NATIONAL GUIDELINES FOR THE IMPLEMENTATION OF

THE BASIC CARE PACKAGE

IMPROVING THE QUALITY OF LIFE FOR PEOPLE LIVING WITH

HIV&AIDS, AND THEIR FAMILIES
THROUGH
THE PREVENTION OF OPPORTUNISTIC INFECTIONS

National AIDS and STI Control Programme (NASCOP)

PO BOX 19361 KNH Nairobi 00202 Kenya
Tel 254-20-272-9502/9549. Fax:254 -20-271-0518
info@nascop.or.ke
www.nascop.or.ke

2010

3
Table of Contents
FORWARD 6
ACKNOWLEDGEMENTS 7
LIST OF ABBREVIATIONS 8
1.0 INTRODUCTION 10
1.1 Background Information 10
1.2 Rationale 11
1.3 Use of the Guidelines 11
2.0 THE BASIC CARE PACKAGE 12
2.1 Goals of The BCP 12
2.2 BCP Contents 12
2.3 Intervention Areas of the BCP 12
2.3.1 Sexually Transmitted Infections 13
2.3.2 Diarrhea Prevention 13
2.3.3 Malaria Prevention 13
2.3.4 Cotrimoxazole Prophylaxis 14
2.3.5 Client Education on the Basic Care Package 14
3.0 ELIGIBLE POPULATIONS 16
4.0 KEY PLAYERS IN BCP 17
4.1 The National Level 17
4.1.1 Ministry of Health 17
4.1.2 National AIDS Control Council 17
4.2 Provincial Level 17
4.2.1 PASCO/PHMT/PHC/BCC Coordinators 17
4.3 County Level 18
4.3.1 DASCO/DHMT/HCBC Coordinators 18
4.4 Facility Level 18
4.4.1 Health Care Workers 18
4.5 Community Level 18
4.5.1 CHEWs 18
4.5.2 Opinion Leaders and other Community Gatekeepers 19
4.6 Partners 19
4.6.1 Donors /Development Partners 19
4.6.2 Implementing Partners/NGOs/CSOs 19

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5.0 BCP SUPPORT SYSTEMS 20
5.1 Personnel 20
5.2 Logistics 20
5.3 Coordination of BCP Services 20
5.4 Sustainability of BCP Program 21
5.4.1 Sustainability of CHW/Peer Educators 21
5.4.2 Sustainability of the logistic supply 21
6.0 IMPLEMENTATION PROCESS 22
6.1 Implementation steps 22
6.2 Integration with other Community Level Interventions 23
7.0 MONITORING AND EVALUATION 24
7.1 Specific M & E Activities 24
7.2 M & E Tools 24
8.0 SAFETY OF THE BCP KIT AND ITS CONTENTS 25

REFERENCES 27
ANNEXES 28
List of Workshop Participants 28

5
FOREWORD
HIV/AIDS is still among the most important health challenges facing
Kenya, and many other African countries. Without appropriate care and
treatment, most People Living with HIV (PLHIV) will suffer from debilitating
opportunistic infections leading to hospitalization, loss of income,
disruptions of their family life and eventually death. Today, HIV/AIDS
no longer has to be an acute, debilitating disease. It is possible to delay
or prevent diseases and improve the quality of life for persons with HIV
through a comprehensive approach to health care that emphasizes on
preventive care, extending beyond just antiretroviral therapy. Simple,
practicable solutions for improving the health and extending the lives of
PLHIV exist.

Evidence has demonstrated that a number of low-cost and practical

interventions can reduce HIV-related morbidity and mortality and prevent
HIV transmission. Long-lasting insecticide treated nets, safe water systems
and Cotrimoxazole preventive therapy are inexpensive and clearly benefit
people living with HIV/AIDS by reducing the incidence of opportunistic
infections e.g. malaria and diarrhea. Correct and consistent condom use
has also been shown to reduce HIV transmission among sexual partners.

Results from the Kenya Aids Indicator Survey 2007, indicated that a
majority of PLHIV in Kenya did not use various components of the Basic
Care Package (BCP).

The KNASP III aims to provide a prioritized package of prevention,

care and treatment services for PLHIV. The BCP is therefore an important
intervention towards the realization of the KNASP III goal and addressing
of the care gaps identified in KAIS 2007.

The publication of these guidelines is indeed timely, as it coincides with a

period of increased efforts by the GOK, to rededicate efforts towards HIV
prevention, and improving the quality of life for those infected with HIV.
We look forward to close partnership with all relevant stakeholders in the
implementation of this Basic Care Package.

Dr. Willis Akhwale

Head, Department of Disease Prevention and Control
Ministry of Public Health and Sanitation
6
ACKNOWLEDGEMENTS
The development of the National guidelines for the implementation
of the Basic Care Package has been spearheaded by the Basic Care
Package Technical Working group (TWG), under the overall chair of Dr.
Nicholas Muraguri. We recognize the work done to initiate the process
by workshop participants who gave practical inputs applicable at both
health facility and community levels.
We are indebted to the BCP TWG membership, who participated in many
meetings and workshops to share useful ideas towards the development
of these guidelines. Members of the TWG who drafted and peer reviewed
these guidelines are listed below:

Dr. Nicholas Muraguri, NASCOP

Pauline Mwololo, NASCOP
Lenet Bundi, NASCOP
Patricia Macharia, NASCOP
Dr. Maurice Maina, USAID
Ruth Tiampati, USAID
Dr. James Odek, CDC
Lucy Maikweki, PSI/K
Dr. Anne Musuva, PSI/K
Dr. Steve Adudans, Mildmay
Mabel Wendo, Mildmay
James Ayuyo, Mildmay
Noni Mumba, PSI/K

We acknowledge the United States Agency for International Development

(USAID) for their financial support during the entire process of developing,
printing, launching and distribution of the National BCP Guidelines, to
various stakeholders in the health system.

Dr. Nicholas Muraguri

Head, NASCOP
Ministry of Public Health and Sanitation

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LIST OF ABBREVIATIONS

BCP - Basic Care Package

CACC - Constituency AIDS Control Committee
CBO - Community Based Organization
CCC - Comprehensive Care Clinic
CDC - Centers for disease control
CD4 - Helper T Lymphocytes
CHW - Community Health Worker
CHEW - Community Health Extension Worker
CPT - Cotrimoxazole preventive therapy
CSO - Civil Society Organization
CTX - Cotrimoxazole
DASCO - District AIDS & STI Coordinator
DHMT - District Health Management Team
FBO - Faith Based Organization
GOK - Government of Kenya
HCBC - Home & Community Based Care
HCW - Health Care Worker
HCP - Health care provider
HIV - Human Immuno-deficiency Virus
IEC - Information Education & Communication
IGAs - Income Generating Activities
ITN - Insecticide treated net
KAIS - Kenya Aids Indicator Survey
KNASP - Kenya National AIDS Strategic Plan
LLITNs - Long-Lasting Insecticide Treated Nets
MOH - Ministry of Health
NACC - National AIDS Control Council
NASCOP - National AIDS & STI Control Programme
OIs - Opportunistic Infections
PASCO - Provincial AIDS & STI Coordinator
PHC - Primary Health Care
PHMT - Provincial Health Management Team
PLHIV - People living with HIV & AIDS
PSI - Population Services International
PWP - Prevention with Positives
QA - Quality Assurance
QC - Quality Control
STIs - Sexually Transmitted Infections

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SWS - Safe Water System
TOT - Training of Trainers
TWG - Technical Working Group
USAID - United States Agency for International Development
WHO - World Health Organization

9
1.0 INTRODUCTION

1.1. Background Information

According to the KAIS 2007, 7.1% of Kenyan adults (aged 15-64 years)
are infected with HIV, representing an estimated 1.37 million people.
There is a wide regional variation in HIV prevalence ranging from
14.9% in Nyanza to 0.8% in North Eastern Province. In rural areas,
approximately 990,000 adults are infected with HIV, compared to
approximately 380,000 adults in urban areas.

Human Immunodeficiency Virus (HIV) infection is a complex condition

affecting the patient, their family and their community and the nation
as a whole. The care of persons living with HIV and AIDS (PLHIV)
therefore, needs to be as comprehensive as possible. It should provide
a wide range of services beyond specific medical treatment and involve
a multidisciplinary team of caregivers to encompass all the important
aspects of this multifaceted condition.

Opportunistic infections (OIs) are the most important cause of morbidity

and mortality in HIV-infected individuals. The Basic Care Package (BCP)
aims at prevention of some of the OIs notably, diarrhea, malaria and
STIs among PLHIV. A number of low-cost and practical interventions have
been shown to reduce HIV-related morbidity and mortality due to OIs
and prevent HIV transmission. Cotrimoxazole preventive therapy (CPT),
long-lasting insecticide treated nets (LLITN), and safe water systems (SWS)
are inexpensive and clearly benefit PLHIV by reducing the incidence of
opportunistic infections. In addition to CPT, LLITN, and SWS, the BCP in
Kenya includes condoms and information, educational and communication
(IEC) materials for PLHIV. The Government of Kenya (GOK) recommends
that all HIV-infected adults and children regardless of their immunological
status should have access to these interventions and refers to them as the
Basic Care Package.

For the care of PLHIV to be effective in its reach, it is essential that the
community, all levels of the health care system and all cadres be involved
in the provision of this package.

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1.2 Rationale
The BCP is designed to offer low cost interventions that prevent illness,
prolong life, and prevent HIV transmission. The interventions of BCP are
evidence based as discussed below:-
Cotrimoxazole preventive therapy (CPT) has been long used in developed
countries in people with advanced HIV disease primarily to prevent
Pneumocystis pneumonia. It has also been known to reduce malaria
and diarrhea episodes in sub-Saharan Africa (WHO, 2007). For the
prevention of malaria, which is more common and more severe in PLHIV,
including children, the use of long-lasting insecticide-treated nets (LLITN)
in combination with CPT provides additive value (Kamya, Gasasira et al.
2007; Lengeler, 2006).

A variety of interventions that improve household water quality and hand

hygiene have been shown to decrease diarrhea related morbidity and
mortality both in persons and families with HIV (Lule, Mermin et al. 2005;
Quick, Kimura et al. 2002). The combination of home water treatment and
a safe storage vessel has been shown to be a very effective intervention,
especially among people living with HIV (Lule, Mermin et al. 2005).
Various combinations of these interventions to reduce morbidity and HIV
transmission have been combined and distributed in countries such as
Uganda and southern Sudan. A pilot of the BCP program in Coast, Nyanza
and Western provinces was carried out in 2009 and the experience
gained guided the roll out to the rest of the country.

1.3 Use of the Guidelines

These guidelines are designed to be used by program managers and
planners for advocacy and resource mobilization. Health care providers
and community health workers/peer educators will use the guidelines to
guide implementation of BCP interventions.
The BCP guidelines provide a significant step towards standardizing
care and support measures to reflect the most up-to-date information and
policies supported by the Ministry of Health

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2.0 THE BASIC CARE PACKAGE

The Basic Care Package is a collection of evidence based interventions

which are easy to implement for the benefit of PLHIV. The interventions
are patient centred and have the potential to improve the quality of life
of PLHIV.

2.1 Goals of the BCP

The goal of the Basic Care Package is to reduce morbidity and mortality
among PLHIV, through the prevention of opportunistic infections, to help
them live longer and healthier lives.

The BCP aims to contribute substantially towards the Kenya National

AIDS Strategic Plan III (KNASP) for the response to HIV in pillar 1&3 and
improve the quality of life of PLHIV in Kenya. The BCP specifically focuses
on the prevention of Sexually Transmitted Infections (STIs), Diarrhea and
Malaria.

2.2 BCP Contents

• The contents of the Basic Care package include:-
• 100 male condoms
• 2 long lasting insecticide treated nets
• Chlorine Water treatment
• A 20 liter safe water vessel with an inlet that has a lid and an
outlet (tap)
• A cotton filter cloth (for filtering particles out of water before
treating)
• Informational materials (for more information on the BCP contents)
Cotrimoxazole preventive therapy (CPT)

2.3 Intervention Areas of the BCP

The BCP focuses on prevention of STIs, diarrhea, malaria and other
common OIs. In addition to provision of the BCP commodities, client
education through use of IEC materials facilitates a better understanding
of OI prevention, and subsequent behavior change.

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2.3.1 Sexually Transmitted Infections
The commonest mode of HIV transmission in Kenya is through sexual
intercourse. The presence of STIs is an important co-factor in the
transmission of HIV infection; the presence of either inflammatory or
ulcerative STIs facilitates acquisition and transmission of HIV infection.
In resource-limited settings where routine screening for STIs is not possible,
prevention and control of STIs is largely dependent on education and
behavior change to reduce the risk of acquiring or transmitting STIs.

Condoms are the most reliable method for reducing the risk of sexual
transmission or acquisition of HIV and other STIs, as well as HIV re-
infection. When used correctly and consistently condoms have been
shown to reduce transmission of STIs and HIV significantly. The BCP
promotes and provides male condoms.

2.3.2 Diarrhea Prevention

Diarrhea is a leading cause of morbidity and mortality among people
infected with HIV. Contaminated water is often the source of microbes
that cause diarrhea. According to KDHS (2008), more than one-third of
Kenyan households get their drinking water from an unprotected source,
mainly surface water from lakes, streams, and rivers. Although only 6%
of urban households use unprotected sources for drinking water, the
proportion is far higher for rural households (46%). According to KAIS
2007, 54.5% of HIV-infected persons live in a household that does not
treat its drinking water.
The Government of Kenya recommends safe water systems for all households
affected by HIV. The Basic Care Package contains an inexpensive, readily
available and easy to use safe water system that comprises of point of use
water treatment chemical, a safe water storage vessel and a filter cloth.

2.3.3 Malaria Prevention

Malaria is the leading cause of morbidity and mortality in Kenya, with
close to 70 percent (24 million) of the population at risk of infection. Co-
infection with HIV and Malaria is very common in sub Saharan Africa,
especially in Malaria endemic areas with HIV increasing the incidence
and severity of Malaria.

13
Despite the GOK recommendation that HIV-infected persons protect
themselves against malaria by always sleeping under an insecticide-
treated net (ITN) every night, only 20.2 % of PLHIV sleep under an ITN
(KAIS 2007).
The Basic Care Package contains two long lasting insecticide treated nets
(LLITNs) for Malaria prevention. These LLITNs are the best because they do
not need to be retreated with insecticide to maintain their effectiveness. In
addition to providing a physical barrier against mosquitoes, LLITNS also
repel and kill mosquitoes.

2.3.4 Cotrimoxazole Prophylaxis

Cotrimoxazole prophylaxis is a cost effective and easily available
intervention that prevents certain bacterial and parasitic infections that
cause Pneumocystis
carinii jiroveci pneumonia, diarrhea, malaria and toxoplasmosis, therefore
prolonging the lives of adults and children with HIV.

According to KAIS (2007), 23.9% of HIV-infected clients in HIV care

were not receiving Cotrimoxazole prophylaxis. The Ministry of Health
recommends that all people with HIV, regardless of CD4 count, should
take Cotrimoxazole daily to reduce the risk of illnesses that are associated
with HIV/AIDS.
All PLHIV should use Cotrimoxazole prophylaxis together with the other
components of the BCP persistently for effective prevention of opportunistic
infections. Cotrimoxazole is part of the BCP but is dispensed from the
health facility.

2.3.5 Client Education on the Basic Care Package

PLHIV need instruction and demonstrations on proper use of the BCP.
Education on other aspects of HIV care including prevention of OIs and
positive living is also important. This is provided by health care workers
and peer educators/ community health workers.
Client education on use of the BCP should cover:-
• Malaria prevention and the use of LLITNs
• Correct and consistent condom use for prevention of STIs and
HIV re-infection.
• Proper use of Safe Water Systems for Diarrhea prevention
• Cotrimoxazole prophylaxis for OI prevention

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The BCP also contains IEC materials which provide information and
education on use of the BCP items. This is key in ensuring that clients use
the components of the package correctly. Clients require comprehensive
health education which targets a holistic approach to nutrition, prevention
of OIs, adherence to treatment, safer sex, disclosure, stigma, psychosocial
support and behavior change. All clients should be given condoms and
adequate information on proper use regardless of service provider’s
beliefs, preferences and religion.

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3.0 ELIGIBLE POPULATIONS

The primary target recipients of the Basic Care Package are people living
with HIV who know their HIV status and are registered at a health facility.
Anyone who tests HIV positive irrespective of his/her religion, age, or
ethnic region is eligible to receive the Basic Care Package.

Recruitment of clients/patients will be carried out either within a health

facility by the health care worker or through referral from the community
settings by trained Community Health Workers (CHW).

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4.0 KEY PLAYERS IN BCP

The smooth implementation of BCP activities involves the active participation

of various individuals, service delivery structures and organizations at all
levels right from the national level to the Community level.

4.1 The National Level

4.1.1 Ministry of Health

The Ministry of health through NASCOP has key roles of:

• Coordinating and collaborating with development partners,
resource mobilization, procurement, storage and distribution of
BCP commodities.
• Development and dissemination of guidelines, policies and M & E
tools
• Coordination of health workers capacity building
• Ensuring that quality assurance and quality control standards are
adhered to.
• Overall coordination of the technical working group (TWG) and
other stakeholders meetings.

The TWG is responsible for:

• Development and approval of guidelines and policies
• Coordination of programmes
• Provision of guidance and direction
• Provision of technical support to BCP implementers

4.1.2 National AIDS Control Council

The National AIDS Control Council (NACC) is the overall coordinating
body responsible for resource mobilization, social mobilization and
advocacy, coordination of CBOs/CSOs/FBOs and the approval of
proposals

4.2 Provincial Level

4.2.1 PASCO/PHMT/PHC/BCC Coordinators

• Coordinate provincial BCP activities including the tracking of BCP

commodities distribution
• Dissemination of guidelines and M & E tools

17
• Generate and share reports at provincial and national level
• Putting in place Quality Assurance/Quality Checks strategies
• Coordinating provincial stakeholders meetings
• Selection and coordination of districts for BCP interventions

4.3 County Level

4.3.1 DASCO/DHMT/HCBC Coordinators
• All provincial roles but at district level
• Coordination of Selection and training of HCWs and CHWs
• Supervision of HCWs
• Facilitate the storage and distribution of BCP commodities within
the district.
• Generate reports and share with the province plus other
stakeholders in the district.

4.4 Facility Level
4.4.1 Health Care Workers
• Implement BCP at facility level
• Train & supervise CHWs
• Generate reports & share with HCBC coordinator and DHMT
• Conduct advocacy and health education sessions.
• Link facility to community

4.5 Community Level

4.5.1 CHEWs
• Assist in the recruitment, training and supervision of CHWs and
volunteers
• Facilitate the implementation of BCP through the Community
Strategy structures
• Participate in M & E at the community level.
• Community mobilization
• Distribution of BCP kits
• Conduct health education sessions
• Conduct defaulter tracing and follow up of clients
• Referral of clients from the community to health facility.
• Maintain records of BCP activities and regular reporting to
facility level
• Participate in monthly meetings

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4.5.2 Opinion Leaders and other Community Gatekeepers
• Facilitation of community mobilization and setting of health care
priorities in the community.
• Represent the community at stakeholders meeting
• Assist in awareness creation
• Assist in recruitment of CHW
• Assist in follow up, linkages and referrals.

4.6 Partners
4.6.1 Donors /Development Partners
• Supporting the programme with required funds
• Participate in development of IEC materials, M&E tools and
training package (curriculum and other materials) in collaboration
with NASCOP
• Procure necessary commodities.
• Assist in the distribution of commodities to the point of use.
• Assist the districts and health facility in facilitating implementation
at the lowest level.

4.6.2 Implementing Partners/NGOs/CSOs

• Advocacy for the uptake of BCP
• Assist in distribution of BCP/provision of services
• Facilitate supportive supervision
• Support CHWs
• Conduct research on effectiveness/impact of the BCP on PLHIV.
• Support capacity building of HCW/CHWs
• Participate in development of IEC materials in collaboration with
NASCOP and other partners
• Evaluate the programme
• Procurement and distribution of commodities
• Participate in curriculum development

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5.0 BCP SUPPORT SYSTEMS

The support systems for the implementation of basic care package include
human resources, logistical support, coordination and sustainability.

5.1 Personnel
It is important to have vibrant teams for BCP implementation from the
community to national levels.
• Community level - CHW and CHEW
- Whose main role is to educate the community on the
BCP, and monitor its use through home visits.
• Facility level - HMT and HCW
- Supervision of distribution at facility level
• District level - DMHT including DHCBC coordinator
- District coordination of the program
• Provincial level - PHMT including PHCBC coordinator
- Provincial leadership of the program
• National level- NASCOP, NACC and TWG
- Guidance of program strategy at national level
• Partners cut across all the levels of implementation

5.2 Logistics
• Timely procurement and distribution of BCP kits to the facilities.
• Efficient procurement, storage and supply system for all logistics
including the appropriate labeling
• To facilitate commodity and patient tracking, patient cards will be
stamped to signify receipt of the Basic care package.

5.3 Coordination of BCP services

Ensure a functional M & E system
• Appropriate and adequate quantities of M & E tools
• Established Referral/and networking systems in place
• Integration of BCP, HCBC and PWP activities at all levels of
implementation

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5.4 Sustainability of BCP Program
5.4.1 Sustainability of CHW/Peer Educators
• Develop a standardized mode of motivating CHWs that is agreed
upon by stakeholders in a given locality to minimize dropouts and
migration from one programme to another.
• Encourage formation of groups of CHW, minimal saving and
training in entrepreneurship.
• Establish linkages for microfinance and income generating
activities.

5.4.2 Sustainability of the logistic supply

• Develop a well managed supply chain system for supply and

distribution of basic care package.
• Prepare adequate budgets with annual allocations for purchasing
BCP contents, training as well as IEC material development.
• Timely distribution of BCP with demand
• Advocate with partners for support of BCP logistic support.

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6.0 IMPLEMENTATION PROCESS

6.1 Implementation steps

It is important to follow the correct implementation steps the BCP to serve
the intended beneficiaries effectively.

Step 1: Identification of implementation sites with special consideration of

population coverage and service delivery gaps.

Step 2: Sensitization of PHMT, DHMTs and HMTs to ensure an in-depth

understanding of BCP basic concepts and for subsequent active
participation and support during implementation

Step 3: Identify district focal persons (HCBC coordinators) to coordinate

the BCP program alongside community PWP and HCBC for the
district.

Step 4: Recruitment of health care workers and Community Health

Workers to carryout BCP activities at every level of implementation.
Use of community strategy approach during the recruitment of
CHWs.

Step 5: Training and sensitization of HCW and CHWs. Using the nationally
approved standard training manual for Health Workers, community
peer educators and CHWs.

Step 6: Maintain accurate records at facility and community level.

Step 7: Conduct regular supportive supervision and meetings to discuss

BCP issues.

Step 8: Motivate service providers where possible e.g. by providing bags,

T-shirts note books, pens, badges etc.

Step 9: In situations whereby more than one client is registered from the
same household, more than one BCP can be given. However care
should be taken to ensure there will be no wastage of the contents.

22
Step 10:Establish a referral, networking and and linkages structure that
ensures that clients access other services unavailable at the point
of BCP service provision

6.2 Integration with other community level interventions

The need and importance of integrating BCP into the existing facility and
community level prevention, care, treatment and support activities cannot
be over emphasized. At the home and community level, BCP strategies
target the same client as the HCBC and community PWP strategies; hence
the importance of integrating the three approaches for quality coordination
and, at service delivery levels.

23
7.0 MONITORING AND EVALUATION

Monitoring and evaluation of the Basic Care Package interventions

facilitates accountability and transparency and ensures overall cost
effectiveness of the programme through accurate capturing of appropriate
inputs, processes and outputs.

7.1 Specific M & E activities

• Compiling monthly and quarterly reports on patient enrollment,
BCP distribution and patient education activities.
• Report on capacity building for health workers, CHW and other
BCP service providers.
• Report of OI occurrences among patients enrolled to BCP
programme
• Documenting best practices of BCP implementation
• Reports of tracking commodity distribution and utilization
• Referral tracking

7.2 M & E Tools

• Tally sheets and treatment registers in Comprehensive Care
Centres
• Community health workers diary/checklist showing activity done
by CHW and Peer educator
• Ledger cards, inventory books and summary tools showing
movement of BCP kits and requirement
• Community referral books
• Distribution register at Health facility to capture commodity
movement
• A Supervisory checklist for use by the district team and the CHEW
• A rubber stamp/pad to identify those already registered for BCP
(stamped on register and client card)

24
8.0 SAFETY OF THE BCP KIT AND ITS CONTENTS

The BCP Kits are assembled centrally at a warehouse and delivered directly
to each health facility. The kit is packed with all contents mentioned on
section 2.2 of this booklet. The following must be adhered to, to ensure
the BCP kit reaches the intended recipient intact/complete.

1. During packaging at the warehouse:

a) The contents packaged in each kit should be double checked to
ensure the correct number of each component of the kit, has been
packed.
b) Upon confirmation that the kit contents are complete, the BCP kits
are then sealed, ready for distribution.

2. Receipt at the Health Facility:

a) Upon, delivery to a health facility, the receiving officer, (Facility
in charge, CCC in-charge, or facility stores officer) must verify that
all kits are properly sealed and there is no sign of tampering.
b) A delivery note should be signed by the receiving officer indicating
receipt of goods in good order.

3. Storage of the BCP kits at the health facility:

a) The kits should be stored inside a secure lockable building/store
to avoid theft of entire packages or pilferage of kit components.
b) The officer at the health facility in charge of the store must take the
responsibility of ensuring safe keeping of the kits, and be able to
account for them whenever required.
c) At the end of the month, a physical stock count should be done by
the supervisor, which should be compared with the records on the
BCP register. Any discrepancies should be investigated
immediately.

4. Preventing theft or pilferage

a) The above measures should prevent theft of the entire BCP kit from
the health facility or pilferage. Pilferage is the removal/theft of
part of the contents of the BCP package. Sometimes it may
also include the entire removal of contents and replacement with
bogus products.

25
b) It should be explained to all recipients of the kit that none of the kit
contents are for sale, and that they should only be used in their
homes to help prevent opportunistic infections.
In the event that a BCP kit is pilfered, or contents found to have
been sold, the following course of action should be applied:
• In the event that an anomaly is noted in a BCP kit, the facility in-
charge must be notified immediately.
• The relevant DASCO should be informed of the anomaly, and
together with the rest of the DHMT members will investigate the
matter and define the appropriate course of action to be taken.
The DHMT may choose to involve the provincial administration, or
take action against the offending officer.
• Contents of the BCP kit found to have been sold should be
confiscated by the MOH officials in the specific region.

26
REFERENCES

Colindres, Mermin et al (2008) Utilization of a basic care and prevention

package by HIV infected persons in Uganda AIDS Care 20(2):
139-145

Gasasira AF, Kamya MR et al (2010) Effect of Trimethoprim

Sulphamethoxazole on the risk of Malaria in HIV infected
Ugandan children living in an area of widespread antifolate
resistance. Malaria Journal 9:177

Lengeler C (2004) Insecticide treated bed nets and curtains for preventing
malaria Cochrane Database System Review (2) CD000363

Lule J, Mermin J et al (2005) Effect of home based water chlorination and

safe storage on diarrhea among persons with HIV in Uganda.
Am J Trop Med Hyg 73 (5): 926-33

Kamya MR, Gasasira AF et al (2006) Effect of HIV infection on Malaria

treatment outcomes in Uganda, A population based study JID
193: 9-15

KNBS (2010) Kenya Demographic and Health Survey 2008-09, Nairobi:

KNBS

MOMS&MOPHS-NASCOP (2009) Kenya AIDS Indicator Survey 2007-

KAIS, Nairobi: NASCOP

MoSSP-NACC (2009).Kenya national AIDS Strategic plan 2009/10 –

2012/13: Delivering on universal access to services. Nairobi:
NACC

Quick, Kimura et al (2002) Diarrhea prevention through household- level

water disinfection and safe storage in Zambia Am J Trop Med
Hyg 66(5) 584-589

27
ANNEXES

List of Workshop Participants

NAME ORGANIZATION

1. Ayieko Carolyne Caren Ugunja Division–Ministry Of Health

2. Dr. Ann Musuva PSI/Kenya

3. Elizabeth K. Nzau Port Reitz Hospital Mombasa

4. Elizabeth Uyoma NASCOP

5. Evans Odhiambo PSI/Kenya (Kisumu regional office)

6. Harrison O. Nyakako Butere District Hospital

7 Josephine Kioli NASCOP

8 Keziah R. Nzole Msambweni District Hospital

9. Lenet M. Bundi NASCOP

10 Noni Mumba PSI/Kenya (Coast regional office)

11 Patricia Macharia NASCOP

12 Pauline Mwololo NASCOP

13 Ruth Musyoki NASCOP

14 Sylvance Osida Malava Hospital

15 Vincent Ojiambo PSI/Kenya (Western regional office)

16 Wafula W. Job Butere District Hospital

28
NOTES

29
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