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AIDSTAR-One Emergency Planning for ART During Post-Election Violence in Kenya
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AIDSTAR-One Emergency Planning for ART During Post-Election Violence in Kenya

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In 2007, Kenya experienced a wave of violence following its presidential elections. This case study documents the emergency plans that had been in place to ensure continuity of HIV treatment programs ...

In 2007, Kenya experienced a wave of violence following its presidential elections. This case study documents the emergency plans that had been in place to ensure continuity of HIV treatment programs prior to the outbreak of violence, and the events that occurred during the period of violence. It also highlights the changes to contingency planning for HIV that have taken place since the violence ended.

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AIDSTAR-One Emergency Planning for ART During Post-Election Violence in Kenya AIDSTAR-One Emergency Planning for ART During Post-Election Violence in Kenya Document Transcript

  • AIDSTAR-One | CASE STUDY SERIES October 2011Emergency Planning for HIVTreatment Access in Conflictand Post-Conflict SettingsPost-Election Violence in Kenya T he emergence of antiretroviral (ARV) drugs in the mid-1990s © 2008 Micah Albert, Courtesy of Photoshare and their improved accessibility in developing countries since the United Nations 2001 Declaration of Commitment on HIV/ AIDS (Joint U.N. Programme on HIV/AIDS [UNAIDS] 2001) has greatly transformed the management of HIV treatment. Between 2004 and 2008, the number of people living with HIV (PLHIV) receiving treatment in sub-Saharan Africa increased 30-fold to reach nearly 3 million. In Kenya, where an estimated 1.4 million people are living with HIV, access to treatment has increased significantly. By the end of 2008, there were approximately 243,000 PLHIV in Kenya withKikuyus find shelter from the rain access to ARV treatment (World Health Organization [WHO], U.N.at the U.N. High Commissioner Children’s Fund [UNICEF], and UNAIDS 2009). Of those, fundingfor Refugees camp near Eldoret,the largest camp in Kenya during by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)the post-election unrest. was providing treatment to 166,400 people, including at least 15,521 children (U.S. Agency for International Development n.d.). As access to HIV treatment expands, ensuring the continuity of treatment has grown as a concern. Continuity is critical to both the health of the individual patient and to the effectiveness of the treatment regimen for the population at large. Complex emergencies, such as short-term unrest, long-term displacement, predictable events (seasonal flooding), and unforeseeable events (droughts) present significant logistic and strategic challenges to ensuring the continuous availability of HIVBy Willis Odek and treatment. Provision of HIV treatment in both the short- and long-term isRebecca Oser complicated by migration and resultant displacement, limited (or absent) health care infrastructure and human resources, and instability of existing program continuity. Ensuring an adequate drug supply, integrating HIVAIDSTAR-One treatment into other humanitarian assistance efforts, and providing theJohn Snow, Inc.1616 North Ft. Myer Drive, 11th Floor This publication was produced by the AIDS Support and Technical Assistance ResourcesArlington, VA 22209 USA (AIDSTAR-One) Project, Sector 1, Task Order 1.Tel.: +1 703-528-7474 USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008.Fax: +1 703-528-7480 Disclaimer: The author’s views expressed in this publication do not necessarily reflect the views of the United Stateswww.aidstar-one.com Agency for International Development or the United States Government.
  • AIDSTAR-One | CASE STUDY SERIESnecessary ongoing monitoring and follow-up for estimated 270,000 refugees, mainly of Somali andthose who may remain displaced are critical issues Sudanese origin, live in the Dadaab and Kakumathat must also be addressed (Culbert et al. 2007). camps in northern Kenya (MOSSP and Ministry of State for Provincial Administration and InternalDespite these complications, WHO, along with Security 2008). Instability resulting from Kenya’s ownUNAIDS, the Office of the U.N. High Commissioner internal political turmoil, as witnessed by the eventsfor Refugees, UNICEF, and Médecins Sans following the disputed general presidential election ofFrontières (MSF), has called antiretroviral therapy December 2007, is of increasing concern.(ART) in these settings an “inalienable human rightand a public health necessity” (WHO 2006, 1). These In December 2007, Kenya’s general election pittedagencies have called for inclusion of ART delivery candidates who had previously cooperated andduring short- and long-term emergencies in national served in the same government against one another.operational and strategic plans. To facilitate this For the first time in Kenya’s history, the electionprocess, a common delivery framework should be results also had the potential to unseat an incumbentdeveloped in conjunction with multilateral agencies, president after just one term in office. Voternongovernmental organizations (NGOs), donors, and turnout was phenomenal, and voting was largelyother partners. peaceful. When the presidential election results were announced on December 28, 2007, the main opposition party contested the results on groundsNatural and Manmade of irregularities, including the delayed tallying and announcement of the results. Violence erupted,Disasters especially in regions that were strongholds of the main opposition party.Extreme weather and climate events (droughtand floods) account for major natural disasters The violent conflicts became ethnically based whenand emergencies in Kenya. Vulnerability to people from the tribe of the contested president-elect,natural disasters in Kenya is exacerbated by poor who had been living within the opposition party’ssocioeconomic conditions. Nearly half (46 percent) of strongholds, were driven away, and vice versa. Thethe country’s population lives below the poverty line violent conflicts were at their worst in the first twoof U.S.$1 per day. The areas most prone to natural weeks of January 2008, with killings and destructiondisasters also suffer the poorest socioeconomic of property. The violence eased after the signingconditions. Child malnutrition rates in the northeast of of a peace accord between the main protagonistthe country persist, with national acute malnutrition parties on February 28, 2008, and the formation of arates ranging from 15 percent to 30 percent, coupled coalition government. The regions most affected bywith low immunization rates. Even though Kenya this violence were Rift Valley, Nairobi, Central, andis a net producer of food, more than 50 percent of Nyanza provinces (see map).the population remains chronically food-insecure(Ministry of State for Special Programmes [MOSSP] Official government communication estimated thatand Ministry of State for Provincial Administration 663,921 people were displaced by the post-electionand Internal Security 2008). violence. Over half of those displaced (350,000) sought refuge in 118 camps in different parts ofKenya is also confronted by complex manmade the country, 313,921 were integrated into existingemergencies resulting from politically instigated communities, and 640 families fled into neighboringconflicts in neighboring Somalia and Sudan. An Uganda. On August 14, 2010, the Government of2 AIDSTAR-One | October 2011
  • AIDSTAR-One | CASE STUDY SERIES for HIV services during an emergency developed by the Inter-Agency Standing Committee Task Force on HIV were unfamiliar to both NACC and NASCOP (UNAIDS 2008). Discussions with the Disaster Response Centre, in the Office of the Prime Minister, also confirmed that while humanitarian responses to crises resulting from floods and drought were well coordinated, contingency planning for the provision of HIV treatment and other services during such emergencies was rarely implemented. To understand how this manmade disaster affected HIV treatment, care, and support services, theProvincial Map of Kenya. authors of this case study conducted in-depth interviews with representatives of relevantKenya reported that it had spent about U.S.$38.5 government ministries and different cadres of staffmillion for the resettlement of internally displaced within HIV prevention, treatment, care, and supportpersons (IDPs) and would require a further U.S.$18.7 programs in Kenya. Additional information wasmillion to complete the resettlement program gathered from a review of documents on Kenya’s(MOSSP 2010). Initially, the population displacement disaster management structures, as well as a reviewwas considered a short-term problem that would of published materials on the effects of post-electionabate following the signing of the peace accord, but violence on HIV services. As such, the findingsthe problem persists in some parts of the country. should be taken as a sample of experiences and impressions of local stakeholders, and not as a comprehensive review of all aspects of the responseThe Crisis for Public Health to the post-election violence.At the time of the 2007 presidential elections, there The key questions addressed include the following:was no comprehensive disaster managementframework or strategies guided by appropriate • What is the level of disaster preparedness andpolicies and legislative provisions in place in Kenya. management in Kenya? To what extent do currentNeither of the two key national AIDS response disaster management plans and frameworkscoordinating agencies, the National AIDS Control address HIV prevention and treatment needs?Council (NACC) and the National AIDS/STD ControlProgramme (NASCOP), had a contingency plan for • How did the 2007 post-election violence affectHIV service provision in times of emergency prior the provision of HIV treatment, care, and supportto the 2007 election crisis. The key governmental services? How were the challenges addressed?organization in Nairobi, the Nairobi City Council, wasalso operating without a contingency plan for HIV • Was any contingency planning done to mitigatetreatment when violence broke out. the effects of election-related violence on HIV treatment, care, and support services? If so,A review by UNAIDS shortly after the post-election how were the plans developed? Were thereviolence reported that the international guidelines contingency plan templates available? Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: Post-Election Violence in Kenya 3
  • AIDSTAR-One | CASE STUDY SERIES• What lessons were learned on planning for displaced by the violence only came as a second HIV treatment, care, and support in emergency thought after the provision of other basic services. situations? How have these lessons been used to provide guidance for the future? The spontaneity of the violence meant that most of the displaced PLHIV did not carry their ARV medicine with them. Even fewer carried treatmentImpact on HIV Treatment documents that detailed their HIV status or treatment history. Health care workers interviewed in NairobiServices and Eldoret indicated this lack of medical history was a major impediment to their efforts to provide basicThe post-election violence impacted HIV treatment services in the early phases of the violence, when ain Kenya in several key ways, including disrupting large number of patients presented for treatment butHIV treatment access, stretching health care worker were unable to verify the medication they had beencapacity, exacerbating hygiene and food supply on or their HIV status. Health care workers indicatedconcerns, and creating shortages of medicine and that they provided treatment for these patients basedother supplies for acute illnesses and injuries. on patient self-report of their medication, sometimes relying on visual identification based on the size,Disruption to HIV treatment access: NACC shape, and color of a pill.estimated that some 15,000 of the people displacedby the post-election violence were living with HIV, Further affecting treatment access was theabout half of whom required ART (Regional Centre interruption in transportation caused by thefor Quality Healthcare 2008). The post-election violence. At the height of the violence in the firstviolence significantly disrupted the provision of HIV week of January 2008, public transport servicestreatment, care, and support services in several were largely unavailable. Roads were sporadicallyareas. In Kibera, Nairobi, the Riruta Health Centre, and unpredictably barricaded by armed protestorsa district-level health facility with inpatient services, in some regions such as Rift Valley Province. Inhad to close because of a lack of security for both these circumstances, neither patients, health carestaff and patients. Relatives of patients admitted at workers, nor medical supplies could reach thethe health facility were asked to take the patients health facilities.back home for one week, during which the facilityremained closed. In Rift Valley Province, the Increased workload for health careAcademic Model for Providing Access to Healthcare workers: Several factors coincided during the(AMPATH), a large HIV treatment program, could not post-election violence that contributed to theprovide its full range of services at the peak of the significant increase in workload for health careviolence in the first two weeks of January 2008. workers. First, violence coincided with end-of-year festivities, when many Kenyans travel to visit familyIn addition, when the violence began, many and friends. Many health care facilities were alreadydisplaced PLHIV did not know how to access understaffed as a result.treatment in their new location. The immediatedisaster response to the violence sought to provide Second, the violence itself caused an influx ofshelter, security, and water and sanitation, primarily new patients. At Riruta Health Center, health carein camps established for IDPs. NASCOP and workers reported an upsurge in the number ofNACC observed that attention to the plight of PLHIV patients with soft-tissue injuries during the acute4 AIDSTAR-One | October 2011
  • AIDSTAR-One | CASE STUDY SERIESphase of the violence. This was true even at HIV the community of a person’s status (Regional Centreclinics that would not normally see trauma patients, for Quality Healthcare 2008).because health care facilities became a place ofrelative safety and refuge within communities. A shortage of medicine for acute illnesses: An important concern in emergency situationsFinally, health care workers who were on duty had for patients on ART is supply chain security. Ingreat difficulty reaching their facilities. At Riruta, the case of Kenya’s post-election violence, thereless than half of the facility’s 17 regular health were no widespread problems with ARV shortagescare staff were able to come to the facility and reported from local health facilities. The violenceprovide services. These were health care workers coincided with the end-of-year holiday season, whenwho lived nearby and belonged to the main ethnic the Ministry of Health supplies extra drugs andgroups surrounding the facility, and therefore did not encourages health care providers to give patientsface special security threats based on their ethnic an extra supply of medication to cover the holidaybackground. But for health care workers traveling a season. Thus, even though displaced patientsgreater distance, or traveling to a clinic located in a on ARV treatment might not have carried theircommunity of a different ethnic group than their own, medication with them, they could obtain medicinethe challenges were greater. from other health facilities. A shortage of medicine and other supplies for managing acute illnesses andThese challenges affected both general health care injuries unrelated to HIV treatment and care was,workers and HIV specialists. Indeed, because of the however, experienced in some health facilities.staffing shortages, many health care workers took onadditional roles that they would not ordinarily fill.Exacerbated hygiene and food supply The Response to theconcerns: Lack of food and poor hygienicconditions within some of the camps established for DisasterIDPs presented special challenges for PLHIV, manyof whom were on medications that had to be taken The government response: Because there wasafter eating. Additionally, patients with HIV may be at no high-level response plan or policy in place for HIVhigher risk for opportunistic infections posed by poor treatment in an emergency, the governmental responsesanitation and lack of clean water. was largely reactive and ad hoc. In February 2008, after the election, NACC worked with several U.N.Concerns about stigma: Complicating agencies and civil society organizations to form thethese factors was that fear of stigmatization led Task Force on HIV and AIDS Emergency Responsesome PLHIV to reject some of the outreach efforts (TAFOHER). TAFOHER was tasked with developingtargeting them. Patients were concerned that being workplans encompassing health responses to theseen accepting assistance from organizations violence and with coordinating the multi-sectoralknown to provide HIV-related services would reveal response in the initial period of the crisis. TAFOHERtheir status. For example, publicizing that a mobile prioritized access to and continuation of ART, servicestreatment center would be in a particular location on for victims of sexual and gender-based violence, anda particular date not only informed those in need of the provision of post-exposure prophylaxis (PEP),treatment but also the general public, so accessing including training of health care workers. However,that treatment center would be an announcement to a review of the implementation of the plan found Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: Post-Election Violence in Kenya 5
  • AIDSTAR-One | CASE STUDY SERIEScoordination to be weak, with the HIV emergency included strong community outreach activitiesresponse being “everyone’s business but no one’s within these areas. The program also maintainedresponsibility” (UNAIDS 2008). a regularly updated electronic database on all its clients.The Nairobi City Council also provided servicesduring the post-election violence in Nairobi. They AMPATH management met on the fifth day of theprovided mobile medical services within Nairobi’s crisis to plan how to ensure access to servicesIDP camps, but the services did not include HIV for patients who had been displaced or couldcare or treatment, focusing instead on acute injuries not access the health facilities. The programand trauma counseling. Working jointly with NGOs, broadcasted announcements through televisionthe Nairobi City Council ensured access to PEP and radio urging patients lacking their drugs tofor rape victims at these camps by providing health seek treatment from the nearest health facility.care workers and PEP kits from its medical stores. In the announcements, hotline mobile telephoneBefore the crisis, most health care workers within numbers were given to call for advice on whereNairobi City Council’s clinics had been trained to to obtain medicine or PEP for rape victims, or todeliver PEP, enabling effective services. report medication side effects. Another method used to reach patients with information on whereNGOs, universities, and implementing they could get help was through the network ofpartners: Despite slow initial response from PLHIV.the Government of Kenya and the Ministry ofHealth, implementing partners developed real- The advice to patients to seek treatment from anytime contingency responses to the crisis, including health facility within their reach was reinforced by theretesting patients in some areas to verify HIV status, Ministry of Health’s similar announcement a few daysproviding treatment based on patients’ verbal history later. This strategy helped most patients maintainof medicines taken, and supplying PEP for persons treatment, even though few monitoring data werereporting that they had been raped. In many cases, maintained at the time of the crisis to demonstrateimplementing partners coordinated with local this impact. AMPATH-supported sites reported angovernment facilities to improve the response. increased number of non-program clients seeking HIV treatment and care. The violence interruptedExceptional emergency responses were noted treatment adherence especially among pediatricamong some large HIV treatment programs located patients, but services overall were restored withinwithin the areas most affected by the violence. In Rift two months, and patients returned to treatmentValley Province, AMPATH, a collaborative initiative (Vreeman et al. 2009).of Moi University, Moi University Teaching Hospital,and Indiana University, with significant funding Unlike AMPATH, MSF (an international, independentand support from PEPFAR, undertook innovative organization for medical humanitarian aid) had anmeasures to prevent treatment interruption among emergency plan in place before the crisis began.their clients. At the time of the violence, AMPATH The development of the plan was informed by MSF’sserved an HIV patient population of nearly 70,000, experience in conflict situations in other countrieswith a strong HIV treatment and care program and in anticipation of violence, given previouscovering 49 sites. This program covered government election tension in Kenya. MSF’s contingency planhealth care facilities across western Kenya and included the following measures:6 AIDSTAR-One | October 2011
  • AIDSTAR-One | CASE STUDY SERIES• Establishment of clear lines of communication The MOSSP was created in May 2008 after the between the program’s various clinics, community formation of the coalition government following the members, staff, and headquarters contested election. The two primary objectives of the MOSSP are to address the plight of those affected• Active solicitation of information from the by the December 2007 post-election violence and to government and other NGOs devise strategic policies and programs for disaster management in Kenya.• Regular assessment of the security situation during the crisis to determine which clinics and Since its formation, the MOSSP has worked to services could operate formulate a national disaster response plan with• Provision of a toll-free mobile phone line for integral HIV responses, formulate a draft disaster patients to obtain advice about their treatment management policy and disaster response plan, (O’Brien et al. 2010; Reid et al. 2008). and create a map of national resources for disaster response.Just as the public health sector was prepared for theyear-end holiday season, MSF’s program benefited Disaster response plans and policy: Thefrom purchase of extra stocks of ARVs and other MOSSP’s Disaster Response Plan mandates thatdrugs and provision of an extra supply of ARVs essential therapies for chronic disease—whichto patients to carry over the holiday season and includes HIV—be provided continuously in timeselection period. of emergency. This plan was developed after the December 2007 post-election crisis and has not yetEven with its contingency plans, MSF faced been implemented in times of a disaster or crisis.challenges, including a huge influx of patients with It is not clear how familiar local public and privateacute injuries paired with a shortage of health care organizations are with the Disaster Response Plan.providers. There were also the other challenges,which included patients on HIV treatment who lacked To complement the Disaster Response Plan, thetheir medical records and clients lost to follow-up due Draft National Policy for Disaster Managementto a breakdown of the program’s monitoring system. in Kenya, published in February 2009, outlines a disaster management framework with legislative provisions (MOSSP 2009). The policy proposesKenya’s New Contingency establishing an institutional framework for management of disasters, the National DisasterPlans Management Agency, to serve as the secretariat for the national disaster management systemThe crisis following Kenya’s December 2007 elections coordinated by the MOSSP.has had a profound impact on disaster managementplanning in the country. Key activities since 2007 At the time this case study was written, NACC wasinclude the creation of a government ministry in the process of forming the National Steeringdedicated to disaster management, the formation of Committee for HIV Response in Emergency. Thisa National Steering Committee for HIV Response in committee will review current disaster responseEmergency, and plans to update guidelines for ART to mechanisms that are adaptable for HIV response ininclude emergency preparedness. emergency situations and will develop a workplan Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: Post-Election Violence in Kenya 7
  • AIDSTAR-One | CASE STUDY SERIESto orient local organizations to the Inter-Agency history documentation during the post-election crisis,Standing Committee’s guidelines for HIV response NASCOP plans to add a chapter to the Guidelines forin humanitarian settings and to the national disaster Antiretroviral Therapy in Kenya to provide guidelinespreparedness plan developed by MOSSP. on management of patients in disaster situations. Proposals from some respondents to this case studyMapping of national resources for for inclusion in the revised guidelines include:disaster response: The MOSSP has formulatedthe Disaster Response Center, a national database • A list of facilities providing HIV care and theirthat inventories resources and capacities available contact informationin all national, private, NGOs, community-based • Instructions to health care workers to provideorganizations, and other types of institutions. patients with extra ARVs and co-trimoxazole whenThe purpose of the database is to allow for faster an emergency is anticipatedmobilization of resources and to avoid duplicationof efforts in response to different kinds of disasters, • Advise health care providers to keep medicalincluding HIV. Populating this database has been records of patients even in emergency situationsproblematic, however. The permanent secretaryof the MOSSP, who chairs the Disaster Response • Advise patients to keep a health passport, orCenter, expressed concerns about the database some similar record of their current ART regimen,because some organizations, especially in the on hand at all times, and especially in cases ofprivate sector, were reluctant to share information emergencyabout their resources with the government. • Advise health care providers to ask patientsUpdating guidelines for ART: Recognizing about any planned moves, and advise patientsthe challenges faced by health care workers on alternative sources of care along with contactattending to patients on ARVs with no treatment detailsSUMMARY OF CHANGES TO CONTINGENCY PLANS IN KENYA SINCE THE 2007ELECTIONSActivity Key Players Key Outcomes/GoalsCreation of a ministry dedi­ ated c MOSSP •  evelopment of a national disaster response plan with integral Dto disaster management. HIV responses •  ormulation of draft disaster management policy F •  apping of national resources for disaster response. MFormation of national steering • NACC •  eview current disaster response mechanisms that are ­ daptable R acommittee for HIV response in • MOSSP for HIV response in emergency situationsemergencies. • Stakeholders and •  rain local organizations on Inter-Agency Standing Committee T partners guidelines and MOSSP’s ­ ational disaster preparedness plan n •  ink to disaster response within the MOSSP to ensure the inte- L gration and implementation of HIV services in disaster responses.Plans to update guidelines for ART NASCOP •  dd guidelines on management of HIV patients in disaster Ain Kenya. s ­ ituations to the Guidelines for Antiretroviral Therapy in Kenya.8 AIDSTAR-One | October 2011
  • AIDSTAR-One | CASE STUDY SERIES• Provision of summary medical information by recommended a number of key changes to better health care workers seeing a patient temporarily to prepare Kenya for crises in the future. Kenya facilitate the patient’s reintegration into regular care has made a number of significant strides toward implementing these recommendations and should be• Advise providers to listen carefully to patients’ commended for its effort. However, particular areas description of drugs used in the absence of for further development exist, including: medical records to ensure treatment continuation • Continuing to work toward including HIV• An express policy statement that lack of medical programming as an integral aspect of disaster history should not be a barrier to treatment access management plans, structures, and processes. Situating NACC within the ministry tasked• Ongoing education to patients that they can obtain with overseeing disaster planning (MOSSP) treatment from any government health facility. was a significant strategic first step and calls for continued work on this integration byRecommendations ensuring technical capacity strengthening of both emergency response specialists and HIVKenya has long experience with emergencies, and specialists.some disaster preparedness and response systemshave been developed to address these disasters. • Formally engaging key implementing partners inHowever, even though HIV has been declared a planning and in implementing emergency plans.national disaster since 1999, disaster preparedness Ensuring that coordinating mechanisms functionand management responses have not factored in at all levels, from the national government downHIV prevention, treatment, care, and support needs. to the field. Working with implementing partnersThis gap is partly explained by lack of familiarity would maximize leverage of their institutionalwith essential HIV responses in emergency settings knowledge and local networks to allow thewithin such key HIV response coordination agencies government to greatly expand its reach withoutas NACC and NASCOP. redundancy or excessive investment.The experiences from the post-December • The authors of this case study found extensive2007 general election emergency help highlight and strong informal networks within somethe importance of factoring HIV into disaster agencies and among stakeholders at the localpreparedness and response planning. The new level. These networks should be formalized anddisaster response plan developed by the MOSSP exploited to facilitate rapid, effective response inidentifies essential HIV services. However, written the case of an emergency.contingency plans in and of themselves areinsufficient and must be augmented by appropriate • Some implementing partners mentionedskills and capacities, resources, clear assignment counseling patients on the importance ofof roles and responsibilities, and effective keeping their medical records with them in timescoordination mechanisms. of emergency. UNAIDS also recommended an education campaign for patients on ARVThe UNAIDS review of the HIV response during treatment about the medications they take andKenya’s post-December 2007 election crisis the opportunity to receive treatment from any Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: Post-Election Violence in Kenya 9
  • AIDSTAR-One | CASE STUDY SERIES government facility when the need arises. It would Settings: The Experience of Medicins Sans Frontiers. be beneficial to formalize this education, possibly Conflict and Health 4:12. through a standardized campaign, to empower individual patients in times of uncertainty. Patients Regional Centre for Quality of Healthcare. 2008. can be a key partner in advocating and managing Innovations in Delivering HIV Services in Conflict their own treatment in times of emergency. g Situations: A Case Study of the Kenya Post- December 2007 Election Period (January – March, 2008).REFERENCES Reid, T., I. Engelgem, B. Telfer, and M. Manzi. 2008.Culbert, H., D. Tu, D. P. O’Brien, et al. 2007. HIV Providing HIV Care in the Aftermath of Kenya’sTreatment in a Conflict Setting: Outcomes and Post-Election Violence Medicins Sans Frontieres’Experiences from Bukavu, Democratic Republic of Lessons Learned January – March 2008. Conflictthe Congo. PLoS Med 4(5):e129. and Health 2:15.Joint U.N. Programme on HIV/AIDS. 2001. United U.S. Agency for International Development.Nations General Assembly Special Session on HIV/ n.d. “Kenya Fiscal Year 2008 Country PEPFARAIDS 25-27 June 2001, New York: Keeping the Operational Plan (COP).” Available at www.Promise. Available at http://data.unaids.org/pub/ pepfar.gov/about/opplan08/102017.htm (accessedreport/2002/jc668-keepingpromise_en.pdf (accessed November 2011)July 2010) Vreeman, R. C., W. M. Nyandiko, E. Sang, et al.Joint U.N. Programme on HIV/AIDS. 2008. After 2009. Impact of the Kenya Post-Election Crisis onAction Review–HIV Integration into the Humanitarian Clinic Attendance and Medication Adherence forResponse–Kenya: Post Election Violence. Geneva, HIV-infected Children in Western Kenya. Conflict andSwitzerland: Joint U.N. Programme on HIV/AIDS. Health 3:5.Ministry of State for Special Programmes. 2009. World Health Organization, U.N. Children’s Fund, andStrategic Plan 2008-2012: Building Resilient Joint U.N. Programme on HIV/AIDS. 2009. TowardsCommunities in Kenya. Nairobi, Kenya: Ministry of Universal Access: Scaling up Priority HIV/AIDSState for Special Programmes. Interventions in the Health Sector. Progress Report. Geneva, Switzerland: World Health Organization.Ministry of State for Special Programmes.2010. Press Statement. An Update on the IDPResettlement Programme. Daily Nation Newspaper, RESOURCESAugust 14. Government of Kenya. 2009. Draft National PolicyMinistry of State for Special Programmes and for Disaster Management in Kenya. Available atMinistry of State for Provincial Administration and www.kecosce.org/downloads/DRAFT_DISASTER_Internal Security. 2008. National Disaster Response MANAGEMENT_POLICY.pdf (accessed AugustPlan. Nairobi, Kenya: Ministry of State for Special 2011)Programmes. Inter-Agency Standing Committee Task ForceO’Brien, D. P., S. Venis, J. Greig, et al. 2010. on HIV. 2010. Guidelines for AddressingProvision of Antiretroviral Therapy in Conflict HIV in Humanitarian Settings. Available at10 AIDSTAR-One | October 2011
  • AIDSTAR-One | CASE STUDY SERIESwww.humanitarianinfo.org/iasc/pageloader. Executive Director, Supply Chain Managementaspx?page=content-subsidi-common-default&sb=66 System; at the Nairobi City Council, Florence(accessed August 2011) Chandi, Deputy Chief Nursing Officer, Nancy Mungai, Deputy Chief Nursing Officer, JenniferInternational Federation of Red Cross and Red Oywer, Nursing Officer, Charles Muchai, DeputyCrescent Societies. 2008. World Disasters Report Communicable Disease Surveillance Officer, and2008 – Focus on HIV/AIDS. Available at www.ifrc. Juma Kisindani, District Medical Officer of Health; atorg/Global/Publications/disasters/WDR/wdr2008-full. AIDS, Population, and Health Integrated Assistancepdf (accessed August 2011) II (Pathfinder International), Dr. Mary Kariuki, Service Delivery Specialist; at the Academic Model forInternational Federation of Red Cross and Red Providing Access to Healthcare, Bornice Biomndo,Crescent Societies. 2009. World Disasters Report Communications and Public Relations, and Dr. S.2009 – Focus on Early Warning Systems. Available J. Kimaiyo, Director; at the Moi University Teachingat www.ifrc.org/Global/WDR2009-full.pdf (accessed Hospital Disaster Response Unit, Dr. NyaberaAugust 2011) Saratiel, Surgeon and Head, Disaster Response Unit, and Anne Kimani, Nurse; Irene Mukui,Kenya National Bureau of Statistics. 2010. Kenya ART Manager at the National AIDS/STD Control2009 Population and Housing Census Highlights. Programme; John Wasonga, HIV/AIDS TreatmentAvailable at www.knbs.or.ke/Census%20Results/ Specialist at the U.S. Agency for InternationalKNBS%20Brochure.pdf (accessed September 2010) Development; Alice Nateche, Communications Officer at the National AIDS Control Council; andNational AIDS Control Council. 2009. Kenya at the Office of the Prime Minister, Crisis ResponseNational AIDS Strategic Plan 2009/10 – Centre, Koitamet Olekina, Consultant/Logistics &2012/13. Available at www.nacc.or.ke/index. Liaison, and Sammy Makama, Public Health Officer.php?option=com_content&view=article&id=112&Ite Thanks also to Robert Ferris and Tom Minior withmid=87 (accessed August 2011) the U.S. Agency for International Development inWorld Health Organization. 2006. Antiretroviral Washington, DC for their support of this case study.Drugs in Emergencies: Neglected but Feasible.Consensus Statement. Available at www.who.int/hac/techguidance/pht/HIV_AIDS_101106_ RECOMMENDED CITATIONarvemergencies.pdf (accessed December 2009) Odek, Willis, and Rebecca Oser. 2011. Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: Post-Election Violence inACKNOWLEDGMENTS Kenya. Case Study Series. Arlington, VA: USAID’sThe authors would like to thank all of the many AIDS Support and Technical Assistance Resources,people who were so generous with their time and AIDSTAR-One, Task Order 1.insights in interviews for this case study including:David Kamau, Nurse-in-charge, Riruta Health Please visit www.AIDSTAR-One.com forCentre, Nairobi; Josephine Mutegi, Nurse-in-Charge, additional AIDSTAR-One case studies and otherMathare North Health Centre; Dr. Ephantus Njagi, HIV- and AIDS-related resources. Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: Post-Election Violence in Kenya 11
  • AIDSTAR-One’s Case Studies provide insight into innovative HIV programs and approachesaround the world. These engaging case studies are designed for HIV program planners andimplementers, documenting the steps from idea to intervention and from research to practice.Please sign up at www.AIDSTAR-One.com to receive notification of HIV-related resources,including additional case studies focused on emerging issues in HIV prevention, treatment,testing and counseling, care and support, gender integration and more.