**MEMORANDUM OF UNDERSTANDING**

**BETWEEN**

**THE UNITED STATES OF AMERICA**

**AND**

**THE REPUBLIC OF KENYA**

**FOR**

**REDUCTION OF FERTILITY AND THE RISK OF HIV/AIDS TRANSMISSION THROUGH
SUSTAINABLE, INTEGRATED FAMILY PLANNING AND HEALTH SERVICES**

**DATE:**

**MEMORANDUM OF UNDERSTANDING**

**BETWEEN**

**THE UNITED STATES OF AMERICA**

**AND**

**THE REPUBLIC OF KENYA**

**FOR**

**REDUCTION OF FERTILITY AND THE RISK OF HIV/AIDS TRANSMISSION THROUGH
SUSTAINABLE, INTEGRATED FAMILY PLANNING AND HEALTH SERVICES**

**ARTICLE 1: Purpose**

**[Section 1.1]{.underline}** The Government of the United States of
America, acting through the United States Agency for International
Development (\"USAID\"), and the Government of the Republic of Kenya
(GOK), acting through the Ministry of Finance and Planning (hereinafter
referred to as the \"Parties\") wish to cooperate in a mutual effort to
support the Strategic Objective No.615-003 to reduce fertility and the
risk of HIV/AIDS transmission through sustainable, integrated family
planning and health services.

**[Section 1.2]{.underline}** USAID wishes to furnish, and the GOK
wishes to receive, assistance for this Objective. Accordingly, the
Parties have concluded the present Memorandum of Understanding,
hereinafter referred to as the 'MOU', to set forth their understandings
with respect to their undertakings in support of the stated Objective.

**ARTICLE 2: Nature of the Assistance**

**[Section 2.1]{.underline}** USAID assistance is intended to provide
technical assistance, training, and commodities to reduce fertility and
the risk of HIV/AIDS transmission through sustainable, integrated family
planning and health services. In order to achieve the Objective, the
Parties agree to work together to achieve the following objectives in
Kenya:

1\. Improved enabling environment for the provision of health services

2\. Increased use of proven, effective interventions to decrease risk of
transmission and mitigate the impact of HIV/AIDS

3\. Increased customer use of family planning, reproductive health, and
child survival services.

The nature of the assistance and coordination between the Parties is
more fully described in Annex 1 to this Memorandum of Understanding. The
description of the assistance in Annex 1 may be changed by written
agreement of the authorized representatives of the Parties named in
Section 4.6 below without formal amendment of this Memorandum of
Understanding.

**[Section 2.2]{.underline}** The effective date of this Memorandum of
Understanding will be the date of signature of the MOU. The completion
date is September 30, 2005 or such later date as the Parties may agree
upon in writing.

**ARTICLE 3 Implementation**

**[Section 3.1]{.underline} Partners Implementing the Program.** In
order to provide the assistance described above and in Annex 1, USAID
may enter into such contracts and other instruments with public and
nongovernmental organizations as USAID deems appropriate. Funds
obligated directly with third party entities (partners) will not be
reflected in the GOK Budget. USAID has ongoing or planned commitments
under this Strategic Objective with the following international Partners
to implement the programs:

1.  Pathfinder International - for community-based care and support for
    people living with HIV/AIDS and their families;

2.  Engender Health - for integrated reproductive health service
    delivery, training and supervision;

3.  Catholic Relief Services - for support to HIV positive children;

4.  Family Health International - for HIV/AIDS prevention, care and
    support, and research;

5.  Population Services International - for social marketing of condoms,
    contraception, insecticide-treated bed nets, and positive behavior
    change messages;

6.  John Snow Inc. - for logistics management of family planning and
    health commodities;

7.  The Futures Group International - for supporting health sector
    policy development, advocacy and dissemination, and health care
    financing and sustainability;

8.  Academy for Educational Development - for nutritional support to
    orphans and vulnerable children under age five affected by AIDS;

9.  University of North Carolina - for post-abortion care training and
    supervision;

10. Macro, Inc. - for national data collection; and

11. Marquette University - for undertaking in-service training in HIV /
    AIDS care.

**[Section 3.2]{.underline}** During the term of the assistance under
the MOU, USAID may enter into contracts, grants, or other instruments
with additional international organizations not listed above to
implement the objective. USAID will notify the GOK of the award of such
instruments and what Partner has been selected to implement the
activity. The GOK agrees that these additional Partners will have the
same status under this MOU as those listed in Section 3.1.

**[Section 3.3]{.underline} Taxation** The GOK agrees that the Partners
implementing the Objective and the assistance provided hereunder shall
be free from taxes imposed under laws in effect in Kenya, to the extent
provided in this Memorandum of Understanding, because the assistance is
for the benefit of disadvantaged, poor and destitute persons and in
support of the GOK poverty reduction strategy. This shall specifically
include the following:

1\. Taxes, customs duties and tariffs levied on any transaction for the
purchase or import of goods or services, which qualify for exemption,
financed by USAID under this agreement, including value-added taxes (V
AT), as contained in the V AT Act and the Customs and Excise Act of
Kenya.

> \(a\) Taxes on the income of a non-Resident organization in respect of
> management or professional fee, royalty or interest certified by the
> Minister in accordance with paragraph 11 of the First Schedule to the
> Income Tax Act of Kenya as may be amended from time to time.

2\. (b) Tax on non-resident employees or employees who are resident
solely for the purpose of performing duties under this Memorandum of
Understanding in regard to emoluments paid under this Memorandum of
Understanding in respect of duties performed in Kenya in accordance with
paragraph 27 of the First Schedule to the Income Tax Act of Kenya as may
be amended from time to time.

\(c\) Taxes on any other income as the Minister may by notice in the
Gazette Specify.

3\. Customs duties, tariffs, or import taxes, on the importation upon
first arrival in Kenya and re-exportation upon leaving Kenya of personal
effects (including a personally-owned automobile) for the personal use
of non-Kenyan individuals employed by the organizations listed in
Section 3.1 or their family members.

In the event of a disagreement about the above provisions, the Parties
agree to promptly meet and resolve such matters, guided by the principle
that the assistance furnished by USAID is free from direct taxation, so
that all of the assistance furnished by USAID will contribute directly
to improvement in the condition of the poor and destitute.

**[Section 3.4]{.underline} Work Permits** The GOK agrees to approve
work permits for persons employed by the Partners for implementation of
the Objective, for the period of this MOU, in accordance with laws in
effect in Kenya for that purpose.

**ARTICLE 4 Standard Provisions**

**[Section 4.1]{.underline} Title to and Use of Property** unless
otherwise directed by USAID, title to all property furnished by USAID
shall be in accordance with the terms and conditions of each individual
agreement between USAID and the implementing Partners. Any property
furnished by USAID and titled to the Partners shall be used effectively
for the assistance purpose described in Article 1 above and, upon
completion of the assistance, shall be used so as to further the
objectives of the assistance.

**[Section 4.2]{.underline} Information and Implementation Letters**
USAID and GOK shall provide each other with such information as may be
needed to facilitate provision of the assistance and to evaluate the
effectiveness of this assistance. In addition, USAID may from time to
time issue implementation letters to provide additional information on
matters discussed in this Memorandum of Understanding. The Parties may
also use jointly agreed letters to confirm their mutual understandings
with respect to implementation of this Memorandum of Understanding,
including changes in elements of Annex 1. Implementation letters shall
not be used to amend the text of the Memorandum of Understanding.

**[Section 4.3]{.underline} Authorized Representatives** The Parties
shall be represented by those holding or acting in the offices held by
the signatories to this Memorandum of Understanding. Each Party may, by
written notice, to the other, identify additional representatives
authorized to represent that Party for all purposes other than executing
formal amendments to this Memorandum of Understanding. Each Party shall
notify the other, in writing, of changes in its authorized
representatives.

**[Section 4.4]{.underline} Amendment and Modification** This Memorandum
of Understanding may be amended or modified by written agreement of the
Parties. Elements of Annex 1 may be changed by written agreement of the
Parties without formal amendment of this Memorandum of Understanding.

**Section 4.5 Suspension and Termination** In the event that USAID
determines that continuation of assistance under this MOU is unlikely to
achieve the Objective or that a violation of U.S. law or regulations
would result, USAID may, at its option, take steps to suspend or
terminate, in whole or part, provision of assistance under this MOU and
provide written notice of its action to the GOK.

IN WITNESS WHEREOF, the Parties each acting through their duly
authorized representatives, have caused this MOU to be signed in their
names and delivered as of this day of 2002.

FOR THE GOVERNMENT OF FOR THE GOVERNMENT OF THE

THE REPUBLIC OF KENYA UNITED STATES OF AMERICA

BY: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ BY:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NAME: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ NAME:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TITLE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ DATE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**ANNEX l**

**AMPLIFIED DESCRIPTION**

**BACKGROUND**

Fertility in Kenya has fallen dramatically over the past 20 years, from
8.1 to 4.3 children per woman. Kenya has continuing development needs,
however, in the health and population sector. Many couples still lack
access to family planning. The HIV / AIDS epidemic is a national
disaster, with one in seven Kenyan adults infected. The health system
itself has been weakened by the lack of needed resources, and is going
through the difficult process of reform and decentralization. Yet in the
face of such uncertainty, good results are possible in Kenya. The
activities supported under the MOU will build on and incorporate past
investments and achievements as they continue support in this critical
area.

USAID/Kenya developed the Strategic Objective No. 615-003 (S03) through
a process that incorporated input from numerous sources. The overall
policy context was taken from the Government of Kenya's Poverty
Reduction Strategy Paper and its Health Sector Strategic Plan, which
articulate Kenyan national priorities. Consultations with various
partners and reviews of individual programs were carried out, as
discussed below. Consultations with agencies operating in the health and
population sector ensured that an integrated approach to the planning
process was taken. Meetings with other donors ensured that approaches
were coordinated, thereby minimizing program gaps and duplication.
Beneficiaries at all levels, from families in rural and urban areas to
nurse-midwives and senior Government officials, were consulted
throughout this process. Major consultative activities include the
following:

[National household-level survey.]{.underline} The 1998 Kenya
Demographic and Health Survey was funded largely by USAID, with
contributions from the UK\'s DFID and the UN Population Fund (UNFP A).
This survey provided extensive health and socioeconomic data from 9,465
households; including 7,881 women and 3,407 men aged 15 to 49, from six
of Kenya\'s seven provinces. Eighty percent of households interviewed
were in rural areas, reflecting the demographics of the rural versus
urban population in Kenya. These respondents answered detailed questions
on fertility preferences, health-care-seeking behavior, childhood health
(including immunization, illnesses, and treatment), and HIV/AIDS
knowledge, attitudes and behavior.

[Collaborative HIV/AIDS strategy development]{.underline} In May 1998,
USAID, in consultation with the Ministry of Health and other Government
agencies, fielded a large team of Kenyan and U.S. consultants to design
a five-year HIV/AIDS strategy. The team used a combination of focus
group discussions, field trips, and meetings to interview customers, GOK
and NGO partners, cooperating agencies, businesses, professional
associations, and other groups to develop a long term strategy to
address HIV/ AIDS in Kenya. One notable outcome was the development of
new activities to mitigate the effects of HIV/AIDS on families and
children.

[Participatory project evaluation]{.underline} In May 1999,
multinational team of25 experts conducted a mid-term review of USAID\'s
five-year bilateral health and population project. The tea contacted
nearly 300 partners and stakeholders. Extensive field travel and
interviews with district and provincial-level GOK officials, NGOs,
central headquarters staff, and a variety of implementing agencies and
customers provided the basis for revised approaches under S03.

Results of this review of past achievements and remaining challenges,
and the strategies developed to address these challenges, fall into
three broad areas:

[Health Sector Reform and Health Care Financing]{.underline}

-   Accomplishments: USAID has assisted the Ministry of Health (MOH) to
    increase its cost­

-   Sharing revenues, which have now reached \$15 million per year.
    USAID has also assisted in the process of national health sector
    reform, and has worked with the MOH to devolve authority and
    accountability in public health to the district level.

-   Challenges: The next phase of assistance will focus on: (1)
    financial management; (2) equity issues; (3) the
    institutionalization of the health reform process; and (4)
    privatizing health commodity procurement and distribution.

-   Strategy: USAID will provide technical assistance to the Ministry of
    Health and will work with parastatals and with Parliament. Partners
    include the Government of Kenya (GOK); the Futures Group\'s POLICY
    Project and John Snow International DELIVER Project; and the UK and
    the World Bank.

[HIV / AIDS Prevention, Care, and Support]{.underline}

-   Accomplishments: President Moi acknowledged that AIDS is a
    \"national disaster\" and established an inter-sectoral GOK
    response. The US AID-supported social marketing project sold almost
    15 million condoms in 2001. Knowledge of AIDS is widespread. Using
    special funds, available as a result of the 1998 bomb attack, USAID
    has constructed and equipped five blood transfusion centers, is
    upgrading the National Public Health Laboratories, and helped
    institute a national blood transfusion policy.

-   Challenges: The epidemic continues to grow - over 13% of all adults
    in Kenya are now HIV positive - and expand to new areas. Behavior
    change, care and support of people living with AIDS, and preventing
    mother-to-child transmission (MTCT) are critical areas.

-   Strategy will focus on: (1) improving the national policy
    environment; (2) prevention of HIV transmission; and (3) care and
    support for those affected by AIDS. USAID will provide technical
    assistance to the National AIDS Control Council and the MOH; expand
    condom social marketing and voluntary counseling and testing;
    strengthen national blood transfusion services; provide assistance
    to hospitals to prevent mother-to-child transmission (MTCT) of HIV;
    and continue community-based care and support. Partners include the
    Government of Kenya; the Centers for Disease Control and Prevention
    (CDC); Family Health International\'s IMP ACT Project; Pathfinder
    International\'s COPHIA Project; Catholic Relief Services

-   (CRS); Population Services International (PSI); the Academy for
    Educational Development; local NGOs such as the Society for Women
    and AIDS in Kenya and the Kenya AIDS NGO Consortium; the UK, Japan,
    World Bank, and UNAIDS.

[Family Planning/Child Survival]{.underline}

-   Accomplishments: Family planning is a national success story, and
    child mortality fell for 40 years, until the mid-1980s. With
    assistance from USAID and others, the public and private sectors
    have jointly developed a strong family planning program, including
    support systems (logistics, training); policies and guidelines; and
    facility improvement.

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-   Challenges: Population is still growing at a relatively high rate
    and many couples still need access to family planning. Child
    mortality rose 25% between 1989 and 1998, due to HIV/AIDS, malaria,
    and the deterioration of health services. The 1999 health facility
    survey showed that improvements in supervision and training are
    needed.

-   Strategy: USAID\'s focus in this area is on: (1) integrated delivery
    by the private sector; (2) improving national training, supervision,
    and logistics systems; and (3) research in malaria and reproductive
    health. Working with Engender Health's AMKENI project, we will
    increase supply and demand for services, improve women\'s ability to
    demand better health services, and encourage positive behavior
    change. Partners in this activity include private sector
    organizations such as the Christian Health Association of Kenya and
    Aga Khan Health Services. This project will also work on MOH
    training and supervision systems, and will train 3,000 health
    workers. Other partners include the Ministry of Health; the
    University of North Carolina\'s PRIME project; PSI\'s AIDS Mark
    project; JSI\'s DELIVER project; FHI\'s contraceptive research
    project; the Malaria Action Coalition; the Centers for Disease
    Control (CDC); and the UK\'s DFID and Germany\'s GTZ and KfW.

**II. GEOGRAPHIC FOCUS**

In order to increase efficiency and possible synergies, USAID implements
many of its activities through integrated programs in targeted
geographic areas. This ensures community consensus, builds NGO and
public-sector capacity, and improves financial and technical
accountability. This strategy is in line with the Government of Kenya\'s
National Health Sector Strategic Plan, emphasizing decentralized
healthcare services and strengthening and expanding the role of NGOs and
the private sector.

**III. CUSTOMERS**

The consultative process that designed this assistance program ensured
that its activities address the needs of USAID\'s customers. These
include the people of Kenya who are the ultimate beneficiaries of
programs, intermediate beneficiaries (such as service providers and
policy makers), development partners, and stakeholders. The primary
beneficiaries of USAID\'s population and health program are the 14.8
million men and women of reproductive age and 4.8 million children under
five years of age.

**IV. RESULTS TO BE ACHIEVED/RESULTS FRAMEWORK.**

USAID has discussed and agreed with implementing partners on the results
to be achieved. USAID will work with its partners to achieve the
following results:

[Result I: Improved enabling environment for the provision of health
services.]{.underline} As a result of this activity, service providers
and managers at all levels will have the policy and regulatory guidance,
resources, and resource management skills to provide quality
reproductive and child health services and care. The Ministry of
Health-whose core function is to provide or enable the provision of
health sector services-will supply the overall guidance, training
opportunities, supervision, and policy direction to ensure quality
service delivery in both the public and private sectors. The enabling
environment will include standardized treatment protocols, trained
personnel with good supervisory support, financial and management
resources, and management controls. Three lower-level results must be
achieved:

-   Policies for family planning (FP), reproductive health (RH), and
    child survival (CS) services improved. This effort will support the
    development of an institutional framework and capacity for policy
    analysis, formulation, and implementation at the national level.
    USAID/Kenya will support data collection efforts that inform policy
    and will undertake advocacy activities aimed at strengthening
    political and other support for FP/RH/CS and AIDS policy issues.

-   Efficiency in the management of health sector resources improved. In
    addition to having better policies in place, efficiency in the
    management of health sector resources must be improved. Increasing
    efficiency in the management of health sector resources will require
    improved management of the national cost-sharing program, joint
    GOK/donor planning, rationalized budgeting at central and
    decentralized levels, and an increase in complementary donor
    financing.

-   Quality of services in health facilities improved. Finally, the
    quality of services provided in health facilities must be improved.
    This will require a comprehensive package of technical support
    activities targeted to key public and private health facilities. It
    will require institutionalized reproductive health logistics
    capacity and improved health training and supervision systems.

[Result 2 Increased use of proven, effective interventions to decrease
risk of transmission and mitigate the impact of HIV/AIDS.]{.underline}
USAID/Kenya\'s response to the HIV/AIDS epidemic will be both effective
and sustainable. Policies to help prevent and mitigate the HIV/AIDS
epidemic will be recommended and supported. Social and cultural
constraints to preventing HIV / AIDS will be reduced. Knowledge and
practice of preventive behaviors will be widespread, especially among
young people. Communities, health facilities, and workplaces will put
effective programs in place to both prevent HIV infection and mitigate
its impacts. When the elements of 00 are implemented - in the context of
the environment created by IR1 - people should be at lower risk of
infection, and those already infected should be better supported. To
realize 00, three lower­ level results must be achieved:

-   Key policy and other contextual constraints to preventing and
    mitigating the impact of HIV/ AIDS reduced. First, key policy and
    other contextual constraints to preventing and mitigating the impact
    of HIV/AIDS must be reduced. This will entail policymakers
    effectively advocating to decrease social, economic, cultural, and
    health impacts of HIV/AIDS; enhanced ability of networking groups to
    mobilize communities to prevent and mitigate the impact of HI V /
    AIDS; and surveillance data which can inform the advocacy process.

-   Knowledge and practice of preventive behaviors improves. Second,
    individuals\' knowledge and practice of preventive behaviors must be
    improved. An integrated approach to behavior change interventions is
    necessary. Close collaboration among partners undertaking behavior
    change interventions will be mandated in all S03 IRs.

-   Provision of HIV / AIDS, and other sexually transmitted infections
    (STI), prevention, care, and support services enhanced. Third, there
    must be enhanced provision of RN/AIDS/STI prevention, care, and
    support services. Since more than 90 percent of RN infections are
    transmitted sexually, prevention will remain a priority. This
    requires working with communities, workplaces, and service delivery
    sites to deliver appropriate services and programs, including
    voluntary counseling and testing.

[Result 3 Increased customer use of FP/RHICS services.]{.underline} The
objective is to expand the availability of integrated family planning,
reproductive health, and child survival services, especially in targeted
geographic areas, and improve service delivery programs through applied
research. It will also increase the demand for these services through
community-level and interpersonal communications and through mass media
campaigns. Increasing access and demand should increase customer use of
these services. Three lower-level results must be achieved:

-   Integrated FPIRHICS services expanded. Increasing customer use
    begins with the expansion of integrated FPIRHICS services. This
    activity will primarily be implemented by a consortium of partners
    working in selected geographic areas. Using MOR and private health
    facilities as \"centers of excellence\", these partners will work
    with public sector and private sector providers to increase the
    availability of services to the community.

-   Improved knowledge of and demand for FPIRHICS services. It is
    generally accepted that the availability of more services will not
    by itself result in greater use of those services. The targeted
    users of those services must not only know of their existence but
    must also want those services. Demand creation activities will
    include both national level mass media activities and community
    level communications activities. These will be linked with each
    other, and with the supply side activities.

-   New and improved FPIRH/CS programs and interventions conducted and
    applied. Finally, it is essential that efforts to develop and apply
    new and improved FPIRHICS programs and interventions be undertaken.
    These programs and interventions currently include pilot
    postabortion care programs, and the strengthening of integrated
    management of childhood illnesses (IMCI). Important elements of IMCI
    include improving the case management and counseling skills of
    health workers, and improving community practices through behavior
    change strategies and the training of caretakers in early
    recognition and treatment of childhood illnesses.

**V. ACTIVITIES/ACTIVITY SELECTION.**

In consultation and collaboration with the Ministry of Health and other
Government agents, a number of approaches and activities are being
considered, or are already being implemented by various partners.
Illustrative examples of activities needed to improve the enabling
environment for the provision of health services, include:

-   Supporting national data collection and dissemination

-   Strengthening structures and processes for policy analysis and
    formulation Strengthening advocacy for policy change for FPIRH/CS

-   Improving management of the national cost-sharing program

-   Rationalizing joint GOK/donor planning and budgeting at central and
    decentralized levels. Increasing complementary donor financing.

-   Institutionalizing health logistics capacity.

-   Improving training and supervision systems.

Under Result 1 in the Results Framework, increased use of proven,
effective interventions to decrease risk of transmission and mitigate
the impact of HIV *I* AIDS will be carried out through activities such
as:

-   Helping policymakers to advocate effectively to decrease the social,
    economic, cultural, and health impacts of HIV/AIDS

-   Provide support to the National AIDS Control Council (NACC) to carry
    out its multi sectoral coordinating role

-   Enhancing the ability of networking groups to mobilize communities
    to prevent and mitigate the impact of Disseminating surveillance
    data to inform the advocacy process

-   Planning and undertaking effective mass media campaigns

-   Implementing effective peer education programs

-   Carrying out effective community outreach programs

Under Result 2 in the Results Framework USAID, in collaboration with the
ministry of Health, will work with communities, workplaces, and service
delivery sites to deliver appropriate services and programs, including
voluntary counseling and testing. The program will promote innovative
research or pilot programs that can contribute knowledge and be scaled
up as funds allow. This can include:

-   Marketing social products (especially condoms) and services
    nationwide

-   Enhancing the capacity of communities to identify their needs and
    carry out home-based care and support for people with AIDS and their
    families

-   Increasing the capacity of selected work sites to develop supportive
    policies and prevention programs

-   Improving the capacity for HIV/AIDS/STI prevention at the community
    and facility level Developing and implementing innovative programs
    to decrease HIVI AIDS transmission, for example, by decreasing
    mother-to-child transmission

-   Improving blood safety, through improved blood transfusion centers
    and a supportive policy

-   and capacity building

-   Improving control of tuberculosis

-   Increasing voluntary HIVI AIDS counseling and testing.

Under Result 3 in the Results Framework, USAID is combining and
refocusing its previously separate clinic, community-based and quality
improvement reproductive health activities to take a more
facility-based, comprehensive approach to service delivery at the
district level. Illustrative IR3 activities include:

-   Increasing availability of facility and community-level family
    planning (FP), reproductive health (RR), and child survival (CS)
    services in selected geographic areas.

-   Encouraging facilities to provide a complete range of FP/RH
    services.

-   Identifying facilities to serve as centers of excellence, and
    provide training and other quality improvement activities to MOH and
    private providers.

-   Increasing the availability of socially-marketed products and
    services.

-   Improving pre-service and in-service training through KMTC, nursing
    schools, and regional training centers.

-   Improving national and regional supervisory systems.

To achieve Result 3, USAID, with its stakeholders, will ensure that
information about services is available to the target groups needing the
services and will influence voluntary behavior to improve personal and
community welfare. Demand creation activities could include:

-   Conducting effective community outreach and interpersonal
    communications programs.

-   Planning and undertaking effective mass media campaigns.

To achieve Result 3, USAID, in collaboration with its stakeholders will
also support operations research, specific assessments, and small-scale
studies, pilot innovative programs, and suggest ways to improve existing
programs. Illustrative activities include:

-   Undertaking research and evaluation to develop better program
    options.

-   Implementing pilot postabortion care programs.

-   Strengthening integrated management of childhood illnesses (IMCI) in
    selected areas.

-   Technical assistance to the National Malaria Coordinating Committee
    (through the international Malaria Action Coalition).

**VI. ROLES AND RESPONSIBILITIES OF THE PARTIES.**

The US Agency for International Development (USAID). The USAID/Kenya
Mission through its Office of Population and Health (OPH) and other
departments at USAID headquarters in Washington will manage and
coordinate implementation activities under the SO 3. OPH will focus on
six key functions central to the implementation and achievement of the
objective: strategic planning; technical assistance; coordination;
reporting; monitoring and evaluation; and dissemination of lessons
learned.

Government of Kenya (GOK). The GOK organizations, i.e., the National
AIDS Control Council (NACC), the Ministry of Health (MOH), and the
Ministry of Finance and Planning (MOF), will be the major collaborative
partners under the Objective.

GOK will not be responsible for the achievement of the strategic
objective results or be held accountable for funds obligated directly
with third party entities under the MOU.

The parties will, however, cooperate in ensuring that all implementing
partners actually work towards achieving the Strategic Objective
Results, and agree to develop modalities for such cooperation on a
case-by-case basis. To this end, USAID shall promptly inform GOK of all
implementing partners with which it contracts/deals directly, and
undertakes to keep GOK fully informed of the scope of activities
entrusted to each such implementing partner.

NACC will provide the overall coordination and supportive structure for
USAID HIV/ AIDS prevention, care and support activities. It will provide
guidance, the framework (within the National AIDS Strategic Plan) within
which grantees and contractors operate technical advice, and the general
\"enabling environment\" for HIV/AIDS activities.

The Ministry of Health will provide overall coordination and guidance,
as well as the overall framework for US AID-supported family planning,
reproductive health, health care financing and child survival
activities. USAID contractors and grantees will share work plans,
strategies and approaches with the appropriate departments (e.g.,
NASCOP, Department of Reproductive Health) to ensure that activities are
in line with national programs and activities. Direct technical teams
may be deployed to specific departments, in areas such as logistics or
training and supervision. The Health and Population Donors Group is one
of many fora which the MOH may use to ensure that USAID activities
complement those of other donors.

The Central Bureau of Statistics (CBS), Ministry of Finance and
Planning, will provide the overall coordination and guidance for
national level surveys (e.g., the Demographic and Health Survey) as well
as provide a forum for donor coordination and collaboration. CBS will
provide technical support, advice, and direction to surveys and studies.

The National Council for Population and Development (NCPD), Ministry of
Finance and Planning, will provide overall coordination and a strategic
framework for population-related activities. It will convene regular
meetings of NGOs, donors and other partners to ensure that USAID
activities (and those of other actors) support Kenya\'s national
population strategy.

Provincial, district and municipal authorities will provide guidance and
an operational framework for contractors and grantees working at the
provincial, district or local level. All activities must be cleared and
coordinated with the Provincial Medical Officer (PMO) or his equivalent
counterpart within the province. USAID contractors and grantees will
endeavor to ensure that their activities are part of district level
workplans. Municipal and other authorities will be encouraged to work
with USAID entities as a team, and provide technical direction and
guidance. A decentralized, participatory approach that supports
communities is envisioned.

**VII. MONITORING AND EVALUATION**

USAID, in consultation with the Ministry of Health is in the process of
finalizing a Performance Monitoring Plan (PMP) to measure the
performance and effectiveness of this assistance. The draft PMP has
proposed indicators to be used to monitor progress toward achievement of
results. Performance data for these indicators will be analyzed
periodically for decision making at predetermined benchmarks and for
assessing the impact of USAID\'s investment in this sector.

This analysis will guide both USAID and GOK in determining necessary
adjustments in program approaches.

USAID will agree with all the implementing partners on how to track,
evaluate and report the performance of this Development Assistance. Our
counterparts, particularly contractors and cooperating agencies and GOK
implementing partners, will monitor these indicators. A detailed listing
of the indicators, including precise descriptions of the numerator and
denominator, and most suitable data source is contained in the draft
performance-monitoring plan.

Evaluation of the activities must be undertaken during the life of the
program as approved. Evaluation findings will inform USAID, GOK and
other implementing partners and provide useful guides for necessary
adjustments of the program approach.