National guidelines for the implementation

NATIONAL GUIDELINES FOR THE IMPLEMENTATION OF
THE BASIC CARE PACKAGE
IMPROVING THE QUALITY OF LIFE FOR PEOPLE LIVING WITH
HIV&AIDS, AND THEIR FAMILIES
THROUGH
THE PREVENTION OF OPPORTUNISTIC INFECTIONS
National AIDS and STI Control Programme (NASCOP)
PO BOX 19361 KNH Nairobi 00202 Kenya
Tel 254-20-272-9502/9549. Fax:254 -20-271-0518
[email protected]
www.nascop.or.ke
2010
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Table of Contents
FORWARD ACKNOWLEDGEMENTS
LIST OF ABBREVIATIONS
1.0 INTRODUCTION
1.1
Background Information
1.2
Rationale
1.3
Use of the Guidelines
2.0 THE BASIC CARE PACKAGE
2.1
Goals of The BCP
2.2
BCP Contents
2.3
Intervention Areas of the BCP
2.3.1
Sexually Transmitted Infections
2.3.2
Diarrhea Prevention
2.3.3
Malaria Prevention
2.3.4
Cotrimoxazole Prophylaxis
2.3.5
Client Education on the Basic Care Package
3.0 ELIGIBLE POPULATIONS
4.0 KEY PLAYERS IN BCP
4.1
The National Level
4.1.1
Ministry of Health
4.1.2
National AIDS Control Council
4.2
Provincial Level
4.2.1
PASCO/PHMT/PHC/BCC Coordinators
4.3
County Level
4.3.1
DASCO/DHMT/HCBC Coordinators
4.4
Facility Level
4.4.1
Health Care Workers
4.5
Community Level
4.5.1
CHEWs
4.5.2
Opinion Leaders and other Community Gatekeepers
4.6
Partners
4.6.1
Donors /Development Partners 4.6.2
Implementing Partners/NGOs/CSOs
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5.0 BCP SUPPORT SYSTEMS
5.1
Personnel
5.2
Logistics
5.3
Coordination of BCP Services
5.4
Sustainability of BCP Program
5.4.1
Sustainability of CHW/Peer Educators
5.4.2
Sustainability of the logistic supply
6.0 IMPLEMENTATION PROCESS
6.1
Implementation steps
6.2
Integration with other Community Level Interventions
7.0 MONITORING AND EVALUATION
7.1
Specific M & E Activities
7.2
M & E Tools
8.0 SAFETY OF THE BCP KIT AND ITS CONTENTS
REFERENCES
ANNEXES
List of Workshop Participants
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FOREWORD
HIV/AIDS is still among the most important health challenges facing
Kenya, and many other African countries. Without appropriate care and
treatment, most People Living with HIV (PLHIV) will suffer from debilitating
opportunistic infections leading to hospitalization, loss of income,
disruptions of their family life and eventually death. Today, HIV/AIDS
no longer has to be an acute, debilitating disease. It is possible to delay
or prevent diseases and improve the quality of life for persons with HIV
through a comprehensive approach to health care that emphasizes on
preventive care, extending beyond just antiretroviral therapy. Simple,
practicable solutions for improving the health and extending the lives of
PLHIV exist.
Evidence has demonstrated that a number of low-cost and practical
interventions can reduce HIV-related morbidity and mortality and prevent
HIV transmission. Long-lasting insecticide treated nets, safe water systems
and Cotrimoxazole preventive therapy are inexpensive and clearly benefit
people living with HIV/AIDS by reducing the incidence of opportunistic
infections e.g. malaria and diarrhea. Correct and consistent condom use
has also been shown to reduce HIV transmission among sexual partners.
Results from the Kenya Aids Indicator Survey 2007, indicated that a
majority of PLHIV in Kenya did not use various components of the Basic
Care Package (BCP).
The KNASP III aims to provide a prioritized package of prevention,
care and treatment services for PLHIV. The BCP is therefore an important
intervention towards the realization of the KNASP III goal and addressing
of the care gaps identified in KAIS 2007.
The publication of these guidelines is indeed timely, as it coincides with a
period of increased efforts by the GOK, to rededicate efforts towards HIV
prevention, and improving the quality of life for those infected with HIV.
We look forward to close partnership with all relevant stakeholders in the
implementation of this Basic Care Package.
Dr. Willis Akhwale
Head, Department of Disease Prevention and Control
Ministry of Public Health and Sanitation
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ACKNOWLEDGEMENTS
The development of the National guidelines for the implementation
of the Basic Care Package has been spearheaded by the Basic Care
Package Technical Working group (TWG), under the overall chair of Dr.
Nicholas Muraguri. We recognize the work done to initiate the process
by workshop participants who gave practical inputs applicable at both
health facility and community levels.
We are indebted to the BCP TWG membership, who participated in many
meetings and workshops to share useful ideas towards the development
of these guidelines. Members of the TWG who drafted and peer reviewed
these guidelines are listed below:
Dr. Nicholas Muraguri, NASCOP
Pauline Mwololo, NASCOP
Lenet Bundi, NASCOP
Patricia Macharia, NASCOP
Dr. Maurice Maina, USAID
Ruth Tiampati, USAID
Dr. James Odek, CDC
Lucy Maikweki, PSI/K
Dr. Anne Musuva, PSI/K
Dr. Steve Adudans, Mildmay
Mabel Wendo, Mildmay
James Ayuyo, Mildmay
Noni Mumba, PSI/K
We acknowledge the United States Agency for International Development
(USAID) for their financial support during the entire process of developing,
printing, launching and distribution of the National BCP Guidelines, to
various stakeholders in the health system.
Dr. Nicholas Muraguri
Head, NASCOP
Ministry of Public Health and Sanitation
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LIST OF ABBREVIATIONS
BCP
CACC
CBO
CCC
CDC
CD4
CHW
CHEW
CPT
CSO
CTX
DASCO
DHMT
FBO
GOK
HCBC
HCW
HCP
HIV
IEC
IGAs
ITN
KAIS
KNASP
LLITNs
MOH
NACC
NASCOP
OIs
PASCO
PHC
PHMT
PLHIV
PSI
PWP
QA
QC
STIs
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Basic Care Package
Constituency AIDS Control Committee
Community Based Organization
Comprehensive Care Clinic
Centers for disease control
Helper T Lymphocytes
Community Health Worker
Community Health Extension Worker
Cotrimoxazole preventive therapy
Civil Society Organization
Cotrimoxazole
District AIDS & STI Coordinator
District Health Management Team
Faith Based Organization
Government of Kenya
Home & Community Based Care
Health Care Worker
Health care provider
Human Immuno-deficiency Virus
Information Education & Communication
Income Generating Activities
Insecticide treated net
Kenya Aids Indicator Survey
Kenya National AIDS Strategic Plan
Long-Lasting Insecticide Treated Nets
Ministry of Health
National AIDS Control Council
National AIDS & STI Control Programme
Opportunistic Infections
Provincial AIDS & STI Coordinator
Primary Health Care
Provincial Health Management Team
People living with HIV & AIDS
Population Services International
Prevention with Positives
Quality Assurance
Quality Control
Sexually Transmitted Infections
SWS
TOT
TWG
USAID
WHO
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Safe Water System
Training of Trainers
Technical Working Group
United States Agency for International Development
World Health Organization
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1.0
INTRODUCTION
1.1. Background Information
According to the KAIS 2007, 7.1% of Kenyan adults (aged 15-64 years)
are infected with HIV, representing an estimated 1.37 million people.
There is a wide regional variation in HIV prevalence ranging from
14.9% in Nyanza to 0.8% in North Eastern Province. In rural areas,
approximately 990,000 adults are infected with HIV, compared to
approximately 380,000 adults in urban areas.
Human Immunodeficiency Virus (HIV) infection is a complex condition
affecting the patient, their family and their community and the nation
as a whole. The care of persons living with HIV and AIDS (PLHIV)
therefore, needs to be as comprehensive as possible. It should provide
a wide range of services beyond specific medical treatment and involve
a multidisciplinary team of caregivers to encompass all the important
aspects of this multifaceted condition.
Opportunistic infections (OIs) are the most important cause of morbidity
and mortality in HIV-infected individuals. The Basic Care Package (BCP)
aims at prevention of some of the OIs notably, diarrhea, malaria and
STIs among PLHIV. A number of low-cost and practical interventions have
been shown to reduce HIV-related morbidity and mortality due to OIs
and prevent HIV transmission. Cotrimoxazole preventive therapy (CPT),
long-lasting insecticide treated nets (LLITN), and safe water systems (SWS)
are inexpensive and clearly benefit PLHIV by reducing the incidence of
opportunistic infections. In addition to CPT, LLITN, and SWS, the BCP in
Kenya includes condoms and information, educational and communication
(IEC) materials for PLHIV. The Government of Kenya (GOK) recommends
that all HIV-infected adults and children regardless of their immunological
status should have access to these interventions and refers to them as the
Basic Care Package.
For the care of PLHIV to be effective in its reach, it is essential that the
community, all levels of the health care system and all cadres be involved
in the provision of this package.
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1.2 Rationale
The BCP is designed to offer low cost interventions that prevent illness,
prolong life, and prevent HIV transmission. The interventions of BCP are
evidence based as discussed below:Cotrimoxazole preventive therapy (CPT) has been long used in developed
countries in people with advanced HIV disease primarily to prevent
Pneumocystis pneumonia. It has also been known to reduce malaria
and diarrhea episodes in sub-Saharan Africa (WHO, 2007). For the
prevention of malaria, which is more common and more severe in PLHIV,
including children, the use of long-lasting insecticide-treated nets (LLITN)
in combination with CPT provides additive value (Kamya, Gasasira et al.
2007; Lengeler, 2006).
A variety of interventions that improve household water quality and hand
hygiene have been shown to decrease diarrhea related morbidity and
mortality both in persons and families with HIV (Lule, Mermin et al. 2005;
Quick, Kimura et al. 2002). The combination of home water treatment and
a safe storage vessel has been shown to be a very effective intervention,
especially among people living with HIV (Lule, Mermin et al. 2005).
Various combinations of these interventions to reduce morbidity and HIV
transmission have been combined and distributed in countries such as
Uganda and southern Sudan. A pilot of the BCP program in Coast, Nyanza
and Western provinces was carried out in 2009 and the experience
gained guided the roll out to the rest of the country.
1.3 Use of the Guidelines
These guidelines are designed to be used by program managers and
planners for advocacy and resource mobilization. Health care providers
and community health workers/peer educators will use the guidelines to
guide implementation of BCP interventions.
The BCP guidelines provide a significant step towards standardizing
care and support measures to reflect the most up-to-date information and
policies supported by the Ministry of Health
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2.0
THE BASIC CARE PACKAGE
The Basic Care Package is a collection of evidence based interventions
which are easy to implement for the benefit of PLHIV. The interventions
are patient centred and have the potential to improve the quality of life
of PLHIV.
2.1 Goals of the BCP
The goal of the Basic Care Package is to reduce morbidity and mortality
among PLHIV, through the prevention of opportunistic infections, to help
them live longer and healthier lives.
The BCP aims to contribute substantially towards the Kenya National
AIDS Strategic Plan III (KNASP) for the response to HIV in pillar 1&3 and
improve the quality of life of PLHIV in Kenya. The BCP specifically focuses
on the prevention of Sexually Transmitted Infections (STIs), Diarrhea and
Malaria.
2.2
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BCP Contents
The contents of the Basic Care package include:100 male condoms
2 long lasting insecticide treated nets
Chlorine Water treatment
A 20 liter safe water vessel with an inlet that has a lid and an outlet (tap)
A cotton filter cloth (for filtering particles out of water before treating)
Informational materials (for more information on the BCP contents)
Cotrimoxazole preventive therapy (CPT)
2.3 Intervention Areas of the BCP
The BCP focuses on prevention of STIs, diarrhea, malaria and other
common OIs. In addition to provision of the BCP commodities, client
education through use of IEC materials facilitates a better understanding
of OI prevention, and subsequent behavior change.
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2.3.1 Sexually Transmitted Infections
The commonest mode of HIV transmission in Kenya is through sexual
intercourse. The presence of STIs is an important co-factor in the
transmission of HIV infection; the presence of either inflammatory or
ulcerative STIs facilitates acquisition and transmission of HIV infection.
In resource-limited settings where routine screening for STIs is not possible,
prevention and control of STIs is largely dependent on education and
behavior change to reduce the risk of acquiring or transmitting STIs.
Condoms are the most reliable method for reducing the risk of sexual
transmission or acquisition of HIV and other STIs, as well as HIV reinfection. When used correctly and consistently condoms have been
shown to reduce transmission of STIs and HIV significantly. The BCP
promotes and provides male condoms.
2.3.2 Diarrhea Prevention
Diarrhea is a leading cause of morbidity and mortality among people
infected with HIV. Contaminated water is often the source of microbes
that cause diarrhea. According to KDHS (2008), more than one-third of
Kenyan households get their drinking water from an unprotected source,
mainly surface water from lakes, streams, and rivers. Although only 6%
of urban households use unprotected sources for drinking water, the
proportion is far higher for rural households (46%). According to KAIS
2007, 54.5% of HIV-infected persons live in a household that does not
treat its drinking water.
The Government of Kenya recommends safe water systems for all households
affected by HIV. The Basic Care Package contains an inexpensive, readily
available and easy to use safe water system that comprises of point of use
water treatment chemical, a safe water storage vessel and a filter cloth.
2.3.3 Malaria Prevention Malaria is the leading cause of morbidity and mortality in Kenya, with
close to 70 percent (24 million) of the population at risk of infection. Coinfection with HIV and Malaria is very common in sub Saharan Africa,
especially in Malaria endemic areas with HIV increasing the incidence
and severity of Malaria.
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Despite the GOK recommendation that HIV-infected persons protect
themselves against malaria by always sleeping under an insecticidetreated net (ITN) every night, only 20.2 % of PLHIV sleep under an ITN
(KAIS 2007).
The Basic Care Package contains two long lasting insecticide treated nets
(LLITNs) for Malaria prevention. These LLITNs are the best because they do
not need to be retreated with insecticide to maintain their effectiveness. In
addition to providing a physical barrier against mosquitoes, LLITNS also
repel and kill mosquitoes.
2.3.4 Cotrimoxazole Prophylaxis
Cotrimoxazole prophylaxis is a cost effective and easily available
intervention that prevents certain bacterial and parasitic infections that
cause Pneumocystis
carinii jiroveci pneumonia, diarrhea, malaria and toxoplasmosis, therefore
prolonging the lives of adults and children with HIV.
According to KAIS (2007), 23.9% of HIV-infected clients in HIV care
were not receiving Cotrimoxazole prophylaxis. The Ministry of Health
recommends that all people with HIV, regardless of CD4 count, should
take Cotrimoxazole daily to reduce the risk of illnesses that are associated
with HIV/AIDS.
All PLHIV should use Cotrimoxazole prophylaxis together with the other
components of the BCP persistently for effective prevention of opportunistic
infections. Cotrimoxazole is part of the BCP but is dispensed from the
health facility.
2.3.5 Client Education on the Basic Care Package
PLHIV need instruction and demonstrations on proper use of the BCP.
Education on other aspects of HIV care including prevention of OIs and
positive living is also important. This is provided by health care workers
and peer educators/ community health workers.
Client education on use of the BCP should cover:•
Malaria prevention and the use of LLITNs
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Correct and consistent condom use for prevention of STIs and HIV re-infection.
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Proper use of Safe Water Systems for Diarrhea prevention
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Cotrimoxazole prophylaxis for OI prevention
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The BCP also contains IEC materials which provide information and
education on use of the BCP items. This is key in ensuring that clients use
the components of the package correctly. Clients require comprehensive
health education which targets a holistic approach to nutrition, prevention
of OIs, adherence to treatment, safer sex, disclosure, stigma, psychosocial
support and behavior change. All clients should be given condoms and
adequate information on proper use regardless of service provider’s
beliefs, preferences and religion.
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3.0
ELIGIBLE POPULATIONS
The primary target recipients of the Basic Care Package are people living
with HIV who know their HIV status and are registered at a health facility.
Anyone who tests HIV positive irrespective of his/her religion, age, or
ethnic region is eligible to receive the Basic Care Package.
Recruitment of clients/patients will be carried out either within a health
facility by the health care worker or through referral from the community
settings by trained Community Health Workers (CHW).
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4.0
KEY PLAYERS IN BCP
The smooth implementation of BCP activities involves the active participation
of various individuals, service delivery structures and organizations at all
levels right from the national level to the Community level.
4.1 The National Level
4.1.1 Ministry of Health
The Ministry of health through NASCOP has key roles of:
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Coordinating and collaborating with development partners, resource mobilization, procurement, storage and distribution of BCP commodities.
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Development and dissemination of guidelines, policies and M & E
tools
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Coordination of health workers capacity building
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Ensuring that quality assurance and quality control standards are adhered to.
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Overall coordination of the technical working group (TWG) and other stakeholders meetings.
The TWG is responsible for:
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Development and approval of guidelines and policies
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Coordination of programmes
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Provision of guidance and direction
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Provision of technical support to BCP implementers
4.1.2 National AIDS Control Council
The National AIDS Control Council (NACC) is the overall coordinating
body responsible for resource mobilization, social mobilization and
advocacy, coordination of CBOs/CSOs/FBOs and the approval of
proposals
4.2 Provincial Level
4.2.1 PASCO/PHMT/PHC/BCC Coordinators
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Coordinate provincial BCP activities including the tracking of BCP
commodities distribution
Dissemination of guidelines and M & E tools
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Generate and share reports at provincial and national level
Putting in place Quality Assurance/Quality Checks strategies
Coordinating provincial stakeholders meetings
Selection and coordination of districts for BCP interventions
4.3
4.3.1
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4.4
4.4.1
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County Level
DASCO/DHMT/HCBC Coordinators
All provincial roles but at district level
Coordination of Selection and training of HCWs and CHWs
Supervision of HCWs
Facilitate the storage and distribution of BCP commodities within the district.
Generate reports and share with the province plus other stakeholders in the district.
4.5
4.5.1
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Community Level
CHEWs
Assist in the recruitment, training and supervision of CHWs and
volunteers
Facilitate the implementation of BCP through the Community Strategy structures
Participate in M & E at the community level. Community mobilization
Distribution of BCP kits
Conduct health education sessions
Conduct defaulter tracing and follow up of clients
Referral of clients from the community to health facility.
Maintain records of BCP activities and regular reporting to facility level
Participate in monthly meetings
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Facility Level
Health Care Workers
Implement BCP at facility level
Train & supervise CHWs
Generate reports & share with HCBC coordinator and DHMT
Conduct advocacy and health education sessions.
Link facility to community
4.5.2
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Opinion Leaders and other Community Gatekeepers
Facilitation of community mobilization and setting of health care priorities in the community.
Represent the community at stakeholders meeting
Assist in awareness creation
Assist in recruitment of CHW
Assist in follow up, linkages and referrals.
4.6
4.6.1
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Partners
Donors /Development Partners
Supporting the programme with required funds
Participate in development of IEC materials, M&E tools and training package (curriculum and other materials) in collaboration
with NASCOP
Procure necessary commodities.
Assist in the distribution of commodities to the point of use.
Assist the districts and health facility in facilitating implementation
at the lowest level.
4.6.2
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Implementing Partners/NGOs/CSOs
Advocacy for the uptake of BCP
Assist in distribution of BCP/provision of services
Facilitate supportive supervision
Support CHWs
Conduct research on effectiveness/impact of the BCP on PLHIV.
Support capacity building of HCW/CHWs
Participate in development of IEC materials in collaboration with NASCOP and other partners
Evaluate the programme
Procurement and distribution of commodities
Participate in curriculum development
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5.0
BCP SUPPORT SYSTEMS
The support systems for the implementation of basic care package include
human resources, logistical support, coordination and sustainability.
5.1 Personnel
It is important to have vibrant teams for BCP implementation from the
community to national levels.
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Community level - CHW and CHEW
- Whose main role is to educate the community on the BCP, and monitor its use through home visits.
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Facility level - HMT and HCW
- Supervision of distribution at facility level
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District level - DMHT including DHCBC coordinator
- District coordination of the program
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Provincial level - PHMT including PHCBC coordinator
- Provincial leadership of the program
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National level- NASCOP, NACC and TWG
- Guidance of program strategy at national level
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Partners cut across all the levels of implementation
5.2
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Logistics
Timely procurement and distribution of BCP kits to the facilities.
Efficient procurement, storage and supply system for all logistics including the appropriate labeling
To facilitate commodity and patient tracking, patient cards will be
stamped to signify receipt of the Basic care package.
5.3
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Coordination of BCP services
Ensure a functional M & E system
Appropriate and adequate quantities of M & E tools
Established Referral/and networking systems in place
Integration of BCP, HCBC and PWP activities at all levels of implementation
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5.4
5.4.1
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Sustainability of BCP Program
Sustainability of CHW/Peer Educators
Develop a standardized mode of motivating CHWs that is agreed
upon by stakeholders in a given locality to minimize dropouts and
migration from one programme to another.
Encourage formation of groups of CHW, minimal saving and training in entrepreneurship.
Establish linkages for microfinance and income generating activities.
5.4.2 Sustainability of the logistic supply
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Develop a well managed supply chain system for supply and distribution of basic care package.
Prepare adequate budgets with annual allocations for purchasing
BCP contents, training as well as IEC material development.
Timely distribution of BCP with demand
Advocate with partners for support of BCP logistic support.
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6.0
IMPLEMENTATION PROCESS
6.1 Implementation steps
It is important to follow the correct implementation steps the BCP to serve
the intended beneficiaries effectively.
Step 1:Identification of implementation sites with special consideration of
population coverage and service delivery gaps.
Step 2:Sensitization of PHMT, DHMTs and HMTs to ensure an in-depth understanding of BCP basic concepts and for subsequent active participation and support during implementation
Step 3:Identify district focal persons (HCBC coordinators) to coordinate the BCP program alongside community PWP and HCBC for the district.
Step 4:Recruitment of health care workers and Community Health Workers to carryout BCP activities at every level of implementation.
Use of community strategy approach during the recruitment of CHWs.
Step 5:Training and sensitization of HCW and CHWs. Using the nationally
approved standard training manual for Health Workers, community
peer educators and CHWs.
Step 6:Maintain accurate records at facility and community level.
Step 7:Conduct regular supportive supervision and meetings to discuss BCP issues.
Step 8:Motivate service providers where possible e.g. by providing bags,
T-shirts note books, pens, badges etc.
Step 9:In situations whereby more than one client is registered from the same household, more than one BCP can be given. However care
should be taken to ensure there will be no wastage of the contents.
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Step 10:Establish a referral, networking and and linkages structure that ensures that clients access other services unavailable at the point of BCP service provision
6.2 Integration with other community level interventions
The need and importance of integrating BCP into the existing facility and
community level prevention, care, treatment and support activities cannot
be over emphasized. At the home and community level, BCP strategies
target the same client as the HCBC and community PWP strategies; hence
the importance of integrating the three approaches for quality coordination
and, at service delivery levels.
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7.0
MONITORING AND EVALUATION
Monitoring and evaluation of the Basic Care Package interventions
facilitates accountability and transparency and ensures overall cost
effectiveness of the programme through accurate capturing of appropriate
inputs, processes and outputs.
7.1
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Specific M & E activities
Compiling monthly and quarterly reports on patient enrollment, BCP distribution and patient education activities.
Report on capacity building for health workers, CHW and other BCP service providers.
Report of OI occurrences among patients enrolled to BCP programme
Documenting best practices of BCP implementation
Reports of tracking commodity distribution and utilization
Referral tracking
7.2
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M & E Tools
Tally sheets and treatment registers in Comprehensive Care Centres
Community health workers diary/checklist showing activity done
by CHW and Peer educator
Ledger cards, inventory books and summary tools showing movement of BCP kits and requirement
Community referral books
Distribution register at Health facility to capture commodity movement
A Supervisory checklist for use by the district team and the CHEW
A rubber stamp/pad to identify those already registered for BCP (stamped on register and client card)
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8.0
SAFETY OF THE BCP KIT AND ITS CONTENTS
The BCP Kits are assembled centrally at a warehouse and delivered directly
to each health facility. The kit is packed with all contents mentioned on
section 2.2 of this booklet. The following must be adhered to, to ensure
the BCP kit reaches the intended recipient intact/complete.
1.
a)
b)
During packaging at the warehouse:
The contents packaged in each kit should be double checked to ensure the correct number of each component of the kit, has been
packed.
Upon confirmation that the kit contents are complete, the BCP kits are then sealed, ready for distribution.
2.
a)
b)
Receipt at the Health Facility:
Upon, delivery to a health facility, the receiving officer, (Facility in charge, CCC in-charge, or facility stores officer) must verify that
all kits are properly sealed and there is no sign of tampering.
A delivery note should be signed by the receiving officer indicating
receipt of goods in good order.
3.
a)
b)
c)
Storage of the BCP kits at the health facility:
The kits should be stored inside a secure lockable building/store to avoid theft of entire packages or pilferage of kit components.
The officer at the health facility in charge of the store must take the
responsibility of ensuring safe keeping of the kits, and be able to account for them whenever required.
At the end of the month, a physical stock count should be done by
the supervisor, which should be compared with the records on the
BCP register. Any discrepancies should be investigated immediately.
4.
a)
Preventing theft or pilferage
The above measures should prevent theft of the entire BCP kit from
the health facility or pilferage. Pilferage is the removal/theft of part of the contents of the BCP package. Sometimes it may also include the entire removal of contents and replacement with bogus products.
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b)
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It should be explained to all recipients of the kit that none of the kit
contents are for sale, and that they should only be used in their homes to help prevent opportunistic infections.
In the event that a BCP kit is pilfered, or contents found to have been sold, the following course of action should be applied:
In the event that an anomaly is noted in a BCP kit, the facility in-
charge must be notified immediately.
The relevant DASCO should be informed of the anomaly, and together with the rest of the DHMT members will investigate the matter and define the appropriate course of action to be taken. The DHMT may choose to involve the provincial administration, or
take action against the offending officer.
Contents of the BCP kit found to have been sold should be confiscated by the MOH officials in the specific region.
REFERENCES
Colindres, Mermin et al (2008) Utilization of a basic care and prevention
package by HIV infected persons in Uganda AIDS Care 20(2): 139-145
Gasasira AF, Kamya MR et al (2010) Effect of Trimethoprim
Sulphamethoxazole on the risk of Malaria in HIV infected Ugandan children living in an area of widespread antifolate resistance. Malaria Journal 9:177
Lengeler C (2004) Insecticide treated bed nets and curtains for preventing
malaria Cochrane Database System Review (2) CD000363
Lule J, Mermin J et al (2005) Effect of home based water chlorination and
safe storage on diarrhea among persons with HIV in Uganda.
Am J Trop Med Hyg 73 (5): 926-33
Kamya MR, Gasasira AF et al (2006) Effect of HIV infection on Malaria treatment outcomes in Uganda, A population based study JID 193: 9-15
KNBS (2010) Kenya Demographic and Health Survey 2008-09, Nairobi:
KNBS
MOMS&MOPHS-NASCOP (2009) Kenya AIDS Indicator Survey 2007
KAIS, Nairobi: NASCOP
MoSSP-NACC (2009).Kenya national AIDS Strategic plan 2009/10 – 2012/13: Delivering on universal access to services. Nairobi: NACC
Quick, Kimura et al (2002) Diarrhea prevention through household- level water disinfection and safe storage in Zambia Am J Trop Med Hyg 66(5) 584-589
27
ANNEXES
List of Workshop Participants
NAME ORGANIZATION
1.
Ayieko Carolyne Caren Ugunja Division–Ministry Of Health
2.
Dr. Ann Musuva
PSI/Kenya
3.
Elizabeth K. Nzau Port Reitz Hospital Mombasa
4.
Elizabeth Uyoma
NASCOP
5.
Evans Odhiambo
PSI/Kenya (Kisumu regional office)
6. Harrison O. Nyakako
Butere District Hospital
7
Josephine Kioli
NASCOP
8
Keziah R. Nzole
Msambweni District Hospital
9.
Lenet M. Bundi
NASCOP
10
Noni Mumba
PSI/Kenya (Coast regional office)
11
Patricia Macharia
NASCOP
12
Pauline Mwololo
NASCOP
13
Ruth Musyoki
NASCOP
14
Sylvance Osida
Malava Hospital
15
Vincent Ojiambo
PSI/Kenya (Western regional office)
16
Wafula W. Job
Butere District Hospital
28
NOTES
29
30