Differentiated Service Delivery in Kenya
Kenya has a national policy on differentiated service delivery (DSD) and an active national technical working group. These assets position Kenya as a DSD leader in sub-Saharan Africa. Kenya’s 2016 National ART Guidelines include the integration of a DSD target package including the target audience, training package, and structure for rolling out DSD at the country, health facility, and community levels.
Kenya has recently updated its monitoring and evaluation (M&E) tools to define the categorization of patients in DSD. Recently, NASCOP released a handbook on improving quality and efficiency of in-country health services and a differentiated care operational guide for 2017. The operational guide highlights best practices, and re-organizes the guidance on how to implement services along the HIV care and treatment cascade.
The DSD guidelines include guidance for county, facility, and community-level planning, implementation, and M&E strategies. Barriers to scaling up DSD include a high health facility staff turnover rate, limited community structures to support ART uptake, and limited use of viral load monitoring for patients on DSD.
The next steps and priorities for scale-up of DSD include monitoring treatment outcomes, developing a DSD dashboard to understand country-level activities, and providing technical assistance to 47 counties and facilities to scale-up DSD. Further research priorities include tracking patient outcomes onDSD, quality improvement initiatives for adolescents and young people, and cost-effectiveness analysis of the current DSD programs.