Download - COUNTY HEALTH STRATEGIC AND INVESTMENT PLAN 2013 - 2018

UASIN GISHUCOUNTY GOVERNMENT OF

Department of HealtH ServiceS

2013 - 2018

COUNTY HEALTH STRATEGIC AND INVESTMENT PLAN

Department of Health Services MINISTRY OF HEALTH

UASIN GISHU COUNTY Health strategic and investment plan 2013-2018

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Uasin Gishu County Health Strategic Plan 2013-2018

any part of this document may be freely quoted, reproduced or translated in full or in part, provided the source is acknowledged. it should not be sold or used in conjunction with commercial purposes.

published by:county Government of Uasin Gishu p.o. Box 40 30100eldoret, KenYa


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acronyms v

preface viii

foreword ix

executive Summary x

process of Development and adoption of the county Health Strategic

and investment plan xii

UGc Health Department xiv

core values of the county Health Department xv

Section 1: introduction and Background 1 1.1 purpose of the Strategic plan 2

1.2 county Geographical location and Size 4

1.3 physiographic and natural conditions 7

1.4 administrative Units 7

1.5 Demographic features 7

1.6 emerging and re-emerging issues 18

1.7 Health Service outputs 23

1.8 issues and challenges in providing Health Services (SWot) 25

1.9 Health System investment 26

Section 2: problem analysis, objectives and priorities 35 2.1 problem analysis 36

2.2 Strategic focus and objectives 38

2.3 Sector input and process targets for achievement of county objectives 40

Section 3: resource requirements and financing 47 3.1 resource mobilization Strategy 52

Section 4: implementation arrangements 54 4.1 county Health Services coordination framework 55

4.2 monitoring and evaluation plan 59

4.3 comprehensive monitoring and evaluation plan 60

Section 5: references 66

Section 6: annexes 68 6.1 annex 1: risk factors 68

6.2 annex 2: the monitoring and evaluation framework 68

6.3 annex 3: participant list 70

6.4 annex 4: functions, roles and responsibilities 70

TABLE OF CONTENTS


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Table of Tables

table 1: Uasin-Gishu county administrative and political Units and Size 7

table 2: Uasin Gishu population Distribution and projection, 2013 to 2017 8

table 3: Uasin Gishu population Distribution by age Group 2013 9

table 4: population projection 2013 2017/2017 10

table 5: Uasin Gishu population Distribution per Sub-county and Health care coverage 10

table 6: Distribution of Health facilities per manning agency across Sub-counties 11

table 7: top ten causes of opD morbidity among Under-5s in Uasin Gishu 12

table 8: over-5 top ten causes of opD morbidity in Uasin Gishu 12

table 9: Uasin Gishu opD Service Utilization 13

table 10: reported causes of inpatient mortality in mtrH 2011 to 2013 15

table 11: inpatient Utilization 17

table 12: Health impact 17

table 13: Key Health indicators 17

table 14: emerging and re-emerging Health issues and interventions 20

table 15: Health Service outputs 23

table 16: issues and challenges in providing Health Services 25

table 17: available Human Workforce against required numbers and Gaps 28

table 18: problem analysis 36

table 19: investment area Details 43

table 20: Budget Summary 48

table 21: investment area Budget Summary 52

table 22: partnership and coordination Structure 57

table 23: Service outcome and output targets for achievement of county objectives 62

table 24: county monitoring indicators 63


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Table of Figures

figure 1: results framework 3

figure 2: map location of Uasin Gishu county in Kenya 4

figure 3: Health facility Distribution map by type -2013 5

figure 4: Saram Kenya 2013: Health facility Distribution by type across constituencies 6

figure 5: Uasin Gishu county population pyramid 2013 9

figure 6: Uasin Gishu outpatient morbidity 2011 to 2013 11

figure 7: outpatient Services Utilization 2011-2013 13

figure 8: Uasin Gishu county immunization coverage 13

figure 9: comparative Uptake of reproductive Health Services 14

figure 10: top ten causes of mortality, 2011-2013 16

figure 11: leading causes of Death, 2011-2013 16

figure 12: Health information System 37

figure 13: UaSin GiSHU county Health Department organogram 56

figure 14: Detailed clinical Services Structure 56

figure 15: comprehensive planning cycle 60

figure 16: Uasin Gishu county planning cycle 61


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ACRONYMS

aiDS acquired immunodeficiency Syndrome

aloS average length of Stay

anc antenatal care

art antiretroviral treatment

arvs antiretrovirals

aWp annual Work plan

Beoc Basic emergency obstetric care

Bor Bill of right

Bmi Body mass index

cBr crude Birth rate

cDH county Director for Health

cDr crude Death rate

cec county executive committee

ceoc comprehensive emergency obstetric care

cHmt county Health management team

cHW community Health Worker

ciDp county integrated Development plan

cme continuing medical education

coH chief officer for Health

coK constitution of Kenya

cSo civil Society organization

cU community Unit

DHiS District Health information Software

DmoH District medical officer of Health

Her electronic Health records

emmS essential medicines and medical Supplies

emr electronic medical records

DQa Data Quality assessment

eSp economic stimulus package

fBo faith-based organization

GBv Gender-based violence

Gf Global fund

HDU High Dependency Unit

HiS Health information System


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HmiS Health management information System

Hiv Human immunodeficiency virus

HrH Human resources for Health

HSSf Health Sector Service fund

icD-10 international classification of Diseases version 10.

icDp integrated county Development plan

ict information and communication technology

icU intensive care Unit

iDSr integrated Disease Surveillance and response

imr infant mortality rate

KemSa Kenya medical Supplies agency

KHp Kenya Health policy

KHpf Kenya Health policy framework

KHSSp Kenya Health Sector Strategic plan

KnBS Kenya national Bureau of Statistics

llitns long-lasting insecticide treated nets

m&e monitoring and evaluation

mDG millennium Development Goal

mDr-tB multi Drug resistant tuberculosis

mtrH moi teaching and referral Hospital

moH ministry of Health

mSf mdicens Sans frontires

naScop national aids and Sti control program

ncDs non-communicable Diseases

nGo non-governmental organization

nHSSp national Health Sector Strategic plan

pHc primary Health care

ppe personal protective equipment

rta road traffic accidents

rtK rapid test Kit

Saram Service availability readiness assessment mapping

ScHmt Sub-county Health management team

SD Standard Deviation

SWot Strengths, Weaknesses, opportunities and threats

Smart Specific, measurable, reliable and timely


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Sops Standard operating procedures

Sti Sexually transmitted infection

tB tuberculosis

tBa traditional Birth attendant

tWG technical Working Group

UGcHSSp Uasin Gishu county Health Sector Strategic plan

UnaiDS Joint United nations program on Hiv/aiDS

Unicef United nations children fund

USaiD United States agency for international Development

Wfp World food programme

WHo World Health organization


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the county Government of Uasin Gishu has committed itself to providing equitable, affordable and quality health care of the highest standard to all Kenyans, as per the Bill of rights in the constitution of Kenya 2010. this will be achieved through appropriate and available policies, guidelines and programmes that the countys Health Department will implement.

this strategic plan conveys the Health Departments vision, mission, goal and core functions, policy priorities, strategic objectives, investment areas, implementation framework and the resource requirements between 2013 and 2018. the plans implementation will also be closely monitored through the Health Departments monitoring and implementation framework at county and sub- county levels. the plan recognizes the strengths, challenges and some of the underlying weaknesses within the current social, economic and political environment under which this plan will be implemented. Being the first strategic plan within the new devolved system of governance, it is expected that all players will rally around the strategic directions outlined in the plan to realize the countys health goals.

the structure and framework of this plan is informed by the Kenya Health Sector Strategic plan (KHSSp) 2014-2018. the KHSSp ensures the linkage between the outputs, outcomes and impact on one hand and investment that are needed to achieve the same on the hand. the ultimate objective is evidence-based and client-oriented focus that deviates away from the old disease-based approach.

the preparation of this plan would not have been possible without the valuable contribution of the Directorate of preventive and promotive Services, Directorate of curative and rehabilitative Services led by the county Health management team (cHmt) and Sub-county Health management teams (ScHmts).

finally, we would like to take this opportunity to thank the technical working group (tWG) and all those who in one way or another participated and contributed in the process of preparing and developing this document.

Dr. evans Kiprotich

county Director of Health, preventive and promotive Services

UASIN GISHU COUNTY

PREFACE


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the constitution of Kenya 2010 established national and county governments, which are distinct but interdependent, and which are expected to carry out their respective functions on the basis of consultation and cooperation. the fourth Schedule of the constitution assigns health policy and health service delivery to the national and county governments respectively. to realize the right to health as stipulated in the Bill of rights and financial management acts 2012. this outlines the priorities envisioned in the Kenya Health policy framework (KHpf) 20122030, which are aligned to the national Health Sector Strategic plan (nHSSp) 20122017 and to the United nations millennium Development Goals (mDGs).

the Uasin Gishu county Health Sector Strategic plan (UGcHSSp) 2013- 2018 is a key milestone in the countys department of health services. it outlines the countys priorities towards the attainment of quality health care for the people of Uasin Gishu. the development of this strategic plan is a result of an evaluation of the sector through an elaborate and participatory process that is intended to ensure leadership & governance, ownership & sustainability, stewardship & commitment by the key stakeholders.

to guide the implementation of the strategic plan, comprehensive essential service packages have been defined and will be provided across the six key strategic objectives and seven health investment areas, which will contribute to achieving the national targets and attaining KHpf 2012-2030 and Kenya vision 2030.

the strategic plan articulates the vision, mission and core values of Uasin Gishu countys health sector. it also sets out strategic objectives, strategies, activities, time frame and resource requirements.

it is expected that the realization of the activities as outlined in the strategic plan will cost a total of KeS

6,653,240,000.

the successful implementation of this strategic plan is expected to provide a basis for quality health care and improved productivity in the county of Uasin Gishu.

mr. Wilson Kemei

chief officer of Health Services

UASIN GISHU COUNTY

FOREWORD


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the county Government of Uasin Gishu was established after the enactment of the constitution of Kenya 2010. the countys Department of Health is mandated to carry out devolved health functions. these include; county health facilities and pharmacies, ambulance services, promotion of primary health care; licensing and control of undertakings that sell food to the public, cemeteries, funeral parlors and crematoria.

the strategic plan is composed of five key chapters that cover specific priorities and thematic areas.

Section one outlines the purpose of this strategic and investment plan as stipulated in the county Government act 2012. it provides background information of Uasin Gishu county, including the 30 administrative units (wards), the demographic features and a map indicating the current distribution of health facilities. it also provides the projected population for the different sub-counties, totalling 1,023,656 in 2013 to 1,178,391 in the year 2018 (the duration of the strategic plan) with an annual growth rate of 3.6% (KnBS). it also outlines the countys vision, mission, and core values.

Section two focuses on the county situational analysis. it highlights the general health status and morbidity and mortality patterns. it includes the following trends: immunization coverage at 63.5% (DHiS 2013), fully immunized, 76% in 2011 (DHiS). i also includes the burden of emerging, re-emerging and non-communicable conditions i.e. cancers, hypertension and diabetes mellitus among the top 10 causes of morbidity and mortality; communicable diseases posing a big challenge with increase in the prevalence of Hiv from 4.5% to 4.9% (UnaiDS/naScop report 2013). there is also an emergence of multi-drug resistant tB (mDr-tB) that has seen cases the rise from the first diagnosed in 2008 to the current total of 31 reported in county, which calls for specialized techniques and expensive equipment to diagnose mDr-tB. the county has a latrine coverage of 86.7% with notable low coverage in the urban slum dwellings where indiscriminate open defecation is witnessed, which increases the risk of waterborne diseases.

Section three states the problem analysis, objectives, and the key priorities of the county strategic plan. it elaborates the strategic focus, sector goal and objectives. in each of the specific objectives, various strategies have been proposed. the section also provides for the sector inputs and processes with targets for achievement and contains the key milestones that need to be reached.

Section four outlines the resources and the financing required to implement the strategic plan. the total cost of implementation is this strategic plan is estimated to be KeS 6,653,240 000 (approximately USD 69 million). the resource mobilization strategies are also highlighted in this section. it is expected that the government will finance most of the budget with implementing and support partners expected to fill the gaps.

Section five illustrates the implementation framework and the organogram for governance, coordination, and managerial structures, with the different functions, roles and responsibilities of each stakeholder outlined. this section also provides the monitoring and evaluation framework that has been proposed to monitor and evaluate the achievement of the objectives and realization of goals as stated in the strategic plan during plan period.

the development of this strategic plan was made possible through the support of the national ministry of Health, which provided technical guidance, the Government of Uasin Gishu county, especially H.e. the Governor, the county executive committee member for health and the county assemblys Health committee who provided resources and leadership.

EXECUTIVE SUMMARY


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We also recognize and commend the role played by health partners and stakeholders during the whole process. We would like to particularly appreciate meaSUre evaluation-pima, Kenya red cross and ampatH plus for their technical and financial support throughout the process of developing this document and the subsequent printing of the initial copies.

With the support of both the county government and the national government and all stakeholders, this pragmatic strategic plan can be implemented successfully for the benefit of the people of Uasin Gishu.

for:

Dr. eunice J. Siria

county executive committee member for Health

UASIN GISHU County


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the Uasin Gishu county Health Strategic and investment plan was developed through a consultative and participatory process at various levels. the process involved the establishment of a technical working group (tWG) that included a wide variety of stakeholders to oversee the following key technical areas: service delivery; human resources for health; health infrastructure; medical products; health information system; finance; and leadership and governance. the stakeholders that constituted the working groups were drawn from county Department of Health, non-governmental organizations (nGos), fBos and the private sector. these included, but were not limited to, meaSUre evaluation-pima, Kenya red cross, ampatH plUS and population Services Kenya, among others. each working group, assisted by a task force that assessed the needs in specific technical areas, identified the key challenges, drafted priority strategic actions, and helped set the specific objectives, indicators, targets and planned outcomes.

the process involved the county government represented by the county executive committee (cec) for Health, the chief officer for Health (coH), the county Health management team (cHmt), the Sub- county Health management teams (ScHmts), partners and stakeholders who provided guidance and oversight.

the planning process involved a workshop where sections of the strategic plan were discussed and a draft of the plan was produced. Subsequently, the document was revised by the Department of Health staff and stakeholders, appraised by the cec, and finally adopted by the county assembly.

PROCESS OF DEVELOPMENT AND ADOPTION OF THE COUNTY HEALTH STRATEGIC AND INVESTMENT PLAN


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Vision Statement

excellence in health care for all people in Uasin Gishu county.

Mission

to promote health and prevent disease and injury through the provision of the highest attainable quality, acceptable, accessible, affordable and equitable health care services that are innovative, sustainable and responsive to the people of Uasin Gishu county and beyond.


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UGC HEALTH DEPARTMENT


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CORE VALUES OF THE COUNTY HEALTH DEPARTMENT

Service excellence

Understandingandrespondingtopublichealthneedsandthepeopleweserve

Pursuingourcommitmenttoinnovationandevidence-basedbestpractices

Fosteringacultureofcontinuousqualityimprovement

integrity

Workinghonestlyandethicallyinourobligationtofulfilourpublichealthmission.

Ensuringresponsiblestewardshipofpublichealthresources

partnership

Workingwith stakeholders and communities to protect andpromote the health of allUasinGishucountys population

Seeking,listeningtoandrespectinginternalandexternalideasandopinions

Optimizingresourcesandleadership

Achievingpublichealthgoalsincollaborationwithourpartnersandothercounties

Exploringanddefiningtherolesandresponsibilitiesofhealthcareprovidersandpartners

Health equity

Eliminatinghealthdisparitiesandworkingtoattainthehighestlevelofhealthforallpeople

Ensuringthequality,affordabilityandaccessibilityofhealthservicesforallresidentsofUasin

Gishu county

Integratingsocialjustice,socialdeterminantsofhealth,vulnerablepopulations,diversityandcommunity

ProtectingallindividualsandcommunitiesinUasinGishuCountyagainstthespreadofdisease, injuries and environmental hazards

leadership

Buildingorganization-wideandcommunity-wideopportunitiesforcollaboration

Fulfillinganinnovativevisionofpublichealthservice

Championingpublichealthexpertiseandbestpractices

Creatingopportunitiesforindividualdevelopmentandleadership

Adheringtopublichealthprinciplesandstandards


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legislative and other mandates

the Health Department is directly responsible for implementing, managing and overseeing the issues emanating from the following health and constitutional articles.

the power of the people, devolution and health:

Article1(4)ofConstitutionofKenya(CoK)2010thatstatesthatthesovereignpowerofthepeopleisexercised at the national and county levels.

Article6(2)ofCoKstipulatesthatthenationalandcountygovernmentsaredistinctandinter-dependentand shall conduct their mutual relations on the basis of consultation and cooperation.

the Bill of rights (Bor):

the coK guarantees the right to the highest attainable standard of health, including:

Therighttolife,reproductivehealthandotherattributesofgoodhealth.

Therighttoemergencytreatment.

Clarityonresponsibilityofthestate(dutybearers)andcitizens(rightholders)inensuringthattheaboveaspects are met.

the coK guarantees health for all Kenyans:

Art.26;Everypersonhastherighttolife.

Art.42;Everypersonhastherighttoacleanandhealthyenvironment.

Art.43.(1)Everypersonhastheright(a)tothehighestattainablestandardofhealth,whichincludesthe right to health care services, including reproductive health care.

53.(1)Everychildhastheright(c)tobasicnutrition,shelterandhealthcare.

56.TheStateshallputinplaceaffirmativeactionprogrammesdesignedtoensurethatminoritiesandmarginalizedgroups(e)havereasonableaccesstowater,healthservicesandinfrastructure.

county Governments

Service delivery: planning is guided by articles 102-121 under county planning in the County Government Act, 2012 and article 121(1) of Public Financial Management Act, 2012. county Government act, 2012 (109) County sectorial plan.

ACountydepartmentshalldevelopcountysectorialplanascomponentpartsofthecountyintegrateddevelopment plan.

TheCountysectorialplansshallbe:

- programme based;

- the basis for budgeting and performance management; and

- reviewed every five years by the county executive and approved by the county assembly, but updated annually.


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1

introduction and Background

Section 1:


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over the years, the country has taken several steps to provide a firm foundation that ensures that health is achieved for all its citizens. the promulgation of the constitution of Kenya on august 27, 2010, was a major milestone towards the improvement of health standards.

the new constitution, which states that (article 43) all citizens are entitled to the highest attainable standard of health including emergency treatment... gave hope to many citizens as it sought to ensure that a rights-based approach to health is adopted and applied in delivery of health services in the country. it provides a conducive legal framework to ensure a comprehensive and people-driven health service delivery.

in the devolved system of governance, the transition authority also devolved the health service delivery mandate to the counties. the national government maintains the responsibility for policy development through the state department for health while the counties are entrusted with the task of implementing the national policy, with a focus on their local priorities; thus the development of this strategic and investment plan.

Uasin Gishu county is committed to implementing the national Health policy 2013-2017 through a consultative and all inclusive approach. the county has developed its integrated Development plan 2013-2017 on which this strategic plan is anchored.

the health strategic plan incorporates information on the health situation and outcomes as envisioned by the county. it also highlights the priority health investment areas needed to attain the health outcomes of the county, the resources needed, the strategy to mobilize the required resources and how the sector will be organized and managed to ensure that the strategic objectives of the county are achieved in an efficient and effective manner.

for this to be realized, there is need for a road map to guide implementation of the same. therefore, the purpose of this strategic and investment plan is to guide the county in:

Prioritizationofkeyinvestmentareasinhealth;

Providingaframeworkandaroadmaponhowthe medium-term county health objectives will be achieved;

Monitoringtargetedcountyhealthperformanceindicators;

Resource mobilization and allocation in theprioritized health investment areas;

Strengthening participation, involvement andpartnerships with both public and private sectors;

Contributing towards the achievement of themillennium Development Goals (mDGs), the Kenya Health policy 2012-2030(KHp) and vision 2030;

Accelerating health service delivery to thehighest attainable standards as envisioned in he 2010 constitution; and

Provide an informed input into the Integratedcounty Development plan (icDp) and county fiscal Strategy paper defined under the county Government act 2012 and the public finance management act 2012.

Uasin Gishu countys health priorities have informed the development of this plan in line with a results framework, which has been developed by the ministry of Health to guide the process of the realization of long-term health goals defined in vision 2030 and the Kenya Health policy 2013-2017, as illustrated in the diagram below.

1.1 Purpose Of The Strategic Plan


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HEALTH SECTOR SPECIFIC

Kenya Health Policy (2012\2030)(long term health intent for Kenya)

Kenya Health Sector Strategic & Investment Plan

(2012/2017)Second Medium - Term Plan (2013/2018)

Integrated County Development Plan(5 year county Development targets)

CountySpecificPriorities

CountySpecificPriorities

County Health Strategic & Investment Plan(5 years county targets and investment

priorities

BudgetDistribution of known or potential resources

Operational Planannual targets and activities for

implementation with available funds

Performance Contractannual performance targets

Vision 2030(long - term development intent for Kenya)

GOVERNMENT - WIDE

Figure 1: Results Framework


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Uasin Gishu county lies in the mid-west of the rift valley and borders six counties, namely elgeyo marakwet county to the east, trans nzoia to the north, Kericho to the south, Baringo to the south- east, nandi to the south-west and Kakamega to the west. the county covers a total geographical area of 3,345.2 km2.

Figure 2: Results Framework

1.2 County Geographical Location And Size


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Figure 3: Health Facility Distribution Map by type -2013


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Figure 4: SARAM Kenya 2013: Health Facility Distribution by Type across Constituencies


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1.3 Physiographic and Natural Conditions

Uasin Gishu county is a highland plateau with altitudes falling gently from 2,700 meters above sea level to about 1,500 meters above sea level. the average amount of rainfall in the county ranges from 900 1200mm per annum. the county has two rainfall seasons: long rains (march to august with the peak being may to august); and short rains (between September to november). temperature ranges from between 25 c32c.

the topography is higher to the east and declines gently towards the western border. the county

is physiographically divided into three zones: the upper highlands, upper midlands and lower highlands. these zones greatly influence land use patterns as they determine the climatic conditions. the geology is dominated by tertiary volcanic rock with no known commercially exploitable minerals.

1.4 Administrative Units

Uasin Gishu county is divided into six sub-counties: turbo; Soy; ainabkoi; moiben; Kessess; and Kapseret. the sub-counties are further sub-divided into 30 wards, as indicated in table 1. eldoret town is the countys administrative and commercial capital.

Sub-County No. of Admin. Units (Wards) Est. Pop. 2013 Area KM2 Pop. Density

per Km2

ainabkoi 3 117,962 479.9 246

Kapseret 5 184,347 415.8 443

Kesses 4 114,529 581.6 197

moiben 5 158,451 777.1 204

Soy 8 268,925 768 350

turbo 5 179,442 322.7 556

Uasin Gishu county 30 1,023,656 3,345.1 306

Sub-county no. of admin. Units (Wards) est. pop. 2013 area Km2 pop. Density per Km2

1.5 Demographic Features

population Size and composition

Uasin Gishu county has a total population of 1,023,656 consisting of 513,649 males and 510,007 females, according to 2013 population estimates. the population is projected to increase to 1,178,391 in 2017. in 2013, there were 231,421 households, which are expected to rise to 266,589 in 2017. the table below shows the population distribution per the various age groups and projection for the strategic plans 5-year period.

Table 1: Uasin Gishu county administrative and political units and size


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DescriptionPropor tion E s t i m a t e s (KBS)

2009 (KBS) 2013 2014 2015 2016 2017

total population 894,179 1,023,656 1,059,767 1,097,918 1,137,443 1,178,391

total number of households

202,291 231,421 239,752 248,383 257,325 266,589

children under 1 year (12 months)

3.90% 34,873 39,895 41,331 42,819 44,360 45,957

children under 5 years

16.9% 151,116 172,877 179,101 185,548 192,228 199,148

Under -15 population 42.3% 378,238 432,704 448,281 464,419 481,139 498,460

W o m e n of child bearing age (15 - 49 yrs)

24% 214,603 245,506 254,344 263,500 272,986 282,814

estimated number of deliveries

3.84% 34,336 39,281 40,695 42,160 43,678 45,250

e s t i m a t e d live births 3.79% 33,889 38,769 40,165 41,611 43,109 44,661

total number of adolescents (1524 yrs)

21% 187,778 214,818 222,551 230,563 238,863 247,462

adults (25-59 yrs) 26.1% 233,381 266,988 276,599 286,557 296,873 307,560

elderly (60+ yrs) 4.80% 42,921 49,101 50,869 52,700 54,597 56,563

Source: KnBS 2009 2013, Growth rate 3.6%

Table 2: Uasin Gishu Population Distribution and Projection, 2013 to 2017


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Age Group Male Female Total

0 to 4 78,574 77,254 155,829

5 to 9 72,289 71,024 143,313

10 to 14 62,394 62,528 124,921

15 to 19 53,426 55,372 108,798

20 to 24 58,228 62,983 121,211

25 to 29 47,004 48,201 95,205

30 to 34 36,754 34,242 70,997

35 to 39 29,488 33,889 38,769

26,995 21% 187,778 214,818

55,768 26.1% 233,381 266,988

40 to 44 19,867 17,507 37,373

45 to 49 16,650 14,905 31,555

50 to 54 11,255 9,955 21,210

55 to 59 8,180 7,570 15,749

60 to 64 5,993 5,633 11,626

65 + 13,847 15,538 29,385

Total Pop. 513,949 509,707 1,023,656

Sex ratio male : female 50.2:49.8

Table 3: Uasin Gishu Population Distribution by Age Group 2013

Figure 5: Uasin Gishu County Population Pyramid 2013

Sex ratio 50.2:49.8male female


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the above population pyramid illustrates that Uasin Gishu county comprises a predominantly youthful population aged between 10-29 years, which comprises 45% of the population (2013 estimates). children under 5 years of age comprise 14.6% of the population. this demands the initiation of youth-friendly health services. the pyramid also indicates that Uasin Gishu county has more males than females (Sex ratio 50.2:49.8). other factors that may require urgent attention include unemployment that may pose challenges to the health of the

youthful population, who may engage in drugs and substance abuse, irresponsible sexual behaviour, crime, etc.

the table below presents the countys projected population over the 5- year period of the strategic plan (20132017). the county had a total population of 1,023,656 as per 2013 projections. this is projected to rise to 1,179,215 by 2017, assuming that the growth rate remains constant at 3.62%. Soy sub-county has the highest population as per the projection and Kesses has the lowest.

Sub-CountyNo. of Administrative Units (Wards)

Est. Sub-County Pop. 2013

2014 2015 2016 2017

ainabkoi 3 117,962 122,209 126,608 131,166 135,888

Kapseret 5 184,347 190,983 197,859 204,982 212,361

Kesses 4 114,529 118,652 122,924 127,349 131,933

moiben 5 158,451 164,155 170,065 176,187 182,530

Soy 8 268,925 278,606 288,636 299,027 309,792

turbo 5 179,442 185,902 192,594 199,528 206,711

county total 30 1,023,656 1,060,508 1,098,686 1,138,239 1,179,215


ainabkoi 3 117,962 479.9 246 14 6,939 24 12 3

Kapseret 5 184,347 415.8 443 10 18,435 37 8 2

Kesses 4 114,529 581.6 197 13 6,737 23 16 4

moiben 5 158,451 777.1 204 17 8,803 32 12 1

Soy 8 268,925 768 350 19 11,692 54 16 5

turbo 5 179,442 322.7 556 17 11,963 36 16 8

UG county 30 1,023,656 3,345.1 306 90 10,237 205 80 23


Sub-

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Table 4: Population Projection 2013 2017/2017

Table 5: Uasin Gishu Population Distribution per Sub-county and Health Care Coverage


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Contribution per health care giver

Distribution of Public Health facilities

tier 2 tier 3 tier 4

public fBo nGo private total DiSp Hc HoSp national cmoH

ainabkoi 14 3 2 12 31 10 3 1 1 14

Kapseret 10 6 0 11 27 8 2 0 0 10

Kesses 13 3 0 7 23 11 2 0 0 13

moiben 17 1 0 6 24 13 3 1 0 17

Soy 19 4 0 7 30 13 5 1 0 19

turbo 17 11 1 12 41 13 3 1 0 17

Uasin Gishu cnty 90 28 3 55 176 79 16 4 1 90

moH mfl 2013/

ehealth Kenya


Figure 6: Uasin Gishu Outpatient Morbidity 2011 to 2013

one of the strategies towards attaining health care for the residents of Uasin Gishu county is to take services closer to the population i.e. through the use of community-based strategies. the ideal number of functional community Units (cUs) to ensure effective health interventions at the community level is 1 unit per 5,000 people. Using these criteria, Uasin Gishu county required 205 cUs (ideal) by 2013; however, only 80 cUs existed, 23 of which were reported to be semi-functional, as indicated in the table above. this calls for investment in this level of service provision i.e. to operationalize (make fully

functional) all the 80 cUs by the end of the plan period. Some sub-counties (Kapseretlangas and turboHuruma) will, however, require more units based on an expected sharp rise in population due to the presence of informal settlements (slums). the number then will need to be raised to 100 cUs as proposed in section 4 of this document (investment area).

the table below shows health service coverage per sub-county with number of health facilities and also showing contribution per sector.

UaSin GiSHU opD morBiDitY 2011 to 2013

2013

2012

2011

Table 6: Distribution of Health Facilities per Manning Agency across Sub-counties


12

2013

2012

2011

the leading cause of morbidity in the county, as illustrated by the chart above and the tables below, is other diseases of the respiratory system. However, confirmed malaria is on the rise with declining cases managed as clinical malaria. this may be attributed to increased use of rapid test Kits (rtKs) to diagnose and manage malaria.

Table 7: Top Ten Causes of OPD Morbidity among Under -5s in Uasin Gishu

Cases reported

Condition 2011 2012 2013

clinical malaria 67,420 64,073 46,303

Diarrhea 19,264 21,125 23,300

Diseases of the skin (incl. wounds) 16,913 16,466 20,925

confirmed malaria 13,908 16,342 18,583

pneumonia 8,158 9,963 12,312

eye infections 4,150 4,985 5,438

intestinal worms 3,540 3,754 3,649

ear infections 3,466 4,832 4,494

accidents - fractures, injuries etc. 2,998 3,170 5,293

chickenpox 2,577 2,384 1,525

all other cases 136,209 162,141 217,884

Total Cases 278,603 309,235 359,706

OPD Attendance (Curative) 230,448 263,732 287,703

Referrals In 4256 5778 2982

Referrals Out 1134 7631 1591

Table 8: Over -5 Top Ten Causes of OPD Morbidity in Uasin Gishu

Cases reported

Disease 2011 2012 2013

1 other Diseases of the respiratory system 136,151 148,379 218,337

2 clinical malaria 124,383 114,122 88,064

3 Diseases of the skin (incl. wounds) 46,348 52,102 65,330

4 confirmed malaria 25,248 36,688 42,434

5 typhoid fever 18,325 23,991 36,120

6 accidents - fractures, injuries etc. 21,338 21,528 25,786

7 pneumonia 18,757 23,064 28,428

8 Diarrhea 15,459 18,640 20,937

9 Dental disorders 17,527 15,737 18,977

10 Urinary tract infection 13,565 15,220 20,820

all other cases 297,772 312,764 424,396

total cases 734,873 782,235 989,629

total opD attendances (curative) 544,684 627,675 762,586

referrals in 10,986 1,911 3,515

referrals out 10,826 6,449 5,795


13

Figure 7: Outpatient Services Utilization 2011-2013

Uasin Gishu County Facilities, 2,011,

962,214

MTRH, 2,011,22,768

MTRH, 2,012,207,344

MTRH, 2,013,200,209

Uasin Gishu County Facilities, 2,012,

1,184,401

Uasin Gishu County Facilities, 2,013,,

1,442,008

in terms of service utilization, there is a general increase in the number of clients seeking services from the primary facilities and a decline in those going for services at the referral facility (mtrH).

Table 9: Uasin Gishu OPD Service Utilization

2011 2012 2013

General opD 1,183,982 1,391,745 1,642,217

immunization coverage (fic) 74.2% 66.8% 63.5%

measles coverage 77% 74% 65.3%

Deliveries by skilled workers 12002 15803 18578

1st anc visit 24004 28093 26913

4th anc visit 7181 10207 9712

Figure 8: Uasin Gishu County Immunization Coverage

Uasin Gishu County Immunization Coverage

Measles coverage

Immunizationcoverage (FIC)

Poly. (Measles coverage)

2013

2012

2011

65%

64%

74%

67%

77%

74%

)% 10% 20% 30% 40% 50% 60% 70% 80% 90%

the previous chart indicates a decline in general immunization and measles vaccine coverage over the three- year period. this is a trend that needs to be reversed, especially bearing in mind that Uasin Gishu


14

has a youthful population, as portrayed by the population pyramid in figure 9. this implies that the children under 5 years of age will be at risk of acquiring vaccine preventable diseases as the threshold for herd immunity is far below. considering that 45% of the population falls in the reproductive age groups, this compounds the situation even further. this, in turn, will pose challenges and strain the countys health system and resources.

Figure 9: Comparative Uptake of Reproductive Health Services

45,000

40,000

35,000

30,000

25,000

20,000

15,000

10,000

5,000

36,974

2011 2012 2013

24,004

7,181

12,002

38,393

28,093

15,803

39,281

26,913

9,712

18,578

CHART SHOWING COMPARATIVE UPTAKE OFREPRODUCTIVE HEALTH SERVICES

Expected Pregnant Women

1st ANC Visit

4th ANC Visit

Skilled Deliveries

38 39339,281

28 093

18,578

10,207

the countys antenatal care (anc) coverage is still low. the picture indicated in the chart above shows low uptake of anc services; this could be due to client attitudes or service limitation (accessibility). Workable solutions include introduction of mobile reproductive health services, construction of health care facilities, upgrading existing facilities, investing in the health workforce and enhancing health promotion services, among others.

other key areas that need to be addressed include the low number of skilled deliveries and fourth anc visits.


15

Table 10: Reported Causes of Inpatient Mortality in MTRH 2011 to 2013

2011 Top Ten Inpatient Mortality Conditions


2013

Hiv 222 Hiv 364 Diseases of the circulatory system

293

Diseases of the circulatory system 151 Diseases of the circulatory system

276 Hiv 254

Diseases of the respiratory system 110 Diseases of the respiratory system

137 Diseases of the respiratory system

179

neoplasm 108 neoplasms 105 neoplasm 166

Diseases of the digestive system 108 Diseases of the digestive system

84 Diseases of the digestive system

150

accidents 95 acute renal failure 67 accidents 131

anaemias 55 accidents 59 anaemias 79

renal failure 43 tuberculosis 54 tuberculosis 69

tuberculosis 40 anaemia 51 renal failure 59

Diarrhoea 36 Diarrheal diseases 33 meningitis 54



2013

Hiv 222 Hiv 364 Diseases of the circulatory system

293

Diseases of the circulatory system 151 Diseases of the circulatory system

276 Hiv 254

Diseases of the respiratory system 110 Diseases of the respiratory system

137 Diseases of the respiratory system

179

neoplasm 108 neoplasm 105 neoplasm 166

Diseases of the digestive system 108 Diseases of the digestive system

84 Diseases of the digestive system

150

accidents 95 acute renal failure 67 accidents 131

anaemias 55 accidents 59 anaemias 79

renal failure 43 tuberculosis 54 tuberculosis 69

tuberculosis 40 anaemia 51 renal failure 59

Diarrhoea 36 Diarrheal diseases 33 meningitis 54

total other causes of Death 1,895 total other causes of Death 1,017 total other causes of Death 1,382

Total Deaths 2,863 2,247 2,816


16

Figure 10: Top Ten Causes of Mortality, 2011-2013

TOP TEN CAUSES OF MORTALITY, 2011 TO 2013

TOTAL OTHER CAUSES OF DEATH

DIARRHOEA

TUBERCULOSIS

RENAL FAILURE

ANAEMIAS

ACCIDENTS

DISEASES OF THE DIGESTIVE SYSTEM

NEOPLASM

DISEASES OF THE RESPIRATORY SYSTEM

DISEASES OF THE CIRCULATORY SYSTEM

HIV DISEASES

0 200 400 600 800 1000 1200 1400 1600 1800 2000

2013

2012

2011

Figure 11: Leading Causes of Death, 2011-2013

LEADING CAUSES OF DEATH, 2011 - 2013

TOTAL OTHER CAUSES OF DEATH

DIARRHOEA

TUBERCULOSIS

RENAL FAILURE

ANAEMIAS

ACCIDENTS

DISEASES OF THE DIGESTIVE SYSTEM

NEOPLASM

DISEASES OF THE RESPIRATORY SYSTEM

DISEASES OF THE CIRCULATORY SYSTEM

HIV DISEASES

0 1000 2000 3000 4000 5000

2013

2012

2011

Hiv is the leading cause of death in the county (mtrH data), as indicated in the chart above, followed by diseases of the circulatory system, respiratory diseases and non-communicable diseases, such as neoplasm, anaemia and renal failure.


17

Table 11: Inpatient Utilization

County Hospitals & Health Centres MTRH

2011 2012 2013 2011 2012 2013

available beds 105 720 779 734

% occupancy 105% 87% 103%

aloS 2 2 2 7 7 6

maternity

admissions 8,155 8,343 10,265

no of beds 112 112 112

no of deliveries 7,315 7,894 10,125

maternal deaths 44 36 41

Table 12: Health Impact

Impact level Indicators National Estimates County Estimates

life expectancy at birth (years) 63 60 (male 56, female 65)

annual deaths (per 1,000 persons) crude mortality female 5.8

male 6.0 7.8 2

neonatal mortality rate (per 1,000 births) 31/1000 33/1000

infant mortality rate (per 1,000 births) 52/1000 57/1000

Under-5 mortality rate (per 1,000 births) 74/1000 80/1000

maternal mortality rate (per 100,000 births) 488/100,000 147/100,000

Table 13: Key Health Indicators

total population projection (2012) 1,023,656

total health personnel (2012) 3,798

Staff: patient ratio 1:270

crude birth rate (cBr) 49.4/1,000

crude death rate (cDr) - 7/1,000

life expectancy 65.9 years

Women of childbearing age (15 49 years) 24%

total fertility rate 3.4 %

neonatal mortality rate 52/1,000

infant mortality rate (imr) 48/1,000

children under 1 year 3.71%

children fully immunized at 1 year of age 35 %

children under 5 years 16.9 %


18

Under - 5 mortality rate 38/1,000

children under 5 years attending growth monitoring clinic (new visits) 38%

children de-wormed at least once a year 25%

pregnant women attending at least four anc visits 22%

Deliveries conducted by skilled health staff in facility 30%

Women receiving family planning commodities 34%

malaria prevalence 43.4%

respiratory infections 20.7%

malnutrition rate among under-5s 61%

Hiv prevalence rate 4.3 %

Hiv+ women receiving pmtct 20%

targeted adult Hiv+ patients receiving art 4.8%

tB in every 100,000 people 170/100,000

Doctor:patient ratio 1:10,034

Source: Uasin Gishu county Health Strategic plan 2013-2018

1.6 Emerging and Re-emerging Issues

introduction

Globally, the number of deaths arising from non-communicable causes, such as heart disease and injuries, is growing. outbreaks of infectious diseases, food borne diseases or contaminated pharmaceuticals and other products can spread from other countries across the globe, counties and communities. the Health Department must continue to prevent and control infectious diseases while addressing health threats from non-communicable diseases and environmental health risks.

as Uasin Gishu countys socio-economic status continues to change, the health system surveillance must improve with a focus on addressing these emerging and re-emerging health concerns. the county should take a leadership role in promoting a comprehensive real-time infectious disease surveillance and emergency response system given the presence of the following features in the county which can contribute to health risk factors and hazards:

The county is situated along an internationalnorthern corridor highway from South africa to cairo.

Theinternationalairport inEldoretexposes thecounty to risks associated with international travel in terms of infections and epidemics listed as WHo notifiable diseases.

Thenationalreferralhospital (MTRH)attractsahigh volume of referral cases of communicable diseases.

Institutionsofhigher learningwithhigh studentpopulations from across the globe pose disease surveillance challenges.

emerging health issues

Diabetesandobesity

Hypertension

Cancer

TB&MDR-TB

Drugsandsubstanceabuse

public health emergencies

the response to any emergency or disaster must be a coordinated community effort. there is a need to develop and disseminate the Uasin Gishu county public Health emergency Guidelines that will assist the county and public health professionals during


19

the first 24 hours of a disaster. these should be used in conjunction with existing emergency operational plans, procedures, guidelines resources, assets and incident management systems.

the dominant public health issues in Uasin Gishu county include:

Occupationalhealthhazards

WHOnotifiablediseasese.g.Ebola,influenza,measles, polio, guinea worm, etc.

Zoonotic diseases i.e. Anthrax, rabies, Riftvalley fever

Neighbouringcounties/countrieswithendemic vector-borne diseases, such as yellow fever,

and viral haemorrhagic fevers and bacterialmeningitis

Roadtrafficaccidents

Risk of HIV among key populations, such asmen having sex with men, long distance truck drivers, commercial sex workers, and injecting drug users


20

Table 14: Emerging and Re-emerging Health Issues and Interventions

output area Situation intervention area

emerging Health issues

increased cases of:Lungdiseasese.g.,pneumonia,TB&MDR-TB

WHOnotifiablediseasese.g.rabiesandmeasles

Diabetesandobesity

Hypertension

Cancer

Drugandsubstanceabuse

HIV&AIDS

Childmalnutritionandstuntedgrowth

Increase case detection, early diagnosis,treatment and management

Strengthen surveillance and responseinitiatives

ProvidePPE

Promotehealthylifestyle

Regularmedicalcheck-upsandscreening

Establish regular specialist clinics and offersubsidized services.

Drugandsubstanceabusesensitizationandlaw enforcement.

Carryoutasurveyondrugsandsubstanceabuse

Strengthen surveillance, internationalscreening and vaccination

Behaviour change communication (amongkey populations, youth etc).

EarlydiagnosisandtreatmentofHIVandSTIs

Structured interventions (alternative income-generating activities)

EnsureconsistentavailabilityofHIVdiagnostics& art/prophylaxis

Strengthenpreventionanddiagnosisofnewinfections of Hiv e.g. eliminate mother- to-child transmission (emtct), early infant diagnosis (eiD)

Improvenutritioneducation


21


re-emerging Health issues

Givemicronutrientsandsupplementation

Carryoutresearchandbaselinesurvey

Terrorattacks/threats

Notifiablediseasese.g.measles,rabies,anthraxetc.

Humanconflict

Roadtrafficaccidents

Workplaceacquiredinfections

Unplannedsettlements(slumdwellings)

Inter-sectoralemergencypreparedness

Networkwithnationalandresearchcenters

Promotecommunitycohesion

Establish and equip modern referral laboratory for promptdiagnosis

Roadsafetyawarenessandresponsebystakeholders

Strengtheninfectionpreventionmeasures

VaccinatestaffusingWHOapprovedantigens

Collaborate with relevant departments for education onimplementation of the occupational Health and Safety act (oHSa) and protocols

rural and urban planning, zoning, and waste management through inter-sectoral collaboration.

malaria epidemics

capacity building and implementation of malaria case management policy

public Health preparedness and response: core competencies in disaster management and emerging health concerns

the public Health preparedness and response core competencies are to be used with the understanding that they are practised within foundational public health competencies, generic emergency core competencies, and position-specific or professional competencies.

the four core competencies span preparedness, response and recovery roles.

performance Goal: proficiently perform assigned prevention, preparedness, response, and recovery role(s) in accordance with established national, state, and local health security and public health policies, laws, and systems.

1. model leadership:

Solveproblemsunderemergencyconditions.

Manage behaviour associatedwith emotionalresponses in self and others.

Facilitatecollaborationwithinternalandexternalemergency response partners.

Maintainsituationalawareness.

Demonstraterespectforallpersonsandcultures.

Actwithinthescopeofoneslegalauthority.

2. communicate and manage information:

Manageinformationrelatedtoanemergency.

Useprinciplesofcrisisandriskcommunication.

Report information potentially relevant to theidentification and control of an emergency through the chain of command.

Collectdataaccordingtoprotocol.

Manage the recordingand/or transmissionofdata according to approved protocol.

3. plan for and improve practice:

Contribute expertise to a community hazardvulnerability analysis (Hva).


22

Contribute expertise to the development ofemergency plans.

Participate in improving the organizationscapacities (including, but not limited to,

programs,plans,policies,laws,andworkforcetraining).

Refer matters outside of ones scope of legalauthority through the chain of command.

4. protect Worker Health and Safety

maintain personal/family emergency preparedness plans.

employ protective behaviour according to changing conditions, personal limitations, and threats.

the disaster competencies for health staff span four broad areas :

Mitigationandprevention

Preparedness

Response

Recovery/Rehabilitation.

the competency domains for the workforce include:

Risk reduction, disease prevention and healthpromotion

Policydevelopmentandplanning

Ethicalpractice,legalpracticeandaccountability

Communicationandinformationsharing

Educationandpreparedness

Careofthecommunity

Careofindividualsandfamily

Psychologicalcare

Careofvulnerablepopulations

Long-term recoveryof individuals, familiesandcommunities.


23

1.7 Health Service Outputs

Table 15: Health Service Outputs


access / Utilization

Human resources:Shortage of human resources for health in terms of numbers

and skill mix: Leadingtotheintermittentclosureofhealthfacilities

Leadingtofacilitiesbeingmannedbyonememberof staff

Highstaffattritionrate

Absenceofattractiveandretentionpackageforhumanresources

Poor workingenvironmentandconditions

Shortageofspecializedskillsinhealthfacilities

Recruitmorestaffaspernormsandstandards

Staff promotion,review ofremuneration,

Availabilityofcriticalinputs(commodities,equipment&innovative interventions, etc.)

Careerdevelopmentthroughboth short-and long-termto develop specialized skills.

Developahumanresourcedevelopmentplan

infrastructure: Inadequatephysicalinfrastructure

Poorlymaintainedinfrastructure

Frequentpowerinterruption

Inadequatesupplyofsafewater

Lack ofadequatestoragecapacity

Renovationandconstructionofmoderninfrastructure

Adheretorecommendedconstructionandmaintenancestructural plans

Providebackuppowergenerators

Providealternativesourcesofportablewater

Constructstaffhouses

Constructstoresandwarehouses

Weak referral systems: Lack ofacountyreferralhospital

Lackofenoughambulances

Ill-equippedhealthfacilities

Lack offullyfunctionalcommunity unitsinplace

Lackofreferralprotocols

Procureandeffectivelymanageambulances

Buildandequipcountyreferralhospitalandsub-countyhospitals

Developareferralpolicy

SensitizeCHWsandhealthcareworkersonreferralsystems

Encouragetwo-wayreferralsystem

Strengthenthecommunitystrategy

Developandimplementreferralprotocols

Geographical inaccessibility due to:

Roughterrainandpoorroadnetwork

Poorroadconditions

Advocacyandmulti-sectoral collaboration to improveroad networks

transport/communication: Low coverageandutilizationofICTandnetworking

in client management Low ICTcapacityofthetechnicalhumanresource

IncreasethenumberoffacilitieshavingICTautomation

CapacitybuildinginICT

Use innovative mobile (sms) alerts to clients andmanagement information systems

Developanelaboratedatainformationsystem

commodities and equipment: Insufficientbasicequipment

Lack ofspecializeddiagnosticlaboratoryequipment

Erraticandinsufficientsupplyofessentialmedicinesandmedical supplies (emmS)

Poorlymaintainedequipment

Procurebasicequipment

Procureandprovidespecializeddiagnosticequipment

Ensuretimely,regularandconsistentsupplyofessentialmedicines and medical supplies

Buildcapacity ofstaffincommoditymanagement

Improveinventorymanagement,

Strengthensupplychainmanagement,

Implementpreventivemaintenancepolicy


24

religious/social cultural barriers: Underutilizationofhealthcare services due to

preference for tBas and herbalists Retrogressive religious/cultural beliefs that dont

conform to modern health practices Low maleinvolvementinhealthissues

Poor health-seekingbehaviour

Advocacyandhealthpromotion

Sensitizationandmaleinvolvementinhealth

Behaviorchangecommunication

ReorientTBAsontheirroleinreferral

Enforcementofpublic health laws

poor emergency preparedness and response capability:

Lack ofthecoordinatingteam/mechanism

Lack ofhumanresource capacity

Lack ofemergencyequipmentandsupplies

Adapt and implement legislation to guide disasterpreparedness and response

Forman integrated county/ sub- county disastermanagement committee

Capacitybuildingofstaffondisastermanagement

Procurementandsupply ofemergencyequipmentandsupplies

Output Area Situation Intervention area

access / Utilization

low client/provider satisfaction: Lackofclientsatisfactionsurveys

Sub-optimal community engagement in healthprogramming and implementation

Non-complianceofservicecharterbyhealthcareproviders

Unfriendlyservicesforminoritygroupse.g.physicallychallenged clients and key populations at risk of Hiv

Poorlymotivatedhealthcareproviders

Inadequatesanitaryfacilities

Lack ofaconduciveandcleanworkingenvironment

Inadequatecommunityawarenessonhealthrights

Conductpatientsatisfactionsurveys

Createcustomercaredesks

Installasuggestionbox

Ensureallhealthfacilitieshaveacustomerservicecharter, and ensure its dissemination and compliance

Youth-friendlyservices

Trainingofstaffoncustomercare

Ensurefacilitiesareaccessibletothedisabled

Motivatestaff(general)e.g.timelypromotions,salaryemoluments (commensurate to skills and qualifications)

Ensureaconduciveworkingenvironment.

Motivatestaffthroughperformance-basedincentives.

GiveRecognitionAwardstothebestperformingstaff.

Poor adherencetoclinical

guidelines and standard operating procedures atservice delivery level

Ineffectivesupportsupervisionandfollow-up

Noclientfeedback

Improperdocumentation

Low datademandand usefordecision-making

Weakdatamanagementstructures

Produce,avail and disseminate clinical guidelines toall staff

Strengthensupportsupervision

AdaptanddisseminateHISpolicy

ConductroutineDQAsandreviews

Capacitybuildstaffondatamanagement

Procureanddistributesufficientdatacaptureandreporting tools

Strengthendocumentationandreportingsystem

Advocateforactivedataand information use fordecision-making

ImplementKenyaqualityimprovementofcare


25

Output Area Situation Intervention area

Non-functional therapeuticcommitteeinhealthfacilities

Poorandinadequatewastedisposalsystems(especiallymedical waste)

Partialadherencetoinfectionpreventionprotocols

Weakenforcementbyregulatorybodies

Lack of and non-adherence standard operatingprocedures in all health facilities

Establishclinicalauditcommittees

Establish and support infection prevention and bio-safety committees

Establish and support a medical board at the countylevel

FormulateanddisseminateSOPsandensureadherence

Putinplaceaneffective waste disposal system at alllevels

1.8 Issues and Challenges in Providing Health Services (SWOT)

Table 16: Issues and Challenges in Providing Health Services

Strengths Weaknesses

Existenceofbasichealthinfrastructure

Existinghealthsectorpartners(donorgoodwill)

Availabilityofhumanresourcesforhealth

Existing innovative healthcare approacheslike integrated outreaches, etc.

Existing policies, plans and documents tobuild on

Existenceofacommunitystrategy

Existence of public-private partnerships inhealth

Humanresourceshortage(skillmixandnumbers)

Poorattractionandretentionofhealthcareworkers

Inadequateinfrastructurecapacitytoofferqualitycare

Sub-optimal sensitization of communities to create demand leading to under-utilization of health services

Poorhealth-seekingbehaviourandlowcustomersatisfaction

Lackofstakeholder/partnershipcoordinatingframework

Inadequateanderraticsupplyofdrugs/non-pharmaceuticalsandequipment

Inadequate infrastructure and poor maintenance of the existing physicalinfrastructure

andequipment

Lack of knowledge on the roles of facility health committee and hospitalmanagement boards

Inadequatefundingforhealth

Weakreferralsystem

Mushroomingofunlicensedprivatefacilities(weakenforcementofregulationofprivate health sector services)

Lackofemergencypreparednessandresponsemechanism

Lackofalegalframeworkforalternativemedicines(traditionalhealers,herbalists)

Poorqualitydataandlowdatautilizationindecisionmaking


26

Opportunities(External) Threats

Devolvedhealthservicesisanopportunitytoaddresslocalhealth priorities and increase local participation

Politicalgoodwillandvisionaryleadership

Presenceofanationalreferralandteachinghospitalwithinthe county with highly skilled personnel

GrowingICTsector

Existinghealthtrainingcolleges,universities

Existence of other competitive suppliers of essentialmedicines and medical supplies

Communitygoodwillandhighliteracylevels

Existenceofamotorableroadnetwork

Sportsforhealthadvocacy

Thecountybeingan international transitcentre (northerncorridorand the international airport) that predisposes it to accidents, injuries and imported communicable and airborne conditions

Harmfulsocial-culturalpracticese.g.keypopulations

Unhealthylifestylese.g.alcohol,drugabuse,diabetes,andheartdisease

Urbanization challenges, including overcrowding/ informalsettlements, refuse management

1.9 Health System Investment

introduction

this section of the strategic plan highlights the current situation of health service delivery in Uasin-Gishu county by looking into the seven investment areas (building blocks) of the health system. it is well known that resources are never enough and, therefore, the right move is to make effective and efficient use of the scarce resources available until the situation improves (World Health organization, 2008). therefore, in order to provide quality, equitable, affordable, acceptable, and accessible health care for the citizens of this county and the country at large as envisaged in both the KHSSp iii and UGcHSp visions, efforts are needed to have these building blocks in the right quantity and quality mix. any skewed distribution of these resources along political, economic, or social lines will definitely create inequity and negatively affect the end users, thereby denying them of their fundamental human rights.

the details of each health investments are captured in a sub-set of this section and relate to:

Humanresourcesforhealth

Healthinfrastructure

Healthleadershipandgovernance

Healthproductandcommodities

Healthinformation

Healthfinancing

Serviceprovision

the human resources for health (HrH) situation in the county is not optimal at all levels of health delivery. Staff shortages cut across all clinical and non-clinical cadres. the county has a total of 187 health facilities comprising both public, faith-based organizations, and other private groups. there are also 80 community units (cUs) that currently exist. the public health facilities consist of 4 tier 3 government facilities, 96 tier 2 facilities and 80 cUs at tier 1. While the number of hospitals is adequate, the hospitals lack basic equipment, physical infrastructure and adequate personnel and hence need to be upgraded and operationalized in all service delivery areas, such as surgical theatres. the overall health system in the county requires strengthening so as to improve health service delivery.

Health Workforce

Human resources for health is the backbone and the strongest pillar of the health system and, hence, without it the health system will not function. the HrH situation in the county is characterized by shortages of health staff at all levels of health delivery.

as of June 2014, the county had a total of 916 health workers working in the county Health Department. out of these 100 were on contractual


27

terms. the recent employment of staff on contractual terms under the economic stimulus program went a long way to mitigate the biting staff shortages. Without these contracted staff, many health facilities in the county, especially lower level heath facilities, would have closed. therefore, there is a need for a permanent solution that includes absorption of contracted staff and employment of more staff. Staff shortages cut across all clinical and non-clinical cadres.

there is a need for the harmonization of salaries and review of terms and conditions of service (transfer, promotion, training opportunities, etc.) between contracted and government staff to reduce inequities and improve staff morale. inequities are compounded by the fact that the terms of service for some contract staff are not clear, leaving health professionals and their managers in a state of uncertainty about their future.

the health workforce forms an integral part of the health care system and it is a key input in the provision of quality health care services. Without proper management of human resources for health, provision of quality, accessible, and affordable health care will be a noteworthy challenge in the county.

the county leadership has prioritized health work force issues in its county agendas.

the key areas of investments are as follows:

1. recruitment, deployment of health workers and outsourcing of non-technical staff. this should be based on needs with the aim of ensuring equitable distribution of health workers.

2. attraction and retention of the health work force to include timely promotions, review of remuneration, career development plan and training policy (training and professional development). public recognition of service, through awards and titles such as the professional of the Year award, as well as developing and supporting a career development system.

3. improvement of the working environment. conducive and safe working environments for the countys entire health workforce can be achieved through provision of appropriate equipment and supplies, training, mentoring, and continuous supportive supervision, as well as improving the living conditions of health workers and their families and investing in infrastructure and services (staff houses, sanitation, electricity, telecommunications, etc.) as these factors have a significant influence on the health workers decisions to relocate and work in rural facilities.

4. institutionalize staff performance reviews through performance contracts and appraisals to track staff productivity.


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30

Health infrastructure

the total number of health facilities in the county is 176. of these, there are about 90 government facilities, which consist of 4 tier 3 facilities, 86 tier 2 facilities and a number of private and fBo facilities. even with the available health services, there lacks an effective and functional referral system, inadequate ambulance coverage, coupled with non-functional community units which had been established to enable communities access to information about services and to provide a link to the formal health structure. to actualize functionality of the community strategy, there is a need to provide cUs with the necessary tools and resources. the facilities also lack adequate health service provision resources i.e. basic essential equipment, such as opD and inpatient diagnostic equipment, clinical rooms and offices and basic amenities at all facilities. the county health facilities also lack adequate staff houses; hence the need to establish these, especially in rural health facilities.

the absence of a county referral hospital has led to heavy dependence on the national hospital located in the county (mtrH) for primary health care, rather than for highly specialized cases as evidenced by data on cases which should have been handled at the county level that show nonconformity with an effective and efficient referral system. However, there is a proposal to come up with a county referral hospital and to enable fully functional sub-county hospitals.

there is also an urgent need to secure reliable funding from the county budget and increase the number of community units to improve access to tier 1 services.

the county lacks a general drugs and supplies store, hence the need to construct one. there is also a need to make provisions for water supplies to all facilities. a number of facilities have no electricity and water connections; thus there is a need to connect them to the national grid.

Key Area of Investment

physical infrastructure

Constructionofacountyreferralhospital

Expansionofexistingfacilitiestoprovidebasicand comprehensive health care

Constructionofstaffhouses

Investinhealthinformationandcommunicationtechnology (ict) infrastructure

Procureambulancestostrengthenreferralsystem

Collaboratewithothersectorstoimproveothersocial amenities, such as road networks, water and sewerage, electricity and communications.

Service Delivery

Service delivery is the key component that incorporates all other building blocks of a health system and through which health service delivery is measured. optimal health service delivery that effectively responds to the health needs of the citizens can be achieved through better organization and management of an integral health system. the main service providers of health care in the county are government facilities in various tiers systems.

Health services utilization is sub-optimal and this can be attributed to the following:

Sub-optimal community engagement in healthprogramming and inadequate community awareness on health rights

Non-compliancewiththeservicecharter

Lackofadequatedisabilityfriendlyservices

Poor adherence to clinical guidelines andstandard operating procedures at service delivery level

Ineffectivesupportsupervisionandfollow-up

Noclientfeedback

Non-functional therapeutic committee in healthfacilities


31

Partial adherence to infection preventionprotocols

Weakenforcementbyregulatorybodies

Lowadherencetostandardoperatingproceduresin all health facilities

Weakreferralsystem

Inadequate quality assurance checks throughinternal or external monitoring systems

Key Areas of Investment:Conductpatientsatisfactionsurveys

Createcustomercaredesks

Providesuggestionboxes

Ensurethatallhealthfacilitieshaveacustomerservice charter and ensure its dissemination and compliance

Setupyouth-friendlyservices

Trainstaffoncustomercare

Ensurefacilitiesareaccessibletothedisabled

Ensure a conducive and safe workingenvironment

Produce, avail and disseminate clinicalguidelines to all staff

Strengthensupportsupervision

Establishclinicalauditcommittees

Establish infection prevention and bio-safetycommittees

Establishamedicalboardatcountylevel

Formulate and disseminate SOPs and ensureadherence

Provideahighcapacitymodernwastedisposalsystem at the county level

Strengthenthecommunitystrategy

Strengthenreferralsystemsthroughprocurementof ambulances

Healthcare financing

the countys health care system has been characterized by under-funding from the central government, which means that most of the funding has gone towards servicing recurrent expenditure and utilities, which has limited the countys capital and developmental activities. in addition, there are few active non-state actors in health care services that can complement the government in providing health care services. this under-funding has led to an over-reliance on donors and user fee collections, which is insufficient and unreliable.

recently, the government abolished user fees at the primary health care level (dispensaries and health centers) and substituted this with a direct government allocation through a project called the Health Sector Service fund (HSSf); hence, the fate of the funding is not clear in this new dispensation.

Key areas of investment and strategies include the following:Lobbyingandadvocatingforalargerallocation

of health sector funding to the county government.

Developing new and strengthening existingpartnerships to enhance integrated health care financing in the county (e.g. a funding pot or single resource envelope).

Strengthening resource mobilization, bothinternally and externally, through developing joint proposals.

Improvingsocialhealthinsurancebyadvocacyfor increased registration of the community to the existing health insurance scheme, a public-private partnership in health insurance.

Improving feecollectionandfinancial controlsin tier 3 facilities through scale-up of financial management/information networking (cash registers) to enhance transparency and monitoring.

Implementing demand-side performance-basedfinancing to increase service utilization, results and quality services.


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Conducting comprehensive costing of healthcare services and ensuring hospital resources are appropriately allocated and utilized.

Seeking innovative pro-poor health carefinancing options to break the financial barriers to accessing health care services.

Strengtheningfinancialaccountability, integrity,management, and capacity building.

Seeking a timely disbursement of allocatedfunds.

Costcuttingmeasurese.g.equipmentplacementfor high volume facilities

Health products and commodities

Health products and commodities are a vital component of public health care. to maintain a regular supply of these inputs, effective public commodity supply management is required. currently, supply of health products and technologies is inadequate due to insufficient funds and/or an inefficient supply chain. this results in under-stocked or out-of-stock supplies at health facilities. clients are then forced to make private purchases, resulting in poor treatment outcomes and inappropriate medicine use (e.g. under- dosage, drug resistance, missed diagnosis, etc.).

the current levels of investments in health products and commodities represent a major under- investment area in the countys health sector. the required investment to deliver the essential package in health is enormous and is driven by the cost of essential medicines and medical supplies.

the county also lacks modern equipment in health facilities. this not only makes service delivery inefficient but also compromises patient safety. there is a need to purchase modern equipment and ensure its maintenance.

Key investment areas are:

Vaccinesandotherrelatedlogistics

Reproductivehealthcommodities

Essentialmedicinesandmedicalsupplies

X-rayandlaboratorycommodities

Purchaseofmodernmedicalequipment

Nutritioncommodities

Environmental, water, hygiene and sanitationcommodities

Health information System

the health information system (HiS) is a comprehensive and integrated structure that collects, collates, analyses, monitors, evaluates, stores, disseminates, health and health-related data for use by all; data is increasingly driving the health care industrys decision making, as evidenced by the many initiatives to capture outcome data.

the role of HiS in the health sector is not just routine collection of health sector data and dutiful conveyance of the same to higher levels, but also facilitation of evidence-based decision- making at all levels, including at the point of collection. information collection, analysis and presentation should be organized in such a way that the most needy groups and individuals are identified and that health planning should be based on such information and strategies designed to address any identified inequalities. HiS forms an integral part in better health planning and monitoring of health service delivery with a view to quality health care. it is, therefore, a powerful monitoring and evaluation (m&e) tool for making health care delivery more effective and efficient.

the county Health records and information management Department is charged with the responsibility of managing and coordinating HiS activities, of which the various public health, clinical services departments and other health providers / players (both public and private) functions and activities form the primary source of data.


33

Figure 12: Health Information System

Monitoring, Evaluation, and Management

Community

Facility

Sub-county/County

National

International

Data Collection

Data Collection and Indicators

Data Aggregation and Analysis



the county faces challenges in the existing HiS. these include: data collection and management; poor clinical records management; low reporting levels from lower levels; poor data utilization and sharing; low deployment and utilization of ict infrastructure; overload of reporting units; limited human resource capacity in terms of numbers and skills; and partner reporting systems / requirements. all these have affected the efficiency of data management in various sub systems.

the county seeks to re-engineer its HiS functionality and role by:

Ensuring a fully functional coordinatingframework for HmiS

- HmiS technical working structure formed, bringing together different sources of information for health in one forum.

- Develop updated HiS structure /legal framework aligned to the health policy and general health law.

Quarterly/Annual Health Forums planned, todisseminate/share sector information

- aimed at improving data demand, use, storage and security at all levels.

Enhancedataqualityassuranceandauditsatall levels by all players (public and private) and ensure continuous appraisal of District Health information Software (DHiS) reports (data verification).

EnhancehumanresourcecapacitybuildingonHiS and deployment of HiS essential resources

Download - COUNTY HEALTH STRATEGIC AND INVESTMENT PLAN 2013 - 2018

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