We have been measurably improving the health of Kenyans since 1989. Our approach harnesses the vitality of the private sector to improve health outcomes for Sara — PSI’s archetype that focuses our interventions.
We address the most serious health challenges affecting resource-poor and vulnerable communities in Kenya, including HIV/AIDS, reproductive health and family planning, non-communicable diseases and the greatest threats to children under five including malaria, diarrhea, pneumonia and malnutrition.
Transition to PS Kenya
After 25 years of successful operations in Kenya, we recognized that Kenya – and our organization – had come a long way. The challenges we face today, while considerable, are greatly different than the days when our program was established. In recognition of that evolution, from 2014, PSI’s operations transitioned to a locally registered, independent, Kenyan entity. By doing so, we ensured that Population Services Kenya continued to be well positioned to sustainably improve the health of Sara for years to come. Today, PS Kenya is part of PSI’s global network of locally governed organizations which makes it stronger, more effective and provides greater value to our donors, the Kenyan government and stakeholders.
We believe a locally led and governed organization is well positioned to work with the Government of Kenya and donors to deliver local solutions driven by best global practices. PSI will continue to provide technical assistance and support to PS Kenya.
PS Kenya estimates that in 2015, its products and services helped avert 2,060,641 DALYs, including, by health area:
- 315,537 Malaria DALYs
- 1,354,485 HIV DALYs
- 386,643 FP DALYs
- 1,365 MNCH DALYs
- 2,524 WASH DALYs
- 87 NCD DALYs
PS Kenya’s family planning programs also provided 1,110,759 couple-years of protection.
Through PS Kenya, we work closely with private sector stakeholders including more than 55 commercial distributors, 700 wholesalers, and more than 30,000 kiosks, dukas, pharmacies, bars and lodges. We support a network of over 320 private providers in the Tunza clinics, dozens of community-based organizations, and hundreds of institutions, suppliers, and partners.
Health Service Delivery
PS Kenya manages the Tunza Family Health Network, a social franchise targeted at providing quality healthcare to low-income and vulnerable populations.
The franchise, launched in 2008, is comprised of selected private health clinics providing primary health care services with PS Kenya franchising the key health areas in line with national priorities.
Through the Tunza Family Health Network of over 320 clinics, PS Kenya delivers quick, quality and affordable integrated health services to vulnerable populations in the rural and peri-urban settings. Franchised services focus on increasing access to family planning, HIV testing, care and treatment, cervical cancer screening and preventative treatment (CCS&PT), HIV testing and counseling (HTC), HIV care and treatment, integrated management of childhood illnesses (IMCI), and voluntary male medical circumcision (VMMC). In 2011, a family planning voucher scheme was introduced and to date 324,888 low-income women have been able to access a family planning method of their choice through the voucher subsidy scheme. In 2014, four new health areas were introduced to the network including safe motherhood, tuberculosis, hypertension management and elimination of mother-to-child transmission of HIV (eMTCT).
More than 70% of Kenyans are at risk of malaria. This preventable disease is responsible for the loss of 170 million working days each year and 13% of all deaths among children under five (34,000 deaths). Malaria still accounts for 30% of outpatient attendances and 19% of admissions to health facilities.
Kenya’s malaria programs support the Ministry of Health through the Malaria Control Unit in achieving its vision towards a malaria-free Kenya.
Through our network member, PSK, the malaria program in Kenya complements the government’s revised National Malaria Strategy 2009-2018’s objective to achieve universal coverage of long-lasting insecticide treated nets (LLINs) through three distribution channels: 1) free routine distribution of LLINs targeting children under one and pregnant women; 2) social marketing of LLINs through community-based operators and rural retail outlets in Nyanza, Western and Coast at a subsidized cost; and 3) mass distribution of LLINs that occurs every 3 years. In addition, implementation began on a pilot project focusing on sustaining universal coverage levels through community distribution channels and to explore alternatives to the resource heavy mass net distribution. The results of this pilot will be used to determine the feasibility of replacing mass net distribution with the continuous community distribution channel.
To increase utilization of the distributed nets, PS Kenya employs an array of behavior change communications (BCC) approaches. These include interpersonal communication in small group sessions especially in net distribution sites and individual door-to-door barrier analysis and counseling by trained community health volunteers. PSK harnesses mass media campaigns through radio and TV targeting high malaria prevalence regions as well as national stations to create overall awareness. To complement the mass media, outdoor advertising has been harnessed through the use of billboards, digital screens at the ferry, health care channels and bus branding.
PS Kenya works closely with the Kenyan government and other partners to contribute to the reduction of HIV incidence in Kenya. Since 1993, PSI’s condom social marketing program has made more than 400 million Trust-branded condoms available. Behavior change, demand creation and increasing access for condom use have been critical elements of the program and surround and engage campaigns focus on those practicing higher risk behaviors. For example, concurrent sexual partnerships are tackled through the Weka Condom Mpangoni campaign, while condom negotiations among youth are targeted through the Nakufeel campaign. HIV testing and counseling, and voluntary medical male circumcision are also important components of our HIV prevention efforts. In addition, PS Kenya has integrated TB and HIV care and treatment services in the private sector through the Tunza Family Health Network. The program focuses on increasing the capacity of private providers to offer quality HIV services and to track and refer clients.
In support of the global call to increase identification of those who are HIV positive, PSK is rolling out HIV self-testing kits. These kits are available through private sector pharmacies and some private health facilities to reach people who don’t test through traditional modes and provide them with an easy and confidential way to know their status. In addition, as part of revitalizing HIV prevention, PS Kenya has rolled out Oral Pre-Exposure prophylaxis – a pill for those who test HIV negative but are at ongoing risk of HIV infection. The program has already enrolled several clients on PrEP in some private sector facilities.
In Kenya, the unmet need for family planning is high – less than half of Kenya’s married couples use modern family planning methods. In collaboration with national and county governments, PSK seeks to provide access, create demand and improve service delivery of contraception within the context of informed choice. PSK’s reproductive health program aims to increase contraceptive use (both long and short-term family planning methods) through social marketing, communication campaigns and community interventions. Recognizing the important role that pharmacies, clinics, and providers play in sustaining health care, teams focus on improving the knowledge, skills, and motivation of health care providers in the provision of quality family planning services. In addition, PS Kenya communicates to reach youth and women of reproductive age through generic family planning campaigns. PSK also builds the capacity of pharmacists and Tunza franchise health providers to counsel clients on all methods to address the supply side barriers, thus improving their knowledge, skills, attitude and performance in offering quality family planning services.
Through the support of African Health Markets for Equity, PSK launched a safe motherhood initiative in 2014 through 75 Tunza facilities with the following strategic objectives: increase demand and access to safe motherhood services within Tunza and improve quality of care through training and support supervision. Communication materials targeting pregnant women such as flip charts and brochures have also been developed.
In Kenya, 74 out of every 1,000 children born do not live to the age of five years of age (KDHSd2008/2009). Childhood illnesses with fever include pneumonia, diarrhea and malaria, and others, with the percentage of deaths in children under five years being: pneumonia 17%, diarrhea 9% and malaria 3% (WHO Kenya Report 2013). Fever cases have been over-treated using antimalarial medicines, leading to increased resistance. Consequently, the malaria policy has changed to stipulate that all suspected malaria cases must be diagnosed using either malaria rapid diagnostic tests (mRDTs) or microscopy. PS Kenya is working with pharmacies and clinics in the Coast region to create a private sector market for rapid diagnostics tests (RDTs). The child survival focus for PS Kenya has changed to addressing major illnesses related to fever.
- Distribution and promotions of household point of use (POU) water treatment products such as WaterGuard, P&G Water Purifier and Aquatabs in an effort to prevent diarrhea.
- Promoting the use of ORS and zinc which is now a Ministry of Health-recommended first line treatment for diarrhea in children under the age of 5 years.
- Social marketing of RDTs to improve fever treatment in children under the age of 5 years presenting fever.
- Increasing the number of care- givers who know diseases prevented by vaccines and also who complete the immunization schedule.
Noncommunicable diseases account for more than 50% of total hospital admissions and over 55% of hospital deaths in Kenya. Major noncommunicable diseases (NCDs) in Kenya include cardiovascular conditions, cancers, diabetes, and chronic obstructive pulmonary diseases. The prevalence of hypertension has increased over the last 20 years. Hypertension is a significant risk factor for coronary heart disease and the single most important risk factor for heart attack, heart failure, stroke or other complications. In Kenya, 44.5% of adults have raised blood pressure, one of the highest prevalence rates across Africa. AstraZeneca’s Healthy Heart Africa (HHA) is an innovative and sustainable program that aims to improve the lives of hypertensive patients across Africa. The program was launched in Nairobi on 28th October 2014. In line with the WHO’s 25 by 2025 global monitoring framework for preventing and controlling NCDs, the ultimate aspiration of HHA is to reach 10 million hypertensive patients across sub-Saharan Africa by 2025. PS Kenya is working with the Healthy Heart Africa program to integrate hypertension services into existing Tunza healthcare facilities and community health worker networks.
During the demonstration program (2015 to 16), PS Kenya worked with 79 Tunza providers and a network of community health workers to reach more than half a million people with hypertension communication messages, with over 200,000 screened and 15,612 patients treated. The demonstration program generated key learnings and approaches that are being used to improve and expand outreach, screening and treatment.
It is projected that the HHA program will result in screening a minimum of 2,246,400 people, treatment of at least 171,607 patients, and adherence and control of a total of 103,761 and 54,636 patients, respectively by 2019. PSK also makes use of an innovative mobile technology platform to register, communicate with and reward program participants in an effort to improve the rate of clinical referrals, thereby increasing patient screening and testing.
Malnutrition in Kenya remains a key public health concern. Kenya has high stunting rates (35%) and is currently experiencing a rise in diet-related non-communicable diseases such as diabetes, cancers, kidney and liver complications that are attributed to the consumption of foods low in fiber and high in fats and sugars. PS Kenya continues to build on partnerships and collaborations to integrate large scale, evidence-based nutrition interventions into the existing programs it currently runs. Some of these high impact nutrition interventions include: scaling up maternal infant and young child nutrition, scaling up micronutrient powders and promotion of fortified foods, management of severe acute malnutrition, and integrating health and nutrition intervention
- UK Department for International Development (DfID)
- U.S. Agency for International Development (USAID)
- Bill & Melinda Gates Foundation (BMGF)
- African Health Market for Equity (AHME)
- Procter & Gamble (P&G)
- The World Bank
- The Global Fund to Fight Malaria, AIDS and Tuberculosis
- Unilever Foundation
- United Nations Children’s Fund (UNICEF)
- Ministry of Health
- Malaria Control Unit
- Family Planning Unit
- Maternal and Child Health Unit
- National AIDS and STDs Control Programme
- National AIDS Control Council
- Division of Nutrition
- Division of Leprosy, TB and Lung Disease
- The Health Promotion Unit (HPU)
- The Community Health Strategy Unit (CHS)
- The Neonatal, Child and Adolescent Health Unit (NCAHU)
- The Division of Nutrition (DON)
- Kenya Medical Research Institute
- Marie Stopes Kenya
- FHI 360
- Safe Water and AIDS Project
- At the community level PS Kenya collaborates with local Community Based Organizations (CBOs) and peer partners such as Safe Water and AIDS Project (SWAP), KMET, UZIMA, SCOPE and Jhpiego among others.
- On the ground, PS Kenya works hand in hand with community members, peer educators, persons living with HIV (PLHIV) and community health workers (CHWs)
- Do anti‑malarials in Africa meet quality standards? The market penetration of non quality‑assured artemisinin combination therapy in eight African countries
This paper uses national and sub-national medicine outlet surveys conducted in eight study countries (Benin, Kinshasa and Kantanga [Democratic Republic of the Congo, DRC], Kenya, Madagascar, Nigeria, Tanzania, Uganda and Zambia) between 2009 and 2015 to describe the non-QAACT market and to document trends in availability and distribution of non-QAACT in the public and private sector.
- Examining the Effects of HIV Self-Testing Compared to Standard HIV Testing Services: A Systematic Review and Meta-Analysis
To inform World Health Organization guidance, we assessed the effect of HIVST on uptake and frequency of testing, as well as identification of HIV positive persons, linkage to care, social harm and risk behavior. A meta-analysis found that HIVST is associated with increased uptake and frequency of testing in randomized controlled trials. WHO now recommends HIVST as an additional HIV testing approach.
- Quality Issues with Malaria Rapid Diagnostic Test Accessories and Buffer Packaging: Findings from a 5‑Country Private Sector Project in Africa
This paper describes quality problems with buffer and accessories encountered in a project promoting private sector malaria rapid diagnostic test use in five African countries and suggests steps to avoid or more rapidly identify and resolve such problems.
- Webinar: Stimulating the Market for Malaria RDTs in the Private Sector
PSI, UNITAID, Malaria Consortium, FIND, and JHSPH held a webinar to discuss leveraging the power of the private sector to transform the mRDT market in support of universal access to malaria diagnostics.
- Shaping the Family Planning Market by Strengthening the Public Sector
PSI considers total market approaches to be critical for achieving universal health coverage, especially when it comes to contraception. This program brief presents cases, supported by several different donors, which take into consideration the total family planning market.
- Transforming the Private Sector to Support Universal Malaria Diagnostic Coverage
To assure the available and use of malaria rapid diagnostic tests in the private sector, PSI and partners conducted a three-year project between 2013 and 2016 to increase the uptake of quality-assured mRDTs in private-sector markets in Kenya, Madagascar, Nigeria, Tanzania, and Uganda by taking a market development approach to identify market failures.
- Towards Subsidized Malaria Rapid Diagnostic Tests. Lessons Learned from Programmes to Subsidise Artemisinin-Based Combination Therapies in the Private Sector: a Review
Private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. A subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries.
- What Happened to the Malaria Market in Kenya after the AMFm?
The AMFm continuation under the private sector copayment mechanism has maintained strong QA ACT availability in the private sector, where nearly 90% of antimalarials are distributed. However, QA ACTs accounted for only half of antimalarial distribution, and 1 in 5 antimalarials distributed were non-QA ACTs. Furthermore, QA ACT price increased following the AMFm pilot to more than double that of SP. Availability of confirmatory testing has improved in the public and private sectors, however availability remains low in the private sector and only 1 in 4 antimalarial-stocking outlets were equipped to test. This result suggests that presumptive treatment remains common.
- Expanding Access to HIV Self-Testing: A Market Development Approach
PSI envisions a healthy market for HIVST to be one that is supported by multiple buyers and suppliers and that delivers on the 5As (Availability, Assured Quality, Appropriate Design, Awareness, and Affordability) to achieve public health goals. Realizing this vision for the HIVST market will require consideration of two key markets- public and private sectors. While HIV testing has traditionally been driven by the public sector, HIVST opens up the possibility of utilizing private sector pharmacies to expand and extend the reach of testing.
- Fever Case Management Supervisor Job Aid
Supervisor job-aids assure that quality of fever case management (FCM) is preserved even many months after trainings. These supervisor job-aids are part of a larger Quality Assurance Manual and Toolkit developed through the UNITAID Private Sector RDT project to provide guidance on quality assurance for FCM in the private sector.