Voices of Change

Samson Oduro Muga, MD: Improving Pediatric HIV Services in Kenya

Between 2008 and 2012, the Population Council’s USAID-funded AIDS, Population, and Health Integrated Assistance Operations Research Project worked with local partners in Kenya to test innovative ways to improve the delivery of health services. Through the project, the Council helped Kendu Adventist Hospital improve pediatric HIV services.

I am the head of clinical services and in charge of the Comprehensive Care Center, the AIDS care unit at Kendu Adventist Hospital. Out of a caseload of 4,500 active patients, we treat about 120 to 210 patients every day. We also conduct voluntary HIV counseling and testing services in our hospital and at various mobile sites outside of the clinic.

The Population Council worked with us to increase HIV testing of children and ensure that those testing positive receive treatment. The Council identified and helped us to institute changes in the way we deliver health services, and to integrate pediatric HIV into our nursing curriculum.

Antiretroviral therapy is available for children. Children can come to the clinic on any day of the week alongside adult clients. However, the hospital has designated Wednesdays and Sundays as special pediatric clinic days when young children and adolescents can get more focused attention. Originally, Wednesdays were the only special pediatric clinic days, but because it is a school day, children who skipped school to come to the clinic may have been stigmatized. So we decided to add Sundays. Children of all ages including teenagers enrolled. A child might come in at eight a.m. and leave at two p.m. We cook porridge so that the children are not hungry. We have them make small paintings and provide toys. But we need more space in order to have more fun areas. We also have clubs that meet quarterly. We encourage the children—especially children just coming into the program—to share and talk about their experiences. We want them to feel free.

Stigma and poverty are issues that stand in the way of HIV testing and treatment. We have clients who must choose between spending 100 shillings (US$1.25) for transportation to the clinic or buying food; it's a tough choice. But currently we are seeing an improvement, and women have been coming to the clinic for health issues and bringing their children along for testing and treatment. We are trying to institute new procedures such as providing testing inside faith-based institutions. That’s been highly positive in doing away with stigma around HIV. We are working to ensure that the national guideline—universal access to HIV prevention, treatment, and care—is met.