Final Report for the
AIDSCAP Program in Kenya: Country Program Description

This report comprehensively summarizes the FHI/AIDSCAP program in Kenya (1992-1997). The report lists program accomplishments, constraints and outcomes, as well as supplying information on lessons learned and recommendations.

Implementation and Management Issues

1. Implementation

In the interim period between the AIDSTECH and AIDSCAP projects, four interventions and a rapid response fund were supported. Kenya became an AIDSCAP priority country program in September 1992. The AIDSCAP/Kenya office, located in the Chancery Building in Nairobi, was officially opened on February 10, 1994.

In February 1994, the program authorization document for the AIDSCAP Project was changed from a cooperative agreement to a contract. While the conversion required changes in a series of AIDSCAP's day-to-day operations at the headquarters level, none of the subagreements for the Kenya project were affected. Kenya's new contract Delivery Order was signed in September 1994, and AIDSCAP/Kenya implements projects under both the Cooperative Agreement and the contract.

Management and Administration

Human Resources

During the life of AIDSCAP, two different Resident Advisors (RA) served in Kenya. The RA supervised a two-member program team and five support staff including an accountant, administrative assistant, office assistant, driver and cleaner/messenger. The accountant, administrative assistant, driver and cleaner/messenger report both to the AIDSCAP and to the FHI Population Program. Office space is shared with the Africa Regional Office (AFRO) of AIDSCAP, and with the FHI Population Program.

The program team's staff members and areas of changed over the life of the project. Until 1995, other than the RA, program staff consisted of two program assistants. One of these assistants chose to leave AIDSCAP, the other was promoted to the position of Program Officer and a second program officer, whose specific duties include NGO coordination, was hired. Staff turnover at any level tends to cause disruptions in program implementation due to the need for orientation of the new staff members: as could have been expected, the turnover at AIDSCAP/Kenya caused temporary setbacks which were eventually overcome.

A mid-term evaluation of the entire AIDSCAP project found several cases where individual workloads appeared to be excessive, and the Kenya office had a minimum of program staff considering the demands of the country program.

The AIDSCAP/Kenya office emphasized human resource development, especially over the last 15-month period of the contract. Staff were encouraged to attend short training courses or conferences each year, if job demands permitted; each of the program and financial staff attended on average one course/conference per year. These included training in financial management of USAID projects (Resident Advisor and accountant); in NGO management from Social Impact, Virginia (Resident Advisor, program officers, accountant); in evaluation (evaluation officer, office assistant); and in proposal writing (office assistant).

Program Implementation Strategy

Twenty-seven subprojects were funded over the life of the project (1994 - 1997). AIDSCAP worked with implementing agencies on well-defined projects fitting into the agency's program mandate and target areas. AIDSCAP also funded a number of unsolicited proposals.

Several aspects of the AIDSCAP/Kenya plan were unusual. First, there was a strong emphasis on policy interventions. Second, no direct condom social marketing projects were included, since this activity was funded by USAID through a separate, pre-existing contract with Population Services International (PSI). Third, there was an interest in integrating HIV/AIDS into family planning activities, reflecting the Mission's lead role in supporting family planning intervention in Kenya since the 1970s. This aspect of the program was reflected in the integration of both HIV/AIDS prevention and counseling, and improved STD case management, into the clinics managed by Family Planning Private Sector. Fourth, there was an emphasis on working with the private sector, and on exploring cost issues related to sustainability at the national and implementing agency level.

In mid-1994, due a change in the nature of the agreement between USAID and FHI, a number of changes were made to the original plan. The secondary target groups which had been included (sex workers and out-of-school youth) were no longer addressed. This related to an increasing program emphasis on working through institutional structures (such as churches, worksites, and institutions of higher education) where target audiences were easier to reach and where the multiplier effect was likely to be greatest.

Other changes followed, some reflecting decisions by USAID/Kenya on how to best assign project responsibilities among the approximately 15 Cooperating Agencies working through USAID family planning and HIV/AIDS-related agreements. STD training interventions, which had been planned to target both private and public practitioners, were limited to the private sector, since a national training project was now underway through NASCOP. Research into issues of the national sustainability of AIDS projects was dropped, since this was included in the mandate of USAID's Health Care Financing Project. New activities were added: a program was begun with the churches to reach church leaders, pastors, and congregations; gender-related projects were developed; and a small study carried out into the issues of care and management.

A January 1996 AIDSCAP/Kenya Program Review stated that one major strength of the AIDSCAP/ Kenya program was the focus on governmental and non-governmental policy. Key success stories, according to the review, were in the areas of technical leadership, policy development and advocacy, and synergy in the use of inputs. The review noted AIDSCAP's ability to leverage outside resources and its activities in laying the cornerstones of institutional and financial sustainability. Other findings from the 1996 review were that AIDSCAP/Kenya had firmly established a regional reputation for its collaboration with other agencies to support Kenya's sentinel surveillance system and modeling of the impact of AIDS.

The program reviewers recommended that AIDSCAP programs focus on areas where AIDSCAP had unique or special expertise (in particular workplace, policy support and capacity-building activities) and give less focus on STD training and media activities. The review also recommended that AIDSCAP increase its emphasis on sustainability, increase the private sector response to the epidemic, and retain the focus on policy awareness and action.

Thus, 1996 marked the start of a transition to a new phase in the program with a greater emphasis on sustainability. AIDSCAP also expanded research on gender and AIDS issues through the funding of the female condom study and the mother/daughter communication needs assessment.

2. Capacity Building

Capacity building refers to outside interventions or inputs aimed at increasing the organizational and technical capacity of an agency. The capacity building component of the AIDSCAP project placed particular emphasis on building local technical capacity and improving the technical quality of the agencies' HIV/AIDS interventions. It was planned to provide technical assistance to expand the capacity of Kenyan program implementers to successfully design, implement and evaluate HIV/AIDS prevention programs with minimal outside technical assistance.

AIDSCAP's capacity building strategy included careful selection of implementing agencies with whom to work. The NGO and private sectors were of particular interest to AIDSCAP/Kenya and agencies capable of reaching and strengthening both sectors were selected. Agencies with existing project management skills and capabilities or those with a strong multiplier effect, such as the NGO AIDS Consortium, were also selected because of AIDSCAP's interest in concentrating on the quality and reach of HIV/AIDS interventions. However, a few smaller agencies, requiring more attention to basic institution building, such as Miujiza Theatre and AMSUNAAC, were selected as they met an important need or gap in HIV/AIDS programming.

Sustainability is linked to capacity building. Sustainability issues were particularly focused upon beginning in early 1996, when a "sustainability initiative" was put in place for selected implementing agencies. This participatory process involved developing a self-assessment questionnaire, in collaboration with the implementing agencies, that covered the political, institutional, and technical aspects of sustainability. A follow-on workshop, to review the results of these self-assessments, was held with implementing agencies in late 1996 (see the description of Sustainability activities in the subproject section for further details). The consensus was that, while the exercise was a valuable first step in addressing sustainability issues, much more needed to be done to define the meaning of sustainability and the extent to which it is a reasonable goal for any particular implementing agency. In addition to these activities, fiscal year 1997 saw a renewed attention to institutional building of the private sector, particularly aimed to increase the likelihood that worksite peer education programs would be continued after AIDSCAP support ended.

Specific capacity-building strategies strongly related to sustainability emphasized by AIDSCAP/Kenya included creation of demand for services provided by implementing agencies which were initially supported by AIDSCAP; and institutionalization and commercialization of activities.

Technical, Organizational and Management Skill Building

Technical assistance provided by consultants

AIDSCAP/Kenya provided implementing agencies with numerous consultants who gave advice and training in technical areas as well as project planning, implementation and evaluation.

The main approach used by AIDSCAP in providing assistance was to assign an individual and/or group of consultants to discrete agency projects who addressed technical, managerial, and organizational issues related to the project over time. There was usually a sustained relationship between the same consultant and agency, some of which is planned to continue after AIDSCAP funding ends. Some time-limited, discrete technical assistance was provided as necessary, e.g. interactive communication training to Miujiza Theatre Company. A list of the types of technical assistance and training provided to implementing agencies is provided below and in Attachment B.

Technical assistance by these consultants was preceded by thorough needs assessments. A prolonged, formal needs assessment was performed for the KANCO Resource Centre, for example. Field trips provided other opportunities for outside consultants to assess needs.

AIDSCAP has found that this strategy of sustained, expert technical assistance which addressed expressed needs was an extremely effective way to support projects. The approach allowed a high sense of mutual trust by both the consultant and the implementing agency, in which consultant and implementing agency interactions were characterized by a supportive and enabling relationship. Many implementing agency staff perceived this as well. A stakeholder evaluation carried out by the AIDSCAP Africa Regional Office in September 1996 reported that one implementing agency representative stated that "coordination with AIDSCAP is that of a supportive relationship, more of a partnership than a donor-grantee one. AIDSCAP worked from within and better understood our problems." Other agencies stated that one of AIDSCAP's strengths in technical assistance was the access provided to expert technical assistance both within and outside of AIDSCAP. Skills training for agency staff was perceived by implementing agencies as a motivating factor for their staff and subsequently contributed to their human resource development.

The following table summarizes the technical assistance given by consultants over the life of the project:

Technical assistance characteristic of the main approach of sustained relationships over time include Bill Rau's (Associate Director, Policy Unit, AIDSCAP/HQ) support to KANCO and MAP on their policy projects; Richard Steen's (STD Officer, AIDSCAP/AFRO) continual support to FPPS and Moi University for their STD Training projects; AHRTAG's ongoing support to KANCO for the Resource Centre Project; Paul Newton's ongoing support to NASCOP to strengthen their HIV sentinel surveillance and the AIDSCAP Behavioral Research Unit and University of California/San Francisco's support to KAPC for the Counseling and Testing Study.