ANALYSIS OF THE

KIRINYAGA COUNTY
HEALTH SYSTEM,KENYA

GAKUU Esbon

Directorate of Health Policy, Planning & Health Programs

County Department of Health

Kirinyaga County

KENYA
 KIRINYAGA County
Proportion of PHC Facilities by Ownership
Total Area - 1,479 KM
Total Population - 632,154 (2018 Projection)
Population Density - 427/Km2 Private Public
Urban: Rural Ratio - 16:84 44% 39%

Faith-
Based
17%

ETHIOPIA Legend
UGANDA

SOMALIA

Public Hospitals
Private For Profit Hospitals
Faith Based Hospitals
INDIAN Primary Healthcare Facilities
TANZANIA OCEAN
2
 ORGANIZATION OF COUNTY HEALTH SERVICES
NATIONAL REFERRAL HEALTH SERVICES

County Health System

LEVELS OWNERSHIP SERVICE COVERAGE

Referral services
• Comprehensive in-patient diagnostic, medical, surgical and
COUNTY REFERRAL HEALTH SERVICES: Government- 4 rehabilitative care;
County/Sub-county hospitals, including Faith Based- 2 • Basic & Specialized outpatient services; and
Faith-Based and Private run Hospitals Private - 4 • Facilitate, and manage referrals from lower levels, and further
Centralized: Permanent; Polyvalent referral.

Referral services • Disease prevention and health promotion services

PRIMARY HEALTH CARE SERVICES: All
Dispensaries, Health centers, Private
clinics & Maternity homes
Decentralized; Permanent; Polyvalent
• Basic outpatient diagnostic and medical services
Government- 59 • Inpatient services for emergency clients awaiting referral, clients for
Faith Based- 26 observation, and normal delivery services
Private - 66 • Facilitate referral of clients from communities, and to referral
facilities

Community Referral
• Basic Health promotion activities
Community Health Services
Community Units - 69 • Provide agreed health services e.g. deworming
Decentralized: Periodic; polyvalent
• Facilitate community diagnosis & referral.
 Health Actors in Kirinyaga county
•National Ministry Responsible for
Health •Technical Partners and Non-
•County Department of Health State Implementing Partners
•Semi-Autonomous Government
Agencies e.g. National Health Insurance
Fund

State Actors External Actors

Faith-Based
Private Health •Catholic Church
•Private Practitioners Health Service •Anglican Church
•Private Health Insurance Providers
Providers Providers •Methodist Church
•Christian Health Associaltion of
Kenya

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 Overview of the Health Workforce Distribution
within the County
Distribution by Ownership
Cadre Government FBOs Private Total Key Cadres per 10,000 people
Medical Consultants 8 3 3 14
Medical Officers/GPs 33 6 12 51 Cadre Kirinyaga National*
Dentists 4 1 2 7 Doctors 1 2
Pharmacists 11 1 7 19 Nurses 12 15.4
Clinical Officers (General) 94 9 21 124
Clinical Officers 26 3 8 37
(Specialized)
Nurses (specialized) 13 4 1 18
Nurses 546 87 104 737
Laboratory Technologists 112 19 46 177
Other Health Personnel 1015 157 204 1376
* World Bank, 2015
Total 1862 290 408 2560 5
 Demand, Need And Supply Analysis
• Basic Emergency Maternal
Obstetric and Neonatal Care
(BEMONC) services
• HIV/AIDS, TB, Malaria diagnosis
care and Treatment services Demand • Irrational use of
• Routine Immunization services antibiotics in the
• Management of common Free Hospital-Level management of colds
ailments Health services and flus.

• Longer operational times

• Provision of HPV
for PHC facilities. Need Vaccine to teenage
• Family Planning services in
girls.
Catholic Run facilities Trauma care
center(s)
Supply • Provision of Cervix-
• Laboratory services in ALL
Dispensaries Mental & treatment
Rehabilitative health Cryotherapy
• Hospital-level Oncology services to PHC
services • Vasectomy
facilities
• Health center expansion
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 UTILIZATION INDICATORS
INDICATOR UNIT 2018/2019
Expectant women attending 1 Antenatal care Visit % 86
Expectant women attending 4 Antenatal care Visit % 54.1
Skilled Birth attendance % 84.4
children under 1 fully immunized % 88

Average distance to the nearest health care facility

KM <5

Average Length of Stay

Days 5

Bed Occupancy Rate (for Public & Faith-Based Hospitals)

% 124

Outpatient utilization per person

Visits Per Person 2.08
Source: Kirinyaga Health Sector Annual Performance Report 2018/2019 7
 Analysis of Access to care
Access Enablers
Dimension
Accessibility  Relatively good geographic access (good
HF distribution and road network)
Affordability  Free treatment of certain population
segments (under 5s) and certain diseases
(TB, HIV, Malaria)
 Insurance cover to mother and unborn
child, All High school students; Insurance  Public-Private dual practice
cover to all elderly (>65)
Acceptability  Enlightened community
Availability  Presence of health workers with the
right competencies and skills mix
Barriers
 Limited Operating times for PHC facilities
 High out of pocket payments due to Low Health insurance
in general population
 Weak community Indigent ID system Weak waiver
system
 Stigma (HIV, mental health)
 Frequent stock-out of essential health commodities in
Public hospitals
 Inadequacy of highly trained health professionals
 Absenteeism in public health facilities
 Inadequate diagnostic equipment in PHC facilities
 Poor Information sharing on health care
providers/choices 9
 ANALYSIS OF QUALITY OF CARE
(Facilitators) (Barriers)

• High workload in PHC

• Unregulated
and time pressure
• Presence Job Aids &
practitioners in • Leadership focus • Health infrastructure
private practice
Algorithms for major on PCC and environment not
• Inadequate
ailments
diagnostic Patient- • Enlightened & conducive for PCC
• Regular clinical audits equipment in PHC Technical Empowered • Inadequate training
Centered
facilities Effectiveness • Unsupportive staff
Care community attitude

Integration • Poor sharing of

Continuity
• There is no strong health information
• Interdisciplinary integration between • Most Private between providers
education the existing health practitioners are • Absence of family
facilities medical records
• Supportive policies
• Weak continuity of
reachable by • Discharge from
• Geographic proximity care phone during off-
of PHCs public hospital
• Weak referral hours without
linkages understanding their
care needs 10
 Structures in HEALTH STEWARDSHIP AND GOVERNANCE
Coordination Health System
Governance Stewardship
Health Sector Inter-Governmental
Coordination Forum
COUNTY EXECUTIVE COMMITTEE
COUNTY LEGISLATIVE ASSEMBLY OF My
KIRINYAGA
County Assembly Committee on Health Team
COUNTY HEALTH
MANAGEMENT TEAM
COUNTY HEALTH STAKEHOLDERS
FORUM

Technical Working Groups County Hospitals

County Hospital Boards
Management Teams

SUB COUNTY HEALTH

MANAGEMENT TEAMS

Primary Care Facility Management Primary Care Facility

Committees Management Teams

COMMUNITY HEALTH COMMITTEE COMMUNITY UNITS

COMPOSITION OF COUNTY HEALTH MANAGEMENT TEAM
HUMAN RESOURCES FOR
FINANCE & PROCUREMENT ← CHIEF OFFICER-HEALTH →
HEALTH
↓
My
COUNTY DIRECTOR-HEALTH
Docket
↓
↓ ↓ ↓ ↓
HEALTH CURATIVE AND PREVENTIVE AND HEALTH POLICY, PLANNING & HEALTH
ADMINISTRATIVE REHABILITATIVE PROMOTIVE HEALTH PROGRAMS UNIT
SERVICES UNIT HEALTH SERVICES UNIT UNIT
GENERAL COMMUNITY HEALTH
→ → PHARMACEUTICAL SERVICES → → TUBERCULOSIS → HEALTH INFORMATICS
ADMINISTRATION SERVICES

ENVIRONMENTAL HEALTH
→ HEALTH INFRASTRUCTURE → NURSING SERVICES → → HIV → HEALTH RESEARCH
& SANITATION

DISEASE SURVEILLANCE & MONITORING AND

→ TRANSPORT → LABORATORY SERVICES → → NUTRITION →
EPIDEMIC RESPONSE EVALUATION

PARTNERS’
→ ICT → CLINICAL SERVICES → HEALTH PROMOTION → MALARIA →
COORDINATION

COUNTY HOSPITALS MATERNAL & CHILD

→ MAINTENANCE → →
MANAGEMENT HEALTH

DISASTER PREPAREDNESS 12
→ LEGAL MATTERS → → NCD CONTROL
AND REFERRAL SERVICES
13 ROLE OF COUNTY HEALTH MANAGEMENT TEAM

• Licensing and accreditation of non-state health service providers

• Planning, management and financing of public health facilities
• Enforcement of standards and policies
• Resource mobilization for county health services
• Supportive supervision to all health service providers in the county
• Monitoring & Review of health service delivery
• Providing linkages and coordination of all health stakeholders
 STEWARDSHIP ANALYSIS
Enablers
• Enlightened community
• Presence of legal framework for
management and governance structures
Barriers
• No clear government policy towards the
private sector
• Lack of concern of social interests within
the private sector
• Poor mechanism for regulating the
quality of health services provided by the
health sector
• Administrative capacity constraints
16 COMMUNITY PARTICIPATION ANALYSIS

Indicator Analysis

Needs assessment  Most of the services at PHC level designed by health professionals with minimal
community involvement

Leadership and  Existence of legal provisions emphasizing inclusion and representation of community
Management interest groups

Resource mobilization  Limited amounts of resources for health raised by the local communities

Organisation  Weak integration of health committees with other public participation structures
Community Participation Analysis

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Health care financing
Public Hospitals Public PHC Facilities Faith Based Health Private For-Profit
Facilities

Direct Government
Financing

Out of Pocket (User

Fees)

National Health
Insurance Fund

Private Insurance
Schemes

Donors/ Development
Partners
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Synthesis of the Kirinyaga County Health System
Strengths Challenges
 Good geographical access  Relatively High Out-of-Pocket Payment for health
services
 Presence of Comprehensive package of care at PHC  Need to create demand for preventive interventions
facilities offered at PHC facilities
 Existence of a clear stewardship framework at the county  Administrative constraints
level  Weak regulation of private health sector providers
 Existence of a formal framework of public participation at  Most of the services at PHC level designed by health
all levels professionals with minimal community involvement

 Leadership focus on patient centered care  High workload and unconducive environment for
 Presence of policies supporting integration of care patient centered care.

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Lessons Learnt
• Need to decode real demand for health
• There is a price to be paid for Integration of services

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