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KIRINYAGA DISTRICT HEALTH PLAN

2007/2008

TABLE OF CONTENTS

Forematter Foreword List of Abbreviations Executive Summary

Section 1: The District Health Service and Capacity Assessment

1.1 Mapping the health services and facilities in the district

1.2 Demographic profile and distribution

1.2.1 District population by service category

1.3 Workload by level of service delivery

1.4 Health facilities (GOK and non-GOK)

1.4.1 Number and type of health facilities in the district

1.5 Access/utilization to health care services both GOK and non GOK

1.5.1 Catchment population per facility

1.6 Human resources

1.6.1 Medical/technical personnel

1.7 Health care financing; Availability and Utilization

Section 2: The district health services analysis

2.1 Key Issue

2.2 Challenges and Constraints

2.3 Priorities

Section 3: Results and targets

3.1 District Consolidated Targets

Section 4 The Work plan

` 4.1Coordination of Service Delivery

4.2 Coordination of Facility Based Management Support Activities

4.3. Management level (DHMT) Support plan

Section 5: the district budget

5.1 District resource envelope

5.2 Budget (DHMT plan)

5.3 Gap/Surplus

Foreword:

The Government through the Ministry of Health has developed strategies to be able to realize the Millennium Development

goals and Economic Recovery. These strategies are operational zed through Annual operational plans. The district is currently implementing AOP2 and has now developed AOP3 to start in July 2007-2008.The DHMT members were introduced to the objectives and the planning process of AOP3, then to all health facility in-charges both GOK and FBOs in order to be all- inclusive and increase participation during the implementation. After introduction and training on facility planning, all facilities were requested to develop plans for AOP3 (2007-2008). The DHMT members supervised facilities during the planning period in January 2007 and completed plans were forwarded to the office of the DMOH by mid-February 2007. The plans were consolidated and the draft plan presented to the stakeholders for ratification early March this year. I wish to thank all who participated in the development of the AOP3, the DHMT members, all staffs from GOK, FBOs/NGOs, development partners, DHMB-Kirinyaga and all who made preparation of the plan a success. It is my sincere hope that the

implementation of AOP 3 will go along way in improving the delivery of health services at all levels and more so involvement/participation in preventive and promotive health services.

DR. I. M. KIMANI DISTRICT MEDICAL OFFICER OF HEALTH KIRINYAGA DISTRICT

community

3

List of Abbreviations:

DMOH

-

District Medical Officer of Health

DPHN

-

District Public Health Nurse

DPHO

-

District Health Officer

DASCO

-

District Aids

DCO

-

District Clinical Officer

DNO

-

District Nutrition Officer

DMLT

-

District Medical Laboratory Technologist

DHAO

-

District Health Administrative Officer

DHRIO

-

District Health Records Information Officer

DHMT

-

District Health Management Team

DDSC

-

District Disease Surveillance Coordinator

PLWA

-

People Living With Aids

VHC

-

Village Health Committee

VCT

-

Voluntary Counseling

PMTCT

-

Prevention of Mother to Child Transmission

CHW

-

Community Health Worker

GOK

-

Government of Kenya

EU

-

European Union

FIF

-

Facility Improvement Fund

FBO

-

Faith Based Organization

NGO

-

Non Governmental Organization

DRH

-

Division of Reproductive Health

AOP

-

Annual Operation Plan

CWC

-

Child Welfare Clinic

KRCHN

-

Kenya Registered Community Health Nurse

KECHN

-

Kenya Enrolled Community Health Nurse

PM&E

-

Planning Monitoring & Evaluation

IPT

-

Intermittent Patient treatment

ANC

-

Ante Natal Clinic

FP

-

Family Planning

OPD

-

Out patient Department

OP

-

Out patient

IDS

-

Integrated Disease Surveillance

h/w

-

Health worker

4

SECTION 1

The District Health Service and Capacity Assessment

5

1.1 KIRINYAGA DISTRICT MAP

1.1 KIRINYAGA DISTRICT MAP 6

6

1.2

DEMOGRAPHIC PROFILE

INTRODUCTION

Kirinyaga District covers a total area of 1, 478 Km2, which is 11.2 percent and 0.3 percent of Central Province and Kenya's total area respectively. The District being one of the seven Districts in the Central Province borders Nyeri and Murang'a Districts to the west, Mbeere District to the south and Embu District to the east. The District is located between latitudes 0 0 1 0 and 0 0 40 0 south and longitude 37 0 and 38 0 east.

ADMINISTRATIVE AND POLITICAL AREAS

The District has four (4) divisions namely; Gichugu, Ndia, Mwea and Central. The largest Division is Mwea, which is located to the Southern side while the smallest Division is Central, which is located almost at the centre of the District

AREA OF THE DISTRICT BY DIVISION

DIVISION

AREA (KM²)

Gichugu

292.7

Ndia

276.4

Central

108.5

Mwea

512.8

Forest area

350.7

Total

1478.1

SOURCE:

District Development Office

N/B:

indiscriminate felling of the forests indigenous trees with no noticeable replacement at the moment.

The area of 350.7 sq. km is made of the forest, which does not specifically fall within any of the Divisions though it could be less with the

The District has 22 locations and 80 sub locations.

Administrative Units by Division

Divisions

No. of Locations

No. of Sub locations

Gichugu

6

23

Ndia

6

24

Mwea

6

20

Central

4

13

Total

22

80

Source: DISTRICT DEVELOPMENT OFFICE

7

The District has four (4) constituencies namely: Ndia, Gichugu, Mwea and Kerugoya/Kutus. Ndia constituency covers Ndia Division, Gichugu constituency covers Gichugu Division, and Mwea constituency covers Mwea Division while Kerugoya/Kutus constituency covers Central Division. The District has 3 local authorities namely: Kerugoya/Kutus Municipality, Sagana Town Council and Kirinyaga County council with a total of 37 elective wards.

1.2.1

District Population by Service category

 

Description

District proportions

Eligible population

1

Total catchment’s population

 

491617

2

Children under 1 year (12 months)

2.76%

13, 569

3

Children under 5 years (60 months)

12%

58, 994

4

Under 15 year population

36.2%

177, 965

5

Women of child bearing age (15 – 49 Years)

26.3%

129, 295

6

Estimated Number of Pregnant Women

2.76%

13, 569

7

Estimated Number of Deliveries

2.76%

13, 569

8

Live Births

2.76%

13, 569

9

Estimated Number of emergency obstetric complications

0.75%

3, 687

10

Estimated Number of Post-Abortion Cases

   

11

Total number of Adolescent (15-24)

23%

113, 072

12

Adults (25-59)

33.7%

165, 675

13

Elderly (60+)

6.6%

32, 447

1.3

Workload by Level of Service Delivery

 

Level of Service delivery

Total Outpatient

 

Total In Patient

Grand

 

Total

 

New

Revisit

Total

   

Level II (Dispensary)

248, 169

280, 679

528, 848

0

528, 848

Level III ( Health Centre)

101, 187

119, 059

220, 246

1, 557

220, 246

Level IV (District Hospital

52, 354

53, 984

106, 338

12, 047

118, 385

Levels 5 & 6 Referral Hospital

0

0

0

0

0

Total

401, 710

453, 722

855, 432

13, 604

867, 479

Note:

Outpatient services include general outpatient and other special outpatient services like MCH, FP, and Counseling etc.

8

1.4 HEALTH FACILITIES (GOK AND NON-GOK)

1.4.1 Number and type of Health Facilities in the district

   

Number of Providers

 
 

GOK

FBO

   

NGO

Private

Total

1

Hospital (Includes District. And Sub-District Hosp) Centre

No.

2

 

2

 

0

1

5

Beds & cots

296

 

160

 

0

53

509

2

Health Centre

No

7

 

2

 

0

0

9

Beds

51

 

24

 

0

0

75

3

Nursing /Maternity home

No

0

 

0

 

0

2

2

   

Bed

0

 

0

 

0

38

38

4

 

Dispensary

37

 

27

 

0

0

64

5

 

Clinic

0

 

0

 

0

82

82

6

Hospitals with COs School

 

0

 

0

   

0

0

0

 

0

   

7

Hospitals with Nursing School

 

0

 

0

 

0

0

0

8

Private Pharmacies

   

0

 

0

38

38

9

Community Pharmacies

   

0

 

8

0

8

Sources: District Health Record

9

1.5 ACCESS/UTILIZATION TO HEALTH CARE SERVICES BOTH GOK AND NON GOK

1.5.1 Catchment Populations per Facility

 

Name of Health Facility

Total

Total Outpatient Attendance

Utilization Rate

Catchment

Population

 

(a)

(b)

 

(c)

(d)

   

= c/d x 100

     

New

Revisit

Total

 

1

Kerugoya district hospital

22239

49324

28958

78,282

352

2

Kimbimbi sub-district hospital

16,673

29,735

11,586

41,321

248

3

ACK Mt. Kenya hospital

1,979

3,001

1,618

4,619

233

4

Mwea Mission hospital

6,347

9,081

10,477

19,558

308

5

Mwea medical centre

2,793

456

60

516

18

6

Sagana H/C

29,236

23,878

38,364

62,242

213

7

Kianyaga H/C

21,532

20,268

30,220

50,488

234

8

Baricho H/C

16,807

9,565

7,234

16,799

100

9

Kabare H/C

17,426

8,376

4,137

12,513

72

10

Difathas H/C

10,572

6,517

3,945

10,462

99

11

Kiamutugu H/C

19,564

17,657

11,827

29,484

151

12

Mutithi H/C

7,985

2,884

8,649

11,533

144

13

Baricho catholic

3,975

1,597

4,791

6,388

161

14

Kianyaga catholic H/C

1,214

630

256

886

73

15

Baragwi maternity

759

211

633

844

111

16

Kagio nursing home

1,869

269

300

569

30

17

Kutus dispensary

3,971

3,128

1,553

4,681

118

18

Ucheru dispensary

5,920

3,700

3,154

6,854

116

19

Mutitu dispensary

3,149

2,454

363

2,817

89

20

Gatwe dispensary

7,855

8,420

9,984

18,404

234

21

Kangaita dispensary

8,072

11,170

6,694

17,864

221

22

Kagumo dispensary

8,425

15,452

4,840

20,292

241

23

Gathambi dispensary

12,512

7,962

7,554

15,516

124

24

Kangaru dispensary

19,920

8,505

25,515

34,020

171

25

Kiaragana dispensary

7,599

3,869

1,946

5,815

77

10

 

Name of Health Facility

Total

Total Outpatient Attendance

Utilization Rate

Catchment

Population

 

(a)

(b)

 

(c)

(d)

   

= c/d x 100

26

Kiangai dispensary

8,582

14,394

1,608

16,002

186

27

Kibirigwi dispensary

9,318

7,079

1,767

8,846

95

28

Kianjege dispensary

7,663

4,426

5,698

10,124

132

29

Gatithi dispensary

6,938

4,176

993

5,169

75

30

Kiburu dispensary

4,088

2,289

6,867

9,156

224

31

Gaciongo dispensary

7,411

2,230

3,067

5,297

71

32

Gatugura dispensary

13,444

15,736

6,185

21,921

163

33

Kamweti dispensary

13,526

7,923

15,235

23,158

171

34

Karumande dispensary

10,027

9,599

3,739

13,338

133

35

Kiangombe dispensary

9,099

14,550

9,290

23,840

262

36

Mumbuini dispensary

3,093

837

2,101

2,938

95

37

Kiumbu dispensary

5,507

7,472

3,601

11,073

201

38

Thiba dispensary

10,374

8,262

2,235

10,497

101

39

Wamumu dispensary

5,853

3,751

1,992

5,743

98

40

Gathigiriri dispensary

6,029

12,522

1,712

14,234

236

41

Murinduko dispensary

10,997

10,368

7,512

17,880

163

42

Njegas dispensary

6,776

6,960

6,622

13,582

200

43

Kandongu dispensary

8,489

9,801

6,268

16,069

189

44

Nguka dispensary

9,976

9,448

6,162

15,610

156

45

Ciagini dispensary

5,110

6,652

3,344

9,996

196

46

GK prisons

2,854

1,000

1,122

2,122

74

47

Rukanga dispensary

6,308

8,437

10,420

18,857

299

48

Kajiji dispensary

4,219

3,510

1,816

5,326

126

49

Kiamanyeki dispensary

2,342

4,098

240

4,338

185

50

Kariini dispensary

1,395

200

434

634

45

51

Joshua Mbai

2,000

1,356

300

1,656

83

52

Kangu dispensary

2,000

1,234

453

1,687

84

53

Kerugoya catholic dispensary

1,669

718

1,120

1,838

110

54

Kutus catholic dispensary

3,069

3,625

1,240

4,865

159

55

CCS Kerugoya dispensary

1,669

744

1,150

1,894

113

11

 

Name of Health Facility

Total

Total Outpatient Attendance

Utilization Rate

Catchment

Population

 

(a)

(b)

 

(c)

(d)

   

= c/d x 100

56

Kagumo catholic dispensary

5,051

5,900

5,052

10,952

217

57

ACK Thaita dispensary

1,054

37

6

43

4

58

ACK Karaini dispensary

1,174

1,548

252

1,800

153

59

Kagio catholic dispensary

3,124

300

269

569

18

60

Sagana catholic dispensary

7,299

1,310

2,000

3,310

45

61

ACK Mutira dispensary

1,342

403

300

703

52

62

Gatumbi SDA dispensary

1,916

277

612

889

46

63

Jesmond dispensary

1,458

345

954

1,299

89

64

ACK Mbiri dispensary

1,296

1,164

679

1,843

142

65

ACK Githure dispensary

466

236

708

944

203

66

ACK Mugumo dispensary

1,649

380

1,140

1,520

92

67

ACK Ngariama dispensary

2,315

266

798

1,064

46

68

ACK ST. Andrews Kabare

754

100

210

310

41

69

ACK ngiriambu dispensary

676

313

939

1,252

185

70

CCS Wang’uru dispensary

1,162

810

1,670

2,480

213

71

St. Teresa catholic dispensary

678

141

200

341

50

72

Difathas catholic dispensary

677

500

182

682

101

73

MCK Kiandegwa dispensary

746

256

130

386

52

74

ACK Thumaita dispensary

412

132

200

332

81

75

Rapha clinic

742

200

100

300

40

76

Gatwe clinic

800

140

200

340

43

77

Kangaita clinic

286

100

186

286

100

78

Heshima clinic

242

80

240

320

132

79

Kabuti clinic

1,414

271

813

1,084

77

80

Afya bora clinic

899

271

813

1,084

121

81

Ithare clinic

1,428

273

819

1,092

76

82

Zawadi clinic

958

300

289

589

61

83

Roadside clinic

921

200

151

351

38

84

Manesh clinic

84

30

39

69

82

85

Ssema clinic

314

120

141

261

83

86

Imani clinic

503

367

230

597

119

12

 

Name of Health Facility

Total

 

Total Outpatient Attendance

Utilization Rate

 

Catchment

 

Population

 

(a)

(b)

 

(c)

 

(d)

   

= c/d x 100

 
 

87 Tumaini clinic

 

142

 

56

46

 

102

 

72

 

88 Mamuki clinic

 

261

 

200

193

 

393

 

151

 

89 Kirimara clinic

 

658

 

130

100

 

230

 

35

 

90 Kianugu clinic

 

93

 

90

 

52

 

142

 

153

 

91 By Faith clinic

 

405

 

300

531

 

831

 

205

 

District total

491,617

449,052

360,195

 

809,247

 

165

1.6 Human Resources Availability 1.6.1 Medical/Technical Personnel

 
   

Description

 

GoK

   

FBO

   

NGO / PRIVATE

Total

   

Level

Level

Level

Level

Level

Level

Level

Level

Level

Level

Level

Level

 
 

1

2

3

4

1

2

3

4

1

2

3

4

1

Consultants (MD

 

0

0

0

 

3

0

0

0

 

0

0

0

0

0

3

2

GP (MD)

 

0

0

0

 

8

0

0

0

 

5

0

0

0

2

15

3

Dentists

 

0

0

0

 

1

0

0

0

 

0

0

0

0

0

1

4

Dental Technologists

 

0

0

0

 

4

0

0

0

 

0

0

0

0

0

4

5

Community Oral Health Officers

 

0

0

0

 

2

0

0

0

 

0

0

0

0

0

2

6

Clinical Officer (Spec)

 

0

0

0

 

5

0

0

0

 

0

0

0

0

0

5

7

Clinical Officers (Gen.)

 

0

0

7

 

28

0

2

0

 

2

0

0

1

0

40

8

KRCHNs

 

0

0

8

 

51

0

2

0

 

10

0

0

0

0

71

9

KECHNs

 

0

56

40

 

141

0

27

0

 

36

0

3

2

0

305

10

Public Health Officers

 

0

5

5

 

2

0

0

0

 

0

0

0

0

0

12

11

Public Health Technicians

 

23

9

 

0

0

0

0

 

0

0

0

0

0

32

12

Pharmacists

 

0

0

0

 

3

0

0

0

 

0

0

0

0

0

3

13

Pharm. Technologist

 

0

0

0

 

2

0

0

0

 

3

0

0

0

0

5

14

Lab. Technologist

 

0

0

2

 

11

0

1

0

 

2

0

0

0

0

16

15

Lab. Technician

 

0

1

4

 

2

0

0

0

 

3

0

0

0

0

10

16

FHFEs

 

0

0

0

 

0

0

0

0

 

0

0

0

0

0

0

13

 

Description

 

GoK

   

FBO

   

NGO / PRIVATE

Total

   

Level

Level

Level

Level

Level

Level

Level

Level

Level

Level

Level

Level

 

1

2

3

4

1

2

3

4

1

2

3

4

17

Nutritionists

0

0

6

4

0

0

0

0

0

0

1

0

11

18

Nutritionists Assistant

0

0

1

 

0

0

0

0

0

0

0

0

1

19

Radiographers

0

0

0

2

0

0

0

0

0

0

0

0

2

20

Physiotherapists

0

0

2

5

0

0

0

0

0

0

0

0

7

21

Occupational Therapists

0

0

1

5

0

0

0

0

0

 

0

0

6

22

Plaster Technicians

0

0

0

2

0

0

0

0

0

 

0

0

2

23

Health Record & Information Officers

0

0

0

5

0

0

0

1

0

0

0

0

6

24

Community Health Workers

120

0

0

0

0

0

0

0

0

0

0

0

120

25

Orthopaedic officers

0

0

0

1

0

0

0

0

0

0

0

0

1

26

Medical engineering technologist

0

0

0

0

0

0

0

0

0

0

0

0

0

27

Medical engineering technicians

0

0

0

2

0

0

0

0

0

0

0

0

2

28

Medical engineering artisans

0

0

0

0

0

0

0

0

0

0

0

0

0

29

Support staff

0

1

1

7

0

2

0

65

0

0

0

0

76

30

Non medical

0

1

4

2

0

14

0

5

0

3

2

0

31

31

Administrator

0

0

0

2

0

3

0

1

0

0

0

0

6

33

Store man

0

0

0

1

0

0

0

1

0

0

0

0

2

34

Artisans

0

0

0

3

0

0

0

 

0

0

0

0

3

35

Accountants

0

1

0

1

0

0

0

1

0

0

0

0

 

36

Drivers

0

0

0

5

0

0

0

1

0

0

0

0

6

Sources: District Health Facilities Records

14

1.7 HEALTH CARE FINANCING AVAILABILITY AND UTILIZATION

Table 1.3 Resource availability and utilization for current Financial Year (AOP II)

 

Source

Amount

Amount

Expenditure

Expenditure

Funds

Accounting

Budgeted

Received

accounted for

utilization

rate=D/CX100

(SOE’s submitted)

rate=C/BAX100

MOH

FIF

7,097,322.00

7,097,322.00

6,621,896.15

5,673,146.15

93.30

85.67

RECURRENT

1,031,354.25

1,031,354.25

635,781.00

608,281.00

61.65

95.67

DEVELOPMENT

440,000.00

440,000.00

311,220.00

224,500.00

70.73

72.14

 

GLOBAL FUND

1,401,949.00

1,401,949.00

699,636.60

699,636.60

49.90

100.00

 

DVBD

80,000.00

80,000.00

16,500.00

16,500.00

20.63

100.00

Kerugoya

             

hosp

FIF

13,930,162.00

13,930,162.00

13,110,081.00

12,902,531.00

94.11

98.42

RECURRENT

3,883,941.25

3,883,941.25

3,144,832.80

2,801,782.80

80.97

89.09

DEVELOPMENT

0

0

0

0

0

0

Kimbimbi

             

SDH

FIF

1,748,878.00

1,748,878.00

1,516,024.45

1,396,852.50

86.69

92.14

RECURRENT

1,067,918.25

1,067,918.25

822,898.95

623,806.25

77.06

75.81

DEVELOPMENT

0

0

0

0

0

0

Kianyaga

FIF

362,650.00

362,650.00

290,797.40

265,617.40

80.19

91.34

Baricho

FIF

274,063.75

274,063.75

186,546.40

171,546.40

68.07

91.96

Sagana

FIF

398,485.00

398,485.00

330,548.60

313,848.60

82.95

94.95

Kabare

FIF

273,409.50

273,409.50

196,102.30

188,102.30

71.72

95.92

Dispensaries

FIF

4, 163, 463

4,105,134

4, 105, 134

4, 105, 134

100

100

DPHO

FIF

948,716.00

948,716.00

627,747.90

612,747.90

66.17

97.61

RECURRENT

208,000.00

208,000.00

185,130.50

185,130.50

89.01

100.00

DEVELOPMENT

260,000.00

260,000.00

154,985.00

154,985.00

59.61

100.00

Source: District Health Office

15

2.0 HEALTH SERVICE ANALYSIS

2.1 KEY ISSUES, CONTRAINTS/ CHALLENGES AND PRIORITIES FOT THE NEXT YEAR

   

UTILIZATION /

CHALLENGES/CONSTRAINTS

PRIORITIES FOR THIS YEAR

RESULT AREA

SUPPLY SIDE

COMMUNITY

       

SUPPLY SIDE

SUPPLY SIDE

-

Low Community

- Inadequate supply of haematinics

- Inadequate ITN supply

Ensure the ANC have adequate equipment and drugs

-

awareness of ANC services

- inadequate knowledge and skills to health

- Procure & distribute ITNs

-

Low Antenatal care

workers

- Train health workers on FANC/MIP

attendances -Late start of ANC

-

staff attitude

Redistribution of personnel according to qualifications and service need - Provide recording tools

-

-

inadequate supply of reagents

-

Low PMTCT services

-

Inadequate staffing

Few health facilities integrating PMTCT services into ANC

-

uptake

-

Lack of recording tools

- Train/update h/Ws on PMTCT

Maternal Health

-

 

-

Irregular supply of FP commodities

- Acquire and distribute FP commodities

 

regularly

-

Update health workers on new FP methods

few facilities offering FP services

-

-Culture & religious belief

Procure FP equipments, non pharmaceuticals and FP training model

-

-

Poverty

Few facilities offering post-natal services

-

-Low post-natal

attendances

   

-

Inadequate delivery equipment

Procure adequate delivery equipment for facilities offering maternity services

-

-

few facilities offering maternity services

-

- Increase no. of maternity units

- Enhance timely referrals

-

Low deliveries by

Equip maternity theatre in Kerugoya and Kimbimbi hospitals

-

skilled attendant

-

Low ITNs use by ANC mothers

-

DEMAND

DEMAND

- Community attitude

Enhance community education on maternal health

-

- High illiteracy level

- Train CORPs on FANC/MIP

- Long distance

- Intensify micro teachings

Child Health

-

Some facilities not

-

Low Community

- Accessibility to immunizing facilities

Increase the no. of h/f offering immunization services

-

offering immunization

awareness of various

- Erratic supply of some antigens

16

   

UTILIZATION /

CHALLENGES/CONSTRAINTS

PRIORITIES FOR THIS YEAR

RESULT AREA

SUPPLY SIDE

COMMUNITY

 

services

child services

- Many cold chain breakdowns

- Conduct outreach services

High child mortality and morbidity

-

-

High immunization

- Incomplete/inaccurate recording

- conduct child health days

defaulters

- Few staff trained in IMCI

- Ensure adequate supply of vaccines

 

stagnating immunization coverage

-