as HIV& AIDs care and treatment, PEP, PREP, STI screening and treatment, lubes distribution, psychosocial support, peer review meeting and training’s, referral as well as working with the technical groups. The DICs provides and optimizes services geared towards reducing HIV and AIDS infections and treatment, STIs treatment, referrals and psychosocial support through a stigma free environment. The three facilities are supported by AMPATH Plus Key Populations Programe and Global Fund HIV project through Kenya Red Cross Society (KRC) further, KANCO has been working closely with the ministry of health (MOH) and the County Governments in the respective regions. In 2019, the KP programme in Kakamega County supported by USAID transitioned seamlessly from FHI 360’s linkages program to AMPATH Plus Key Population Programe, facilitating uninterrupted, continued support and care for the key populations served by the facility. The Mariakani DIC continued to be supported by the Kenya Red Cross Society through the Global Fund HIV project, while the Kajiado DIC is supported by KANCO.

KAKAMEGA DIC 3,913 FSWs and 390 MSMs reached with HIV prevention information 4,031KPs reached with HIV prevention services 33 integrated outreaches done 3,312 KPs Reached with HIV testing services and received their results 43 KPs on care and treatment at the DIC 200 KPS Linked to GOK facilities for care and treatment

KAJIADO DIC

MARIAKANI DIC

40,394 Male condoms dispensed to the key populations

691 of FSWs reached with prevention programmes

818 Female condoms dispensed during the period

859 FSWs received STI screening and treatment

327 Sex workers screened for STI

580 FSWs received HTS counselling during the process

663 Clients in the CCC 61 treated for STI’s 66 Female sex workers provided with family planning 45 KPs provided with PEP 14 KPs provided PREP 128 Referrals

283 KPs provided with Prep 11 KPs initiated on PEP

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In 2019, KANCOs DICs contribution to UHC through supporting access to health for key populations stood out, with the Kakamega DIC being recognised as the best in DHIS Reporting facility in the County.

Improving Access to Immunization Services In 2019, KANCO with the support of GAVI partnered with the Ministry of Health and the Civil Society in Kenya to improve access to immunization services. The partnership aimed at creating demand for immunizations and securing political commitment at national and county level for equity, improved coverage and sustainability of immunization program in Kenya. KANCO implementing the GAVI Health System Strengthening Grant, (GAVI HSS) continued with its supporting 17 Counties as well as informal settlements in Nairobi. The two objectives of the grants were; ď&#x192;ź

To accelerate strong political engagement, improve governance and financial sustainability for immunization outcomes in line with devolution by 2020.

ď&#x192;ź

To achieve equitable access to and utilization of routine immunization services in 17 focus counties and in special populations in Nairobi County by 2020.

With the national immunization coverage at 87% in quarter one of 2019, and with over 21 counties having a coverage below 80%, KANCO working at community level and at the national level through high level engagements saw the coverage move to 90% by the end of year. The joint GAVI-HSS activities conducted at the national and counties level in partnerships with National Vaccines and Immunization Program (NVIP) and County Health Department were key drivers in this increased performance.

Reaching Communities where they are with immunization services KANCO engaged in a series of campaigns and activities to promote equitable access and utilization of routine immunization services in 2019. These engagements included community outreaches, defaulter tracing, grass root training on immunization and use of champions and opinion leaders to reach the un-reached and promote uptake of services.

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TELLING THE STORY

Immunization is the process by which an individualâ&#x20AC;&#x2122;s body is fortified against diseases. Vaccines are important to an individual and to the larger community. However, vaccines being one of the most cost effective interventions and a right for every child, some children still do not enjoy this right due to varied reasons as they unfolded during immunization drive at an informal settlement in Nairobi supported by KANCO.

Defaulter Tracing

A health care worker with Josephine a mother of three and her children who had never been immunized. This family was reached during the immunization drive at Embakasi, an informal health settlement in Nairobi.

Josephine a mother of three aged 13, 7 and 6 years has never had any of her children immunized. All her three children were delivered from home explaining why they could had missed the first BCG vaccine. The children had never been vaccinated but were reached through a community health worker and vaccinated during the Outreach. Josphine said that she thinks vaccines are important but cited lack of transport to the facility as the major hindrance to taking her children for immunization. â&#x20AC;?As a single parent with no reliable source of income, I opted to use the little money I get for other pressing needs like foodâ&#x20AC;? she stated. Further before the outreach, Josephine had very little appreciation for vaccines and felt her children were in perfect health even without the vaccines. During the outreach this family got a chance to access immunization service and learn more on the importance of immunization.

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Finding the Missing Immunization Cases

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Most children born to street families face multiple deprivations from poor nutrition to limited access to health, water and sanitation services. This makes them highly susceptible to a myriad of disease including vaccine preventable diseases. Monica’s case is one that many street families can relate with.

Right- Monica a mother of two living in the streets accompanied by Njeri a CHV to access health services during the immunization outreach in Embakasi .

Monica became a mother at a young age and has been living in the streets since then. Her Two children aged 4 and 2 years had received few vaccinations . During the outreach by KANCO, street families in the area were reached out. “I’m happy that my children and I will get services here today for free. I don’t have to take so much time, this kind of health service delivery would help other parents like me to protect their children. Many mothers like me shy away from hospitals because we are ungroomed and unpresentable and usually face a lot of stigma” Monica expressed. She requested that special attention be given to the street and migratory populations as they create pockets of infections that pose a danger to themselves and other children.

Many mothers like me shy away from hospitals because we are ungroomed and unpresentable and usually face a lot of stigma - Monica.”

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Mama Caleb, a mother of 2 both under two years shared that her children got their first dose of immunization and then dropped off (defaulted). She cited lack of transport money to enable her reach to the nearest facility. Being a casual laborer the earnings she got barely covered her family’s basic needs. She also shared that she did not quite understand how immunization works.Through the efforts of a CHV she got information about the immunization outreach. She expressed that she was happy with the immunization and health drive and was thankful that the services had been brought closer to them and free of charge thus a huge opportunity for the residents. She was happy to learn that a facility would be set up at the chief’s camp following the collaborative efforts of KANCO, the Nairobi County Ministry of Health and the area MP, Hon, John Kairie. Mama Caleb expressed that she was happy that going forward she would be able to take her children for services conveniently.

I am happy that going forward, I will be able to take my children for Health Services conveniently - Mama Caleb.”

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World Immunization Week 2019. 32

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During the world immunization week 2019, KANCO and Partners in 10 Counties across Kenya launched a door-to-door campaign which engaged CHW in mobilising communities for immunization and nutrition health services organized through outreaches, seeking to reach all children under five years of age. These efforts have paid off more than 7,000 children received vaccines, deworming medicines and Vitamin A, in support of a healthier start in life. Pregnant women were also targeted and encouraged to go to the clinics for critical antenatal care. In addition, KANCO continued to build support from key stakeholders including community and religious leaders, school teachers, women groups through trainingâ&#x20AC;&#x2122;s towards rebuilding trust in the health system for increased immunization uptake.

Community Outreaches

Community procession in Embakasi Constituency during the Launch of the World Immunization Week in April 2019. In Nairobi County, KANCO partnered with the Ministry of Health to mark the World Immunization Week (WIW) outreach in Dagoretti Sub County, an informal settlement that had a 36% immunization coverage against a national coverage of 87%. The week long activities included; sensitization of CHVs on the importance of immunization, community dialogue with the communityâ&#x20AC;&#x2122;s gatekeepers, advocacy and social mobilization including using main stream and social media. This event was graced by the area Member of Parliament Hon. John Kiarie and the Nairobi County Chief Officer of Health.

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Right: Allan Ragi Executive Director KANCO shaking hands with Dagoretti MP. Hon. John Kiarie during the launch of the immunisation Outreach supported by GAVI through KANCO during the 2019 World Immunization week. Services offered during the integrated outreach included: Health promotion messages; Child growth monitoring, Nutritional services & counselling, Antenatal and Family Planning Counselling; Immunization of the under vaccinated children under five years; a supplementation of Vitamin A and deworming; Paediatric TB screening . In total, 49% of the households (5000 out of 10157) were reached by the 30 CHV’s during the immunization outreach. Over 536 clients received services: 484 children reached with immunization services, 78 screened for TB, and 24 of them were identified with presumptive TB. 1 case of bacteriologically confirmed TB was identified and linked to care and treatment. 52 Women of Reproductive age were reached for ante natal Clinic (ANC) and Family Planning (FP) services. A total of 11 immunization outreaches were conducted in Nairobi Informal settlements and across the GAVI-HSS 17 counties reaching over 7, 000 children. Further the area Member of Parliament, in partnership with the County Ministry of Health pledged the following: 

The area administration offered to open an immunizing facility by donating one office at the Chiefs camp.

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An additional container office space to ease access to health services in the area.

In 2019, through the Community Health Volunteers (CHVs), over 1510 immunization defaulters were traced and brought back to care. In Nakuru County the immunization coverage improved from 70% in the previous year to 84% in 2019. This immense increase is attributed to the support of KANCO in defaulter tracing in three sub-counties (Subukia: 94%, Rongai: 74% and Nakuru north) through 105 Community Health Volunteers. Further some areas have greatly improved for example, Tinderet Sub County in Baringo County. The immunization coverage moved to 70% from 54% yielded by defaulter tracing and Community Health Volunteers efforts to promote uptake of immunization. In Nairobi County informal settlements, 199 defaulters were brought back to care. Defaulter tracking was also effectively carried in Garrisa, Nandi, Baringo, Isiolo, Meru, Laikipia, Kitui, Bungoma, Kakamega and Transzoia Counties of Kenya.

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Strengthening Grassroots Groups Engagements 34

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A total of 180 grassroots group members were engaged in 2019, and played an instrumental role in advocating for effective and quality immunization and health services delivered to the public. Through the grassroots model KANCO continued to engage towards promotion of transparency, accountability and responsiveness in the implementation of GAVI HSS Grant activities. There was also the follow up on the CHV’s bill for Nairobi County. In the lead up engagements, KANCO supported the formation and engagement of the Nairobi County Grassroots Chapter that was instrumental to towards advocating for this legislation. After a spirited lobbying during the budget public participation forums for the County Fiscal strategy paper year 2019/20, Nairobi County proposed an allocation of Kshs 100 Million for CHV’s. In total KANCO has been able to form 11 Grassroots groups that are active around Nairobi County in 9 different informal settlements with ongoing mentorship them to effectively engage, mobilize grassroots action and advance public participation.

Regional Meetings and Civil Society Engagements

A session of CSOs leadership meeting, at the KANCO Offices . Through the grant, KANCO engaged over 368 CSO’s through the quarterly review meetings, facilitating feedback, learning and sharing on matters immunization as well as other cross cutting issues. Further KANCO in partnership with the MOH have been conducting quarterly visits to help evaluate and strengthen communities activities on immunization and advocacy towards realization of Universal Health Coverage.

CSO’s Pre-budget forums for advocacy and lobbying. Forty (40) Civil Society Organizations were sensitized and engaged in the review of County Budgets. Several Counties were able to redirect some money towards support of child health and immunization like Laikipia, Meru, Nairobi and Garissa. These engagements leveraged on the county budget making forums to push for increased allocation for immunizations and vaccines procurement funds

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Women Representative Nairobi County Hon. Esther Passaris expressing her support for immunization during a HPV Vaccine sensitization meeting for women leaders organised by KANCO ahead of the national launch. KANCO held a series of advocacy engagements incorporating different stakeholders, with legislators and policy makers towards advocating for increased and sustainable domestic financing for health. With the dwindling donor funding due to transition and changing focus concerted advocacy efforts remain critical, to improve the legal and policy governance environment, push for adequate resources to address health in Kenya, build strong networks and partnerships at both national and county levels to strengthen the health response in Kenya through enhanced accountability

Health Policy Advocacy- GAVI-HSS Programe KANCO worked with National stakeholders and CSOs partners in supporting the launch of new vaccines in 2019. These were the Human Papilloma Virus (HPV), Malaria Vaccine and Meningitis new switches. The new vaccines introduction involved planning through Advocacy, Communication and Social Mobilization (ACSM) meetings as well as community health workers engagement. To increase the coverage of these new vaccines required community engagement to ensure communities and families understand the value of the new vaccines immunization.

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STRATEGIC DIRECTION 2: HEALTH POLICY AND ADVOCACY

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KANCO supported engaging communities to build trust in the new vaccines in all the 17 counties through Community health volunteers and community extension workers trainings and support, while the National and County Governments conducted trainings for front-line health workers.

KANCO HIGH LEVEL ENGAGEMENTS

Engagement with women Members of Parliament ahead of HPV vaccine launch. Immunization is a basic right as articulated in the Constitution of Kenya and in the Childrenâ&#x20AC;&#x2122;s Act. Immunization is a key pillar, critical to achieving UHC in Kenya. Through the GAVI-HSS project KANCO has been mobilizing CSOs to advocate for strong political commitment and leadership to elevate immunization and child health on the County and national political agenda. These high-level commitment are key in ensuring that all counties commit to immunization as a priority. To support in securing adequate resources for immunization, support for GAVI transition, and improving on Domestic resource mobilization for health and immunization in 2019, KANCO facilitated engagement with Members of the National Assembly and Senate, to advocate for increased budgetary allocations. The meetings with the Parliamentary health committee, Budgeting committee and the Finance committee together with the Ministry of Health and National Vaccines and Immunization Programme (NVIP) reviewed the state of immunization and budget needs. From the three meetings, the Members of Parliament agreed to push for increased allocation for the National Vaccines and Immunization Programe (NVIP) from the current KSES. 800 Million to KES.1.4 Billion, through the Ministry of Health.

Engagement with the Senate Health Committee The Senate Standing Committee on Health, is mandated under the second schedule of the Senate standing orders to â&#x20AC;&#x2DC;consider all matters relating to medical services, public health and sanitation. KANCO shared its submissions to the Senate on three bills (a) The Mental Health (Amendment) Bill, Senate Bills No.32 of 2018. (b) The Kenya Medical Supplies Authority (Amendment) Bill, Senate Bills No. 38 of 2018. (c) The Cancer Prevention and Control (Amendment) Bill, Senate Bills No.9 of 2019.

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Regarding the Health (Amendment) Bill, and the Kenya Medical Supplies Authority (Amendment) Bill, 2018, the committee considered the submissions made by the public, including KANCO’s submission and tabled reports on each of the two Bills in the Senate in 2019. Key issues in submission included: addressing the operations of Kenya Medical Supplies Authority (KEMSA), its supply chains and the outstanding payments owed to KEMSA by various County Governments; increasing budgetary allocations to health as a devolved function and addressing the welfare of health workers in the Counties.

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KANCO facilitated a meeting between the Council of Governors (COG) and the GAVI board in November 2019 to discuss immunization financing and how to ensure quality immunization services are delivered at the counties. From this engagement KANCO’s submissions to the COG and policy makers was on addressing the welfare of health workers in the Counties and Immunization financing now and in future in the context of transition.

Engagement with the Women Legislators. Immunization is a basic need for every child and when law makers champion the cause there is greater acceptability by their communities. Towards the launch of the HPV vaccine in Kenya, KANCO engaged 30 Women legislators (MPs, Women representatives and Senators) to rally their support and leverage their influence in the uptake of the vaccine and to support in increasing the budgets for NVIP to facilitate timely and effective delivery of vaccines.

Accelerating strong political engagement; improve governance and financial sustainability for immunization at the counties level KANCO focused on strengthening health systems through Advocacy in the 17 counties to create strong political engagement hence ownership and investment in the immunization program at the national and county levels. Advocacy was also geared towards strengthening coordination, accountability for results and evidence based planning for resources. To this end KANCO supported NVIP – MOH meetings and stakeholder’s forums to discuss and deliberate on improving the immunization coverage in the country supporting uptake, introduction of new vaccines and switches. KANCO further facilitated a meeting between the GAVI High Level Mission delegation to Kenya and the Parliamentary Health Committee led by the Chairperson Hon. Sabina Chege, with the MOH through NVIP also participating in the discussions. This engagement facilitated discussions around the state of immunization in Kenya, the GAVI transition model and what the legislator can do in enhancing domestic financing for health

County Engagement Activities Members of county Assembly Engagement KANCO engaged 221 policy makers including members of the county assemblies and CEC’s from 17 counties of focus under the GAVI HSS Grant. This was done through sensitization forums, breakfast meetings and engagement of the MCA’s in planning meetings for immunization across their different levels of jurisdiction. Further through the grassroots advocacy approach, KANCO was intentional in urging governments, donors and the private sector to invest sustainably in child health and immunization through policy development and influence in the government budgeting and planning through public budget participation for improved immunization services, as well as following up for accountability.

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Engagement with the Council of Governors

County Health management Teams engagement and involvement 38

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The Ministry of Health and the County Governments have made significant investments and reforms that were aimed at transforming healthcare delivery in Kenya in line with the Universal Health Coverage (UHC) prioritised in its Big 4 agenda over the next 5 years. In this endeavour, key stakeholders including the county health teams remain critical. To this end 6 (six) County Health Management Teams (CHMT) members from the 17 Counties of implementation were engaged as the decision makers and users of existing immunization data to support the cause on increased immunization financing.

ADVANCING THE RIGHT TO FOOD IN KENYA KANCO under the action partnership, advocates for increased resource allocation, policy formulation, implementation and accountability for a healthy start in children with a special focus on TB, immunization and nutrition .In regard to nutrition, advocacy is geared towards two main objectives: Increased financing for nutrition in Kenya and Accountability for results and effective use of resources Under accountability for results and effective use of resources, KANCO engaged in a series of high level forums championing the nutrition cause including the Universal periodic review on human rights (UPR), the agri-nutrition conference, TICAD, SUN global gathering, world breastfeeding week among others.

Advancing the Right to food through the Universal Periodic Review (UPR) forum

Esther Kagure, Nutrition Officer making a contribution during CSOs UPR engagements on the Right to Food, spearheaded by KANCO. Under the Universal Periodic Review (UPR) on human rights, KANCO was the delegated convener for the right to food leading a concerted effort of CSOs engagement for the first time on the nutrition cause under this forum and the first time for the right to food to be used as a parameter to assess the

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KANCO also participated in the annual Agri-nutrition Conference under the theme “Enhancing Multisectoral Agri-Nutrition Approaches for Improved Nutrition Outcomes in Kenya” This is in the view that, investments in agriculture could play a vital role in poverty alleviation and improvement of food and nutrition security. The conference made the following recommendations: Need to strengthening multi-sectoral coordination, partnerships and mutual accountability; increasing productivity of food systems; Sustaining nutrition and resilience of households; and Effective knowledge management and communication for Agri-Nutrition

Marking important Days in the Nutrition Calendar In 2019, KANCO observed and marked important nutrition events including the World Breastfeeding week. KANCO together with partners participated in 2019 world breastfeeding week that was officially launched in Nakuru County, under the theme’ Empower Parents: Enable Breastfeeding’ aligned to SDGs 5, 8 and 10 and thematic area 4 in the WBW 2030 framework. The theme addressed women’s productivity and employment underscoring employers’ benefit from having a more content and productive workforce as a result of less absenteeism, increased loyalty and less staff turnover through provision of lactating rooms.

Launch of the Cost of Hunger Study Kenya KANCO participated in the review and launch of the Cost of Hunger in Africa (COHA) study, Kenya report. The COHA Kenya report gave important insights on the state of nutrition highlighting key advocacy issues for nutrition. The report indicated high implications of malnutrition and the ripple effect across sectors including health, education and overall productivity Under-nutrition is, on average, contributing to a loss of 6.9% of the GDP.

Enhanced partnerships for nutrition advocacy in Kenya In 2019 KANCO was deliberate in strengthening partnerships for nutrition, leveraging on presenting moments for nutrition, and working closely with partners such as SUN CSA, the Ministry of Health, and Ministry of Agriculture, Livestock and Fisheries and other government agencies. Under this pillar KANCO in partnership with the SUN-CSA conducted media trainings across four counties (Nairobi, Nyeri, Tharaka Nithi and Isiolo Counties). The trainings focused on leveraging on the role of the fourth estate at the national and counties in advocating for increased resources in nutrition specific and sensitive programming. It was also an opportunity to explore the national and county nutrition landscape and the relevance of nutrition in development, giving an overview of SUN CSA and KANCO in the lens of ending hunger and malnutrition in all its forms, embracing the need for multi-sectoral collaboration for nutrition including working with media to put nutrition agenda to the forefront of development issues by giving nutrition more coverage and development of joint work plans to profile nutrition. KANCO further supported Nyeri and Mombasa Counties to develop the County Nutrition Action Plans, to support advocacy for increased financing for nutrition at the county level.

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state of human rights in the country. Together the CSOs developed a position paper making several recommendation including anchoring nutrition in the highest office for better coordination to realize the envisioned outcomes; ending hunger and malnutrition in all its forms. The paper was shared with United Nations, Office of the United Nations, Office of the High Commissioner on Human Rights in Geneva to inform the recommendations as well as the ministry of Interior and coordination of National Government impressing on better coordination for nutrition.

STRENGTHENING GRASSROOTS ENGAGEMENTS FOR SUSTAINABILITY OF HEALTH ADVOCACY

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Samburu Council of Elders and KANCO team during a grassroots sensitization on immunization forum. KANCO held targeted grassroots advocacy meeting on immunization, child health and domestic resources for health. Through the model KANCO held sensitization meetings with the Samburu Council of Elders. The meetings were held with the intent of sensitizing the elders on the importance of the grassroots advocacy movement. The elders were encouraged to use their roles to promote health advocacy in their respective communities.

Supporting lobbying and advocacy based support to the Nairobi CHV Network towards the approval of the Nairobi City County Community Health Services Bill (2018) KANCOs’ grassroots advocacy model is an innovation that is implemented in 27 (twenty seven) counties in the country. One of the most notable advocacy based efforts KANCO supported this year was the lobbying of the Nairobi County Community Health Services Bill; this bill is expected to legitimize community health volunteers (CHVs) in the public health sector. The CHVs are a diligent and passionate resource in the health care system whose impact in providing health care services to communities is underrated and the that this bill will not only cement their role but also reward them for their efforts. The allocation of Kshs 100 Million will support CHVs stipend and their enrolment into the National Health Insurance Fund.

Close out of the Wezesha Mashinani Project 2019 saw the wrap up of the Wezesha Mashinani project implemented between 2016 and 2018 with the support of USAID, across four counties: Murang’a, Siaya, Vihiga and Turkana. The project’s primary objective was the enhancement of citizen engagement and support effective implementation of devolution. The project wrapped up towards the end of January 2019 and in

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addition to the establishment of the grassroots chapters, the project recorded great success including development of the Community Health Services Bill in Siaya and Vihiga & CHV Bill in Nairobi County. The establishment of rehabilitation centres and friendly facilities for use by persons living with disabilities in Murang’a and an increase of the number of medical personnel in Vihiga. The project also documented the lessons learnt in the duration of the implementation that would be helpful in the continued engagements with the grassroots.

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Kenya Launches National Strategic Plan for Tuberculosis, Leprosy and Lung Health 2019-2023 KANCO partnered with the Ministry of Health’s National Tuberculosis, Leprosy and Lung Disease Programe in the launch the Kenya National Strategic Plan (NSP) for Tuberculosis, Leprosy and Lung Health 2019-2023 during the World Tuberculosis Day commemoration held at Thika Stadium, Kiambu County. Addressing the stakeholders, Mr Allan Ragi, Executive Director- KANCO reiterated on the need for integrated patient centred approach in management of health services and also in recognition of prioritization of UHC. KANCO representative said that Kenya being one of the highest beneficiaries of Global fund grants needs to commit to the 6th GF Replenishment that was to take place in October 2019 in France.

Global and regional engagement at ICASA and the Union Conference to Advance TB Accountability and domestic resource mobilization for health KANCO participated at the Union Lung Conference in Hyderabad, India and engaged in dialogues on TB accountability. RESULTS UK, a member of the ACTION Global Health Partnership launched a new report “Tuberculosis and Universal Health Coverage” that analyses the relationship between TB and universal health coverage (UHC), outlining the essential set of services that would both help to make the TB response universal and contribute to the achievement of UHC more broadly. At the conferences, KANCO engaged in discussion on implementing national level accountability for global and national commitments including the UNHLM and TB and PEPFAR in Kenya. At the WHO Annual Meeting of the Child and Adolescent working Group in India, it was noted that that children under 5 years had now been categorized as vulnerable population in TB. Going forward this means that specific emphasis would be towards this category in the elimination of TB. It was also announced that one big pharma producing bedaquline (BDQ) had considered and approved the sale of BDQ treatment for TB patients to be KSHs 500 per year. This was a great achievement of a campaign that KANCO took part in as it would now ensure access for treatment for patients and with less side effects.

High level engagement to the support Sixth Global Fund Replenishment and increased DRM for Health in Kenya: Towards the sixth Global Fund replenishment in 2019, KANCO partnered with GFAN and organized various engagements towards mobilizing resources to reach the USD 6Million target of new resources for the Global Fund. KANCO attended the GFAN Africa regional meeting that was a platform on engaging on advocacy messaging and drawing an advocacy plan. Thereafter, KANCO in collaboration with Nairobi City County and Youth Advisory Council, Nairobi engaged young grassroots advocates in writing letters to 25 Members of Parliament to request for their support in Kenya’s commitment at the replenishment. Additionally, through social media engagement the youth were able to reach many audiences with the messaging. KANCO also partnered with regional and global CSOs to drum support for the replenishment through social media campaign with messaging under the treatment for all campaign.

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KANCO HEALTH CAMPAIGNS

Taking stock of UHC in Kenya 42

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Universal Health Coverage (UHC) has become a policy priority at both the national and global level. The goal of UHC is to ensure that every citizen has access to quality healthcare services that they need without getting into financial difficulties or, worse, pushed into poverty. To progress towards UHC countries must advance along at least three lines of action. They must expand priority services, include more people, and reduce out-of-pocket payments. The Kenyan government has made a commitment to achieve UHC by the year 2022 as part of the Big Four Agenda. This includes healthcare for all as one of the key development priorities. It is envisioned that all persons in Kenya will be able to use the essential services they need for their health and wellbeing through a single unified benefit package, without the risk of financiall catastrophe. The installation of UHC as a global and country health policy goal has highlighted the need to measure it, and to track progress over time. Kenya’s Sh4 billion UHC pilot in four counties; Nyeri, Isiolo, Machakos and Kisumu is in its seventh month in four counties. There are plans to gradually roll out benefits countrywide at an annual cost of approximately Sh44 billion. The ministry is restructuring the National Hospital Insurance Fund to play a bigger role in the national roll-out. In line with this KANCO has been engaging with the UHC Taskforce by providing recommendations on UHC roll out and proposed a UHC benefit package for Kenyans. KANCO will be evaluating further the impact of the UHC in the four pilot counties.

First UN- Habitat Assembly The United Nations Human Settlements Programme (UN- Habitat) held its inaugural Assembly from 27th to 31st May 2019 in Nairobi, Kenya with a delegation from 127 countries, including four Heads of State, Government officials and 49 ministers in attendance. The theme was; Innovation for Better Quality of Life in Cities and Communities. In collaboration with Africa Union and UN-Habitat KANCO engaged in a panel on innovative approaches to planning and health for all. Current urbanisation trends are negatively affecting human health and wellbeing of citizens, challenging the development of competitive, inclusive and livable cities. As recognised in the “Health as the Pulse of the New Urban Agenda” report by the WHO, key urban stakeholders must incorporate health as a central consideration in their decision making processes. Discussion at the Assembly included innovative approaches on how partnerships between planners and health professionals can contribute to delivery of healthier cities for all, contribute to reduced spatial and health inequalities in urban settlements and improving the quality of life of its citizens. The UN-Habitat Assembly passed five resolutions focusing on safer cities, implementation of the New Urban Agenda, achieving gender equality through UN-Habitat’s work to support inclusive, safe, resilient and sustainable cities and human settlements. It also determined the strategic priorities for accelerating implementation of the New Urban Agenda to achieve the Sustainable Development Goals for the next six years, through UN-Habitat’s Strategic Plan (2020-2025). The first UN-Habitat Assembly concluded with a Ministerial Declaration that recognised the unprecedented rate of urbanisation brought along both as a challenge and an opportunity.

Strengthening Partnership for Sustainability of Harm Reduction In 2015, KANCO, with the support of the Global Fund through the Regional HIV and Harm Reduction Project, embarked on a journey to introduce and cement harm reduction in the greater Eastern Africa region. Armed with three objectives: to improve the policy environment, the service delivery environment as well as generate evidence to inform harm reduction interventions in the region. One of the best practices by the end of the project in 2019 was Partnership with government entities/ structures/country Global fund Country Coordinating Mechanisms (CCMs) which enabled the project achieve results. An important lesson from the project is appropriate sensitization of political and

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Development of the East Africa Community Regional Policy on Alcohol, Drugs and Other Substance Approval and Adoption for use in the region:

In 2016, KANCO working with the EAC Secretariat with support from the Global Fund under the HIV and Harm Reduction Regional Project for Eastern Africa, and the EAC Partner States commenced the process of developing the Policy. The International Drug Policy Consortium (IDPC) provided the initial technical support in the formulation of the draft EAC Regional Policy on Prevention, Management, and Control of Alcohol, Drug and Other Substance Use.

The policy was developed through a consultative process with discussion taking place both at the regional and national levels. Numerous parties and individuals including experts from the East African Community (EAC) Partner States, Experts from regional and international organizational including KANCO, IDPC, OSIEA, UNODC,UNAIDS,WHO, and the technical experts from the EAC Secretariat HIV and AIDS unit contributed to the development of this policy. The EAC Regional Policy on Alcohol, Drugs and Other Substance use recognizes that alcohol, drugs and other substances use or consumption is associated with related problems arising from the complex relationship between the individual consumer of the alcohol, drugs and other substances and the broader cultural, political, social, economic and physical environment. Therefore, this policy provides broad framework within which all stakeholders in the region will contribute to the reduction of the negative consequences caused by Alcohol, drugs, and other substances used in the EAC region with specific emphasis on comprehensive prevention, control and management of the harmful effects.

Closeout Meeting for Regional Global Fund HIV and Harm Reduction Project

The closeout meeting of the HIV and Harm Reduction Regional project brought together different key stakeholders. The participants included the Deputy Governor for Lamu County, representatives of the community of people who use drugs, National AIDS/STI Control Programe, National Authority for the Campaign against Alcohol and Drug Abuse (NACADA), UNODC, UNAIDS, Office of Attorney General, Department of Justice, International law Division, Kenyatta University, University of Nairobi, KANCO Grassroots, Representatives of People Who Use Drugs, Kenya Harm Reduction Network, Probation Department, LVCT Health, Mathari Hospital, Ngara MAT Clinic, Reachout, Teenswatch, Kwale County representative, Mombasa County Representative, KANCO and KANCO Consultants.

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religious leaders is important for buy- in and eventual support in championing the course of People Who Inject Drugs.

Key Populations Programs at the 20th International Conference on AIDS and STIs in Africa in Kigali, Rwanda

KANCO participated in the 20th International Conference on AIDs and STIs in Africa in Kigali Rwanda themed “AIDS Free Africa-Innovation, Community, and Political Leadership”.

In Line with the conference theme, the KANCO Key Populations Programs held three sessions as follows: Leadership focusing on Harm Reduction Programmes in Africa Policies and Progress. The session looked at the state of harm reduction at the global and regional level, providing an opportunity to learn and share on policies and practice across the region as well as deliberate on the way forward for harm reduction in the region. Addressing the participants at the harm reduction event organized by KANCO and PILS– Mauritius, Allan Ragi, Executive Director KANCO impressed on the need for adoption of an integrated people centred approach to harm reduction programming that would go a long way in addressing the multiple and unique challenges faced by key populations.

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KANCO also participated in the International Drug Policy Consortium (IDPC) member’s roundtable discussions with participation by members from South Africa, Nigeria, Kenya, Senegal, Zimbabwe, Ghana and Mauritius. The members focused on the vision and the mission of the consortium and strategy for the period 2020-2022 for better coordination of their activities. The Key Populations Programe Manager at KANCO was also a panellist at the United Nation Populations Fund (UNFPA) satellite Symposium, “Putting People at the Centre of Integration” which shared on efforts to integrate Sexual and Reproductive Health and Rights and HIV to improve health outcomes for national health systems and all people, including those living with HIV, sex workers and injecting drug users. KANCO presented on integrated community-based HIV prevention, harm reduction, SRHR services for women who inject drugs.

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STRATEGIC DIRECTION 3: INSTITUTIONAL SYSTEMS STRENGTHENING

EANNASO regional partners during a capacity building on achieving the Global Fund objectives by enhancing community engagement in Anglophone Africa. KANCO continued to engage towards strengthening the consortiums membership, enhance sustainable programming as well as the institutional operational systems. To this end, KANCO engaged in a series of activities towards strengthening the institutions capacity for and effective, responsive and suitable health programming as follows:

Capacity Building for Adolescent Girls and Young Women Organizations Adolescents and young women continue to face a myriad of Sexual Reproductive Health and Rights (SRHR) challenges, further compounded by challenges in accessing health as well as prohibitive legal and policy legislations as well as Limited Capacity of Adolescent Girls and Young Women (AGYW) organizations to effectively offer services to these populations. KANCO with the support of the Eastern Africa National Network of AIDS Organizations (EANNASO) through the Amplify Change project worked to capacity build AGYW organizations around Nairobi towards strengthening their capacity on a range of topics including; Programme Management, Sexual Reproductive Health and Rights (SRHR), Monitoring and Evaluation, Policy Advocacy, Communication, Media Engagement and Visibility, Leadership and Governance.

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Through the project KANCO sought to bring together key stakeholders, establish partnership and create alliances for a concerted SRHR response. The project successfully carried out a number of other activities including: review of the legal and policy framework for SRHR in the region and identifying the gaps and presented the finding at the regional policy dialogue forums including EALA. The project also facilitated mapping, capacity assessment, development of capacity building plans and cross learning and sharing among the partners.

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Diversifying Partnerships KANCOs partnership continued to expand in 2019 both with like minded and non-traditional actors including engagements with corporates, to foster Public Private Partnership for health. In 2019, KANCO participated in the Kenya Association of Fundraising Professionals (KAPF) forum, where discussions around fundraising for health with the impeding donor transition were held while exploring opportunities for collaboration. KANCO further held various campaigns and forged partnerships with different health actors including the Career Mothers for Exclusive Breastfeeding Campaign (CAMFEB) advocating for actualization of the breastfeeding bill during the world breastfeeding week. Further KANCO took part in the multisectoral campaigns on treatment for all towards raising the US $14Bn for the global fund kitty. KANCO also partnered in various forums and conferences for enhanced learning.

Capacity Building of stakeholder to support uptake of immunization KANCO held a series of capacity building engagements for multiple stakeholders including: the Civil Society Organizations (CSOs), Religious Leaders, Health Care service providers, Media/ journalists and Community Health Volunteers (CHVs) for a concerted multi-stakeholder approach and prioritization of immunization. In total over 400 CSOs and grassroots were trained on advocacy towards prioritization and sustainable funding for immunization. 400 Religious leaders in 13 counties were trained to address vaccine hesitancy and resistance, 478 CHEWs across the 17 implementing counties to community health strategy, 106 Journalists trained to effectively report and profile immunization and 1000 CHV’s in 12 Counties trained on defaulter and missed cases tracing improve immunization coverage in Kenya.

Empowering CHVs through the LEAP Project KANCO engaged AMREF health Africa to pilot the Leap M-health project in Bungoma County. The leap project is an innovative, scalable, and integrated mobile learning solution that offers continuous training opportunities, peer collaboration, real time evaluation of reports and effective supervision, by promoting learning through mobile technology. Through this project 500 CHVs were engaged and learning sessions ensued guided by a curriculum that was developed to guide the process. The process seeks to cultivate a proactive approach to health through continuous engagement and empowerment of the communities to effectively leverage the human and social capital that exists in a community.

Strengthening Key Populations Engagements In 2019 KANCO continued to leverage various platforms to champion the issues of the key populations. Some of the forums included KP annual symposium, the ICASA conference among other issues. During the 2019 key population’s consortium, KANCO Mariakani DIC with the support of The Kenya Red Cross, participated and made presentation during the symposium dubbed “Communities make the difference’. The annual event, sought to share best practices, challenges and lessons learnt from each other. KANCO got to share their experiences, and showcase the services KANCO offers through the DIC model.

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Eastern Africa Harm Reduction Network Third Annual General Meeting.

Brand Strengthening In 2019, KANCO continued to enhance the brand relevance and visibility through representation in different platforms and arenas. KANCO developed a number of publications as follows: over 10 thematic publications, over 50 weekly bulletins as well as increased media (mainstream and social) media presence and engagements.

Membership The KANCO membership continued to grow, with new members coming on board as well as strengthening of the existing consortium members to effectively engage towards the realization of Universal Health Coverage. Cumulatively there was more membership engagement at the counties levels, to effectively address county specific health related issues under the new health devolution dispensation. The members were able to collectively take on advocacy and health implementation issues, using a ground up approach through the grassroots advocacy engagement, cascading the issues upwards to their elected leaders. In 2020, KANCO seeks to expand the membership base as we collectively works towards the realization of a healthier people and empowered communities.

EANNASO regional partners during a capacity building on achieving the Global Fund objectives by enhancing community engagement in Anglophone Africa.

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The Eastern Africa Harm Reduction Network (EAHRN), a regional harm reduction advocacy network formed under the Regional HIV and Harm Reduction project, where KANCO was the PR, held its 3rd Annual General Meeting (AGM) in 2019. The forum facilitated discussions on the purpose of the network including: advocating for and on behalf of the PWUDs in the region, increased information across the region through the in-country networks and also create a strong voice to fundraise resources to support in country networks among others. The forum also facilitated the board elections for the vice chairperson with the slot being taken by Kenya.

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STRATEGIC DIRECTION 4: RESEARCH, LEARNING AND INNOVATION KANCO continued to focus on research learning and innovation for enhanced evidence based programming, improved stakeholder engagement and improved national regional and global knowledge sharing. To this end, in 2019, KANCO had a host of publications and research collaborations

Eastern Africa HIV and Harm Reduction Project End-line Evaluation KANCO undertook the Eastern Africa HIV and Harm Reduction project evaluation engaging partners in all the 8 implementing countries. This project was anchored on three objectives: Create an enabling environment to conduct harm reduction activities in Eastern Africa; strengthen community systems for a sustained HIV response among PWIDs in Eastern Africa; and generate and utilize strategic information on drug-use-related interventions in the region. The overall purpose of the evaluation exercise was to document lessons learned from the project implementation that could inform the management of local and Regional Grants in future. The specific purpose of this evaluation was to measure progress towards the achievement of the expected outcomes and to assess the strategies that The project has put in place in order to create a positive impact among communities of PWIDs. The evaluation concluded that overall, the Project achieved its intended outcomes recommending that, given the project was a pilot; therefore, it is important to expand the model for continuity of advocacy for harm reduction service delivery in the region through continued support by the global fund.

Publication on the HIV and Harm Reduction Regional Project Milestones-Community and Implementing Partners Experiences As part of the closeout activity on the Harm Reduction Regional Project, a video documentation and best practices book were developed to highlight the successes and learning that happened within the projects lifespan of October 2015-September 2018. KANCO conducted interviews through a consultant of various stakeholders spanning the eight Eastern African Countries where the project was conducted. The stakeholders included East Africa Community (EAC) Secretariat, Ministries responsible for Health, Justice/Constitutional and Legal Affairs, National Drug, Civil Society Organizations (CSOs), SRs, SSRs and UNODC to share stories of transformation through the Harm Reduction Project. A full report of these change stories is ready for dissemination.

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Supported by to fight AIDS, TB and Malaria

CELEBRATING THREE YEARS ON

HIV and Harm Reduction in Eastern Africa Project Milestones-Community and Implementing Partners Experiences

KANCO conducted a CSOs mapping successfully mapping more than 300CSO’s in 13 Counties where the GAVI-HSS project is implemented. Of the CSOs mapped less than 50% have immunization or child health as an agenda or a priority. The insights from the report will inform future engagements for advocacy on immunization.

Cross Cutting Issues Revival of the Kenya Gender Budgeting Network (KGBN) KGBN was formed with the intent of promoting women centred economic empowerment. This would turn create a domino effect where the empowerment of women would lead to the empowerment of their families, then in turn their communities and ultimately national empowerment would be realized. This would also curb the increased effect taxation has on women. The KGBN’s network of partners includes: CSOs (especially those focused on women empowerment), government ministries and various parliamentary committees. The revival of the network was in line with forming an effective gender responsive budget (GRB) structure and KANCO was part of the organization that came together to support this initiative

Championing the Mental Health Cause Kenya was ranked at position four in Africa with 1.9 million people who have the condition (WHO Report, 2014).According to the Kenya Mental Health Policy (2015-2030), mental disorder cases in Kenya continue to rise rapidly. Estimates point that 20-25 percent of outpatients seeking primary healthcare present symptoms of mental illness at any one time, while government statistics indicate that at least 1 in every 4 Kenyans suffer from a mental illness at one point in their lives. In line with this KANCO has been mobilizing Civil Society around, mental health advocacy in Kenya, investment in mental health and a change in public policy on mental health, building the capacity of civil society and Non-Governmental Organizations to advocate, promote accountability and push of policy change around mental health. KANCO has also been providing tools and knowledge to foster greater public participation and awareness around mental health.

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Mapping of CSO’s and GIS Coding and Appraisal of Health Facilities in 8 Counties.

FINANCIAL REPORT

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Kenya Aids NGOs Consortium (KANCO)

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Financial statements For the year ended 31st December 2019 STATEMENT INCOME AND EXPENDITURE FOR THE YEAR ENDED 31ST DECEMBER 2019 2019

2018

Note

Total KShs

218,298,376

408,517,206

31,225,565

218,298,376

439,742,771

125,750,302

162,016,745

INCOME Income Other income

EXPENDITURE Improving access to health programs Policy and advocacy

80,791,656

244,197,013

Strengthening institution systems

6,216,000

80,231

Research, learning and innovation

960,000

Administration

4,5080,418

4,448,053

218,298,376

410,742,043

29,000,728

Total Expenditure Surplus

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OUR PARTNERS

Council of Goverrnors

MINSTRY OF HEALTH

United Nations Office on Drugs and Crime

European Union

University of Nairobi

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KANCO Regent Mangement Limited Court Opposite Nairobi Womens Hospital Argwings Kodhek Road/Block C

P.O Box 69866 - 00400 Nairobi Kenya Phone: +254 20 232 3533 | +254 722 203 344 Email: kanco@kanco.org www.kanco.org