Differentiated Service Delivery in Kenya
Percent of health facilities providing less-intensive DSD models. Of the 3,837 ART facilities in the country, 2,800 have enrolled at least 10% of eligible recipients of care into less-intensive models. Source: October 2021 CQUIN DSD Dashboard staging
% In Less-Intensive
Percent of people on ART who are enrolled in less-intensive DSD models. In a sample covering 45% of all people on ART, 243,135 of 556,698 recipients of care have been enrolled in less-intensive models. Source: National electronic medical records data, end June 2021
# of Less-Intensive
Number of less-intensive DSD models designed for people doing well on ART. Less-intensive models include: Fast Track, Facility ART Distribution Groups, Peer-Led Community ART Groups, and Health Care Worked-Led Community ART Groups. Source: October 2021 CQUIN data report
Number of groups for whom less-intensive DSD models have been designed and implemented. Differentiated ART models are available for adults who are doing well on ART and eligible adolescents, as well as adults with co-morbidities, patients at high risk of disease progression, men, pregnant or breastfeeding women, and key and vulnerable populations. Source: October 2021 CQUIN DSD Dashboard staging
Differentiated Service Delivery in Kenya
Kenya joined the CQUIN learning network in 2016, bringing with it an existing national policy on differentiated service delivery (DSD) and a technical working group tasked with providing input and guidance on DSD implementation. Currently, Kenya’s Ministry of Health and the National AIDS and STI Control Program (NASCOP) provide guidance on DSD implementation and work toward improving and expanding upon existing DSD models to present recipients of care with more options.
Recipients of care have played an integral role in the scale-up, implementation, and prioritization of DSD in Kenya. Community members actively participate in policy revisions and the development of new guidelines. One such policy propelled by the RoC community called for the provision of a basic health education curriculum to everyone receiving ART, creating more informed and empowered DSD mechanisms.
Currently, Kenya offers five different models of ART service delivery, including four less-intensive DSD models and the more-intensive conventional model known as “Standard Track.” All four less-intensive models include three-month multi-month scripting for ART refills, allowing recipients of care to pick up medication in bulk and minimize clinic visits. The less-intensive differentiated models include:
- Two facility-based models: fast track; family-centered model of care delivery within a family unit.
- Two community-based models: peer-led community-based ART distribution; and health care worker-led community-based ART distribution.
According to July 2019 data from the national health information system and the data warehouse, NASCOP estimates that 88 percent of people on ART are enrolled in a less-intensive DSD model versus 12 percent who continue to receive services in the more-intensive Standard Track model.
One major barrier to DSD implementation in Kenya is the lack of an effective monitoring and evaluation (M&E) system. According to NASCOP and its partners, there are persistent challenges in M&E of DSD, such as incompleteness of reports, varied understanding of DSD indicators, and a lack of effective M&E tools. Therefore, Kenya is intensifying its focus on M&E and quality, efforts supported by CQUIN.
In June 2018, a team from Kenya visited Uganda on a south-to-south learning exchange, where they observed the linkage of The AIDS Support Organisation’s (TASO) community M&E system with Uganda’s national DSD M&E system, learning how these resources could be adapted to fit Kenya’s context. Additionally, in June 2019, CQUIN’s Quality Improvement workshop was held in Nairobi, Kenya, convening 165 experts in-country to share knowledge and develop resources to strengthen quality improvement in DSD implementation.
Visit ICAP’s website for a broader portfolio of work in CQUIN network countries.