USAID FAHARI YA

JAMII

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1st April – 30th June 2022

Disclaimer: This document was produced for review by the United States Agency for International Development Kenya Mission (USAID/
[Kenya]). The authors’ views expressed in this report do not necessarily reflect the views of USAID Kenya/East Africa

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 USAID Fahari ya Jamii
Program Summary

Program Title USAID Fahari ya Jamii

Sponsoring USAID Office: 1.

2. USAID Kenya/East Africa
3. Cooperative Agreement Award Number: 4. 72061521CA00014

5. Awardee/Implementing Partner: 6. University of Nairobi

Date of Submission: 7. 31st July 2022

Author: The University of Nairobi
8. Name of subcontractors/sub-awardees Savannah informatics limited
9. Health area focus SP1, SP2, SP4, SP5
10. Geographical coverage Nairobi and Kajiado Counties

Prepared for
Dr. Teresa Simiyu
The Agreement Officer Representative
United States Agency for International Development/Kenya and East Africa
C/O American Embassy
United Nations Avenue, Gigiri
P.O. Box 629, Village Market 00621
Nairobi, Kenya

Prepared by
The University of Nairobi
School of Medicine
USAID Fahari ya Jamii Program
P.O. Box 30197-00100,
Phone: (+254) 020-4910000
Nairobi, Kenya

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Table Of Contents

Contents
Table Of Contents................................................................................................................................................iii
Executive Summary..............................................................................................................................................1
Program Administration........................................................................................................................................2
Next Quarter’s Work Plan.....................................................................................................................................2
Introduction...........................................................................................................................................................3
Background.......................................................................................................................................................3
Activity Progress (Quantitative)............................................................................................................................3
1. Sub-Purpose 1: Increased Access and Demand for Quality HIV Prevention Services..................................3
1.2 Increased Uptake of Targeted HIV Testing Services (HTS)........................................................................4
1.3: Increased linkage of identified HIV-positive individuals to treatment services..........................................6
2. Increased Access and Demand for Quality HIV Treatment Services............................................................6
2.1 Increased Access and Demand for Quality Prevention of Mother to Child Transmission (PMTCT)
Services.........................................................................................................................................................6
2.2 Increased Access and Demand for Quality ART Services...........................................................................8
2.6 Increased Viral Load Coverage and Attainment of Viral Suppression for all Patients on Treatment........10
2.7 Increased Utilization of TB/HIV Collaborative Services...........................................................................11
2.9. Increased Uptake of Quality HIV treatment Services: Population Specific Efforts..............................12
2.10. Increased Reporting and Prevention of Sexual and Gender-Based Violence (SGBV)........................12
4. Increased Access and Demand for Quality Family Planning, Reproductive Maternal New-born Child and
Adolescent Health, Nutrition, and Water and Sanitation Services.......................................................................12
4.1 Increased Availability and Delivery of Quality FP/RMNCAH, WASH Services......................................12
4.2 Strengthened Delivery and uptake of FP/RMNCAH, WASH Services at Health Facilities, Including
Referral from Lower-Level Facilities and Communities.................................................................................14
4.3: Water Sanitation and Hygiene (WASH....................................................................................................15
5. Strengthened Capacity of County Health Systems, Local Partners, and Communities to Deliver Quality
Health Services...................................................................................................................................................16
5.1.1. Pharmacy Health Systems Strengthening..............................................................................................16
5.1.2 Strengthened Human Resources for Health systems to provide quality health services.....................18
5.1.3 Strengthened capacity for financing and accountability of county health services.............................18
5.1.4 Increased coordination and provision of laboratory services to support quality of care......................18
5.2: Strengthened Case-based surveillance, public health response, and quality improvement...................22
5:4 Strengthened engagement of the community in the delivery of quality health service..............................22
Constraints and Opportunities.............................................................................................................................23
Challenges...........................................................................................................................................................23

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Performance Monitoring.....................................................................................................................................23
Progress On Gender Strategy..............................................................................................................................24
Progress On Environmental Mitigation...............................................................................................................24
Progress On Links with Other USAID Programs................................................................................................24
Progress On Links with GoK Agencies...............................................................................................................25
Progress On Journey to Self-Reliance.................................................................................................................25
Subsequent Quarters Work Plan..........................................................................................................................25
See separate attachment......................................................................................................................................25
Activity Administration.......................................................................................................................................25
Financial Information............................................................................................................................................1

List of Acronyms

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ADT ART DISPENSING TOOL

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AGYW Adolescent Girls and Young women
AHD Advanced HIV Disease
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal Care
APHRC African Population & Health Research Center
APNS Assisted Partner Notification Services
APR Annual Progress Report
AOR Agreement Officer Representative
ART Antiretroviral Treatment/Therapy
ARV Antiretroviral
AWP Annual Work plan
AYP Adolescents and Young People
AYSRH Adolescents and Young People Sexual Reproductive Health
CBS Case-based Surveillance
CCC Comprehensive Care Center
VL Viral Load
EID Early Infant Diagnosis
DBS Dried Blood Spot
CHAI Clinton Health Initiative
CHMT County Health Management Team
CHS Center for Health Solutions
CHV Community Health Volunteer
CHW Community Health Worker
CLA Collaborative Learning and Adaptation
CLHIV Children Living with HIV
CLTS Community-Led Total Sanitation
CME Continuous Medical Education
CMLC County Medical Laboratory Coordinator
COE Center of Excellence
COP Country Operational Plan
COT Continuity of Treatment
COVID 19 Coronavirus Disease-19
CPMIS Children Protection Information Management System
CPR Contraceptive Prevalence rate
CQI Continuous Quality Improvement
CSO Civil Society Organization
CTLC County Tuberculosis and Leprosy Coordinator
CWC Child Wellness Clinic
DCM Differentiated Care Model
DHIS District Health Information System
DIC Drop-in Centers

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DQA Data Quality Audits
DREAMS Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe
DTG Dolutegravir
EID Early Infant Diagnosis
EMONC Emergency Maternal Obstetric and Newborn Care 
EMR Electronic Medical Records
HRH Human Resource for Health
HTS HIV Testing and Counselling Service
HVF High Volume Facility
HVL High Viral Load
ICAP International Center for AIDS Care and Treatment Program
ICF Intensive Case Finding
ICT Information’s Communications and Technology
IEC Information Education and Counselling
IGA Income Generating Activity
IIT Interruption in Treatment
IMNCI Integrated Management of Newborn and Childhood Infections
IP Implementing Partner
IPC Infection Prevention and Control
IPT Isoniazid Preventive Therapy
IPV Intimate Partner Violence
IRC International Rescue Committee
KAIS Kenya AIDS Indicator Survey
KASF Kenya AIDS Strategic Framework
KDHS Kenya Demographic Health Survey
KEA Kenya and East Africa
KHPQS Kenya Health Partnerships for Quality Services
KP Key Populations
KPLHIV Key Population Living with HIV
LHIV Living with HIV
LIVES Listen Inquire Validate Enhance Safety and Support
LVCT Liverpool VCT
M4MXM Men for men by men
MCH Maternal Child Health
MDT Multidisciplinary Team 
MEL Monitoring Evaluation and Learning
MMD Multi-month Dispensing
MMR Measles Mumps and Rubella
MNCAH Maternal Newborn, child, and adolescent health
MNCH Maternal Newborn and child health
MNH Maternal and Newborn Health

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MOH Ministry of Health
MOU Memorandum of Understanding
MPDSR Maternal Perinatal Death Surveillance and Response
MSM Men having sex with men
MSW Male Sex Workers
MTCT Mother-to-child Transmission
NACS Nutritional Assessment and counseling
NASCOP National AIDS and STIs Control Programme
NB Newborn
NGO Non-Governmental Organization
NHRL National HIV Reference Lab
NMS Nairobi Metropolitan Services
NTRL National Tuberculosis Reference Laboratory
NPHLS National Public Health Laboratories Services
ODF Open Defecation-free
OI Opportunistic Infection
OJT On-the-job Training
OPD Outpatient Department
ORT Oral Rehydration Therapy
OTZ Operation Triple Zero 
OVC Orphaned and Vulnerable children
PAC Post-abortal Care
PCR Polymerase Chain Reaction
PEP Post-Exposure Prophylaxis
PEPFAR The U.S President’s Emergency Plan for AIDS Relief
PHO Public Health Officer
PLHIV Person Living With HIV
PLHIV people living with HIV
PMTCT Prevention of Mother-to-child Transmission
PNC Post-natal Care
PNS Partner notification services
PPE Personal Protective Equipment
PPFP Post-partum Family Planning
PRC Post-rape Care
PT Proficiency Testing
QI Quality Improvement
RDQA Routine Data quality audits
RH Reproductive Health
RMNCAH Reproductive, maternal newborn, child, and adolescent health
RNR Risk network Referral
RRI Rapid Result Initiative

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RTKS Rapid Test Kits
RTT Return to Treatment
RUSF Ready-to-use Supplementary Food
RUTF Ready-to-use Therapeutic Food
SBA Skilled Birth Attendance
SBCC Social Behavior Change and Communication
SCASCO Sub County AIDS and STI Coordinator
SCH   Sub County Hospital
SCHMT Sub County Health Management Team
SCP Sub County Pharmacist
SCTLC Sub County Tuberculosis and Leprosy Coordinator
SDG Sustainable Development Goals
SGBV Sexual Gender-based violence
SHOFCO Shining Hope for Communities
SI Strategic Information
SIL Savannah Informatics Limited
SIMS Site Improvement Through Monitoring Systems
SMT Senior Management Teams
SNR Social Network Referral
SOP Standard Operating Procedure
SS Supportive Supervision
STC Special Treatment Centre
STI Sexually Transmitted Infections
TA Technical Assistance
TAT Turn-around Time
TB Tuberculosis
TLD Tenofovir+Lamivudine+Dolutelgravir
TO Transfer out
TOT Trainer of Trainees
TPA Treatment Preparation and Adherence
TPT Tuberculosis Preventive Therapy
TWG Technical working Group
U5 Under five
UCLTS Urban Community-led Total Sanitation
UNAIDS United Nations programme on HIV/AIDS
UNICEF United Nations Children’s Fund
USAID United States Agency for international Developmental 
VIA Visual Inspection with acetic acid
VL Viral Load
VMMC Voluntary Male Medical Circumcision
WASH Water, Sanitation, and Hygiene

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WFP World Food Program
WHO World Health Organization
WIT Work Improvement Team
WLHIV Women Living with HIV

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Executive Summary
The United States Agency for International Development (USAID)/Kenya and East Africa awarded the
University of Nairobi (UoN) through its School of Medicine (UONSOM), a five-year cooperative
agreement activity – USAID Fahari ya Jamii on April 23, 2021. It is a collaborative program between the
University of Nairobi and the County governments of Nairobi and Kajiado to improve county-level
institutional capacity and health service delivery. The project aims to increase equitable access and
quality county-led health services in Nairobi and Kajiado Counties.

The project’s scope of work includes HIV prevention, HIV care and treatment, Reproductive, Maternal,
Newborn, Child, and Adolescent Health (RMNCAH), Water Sanitation and Hygiene (WASH) services,
and Health Systems Strengthening (HSS). In Q2 of FY 22, the project focused on a thoughtful, data-
driven implementation approach to ensure precision in programming, employing adaptive programming
for people-centered and evidence-based approaches, emphasizing urgency and fidelity in implementation.

The pivot was on patient-level monitoring to strengthen individual follow-up and population-specific
strategies. This enabled ongoing learning and coaching of technical staff (program- and facility-level) for
improvement. Contingency plans were developed to address anticipated service interruptions related to
the country’s general elections, including front-loading several targets and accelerating timelines for
implementation.

Sub-Purpose 1: Increased Access and Demand for Quality HIV Prevention Services

In FY22Q3, USAID Fahari ya Jamii reached 28 % (277/1002) of clients aged 15 years and older
through VMMC interventions, including a minimum package comprising sexually transmitted
infection (STI) screening and treatment, HIV testing services (HTS), condom distribution, risk
reduction counseling, and eventually circumcision. This achievement increased over FY22
SAPR where the project reached 122 clients aged 15 and over through VMMC interventions.
As at SAPR, the project had reached 111% (1118/1002) of clients through VMMC
interventions, against a target of 1002, translating to 151 % of the annual target.

During this period, USAID Fahari ya Jamii tested 16% (47,285/294,008) clients for HIV and identified
21% (1,422/6668) individuals with new HIV infection (a yield of 3%). In FY22 Q2, USAID FYJ tested
19% (57,444/294008) individuals and identified 25% (1,693/6668) new infections (yield of 2.9%).
Although the number of newly diagnosed clients decreased in FY22 Q3 compared to F2 Y2Q2, the yield
was higher in FY22 Q3 compared to Q2.

Sub-Purpose 2: Increased Access and Demand for Quality HIV Treatment Services

In FY22Q3, USAID Fahari ya Jamii reported a Tx current of 64,259 (98.4% achievement against targets).
Compared to the Tx current reported in Q2 (63,538), this is an increase in the treatment cohort by 721
patients. Females account for 66.7% of all the active patients on treatment with males accounting for only
33.3%. In Q3, MMD coverage was a key priority; by the end of the quarter, 74.4% of the Tx Curr were
on MMD > 3 months. 25.6% of the (16,428/64259) patients were receiving <3 months ART dispensation
compared to 25.7% in Q2; 58.6% (37,677/64259) received ART dispensation of 3 - 5 Months, a drop
from 63% reported in Q2, and 15.8% (10,154/64259) received 6+ Months of ART, an improvement from
12% reported in Q2.

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Sub-Purpose 4: Reproductive Maternal New-born Child and Adolescent Health, Nutrition and Water
and Sanitation Services

USAID Fahari ya Jamii worked closely with the NMS health team to reach 123077 women with ANC
services achieving 78% of the annual target (123077/ 158009). 72142 were reached with ANC 4 services
achieving 69% of the annual performance 72142/104252). In the service provision and reporting for PNC
services provided within 48 hours, they have achieved 45% (.71304/158009). For child health services,
70%(98411/139864)of children were fully Immunized by 1 year of the annual target while 145%
(348670/239604) of the Family planning target in terms of couple years of protection.

In Q3 the project identified gaps in sanitation and hygiene facilities in high-volume facilities including
Mbagathi Hospital, Kangemi HC, Mama Lucy Hospital, and Dandora II Health Centre. In Q4 the project
will support improvement of the 4 facilities focusing on the sanitary facilities.

Sub-Purpose 5: Strengthened Health Systems for Commodity Security Management, HRH, Health
Financing, Laboratory Quality Systems, Quality Assurance, and Information Systems

In Y2Q3 USAID Fahari ya Jamii continued to strengthen county health systems for Human Resources
for Health (HRH) in Nairobi and Kajiado counties to facilitate ongoing service delivery at the facility
level. The project supported 383 technical and 400 lay staff during the quarter to support quality service
provision in project-supported facilities in Nairobi and Kajiado counties. In Q2 of FY 22, 770 USAID
FYJ supported facility level HRH, 589 in Nairobi, and 181 in Kajiado to support the delivery of quality
services.

Implementation of the internal system that mirrors DATIM was a key milestone for the program during
this reporting period. As a follow up to the Kenyan National Recency Surveillance Dashboard rollout on
February 24, 2022, the project activated 9 facilities to cover HTS recency testing.

Program Administration
During the year, no significant constraints or critical issues were encountered within the program
administration process.

Next Quarter’s Work Plan

FY22Q4 being the electioneering period, in Q3 USAID Fahari ya Jamii jointly, with the respective
counties, developed and discussed a contingency plan to minimize disruption of services. The project
focused on frontloading of targets to compensate for the short implementation period anticipated in Q4.
The election preparedness plan significantly addresses client-centered approaches to possible HIV
prevention and interruption of treatment services. These include, but are not limited to:
 Multi-Month Dispensing (MMD) of medications including Antiretroviral therapy (ART) Pre-
exposure prophylaxis (PrEP) and anti-TB drugs
 Community distribution of lubricants, condoms, HIV self-test kits, ART, PrEP, TB preventive
therapy (TPT), and Anti-TB medications among others
 Use of online platforms for monitoring and reporting
 Strengthened health messaging especially around gender-based violence (GBV) reporting
 Introduction of hotline numbers to clients for support

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Introduction
Background

USAID Fahari ya Jamii is a collaborative program of the University of Nairobi (implemented through the
School of Medicine) as the prime partner, the county governments of Nairobi and Kajiado (cluster 2), and
Savannah Informatics as the sub-awardee. The program collaborates with other faith-based and local
service delivery partners and community-based organizations. It aims to strengthen Nairobi and Kajiado
Counties’ institutional and management capacities to improve and increase access and utilization of
quality health services. Below are the key highlights of interventions implemented in FY2022 Q3 (April –
June) across the four components.

Activity Progress (Quantitative)

1. Sub-Purpose 1: Increased Access and Demand for Quality HIV
Prevention Services
1.1 Increased Access and Demand to Targeted HIV Prevention Services among Key Population,
AGYW, and Men

Voluntary Medical Male Circumcision (VMMC): Nairobi

In FY22Q3, USAID Fahari ya Jamii reached 28 % (277/1002) of clients aged 15 years and older through
VMMC interventions, including a minimum package comprising sexually transmitted infection (STI)
screening and treatment, HIV testing services (HTS), condom distribution, risk reduction counseling, and
eventually circumcision. This was an increase from FY22 SAPR where
the project reached 122 clients aged 15 and over through VMMC
interventions. By SAPR, the project had reached 111% (1118/1002) of
111% clients
reached through VMMC
clients through VMMC interventions, against a target of 1002, interventions
translating to 151 % of the annual target.

Cumulatively USAID FYJ has reached 1,517 clients through VMMC

interventions against 1,002, translating to 151 % of the annual target. The achievement was possible
through focusing on patients’ sources from the previous reporting period and weekly monitoring of
facility performance. Through SURGE 2.0 pivots the teams managed to improve on reaching the older
males 20 years plus from 12% previous quarter to 26 %. Patients' follow-up included physical follow-up
after 7-14 days postoperatively at the facility and phone contact for clients who failed to physically return
to the clinic, ensuring 97% follow-up rates, with 0 adverse events reported during the reporting period.

During the reporting period, the emphasis was on reaching the older males 20 years and above with 25%
(69/277) of clients reached in this age group as compared to 12% (132/1118) reached in the previous
quarter. Efforts to integrate PrEP into VMMC to achieve combination prevention for clients identified
HIV negative improved this quarter with the 3 sites having integrated PrEP in the VMMC room. Priorities
for Q4 will include referral for other preventive services for clients identified HIV negative and close
monitoring of Adverse events for clients who receive circumcision.

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 Key populations (KP) - Nairobi
In FY22Q3, USAID Fahari ya Jamii continued to support KP prevention
implementation cumulatively achieving 121 % (9535/7873) against the annual
target.

Behavioral component: 112 peer educators (72 FSW & 40 MSM/MSW) were engaged to
support the validation of hotspots in the community. Peer outreach programs focused on delivering
information, education, and communication (IEC) materials to the hard-to-reach KP. Best practices
including Focused group discussions (FGDs), sensitization of PrEP champions and procurement of pill
boxes were implemented to improve PrEP uptake including improving reporting for Sexual based
violence (SGBV). Rapid result initiative (RRI) to reach the unreached key population
including high-end MSM was conducted to scale uptake of KP prevention services
through distribution of HIV self-test kits by the peer educators at the community level.

Biomedical Component: HIV case finding strategies including eligibility screening,

social/risk network, and referrals (SNR/RnR) implemented to reach the hard-to-find
populations identifying 44 new positives. The project continues to provide care, support, and treatment to
1,211 key populations living with HIV (KPLHIV) at both DICs. This is a drop from 1216 reported in Q2.
BHESP DIC has been able to reach 7% (649/745) of their eligible population of women of reproductive
(WRA) with cervical screening services. Interventions for KPs abusing substances and alcohol also were
supported with 25 KPs reached with counseling in the reporting period.

Structural component: Sexual and gender-based violence reported improved during this quarter with 77
cases reported up from 8 cases reported in Q2. Peer educators, outreach workers & the clinical team on
screening and identification of SGBV including FGDs to demystify myths. County and sub-county level
support continued with the participation of Fahari ya Jamii in the county technical working group (TWG)
to promote partner coordination in Nairobi metropolitan services.

1.2 Increased Uptake of Targeted HIV Testing Services (HTS)

In FY 22 Q3, USAID Fahari ya Jamii continued working jointly with the Nairobi
Metropolitan Services (NMS) and Kajiado County to provide targeted cost-effective and
high yielding modalities while focusing on improving testing coverage, yield, and testing
efficiency. This was achieved through the following:

Increase uptake of HIV Self Testing: In FY22Q3, USAID Fahari ya Jamii continued implementing
HIVST in line with the national guidelines. Demand creation for HIVST was created through health talks,
one on one counseling, and the use of IEC materials. A total of 4,497 HIVST kits were distributed, out of
which 4,009 reported results. Of the reported results 36 had a positive result, out of which 36 were
confirmed as positive, with 34 being linked to treatment.
As at SAPR, the project had distributed 7,602 HIVST kits, out of which 5553 brought back results. Out of
the reported results, 40 had a positive result which was confirmed as people the HIVST guidelines. In
addition, the project worked with Gertrude’s Githogoro to conduct community distribution of HIVST kits
targeting men, reaching 36 men. Eligibility screening and IPV screening was done before kit issuance,
with the follow-up being done within 48 hours.

Targeted HTS for the general population: Risk based eligibility screening using the
Kobo Collect platform, index testing and aPNS to ensure targeted testing continued
being implemented, reaching 35,068 with HIV testing services and identified 1,067
HIV positive individual, out of which 990 were linked (93% linkage rate) in NMS

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and 11,271 with HIV testing services and identified 355 HIV positive individual, out of which 343 were
linked (97% linkage rate) in Kajiado. “Red carpet” Services targeting men were also scaled up to
Kangemi HC, Mukuru MMM, Kayole 2 and Mama Lucy, and reached 386 men during the quarter, out of
which 14 were diagnosed as HIV positive (4.9% yield). Men were also reached through flexi hour
services being done in Ongata Rongai SCH, Ngong SCH, Bisil HC and Kajiado CRH reaching 79 men.
Targeted community testing (targeting Maasai Morans in Oltepesi, Kajiado County) reached 83 Morans
with testing services, out of which 4 were diagnosed as HIV positive. Mentorship and OJT on quality
HTS continued being provided to the HTS providers, eligibility screeners and aPNS champions during the
reporting period.

Index Testing and HIV Case Based Surveillance: USAID Fahari ya Jamii continued implementing safe
and ethical index testing in 72 project supported facilities in line with the set guidelines. The elicitation
rate during this period was 1: 2.1 (1:2.3 in Nairobi and 1:1.6 in Kajiado), the testing rate was 65% (64%
in Nairobi and 76% in Kajiado) with a yield of 16.3% (15.5% in Nairobi and 20.7% in Kajiado). IPV
screening with appropriate referrals continued being done before offering index testing to mitigate against
IPV. The project also supported the capacity building of HTS providers through refresher training, OJT,
and mentorship to ensure implementation of safe and ethical index testing. Physical tracing and aPNS
follow up was done in 6 facilities during the quarter.

Recency surveillance continued in 14 facilities, reaching 150 newly diagnosed HIV positive individuals
who were enrolled in the Recency surveillance. Out of these enrolled, 15 were confirmed as having a
recent HIV infection. A refresher training was done for 10 facilities in NMS with the aim of streamlining
HIV recency surveillance implementation. An additional 10 facilities were trained in the quarter, with site
activations continuing until the next quarter. The site activations have been negatively affected by the
unavailability of the National team. The scale up plans will continue in the next quarter targeting to reach
10 additional facilities.

Scale up PrEP Uptake: n FY22Q3, USAID Fahari ya Jamii supported PrEP

implementation in 69 project facilities reaching 39% (1,397/3,527) new clients on
PrEP services. Of these, 26% (368/1397) were males while 74% (1,029/1397) were
females. Cumulatively, the project has initiated 3,962 clients at risk on PrEP,
translating to 112% against the annual target. The project scaled up PrEP integration
in the MCH through provision of targeted facility support, sensitizations, On the Job
Training (OJT) and mentorship, through which the project managed to initiate 223 PBFWs on PrEP, an
increase from FY22 Q2 in which 38 PBFWs were initiated on PrEP Focused Group Discussions (FGD)
were done in 4 project facilities, to understand the reasons clients decline PrEP The major reasons
highlighted included dislike for drugs, Monogamy, perceived low risk, fear of repatriation by partner and
preference for other preventive methods including condoms. Clients also cited a preference for condoms,
fear of side effects, and concerns about pill burden. Those initiated on PrEP were tracked and monitored
throughout their treatment period. USAID FYJ provided mentorship on commodity management and
service provision to healthcare workers (HCWs) throughout the quarter to ensure uninterrupted service
provision.

Quality assurance and improvement: USAID Fahari Ya Jamii continued supporting QA/QC activities
through PT enrollment, Counselor support supervision, observed practice as well as joint support
supervision.

1.3: Increased linkage of identified HIV positive individuals to treatment services

In Q3 of FY 22 USAID Fahari ya Jamii supported the linkage of 1,298 out of the 1,419 newly diagnosed
HIV positive clients in project supported facilities and a further 26 to care outside facilities, giving a total

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linkage of 93%. Newly diagnosed clients were escorted physically to the CCC for enrollment into care by
the HTS providers, Treatment Preparation and Adherence (TPA) counselors and peer educators. Those
opting for enrollment in other facilities were referred using the facility directory and referral forms and
were followed up to ensure complete linkage.

2. Increased Access and Demand for Quality HIV Treatment

Services

2.1 Increased Access and Demand for Quality Prevention of Mother to Child Transmission
(PMTCT) Services

In Q3 of FY 22 USAID Fahari ya Jamii project continued to prioritize HIV testing services for
ANC 1 clients, 100% of those identified positive are initiated on ART and stay in care, and
their infants receive timely growth monitoring and testing services and stay in care for the 24
months of follow up. This was achieved through case management for all PMTCT clients,
weekly facility and program performance review, physical tracing, home visits, peer
education, and psychosocial support by mentor mothers. Leveraging on CHVs supported
through SP4 to provide messaging and referral at the community level for timely ANC
attendance, *** clients were referred for ANC 1 from 17 facilities where CHVs are supported.
In collaboration with Kajiado County, a PMTCT HEI Audit was conducted for 10 infants
confirmed HIV positive in Kajiado. Findings from this audit will be used to improve service delivery for
PMTCT clients and their infants.
Routine HIV and syphilis testing: In Q3 of FY22, USAID Fahari ya Jamii, in collaboration with the NMS
and Kajiado counties, reached 16,249 pregnant women with testing services out of 19,944 new antenatal
care (ANC) clients (91 percent testing coverage). Cumulatively, by the end of quarter 3 USAID FYJ
reached 67% of pregnant women (54,031/60,861) of the annual target with testing services. USAID FYJ
accomplished this by integrating HIV testing into antenatal settings and deploying HTS counselors in
high-volume health institutions. Additionally, mentor moms and CHVs have continued to educate and
teach clients on the necessity and advantages of HIV testing during pregnancy, ensuring
that USAID FYJ sustained success in this area. In the months of May and June 2022, test
kit shortages in both counties resulted in clients missing HIV testing as part of the 1st
visit antenatal care package. 11,212 of 12,446 clients (90 percent) in Nairobi were
tested, while Kajiado County only tested 5,037 of 7,498 clients (67 percent).
Throughout Q3, facility employees continued to monitor line lists to guarantee that
clients receive testing services on subsequent antenatal care visits.
Immediate ART for PMTCT clients: In the Q3 of FY22, USAID FYJ reached 557 (98% initiation rate)
women out of 563 HIV positive women with ART services. Of the women identified as HIV positive in
Nairobi County, 6 declined treatments. Cumulatively, by the end of Q3, USAID FYJ supported the
initiation of 1879 (98.7%initiation rate) out of 1902, translating to 46%
achievement against the annual targets. The missed opportunities for
testing at ANC 1 due to the shortages experienced with RTKs
contributed mainly to the underachievement of this target. A case
98% initiation
management approach is being implemented by EMTCT nurses and reached
mentor mothers engaged through USAID FYJ to ensure that the 6
clients who declined treatment in FY22 Q3 are supported to initiate treatment within the coming months.
Early infant diagnosis and follow up: In Q3 of FY 22, USAID Fahari ya Jamii tested 337
HIV-exposed infants, with 104 (30 percent) receiving their first test before two months.

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Cumulatively by the end q3 , USAID FYJ had provided testing services to 1987 HIV-exposed infants
achieving 51% (1987/3916) of the annual objective. USAID FYJ continued to perform dismally in this
area due to encountered difficulties acquiring PCR commodities from National mechanisms, which
contributed to the delay in infant testing. USAID FYJ collaborates with HCWs in supported facilities to
maintain a constant list of untested children to expedite their testing.
USAID Fahari ya Jamii identified 7 infants as HIV positive in Q3 of FY22 at a positivity rate of 2.07%
(7/337). Kajiado county identified 2 HIV-positive infants, and 5 were identified in Nairobi. 6 infants were
initiated into therapy in the supported clinics, while 1 infant is still on follow up. A case management
approach is being utilized to ensure that the infant is initiated into ART. In addition, a county wide HIV
positive audit exercise was conducted for 10 infants identified positive between October 21 and March 22
in Kajiado. Audit findings show that treatment interruption and adolescent girls under the age of 19 who
do not attend ANC clinic account for over 80% of all transmissions. The USAID Fahari ya Jamii project
in partnership with the Kajiado County will collaborate community partners to provide education and
create demand for ANC services even for pregnant adolescents. The project will also strengthen COT of
care strategies for PMTCT clients to include MMD, Community ART distribution and decentralized ART
sites to ease on clinic attendance pressure.

Treatment Continuity and adherence to ART treatment for PMTCT clients

The program working with sub county teams supported OJT and mentorship to build nurses
and clinical officers' capacity to monitor viral suppression and ensure mothers stay on
treatment. At the end of the quarter clients in different ART cohorts in Nairobi had reported
a high VL suppression of 95% in Nairobi and 94% suppression in Kajiado. The project also
prioritized scaling up of community ART groups for pregnant and breastfeeding women
and multi month dispensing for PMTCT clients. 15 groups were formed in Nairobi.
Mentor Mothers continued to provide peer education and psychosocial support to
PMTCT clients to improve the mother-baby pair retention in the eMTCT cascade, in line
with the national strategy. The program retained 94% of PMTCT clients in one year in Nairobi and 91%
in Kajiado (measured during January – March Maternal cohort analysis). The project trained facility
project nurses, sub county health management teams on PMTCT/OVC integration services as part of
reducing losses for PMTCT clients and their babies.

2.2 Increased Access and Demand for Quality ART Services

In FY2022 Q3, USAID Fahari ya Jamii identified 1401 clients with HIV infection. This is 69%
(4423/6384) achievement against the annual target, a drop from the previous quarter’s achievement of
1571. Of these, 358 were identified in Kajiado while 1043 were identified in Nairobi). 3.9% (55/1401)
were below 15years and 96.1% (1346/1401) were above 15years. The dip in the achievement Q3 was
attributed to the RTK stock outs experienced especially in the months of May and June.
The technical teams continued to strengthen linkage for the newly identified
HIV positive clients in both counties and managed to enroll and initiate on
93% newly treatment 93% (1324/1422). In collaboration with both counties, the
enrolled project continued to support strategies to increase access and demand for
ART services. These included same day ART initiation, treatment
preparation and literacy for new clients, psychosocial support group (PSSG)
meetings and case management for all new clients.

The project reported a Tx current of 64,259 (98.4% achievement against targets). Compared to the Tx
current reported in Q2 (63,538), this is an increase in the treatment cohort by 721 patients. Females
account for 66.7% of all the active patients on treatment with males accounting for only 33.3%. In Q3,

7
MMD coverage was a key priority; by the end of the quarter, 74.4% of the Tx Curr were on MMD > 3
months. 25.6% of the (16,428/64259) patients were receiving <3 months ART dispensation compared to
25.7% in Q2; 58.6% (37,677/64259) received ART dispensation of 3 - 5 Months, a drop from 63%
reported in Q2, and 15.8% (10,154/64259) received 6+ Months of ART, an improvement from 12%
reported in Q2.

In Q4 the project will follow up on the line lists of adults and children eligible for optimization and ensure
that they are optimized. The project will also strengthen case management approaches to reduce
interruption in treatment. M-health health solutions via Ushauri platform will be scaled up to support
continuity of treatment.

Differentiated Service Delivery (DSD): In Q3, A total of 47814 clients (36693 in Nairobi and 11,121 in
Kajiado) were on MMD 3-5Months and 6+Months which translates to 74% of the treatment current.
To provide patient centered services, FYJ continued to support the implementation of the various forms
of DSD in the two counties. The distribution of the various forms of DSD across the sites is as per the
table below.
DSD Model No. of clients
MMD3-5 Months 37,677
MMD 6+ Months including express services 10,154
Community ART Groups (CAGs)-Peer led 104
Community ART Groups CAGss)-HCW led 87
Differentiated Drug Distribution-community and 127
designated distribution points
Facility-based ART distribution 538

In Q4 the project will support full-scale DSD rollout and implementation through the dissemination of
standard operating procedures for institutionalization.

Continuity on Treatment: In FY22 Q3, USAID Fahari ya Jamii reported an overall patient loss of 2.6%
(1678/63538) with a net gain of 721, a drop from Q2 where we had a net gain of 1023. Significant
proportion of the losses were attributed to treatment interruptions (1.56% (994/63538)) and transfer outs
(0.9% (566/63538)).
Interruption in treatment (IIT): Interruption in treatment (IIT) remains the most predominant cause of
losses at USAID FYJ, with 1043 (312 males and 543 females) reporting IIT within the quarter, up from
855 in Q2 of FY22. The age disaggregation is as shown in the figure 994 below. For patients on
medication for less than three months, IIT decreased from 174 in Y2Q2 to 82 in Y2Q3. The IIT age and
gender segregation is as below

8
 TX_ML IIT=994
50+ 65 86
45-49 41 69
40-44 61 75
35-39 49 109
30-34 48 102
25-29 31 115
20-24 21 61
15-19 8 19
10-14 7 10
5-9 3 5
1-4 4 5
<1 0
0
100 50 0 50 100 150

Series3 Males Females

There were pronounced client losses among clients between 25 and 39 years of age. USAID FYJ
conducts weekly evaluations of the appointment management cascade and IIT tracking procedures to
identify and resolve any issues that will continue in FY22 Q4

Transfers Out (TO): In Q2 of FY22, USAID Fahari ya Jamii reported 566 patient transfers, compared to
633 in FY22 Q2. 20% (116/566) of clients were transferred out of Nairobi and Kajiado County facilities,
with only xx () transferred to Nairobi facilities and 10 (1.5 %) to Kajiado County facilities.

Deaths: In the Q2 of FY22, USAID Fahari ya Jamii reported 110 (female – 65, male – 45)
deaths compared to 96 in Y2Q1. The highest mortality rate reported was among clients
aged 50 and above. USAID FYJ worked with health care workers (HCWs) in supported
facilities to conduct mortality audits to establish the cause of death for each reported case, as
captured in the mortality audit reports.

Return to treatment (RTT): In FY22Q3, USAID Fahari ya Jamii restarted 676 clients who had
interruption of treatment in the previous reporting periods, an improvement from FY22 Q2, in which
USAID FYJ restarted 589 clients on treatment. Out of the 676 clients, 260(38%) had treatment
interruptions of between three and five months, and 288 (43%) had fallen out of treatment for more than
six months.

The project implemented SURGE 2.0 pivots with weekly reviews focused on updating of correct locator
information, tracking TO, those who stopped ART and mortality reviews. Case management approaches
were employed with line listing of defaulters and IIT drawn on a weekly basis. Lay health workers were
tasked with tracking targets that were also monitored weekly. A “welcome back” package was
institutionalized to support continuity on treatment.

In Q4, FYJ will continue with Surge 2.0 strategies of weekly appointment management and IIT tracking
data reviews, weekly planning, and execution of CoT ART access and IIT tracking community
interventions and follow up mentorship on use of disseminated SOPs and CoT approaches at the facility

9
level. The project will work on conducting FDGs to have client feedback on CoT and support client
involvement interventions that addresses their CoT needs. The program will also work with county
government to provide technical assistance to private facilities to address CoT concerns. The program
will work on DSD approach implementation, documentation, and reporting to address the gap on
community led HIV care & treatment engagement.

2.6 Increased Viral Load Coverage and Attainment of Viral Suppression for all Patients on
Treatment

The project reported an overall viral load coverage of 22%The overall suppression rate of 96%.

Program Overall Kajiado Nairobi

CALHIV suppression 53% 53% 52%
rate(0-19)
> 20 + 21% 9% 23%

The low viral load uptake in the quarter is attributed to lack of viral load testing commodities since April
2021.The facility teams have continued to offer treatment literacy sessions to both the new and continuing
clients on treatment. To address the low viral suppression, the project has line listed all the viremic clients
and assigned case managers. Additionally, categorization of all clients is ongoing to ensure all the eligible
are on a form of differentiated service that addresses their access challenges.

The program has held treatment literacy to 75% of new clients in the quarter, the goal
being to prepare them for lifelong treatment therapy and detailed explanation
75% on the importance of adherence and continuing treatment is actively
treatment implementing case management for all the High Viral load clients. For
literacy
pediatric cohort, the clients are closely being followed up through Jua mtoto
Wako and the OVC partner in development of plan addressing the barriers to
adherence highlighted and interventions to address the barriers that are followed
through by the case managers.For 20+ years, high viral load clients taken through the
EACs,linked to case managers, treatment literacy classes for HIV education, follow ups and supported
through the viremic clinic where quality management review are carried out by the facility teams.

In Q3, the program has been prioritizing the CALHIV, PMTCT clients and the new clients for Viral load
uptake coverage. The facility is using the developed line list for the priority cohort groups for VL
bleeding. The program has also sensitized the adherence counselors to continue with Adherence
messaging to all PLHIV through one-on-one sessions, health talks and psychosocial support groups.

2.7 Increased Utilization of TB/HIV Collaborative Services

In Q3 of FY22, USAID Fahari ya Jamii continued implementation of TB active case
finding and 1,633 new and relapsed TB cases were identified (1,291 in Nairobi and
342 in Kajiado). PITC services were offered to 1,400 clients (1,163 Nairobi and
237 Kajiado) and this resulted in 85.7% performance. The suboptimal
performance for testing was attributed to erratic supply of testing kits in the month
of May and June 2022 in Nairobi and Kajiado County. Cumulatively, as at the end
of quarter 3, USAID FYJ identified 5,033 new and relapse cases those knowing

10
status at 4,596 resulting to performance of 87% and 79% respectively against the annual targets. The
supported facilities continued to maintain and update line-lists for (232 clients) missed opportunities and
clients will be prioritized once RTK’s are available. The program endeavor to offer 100% testing to all
TB clients accessing services in the supported facilities.
The program supported the initiation of 365 TB/HIV coinfected clients out of 392 clients who were
identified positive resulting in initiation rate 93.1% performance and 78% and 74% respectively against
annual targets. The 28 missed opportunities in ART initiation were attributed to a delay in initiating
clients on ART due to the two-week intensive phase of TB treatment and 5 TBM clients. The program
will continue to audit TB/HIV coinfected clients not initiated on ART on a monthly basis and track
outcomes.
The program will continue to integrate TB active case finding and Covid screening at outpatient, MCH
and special clinics to increase case identification. The program will endeavor to monitor the introduction
of new tools like the digital chest x-ray for TB screening at the outpatient for TB screening at Mathare
North HC and Rhodes chest clinic in Q4.

Introducing New Tools Project (iNTP): USAID Fahari ya Jamii Program staff and Health
care workers sensitization was done on new tools project by the national TB program.
LTBI/IGRA trainings and WHO recommended screening tools among them the Ultra-
portable chest X Ray. The aim of the iNTP is to provide new diagnostic for testing TB and
latent TB including point of care ultra-portable chest x ray in addition to symptomatic
screening and molecular WHO recommended rapid diagnostics. FYJ facilities (Mathare
North Health center and Rhodes chest clinic have received the ultra-portable digital chest x-ray and the
official launch for the iNTP was done in quarter 4 at Mathare North Health center. A total of 12 HCW
were trained on the digital x-ray and 30 sub county teams were trained on LTBI/ IGRA testing.
Sensitization for the HCW is scheduled in the coming quarter for Nairobi and Kajiado counties.
Tuberculosis preventive therapy: TPT is considered one of the most critical public health measures to
protect both individuals and the community from TB. In Q3 of FY 22, the project implemented same day
ART initiation and same day TPT initiation. A total of 372 clients were started on ART and TPT on the
same day. Cumulatively 2,334 PLHIV were initiated on TB Preventive Therapy (TPT) in the
quarter(Nairobi 1,521 and Kajiado 805).Facilities will continue with acceleration of TPT to further
improve TPT uptake from58% to 80%. Drug adverse effect monitoring will be mainstreamed with the
county pharmacists and USAID Fahari ya Jamii project teams for technical support during site visits.

TB/HIV stakeholder’s meeting-USAID FYJ continued to support the TB/HIV stakeholder’s forums where
the counties and implementing partners gather to deliberate on TB issues. Among the key issues
discussed is Uptake of TPT, integration of TB/HIV services and TB commodity security.

2.9. Increased Uptake of Quality HIV treatment Services: Population Specific Efforts

Finding men and children: In FY2Q3, USAID Fahari ya Jamii worked to

increase case finding among men and children. Men were reached through
implementation of the “Red Carpet” services, flexi hour, community testing
including HIVST distribution as well as through index testing. Children were
identified through targeted PITC, index and OVC testing. This will continue in
the coming quarter.

11
2.10. Increased Reporting and Prevention of Sexual and Gender-Based Violence (SGBV)

In Q3 of FY22, USAID Fahari ya Jamii provided gender-based violence (GBV) with an overall no of
5906 identified cases in both counties placing the program at 49% achievement. The numbers have
plateaued in Q3 however with revamped LIVES training for HCWs on GBV and LIVES it is anticipated
the screening numbers will improve in Q4 . So far 74 HCWs have been trained in
Kajiado and 45 in Nairobi. Kajiado county has also invested in training GBV
Trainers of Trainees (TOT) through the support of NASCOP.
5906
USAID FYJ conducted a 1-day sensitization to 40 women from Kenya Society GBV cases
for the Blind. The plan is to have a TOT for PWD so GBV training can be identified
cascaded within the institutions of People with Disabilities (PWD). The program
is working with the institutions where we can provide some of our services to them
by reaching out rather than waiting for them to come to the facilities.

It was observed during the facilitator mentorship support visits that reporting and documentation in
registers was incomplete, hence a session during the training is set aside to point out the gaps, need for
proper documentation and enhance the skills on the same.

4. Increased Access and Demand for Quality Family Planning, Reproductive Maternal
New-born Child and Adolescent Health, Nutrition, and Water and Sanitation Services

4.1 Increased Availability and Delivery of Quality FP/RMNCAH, WASH Services

Improving ANC Attendance: USAID Fahari ya Jamii working closely with the NMS
team reached 40,836 women with 1st ANC services during the quarter which is a 26%
achievement of the quarterly target. Health care workers and CHVs continued to
promote early ANC attendance and promote the continuum of care to ensure that mothers
take up all 4 recommended ANC visits. During the quarter 23,362 pregnant women
attended 4 ANC visits translating to 69% achievement of the annual target
(72142/104252). 9469 clients were referred from the community to the HFs for ANC 1
through the 189 CHVs that have been engaged to support 18 HFs in Nairobi. The
CHVs targeted communities around the NMS high volume facilities for information,
education, and referral for ANC services. Sub-county public health nurses and facility
champions continued to provide mentorship and OTJ throughout the quarter. The focus
during the quarter has been on improving documentation on referrals from community for both ANC 1
and ANC 4 by strengthening the use of the MoH 100.

Increasing ANC uptake and Completion among Adolescents: USAID Fahari ya Jamii reached 3709
AGWY with ANC services during the quarter.

Increased safe deliveries: In the quarter 35,032 women were reached with skilled delivery services and
34,950(99%) were provided with uterotonics during the 3rd stage of labor. Through the quality
improvement initiatives implemented in the past 2 quarters the project is on track achieving 68% of the
annual target. The program worked closely with the
sub-county teams and provided mentorship on the 35,032 women reached with skilled
correct use of partographs for management of labor delivery
99% provided with uterotonics
12
and documentation of delivery processes. In addition, there was a lot of emphasis on quality improvement
initiatives to get documentation for uterotonics given to 100%. Facility in charge monthly meetings were
also utilized to emphasize on the need to always check and verify before upward submission of monthly
reports. Further to this is ensuring that all registers are properly documented and summarized.

Improve uptake and provision of PNC for mothers and newborns: During the quarter the NMS working
closely with the program reached a total of 31,989 out of 35,032 (91%) clients with PNC services within
48 hours of delivery. This translates to 45% of the annual target. Service delivery gaps and documentation
gaps were highlighted as major challenges to the achievement of this indicator during the previous
quarter. Quality improvement initiatives and tracking implemented have improved both service delivery
and documentation of this service this quarter.

Strengthen County maternal and perinatal death review surveillance and response (MPDSR): The
USAID FYJ Working closely with sub-county and facility teams to conduct MPDSR audits and take
corrective actions for gaps identified. 43 maternal deaths were reported during the quarter and 100% were
audited. This is an improvement from the previous quarter’s performance where only 91% of deaths were
audited. Emphasis was also made on correctly filling the maternal death surveillance form. The program
continued to focus on the prevention of maternal deaths and morbidities through PROMPT identification
and management of complications to include PROMPT referrals. The project was instrumental in
supporting facility-based reviews of near-miss and macerated stillbirths as a way of improving the quality
of care both at ANC and delivery. In addition, facility specific work plans to track MPDSR action plans
were developed for Mbagathi, Mama Lucy and Pumwani Hospitals.

Increase knowledge and uptake of infant and child health services at the household and community level:
USAID Fahari ya Jamii working closely with the county teams reached 82% with treatment for diarrhea
services over achieving the annual target though there were stock outs of Zinc commodities the entire
quarter, while 35,941 children were declared fully immunized during the quarter a 5 % increase from the
previous quarter, this translates to a 70% achievement of the annual target. In addition, 33,960 children
were provided with Pentavalent 3 achieving 74% of the annual target. Drop offs from Immunization were
experienced between Penta 1, Penta 3 and MMR1. The project's focused on strengthening immunization
defaulter tracking through CHVs and CHAs, documentation into the permanent register and having robust
facility quality improvements projects focusing on these areas. In addition, CHVS will be engaged for
Westlands HC and Huruma Nursing Home to support community follow up for mothers and children.
During the quarter 48 HCWs were trained on IMNCI during the quarter as part of service delivery
improvements initiatives. Post training mentorship and support supervision is planned for the July -
September quarter. The program continued to focus on sensitizations for diagnosis and treatment of
pneumonia and strengthening referral systems for Diarrhea and treatment with ORS and Zinc.
Community education and referrals for Immunization, exclusive breastfeeding, and other child health
services were emphasized during household visits by CHVs. Engagement of communities through
community dialogues will also be prioritized in the coming quarter

4.2 Strengthened Delivery and uptake of FP/RMNCAH, WASH Services at Health Facilities,
Including Referral from Lower-Level Facilities and Communities

Family Planning

13
Strengthen County and Sub-County FP coordination and service delivery: The program working closely
with the sub-county teams continued to support mentorship and commodity distribution of FP
commodities as Nairobi continues to face shortages of injectable contraceptives and Pills. USAID Fahari
ya Jamii participated in the NMS quarter FP TWG where issues were discussed regarding improving FP
service delivery with the NMS, prioritizing populations with high unmet needs including HIV + mothers.
Integration of FP services into HIV clinics has been an area of focus during this quarter.

Improve access to and quality of facility-based FP services: During the quarter the program
achieved 348 670 (145%) of the annual CYP target. 9499 adolescents between
the ages of 10-19 years received family planning services. The program
145% worked closely with sub-county and facility champions targeting high
volume maternity services to provide mentorship on PPFP including a
target
achieved. focus on counseling during the ANC visits and to clients who seek
PAC services in outpatient and gynecological wards. The project
working closely with the NMS trained 25 HCWs in Long acting and
Reversible contraceptives. Additional HCWs will be trained in the
July - September quarter. Engaged CHVs have been supporting FP education and
referrals. In collaboration with NMS there was a focus on improving the quality of care in
FP service delivery points to reduce unmet needs among women of reproductive age through
the provision of balanced counseling cards, job aids, and SOPS and reduce the removals for long-acting
contraceptives. HCWs through integrated support supervision were mentored on how to monitor stock
status monthly and timely ordering to ensure commodity security. The county experienced stockouts of
injectables.

Gender and GBV approaches in FP/RMNCAH: The USAID Fahari ya Jamii program working with the
sub-county public health nurses and community focal persons to support the provision of a male-friendly
package of services to encourage male involvement in ANC, maternity wards, and PNC. GBV focal
persons in Nairobi assessed missed opportunities for reporting GBV indicators to improve reporting.

4.3: Water Sanitation and Hygiene (WASH)

County-level WASH system strengthening support

Capacity building on UCLTS: In Q3 Fahari Ya Jamii supported the County WASH unit to
conduct UCLTS training to WASH Focal persons. The training targeted 34 WASH focal
persons from 17 Sub counties. The three-day training with a practical session on triggering
on the third day and the team managed to trigger kamitha Village in Dagoretti Sub
County. The WASH focal persons were trained on the implementation of the UCLTS
approach.

WASH Focal Persons Monthly Review Meeting: In collaboration with the County WASH
unit, the project supported a monthly review meeting for the WASH Focal
persons. The monthly review meeting acts as a forum to share progress in
implementation of WASH activities, sharing of monthly activities and achievements and
planning for upcoming activities and case studies on WASH. The project supported 34
WASH focal persons for the meeting.

Menstrual Hygiene Day: The project supported Makadara and Kibra Sub counties in commemorating the
day which is held every 28th day of May. With the theme being “Making menstruation a normal fact of

14
life by 2030” The main aim of the day was to sensitize the community on basic information about
menstruation. The activities reached approximately 5,500 community members.

Sub-County and facility-level WASH support

Quarterly Support supervision on IPC/WASH in health Facilities; Fahari ya Jamii supported 5 Sub-
Counties (Langata, Embakasi West, Dagoretti South, Kasarani and Mathare Sub Counties) to undertake
supportive supervision on WASH/IPC in health facilities. A total of 36 health facilities were assessed
during the reporting period. Key findings of the support supervisions were 34 health facilities had
functional active IPC committees in place. 104 health care workers were trained on IPC.

ORT Corners: In Q3 The project-initiated engagement of WASH Champions in 30 health facilities to

improve functionality of the ORT corners, management of diarrhea for under 5 years and improve
documentation of the diarrheal cases in the high-volume facilities.

Sanitation facilities improvement in health facilities: In Q3 the project identified gaps in sanitation and
hygiene facilities in the following facilities Mbagathi Hospital, Kangemi HC, Mama Lucy Hospital,
Dandora II Health Centre, the project has initiated improvement of the 4 facilities focusing on the sanitary
facilities.

Implement and scale up UCLTS in NMS informal settlements

Capacity building on UCLTS: The project supported a two-day sensitization of 15 Natural leaders on
UCLTS. The natural leaders were sensitized on basic information in implementation of UCLTS and their
roles as natural leaders in attaining Open defecation free (ODF).

Pre-triggering and Triggering activities: USAID Fahari ya Jamii with the aim of
strengthening the County and communities to promote sanitation in informal settlements
through urban Community Led Total Sanitation (UCLTS) approach. In Q3 the project
triggered 17 “villages” in Sub Counties making a total of 29 villages triggered.

UCLTS Pre-Triggering: The project has also supported in pre-triggering of 12 more “villages’ ‘in 10 Sub
Counties which are planned for triggering in the next quarter.

Landlord’s forum: The project supported landlord’s forums in 4 Sub Counties (Dagoretti, Langata,
Kamukunji and Mathare). The issues discussed during the forum are as mapped by community members
during the post triggering follow ups undertaken in the village. The supported landlord’s forums reached
approximately 175 landlords across all the villages.

Post triggering monitoring and follow up: To support triggered villages and ensure progress in facilitating
villages to be open defecation free, the project facilitated 18 post-triggering monitoring and follow-up
field visits in triggered villages.

People gaining access to a basic sanitation service: - In Q3 the project

achieved a total of 112 new sanitation facilities because of UCLTS
7,360 People implementation through frequent monitoring follow ups in the triggered
benefiting from new villages. Approximately 7,360 people benefitting from the new build
sanitation facilities sanitation facilities, translating to 88% of quarterly targets, of which 16
out of the reported sanitation facilities were erected in institutions settings.

15
People gaining access to basic drinking water services: Mapping and water sampling was done in 7 Sub
Counties namely. 112 water points mapped, and samples collected for bacteriological analysis. 142, 622
aqua tabs distributed during Q3 for treatment of water at household level Through these interventions
8,055 people benefitted from basic drinking water 96% of the quarterly target achieved.

5. Strengthened Capacity of County Health Systems, Local Partners, and

Communities to Deliver Quality Health Services

5.1.1. Pharmacy Health Systems Strengthening

Optimization of CALHIV: In FY22Q3, USAID Fahari ya Jamii achieved an overall optimization of 86%
for clients under 15 years on 1st line regimens. 87% in NMS and 85% in Kajiado. This is an improvement
from Q2 that realized a 74% (1322/1797) achievement. Site level line lists are drawn weekly and assigned
to clinicians for tracking. This will continue into Q4 to achieve 100% optimization.

Multi Month Dispensing: In FY22Q3 Fahari ya Jamii achieved 74% Multi Month Dispensing in both
NMS and Kajiado. In Q4 Fahari ya Jamii will focus on improving this by sensitizing facility staff on how
to identify patients eligible for MMD, and conducting joint support supervision with County and Sub
County on MMD. The project will also conduct facility level commodity management mentorship to
ensure that sites have enough stocks to provide MMD to clients.

Commodity Oversight at County and Sub County Level: The project strengthened oversight of Pharmacy
Supply Chain by supporting NMS to conduct a commodity data review meeting in June 2022. As a result,
strategies to improve the quality of data reported were identified including developing a DQA tool to be
used to review quality at facility level. 

USAID Fahari ya Jamii strengthened oversight of Pharmacy supply chain in Kajiado through conducting
joint support supervision with the County and Sub County Pharmacists in Oloitoktok, Kajiado East and
Kajiado North. In Loitoktok sub county this included Loitoktok Sub County Hospital, Isinet Health
Centre, Kimana Health Centre, Rombo Health Centre, Entarara Health Centre, Nkama Dispensary,
Imurtot Health Centre, and Namelok Health Centre. In Kajiado East these included Kitengela Sub County
Hospital, Isinya Health Centre, GK Prison, Masimba Health Centre, Murueshi Maasai Health Centre,
Mashuuru Health Centre, Father Adrian Health Centre, Kitengela Medical Services, Fatima Mission
Hospital Kitengela. In Kajiado North this included Ongata Rongai Sub County Hospital, Fatima Mission
Hospital Rongai, Wama Hospital and Wanainchi Jamii Maternity, Ololua Dispensary, Embulbul
Dispensary, Matasia Nursing Home, Matasia Health Centre, Gataka Health Centre, Ngong Sub County
Hospital.

Commodity Security and Inventory Management: In Q3 USAID Fahari ya Jamii strengthened inventory
management by distributing ART Daily Activity Registers and ART Distribution Booklets in both NMS
and Kajiado. USAID FyJ also conducted TA for commodity management in Mariakani Cottage Hospital,
Kayole 2 HC, Bahati HC, Mukuru MMM, Westlands HC, Ngong Rd HC, Kariobangi North, Prudent
Cottage, Korogocho HC, Soweto Kayole HC, Lunga lunga HC, Mukuru MMM, AAR Clinic Sarit Centre
and Ngong Road HC.In Kajiado commodity management TA was conducted in Wama Hospital Rongai,
Wanainchi Jamii, Sinai Hospital, Nairobi Womens Rongata Rongai, Loitoktok sub county Hospital,
Namelok HC, Imurtot Health Centre, Ongata Rongai Sub County Hospital, Bissil Health Centre, Kajiado
County Referral Hospital, AIC Kajiado, Isinya HC, and Ongata Rongai Sub County Hospital.

16
Commodity Redistribution: In Q3 FyJ continued to support Commodity Redistribution in both NMS and
Kajiado to mitigate low stock levels and prevent expiries. Commodities redistributed in the quarter
included ABC/3TC 600/300 MG, PREP, TLE, Darunavir, Ritonavir and TPT.

EMR for Dispensing ART: USAID Fahari ya Jamii improved the use of EMR for dispensing commodities
by conducting OJT on use of the ARV Dispensing Tool in Kayole 2 HC, Bahati HC, Mukuru MMM,
Ngong Rd HC and Kivuli Health Centre.  In Kajiado mentorship on use of the ART Dispensing Tool was
conducted in Ongata Rongai Sub County Hospital, Kimana HC, AIC Kajiado, and Bissil Health Centre.

Strengthening Patient Safety: Pharmacovigilance Reporting Mentorship: USAID Fahari Jamii built the
capacity of facility staff to report on Pharmacovigilance using the Pharmacy and Poisons Board Online
Reporting system in Wama Hospital Rongai, Namelok Health Centre, Immurtot Health Centre, Nkama
Dispensary, Isinet Health Centre, Entarara Health Centre, Rombo Health Centre, Kimana Health Centre,
Ongata Rongai, Embul Bul Dispensary, Nairobi Hospital, Sinai Hospital, Wanainchi Jamii, Ololua
Dispensary, Wama Hospital, and Ngong Sub County Hospital.
 
Stock Verification: In Q3, USAID Fahari ya Jamii continued to verify stocks received at facility level as
part of implementing the USAID commodity security and risk mitigation measures. The project was able
to verify stocks received from MEDS by facilities in both NMS and Kajiado. Additionally, the project
included commodities from KEMSA on the list of commodities for verification.

Commodity reporting rates: In Q3, USAID FYJ continued to support facilities in Nairobi and Kajiado to
order for and report on the use of ART commodities. In Kajiado,
COUNTY CD RR FMAPS the facility’s monthly ART patient summary reporting rate was 100
%, and the FCDRR reporting rate was 100 %, both improved from
Nairobi 96.6 96.9 the previous month. NMS's monthly ART patient summary
Kajiado 100 100 reporting rate was 96.9 %, and the FCDRR reporting rate was
96.6% also an improvement from the previous month. The project
will continue to work closely with the county teams to sustain the improvement results in Kajiado and
improve the rate in NMS.
5.1.2 Strengthened Human Resources for Health systems to provide quality health services

In Y2 Q3 USAID Fahari ya Jamii continued to strengthen county health systems for

Human Resources for Health (HRH) in Nairobi and Kajiado counties to facilitate
ongoing service delivery at the facility level. The project supported 383 technical
and 400 lay staff during the quarter to support quality service provision in project
supported facilities in Nairobi and Kajiado counties. The project continued to work
in close collaboration with the CHMTs in both counties in all aspects of HRH
management and development including assessment of facility staffing levels based
on facility performance and targets, recruitment, mentorship, and supervision as well as performance
management.

During the quarter, the project also supported the NMS directorate of health to hold a three-day workshop
to address all pending HRH issues such as staff promotions, redesignations, and right placement of staff
as per qualifications before transition of the staff back to Nairobi City County Government. This process
also addressed succession management gaps and provided a guide in appointment of qualified officers to
fill positions at the county, sub county and facility levels as per the public service schemes of service .
This is expected to improve staff satisfaction through promotion of staff due for promotion and improve
service delivery by ensuring that qualified managers are appointed at the county, sub
county and facility level. The project also continued working with the Nairobi CHMT in

17
the development of a comprehensive mobile based HRH management system which will be deployed in
Q4. The HRH management system is expected to improve productivity and quality of health services
provided at all health facilities within the county.

5.1.3 Strengthened capacity for financing and accountability of county health services

In Y2Q3, the project supported Nairobi County to review the 2021/2022 Annual Work
Plan (AWP) key priorities and implementation progress. Furthermore, the project
supported the county to consolidate and finalize the 2022/2023 AWP which was fully
approved and ready for implementation by the end of the quarter. The project
continued to support facility supervision and mentorship on financial management by
the CHMT to monitor implementation of facility work plans on effective engagement
with NHIF aimed at improving revenue collection. The CHMT addressed each facility’s gaps in engaging
with NHIF particularly recruitment drives to increase revenue through capitation as well ensuring that all
facilities are aware of outpatient services covered by NHIF and that they are claiming reimbursements for
more outpatient services.

5.1.4 Increased coordination and provision of laboratory services to support quality of care

Joint Project Coordination, planning, implementation, and monitoring: USAID Fahari ya Jamii project
continued to provide technical support to Nairobi Metropolitan Service and Kajiado County on
implementation of quality medical laboratory services. This is being done in collaboration with other
laboratory supporting implementing partners to leverage on resources and mitigate duplication of effort.

Laboratory commodities management: During the reporting period, the project supported laboratory
commodities quantification, allocation and reporting for HIV and TB related commodities.
This involved provision of technical support on facility level inventory management and
reporting, and logistics support on re-distribution of laboratory commodities. Generally, the
facilities experienced inadequate supply of laboratory HIV Test kits,

Gene Xpert cartridges, Plasma Preparation tubes, DBS filter papers, CD4 reagents for
HIV and TB diagnosis and monitoring. In June, FYJ re-distributed 400 EID DBS
bundles in NMS and 200 EID DBS bundles in Kajiado. Viral Load samples
collection commodities that were distributed in the same period were 12,000 in
NMS and 5000 in Kajiado.

There was a delayed distribution of rapid HIV test kits (RTKs) to NMS which
was done in late June (204,400 determine test kits and 10,200 First Response test kits) but expected to
have been done in April 2022. Kajiado county has experienced stock out of Rapid HIV test kits (RTKs)
from the beginning May to End of June 2022 resulting to missed opportunities in HIV testing across the
facilities.

The project responded by supporting inter-facility redistribution to mitigate stock-outs and expiry of the
commodities. The redistribution was informed by the facility consumption levels and commodity expiry
dates. The project provided internet bundles to the SCMLCs and CMLC to ensure verification and timely
upload of stock reports to the Health Commodities Management Platform (HCMP) thereby ensuring a
reporting rate of over 95% for both NMS and Kajiado against the national reporting rate of 88%.

18
In addition to RTK allocation, USAID Fahari ya Jamii worked closely with the CMLC and SCMLCs to
quantify and forecast for CD4, TB and viral load commodities. This involved monthly tracing of
Provided internet bundles which ensured commodities and preparation of quarterly requisitions to
NASCOP and the National TB program for supply of
over99% reporting rate in HIV and TB commodities respectively.
Nairobi and Kajiado.
Integrated Laboratory Samples referral network and
results management (Lab-clinical interface): USAID Fahari ya Jamii project continued
to strengthen laboratory sample referral networks through integration of HIV and TB
samples and results management using the motor-bike riders and a G4S from the
hubs to the referral laboratories. A total of 16153 samples for VL, Cd4, EID, Gene
Xpert and TB culture were referred in NMS and Kajiado. Out of 12193 Vl and 270
EID results received in Q3, only one sample was rejected at the National HIV
Reference Laboratory (NHRL). Turnaround time for VL and EID was 29 days and 12
days respectively. The project will continue to strengthen the sample referral system to ensure minimal
facility level delay and collaborate with NHRL to ensure overall minimal TAT. USAID Fahari ya Jamii
project will continue to strengthen the Laboratory and clinical interface by enabling clinical teams to
access VL and EID results in the VLEID Nascop website and SMS short code.

Laboratory External Quality Assessment (EQA), Rapid HIV Testing Proficiency Testing (PT) and RT-
CQI: A total of 47 (100%) facilities with 116 HTS service delivery points in Kajiado were enrolled in the
RT-CQI program. In NMS 41 (43%) facilities with 119 service delivery points were enrolled.

Laboratory Continuous Quality Improvement (L-CQI) and SIMS assessment: USAID Fahari ya Jamii
conducted facility level SIMS assessment in 47 health facilities in NMS and Kajiado county. Major gaps
identified included, long TAT for VL and EID samples, stock out of VL, EID and Gene Expert
commodities, SOPs not updated. Facility level Mentorship on sample tracking and SOPs development
and review was done as part of corrective action.

19
HIV Recency Surveillance Scale up (RTRI), TB New Diagnostic tools (IGRA and Truenat) uptake:
USAID Fahari ya Jamii project activated HIV Recency testing in four facilities in Kajiado County and ten
facilities in NMS over the reporting period. USAID Fahari ya Jamii plans to activate additional twenty
facilities in NMS as part of saturation counties as per the National guidance in Q4. In collaboration with
the National TB program and County government the project activated Interferon Gamma Release Assay
(IGRA) testing in two facilities and one facility in NMS and Kajiado county respectively as part of new
TB tools. Additional two facilities were supported to start Truenat testing in collaboration with the
National TB program.

Laboratory Safety, Blood safety and equipment management: USAID Fahari ya Jamii
program continued to provide mentorship and support on implementation of biosafety and
biosecurity strategies to ensure clients’ and patients' health and safety. In Q3, the program in
collaboration with the National Biosafety office supported certification of 43 (86%)
biosafety cabinets/TB hoods/VWS with 7(14%) due for certification scheduled to be done in Q4. Support
calibration of laboratory equipment in liaison with the MOH-Department of Laboratory Services (DLS).
During the certification exercise, on job training was done for laboratory staff on routine preventive
maintenance and proper use of the equipment. In collaboration with the National Biosafety and
biosecurity office, the project has trained 137 (48%)288 Medical Laboratory Technologists in Biosafety
and Biosecurity from NMS and Kajiado County. Annual biosafety and biosecurity refresher training has a
coverage of 95%. USAID Fahari ya Jamii plans to train the remaining staff in Q4.

5.1.5. Strengthened Strategic Information Systems for Planning, Coordination, Monitoring, and
Learning

Program Monitoring and Reporting: In FY2022/Q3, the project continued to implement all key priorities
that covers data reporting and monitoring, data dissemination, data quality mechanism, OJT, and
mentorship of health care workers on M&E tools and data quality verification. Regular EMR support was
provided across all 68 EMR facilities with the focus being on system updates, integration through the
interoperability layer and OJT. Implementation of internal system that mirrors DATIM was a major
milestone in the program during this reporting quarter. As a follow up to the Kenyan National Recency
Surveillance Dashboard rollout on February 24, 2022, the project activated 9 facilities to cover HTS
recency testing.

Data Quality Assurance: The project continued implanting measure, that ensure data quality assurance
and concordance from facility level to county level. Strict DQA process involving timelines, integrity,
and data accuracy from data production to data dissemination was adhered. The project has
institutionalized data calendar with clear schedule of reporting dates for all required indicators, regular
RDQA timelines and data dissemination/reviews at facility, sub-county, and county level

Enhancing EMR: The project has customized DHIS 2 instance to support aggregated PEPFAR MER
reporting, non-MER program data, COVID-19 Vaccination and Surge (20 Datasets). This has helped to
automate quarterly reporting into DATIM and implement validation rules to aid in correct data capture
and reporting. More so, on boarding of program and county CHMT teams. The project also embarked on
end user training on navigation, data capture, report generation and DDIU, deployment of inbuilt
dashboards for routine performance tracking. Digitization of SIMS, DQA, Eligibility screening, and
WASH survey tools, Consolidation of eligibility screening tools for HTS, GBV, TB and PrEP

20
COVID-19 Vaccine-M&E: With the ARPA coming to effect in Q3, to support Covid 19 vaccination
Acceleration Program the MEL section supported in data capture, DQA and data analysis and reporting.
For more efficient tracking the indicators for COVID-19 vaccination was disaggregated by Vaccine type,
gender, age, modality (In reach and Outreach), Outreach Archetypes and in reach Service Delivery
Points. For Data Capture Tools the project utilised Mchanjo (captures patient level data), Tally sheets
(captures aggregate data) and internal DHIS2.

Case Based surveillance and Recency Testing

In terms of metrics of CBS and Recency testing, the project has implemented Routine ETL extractions
from 60/64 (94%) EMR Facilities, Creation of a host page for CBS, COVID and SIMS dashboards,
Development of dashboards for 1st 2nd and 3rd 95 cascades with access to deidentified patient records
and on boarding of users across the program 59 so far

Priorities for Q4: Implementation of central inventory management tools for use at the county and sub-
county level. Develop and support a multitenant instance of KenyaEMR (CloudEMR) and offer it as a
web service to non-EMR, low volume, remote facilities. Support epidemiological research on key
populations and cohorts with the use of big data approaches. Develop and incorporate machine deep
learning models to derive knowledge for accurate forecasting and projections of patient behavior and
outcomes. Knowledge transfer to SI associates, mentors, facility HRIOs and County teams. Support
health financing and sustainability activities

5.2: Strengthened Case-based surveillance, public health response, and quality improvement

In FY22Q3, the Fahari ya Jamii technical team continued to implement quality improvement plans for
each facility based on gaps identified during routine TA visits, data reviews as well as internal and
external SIMs assessments in Nairobi and Kajiado counties. The project teams particularly focused on
improving development of facility stakeholder engagement and child safeguarding policies as well as
sensitizing facility staff on child safeguarding, patients’ rights, stigma, and discrimination. The project
also supported Nairobi County to assess 56 facilities using the Kenya Quality Model for Health (KQMH)
facility level specific tools to identify the best facilities for recognition and awarding in Q4 during the 4 th
Annual Health Service Delivery Awards (HSDA) Ceremony.

5.3.1 Strengthened Capacity of County Health System to deliver quality services

In YF22Q3, Fahari ya Jamii held routine quarterly county program performance review meetings in
Nairobi and Kajiado counties aimed at reviewing progress in implementation of the co-created COP21
work plan. In both counties key priority areas for implementation in Q4 and the required resources were
identified, and an implementation plan agreed upon. The project also worked in collaboration with both
Nairobi and Kajiado counties to co-create COP22 work plans.

Furthermore, the project supported review of 2021/2022 AWP implementation progress as well as the
process of consolidating the 2022/2023 AWP. This process is aimed at ensuring that the county AWP is
implemented in accordance with allocated resources. However, challenges with delayed disbursement of
funds for implementation of the AWP persist and affect the effective implementation of AWP with
fidelity.

5.3.2 Strengthen local prime partner capacity development

In Y2Q3, the technical team held progress review meetings with each of the nine sub awardees aimed at
monitoring performance and achievement of set targets based on the respective co-created work plans.

21
The meetings are also aimed at strengthening the capacity of each sub awardee to deliver quality health
services as well building their capacity to manage grants. The project’s technical and operational teams
continued to address gaps in institutional capacity gaps identified during the organizational risk
assessment conducted for each sub awardee in Y1Q3.

5:4 Strengthened engagement of the community in the delivery of quality health service

In Y2Q3, Fahari ya Jamii continued strengthening community engagement in the delivery of quality
health services through community link desks at the facility level in all high-volume facilities. These
desks are manned by various categories of expert patients such as peer educators, adolescent champions,
mentor mothers and mentor fathers and are aimed at fostering meaningful engagement of PLHIV as well
as collect client feedback for improvement of service delivery.

Constraints and Opportunities

Challenges
Shortages in commodities (RTKs, and HIVST kits) negatively affected the uptake of case finding
approaches, testing among TB clients which was mitigated by interfacility distribution as needed. In
addition, shortages in PrEP commodities towards the end of Y2Q3 negatively affected uptake of PrEP
services during the quarter.
Facilities continued to experience Stock out of Isoniazid(6H) for pregnant and breastfeeding populations
however updated line-lists are maintained at site level and clients will be prioritized once commodities are
available.

Performance Monitoring
Service Area Qtr1 Qtr2 Qtr3 Achievement at Target Performance
75% Time spent (%)

PREVENTIO PrEP_NEW 756 1,807 1,497 4,060 3,527 115%

N
PrEP_CT_FY22 2,125 2,605 2,457 2,605 4,699 55%

VMMC_CIRC 122 1,118 280 1,520 1,002 152%

TB_PREV_N   945 1,511 2,456 4,561 54%

TB_PREV_D   1,155 1,780 2,935 5,069 58%

GEND_GBV 3,238 7,356 5,951 16,545 33,872 49%

KP_Prev 0 8,674 9,585 9,585 7,873 122%

95 = HTS_TST  57,795 57,444 47,285 162,524 294,008 55%

KNOWING
HIV STATUS HTS_TST_POS 1,583 1,693 1,422 4,698 6,668 70%

HTS_SELF 5,085 2,703 4,594 12,382 55,556 22%

HTS_RECENT 48 113 150 311 4,569 7%

PMTCT_STAT (N) 17,743 19,786 16,239 53,768 80,342 67%

22
 PMTCT_STAT (D) 19,604 21,059 19,923 60,586 83,765 72%

PMTCT_STAT (POS) 646 691 565 1,902 4,060 47%

PMTCT_EID 1,219 433 352 2,004 3,916 51%

PMTCT_EID_<2Months 250 211 115 576 3,524 16%

PMTCT_EID_2- 969 222 236 1,427 392 364%

12Months

TB_STAT (N) 1,486 1,710 1,400 4,596 5,799 79%

TB_STAT (D) 1,621 1,779 1,633 5,033 5,799 87%

TB_STAT_POS 322 412 392 1,126 1,441 78%

CXCA_SCRN   8,539 3,645 12,184 16,068 76%

95:95 = ON TX_NEW 1,451 1,571 1,401 4,423 6,384 69%

ART
TX_CURR 62,453 63,538 64,259 64,259 65,979 97%

PMTCT_ART 634 686 559 1,879 4,001 47%

TB_ART 307 378 365 1,050 1,427 74%

TX_TB (Screening) 59,099 59,652 58,220 58,220 65,978 88%

95:95:95 = TX_PVLS _N 19,003 7,307 10,767 10,767 62,027 17%

VIRAL
SUPPRESSIO TX_PVLS_D 19,895 7,658 11,232 11,232 65,296 17%
N

Progress On Gender Strategy

Scope of work developed during the quarter and awaits procurement to advertise for recruitment qualified
consultants to support baseline assessment.

Progress On Environmental Mitigation

During this reporting period USAID Fahari ya Jamii project has supported proper waste management in
all facilities that provide either CCCs, RAMCAH or both activities. Medical waste handling, labeling,
storage, transport, and disposal are satisfactorily reported through support supervision and visual audits,
during the quarter. In addition, capacity building to sustain these gains has been strengthened by training
104 health care workers on Infection prevention and control. This training was necessitated by a
participatory- joint support supervisions, where gaps on IPC implementation are noted. Key finding
notably to be reported is 34 health facilities had functional active IPC committees in place out of the 36
facilities visited during supervision. At Mbagathi hospital the incinerator was not functional during this
reporting period; The project did advocacy and coordination role to fasten in fixing the mechanical
problem of the incinerator.

In terms of COVI-19 vaccination activities; both in-reach and outreach activities have proper Infection
control and waste disposal guide where all the segregation and disposal of waste including sharp disposal
are in place. Each team has coded bins and waste segregation posters utilized during the vaccination
services.

23
It is thus noted that with all those successful waste management negative determination is noted in terms
of environmental management for the USAID/Fahari ya Jamii program.

Progress On Links with Other USAID Programs

In Y2Q3, the project continued working in close collaboration with the USAID Tumikia mtoto and
USAID 4Betterhealth projects with regards to OVC service delivery in Nairobi and Kajiado Counties
respectively. The project has jointly developed Memorandums of Understanding (MOUs) with clearly
defined TORs with both partners which are currently being implemented. The program technical team
also participated in COP22 development meetings in collaboration with all USAID programs which was
key in identification of priorities and implementation strategies.

Progress On Links with GoK Agencies

In Y2Q3, USAID FYJ continued working with key GOK agencies in strengthening service delivery and
health systems. USAID FYJ team participated in NASCOP performance reviews and supervision
activities throughout the quarter, during which performance gaps were identified and addressed with the
NASCOP team. USAID FYJ continued to upload patient-level data to the national data warehouse
routinely. USAID FYJ worked with the National HIV Reference Lab (NHRL) during the quarter to
facilitate early infant diagnosis and viral load testing.

Progress On Journey to Self-Reliance

Since inception, USAID Fahari ya Jamii has worked collaboratively with the Cluster 2 county
governments to ensure efficiency, ownership, and sustainability of the project activities as part of
achieving Journey to Self-Reliance (J2SR) through strengthening their capacity and commitment to the
HIV response. To this end, the project has so far co-created COP 20, COP 21 and COP 22 work plans
with the respective county governments and is currently jointly implementing the COP 21 work plan. The
project has also been holding consultative and planning meetings with the two county governments aimed
at transferring the management of project HRH to the counties through a sub awardee mechanism. The
management of project HRH is expected to take effect in COP22 and will go a long way in strengthening
the capacity and commitment of the county governments in the HIV response. In Y2Q4, the project will
continue to engage with each County key stakeholders to develop county specific transition plans aimed
at increasing capacity and commitment of host country governments and local organizations in
management and funding of key health priorities

Subsequent Quarters Work Plan

See separate attachment

Activity Administration
Personnel Recruitment: During the quarter, recruitment for various positions was contacted, the position
of the Deputy Chief of Party was done the recruitment package submitted to USAID for review and
approval before confirmation. For Some positions, interviews were contacted, and the potential
candidates were identified, some of them have already joined the project, they include, Procurement
specialist, project accounts assistant for Kajiado county, Grants officer,2 drivers, and eight program

24
assistants. Some interviews were contacted but the potential candidates are yet to join the project, they
include the TB/HIV Officers positions. They will be joining in the 4 th quarter. So far 30 out of the 41
positions have been filled, this is about more than 75% of the entire recruitment. The rest of the positions
will be completed in the last quarter.

Procurement Processes: -During the period the USAID Fahari ya Jamii project was granted approval to
procure commodities up to a value of KES.3 Million and repair work for a value of up to KES. 5 million.
With the procurement specialist on board, the approval has improved the turn-around time for some of the
commodities.

Bank Signatories. During the Quarter, an application from Fahari ya Jamii project was done to the Vice
Chancellor for approval to grant the project Chief of Party Bank approval rights. The approval was done,
and the application is in process. The program finance officers were also considered in the approval to
have the bank access rights to view, upload, and extract bank statements. The application for this is also
in process and anticipated to be complete by end of the 4 th Quarter

Accounting & HMIS system: During the quarter, USAID Fahari ya Jamii project initiated a discussion
with the University central administration to have the project staff access and transact within the systems
as above. The accounting software will allow posting and generation of the accounting ledgers to be done
at the project level. Currently, this is being done at UoN central Grants department. HMIS system will
support timesheets update and leave management. The two systems are in the final stages of installation
and are anticipated to be operational in the 4th Quarter.

Reporting and Incremental obligation: During the quarter, USAID Fahari ya Jamii submitted all the
relevant reports including forms SF425, SF1034, liquidation reports, Advance requests and PEPFAR
Expenditure Report for the Quarter ending 30th June 2022. The reports were submitted before the due
dates. In June 2022, USAID Fahari ya Jamii received incremental obligation which increased the
obligated amount from USD $9,489,619.67to USD $ 15,003,463.40.

Contractual: The grants and compliance unit rolled out new reporting template and ensured all the subs
are up to date in their periodic reporting. Targeted capacity building of the sub awardees continued during
the period and eight out of the nine subs were visited for technical support and capacity building. In the
same period, we finalized the selection of five new sub awardees, and we are currently waiting for
USAID approval to bring them on board. We also finalized the recruitments of a new Human Resource
for Health (HRHJ) service provider, and we are waiting for USAID approval to onboard them as well.
Please find below the subs spending position as at the end of the period under review.

25
26
 USAID Fahari ya Jamii Sub awards Burn Rate - June 30, 2022

  Sub Awardee Approved Budget Cumulative Budget Balance Percentage of Percentage of Time Spent
Expenditure To date Budget Spent

  KES KES KES KES KES KES

1 HOYMAS 31,113,756.00 21,239,985.73 9,873,770.27 68% 73%
2 Neema Uhai 12,909,520.00 10,421,666.18 2,487,853.82 81% 73%
3 St Francis Hospital 11,417,744.00 8,701,783.00 2,715,961.00 76% 73%
4 Getrudes Hospital 17,758,936.00 13,554,062.37 4,204,873.63 76% 73%
5 St Mary’s Hospital 14,343,160.00 10,676,616.00 3,666,544.00 74% 73%
6 Savannah 59,662,209.54 46,354,744.54 13,307,465.00 78% 73%
Informatics
7 BHESP 24,049,896.00 19,149,115.68 4,900,780.32 80% 73%
8 BOH 21,657,577.00 13,477,169.04 8,180,407.96 62% 73%
9 Amurt 8,317,764.00 5,201,819.14 3,115,944.86 63% 73%

TOTAL 201,230,562.54 148,776,961.68 52,453,600.86 74% 73%

Financial Information
A. Cumulative obligation

FINANCIAL INFORMATION
A. Cumulative obligation. US $15,003,463.4
PIPELINE= US $7,740,042.19
B. Actual expenditure to June 30, 2022
Table 1: Budget vs Actual expenditure to June 30,2022
Authorized Total Budget Total Budget Cumulative Cumulative Expenditure Cumulative Remaining Total
Budget Line Obligation Expenditure this period: Expenditure Budget Expenditure
items Amount up to June, 2022 up to (June Balance as a % of

1
 previous 2022) Total Budget
period: May,
2022
CURRENCY US$ KES USD KES KES KES KES
Personnel 6,649,811.00 691,580,344 103,048,157 12,281,570 115,329,727 576,250,617 16.7%
Fringe 1,625,408.00 169,042,432 10,787,951 132,011 10,919,961 158,122,471 6.5%
benefits
Travel 613,781.00 63,833,224 4,185,622 1,841,397 6,027,019 57,806,205 9.4%
Equipment 305,101.00 31,730,504 1,637,600 3,820,000 5,457,600 26,272,904 17.2%
Supplies 1,973,761.00 205,271,144 22,116,330 11,168,166 33,284,496 171,986,648 16.2%
Contractual 23,634,303.50 2,457,967,564 329,053,250 53,474,365 382,527,615 15.6%
2,075,439,949
Construction - - - - - - #DIV/0!
ODC 5,816,130.50 604,877,572 211,811,594 20,768,834 232,580,428 372,297,144 38.5%

Total Direct 40,618,296.00 4,224,302,784 682,640,503 103,486,343 786,126,846 18.6%

Charges 3,438,175,938
Indirect cost 1,767,889.00 183,860,456 28,470,683 - 28,470,683 155,389,773 15.5%
(10%
Deminimis)
TOTAL 42,386,185.00
ESTIMATED 4,408,163,240 9,489,619.67 711,111,186 103,486,343 814,597,529 3,593,565,711 18.5%
AMOUNT
(Federal
Share)
Cost Share 4,238,618.50 440,816,324 - 440,816,324

Summary Expenditure broken down by the various PEPFAR program areas

Table 2: Expenditure broken down by the various PEPFAR program areas

2
EXPENDITURE REPORT BY Cumulative Cumulative Expenditure Cumulative Remaining Total
PROGRAM AREA - USD obligation amount expenditure up this period: expenditure obligation expenditure/
to (may. 2022) June, 2022 up to (June. amount obligation
2022) (%)

HIV/AIDS PEPFAR (HL.1) 9,621,260.23 5,607,848.19 599,236.37 6,207,084.56 64.5%

3,414,175.67
American Rescue Plan Act 761,860.00 33,083.45 57,535.37 90,618.82 11.9%
(ARPA)(HL.1) 671,241.18
TB/Tuberculosis (HL.2)   -   - #DIV/0!
-
PMI / Malaria (HL.3)   -   - #DIV/0!
-
MCH / Maternal Child Health 1,521,705.10 470,546.59 70,218.38 540,764.96 35.5%
(HL.6) 980,940.14
POP / Family Planning and Rep. 998,638.07 176,623.71 17,682.75 194,306.46 19.5%
Health (HL.7) 804,331.61
COVID-19 (HL.4) 2,100,000.00 87,464.72 143,181.69 230,646.40 11.0%
1,869,353.60
           
887,854.56
TOTAL 15,003,463.40 6,375,566.65 7,263,421.21 7,740,042.19 48.4%

3
Item Description Date HIV/AIDS American MCH/Maternal POP/ Family COVID-19 Total
PEPFAR Rescue Plan Child Health Planning and
Act (ARPA) (RMNCAH)& WASH Reproductive
Health

    HL.1 HL.1 HL.6 HL.7    

1st Obligation 4/23/2021 $2,425,647.73   $426,204.00 $318,259.00   $3,170,110.73

2nd Obligation 12/15/2021 $3,216,876.50   $284,136.00 $212,173.00   $3,713,185.50

(Mod.P001)
  $761,860.00 $426,204.00 $318,259.44   $1,506,323.44
3rd Obligation 3/9/2022         $1,100,000.00 $1,100,000.00
(Mod.P002)

4th Obligation 31/05/2022 $3,978,736.00   $385,161.10 $149,946.63 $1,000,000.00 $5,513,843.73

(Mod.P003)

               
TOTAL   $9,621,260.23 $761,860.00 $1,521,705.10 $998,638.07 $2,100,000.00 $15,003,463.40

Obligations Received as of 30th June 2022

Chart 1: Obligations vs. Current and Projected Expenditures

4
Pivot Summary:

  Obligation Pipeline Expenditure $3,414,175.67

Obligation as at $   $9,000,000.00
30th June2022 10,383,120.23
$3,245,191.37
$8,000,000.00
Prior Years   $ 1,061,994.29
Actual $7,000,000.00
Expenditure $6,000,000.00
1st Quarter   $ 1,680,422.86 10383120.23
$5,000,000.00 $2,961,893.19
Actual Costs
2nd Quarter   $ 2,961,893.19 $4,000,000.00
Actual Costs $3,000,000.00 $1,680,422.86
3rd Quarter   $ 3,245,191.37 $2,000,000.00
Actual Costs $1,061,994.29
$1,000,000.00
4th Quarter   $ 3,414,175.67
Projected Costs $-
Obligation Pipeline Expenditure

Obligation as at 30th June2022 Prior Years Actual Expenditure

1st Quarter Actual Costs 2nd Quarter Actual Costs
3rd Quarter Actual Costs 4th Quarter Projected Costs

5
Success Story

Enhancing prep uptake among morans in Kajiado County

Strategies to achieve 1st 95 Background
Kajiado West is located on the rural side of Kajiado county, and the main economic activity is pastoralism.
The men in this community are mostly involved in economic activities to fend for their families. Some of
these activities are charcoal burning, sand harvesting, boda boda business, and running of entertainment joints
at the village squares.
These men spend most of their time away from home thus predisposing them to health risks such as HIV
infections. Their daily engagements in turn deny them opportunities to seek health care services, thus
prompting the prevention team to reach out to them in the community.
The stigmas, myths, and lack of knowledge about HIV that we discovered during our interaction necessitated
tailor-made literacy education, HIV screening, and HIV testing, Condom demonstration and distribution,
PrEP information and initiation, HIV self-test distribution, and other health care services.

Findings
From the five villages visited USAID Fahari ya Jamii observed that most of the men had never heard about
the prevention services and thus managed to reach 310 of these 83 tested for HIV, and 27 were initiated on
PrEP, 4 tested HIV positive and were safely linked to treatment while 30 others were issued with HIV self-
test.

my confidence in the Way forward

services at our local USAID Fahari ya Jamii plans to scale up on this targeted initiative to reach more men in Kajiado County.
healthcare center
has increased after
knowing my HIV
status- one of the
Morans

6
USAID Fahari ya Jamii Quarterly Progress Report – FY22 Q3

USAID Fahari ya Jamii

Contact Person: Reson Marima

The Chief of Party

University of Nairobi

P.O. Box 19676 (00202)

45
Church Road, Off-Waiyaki Way in Westlands

Email: [email protected]