"PEPFAR gives impact"

PEPFAR Kenya gives hope and impact through....

equipping medical providers to do their work with excellence

"Do not be discouraged by the numbers; look instead at the impact you are having." (Colonel Shannon Lacy + Dr. Isaac Tsikhutsu)

Human Resources for Health (HRH) is a critical component to the success of any program. A large part of PEPFAR’s support in Kenya therefore includes HRH employment at implementing partner (IP), facility, and community levels, as well as capacity building through trainings and mentorships. PEPFAR Kenya spends close to 50% of the annual budget on health workforce support for about 30,000 staff, including clinical and community/ lay cadres. However, these alone are not sufficient to provide continued care to the over 1.3 million Kenyans on ART and millions more receiving HIV prevention, testing, and care for orphans and vulnerable children affected by HIV. PEPFAR therefore works with the Government of Kenya, faith-based organizations, the private sector, and other stakeholders to address critical staffing gaps.

Over the last 20 years, PEPFAR has supported the GOK to ensure the health care workforce in Kenya possesses the requisite capacity to manage and sustain HIV impact and address other related health issues at the national, sub-national, and community level. This intervention has been described by Dr. Isaac Tsikhutsu, a PEFFAR trained pediatrician, as a tremendous game changer. Dr. Isaac notes that, “when PEPFAR came, we were excited that we now had ARVs, but most of us didn’t know the drugs, we didn’t know the side effects… and then there was the challenge that most children were not being put on antiretroviral drugs, because their regimens were more complicated”. Initially, ART, and especially pediatric ART, was being provided only by specialist doctors like Isaac, but capacity has been built throughout the health care workforce, cascading down to medical officers, clinical officers, nurses, and other lay cadres who are all critical in the outcomes of patients. “PEPFAR organized a very big training of trainers,” Isaac recalls, and it was through such trainings of senior staff that Dr. Isaac became part of the trainers who helped cascade the trainings to more health care workers; twenty years on, Dr. Isaac continues building the capacity of other health care providers through mentorship.

As Kenya approaches HIV epidemic control, focus is now shifting towards sustainability, and MoH staff - including community level staff - are central to HIV service provision through what Dr. Isaac describes as the ‘multiplier effect’ of the trainings’ impact. In his opinion, PEPFAR’s impact goes beyond the numbers to the hope he sees in the children he once attended to when they were infants, who are now young adults, and in the HIV positive youth he once cared for who are now adults, living productive lives, positively. The current Kenya government has primary health care (PHC) as its priority health agenda under universal health coverage (UHC).  In FY 2024, part of PEPFAR investments will support development and review of standards, guidelines, training curricula and support supervision materials for effective HIV service delivery, and workforce alignment to the PHC/UHC agenda at the national and county levels for a responsive, sustainable HIV program in Kenya.

As the country’s HRH arena evolves, we cannot forget the tremendous contributions of the early physicians who boldly assisted our country to fight the then considered deadly emergency: HIV. Dr. Isaac has worked in the South Rift valley region for over 20 years. His story is one among thousands of other untold heroic stories.  

Dr. Isaac started working as a Medical Officer in the late 90s when ARVs were not readily available, and patients were only being put on Cotrimoxazole for opportunistic infections. The mortality rate was very high then. Things changed in 2004 when PEPFAR made life-saving ARVs available. By then Dr. Isaac had completed his residency in pediatrics and started being actively involved in PEPFAR-supported pediatric ART trainings, mentorship, and treating HIV positive children in hospitals in the South Rift region. He helped the PEPFAR team to set up child- and adolescent-friendly services. He mentored health care workers and was instrumental in decentralizing pediatric ART services to the lower facilities. After working as a sub-specialist at Kenyatta National Referral Hospital, he later transitioned from GoK/MoH to the PEPFAR program in 2015, and is currently leading the clinical, mentorship and technical assistance team, where he continues to mentor more people to support pediatric ART. He was also actively involved in some of the policy-changing research at the KEMRI/Walter Reed Kericho site, including the clinical trial that made dolutegravir licensed for use in children, as well as the TB regimen shortening study, among other breakthrough findings.

As he reflects on his 20-year career as a pediatrician, Dr. Isaac is struck by how PEPFAR has saved and transformed so many lives, and he is grateful for the equipping he and thousands of other medical providers have received, through PEPFAR, that has enabled them to impact so many people – providers and patients alike. “Through the investment of PEPFAR in human resources like myself, we've now had a very big multiplier effect, and if I look at the program currently, I think PEPFAR is only providing technical support; because of this multiplier effect, most of the work actually is now done by the Ministry of Health and the faith-based organizations, by Kenyans.” He also reflects with gratitude on the impact he has been able to have – measured not by numbers, but by stories of hope, in the form of increased health and future opportunities for HIV positive children and youth, like Aron. Beyond treating them, he also mentored and encouraged children and adolescents infected with HIV to live positively, with hope for the future. Some of the children he treated are now adults in gainful employment … “And now, 20 years down the line, they are living healthy, productive lives; some are musicians, others work in banks, and they are now encouraging other adolescents and helping them go through their young adult process… I'm very proud of this, and even if I leave PEPFAR, I think I will still continue talking about this wherever I will be.”

Photos © Sarah Day Smith + Rachel Weber / US Embassy Nairobi