Kenya has taken the lead in responding to sexual violence within the continuum of Prevention, Care and Rehabilitation. Kenya's political and social committment has been and continues to be demonstrated since 2004 in national dialogue, followed by action in legislation, Public Health service delivery and multi-disciplinary collaboration. LVCT has been involved in the policy reform process, supporting and strengthening Government efforts in fulfilment of our mandate to deliver Technical Assistance to Government and partners as outlined in our Mission.

Preventing sexual violence: Kenya's legislation Changes
The Sexual Offences Act 2006 that reviewed Kenya's sexual offences was undertaken to respond to fundamental concerns in the previous Bill that was enshrined within a moral offences framework. It placed the Act within a criminal offences framework. This has now become popularly referred to as "the Njoki Ndung'u Act" as it was a Private Members Bill.

Strengthening care services: Responding to the needs of survivors of sexual violence

The Ministry of Public Health through the Division of Reproductive Health of Kenya undertaken to strengthen delivery of post rape care services through a systematic approach informed by a scale-up plan and a costing study that outlined the resource requirements of such a national plan.

(View the costing study report and summary)

In 2004/5, the Division of Reproductive Health formed a post rape care committee, comprising stakeholders interested in post rape care as part of the Gender and Reproductive Health Rights working group. The mandate of this committee was to support the development of national protocols and make recommendations for the development and implementation of a regulatory framework for post rape care as required by the Ministry of Health in Kenya. The committee objectives were:

• To develop national guidelines for the medical management of rape/sexual violence that would provide guidance and act as the reference for service delivery
• To develop and institutionalise requisite protocols and tools to support the use of these guidelines and support the development of a documentation framework
• To develop training curriculum, materials and guidelines for health providers. Training was noted as integral to the scaling up of the service
• To develop requisite policy level inter-sectoral linkages to support the planning, coordination and delivery mechanisms for the different services required.

ACHIEVEMENTS OF THE PRC COMMITTEE:

• 2005 - The National Guidelines on the Medical Management of Rape/Sexual Violence were developed by this committee as the guiding protocols for services delivery were published and launched at a national workshop in September 2005 having been approved by the Director of Medical Services (see attached national guidelines).
• 2005 - A policy framework for the implementation of Post-Rape care services in Kenya was supported by the Population Council and LVCT among other stakeholders. This document, in whose development I took the lead, forms the basis for two critical developments.
• The inclusion of sexual violence as a key issue within the Reproductive Health Policy in subsection 3.6 under the Gender and Reproductive Health Rights section.
• The inclusion of indicators and outputs focused on post rape care within the DRH business plan 2006/7, 2007/8 and now in 2008/9 thus ensuring MoH/DRH annual reporting against set targets.
• The DRH has captured Post Rape Care as a part of the Annual Operational Plan 4
• The development of standards for post rape care service delivery as part of development of the Output Based Approach (this includes the use of a pre-paid voucher system by district hospitals to provide essential health services to vulnerable groups). Post rape care is now captured as one of the services targeted within the OBA approach in addition to safe motherhood.

• 2005 - The PRC 1 form (MoH 363) was developed to serve the need for formal documentation for clinical care and for delivery of evidence to the justice system, making this form the first comprehensive document for health provider examination and documentation
• 2006, the National Trauma Counselors Training Manual was approved by the Ministry of Health as the national standards for in-service counselor training
• 2006 the National manual for training clinical management of sexual violence care for survivors were approved by the Ministry of Health providing national standards for training in-service clinical health providers for delivery of care following sexual violence.

The Ministry of Public Health through the National AIDS and STI Control Programme (NASCOP) facilitated the scale-up of access to Post Exposure Prophylaxis following sexual violence as part of the ART scale-up plan. This process was concomitant to the Division of Reproductive Health scale-up plan thus allowing the smooth delivery of post rape care services. In addition, the NASCOP entrenched training of PEP delivery and administration into the ART training curriculum for Kenya, strengthening service delivery at the local level.

The National AIDS Control Council (NACC) is Kenya's coordinating agency for the national HIV response. The NACC identified sexual violence as a concern for HIV prevention and thus treatment and care and articulated these concerns in the Kenya National HIV/AIDS Strategic Plan (KNASPII) with survivors of sexual violence categorised as a vulnerable group and thus require attention in the national response to HIV.

In order to ensure appropriate attention to this group by partners, the Monitoring and Evaluation Framework of the plan captures, HIV PEP and Post Rape Care as part of the National Indicators (# 47 - 51).

• # 47 - Number of health care workers trained on PEP
• # 48 - Number of health facilities with PEP operational centres
• # 49 - % of police officer sensitised on PEP for victims of sexual violence
• # 50 - % of Anti-Retroviral Therapy Sites with PEP and Post Rape Care centres
• # 51 - % of health workers trained on PEP with Post Rape Care services

This in effect means that Government now has the mandate to report achievements on these indicators through the Joint Review Mechanism and therefore requires to make resource commitments towards sexual violence. This has been demonstrated in ways:

• The Division of Reproductive health assigned resources (Government and Co-financing including funds from the UNFPA) to the purchase of emergency contraception for sexual violence survivors as part of broader EC requirements
• The National AIDS and STI Control Programme has assigned resources and ordered for HIV PEP as part of the new national ART consignment