WORLD VISION IS PROUD OF PEPFAR
On this World AIDS Day, GAPP members share why they are so proud of PEPFAR’s and what they envision for its future. Below, James Mukabi, Chief of Party, World Vision Kenya, provides an overview of the Tumikia Mtoto, a PEPFAR funded project in Kenya.
PEPFAR is widely recognized as a shining example of U.S. global leadership and bipartisanship. Why do you think this is?
Before the inception of PEPFAR in 2003, the HIV pandemic was spiralling out of control and the infection was almost sure death sentence. Over the years, PEPFAR has invested more than $100 billion in over 50 countries in a well-organized global response. Over 25 million lives have been saved with more than 20.5 million people on life saving drugs; 5.5 million babies born HIV free, 7 million orphans and vulnerable children (OVC) supported, and over 2.5 million adolescent girls and young women (AGYW) reached with HIV prevention services.
Kenya is an example of this progress. The country is on a path to meet the UNAIDS 95-95-95 targets. Currently, 1.3M people are on life saving drugs, 32,000 HIV-positive pregnant women have received antiretroviral drugs to reduce risk of mother-to-child transmission during pregnancy and delivery, 608,090 OVC are supported, and 43,000 health care workers have been injected into the health system.
Kenya is home to USAID Tumikia Mtoto, a PEPFAR funded-five year project supporting OVC and AGYW. It’s implemented by World Vision Kenya working with six local implementing partners in Nairobi and Kiambu counties in Kenya. Since its inception, the project has supported 162,954 OVC with various services based on identified need. The support includes immunizations, educational materials, birth certificates and more for orphans and vulnerable children. It supports AGYW with various needs-based interventions including Pre-Exposure Prophylaxis (PrEP) and HIV prevention messages, entrepreneurship, financial, and parenting training, as well as educational subsidies.
Why do you think it’s so important for the U.S. to play such a significant role in the global HIV/AIDS response?
Despite the heavy investments made to the global AIDS response through PEPFAR, the pandemic continues to evolve in countries and in communities. In many countries, we are seeing increasing infections among adolescents and young people, especially among girls and women aged 15-30 years. We are also seeing lower treatment success rates among children compared to adults. Sexual and gender-based violence also remain a challenge, especially among AGYW. Such challenges and gaps call for continued investments in the global AIDS response through PEPFAR, otherwise it may negate the gains already made.
Challenges and gaps call for continued investments in the global AIDS response through PEPFAR, otherwise it may negate the gains already made.
What makes PEPFAR so effective? What lessons from PEPFAR can we apply to other global health challenges?
PEPFAR has strengthened data management and reporting systems at community to national levels, making it easier to access HIV data. This has improved reporting as well as use of the data for planning and inform implementation strategies. The data management strategies have not only benefited HIV programs but have been replicated in other services areas such as reproductive, maternal, neonatal, child health and adolescent health, water sanitation and hygiene, and nutrition. For example, USAID Tumikia Mtoto utilizes the Child Protection Information Management System to provide data and report on OVC activities. It also uses PEPFAR’s DREAMS’ (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) database to report on AGYW interventions.
Through PEPFAR support, a lot of focus has been put on strengthening the capacity of local organizations so that they play a bigger role in the ongoing response at national, subnational, and community levels. As a result, an increasing number of local organizations are successfully implementing PEPFAR funded programs, either as lead organization or sub-awardees. This may provide lower implementation costs, helping each dollar go further. It also ensures better sustainability of the ongoing interventions. Under USAID Tumikia Mtoto, World Vision Kenya has been strengthening the capacity of it six local implementing partners (LIPs) based on gaps identified through an organizational capacity assessment. The LIPs have reported improved capacity in key areas including leadership and governance, financial management systems, procurement systems, health information systems and program management.
PEPFAR programs work with key sectors, as well. USAID Tumikia Mtoto works with county Departments of Health, Education, Gender, Children Services, and Trade, among others. The project also partners with over 20 actors from the private sector. Through partnership with Family Bank, over 400 AGYW have been trained in construction skills, an industry that is traditionally male dominated, and linked to employment opportunities.
USAID Tumikia Mtoto, like other PEPFAR programs, works with government systems as appropriate. The project collaborates with county government in co-creation of its annual workplans and budgets, co-activity implementation, and co-monitoring. This ensures county buy-in and transition of interventions from the project to counties for sustainability. The project has trained over 4,000 community workers to ensure continued follow up and support of OVC and AGYW at community level. Capacity strengthening of LIPs is ongoing to ensure they continue with the interventions beyond the life of the project.
What would you tell people who say that we shouldn’t be focusing on one single disease area at this level when there are so many other global health challenges?
PEPFAR investments have strengthened health systems, including building additional clinics, providing additional human resources for health, strengthening laboratories, improving commodity management and supply chain systems, improving data management and its use for decision making, and improving disease surveillance and reporting systems. These improved health systems have directly or indirectly supported delivery of other services such as reproductive, maternal, neonatal, child health and adolescent health, water sanitation and hygiene, and nutrition. During the COVID-19 pandemic, these strengthened health systems helped in preparedness and response, and averted many deaths in countries like Kenya.
This past spring, PEPFAR was reauthorized for one year. Typically, it receives a 5-year reauthorization. Why is a multiyear reauthorization necessary?
A multi-year extension provides required certainty and allows for long- term plans. Although we are making good progress towards the UNAIDS 95-95-95 target, the uncertainty in continued funding could affect on-going treatment of the over 1.3M people living with HIV in Kenya and the control of new infections, especially in children and adolescents and young people.
If you could tell U.S. decision makers one thing about why you are proud of PEPFAR, what would it be?
I am proud of the way it has restored hope in the lives of many desperate people affected by HIV and AIDS such as 19-yeard old Peter (not his real name) who recently graduated from the Tumikia Mtoto program. Peter is HIV positive and was enrolled in the program four years ago while living with his single mother and two other siblings. HIs mother was also HIV positive, though his siblings were not. The family could barely afford a meal a day. The children were out of school due to lack of school fees. Peter and his mom were not adhering well to their HIV drugs mainly due to inadequate food, and, as a result, suffered from frequent opportunistic infections.
Once in the program, the family was supported with food rations and Peter and his mom followed up regularly to ensure adherence to their HIV drugs. The program also paid school fees for Peter and his siblings. His mom joined a savings group comprised of 20 other HIV positive women. The group was trained by the program on entrepreneurship and given a small grant to start a local peanut butter production business. The business grew from the initial grant of US$100 to an average monthly income of US$2,300 over a three-year period. Earnings from the business have enabled Peter’s mom to meet her family’s needs, including paying fees for Peter and his siblings. Achieving economic resilience, Peter’s family was able to graduate from the program. His mom could not hide her joy during the graduation event and exclaimed that she had “seen the face of God” through the program’s support that had “saved the family from shame and imminent death.”