Health Sector Strategic and Investment Plan 2013-2018healthgarissa.go.ke/downloads/Garissa County SP final5.pdf · 2.0 Overview of Health Care Services (Health Investment) 8 2.1 Major

1Garissa County Health Strategic Plan 2013-2018

2013-2018

Health Sector Strategic and Investment Plan

GARISSA COUNTY

MINISTRY OF HEALTH

2 Garissa County Health Strategic Plan 2013-2018

iGarissa County Health Strategic Plan 2013-2018

2013-2018

Health Sector Strategic and Investment Plan

GARISSA COUNTY

MINISTRY OF HEALTH

ii Garissa County Health Strategic Plan 2013-2018

Any part of this document may be freely reviewed, reproduced, translated or quoted in full or in part for noncommercial use only, provided the source is acknowledged. It may not be sold or be used in conjunction with a commercial purpose or for profit.

Garissa County Health Sector Strategic and Investment Plan 2013-2018

Published by: Ministry of Health

Garissa County

P.O. Box 40 - 70100

Garissa

iiiGarissa County Health Strategic Plan 2013-2018

Table of ContentsList of Figures ivList of Tables ivAcronyms vForeword viAcknowledgements viiExecutive Summary viiiProcess of Development and Adoption of the Strategic and Investment Plan xVision Statement xiMission xiCore Values xi

Section1: Introduction and Background 11.0 Purpose of Strategic Plan 11.1 Location and Size 31.2 Physiographic and Natural Conditions 41.3 Administrative Units 51.4 Demographic Features 6

Section 2: Situation Analysis 82.0 Overview of Health Care Services (Health Investment) 82.1 Major Risk Factors Causing Morbidity and Mortality in the County (In Order of Priority) 122.2 Health Services Outputs 132.3 Issues and Challenges with Providing Health Services (SWOT) 152.4 Health System Investment 16

Section 3: Problem Analysis, Objectives and Priorities 243.0 Problem Analysis 243.1 Strategic focus and Objectives 273.2 Sector Input and Process Targets for Achievement of County Objectives 28

Section 4: Resource Requirements and Financing 354.0 Resource Mobilization Strategy 40

Section 5: Implementation Arrangements 415.0 County Health Coordination Framework 415.1 Management structure (Organogram for County Health Management) 425.2 Monitoring and Evaluation Plan 445.3 Comprehensive Monitoring and Evaluation Plan 45

Section 6: References 50Annexes 51Annex 1: Risk Factors 51Annex 2: The Monitoring and Evaluation Framework 52Annex 3: Participant List 53

iv Garissa County Health Strategic Plan 2013-2018

List of Tables

List of Figures

Table 1: Garissa County Administrative and Political Units and Size 5

Table 2: Population Projection 2013/2014 – 2017/2018 6

Table 3 : Distribution of Health Facilities per Sub-County by levels 8

Table 4: Population Projections for Selected Age Groups 10

Table 5: Health Impact 11

Table 6: Morbidity 2012 (Under 5 Years) 11

Table 7: Morbidity 2012 (Over 5years) 11

Table 8: Major Causes of Mortality in the County (%) 12

Table 9: Health Services Outputs 13

Table 10: Issues and Challenges with Providing Health Services 15

Table 11: Avaliable Human Workforce against Required Numbers and Gaps 18

Table 12: Policy Analysis 25

Table 13: Milestones and Achievements 31

Table 14: Budget Summary by Investment Areas 35

Table 15: Investment Area Details 36

Table 16: Partnership and Coordination Structure 43

Table 17: Service Outcome and Output Targets for Achievement of County Objectives 47

Table 18: County Monitoring Indicators 49

Figure 1: Map Location of Garissa County in Kenya 3

Figure 2: Health Facility Distribution Map by type -2013 4

Figure 3: Garissa County Administrative Units Map 5

Figure 4: Population Estimate per Sub-County 6

Figure 5: Histogram showing Population Projections by Age Cohorts 7

Figure 6: Garissa County Population Pyramid 2013 7

Figure 7: Immunization Coverage 10

Figure 8: Organogram for County Health Management 42

Figure 9: Comprehensive Planning Cycle 46

Figure 10: Garissa County Planning Cycle 47

vGarissa County Health Strategic Plan 2013-2018

AcronymsAWP Annual Work Plan

BoR Bill of Right

CDH County Director for Health

CEC County Executive Committee

CHMT County Health Management Team

COH Chief Officer for Health

CoK Constitution of Kenya

DHIS District Health Information Software

DMOH District Medical Officer of Health

EHR Electronic Health Records

ESP Economic stimulus package

HIS Health Information System

HRH Human Resource for Health

HSSF Health Sector Service Fund

ICD-10 International Statistical Classification of Diseases and Related Health Problems, Version 10

ICDP Integrated County Development Plan

ICT Information and Communications Technology

IDSR Integrated Disease Surveillance and Response

KDHS Kenya Demographic Health Survey

KEMSA Kenya Medical Supplies Agency

KHP Kenya Health Policy

M&E Monitoring and Evaluation

MDG United Nations Millennium Development Goals

MDR-TB Multi Drug Resistance Tuberculosis

MSF Médecins Sans Frontières

NASCOP National Aids and STI Control Program

NCDs Non Communicable Diseases

NGO Non governmental Organization

SARAM Service Availability Readiness Assessment Mapping

SD Standard Deviation

SWOT Strengths, Weaknesses, Opportunities, and Threats

SMART Standardized Monitoring and Assessment of Relief and Transition

SOP Standard Operating Procedures

TDH Terre des Hommes Foundation

UNHCR United Nations High Commissioner for Refugees

UNICEF United Nations Children Fund

USA United States of America

WHO World Health Organization

vi Garissa County Health Strategic Plan 2013-2018

Foreword

The constitution of Kenya 2010 establishes the national and county governments, which are distinct and interdependent and will conduct their mutual relationships on the basis of consultation and cooperation. The fourth schedule, mainly assigns health policy and service delivery to the national and county levels respectively. To realize the right to health as stipulated in the Bill

of Rights (BOR), the national and county governments through the County Government and Financial Management Acts 2012 have outlined their priorities envisioned in the Kenya Health Policy Framework (KHPF) 2012 – 2030, aligning to the National Health Sector Strategic Plan (NHSSP) 2012 – 2017, and to global commitments including the United Nations Millennium Development Goals (MDGs).

The Garissa County Health Sector Strategic Plan (GCHSSP) 2013 - 2018 is a key milestone of the county government and the partners to outline their priorities towards attainment of quality health care to the populace of Garissa County. The development of this strategic plan is as result of taking stock of the sector through an elaborate, all inclusive, participatory and consultative process that is intended to ensure ownership, stewardship and commitment by the key stakeholders. It clearly puts forth the key strategic imperatives that will be achieved by Garissa County Health Sector (GCHS) and the community in collaboration with other health related sectors to realize the goal of reducing illnesses, disabilities and exposure to risk factors through evidence-based interventions and best practices with ultimate vision of a healthy and productive county. This strategic plan has emphasized on good partnership, leadership, coordination, mutual accountability and efficient utilization of the resources.

To guide implementation of the strategic milestones, comprehensive essential service packages have been defined and will be provided across the six key strategic objectives and seven health’s investment areas which will contribute to achieving the national targets and attaining KHPF vision for 2030. The county has planned to use the “three ones” framework; one plan, one financing mechanism, one monitoring and evaluation mechanism. This strategic plan has an elaborate monitoring and evaluation mechanism where results shall be shared by all stakeholders. This document is indeed a great milestone for taking GCHS ahead to enable it provide quality health care and provide information for decision making.

The plan provides a roadmap and strategic direction on key priorities in line with the Health Sector Strategic Plan and it articulates the agreed vision, mission, and core values of Garissa county health sector. It also sets strategic objectives, strategies, activities, time frame, resource requirements and assigned responsibilities for achieving expected outputs in the next five years. It is envisaged that the implementation of the activities as outlined in the strategic plan will cost a total of Kshs 7,246,822,000 (US $83,297,000).

The successful implementation of this strategic plan is expected to provide a basis for quality health care and improved productivity. The county’s Ministry of Health will provide the necessary leadership in the implementation of this strategic plan.

The successful execution of the strategic plan requires total commitment by the governments (county/ national), development partners and all stakeholders to support through collaboration and partnership.

Mukhtar Bulale M.County Executive Member-Health, Water & SanitationGARISSA COUNTY

viiGarissa County Health Strategic Plan 2013-2018

Acknowledgements

The development of the strategic plan has always been the task of the Ministry of Health at the national level. However, the promulgation of a new constitution with the devolved system of governance in Kenya, which has placed new authority and responsibility at the county level has mandated county governments to develop county-integrated plans and subsequently develop departmental strategies

and plans. Consequently, this health strategic plan was developed, in order to provide quality, accessible and affordable health care services to the population of Garissa County. The county health strategic plan is aligned and anchored to the Integrated County Development Plan, National Health Policy, The Kenya Health Sector Strategic and Investment Plan, the United Nations Millennium Development Goals and The Kenya Vision 2030.

The process of developing the strategic planning involved data collection, collations, review of documents, research, consultation and coordination hence was not an easy task as it was the first time the county health management team was developing a document of this magnitude. However, reflecting on the entire process, it has been the greatest learning process that will certainly set a milestone and basis for future planning.

The preparation of Garissa County Health Strategic and Investment Plan wouldn’t have been easy without the valuable contribution of the county health management team, sub-county health management teams, health partners and stakeholders. The commendable efforts put forward by all who were involved cannot be overemphasized, especially considering the difficulties encountered in interpreting and eventually coming up with a document which is meant to provide the strategic direction of the department of health in Garissa County.

We would like to particularly thank MEASURE Evaluation-PIMA for its technical and financial support throughout the development process of this document. We also acknowledge the support from MEASURE Evaluation-PIMA for printing copies of the strategic plan. We are grateful to the following organization for providing inputs and support: APHIAplus IMARISHA, United Nations Childrens Fund (UNICEF) Garissa office, Kenya Red Cross, Terre des Hommes Foundation (TDH), Mercy USA, SIMAHO, Care Kenya, United Nations High Commissioner for Refugees (UNHCR), Médecins Sans Frontières (MSF)-Swiss and Mentor initiatives.

Lastly, we would like to take this opportunity to thank all those who in one way or the other participated and contributed in the process of preparing and developing this document.

Dr Mohamed A. SheikhCounty Director of HealthGARISSA COUNTY

viii Garissa County Health Strategic Plan 2013-2018

Executive Summary

The Garissa County Health Strategy Plan (GCHSP) 2013 – 2018 is the first of its kind aligning itself to the national health sector priorities as defined in the Kenya Health Policy Framework 2012 – 2030 and Vision 2030 affirmed by the Constitution of Kenya 2010. The county health strategic plan is guided by the overall vision of the health sector “a globally competitive Healthy

and productive nation and the county vision and mission. The development of this strategy was through consultative and participatory efforts by the various county stakeholders as outlined in the County Government Act of 2012 with an oversight technical team constituted by the county health sector. The GCHSP is a critical input into the Integrated County Development Plan (ICDP), defined under the County Government Act 2012 and Public Finance Management Act 2012.

The strategic plan provides the county health sector (CHS) focus, objectives, and priorities to enable moving towards attainment of the Kenya health policy directions and the National Strategic Plan 2012 ¬ 2017. It provides a framework and a road map on how the medium-term county health objectives will be achieved. It also provides for all actions to be taken in collaboration with other health related sectors to have an impact on health. It will guide the county and sub-counties on annual work plan prioritizations that focus on health sector interventions in order to accelerate and attain better health outcomes. It places emphasis on implementing interventions for better access to services; on improving quality of service delivery; and on prioritising seven investment areas. It also states how the sector will monitor and guide attainment of the above priorities.

This strategic plan has its vision as “a healthy and productive county” with the mission statement “to provide quality, an accessible and affordable health care service that is innovative and culturally acceptable to the people of Garissa County”. The health sector aims to attain the implementation of a broad based health and health related services that will positively impact on health of the people of Garissa County. Its emphasis on implementation of interventions and prioritization across the seven investment areas for health as well as outlined in the Kenya Essential Package for Health (KEPH). These interventions will also be monitored during this strategic period and the performances shared across the health sector stakeholders and beyond. Monitoring and evaluation of the key milestones proposed shall have an index calculated from the key outcome indicators in all the investment areas.

The strategic plan is compose of five key chapters that cover specific priorities/thematic areas.

Section 1 outlines the purpose of this strategic and investment plan as stipulated in the County Government Act 2012. The section gives the background information of Garissa County, the administrative units, the demographic features, and a map indicating the current distribution of health facilities. It also provides the projected population for the different sub-counties up to 2018 with an annual growth rate of 3.9%. Moreover, it outlines the county’s vision, mission, and core values.

In section two, the GCHSP focuses on the county situational analysis highlighting the general health status, morbidity and mortality patterns, and the nutritional status with wasting of 12% and stunting of 17%. The county has also low immunization coverage of 54% (fully immunized). There is also rising burden of emerging, re-emerging, and non-communicable diseases. The county has latrines coverage of 46.8% with majority of the population (53.2%) practicing indiscriminate open defecation causing the

ixGarissa County Health Strategic Plan 2013-2018

risk of water borne diseases. The section continues to outline baseline information from the impact, outcome, and output indicators. The section also demonstrates major risk factors causing morbidity and mortality in the county (in order of priority). Using a strengths, weaknesses, opportunities, and threats (SWOT) analysis approach, the section identifies the gaps and existing opportunities. Furthermore, this section provides health system investments areas and details of each key strategic area in health investments captured in a subset of this section related to health workforce, infrastructure, leadership, product and commodities, information, and service delivery provision.

The strategic plan in section 3 outlines the problem analysis, objectives, and the key priorities of the county strategic plan. It elaborates the strategic focus, the overall 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 by the county and contains the key milestones to achieve.

Section 4 stipulates the resource required and financing of this strategic plan per each objective area of investments with the key priority interventions/ milestones. A total cost of the strategic plan is Kshs 7,246,822,000. This amount is required to facilitate the implementation of the key priorities in the health sector with an annual average of Kshs 1,449,364,000. The costed matrix highlights the different area of investments and source of funding. The resource mobilization strategies are also highlighted in this section and it is expected that the governments will finance most of the budgeted activities while different stakeholders are expected to fill the gaps.

The county strategic plan section 5 elaborates the county’s implementation framework and the organograms for the governance, coordination, and management structures with the different functions. The roles and responsibilities of each stakeholder are also outlined. Section 5 also gives the monitoring and evaluation framework that have been proposed by the GCHSP to monitor the progress of the strategic plan during the implementation period. A matrix with key strategic inputs, outputs, outcomes, and impact indicators have been provided and one framework of monitoring the progress. The use of health and health related information is also encouraged at all levels and data quality must be embraced by all. The strategy has provided for evaluation criteria and we expect both internal and external mechanism to follow the timelines proposed to this. Strong linkages and data sharing with the national government as provided for in the County Government Act 2012 and Constitution 2010. This will also align to the county government development monitoring and national government monitoring and evaluation (M&E) health sector framework.

x Garissa County Health Strategic Plan 2013-2018

Process of Development and Adoption of the Strategic and

Investment Plan Summary

The County Health Strategy Plan was developed through a consultative and participatory process at various levels which involved various partners. A task force provided oversight and guidance and also coordinated the process. The process involved county government represented by County Executive Committee (CEC) for Health, sub-county, County Health Management Team

(CHMT), partners, and private sectors. The task force county health management team was critical in questioning the relevance, affordability, and feasibility of the suggested work and how it relates to the County Health Strategy Plan.

The process of developing the strategic plan involved the establishment of technical working groups which included a wide variety of stakeholders to oversee key technical areas: service delivery; human resources for health; and health infrastructure, information system, finance, leadership, and governance. The stakeholders that constituted the working groups were drawn from nonogovernmental organisations (NGOs), the private sector, and Ministry of Health (MOH), which included but were not limited to, MEASURE Evaluation-PIMA, UNICEF, WHO, Mercy USA, Red Cross, TDH, Red Cross Kenya, and Care International, 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, and targets and planned outcomes.

The planning process involved a one-week workshop where sections of the strategic plan were discussed in group work resulting in a draft of the plan. This was followed by one week where the taskforce and drafting team fine-tuned the draft. This revised document was further shared for scrutiny and inputs by all the stakeholders and MOH staff who participated in the strategic planning.

The document consists of five sections. Section 1 is an introduction with background information. Section 2 provides a situation analysis. Section 3 describes the problem analysis and objectives. Section 4 covers resource requirements. Section 5 involves the implementation arrangement which summarizes the arrangements for implementation, monitoring and evaluation plan.

xiGarissa County Health Strategic Plan 2013-2018

Vision Statement

A healthy and productive county.

Mission

To provide quality, accessible, and affordable health care services that is innovative and culturally acceptable to the people of Garissa County.

Core Values

Accountability

Accept our individual and team responsibilities and meet our commitments. Take responsibility for our performance in all of our decisions and actions. We expect to be judged by the successful execution of our commitments.

Innovation

Celebrate creativity and open-minded thinking. We are advocates and instruments of positive change. Being innovative builds competitive advantage and creates new opportunities.

Teamwork

Work together to meet our common goals. Leverage the abilities of all team members.

Commitment

We strive to be the best, and we work continuously to improve our performance and exceed expectations.

Transparency

We operate with open communication and processes.

Integrity

Do what we say. Communicate with transparency. Deal fairly and honestly with the public and one another.

xii Garissa County Health Strategic Plan 2013-2018

Legislative and Other MandatesThe department is directly responsible for implementing, managing or overseeing the issues emanating from the following health and constitutional articles.

The power of the people, devolution and health:

1. Article 1(4) of Constitution of Kenya (CoK) 2010 provides for the sovereignty power of the people to exercise at national and county levels defining the destiny and self-governance.

2. Article 6(2) of CoK stipulates that the national and county governments are distinct and inter-dependent and, shall conduct their mutual relations on the basis of consultation and cooperation.

The Bill of Rights (BoR): The CoK provides the right to the highest attainable standard of health including: The right to life, reproductive health and other attributes of good health. The right to emergency treatment. Clarity on responsibility of the state(duty bearers) and citizens (right holders) in

ensuring that the above aspect are met.

The constitution guarantees health for all Kenyans: Art. 26; Every person has the right to life. Art.42; Every person has the right to a clean and healthy environment. Art. 43. (1) Every person has the right— (a) to the highest attainable standard of health, which

includes the right to health care services, including reproductive health care. 53. (1) Every child has the right––(c) to basic nutrition, shelter and health care. 56. The State shall put in place affirmative action programmes designed to ensure that

minorities and marginalised groups—(e) have reasonable access to water, health services and infrastructure.

County GovernmentsService delivery: planning is guided by Articles102-121 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 plans.

(1) A County department shall develop county sectoral plan as component parts of the county integrated development plan.

(2) The County sectoral plans shall be

a) programme based;

b) the basis for budgeting and performance management; and

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


OFAB 45 - February 23, 2012SECTION

Introduction and Background

1

1.0 Purpose of Strategic PlanThe promulgation of the Constitution of Kenya on August 27, 2010, was a major milestone towards the improvement of health standards. Citizens’ high expectations are grounded on the fact that the new constitution states that every citizen has the right to life; right to the highest attainable standard of health, including reproductive health and emergency treatment; right to be free from hunger and to have food of acceptable quality; right to clean, safe, and adequate water and reasonable standards of sanitation; and the right to a clean healthy environment.

The constitution provides an overarching conducive legal framework for ensuring a more comprehensive and people driven health services, and a rights – based approach to health is adopted, and applied in the country.

The purpose of this strategy and investment plan is therefore to guide the county in:

I. Resource mobilisation and allocation in the health investment areas.

II. Contributing towards the achievement of Millennium Development Goals (MDGs), Kenya Health Policy 2012-2030 (KHP) and Vision 2030.

III. Prioritizing key health investment areas.

IV. Accelerating health service delivery to the highest attainable standards.

V. Monitoring targeted county health performance indicators.

VI. Providing a framework and a road map on ‘how’ the medium-term county health objectives will be achieved.

VII. The CHSP is a critical input into the Integrated County Development Plan (CDP) and County Fiscal Strategy Paper defined under the County Government Act 2012 and Public Finance Management Act 2012.


RESULTS FRAMEWORK

HEALTH SECTOR SPECIFIC GOVERNMENT-WIDE

KENYA HEALTH POLICY (2012\2030)

(Long Term health intent for Kenya)

VISION 2030

(Long Term Development 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)

COUNTY HEALTH STRATEGIC & INVESTMENT PLAN

(5 year County health targets and investment priorities)

BUDGET

Distribution of known or potential resources

OPERATIONAL PLAN

Annual targets and activities for implementation with available funds

PERFORMANCE CONTRACT

Annual Performance targets

COUNTY SPECIFIC

PRIORITIES

COUNTY SPECIFIC

PRIORITIES


1.1 Location and SizeGarissa County is one of the 47 counties in Kenya. It covers an area of 44,174.1 km2 and lies between latitude 10 58’N and 20 1’ S and longitude 380 34’E and 410 32’E. The county borders the Republic of Somalia to the East, Lamu County to the South, Tana River County to the West, Isiolo County to the North West, and Wajir County to the North.

Figure 1: Map Location of Garissa County in Kenya

Source: Kenya National Bureau of Statistics, 2013


Figure 2: Health Facility Distribution Map by type -2013

Source : SARAM 2013

1.2 Physiographic and Natural ConditionsGarissa County is principally semi-arid area and receives an average rainfall of 275 mm per year. There are two main rainy seasons, the short rains from October to December and the long rains from March to May, with interval of two dry spells; Hagga (May to Sept) and Jilal (January to March).

Given the arid nature of the ccounty, temperatures are generally high throughout the year and range between 200C to 380C. The average temperature is however 360C. The hottest months starts


September, through January to March, while the months of April to August are relatively cooler. The humidity averages 60g/m3 in the morning and 55 g/m3 in the afternoon. An average of 9.5 hours of sunshine is received per day. Strong winds are also experienced between April and August with the rest of the months getting calm winds.

1.3 Administrative Units1.3.1 Administrative Sub-division (Sub-county, Wards)

Garissa County has six sub-counties which include: Fafi, Garissa, Ijara, Lagdera Balambala, and Dadaab. The county is further divided into 30 wards as indicated in Table 1.

Table 1: Garissa County Administrative and Political Units and Size

Source: County Government Act 2012

Figure 3: Garissa County Administrative Units Map

Source: Kenya National Bureau of Statistics, 2010

Sub-county Area (Km2) Wards

Garissa 2,538.5 4

Balambala 3,049.2 5

Lagdera 6,519 6

Dadaab 6,781 6

Fafi 15,469 5

Ijara 9817.4 4

Total 44,174.1 30


1.4 Demographic Features1.4.1 Population Size and Composition

The county has a total population of 727,768 consisting of 371,162 males and 356,606 females as at 2013. The population is projected to increase to 786,547 and 850,077 persons in 2015 and 2017, respectively.

Table 2: Population Projection 2013/2014 – 2017/2018

Source: Garissa County CDP – 2013, Growth rate – 3.9%

Figure 4: Population Estimate per Sub-County

No Sub County Units

CENSUS2009

Population trends

Year 2013

Year 2014 Year 2015

Year 2016

Year 2017

Year 2018

1 Garissa 116953 136608 142017 147641 153488 159566 165885

2 Balambala 73109 85395 88777 92292 95947 99747 103697

3 Lagdera 92636 108204 112489 116943 121574 126389 131394

4 Dadaab 152487 178113 185167 192499 200122 208047 216286

5 Fafi 95212 111213 115617 120195 124955 129903 135048

6 Ijara 43849 51218 53246 55355 57547 59825 62195

7 Hulugho 48814 57017 59275 61622 64063 66600 69237

TOTAL 623060 727768 756588 786547 817696 850077 883,744


Figure 5: Histogram showing Population Projections by Age Cohorts

Figure 6: Garissa County Population Pyramid 2013

The above population pyramid illustrates that Garissa County is comprises a predominantly youthful population aged between 10-29 years, which stands at 45% of the current estimated population. Children under 5 years of age comprise 14.6% of the current population estimate, 2013.


OFAB 45 - February 23, 2012

SECTION

Situation Analysis

2

2.0 Overview of Health Care Services (Health Investment)Health care services in the county is provided by a mix of public, private, traditional groups and NGOs (especially in the refugee camps) with the government providing over 90% of the health services through community units (21 units), primary health care (72), hospitals (seven), and one county referral hospital. The private health facilities are mainly confined to the big commercial centres and a very few small towns. The average distance between health facilities is more than 45 km.

The table below shows the percentage of health facilities in each sub-county compared to the total number of health facilities in the county.

Table 3: Distribution of Health Facilities per Sub-County by Levels

Majority of the health facilities in the county are concentrated in Garissa sub county comprising 56% with the lowest in Hulugho (5%).

S/Nos

Districts/HFs Tier1 (Community Units)

Tier 2 (Primary Health Care)

Tier 3 (Hospital)

Tier 4 (Referral Hospital)

Private Facilities

Total % HFs

1 Balambala 2 8 1 0 3 14 8%

2 Dadaab 6 10 1 0 0 17 7%

3 Fafi 2 13 1 0 0 16 8%

4 Garissa 4 17 1 1 85 108 56%

5 Hulugho 1 6 1 0 0 8 5%

6 Ijara 4 8 1 0 1 14 7%

7 Lagdera 2 10 1 0 3 16 8%

Total 21 72 7 1 92 193 100%


In addition to the above health facilities, the county has also twenty two (22) health facilities in the refugee camps manned by agencies under the United Nations High Commissioner for Refugees (UNHCR).

They are as follows:

1. Hagadera Camp 1 hospital and 5 health posts

2. IFO Camp 1 hospital and 6 health posts

3. IFO 2 Camp 1 hospital and 3 health posts

4. Dagahaley Camp 1 hospital and 4 health posts

The major challenges in providing health care services in the county are the vastness of the county, poor road networks and frequent diseases outbreaks. Moreover, severe shortage of health personnel coupled with high level of staff turnover is a major hindrance to service delivery. For instance, the doctor to population ratio is currently 1:41,538 while the nurse to population ratio is 1:2,453. This compares with the World Health Organisation (WHO) recommend norms of 1:10,000 and 1:1000, respectively.

The five most prevalent diseases in the county are upper respiratory tract infections (40%), diarrhoeal diseases (8%), urinary tract infection (3%), skin diseases, (9%) and pneumonia (4%). Though HIV/AIDS prevalence rate is low as compared to the national level, there is a marked increase in the incidence from 0.2%to 2.8% within the last five years (Sentinel Surveillance 2012).The county has a high maternal mortality ratio (1000 per100,000 live births) and under five mortality rate (80 per 1000 live births) (KDHS 2008/9).

In addition to the above, there are such communicable and non-communicable diseases as cancer, diabetes, and multi-drug resistance tuberculosis (MDR-TB) among others. MDR-TB cases increased from three cases in 2008 to 80 cases in 2013. This is a 27-fold increase and has a profound impact on the cost of TB management. To treat non-drug resistant TB patient cost Kshs 1000 while MDR-TB is over Kshs 800,000.

In terms of nutritional status, the prevalence of wasting in Garissa County among children of 6-59 months is 12.0% (weight for height of less than -2 SD) while, underweight is 14.0% and . Stunting is 17.1 per cent (SMART Survey 2013).

The proportion of the population that has access to sanitation facilities is low, with latrine coverage at 46.8% while 53.2% practice open defecation. None the towns/settlements in the county have sewerage systems, except in Garissa Township with only 2% coverage. The main source of water is River Tana, boreholes, and water pans. The mainstream population have no access to safe drinking water.

Universal immunization of children against vaccine preventable diseases is crucial to reducing infant and child morbidity and mortality. In 2012, only 54% of children were fully immunized (DHIS 2012) as compared to 90%, which is the required coverage as shown in figure 7 below. This suboptimal immunisation coverage has contributed to the frequent outbreaks of vaccine-preventable diseases such as polio, measles, and whooping cough.


Figure 7: Immunization Coverage

The county has a very low contraceptive prevalence rate of 3.5% compared to the 46% national coverage, which is largely attributed to misinformation and cultural beliefs.

In the existing routine health information system in the county, there is poor quality of data collected, centralization of information management without feedback to lower levels, inadequate health information system infrastructure, and fragmentation into “program- oriented” information systems (duplication and waste). This has led to poor use of information at all levels. Care providers as well as managers rely on more expensive data collection methods such as Kenya Demographic Health Survey (KDHS).

Table 4: Population Projections for Selected Age Groups

Source: Garissa County CDP – 2013

Description Proportion Target population

Estimates Year 2013

Year 2014

Year 2015

Year Year

2016 2017

1 Total population 727768 756588 786547 817696 850077

2Total Number of Households

103966 108084 112363 116813 121439

3Children under 1 year

3.90% 28383 29507 30675 31890 33153(12 months)

4 Children under 5 years 16.90% 122993 127863 132926 138191 143663

5 Under 15 year population 42.30% 307846 320037 332709 345885 359583

6Women of child bearing age (15 – 49 Years)

24% 174664 181581 188771 196247 204018

7Estimated Number of Pregnant Women

3.84% 27946 29053 30203 31400 32643

8Estimated Number of Deliveries

3.84% 27946 29053 30203 31400 32643

9 Estimated Live Births 3.79% 27582 28675 29810 30991 32218

10Total number of Adolescent (15-24)

21% 152831 158883 165175 171716 178516

11 Adults (25-59) 26.10% 189947 197469 205289 213419 221870

12 Elderly (60+) 4.80% 34933 36316 37754 39249 40804


Table 5: Health Impact

Table 6: Morbidity 2012 (Under 5 Years)

Table 7: Morbidity 2012 (Over 5years)

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 5.8Male 6.0

7.8

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 1000/100,000

No NATIONAL No. of cases reported

No GARISSA COUNTY No. of cases reported

1 Other Dis. of Respiratory System

5302395 1 Other Dis. of Respiratory System 60461

2 Clinical Malaria 2583362 2 Diarrhoea 26527

3 Diarrhoea 1176958 3 Dis. of the skin (incl. wounds) 13079

4 Confirmed Malaria 876228 4 Intestinal worms 9559

5 Dis. of the skin (incl. wounds)

825947 5 Pneumonia 9116

6 Pneumonia 534691 6 Clinical Malaria 7716

7 Intestinal worms 357840 7 Ear Infections 5552

8 Eye Infections 261660 8 Confirmed Malaria 5397

9 Ear Infections 212002 9 Eye Infections 3352

10 Accidents - Fractures, injuries etc.

113622 10 Malnutrition 3244

NATIONAL No COUNTY No

1 Other Dis. of Respiratory System 6912399 1 Other Dis. of Respiratory System 66405

2 Clinical Malaria 4342116 2 Urinary Tract Infection 30283

3 Dis. of the skin (incl. wounds) 2224880 3 Dis. of the skin (incl. wounds) 18765

4 Confirmed Malaria 1535322 4 Diarrhea 11214

5 Diarrhea 904221 5 Clinical Malaria 11212

6 Rheumatism, Joint pains etc. 845427 6 Pneumonia 9948

7 Urinary Tract Infection 824880 7 Confirmed Malaria 8354

8 Accidents - Fractures, injuries etc. 732547 8 Typhoid fever 6579

9 Typhoid fever 602937 9 Rheumatism, Joint pains etc. 5727

10 Pneumonia 600259 10 Anaemia 4856


2.1 Major Risk Factors Causing Morbidity and Mortality in the County (In Order of Priority)1. Unsafe water, sanitation, and hygiene

2. Unhealthy lifestyle

3. Food insecurity/deficiencies

4. Poor housing/shelter

5. Ignorance and illiteracy of community

6. Insecurity (clan- and resource-based conflicts)

7. Road traffic accident

8. Harmful socio-cultural practices

9. Drug and substance abuse

10. Natural disasters (floods, drought, etc.)

Refer to Annex 1 for comparison with the national risk.

Table 8: Major Causes of Mortality in the County (%)

Diseases No of Cases %

Pneumonia 27 10%

Diarrhoea and Gastroenteritis 23 9%

Malaria 16 6%

Malnutrition 13 5%

Cryptoccocal Meningitis 13 5%

Foetal death of unspecified cause 13 5%

Anaemia 10 4%

Tuberculosis 9 3%

Human immunodeficiency virus (HIV) 8 3%

Cancer 7 3%


2.2 Health Services Outputs

Table 9: Health Service Outputs

Access/Utilization

• Availabilityofcriticalinputs(human resources,

infrastructure, commodities, innovative interventions, etc.)

• Demandcreationthroughintersectoral/stakeholders collaboration, community engagement, etc.

Human resource:Inadequate human resource• Leadingtotheintermittentclosureofhealth

facilities• Leadingtofacilitiesmannedbysinglestaff• CentralizedRecruitmentanddeploymentof

staff• Poorharmonizationofrecruitment

procedures/guidelines among partners• Highstaffattritionrate• Absenceofattractiveandretentionpackage

for human resource• Poorworkingenvironmentandcondition

Infrastructure:• Inadequatephysicalinfrastructure• Numbers• Space• Maintenance

Weak referral systems• Lackofenoughambulances• Ill-equippedreferralhospital• Fewcommunityunitsinplace

Geographical inaccessibility due to:• Poorterrain• Unpredictableweather• Longdistance

Security• Longporousborder• Externalaggression• Resourceconflict• Titledeedforfacilitiesandland

Transport/communication• Unavailabilityofnetworkconnectivityin

most of the areas• Inadequatemeansofpublictransport

Commodities:• Insufficientbasicequipment• Erraticandinsufficientsupplyofessential

medicines and medical supplies (EMMS)

Religious/social cultural barriersUnderutilization of health care services• Preferenceforfemalenursesinmaternity• Traditionalhealthpractice(TBAandQuran

reading)• Decision-makingissues• Resourceownership

Output area Intervention area Situation


Functionality of critical inputs (maintenance, replacement plans, etc.)

Maintenance:• Inadequatefundsformaintenance• Nopreventivemaintenance• Lackoftechnicalpersonnelfor

maintenance• Poorworkmanship

Replacement plan:• Noresponsibilityandownershipfrom

health workers and community• Longprocurementanddisposal

procedures

Readiness of facilities to offer services (appropriate HR skills, existing water / sanitation services, electricity, effective medications, etc.)

Appropriate HR skills:• Pooremergencypreparednessand

response capability.• Absenceofoperationaldistricthealth

facilities amenities i.e. complete theatres• Shortageofspecializedskillsinhealth

facilities• Shortageofhumanresourceforhealthin

terms of numbers and skill mix

Existing water/sanitation: • Inadequateand unsafe

Electricity:• Inadequate

Effective medication:• Erraticessentialmedicalandnon-pharm

supplies• Inadequacyofreferralsystem

Quality of care

Improving patient/client experience

Assuring effectiveness of care

Assuring patient/client safety (do no harm)

• Noclientsatisfactionsurvey• Suboptimalcommunityengagementin

health programming• Noncomplianceofservicecharter

• Pooradherencetoclinicalguidelinesandstandard operating procedure at service delivery level.

• Ineffectivesupportsupervisionandfollowup

• Noclientfeedback• Improperdocumentation

• Non-functionaltherapeuticcommitteeinhealth facilities

• Weakwastedisposalsystems• Partialadherencetoinfectionprevention

protocols• Weakenforcementbyregulatorybodies• Inadequatecommunityawarenesson

health right

Output area Intervention area Situation


2.3 Issues and Challenges with Providing Health Services (SWOT)

Table 10: Issues and Challenges with Providing Health Services

Strengths (Internal) Weaknesses (Internal)

•Existenceofbasichealthinfrastructure

•Manageablepopulation(Relativelysmallpopulation)

•Availabilityofhealthpartners

•Availabilityofhumanresourceforhealththoughinadequate

•Politicalcommitmentandvisionary

•Homogenouscommunity(Onelanguage,religion & culture)

•Lowdiseasesburdene.g.Malaria,HIV/AIDs,

•Existinginnovativehealthcareapproacheslikenomadic clinics, OBA, outreaches etc.)

•Existingpolicies,plansanddocumentstobuildon

•Existenceofcommunitystrategy

•Persistenthumanresourceshortage–skillmix&numbers.

•Highstaffturnover,poorattractionandretentionofhealthcare workers

•Healthworkersattitude

•Inadequateinfrastructurecapacitytoofferqualitycare

•Sub-optimalsensitizationofcommunitiestocreatedemand leading to under-utilization of health services)

•Poorhealth-seekingbehaviorofthenomadiccommunities

•Inadequate/erraticsupplyofdrugs/non-pharmaceuticals and equipment

•Poormaintenanceofexistingphysicalinfrastructure/equipment

•InadequatefundingforHealth(Uncoordinatedvertical funding)

•Weakreferralsystem

•Mushroomingofunlicensedprivatefacilities(Weakenforcement of regulation of private health sector services)

•Inadequateemergencypreparednessandresponse

•InadequatelegalframeworkforAlternativeMedicine (Traditional healers, herbalists)

Opportunities(External) Threats(External)

•Devolvedgovernance(health)toenhancelocalpriorities, advocate for additional funding.

•Politicalgoodwill

•Existinghealthsectorpartners(donorgoodwill)

•Existenceofpublic-privatepartnershipinHealth

•GrowingICTsector

•Existingandupcominghealthtrainingcolleges,universities

•ExistenceofothercompetitivesuppliersofEMMS

•Establishmentofsedentarysettlements

•CommunitygoodwillandExistenceofaffirmativeaction

•Retentionpackagesandscholarships

•Longporousbordersleadingtodiseaseimportationand pressure on healthcare

•Hugeinfluxofrefugeesinthecounty

•Insecurity

•Naturalcalamities-floods,drought(=disease)

•HarmfulSocial/culturalpractices

•Unhealthylifestyle-drugabuse

•Persistenceoftraditionalbirthattendantandherbalist

•HighPovertyIndex

•Illiteracy


2.4 Health System InvestmentsThis section of the strategic plan highlights the current situation of health service delivery in Garissa County by looking into the seven investment areas (building blocks) of 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 the vision, efforts are needed to have these building blocks in the right mix in both quantity and quality. 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 subset of this section and relate to:

health workforce

health infrastructure

health leadership

health product and commodities

health information,

service provision

The human resources for health (HRH) situation in the county is quite dire and is characterized by an acute shortage of health staff at all levels of health delivery and high staff turnover. Human resources management, or the lack of it, directly contributes to the high staff turnover and the migration of trained health workers out of the county. Staff shortages cut across all clinical and non-clinical cadres. The county has a total of 172 health facilities comprising both public, faith-based organizations, and other private groups. There are also 21 community units that currently exist.

The public health facilities consist of one county referral hospital, seven sub-county hospitals, 72 primary health facilities, and 21 community units. While the number of hospitals is adequate, the hospitals lack basic equipment, physical infrastructure, and adequate personnel and hence need to upgrade and operationalize all service delivery areas, such as surgical theatres. Garissa is one of the poorest counties in the country, where close to 73% of the population live below the poverty line (Economic index survey, 2009), and 90% of the healthcare services is provided by the Ministry of Health (MOH). The county has weak health information system that leads to underreporting of some of key health indicators.

2.4.1 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 quite dire and is characterized by an acute shortage of health staff at all levels of health delivery, high staff turnover.

In general, the county has an estimated 606 technical health workers working in the 80 public health facilities managed by the government, however the health workers in the county are not sufficient with high turnover rate coupled with poor health indicators accordingly. HRM or the lack of it directly contributes to the high staff turnover and the migration of trained health workers out of the province. Staff shortages cut across all clinical and non-clinical cadres.

In the last 15 years, the staffing situation got progressively worse although the trend has been reversing in the last few years. However, with the devolution of health care services to the county, there is anxiety and unease among health workers due to lack of awareness and policy guidance. Any gain in the


level of staff is quickly eroded by the recent rapid increase in the number of health facilities. A very progressive recent development is the recruitment of health workers on long-term contracts by different development partners. These programs include Global Fund (malaria project and National AIDS and STI Control Program (NASCOP), Capacity Project, Clinton Foundation, Economic Stimulus Package (ESP) and UNICEF. Without these contracted staff, many health facilities in the county, especially lower level heath facilities, would close.

There is no harmonization in salaries or terms and conditions of service (transfer, promotion, training opportunities etc.) between contract and government staff, leading to inequity and possible loss of motivation. This inequity is confounded 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.

Health workforce forms the integral part of 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.

Human resources for health is a major challenge in the county. There is significant shortage of health workers, skill imbalances, distribution, and challenges in retention.

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

In this strategic plan, the key areas of investments are the following:

1. Recruitment and deployment of health workers should be based on facility needs and for certain period of time with aim of ensuring the availability of health workers in the remote areas.

2. Attraction and retention of health work force should involve financial incentives paid or provided to health workers in hard to reach areas to entice them to work in remote and rural areas (hardship allowance). This includes monetary bonuses, in-kind benefits (for example, a free house or vehicle) and other benefits that reduce the opportunity costs associated with working in rural areas. However, prior to the implementation of financial incentives it is important to conduct feasibility and mapping studies to determine the type of financial incentives and the design of implementation.

3. Provision of personal and professional support is important. Opportunities should be provided to health workers to advance their career and consult with peers through networks, such as telemedicine or professional associations. Public recognitions of their services to create rural health days, awards, and titles such as the professional of the year award should be encouraged, as well as developing and supporting a career development system with strong bonding schemes.

4. Improving the working environment is needed. Good and safe working environments for the county’s entire health workforce can be achieved through provision of appropriate equipment and supplies, training, mentoring, and continuous supportive supervisions, as well as improving the living conditions for health workers and their families and investing in infrastructure and services (sanitation, electricity, telecommunication, schools, etc.) as these factors have a significant influence on the health workers decisions to relocate and work in rural facilities.


Table 11: Available Human Workforce against Required Numbers and Gaps

2.4.2 Health Infrastructure

The total number of health facilities in the county is 192. Of these, there are about 100 government facilities, which consist of one county referral hospital, seven sub-county hospitals, 72 primary health care facilities, and 21 community units. While the number of hospitals is adequate, they lack basic equipment and hence need to upgrade and operationalize all service delivery areas, such as surgical theatres and specialized clinics. Out of the seven sub-county hospitals, only two have a functional operating theatre (i.e., Masalani and Dadaab hospitals). The physical infrastructure is also poor and there is need for expansion and routine maintenances. There is a shortage of staff houses and offices for the management teams.

The county lacks an adequate number of functional ambulances and utility vehicles, which affects referral services and transport for other service delivery, including supportive supervision. The road network is very poor in most areas, with no road access to a health facility; and the rough terrain typically requires frequent maintenance of vehicles, an item that is poorly funded.

The community units rely on partners’ support and have no proper transport system, hence the need to provide motorcycles and bicycles or other basic equipment and supplies. 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.

S/No Cadre Number Available

Required Numbers

Gaps

1 Medical officers 30 102 72

2 Medical specialist 8 33 25

3 Dentists 2 14 12

4 Clinical Officers (specialists) 13 20 7

5 Clinical Officers (general) 49 200 151

6 Nursing staff (KRCHNs) 352 835 483

7 Dental Technologists 2 30 28

8 Public Health Officers 51 114 63

9 Pharmacists 5 30 25

10 Pharm. Technologist 10 30 20

11 Health Records & Information Officers 9 60 51

12 Lab. Technologist 46 148 102

13 Orthopaedic Technologists 3 24 21

14 Nutritionists 12 71 59

15 Radiographers 4 30 26

16 Physiotherapists 3 20 17

17 Occupational Therapists 2 20 18

18 Plaster Technicians 3 20 17

19 Medical engineering technologist 3 20 17


The introduction of nomadic clinics in this area has improved access to health care especially for the nomadic populations. Although many settlements are coming up along main roads, the existence and relevance of this innovative way of service delivery will remain in the region. It therefore calls for more support in areas that have poor immunization coverage, where some areas have proved to be a source of recent polio outbreaks. Other innovations, such as maternal shelters and mobile outreaches that target specific underserved or hard-to-reach populations, also need special infrastructures.

Key Area of Investment

Physical infrastructure

1. Expansion of facilities providing basic and comprehensive emergency care at sub county level.

2. Establishment of staff housing.

3. Provision of modern medical equipment’s and comprehensive medical supplies.

4. Invest in health information and communication technology(ICT).

5. Provision of reliable transport system with proper maintenance.

6. Collaborate with other sectors to improve other social amenities such as road networks, water and sewer, electricity, and communications.

2.4.3 Service Delivery

Service delivery is the key component that incorporates all other building blocks of health system and through which health service delivery is measured.

Optimal health service delivery that can effectively respond to the health needs of the citizens can be achieved through better organization and management of integral health system.

The main service provider of health care in the county is government facilities through various tiers systems.

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

Limited access to health services due to sparse and nomadic mobile population.

Lack of a robust referral strategy.

Non adherence to existing guidelines and policies related to service delivery such as standard operating procedures (SOPs), Service charters, therapeutic committees.

Inadequate quality assurance checks through internal or external monitoring systems.

Insufficient health education and promotion programs to improve service utilization.

Key Areas of Investment 1. Innovative approaches/strategies like maternal shelter, output-based approach, Malezi Bora,

nomadic clinic, integrated outreaches, and tele-medicine technology, etc.

2. Strengthen existing static health facilities.

3. Comprehensive essential health package.

4. Community health strategy.

5. Improved referral systems.

6. Operational research.

7. Monitoring and evaluation.


8. Improved private-public partnership.

9. Sector-wide approach and partnership.

10. Environmental health services and disaster preparedness.

11. Program intervention.

12. Establish Huduma Centre-Giving Information about Health.

2.4.4 Healthcare Financing

Garissa is one of the poorest counties in the country, where close to 73% of the population live below the poverty line (Economic index survey, 2009). With an insignificant number of the county residence benefitting from health insurance schemes, there is high dependency on out-of-pocket health care financing. This has a negative impact on household income of the community. Currently, 90% of the healthcare services are provided by the government.

The healthcare system has been characterized by under funding from the central government that has led to servicing recurrent expenses and utilities limiting capital and developmental activities. There are few active non-state actors in healthcare services to 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 centres) 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:

1. Lobbying and advocating for allocation of adequate funding by the county government to the health sector.

2. Developing and strengthening existing partnerships to enhance integrated healthcare financing in the county (e.g., a funding pot or single resource envelope).

3. Strengthening resource mobilization, both internally and externally, through developing joint proposals.

4. Improving social health insurance by advocacy for increased registration of the community to the existing health insurance scheme, a public-private partnership in health insurance.

5. Improving fee collection and financial controls in our tier 3 facilities through scale-up of financial management/information networking (cash registers) to enhance transparency and monitoring.

6. Implementing demand side performance-based financing to increase service utilization, results and quality services.

7. Conducting comprehensive costing of health care services and ensuring hospital resources are appropriately allocated and utilized.

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

9. Strengthening financial accountability, integrity, management, and capacity building.

10. Seeking a timely disbursement of allocated funds.


2.4.5 Health Products and Commodities

Health products and technologies 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 are inadequate due to insufficient funds and/or 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 technologies represent a major under-investment area in the county’s health sector. The required investment to deliver the essential package in health is enormous and is driven by cost of essential medicines and medical supplies. These needs suggest the current investments in the national health budget represent under 7% of these needs. The financing gaps are higher for TB and leprosy drugs, primarily due to the high costs of MDR or extensively drug-resistent TB, the burden of which is increasing. The gaps in other non-communicable diseases such as cancer, diabetes, and hypertension are also due to similar reasons. On the other hand, gaps due to vaccines are primarily driven by the costs of the new vaccines intended to be introduced in the health sector during the period of this strategic plan; for example, measles second dose and Rota virus vaccine.

The county currently receives less than 1% funds for health products and technologies, leaving health facility operations unsustainable and insufficiently funded.

Key investment areas are:

1. Vaccines and other related logistics

2. Family planning commodities

3. Essential medicines and medical supplies

4. Logistics management for medicine and medical supplies

5. X-ray and laboratory commodities

6. Essential transaction documents

7. Nutrition, environmental, water, hygiene and sanitation commodities

2.4.6 Health Information

Health Information is the foundation for better health, is the glue holding the health system together and is the oil keeping the health system running. As a country, there is a national health information system that is used to link the county and national health sector (i.e., DHIS 2). In Garissa County, there is a shortage of human resources, tools, technology, and physical infrastructure (space). There are no data verification mechanisms, and data demand and use practices are also weak across all the players. Currently, resource allocations towards supporting evidence-based practice, innovation, and information management are inadequate. None of the current health facilities have been automated. This leads to inefficiency and accountability problems. Information is not easily generated.

The health information system in the county covers five key areas:

1. Information generation

2. Information validation

3. Information analysis

4. Information dissemination

5. Information utilization


Key areas of investment HIS 1. Printing and distribution of integrated data collection and reporting tools (registers and summary

forms).

2. Improving data demand, use, storage and security at all levels.

3. Developing a comprehensive electronic health records (EHR) and networking for all county referral, sub-counties and ESP facilities.

4. Capacity building on:

District Health Information Software (DHIS);

International Statistical Classification of Diseases and Related Health Problems sversion 10 (ICD- 10), certification and classification;

EHR;

Monitoring and evaluation;

Data management and use of information;

ICT; and

Monitoring of vital events by use of information technology.

5. Improving such health information infrastructure as airtime, computers, and physical infrastructure.

6. Conducting eata quality audits, verification, develop reports, dissemination, and support supervision.

7. Developing and reviewing annual work plans.

8. Enhancing use of operational research in health information system (HIS) and innovations (e.g., e-health, geographic information systems, cloud computing, and use of mobile technology).


2.4.7 Leadership and Governance

The County Department for Health is mandated to coordinate and provide overall leadership and management to the entire department. It will be responsible for the overall coordination and management of county health services. The scope includes partnership and coordination of health care delivery, leadership and stewardship capacity of county governance systems and functions, planning and monitoring systems and services, and health regulatory framework and services. Better governance and leadership initiative aim to increase the participation of citizens in decisions that affect their lives and promote ethical and effective leadership in the county. Increased partnership and community involvement in county accountability for health service delivery, including assessing the transparency and quality of services, is important for growth.

A key challenge in the county is how to foster good governance and the evolution of the requisite investment environments for bringing about health services improvement and poverty alleviation through partnerships for growth. The development of indigenous capacity and homegrown policies informed by local knowledge and perspectives provides the best hope for improving health services delivery. Therefore, the onus falls squarely on accomplished leaders to proactively take charge of fostering good governance and the evolution of visionary and transformational leaderships in the ounty.

The sector will not only invest in health system managers but also incorporate like-minded health partners to invest at community level governance to strengthen primary health care across the board. The community structure at sub-counties, wards, and community units will be organized, supported and their capacity built to participate in health actions in order to improve health services delivery and utilization.

Key investment areas

1. County health policy, laws development, implementation, and enforcement.

2. Development of county, sub-county health sector strategic plans, and annual work plans.

3. Resource mobilization.

4. Governance, stewardship, and coordination of stakeholders in the county health sector.

5. Recognition, harmonization, and real alignment of support around government agenda.

6. Coordination of performance reviews.

7. Training on leadership, governance, and management.

8. Enhancing communication, networking, and support supervision.

9. Retention and motivation of key employees.



SECTION

Problem Analysis, Objectives and Priorities

3

3.0 Problem AnalysisTable 12 provides a listing of policy objectives and priorities.


Tab

le 1

2: P

olic

y A

naly

sis

Po

licy

ob

ject

ive

Ch

alle

nges

Pri

ori

ty In

vest

men

t ar

eas

Elim

inat

e co

mm

unic

able

co

nditi

ons

•Uncoordinatedandunsustainedoutreachservices

•NomadiclifestylewithLongdistancetohealthfacilities

•Breakdownofcoldchainssystemsandperiodicstock-outsof

esse

ntia

l sup

plie

s.

•Riskofdiseaseimportationthroughporousborders

•Inadequatefundingforinnovativeapproaches

•Inadequatepublic-privatepartnershipinprovisionofpreventiveand

prom

otiv

e he

alth

ser

vice

s

•WeakSchoolhealthprograms

•Inadequatehumanresourceforhealth(numbersskillsandretention

chal

leng

es)

•Weakpolicyimplementationtoimprovehygienestandards(waste

disp

osal

/wat

er a

nd s

anita

tion)

•Lowknowledgeongoodhygienepracticesamongcommunitiesin

the

coun

ty

•Lowdemandforhealthservicesduetopoorhealthseekingbehavior

and

Inad

equa

te in

vest

men

t in

heal

th e

duca

tion

to im

pact

on

heal

th

seek

ing

beha

vior

•Poorhousingandovercrowdinginurbanareasduetolackof

enfo

rcem

ent o

f urb

an h

ousi

ng

•Substanceabuse,unprotectedsex

•Fullimplementationofcommunityhealthstrategy

•Strengthenoutreachservices

•Strengthenschoolhealthprogramsandhealtheducation

•Strengthenprivatepublicpartnership

•Advocateforadditionalfundingforcriticalcountyhealthpriorities

•Implementstrategiestoattractandretainstaff

•Investininnovativeservicedeliveryapproachesresponsivetothe

lifes

tyle

s cu

lture

and

pra

ctic

es

•Advocateforappropriatecountylevellegislationandpoliciestopromote,

good

hou

sing

, hea

lth e

duca

tion

and

hygi

ene

•Strengthencrossbordersurveillanceandestablishscreeningprogramat

bord

er p

oint

s

•Routinemaintenanceofcoldchainsystems

•StrengthenMonitoringandevaluationframework

•Establisheffectivesupplychainmanagement

Hal

t, an

d re

vers

e th

e ris

ing

burd

en o

f non

-com

mun

icab

le

cond

ition

s

•Inadequateinvestmentinaddressingpredisposingfactorsfornon-

com

mun

icab

le d

isea

ses

(NC

Ds)

•Malnutrition

•Inadequateinvestmentinmanagementandrehabilitationservicesfor

NC

Ds

•LackofcommunityawarenessonNCDs

•Weakregulatorybodies(foodanddrugs).

•Lackofoperationalresearch

•Sedentarylifestyle

•InvestmentsincommunityawarenesscreationonNCDs

•Investinmassscreeningofnon-communicablediseases

•Provisionofdiagnosticequipment.

•Capacitybuildingofhealthworkerstohandleemergingnon-

com

mun

icab

le d

isea

ses

•Scaleupinvestmentinrehabilitationservicesintier3andtier4facilities

•AllocateresourcestoensureoperationsresearchondiverseNCDs

•Advocateforcommunity/workplacebehaviorchangecommunication

•Advocateforstringentmeasuresonqualitycontrolforfoodanddrug

safe

ty


Red

uce

the

burd

en o

f

vi

olen

ce a

nd in

jurie

s•Inadequateemergencypreparednessandresponse

•Limitedcapacityofhealthworkerstoprovidespecializedcare

•Harmfulsocio-culturalpractices

•Non-complianceofexistinglaws

•Inadequaterehabilitationandpsychosocialcarecentres

•Illequippedreferralcentres

•Perennialcommunityconflicts

•Setupemergencypreparednessandresponsecommitteesatalltiers

•Establishspecializedunitstocaterforinjuriesandviolence

•Capacitybuildingofthehealthworkersonlifesavingskillsand

spec

ializ

ed c

are

•Sensitizethecommunityontheriskofnegativeculturalpractices

•Advocateandenforcepublichealthlaw/thepenalcode

•Establishmorerehabilitationandpsychosocialcentres

•ImproveCountyreferralhospitaltoprovidespecializedservices

•Strengthenpeacebuildingandconflictresolutioninitiatives

Min

imiz

e ex

posu

re to

hea

lth

risk

fact

ors

•Poorhealthpromotion/educationtoreducelifestylerisk

•Poorwastemanagementespeciallyinurbansettings

•Weakimplementationofinfection,preventionandcontrolpolicies.

•Weakenforcementonregulationsandguidelinesonminimizingof

expo

sure

to h

ealth

risk

fact

ors.

•Rampantdrugabuseamongtheyouth

•Lackofoccupationalhealthandsafetymeasures

•Developproperwastemanagementsystemsformedicaland

non-

med

ical

was

tes.

•Sensitizethecommunityandotherauthoritiesonsafewastedisposal

•Enforceoccupationsafetyandhealthmeasuresintheworking

envi

ronm

ents

•Strengthenpubliceducationonpreventionofdrugandsubstanceabuse

•Strengthenhealthpromotionmechanismtoreducelifestylerisk

Pro

vide

ess

entia

l hea

lth

serv

ices

•Inadequateinfrastructure

•Shortageofhumanresourceforhealth.

•Weakreferralsystems

•Poorutilizationofdatafordecisionmaking

•Weakhealthfacility-communitylinkage

•Poorutilizationofhealthcareservices

•Equipandoperationalizetheexistinghealthfacilitiestoincreasethe

scop

e of

hea

lth s

ervi

ce d

eliv

ery

•Bottom-upprocurementprocessofEMMSandequipment

•Recruitmentofstaffadequateinnumber,skillsandmixwithanattraction

and

rete

ntio

n pa

ckag

e

•Usedatafordecisionmaking

•ACSMthroughreligious,politicalandcommunityopinionleadersto

incr

ease

util

izat

ion

of s

ervi

ces

•Sourceforambulancesandestablishfleetmanagementunit

•Strengthenimplementationofcommunityhealthstrategy

Str

engt

hen

colla

bora

tion

with

he

alth

rel

ated

sec

tors

•Weakintersectoralcollaborationandlinkage

•Weakcentralcoordinationmechanism

•Weakpublic-privatepartnership

•Differentsectorplanningcycles

•Unpredictablepartnersupport

•Strengthenregularjointplanning,monitoringandevaluation

•Strengthencoordinationamongrelatedsectors

•InitiateandstrengthenMOUwithallrelevantpartners

Po

licy

ob

ject

ive

Ch

alle

nges

Pri

ori

ty In

vest

men

t ar

eas


3.1 Strategic Focus and Objectives

3.1.1 Overall Goal

The overall goal of this plan is to reduce illnesses, disabilities, and exposure to risk factors through evidence-based interventions and best practices.

3.1.2 Specific Objectives

a) Eliminate and contro lcommunicable conditions

Scale up the number of functional community units

Increase immunization coverage

Improve access to safe water and sanitation services

Revive number of schools providing complete school heath programme

Increase the number of facilities reporting Integrated Disease Surveillance and Response (IDSR)

Establish isolation centres in all tier 2 and 3 facilities

Reduce incidences of emerging and re-emerging diseases

Engage and strengthen private health providers

b) Halt and reverse increasingbBurden of NCDs

Increase public awareness of NCDs

Promote early detection, screening and diagnosis of common NCDs

Set up well equipped and accessible diagnostic and treatment centre

Set up a palliative and rehabilitation centre

Advocate for bylaws that promote healthy lifestyles and reverse trend of risk factors

c) Reduce the burden of violence and injuries

Establish emergency preparedness and response teams at sub-county level

Establish emergency, diagnostic and specialized facilities (e.g., burn treatment centres, intensive care units, etc.)

Create public awareness and promote safety measures among the citizens on violence and injuries

Establish psycho-social care units at sub-county level

Support/strengthen peace building and conflict resolution initiatives

d) Provide essential health services to Garissa County citizens

Set up well equipped and accessible diagnostic and treatment centres

Improve client referral systems

Encourage dissemination and adherence to standard operating procedures

Provide comprehensive and integrated service packages (one-stop shop)

Improve customer care at all levels by sharing information to the citizens

Strengthen patient triage

Reduce stock out of essential medicine and medical supplies (improve supply chain management)


Enhance infection and prevention control measures

Conduct client satisfaction surveys

Adhere to citizen service charter

Reduce average length of stay in hospitals

Improve capacity of the human resources in numbers and skill mix

Upgrade existing health facilities, putting up new ones and maternal shelters

e) Minimize exposure to health risk factors

Establish youth friendly centres and encourage peer group discussion

Increase health promotion and provision of information to the citizens on health seeking behavior and risks associated

Improve health safety and infection prevention among the health workers and citizens

Promote food security

Strengthen linkages and referral systems between various tiers of health care service delivery

Increase knowledge and awareness on integrated health services among communities through community units

f) Strengthen collaboration with health related sectors

Strengthen collaboration with other health related sectors for provision of Safe water, improvement of road networks, communication equipment, education and food diversification.

Promote public private partnership at all levels

Establish forums for engagement and information sharing (coordination meetings with stakeholders)

3.2 Sector Input and Process Targets for Achievement of County Objectives

Table 13 contains the key milestones to achieve the overall goal, objectives, and key outcomes of the investment areas.

Service Delivery:

Enhancing community services and outreaches

Mentorship and capacity building

Ensure proper referral systems and emergency preparedness

Providing comprehensive essential health service package to the citizens

Availability of essential services with medicine and medical supplies

The key outcomes and outputs will be100 functional Community units.

Providing 1200 outreaches per year

Providing 40 support supervisions per year and 132 health workers mentored per year

Procuring and maintaining 13 ambulances

Upgrading 15 health facilities per year


Health Infrastructure (physical Infrastructure, Equipment, Transport, ICT)

Facilities renovated and constructed with staff houses

Specialized units constructed

Medical equipment provided to facilities

Proper inventory in place

Purchase of vehicles and ICT equipment

The key outcomes and outputs will be

Renovating 36 health facilities and upgrading 28 dispensaries through expansion of diagnostic service units

Constructing 21 staff houses, two kitchen blocks, and 2 OPD blocks

Building four functional theatres and 25delivery rooms

Specialized units constructed and equipped in the county referral hospital.

Purchasing 13 vehicles

Equipping 15 health facilities with ICT set up

Health Products

Purchase of required health products, warehouse storage, and distribution

Creation of commodities software management and guideline disseminated


Medicine supplied with online ordering

Regular supply of health products

Health Financing

Costed health services

Resources mobilization done


Well-coordinated and mapped stakeholders

Quarterlyandannualaudits

Fund raising strategies initiated

Leadership and governance

Annual health stakeholders meetings

Quarterlycoordinationmeetings


Annual work plan and review

Quarterlycoordinationmeetings


Health Workforce

Recruitment and retention of staff

In-service and pre-service training

Staff motivation


Health workers recruited

Staff skills upgraded

Staff motivated well

Health information

Data collection for routine health information, vital events, research and surveillance

Dissemination of health information


Printed health information registers and reporting tools

Electronic health records established in hospitals and ESP facilities and e-mobile reporting

Data properly stored and secured

Appropriate use of information at all levels

Internet connectively available at county and sub-county levels

Continuous capacity on HIS areas done yearly

Sharing of information in all levels


Inve

stm

ent

Are

aIn

terv

entio

n ar

eaM

ilest

ones

for

achi

evem

ent

Mile

ston

eA

nnua

l tar

gets

Year

1Ye

ar 2

Year

3Ye

ar 4

Year

5

Ser

vice

de

liver

yC

omm

unity

ser

vice

sE

stab

lishe

d 10

0 fu

nctio

nal c

omm

unity

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ts

1030

2020

20

25 c

omm

unity

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t stre

ngth

ened

55

74

4

Out

reac

h se

rvic

esE

nhan

ced

cap

acity

to c

ondu

ct ta

rget

ed fa

cilit

y in

tegr

ated

hea

lth o

utre

ache

s in

50

faci

litie

s

600

1200

1200

1200

1200

Sup

porti

ve s

uper

visi

on

to lo

wer

uni

tsR

egul

ar m

anag

eria

l and

pro

gram

mat

ic s

uppo

rt su

perv

isio

n40

4040

4040

On

the

job

train

ing

Impr

oved

ski

lls fo

r the

sta

ff at

all

tiers

3232

3232

32

Em

erge

ncy

prep

ared

ness

pla

nnin

gE

stab

lish

skill

ed e

mer

genc

y pr

epar

edne

ss a

nd re

spon

se c

omm

ittee

s3

40

00

Patie

nt S

afet

y in

itiat

ives

IEC

mat

eria

ls p

ut u

p in

all

faci

litie

s to

impr

ove

wor

k sa

fety

2828

1111

0

Ther

apeu

tic c

omm

ittee

m

eetin

gs a

nd fo

llow

up

Ther

apeu

tic c

omm

ittee

s se

t up

in a

ll su

b-co

untie

s an

d eq

uiva

lent

hos

pita

ls8

100

00

Hea

lth P

rom

otio

nE

nhan

ce a

dvoc

acy

com

mun

icat

ion

and

soci

al m

obili

zatio

n10

1010

1010

Clin

ical

aud

its

(incl

udin

g m

ater

nal

deat

h au

dits

)

Form

and

stre

ngth

en m

ater

nal/n

eona

tal a

udit

com

mitt

ee a

t all

tiers

3,

413

00

0

1,2

2369

2020

20

Ref

erra

l hea

lth s

ervi

ces

13 F

unct

iona

l ref

erra

l am

bula

nce

serv

ices

pur

chas

ed

52

22

2

Rec

urre

nt E

xpen

ses

Util

ity s

ervi

ces

1010

1010

10

Info

rmat

ion

Cen

treE

stab

lishm

ent o

f Hud

uma

Cen

tre1

11

11

Dis

aste

r pre

pare

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sR

apid

resp

onse

to o

utbr

eaks

1010

1010

10

Ope

ratio

nal R

esea

rch

Res

earc

h2

22

22

Tab

le 1

3: M

ilest

one

s fo

r A

chie

vem

ent


Hea

lth

Infra

stru

ctur

e (p

hysi

cal

infra

stru

ctur

e,

equi

pmen

t, tr

ansp

ort,

ICT)

Phy

sica

l inf

rast

ruct

ure:

co

nstru

ctio

n of

new

fa

cilit

ies

and

expa

nsio

n of

exi

stin

g fa

cilit

ies

Exi

stin

g he

alth

faci

litie

s re

nova

ted

87

77

7

Con

stru

ct n

ew h

ealth

faci

litie

s an

d no

mad

ic c

linic

with

sta

ff ho

uses

33

22

2

4 fu

nctio

nal o

pera

ting

thea

tres

cons

truct

ed0

11

11

25de

liver

y ro

oms

and

mat

erna

l she

lter c

onst

ruct

ed &

equ

ippe

d 10

1010

1010

28 d

ispe

nsar

ies

expa

nded

to o

ffer l

abor

ator

y an

d di

agno

stic

ser

vice

s4

66

66

Kitc

hen

bloc

ks c

onst

ruct

ed in

Bur

a D

H a

nd M

odog

ashe

DH

20

00

0

Con

stru

ctio

n of

21

staf

f hou

ses

in e

xist

ing

heal

th fa

cilit

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77

7-

-

2 O

PD

blo

cks

cons

truct

ed0

11

00

Spe

cial

ized

uni

ts c

onst

ruct

ed a

nd e

quip

ped

in P

GH

Gar

issa

(ICU

uni

t, bu

rn u

nit,

psyc

hiat

ric

unit,

trau

ma/

orth

oped

ic u

nit/A

&E

uni

t, on

colo

gy u

nit),

ultr

amod

ern

mat

erni

ty u

nit

12

22

2

Equ

ipm

ent:

Pur

chas

eH

ealth

faci

litie

s pr

ovid

ed w

ith m

edic

al e

quip

men

t.(la

b/im

agin

g/m

ater

nity

/gen

eral

war

ds/

dent

al)

44

44

4

Hea

lth fa

cilit

ies

prov

ided

with

pro

per e

quip

men

t inv

ento

ry50

5050

5050

Equ

ipm

ent:

Mai

nten

ance

and

repa

irA

ll he

alth

faci

litie

s eq

uipm

ent r

egul

arly

ser

vice

d an

d m

aint

aine

d.

8080

8080

80

Tran

spor

t: P

urch

ases

an

d re

pairs

13 v

ehic

les

proc

ured

5

32

22

Util

ity v

ehic

les

and

ambu

lanc

e re

paire

d3

33

33

ICT

equi

pmen

t set

up

in 1

5 he

alth

faci

litie

s-

78

--

Hea

lth

prod

ucts

Pro

cure

men

t of h

ealth

pr

oduc

tP

rocu

rem

ent a

nd d

istri

butio

n of

Med

icin

e, N

on-P

harm

aceu

tical

and

Vac

cine

s di

strib

utio

n in

al

l pub

lic fa

cilit

ies

100

100

100

100

100

War

ehou

sing

sto

rage

Con

stru

ctio

n of

dru

g st

ore

-1

11

-

Col

d ch

ain

mai

nten

ance

and

upg

radi

ng

2550

5050

50

Inve

st in

a s

oftw

are

to m

anag

e st

ock

and

orde

ring


Hea

lth

fin

anci

ngM

onito

ring

and

eval

uatio

nP

urch

ase

of s

oftw

are

for f

inan

cial

man

agem

ent

11

--

-

Cos

ting

of h

ealth

se

rvic

e pr

ovis

ion

Bud

get P

repa

ratio

n1

11

11

Lobb

y fo

r cor

pora

te s

ocia

l res

pons

ibili

ties

11

11

1

Res

ourc

e m

obili

zatio

nC

ondu

ct F

inan

cial

Aud

it1

11

11

Ann

ual W

ork

plan

88

88

8

Lead

ersh

ip

and

gove

rnan

ce

Ann

ual h

ealth

st

akeh

olde

rs m

eetin

gC

ount

y H

ealth

sum

mit

and

Perfo

rman

ce R

evie

w M

eetin

g2

22

22

Quarterlystakeholdersmeetingandforums

2828

2828

28

Quarterlycoordination

mee

ting

Est

ablis

hmen

t of T

echn

ical

Wor

king

Gro

up1

X

QuarterlyProgrammaticandmanagerialsupportsupervision

5656

5656

56

Hea

lth

w

orkf

orce

Rec

ruitm

ent o

f New

S

taff

Rec

ruitm

ent o

f Hum

an R

esou

rce

for H

ealth

100

100

100

100

10

Pers

onne

l em

olum

ents

fo

r exi

stin

g st

aff

Sal

ary

Rem

uner

atio

n an

d em

olum

ents

75

085

095

010

5011

50

Ince

ntiv

es H

ards

hip

Allo

wan

ce75

085

095

010

5011

50

Upg

radi

ng th

e ex

istin

g lo

cal m

edic

al c

olle

ge to

offe

r var

ious

cou

rses

11

11

1

Spo

nsor

ing

and

bond

ing

of q

ualif

ied

scho

ol le

aver

s fro

m c

omm

unity

to jo

in m

edic

al tr

aini

ng20

2020

2020

Pre

ser

vice

Tra

inin

gIn

duct

ion

of n

ew s

taffs

100

100

100

100

100

Car

eer D

evel

opm

ent

1010

1010

10

In s

ervi

ce T

rain

ing

Spe

cial

ized

Tra

inin

g5

55

55


Hea

lth

in

form

atio

nR

outin

e D

ata

Col

lect

ion

Prin

ting

of d

ata

colle

ctio

n an

d re

porti

ng to

ols

3030

3030

30

Intro

duct

ion

of E

lect

roni

c M

edic

al R

ecor

ds S

yste

m in

15

Hea

lth F

acili

ties

-5

43

3

Dat

a st

orag

e, d

ata

bank

and

bac

k up

1010

1010

-

Enh

ance

Dat

a D

eman

d an

d us

e in

all

leve

ls10

10-

--

Inte

rnet

Con

nect

ivity

1010

1010

10

M&

E P

lan

deve

lope

d1

--

--

DH

IS, 1

CD

-10,

EH

R, M

&E

, Dat

a M

anag

emen

t and

use

and

ICT

5070

50-

-

Pro

visi

on o

f Lap

tops

, Tab

lets

and

Des

ktop

com

pute

rs20

30-

--

Pro

visi

on o

f Airt

ime

1010

1010

10

Intro

duce

Mob

ile P

hone

repo

rting

Sys

tem

for B

irths

and

Dea

ths

1010

1010

10

Mon

itorin

g of

Vita

l Eve

nts

by u

se o

f Inf

orm

atio

n Te

chno

logy

50

50-

--

Dat

a co

llect

ion

for v

ital

even

tsE-

Hea

lth, G

eogr

aphi

cal I

nfor

mat

ion

Sys

tem

(GIS

)-

3030

--

Targ

eted

Hea

lth in

form

atio

n m

onito

ring

1010

1010

10

Hea

lth in

form

atio

n

inno

vatio

nsE

vide

nce

Bas

ed S

urve

ys

12

22

2

Mon

itorin

g an

d

surv

eilla

nce

DistrictBasedMeetingsandQuarterlyReviewMeeting

77

77

7

QuarterlyDataQualityAuditandVerification

44

44

4

Dat

a an

alys

isA

naly

tical

Dat

a Pa

ckag

es (S

PS

S, E

PI I

NFO

, STA

T et

c.)

2040

-

Info

rmat

ion

di

ssem

inat

ion

Com

mun

ity D

ialo

gues

Mee

ting

100

100

100

100

100

Faci

litat

ed F

eedb

ack

to a

ll le

vels

by

Cou

nty

Team

1212

1212

12



Resource Requirements and Financing

4

Table 14: Budget Summary by Investment Areas

Orientation area Annual targets(KSHS ‘000)

Year 1 Year 2 Year 3 Year 4 Year 5 Total

Service delivery 127,364 150,364 139,864 130,364 129,864 677,820

Health infrastructure (physical infrastructure, equipment, transport, ICT)

108500 182500 199500 174500 192500 857,500

Health products 301,000 327,000 346,000 364,500 383,000 1,721,500

Health financing 2,300 2,300 1,300 1,300 1,300 8,500

Leadership and governance 11500 11000 11000 11000 11000 55,500

Health workforce 560,300 593,800 627,300 660,800 694,300 3,136,500

Health information 27220 64020 15320 13320 10820 130,700

Sub Total 1,138,184 1,330,984 1,340,284 1,355,784 1,422,784 6,588,020

Contingency of 10% of Sub Total

113818 133098 134028 135578 142278 658,802

Grand Total 1,252,002 1,464,082 1,474,312 1,491,362 1,565,062 7,246,822

The table above summarizes the overall budget estimates in each of the investment area: service delivery is 10.3%; health infrastructure, 13%; health products, 26.1%; health financing, 0.1%; leadership and governance, 0.8%; health workforce, 47.6%; and health information, 2%. The details of each of these investment areas are stated in table 15.


Tab

le 1

5: In

vest

men

t A

rea

Det

ails

Ori

enta

tion

area

Inte

rven

tion

area

Mile

sto

nes

for

ach

ieve

men

t

Mile

sto

neA

nnua

l tar

get

s (K

shs

‘000

Year

1Ye

ar 2

Year

3Ye

ar 4

Year

5

Ser

vice

d

eliv

ery

Com

mun

ity s

ervi

ces

Est

ablis

hed

100

func

tiona

l com

mun

ity u

nits

10,0

0030

000

2000

020

000

2000

0

25 c

omm

unity

uni

t stre

ngth

ened

2,50

02.

500

3500

2000

2000

Out

reac

h se

rvic

esE

nhan

ced

cap

acity

to c

ondu

ct ta

rget

ed fa

cilit

y in

tegr

ated

hea

lth

outre

ache

s in

50

faci

litie

s3,

000

6,00

06,

000

6,00

06,

000

Sup

porti

ve s

uper

visi

on to

low

er u

nits

Reg

ular

man

ager

ial a

nd p

rogr

amm

atic

sup

port

supe

rvis

ion

7,76

47,

764

7,76

47,

764

7,76

4

On-

the-

job

train

ing

Impr

oved

ski

lls fo

r the

sta

ff at

all

tiers

(sem

inar

s, w

orks

hops

, OJT

, m

ento

rshi

p vi

sit)

4,00

04,

000

4,00

04,

000

4,00

0

Em

erge

ncy

prep

ared

ness

pla

nnin

gE

stab

lish

skill

ed e

mer

genc

y pr

epar

edne

ss a

nd re

spon

se

com

mitt

ees

1,00

01,

000

00

0

Patie

nt s

afet

y in

itiat

ives

IEC

mat

eria

ls p

ut u

p in

all

faci

litie

s to

impr

ove

wor

k sa

fety

1,00

01,

000

500

500

0

Ther

apeu

tic c

omm

ittee

mee

tings

and

fo

llow

up

Ther

apeu

tic c

omm

ittee

s se

t up

in a

ll su

b-co

untie

s an

d a

t all

hosp

itals

--

--

-

Hea

lth p

rom

otio

nE

nhan

ced

advo

cacy

, com

mun

icat

ion,

and

soc

ial m

obili

zatio

n5,

000

5,00

05,

000

5,00

05,

000

Clin

ical

aud

its (i

nclu

ding

mat

erna

l dea

th

audi

ts)

Form

ed a

nd s

treng

then

ed m

ater

nal/n

eona

tal a

udit

com

mitt

ee a

t all

tiers

3,4

1,2

Ref

erra

l hea

lth s

ervi

ces

Pro

cure

men

t of 1

3 am

bula

nces

24,0

0024

,000

24,0

0024

,000

24,0

00

Rec

urre

nt e

xpen

ses

Util

ity s

ervi

ces

avai

led

60,0

0060

,000

60,0

0060

,000

60,0

00

Info

rmat

ion

cent

reE

stab

lishm

ent o

f Hud

uma

Cen

tre10

010

010

010

010

0

Dis

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spor

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3,00

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0

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form

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prin

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500

500

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800

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4.0 Resource Mobilization Strategy

4.0.1 Strategies to Ensure Available Resources Are Sustained

Partners disclosure of their resource envelope

Introduction of good attraction and retention packages for health workers

Prioritization of needs

Optimal use of the available resources

Proper mapping and coordination of the existing partners to avoid duplication of the available resources

Ensure timely and continued flow of resources from the county government

Optimal collection and utilization of user fees

Ensure transparency and accountability

4.0.2 Strategies to Mobilize Resources from New Sources

Introduction of income generating activities in big hospitals (i.e., pharmacies, restaurants, and shops)

Creation of friends of Garissa County hospitals for income generation

Solicit external support in terms of grants and loans

4.0.3 Strategies to Ensure Efficiency in Resources Utilization

Introduction and strengthening of performance contracting

Strengthen internal and external control mechanisms to minimize corruption and embezzlement of resources

Regular meeting with county health committees on resources utilization

Empowering governance and leadership structures at all levels

Establishment of interdepartmental networking system

Introduction of CCTV at all resource collection points

Capacity building of the managers on financial management



Implementation Arrangements

5

5.0 County Health Coordination FrameworkThe County Department for Health is a standalone department with a County Secretary for Health (County Executive Committee [CEC] Member for Health) who is responsible for the overall coordination and management of county health services. The county shall have a Chief Officer for Health (COH), who will be the overall Chief Accounting Officer for Health.

The COH will report to the CEC member responsible for health. Working with the COH will be the County Director for Health (CDH), who will be the technical head for health services within the County. The CDH will work closely with the COH to ensure effective management of resources within the department to achieve health objectives laid out in this plan. The CDH will exercise their functions through the three technical directorates: promotive and preventive health services; curative and referral services; planning, monitoring and evaluation; and administrative support services.

A County Health Management Team (CHMT) will be headed by the CDH and will consist of:

Heads of the three directorates in the County Department for Health assisted by various officers constituting the different functions of the health departments

Medical Superintendents of all county and sub-county referral hospitals within the county

This team’s main responsibility will be to ensure the implementation of the county and sub-county health strategic plan and its annual work plans. It will meet monthly, and its operations guided by clear terms of reference approved by the COH. It will define areas of responsibility for each county referral hospital and sub-county referral facilities. The CHMT will plan, supervise, coordinate, and monitor service delivery in this area. The county health service delivery will be managed by the county health management team with the leadership of the county executive member for health as the executive arm. The COH will be the accounting officer of the health department and will oversee service provision at the county level. He or she will be directly answerable to the county executive member for health who in turn will be directly answerable to the Governor.

The county health management team will coordinate health services at the county level and will have an implementing arm at the sub-county level to oversee service provision in all levels at their respective sub-counties. Hospitals will have hospital management teams to supervise health service provision and ensure that services offered are of the highest attainable standards. Primary health care facilities will


be headed by technical staff. Service provision at the community level will be overseen by community health extension officers who will supervise the community health workers.

For effective governance and social accountability to the community, county and sub-county hospitals will have health management committee and primary health facilities will have facility management committees. Service provision at the community level will be overseen by community health committees. Their main responsibility will be to represent the community at the various tiers of service provision ensuring the rights-based approach in health care delivery is realized. They will oversee implementation of activities and approve budgets and assist in resource mobilization for health services.

To facilitate operational provision of health services, this strategic plan proposes the following organizational structure based on the county functions for health outlined in the Fourth Schedule of the Constitution, the health policy objectives and orientations, and the need for clearly demarcated areas of responsibilities. The proposal also takes into account the need to have a lean structure based on functionality and integration of services at the county level. The rationalized organogram for county health management is shown section 5.2 (figure 8).

5.1 Management Structure (Organogram for County Health Management)

Figure 8: Organogram for County Health Management

PREVENTIVE AND PROMOTIVE HEALTH

SERVICES

COUNTY HEALTH PLANNING AND MONITORING

Disease prevention and control, environmental health, family health, disease surveillance,

health promotion, community health, TB,

immunization, HIV/AIDS, malaria

Planning, M&E coordination

COUNTY EXECUTIVE COMMITTEE MEMBER FOR HEALTH

COUNTY CHIEF OFFICER FOR HEALTH

COUNTY DIRECTOR OF HEALTH

County hospitals, primary health facilities and referral services.

CURATIVE AND REFERRAL

HEALTH SERVICES


Table 16: Partnership and Coordination Structure

Partners Intervention Areas Outputs Outcomes

Ministry of Health

•Policy, guidelines, standards and norms development

•Training and capacity building

•Regulatory role

•Strategic plan development

•Monitoring and evaluation

•Uniformity Of health services

•Skilled health workforce

•Safe health care

•Investment plan document

•Progress review

•Clientsatisfaction

•Qualityhealthcare

•Achievementofhealthsector goal

•Timelyinterventions

External stakeholders (WHO, USAID, World Bank)

• Support strategic plan development

•Monitoringandevaluation

•Capacitybuilding

•Infrastructuredevelopment

•Programfunding

•Investmentplandocument

•Progressreview

•Skilledhealthworkforce

•Improvedaccesstoqualityhealth services

•Improvedworkplaceenvironment

•Availableresources

•Achievementofhealthsector goal




•Motivatedstaff

Internal stakeholders (APHIA Plus, MEASURE Evaluation, TDH, CARE)

•Supportingcommunitystrategy implementation

•Capacitybuilding

•Foodprogramsupport

•Staffemployment

•Infrastructuredevelopment

•HISsupport

•Healthproductsmanagement

•Empoweredcommunity

•Skilledhealthworkforce

•Foodsecurity

•Improvedaccess

•Timelyandqualitydata

•Availabilityandrationaluseofhealth products

•Reducedcasesof communicable diseases



•Promptandevidence-based decision making

Other government sectors and departments (agriculture, water, roads, environment, education, interior and coordination, etc.)

•Provisionofsafewater

•Technicalsupport(e.g.,planapprovals, inspections, health education)

•Availabilityofsafewater

•Safeenvironment

•Reductionofmorbidityand mortality due to water-borne diseases

•Healthypopulation

County political leadership (Governor, CEC, County Reps, MPs, Senators)

•Political goodwill

•Projects and commitments,

•Approval of budgets

•Resource mobilization

•Resource allocation

•Political support

•Resource availability

•Achievementofhealthsector goals


Internal security (County Commissioner, Chiefs)

•Socialandcommunitymobilization

•Security

•Resourcemobilization

•Emergencyresponse

•Intergovernmentallinkage

•Communityempowerment

•Secureenvironment

•Resourceavailability


•Informeddecisionmaking

•Healthypopulation

•Emergencypreparedness

•Improvedservicedelivery

Individual and private stakeholders (mobile, nursing homes, hotels, banks, industries etc.)

•Financialandmaterialaid

•Projectssupport

•Corporateresponsibility

•Serviceprovision

•Availabilityofresources •Improvedqualityofcare

5.2 Monitoring and Evaluation PlanMonitoring and review process is at both the operational and the strategic level. At the strategic level, the monitoring process will be in line with monitoring support towards the strategic objectives of the overall health sector. On the other hand, the operational monitoring will focus on monitoring progress towards the strategic priorities using one monitoring framework and indicators to measure progress.

Strategic monitoring will be done at the mid-term and end term of this plan period. The mid-term review will coincide with the formal articulation of the strategic policy objectives of the health sector. Hence, it will focus on:

reviewing progress made and identifying challenges and strategies for acceleration; and

incorporating any realignment of the strategic priorities with the policy framework.

All levels of the health department will be involved in the process of strategic monitoring, including partners. Each level of service delivery will carry out its own monitoring and evaluation. Operational monitoring will be carried out monthly, quarterly, and annually. It will focus on monitoring progress against interventions and activities set out in the annual work plans.

Indicators will be utilized to measure progress against set targets. The indicators will be used in the following ways:

a. Sector-wide indicators: This is a set of indicators the sector will use to inform on progress at the strategic level. Collection and monitoring of progress will be the responsibility of the entire health sector.

b. Programme indicators: These involve indicators that the respective programme areas will use to inform on progress towards programme objectives. The number will depend on the particular programme area. Monitoring of progress will be the responsibility of the respective programmes area.

c. County specific indicators: These are indicators that will be unique to the county for monitoring progress.

The overall purpose of the M&E framework is to improve on the accountability of the health sector. This shall be achieved through a focus on strengthening of the county capacity for information generation, validation, analysis, dissemination, and use through addressing the priorities as outlined in the health information system investment section of this document. This M&E chapter focuses on how the sector


will attain the stewardship goals needed to facilitate achievement of the HIS investment priorities. These stewardship goals are:

a) supporting the establishment of a common data architecture for the health sector;

b) enhancing sharing of data and promoting information use at all levels; and

c) improving the performance monitoring and review processes at county, sub county and facility levels.

5.3 Comprehensive Monitoring and Evaluation PlanA comprehensive M&E plan will be developed clearly defining the extent of investment and support that the county will put in place to ensure the realization of this strategy. The monitoring and evaluation plan to be developed shortly after the completion and adoption of this strategy will:

provide a brief description of the county health vision and strategy and its results framework;

describe the components of health management system including the process and implementation strategy to collect, analyze and use health data as well as the county’s M&E needs by program area/strategic objectives;

describe the range of activities that will be undertaken to satisfy those health sector data needs in the county, the timeline and the human resources that will be devoted to implementing the M&E strategies;

outline activities that will support the health information systems at all levels; and

describe an evaluation plan that addresses how and when the baseline assessments will be conducted and when the mid-project and end-line evaluations will be conducted.

Detailed M&E operational plans will be developed at departmental, section and health facility level that will be used as an internal document to provide additional guidance health leaders and staff on M&E activities and responsibilities.

Common Data Architecture

Common data architecture is needed to ensure coordinated information generation; data and information sharing and efficiencies are maximized in data and information management. The county M&E unit will carry the mandate of establishing and overseeing the common data architecture by use of DHIS platform for aggregate data and electronic health records System. The health sector has identified sector indicators for monitoring and evaluating the implementation of county a health sector strategic and investment plan. The common data architecture will provide the data sources for these indicators as defined in the health sector indicator manual.

Enhancement of Sharing Data and Promoting Information Use

The sector recognizes the fact that different data are used by different actors for their decision-making processes and investment decisions. For this, data need to be translated into information that is relevant for decision making and use by county citizens. Data will be packaged and disseminated in formats that are determined by the needs of the stakeholders.

Sharing Service Delivery Expectations

In line with the Kenya 2010 Constitution, County Government Act 2012, and Financial Management Act 2012 need for sector transparency, accountability information on expected services will be publicly displayed outside each facility unit, based on the package to be delivered there.


Garissa County and Sub-county Annual State of Health Report

The health sector shall publish annually a state of health report which will be a compilation of statistical information from different sources presenting a snap shot of performance covering the different strategic objectives articulated in this strategic plan. It will be informed by the county and sub-county annual health state report and will be produced by the planning and M&E units at the county levels. The sub-county and county state report will be presented at a county annual health review summit and be published on the county MOH Web site. This forum will draw attendance from MOH county level, the county health management teams, SAGAs and CSOs, DPs and county implementers and other health related sectors etc.

Quarterly Performance Review Reports

At all levels, performance review reports will be produced outlining the performance against the strategic objectives outlined in this plan. The reports will be discussed by the health management teams including all the stakeholders at the quarterly performance review meetings. The discussion will focus on a review of the findings and the agreed action points. The final report will be submitted to the next level of reporting.

Annual Work Plan

During the five-year strategic period, we shall implement the activities through annual work planning at different levels.

The planning and M&E unit at the sub-county and county levels will translate data and information according to the targets set and performance review through various communication channels to disseminate the information to all the stakeholders. The plan shall be shared through the county assembly and national government.

Figure 9: Comprehensive Planning Cycle

COUNTY HEALTH SECTOR AWP

Figure 9: Comprehensive County Health Planning Cycle

COMMUNITY UNIT ANNUAL WORK PLAN (AWP)

COUNTY HOSPITAL AWP PRIMARY CARE AWP SUB COUNTY MANAGEMENT AWP

SUB COUNTY ANNUAL WORK PLAN

COUNTY MANAGEMENT AWP COUNTY REFERRAL HOSPITAL


Figure 10: Garissa County Planning Cycle

5.3.1 Performance Monitoring and Evaluation

Performance monitoring and review processes

All performance reviews and evaluations will contain specific, targeted and actionable recommendations; the process will be outlined in the County Health M&E framework

All institutions will provide a response to the recommendation(s) within a stipulated timeframe.

All the planning units and institutions will be required to maintain implementation tracking Plan

The implementation of the agreed actions will be monitored by the planning and M&E unit at all levels with coordination and oversight from County Health Management.

Table 17: Service Outcome and Output Targets for Achievement of County Objectives

Objective Indicator Targets

Yr. 1 Yr. 2 Yr. 3 Yr. 4 Yr. 5

Eliminate communicable conditions

% Fully immunized children 65 75 85 90 95

% of target population receiving MDA for schistosomiasis

% of TB patients completing treatment 88 90 92 94 98

% HIV + pregnant mothers receiving (PMTCT)preventive ARV’s

100 100 100 100 100

% of eligible HIV clients on ARV’s 100 100 100 100 100

% of (targeted) under 1’s provided with LLITN’s 100 100 100 100 100

% of pregnant women attending at least 1 ANC visit provided with LLITN’s

30 35 40 45 50

% of under 5’s treated for diarrhoea 55 67 79 91 100

% School age children dewormed 40 50 60 70 80

% of children 12-59months dewormed 66 70 74 78 80

Figure 10: Garissa County Planning Cycle

ANNUAL WORK PLAN

Start: November End: Mid February

Annual County Health Report

Start: December End: January

Annual Performance Review

Start: June End: July

Heath SP


Halt, and reverse the rising burden of non-communicable conditions

% of adult population with BMI over 25 2 5 10 15 20

% Women of Reproductive age screened for Cervical cancers

7 11 16 20 25

% of new outpatients with mental health conditions 0.5 0.3 0.2 0 0

% of new outpatients cases with high blood pressure 3 5 7 9 11

% of patients admitted with cancer 6 4 3 2 1

Reduce the burden of violence and injuries

% new outpatient cases attributed to gender based violence

1 1 1 1 1

% new outpatient cases attributed to Road traffic Injuries 35 30 25 20 20

% new outpatient cases attributed to other injuries 12 10 8 8 6

% of deaths due to injuries 1 1 1 1 1

Provide essential health services

% deliveries conducted by skilled attendant 30 40 45 50 60

% of women of Reproductive age receiving family planning

10 20 30 40 50

% of facility based maternal deaths 5 4 4 3 2

% of facility based under five deaths 2 1 0.5 0.5 0.5

% of new-borns with low birth weight 17 15 12 10 5

% of facility based fresh still births 2 1 1 1 0

Surgical rate for cold cases 1 5 8 10 15

% of pregnant women attending 4 ANC visits 15 25 40 50 60

Minimize exposure to health risk factors

% population who smoke 15 12 10 8 6

% population consuming alcohol regularly 5 4 3 2 1

% infants under 6 months on exclusive breastfeeding 33 43 55 65 85

% of Population aware of risk factors to health 20 40 60 80 90

% of salt brands adequately iodized 60 65 70 80 80

Couple year protection due to condom use 30 35 45 55 65

Strengthen collaboration with health related sectors

% population with access to safe water 30 35 40 45 50

% under 5’s stunted 15 14 11 8 4

% under 5 underweight 13 10 8 6 3

School enrolment rate 60 70 80 90 90

% of households with latrines 52 57 62 67 72

% of houses with adequate ventilation 30 40 50 60 65

% of classified road network in good condition 10 12 15 20 30

% Schools providing complete school health package 10 15 20 25 30

INVESTMENT OUTPUTS

Improving access to services

Per capita outpatient utilization rate (M/F)

% of population living within 5km of a facility

% of facilities providing BEOC

% of facilities providing CEOC

Bed occupancy rate

% of facilities providing Immunisation 80 85 85 90 90

Improving quality of care TB cure rate 85 87 89 91 93

% of fevers tested positive for malaria

% maternal audits/deaths audits 100 100 100 100 100

Malaria inpatient case fatality

Average length of stay (ALOS) 4 3 3 2 2


Table 18: County Monitoring Indicators

County Objectives Indicators

Scale up the number of functional community units Number of Community Unit established and reporting to DHIS

Increase immunization coverage % of immunization coverage

Improve access to safe water and sanitation services

Enhance provision of complete heath package in school

Number of schools providing complete heath package

Increase IDSR reporting in health facilities Number of facilities reporting IDSR

Establish isolation Centre’s in all tier 3 and 4 facilities Number of facilities with functional Isolation centres established

Promote early detection and diagnosis of common NCDs

% of NCDs detected

Increase public awareness on non-communicable diseases

Number of public awareness conducted on NCDs

Increase access to diagnostic and treatment services Number of centres providing diagnostic and treatment services

Set up palliative and rehabilitation centres Number of palliative and rehabilitation centres

Advocate for bi-laws that promote healthy lifestyles and reverse trend of risk factors

Number of acts/bylaws that promote healthy lifestyles

Establish emergency preparedness and response teams at sub-counties.

Number of sub-counties that have an emergency and response team

Establish emergency, diagnostic and specialized facilities (e.g. burn units, ICU/HDU).

Number of emergency, diagnostic and specialized facilities established

Create public awareness on violence and injuries Number of public awareness conducted on violence and injuries

Establish psycho-social care units at sub-counties. Number of sub-counties with psycho-social care units

Improve client referral system % of referrals initiation% of referrals received%referrals completion %referrals counter referred

Adherence to standard operating procedure Number of health care workers adhering to the SOPs disseminated

Provision of integrated services (one stop shop) a health facilities

Number of health facilities providing integrated services

Reduce stock out of essential medicine and medical supplies

Number of health facilities reporting stock-outs of essential medicines

Improved quality of care at the health facilities % of health facilities reporting improved quality of careservices(QoCsurvey)

Adherence to citizen service charter Number of health facilities with citizen service charter

Strengthen linkages and referral systems between various tiers of health care service delivery.

% of intra facility referrals initiation% of intra facility referrals completion%of inter facility referrals initiation%of inter facility referrals completion& of inter facility counter referrals

Foster partnerships in improving health and delivering services with health stakeholders

Number of stakeholders actively participating in the stakeholder forums

Improve the financing of health sector % of resources allocated to the health sector



SECTION

References

6

1. Constitution of Kenya 2010

2. Kenya Demographic health Survey 2008/09

3. Kenya DHIS 2012- www.hiskenya.org

4. Kenya, County Government Act No 17, 2012

5. Kenya, Transition to devolved Government act, 2012

6. Kenya, Vision 2030

7. Ministry of Health, Norms and Standard, 2007

8. Ministry of Health. Annual Work plan July 2012- June 2013, Garissa County

9. Ministry of Health. Kenya SARAM county Fact sheet 2013

10. Ministry of Medical Services and Ministry of Public Health and Sanitation. Kenya Health Sector Strategic Plan (KHSSP) III, 2012-2017 Nairobi.

11. Ministry of Medical Services and Ministry of Public Health and Sanitation. Kenya Health Policy 2012-2030. Nairobi: Government of Kenya; 2012


OFAB 45 - February 23, 2012 Annexes

Annex 1: Risk Factors

Risk Factors Causing Mortality Risk Factors Causing Morbidity

National County-specific National County-specific

No Condition No Condition No Condition No Condition

1 Unsafe sex 1 Unsafe water, sanitation and hygiene

1 Unsafe sex 1 Unsafe water, sanitation and hygiene

2 Unsafe water, sanitation & hygiene

2 Unhealthy lifestyle 2 Unsafe water, sanitation & hygiene

2 Unhealthy lifestyle

3 Suboptimal breastfeeding

3 Road traffic accident 3 Childhood and maternal underweight

3 Road traffic accident

4 Childhood & maternal underweight

4 Harmful socio-cultural practices

4 Suboptimal breastfeeding

4 Harmful socio-cultural practices

5 Indoor air population

5 Drug and substance abuse

5 High blood pressure

5 Drug and substance abuse

6 Alcohol use 6 Insecurity (clan and resource based conflicts

6 Alcohol use 6 Insecurity (clan and resource based conflicts

7 Vitamin A deficiency

7 Natural disasters – (floods, drought, etc.)

7 Vitamin A deficiency

7 Natural disasters – (floods, drought, etc.)

8 High blood glucose

8 Ignorance and illiteracy of community

8 Zinc deficiency

8 Ignorance and illiteracy of community

9 High blood pressure

9 Food insecurity/ deficiencies

9 Iron deficiency

9 Food insecurity/ deficiencies

10 Zinc deficiency

10 Poor housing/shelter 10 Lack of contraception

10 Poor housing/shelter


Annex 2: The Monitoring and Evaluation Framework

Frequency Targets Focus Level of Monitoring and review

Monthly Monthly activity reports

Identify activities whose implementation is delaying delivery of outputs, and plan to address challenges

Activity level

Quarterly Quarterlyprogress reports

Identify outputs whose achievement during the year is threatened, and plan to address challenges affecting them

Output level

Annually Annual progress reports

Identify progress, issues and challenges affecting implementation of outputs, and make recommendations of priorities for coming year

Output level

Mid term Mid-term review

Identify progress, issues and challenges affecting implementation of outcomes towards supporting the achievement of the overall goal, and make recommendations for the remaining half of the strategic plan

Outcome level

End term End-term review

Identify progress, issues and challenges that affected achievement of the overall goal, and make recommendations for the next strategic plan focus to enable it to support achievement of overall sector policy

Goal level


Annex 3: Participant List

Members of Strategic Task Team

1. Dr Mohamed Sheikh- County Director of Health, Garissa

2. Shale Abdi- Ministry of Health- Garissa

3. Abdirahman Farah- Ministry of Health- Garissa

4. Habon Golo Abdi- Ministry of Health- Garissa

5. Abdille Nur Farah- Ministry of Health- Garissa

6. Omar Mahat Ore- Ministry of Health- Garissa

7. Siyat Moge Gure- Ministry of Health- Garissa

8. Nimo Hussein Omar- Measure Evaluation-PIMA

9. Dr Abddullahi Abagira- UNICEF

10. Dr Farah Amin- Ministry of Health- Garissa

11. Dr Eric Ochieng- Ministry of Health- Garissa

12. Dr Peter Mogoi- Ministry of Health- Garissa

List of Contributors

1. Adan Hussein- Ministry of Health- Garissa

2. Hassan Hussein- Ministry of Health- Garissa

3. Yusuf Hassan Ali – Ministry of Health- Garissa

4. Abdirashid Diney- Ministry of Health- Garissa

5. Hassan Dahir Elmi- Ministry of Health- Garissa

6. Ahmed Haji- Ministry of Health- Garissa

7. Muhamed Buul- Ministry of Health- Garissa

8. Noor I. Gorat- Ministry of Health- Garissa

9. Fatuma Iman- Ministry of Health- Garissa

10. Noor Sheikh- Ministry of Health- Garissa

11. Sahara Aden- Ministry of Health- Garissa

12. Mohamed Salat- Ministry of Health- Garissa

13. Anthony Nyaga Njuguna- Ministry of Health- Garissa

14. Pamela Barasa- Ministry of Health- Garissa

15. Charles Chege- Ministry of Health- Garissa

16. Jillo Hapana Wako- Ministry of Health- Garissa

17. Joseph Mutua- Ministry of Health- Garissa

18. Bashir Hassan- Ministry of Health- Garissa

19. Siyat Hassan- Ministry of Health- Garissa


20. Mohamed Haret- Ministry of Health- Garissa

21. Alkanjero Gitari- Ministry of Health- Garissa

22. Philippe Rougier- TDH

23. Sanjeev Verma- TDH

24. Daniel Langat- Kenya Red Cross, Garissa

25. Aden Mohamed- Care International, Garissa

26. Victor Mwiti- Care International, Garissa

27. Mohamud Osman- Mercy USA

28. Abdullahi Daud- APHIAplus Imarisha

29. Ahmed Boray- APHIAplus Imarisha

30. Hussein Bashey- APHIAplus Imarisha

31. Achim Chiaji- MEASURE Evaluation-PIMA

32. Zahara Hashi- Simaho

33. Bernard Mutemi-Planning and Devolution –Garissa County

34. Mohamed Hussein Ali Planning and Devolution –Garissa County

35. Jacob Wambaya Planning and Devolution –Garissa County





Support for this activity has been provided by the U.S. Agency for International Development through the MEASURE Evaluation PIMA project. Views expressed in this document do not necessarily reflect the views of USAID or of the United States Government.

Documents

Health Sector Strategic and Investment Plan 2013-2018healthgarissa.go.ke/downloads/Garissa County SP final5.pdf · 2.0 Overview of Health Care Services (Health Investment) 8 2.1 Major