A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

Background: Kenya experienced rapid scale up of HIV testing and counselling services in government health

services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and

counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health

policy reform (policy analysis triangle).

Methods: Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This

included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis

of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya

and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the

importance of the local context in which scale up occurred.

Results: The scale up of VCT in Kenya had a number of human resource policy implications resulting from the

introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid

testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals,

counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key

groups underpinned the process. The process of reaching consensus required compromise and time commitment

but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring

standardisation of content and approach.

Conclusion: The introduction and scale up of new health service initiatives such as HIV voluntary counselling and

testing necessitates changes to existing health systems and modification of entrenched interests around

professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities

of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors,

the context and the process, is required to mitigate risks and maximise impact.