HPI Project Brief
Building the capacity of PLHIV networks for Policy Engagement
With technical support from HPI and funding from the Government of the United States of America through USAID, NEPHAK has been involved in Policy Analysis and Systems Strengthening (PAS) through training workshops on policy development and advocacy; and OVC care and psychosocial support for community based support groups and local networks of people living with and affected by HIV and AIDS in Transmara and Kajiado districts in the last seven (7) months. Working with community based PLHIV support groups 25 TOTs from each of the two districts were identified and trained in the following areas:

Community mobilization for policy development and advocacy for reduction of HIV related stigma and discrimination.

Community mobilization for HIV prevention, care and support.

Community based care givers training on HIV palliative care including tuberculosis

Care givers training on OVC care and psychosocial support.

After the TOT level residential training workshops in Transmara and Kajiado districts, it was now the turn for the TOTs to mobilize community members from the grassroots and train them on the 4 areas cited in 1-4 above. By the end of the
Project in January 2009, the rate of OVC receiving care and psychosocial support courtesy of the training supported by HPI had risen from 34% at the beginning of the project to 52%. Stigma and discrimination have also taken a beating with 10 members of PLHIV support groups and networks from the two districts giving their informed consent to enable NEPHAK to use their photographs on IEC materials for advocacy and communication.
NEPHAK has overshot the HPI targets of 400 community level participants in its grassroots training. The TOTs mobilized members of their various communities and conducted trainings in church halls, classrooms, under trees and in members’ homesteads. Facilitators were drawn from neighboring support groups with the host TOT acting as the training director in each case. The training involved 624 members of the community in the two districts. This grassroots training model is increasingly gaining popularity among PLHIV support groups and has had an empowering advantage since it has given the organizers and facilitators a feeling of responsibility and control. It has also enhanced GIPA among PLHIV groups in the two districts. In Transmara district alone, older OVC have benefited from a local scholarship through the liaison of one of the TOTs. So far 25 youths have undergone basic training in IT skills, thanks to the OVC care and psychosocial support training that opened new horizons for the support groups and their dependants.

Successes and set-backs of the TB Program

NEPHAK through funds from Global Fund round 5 held a 3-day national conference during which the burden of tuberculosis on people living with HIV/AIDS was highlighted.

Thereafter, NEPHAK conducted a training workshop involving 103 civic leaders and local administrators. The local administrators and civic leaders have expressed the need to form a network that would not only address their concerns about the two epidemics but also help them amplify NEPHAKs advocacy on TB/HIV.

The urgency to train a further 100 ambassadors was based on DLTLDs instructions that NEPHAK should have had two hundred Ambassadors and with that number, could reach the shared target of 1,200,000 school children with health talks on tuberculosis. NEPHAK promptly trained 100 more Ambassadors in mid 2008 to meet the new demand.

NEPHAK Ambassadors did their best and submitted prompt reports contributing to DLTLD overshooting its target on school health talks. (Compare 1,385,795 equivalent to 115% with the target number of 1,200,000 school children planned to be reached).

NEPHAK contributed significantly to the country’s overshooting of the WHO country target of 40% children who fluently speak on TB by contributing to the achievement of 72%.

NEPHAK participation and contribution to the number of NGOs nationally, who were expected to be implementing TB ACSM helped the country to overshoot the WHO country target of 32 by reaching 47 (146%) by the third quarter.

Long after DLTLD had asked NEPHAK to put the Ambassadors on hold, NEPHAK still receives calls indicating that many of the ambassadors are still rendering their voluntary service to the health facilities and TB patients without any allowances to date. This voluntarism demonstrates the interest and personal sacrifice and commitment that NEPHAK Ambassadors attach to their training and calling.

NEPHAK enjoys the support and cooperation of DTLC, NACC field Coordinators and CACC coordinators, civic and administration leaders; and local partners wherever it has community projects. The TB project is no exception.

NEPHAK has complied with DLTLD and E & Y instructions to do a compressed work plan putting activities of year 1 quarter 4 and year 2 and 3 together into year 3 work plans. This compressed work plan was done and submitted as required to DLTLD in the period Oct-Nov 2008.

A no-cost extension of the project that was communicated in July 2008 came a full seven (7) months after the TB Ambassadors had given their energies and time to participate in supervised tracking of treatment defaulters, intensive case finding in facilities with in-patients, and school health talks on tuberculosis as part of NEPHAK TB ACSM contribution to the national tuberculosis program.

The 100 TB ambassadors drawn from within 17 districts earlier mapped out before the start of the project worked for 7 months without receiving their monthly travel and communication allowances due to non-disbursements of quarter four (4) funds to NEPHAK by the Financial Management Agency. The Agency cited budget overruns occasioned by the delay in communicating the no-cost extension of activities to NEPHAK

The Devolved Network Concept
As currently constituted, the institution of NEPHAK has a representative board drawn from the provinces through a system in which delegates from districts elect their representatives to the board of NEPHAK. The regional representation has helped NEPHAK to achieve representative democracy at the National Delegates Conference (NDC) held every two years. However, the regional governance structure was never meant to be an implementation structure. It is instructive that NEPHAK as a national network is not a direct implementer of programs or projects but rather a network membership coordination mechanism, a resource mobilization organ, a capacity strengthening companion for its constituents and a representative voice of PLHIV at National level. NEPHAKs strength is in its country-wide grassroots reach via PLHIV support groups and post-test clubs. It is the support groups either singly or variously in their networks who are the end-users/implementers of NEPHAK programs. NEPHAK seeks to create a stronger institutional base by empowering PLHIV support groups at the two network levels. Up until recently, NEPHAK was not as strong at the base as would have been expected due to this structural weakness. Today, it is NEPHAKs position that stronger constituency and district level PLHIV networks would be NEPHAK point of contact with PLHIV groups and these in turn would form NEPHAK implementation structure. Precisely it would be NEPHAK constituent member networks drawn from support groups into location, constituency and district networks that would be NEPHAK face and feet on the ground.

It is reasoned that PLHIV groups are better off positioning themselves strategically as individual NGOs/CBOs but even better still as local networks to realize synergies in order to attract better funding prospects for their core activities.

To realize its objectives, NEPHAK has mobilized and formalized support groups into constituency and district-level networks. In Coast province alone, networks of people living with and affected by HIV have been formed in all the 13 districts namely Mombasa, Kilindini, Malindi, Kilifi, Kwale, Msambweni, Kinango, Tana River, Tana Delta, Lamu, Taita and Taveta, and 21 constituencies courtesy of APHIA Coast in through NEPHAK in close collaboration with WOFAK. In Nyanza, NEPHAK has worked in collaboration with APHIA Nyanza and AMREF to realize the formation of five (5) district namely Kisumu East, Homabay, Ndhiwa, Rongo and Rachuonyo; and seven (7) constituency level PLHIV networks. The following districts in Nyanza are currently the target of this initiative meant to cover at least 50% of Kenya’s 147 districts by 2010:
Rongo, Kisumu, HomaBay, Karachuonyo, Suba, Nyando, Bondo, Siaya and Kuria.

NEPHAK fully recognizes existing and well established networks like, COPE, Husiko la Pwani, KOCPHEN, LICASU Kenya and proposes to strengthen their capacities to deliver various target interventions. In South Rift region where NEPHAK had had over four years of engagement with PLHIV groups in Narok, Nakuru and lately Transmara and Kajiado districts, PLHIV networks are already in place in 2 districts namely Kajiado and Transmara but plans are underway to facilitate the formation of similar networks in Narok, Nakuru, Koibatek, Molo, Kericho, and Bomet districts.