Kenyatta National Hospital Nairobi, Kenya



Lina Thiira Njoroge, Senior Nutrition Officer, Nutrition Department

Faculty Supervisor:

Phares Ochola


April 2008

History of the Agency:

Kenyatta National Hospital (KNH) was established in 1901 and has become the largest hospital in Kenya and East Africa. KNH is a teaching and referral hospital providing specialized medical care, training and research. Its mission is to provide specialized quality prevention interventions, facilitate training and research in HIV/AIDS prevention and care, and support specialized specific psychosocial initiatives in HIV/AIDS care.

CHIP Project:

“Establishment of a Community-Based PMTCT Adherence System”

The 2007 Kenya AIDS Indicator Survey reported that 7.4% of the Kenyan population is infected with HIV. This means that about 1.4 million adults are living with HIV/AIDS, with more women infected (8.7%) than men (5.6%).

KNH, which works on prevention of mother-to-child transmission (PMTCT), identified the lack of a PMTCT follow-up adherence mechanism after the first six months as a critical problem in HIV/AIDS prevention, treatment, care and support. Njoroge’s project aims to create a community-based PMTCT adherence/follow-up program to link 40% of the defaulting PMTCT clients in the facility.

This project involves many action steps. In addition to developing a strategy and implementation plan, Njoroge sought buy-in from the KNH Nutrition Department and management. She also had to align the project with KNH’s performance targets, as well as the priorities of KNH donors and partners. Once approved, KNH must develop a network of trained community health workers, create capacity development tools and curriculum, conduct
capacity building sensitization for community health workers, establish a PMTCT support group for clients, implement followup tools, and create metrics for monitoring and evaluating the program’s success.

Changes Made:

KNH participated in the MDI in April 2007, so it has not completed all of its action steps. However, KNH has made the following progress:

  • Njoroge has held consultative meetings with stakeholders within the hospital, including management and staff in the comprehensive care clinic, antenatal clinic, PMTCT, Nutrition, and voluntary counselling and testing departments.
  • The Nutrition Department has pledged its support for the project and has included it as part of the performance activities as a CSR for the department and the hospital.
  • Ultimately, KNH will review current PMTCT client transfers between its antenatal and comprehensive care clinics, identify gaps in care, strengthen linkages between PMTCT clients and the facility, and form a network of community health workers to serve as a follow-up mechanism.

Lessons Learned:

  • Funding for any project is a primary concern. KNH’s main challenge has been a lack of funding to implement the proposed activities on time. Njoroge adds, “I am in discussion with the relevant departments in charge of project development for the hospital for possibility of funding. There is also positive buy-in to develop a funding proposal as a hospital for the CHIP.”
  • “The most valuable thing I learned at the MDI is that I can actually make a difference and an impact in my community and don’t have to wait for others to do it,” Njoroge emphasizes. “I learned how to develop a concept into a project. This was very valuable to me because I can translate the needs that I see in the health care system into not only a conceptual framework but also go further in developing various interventions through projects like the CHIP.” 

KNH has had many employees graduate from the MDI, including Dr. Henderson Munene Irimu, Jared Meshack Owiny, Dr. Margaret Makanyeno, Dr. David Bukusi, Dr. Peter Nduati Muiruri, and Tartision Machinga Kinyanki. This continued involvement in the program leads to enhanced management capacity and support at KNH for the CHIP and other hospital projects.