KENYA MEDICAL TRAINING COLLEGE

FACULTY OF HEALTH SCIENCE

DEPARTMENT OF NURSING
KITUI CAMPUS
KAITI SUB-COUNTY, KILUNGU SUB-COUNTY
HOSPITAL DISTRICT EXPERIENCE REPORT
FROM 16/01/2023 TO 10/02/2023
SUBMITTED TO THE DEPARTMENT OF
NURSING IN PARTIAL FULFILMENT OF THE
REQUIREMENT FOR THE AWARD OF DIPLOMA
IN REGISTERED COMMUNITY HEALTH
NURSING.

SUBMITTED BY;
1. STELLA MWENI: D/NURS/19028/4127
2. ESTHER MWENDE: D/NURS/19028/6359
3. MUTHAMA CEPHAS: D/NURS/20028/1173

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DECLARATION
This report was compiled and written by the SEP-2019 Diploma Nursing class.

This report has been submitted to,

STUDENTS
STELLA MWENI
SIGNATURE…………..
ESTHER MWENDE
SIGNATURE………….
MUTHAMA CEPHAS
SIGNATURE…………….

SUPERVISOR:
MRS MARY MWANGI
DATE .................................................

SIGNATURE......................................

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DEDICATION
We humbly dedicate this Sub County Public Health Nurse experience to our loving parents for
their unwavering support morally and financially throughout the entire experience.
We also dedicate the experience to our sub-county public health nursing officer Mrs Mary
Mwangi and the entire sub-county health management through their guidance, teaching and
support we successfully met our objectives.

ACKNOWLEDGEMENT
We thank the ALMIGHTY GOD for allowing us to successfully entire experience and our
experience for their continued support.
We also acknowledge the Sub County Health Management team for their continued support in
ensuring that we achieved our objectives. We also appreciate the entire departmental heads in the
Sub County for availing their time and knowledge during our visit to their offices.
We wish to convey special thanks to KILUNGU Sub-county health facilities and the staff in
general for their continued support during the sub-county experience.

FORWARD
Sub County experience is part of the curriculum in KRCHN and it helps the students to gain and
acquire managerial skills, attitudes and practices in the provision of health services.

TABLE OF CONTENT

DECLARATION 2

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DEDICATION 3

ACKNOWLEDGEMENT 3

FORWARD 3

TABLE OF CONTENT 4

LIST OF ABBREVIATIONS 5

OBJECTIVES OF THE EXPERIENCE 6

FACILITIES IN KILUNGU SUB-COUNTY 7

MEMBERS OF SCHMT 9

FUNCTIONS OF SCHPN 9

SUB COUNTY QUALITY COORDINATOR ROLES 10

PUBLIC HEALTH OFFICER ROLES 10

REPRODUCTIVE HEALTH COORDINATOR ROLES 10

SUB COUNTY EPI COORDINATOR ROLES 10

SUB COUNTY HEALTH MANAGEMENT TEAM ROLES 11

SUB COUNTY ADMINISTRATOR ROLES 11

TOP TEN CONDITIONS CAUSING MORBIDITY 11

COUNTY EXPERIENCE 12

WEEK ONE 12

WEEK TWO 14

WEEK THREE 15

WEEK FOUR 16

SUPPORT SUPERVISION AT KAITI SUB-COUNTY 18

Purpose of supervision 18

EXPERIENCE ACHIEVEMENTS 19

CHALLENGES 19

CONCLUSION: 19

RECOMMENDATION 19

SPECIAL THANKS 19

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CONCLUTION 20

LIST OF ABBREVIATIONS
SCHMT Sub-county health management team
CHV’S Community health volunteers
CHA’S Community health assistance
SCPHN Sub-county public health nurse
SCRHN Sub-county reproductive health nurse
SCRHIO Sub-county health record and information office
SCHRA Sub-county human resource administrator
SCNDO Sub-county nutritional and dietary officer
PHO Public health office
MCH/FP Paternal child health care clinic/family planning
DVI Division of vaccine and immunization
ANC Antenatal clinicSexual transmitted infections
NHIF National hospital insurance fund
CCC Comprehensive care clinic

OBJECTIVES OF THE EXPERIENCE

1. Outline the structural organization of the ministry of health at national county and
sub-county and the communication flow.
2. Identify the roles of each SCHMT member
3. Identify the works of NGOs supporting services in the sub-county

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 4. Participate in the ordering and distribution of vaccines
5. Outline the stakeholders' DEO, DAO, probation officers, and child welfare
6. Provide health education in baraza
7. Outline the purpose and objectives of the health programme in the community
8. Identify the roles of CHVS´, CHWŚ,
9. Participate in HIV and aids activities within the sub-county
10. We attend the SCHMT meeting

FACILITIES IN KILUNGU SUB-COUNTY

LEVEL 4
Kilungu sub-county hospital
Mukuyuni sub-county
Kikoko sub-county

LEVEL3

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Kyuasini health center
Iuani health centre
Kyambeke health center
Kivani health centre
Kee health centre
LEVEL 2
Kyenzenzeni dispensary
Kaia dispensary
Mbuini
Musalala
Kavata-nzou
Kyanganda
Ikalyoni
Itithini
Kithuni
Mangala
Nthangu
Nthimbani
Ukia
Kyau
Ngiluni
Nzouni
Nyaaani
Kya´nga
Kwa mukuta
Kituluku
Kasunguni
Syanthani

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Kauti
Nzukini
Mutulani
Mitini
Nunguni medical clinic
Shalom medical clinic
Neema medical clinic
Damanje medical clinic
Mars medical clinic

MEMBERS OF SCHMT
Sub-county medical officer of health
Sub-county public health nurse
The sub-county public health officer
Sub-county disease surveillance coordinator
Sub-county health records and information officer
Sub-county pharmacists

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Sub-county laboratory officer
Sub-countynutrutionoist
Sub-county health promoter
Sub-county clinical officer
Sub-county TB/leprosy coordinator
Sub-countyAIDS/STI coordinator t
Sub-county administrative officer

FUNCTIONS OF SCHPN
● ordering and receiving supplies from regional stores
● issuing of supplies to facilities within the sub-county
● attend the meeting at the county and national level
● organize monthly meetings at the sub-county level
● receive a monthly report from the sub-county facilities
● compile sub county facilities reports and submit them to the county
● maintain the cold chain for vaccine variability
● organizing outreach services with the sub-county
● conducting supportive supervisory visits to the sub-county facilities

SUB COUNTY QUALITY COORDINATOR ROLES

● Assist in identifying service delivery indicators and outcome measures to be able to
evaluate the effectiveness and applied standards
● Assist in the development and implementation of surveys and other related evaluation
tools
● Participate in quality improvement meetings and speciality training sessions
● Carrying out supervision to health centres and dispensaries
● Provide education and training about quality management and network staff.
HEALTH PROMOTION OFFICER ROLES
● Develop health materials
● Creating awareness concerning health
● Research on community attitudes and behaviour that affect health
● Initiate, plan, implement and monitor health promotion programs
● Coordinate communication aspect of primary health care
● Organize exhibitions and shows
● Information, education and communication
● Create demands for health services

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PUBLIC HEALTH OFFICER ROLES
● Ensure proper sanitation
● Conduct school health programs
● Public health laws and enforcement
● Communicable disease control
● Ensures access to safe water for the people
● Ensures management of public health services
● Participate in evaluation and support supervision

REPRODUCTIVE HEALTH COORDINATOR ROLES

● Gives a verbal autopsy after death
● Referral strategy
● Train to train others
● Work with community focal persons to reduce maternal and prenatal deaths

SUB COUNTY EPI COORDINATOR ROLES

● Coordinates immunization services within the sub-county
● Organizes and coordinates sub-county immunization stakeholders' meeting
● Quantifying and forecasting EPI commodities in the sub-county
● Compilation of monthly immunization reports and forward to the county
● Coordinates and guides service providers on EPI activities and continues EPI mentorship.

SUB COUNTY HEALTH MANAGEMENT TEAM ROLES

● To plan and implement the effectiveness of referrals systems in the sub-county
● Conduct health service and studies
● Monitor and support health services
● Deploy staff within the sub-county
● Collaborate with other health sectors: NGOs, Government
● Plan expenditure for sub-county activities
● Conduct sub-county monthly meetings
● Conduct surveillance and outreaches

SUB COUNTY ADMINISTRATOR ROLES

● Custodian in personnel records
● Takes minutes and keeps records of every meeting
● Oversees and supervises support staff
● Assist in personnel appraisals
● In charge of transportation
● Ensure a conducive environment for working

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 ● Prepare annual work plan

TOP TEN CONDITIONS CAUSING MORBIDITY

1. Amoebiasis
2. Upper Respiratory Tract Infection
3. Urinary Tract Infection
4. H-pylori bacteria
5. intestinal worm
6. Diarrhoea
7. Dental condition
8. Pneumonia
9. Hypertension
10. common cold

COUNTY EXPERIENCE

WEEK ONE
We arrived at the SCPHN office on 16th January and we were welcomed by Sub-county nursing
officer Mrs mary Mwangi who received us and then allowed us to settle and report the following
day at 8:00 am.
17/01/23
On Tuesday morning we reported where he introduced us to the other staff in the office. we were
then oriented in the sub-county offices with respective officers and their roles in the sub-county.
We learnt EPI tools which include :
Vaccine Order sheets
Ledger books

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Temperature monitor charts
Vaccine focus sheet
Mother-child booklet
Summary sheet (MOH 710)
Tally sheet (MOH 702)
Vaccine vial Monitor
Stickers that show arrangements of vaccines in the fridge
Child Welfare Clinic
Permanent Register
the cervical cancer screening tool
18/01/23
Reported to the office at 8 am recorded the temperatures of the fridge tags at the sub-county
refrigerators and we were allocated to the mch/fp clinic where we attended to the mothers and
supervised the family-planning an immunization schedule

19/01/23
We reported on duty and maintained the cold chain by recording temperatures in the sub-county
refrigerators we later allocated to the comprehensive care clinic to learn about services offered
and different regimes used in special people and their approach to prompt adherence to anti- TB
and ARVS

20/01/23
Reports to duty in the morning and maintained cold chain by recording temperatures in the
sub-county refrigerators. we then we were allocated to the maternity wing
where we monitored mothers on paragraph and educated the postnatal mothers about the care of
their newborns with emphasis on exclusive breastfeeding and maintaining a warm chain

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 WEEK TWO
INTRODUCTION TO THE VARIOUS PROGRAM OFFICERS OF THE SCHMT
In Our week two experience, we continued with our different appointments and also met with
various program officers of the sub-county health management. Also, we got a chance to attend
one of the community dialogues, in which they were discussing the issue of cervical cancer
screening and family planning.
23/01/23
We reported to duty in the morning and maintained cold chain by recording temperatures in the
sub-county refrigerators one of us was able to attend supervision in the sub-county, the facilities
included,syanthani,mukuyuni sub- county kaia dispensary,mbuini, where the sub county
supervisory team included the sub county clinical officer, health record officer, diseases
surveillance officer, public nurse,
24/01/23
We reported on duty and maintained cold chain by recording temperatures in the sub-county
refrigerators one of us was able to attend supervision in the sub-county in kavata nzou, musalala,
ngiluni

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25/01/23
We reported to duty in the morning and maintained cold chain by recording temperatures in the
sub-county refrigerators and larger books later we attended the facilities CME which was on
breastfeeding and breastfeeding products according to the new world health organization's
stature. later the staff was taught about networks of care in the referral system by the jhpiego
organization. one of us was able to attend supervision in the sub-county, the facilities included,
kauti, mwani dispensary, kyambeke.
26/01/23
We reported to duty in the morning and maintained cold chain by recording temperatures in the
sub-county refrigerators and larger books. we offered anc services to pregnant women.
27/01/23
We reported to duty in the morning and maintained a cold chain by recording temperatures in the
sub-county refrigerators and larger books. we were allocated int the ccc clinic where we learned
more about the importance and modes of prophylaxis of exposed infants. in the afternoon the
facility had a student CME on pre-eclampsia

WEEK THREE
We reported as usual at 8 am did the ruten cold chain management and ledger book balancing
and later the schpn took us through the functions of the scphn and taught us how to order and
balance vaccine ledger books
31/01/23
We reported as usual at 8 am and did the ruten cold chain management and ledger book
balancing, we then set out for the outreach that was planned for the month on vital monitoring,
glucose level check-up, cervical cancer screening and family planning at mutungu market.
1/02/23
We reported as usual at 8 am and did the ruten cold chain management and ledger book
balancing, we started with a student CME on the cervical screening programme and afterwards
allocated to the family planning clinic where we taught and performed procedures on different
family planning methods.
2/02/23
We reported as usual at 8 am and did the ruten cold chain management and ledger book
balancing. We attended the morning services offered at the facility and then afterwards we were

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allocated to the mch where we shared targeted messages to the waiting mothers on breastfeeding
and nutrition and the importance of immunization.
03/02/23
we reported as usual at 8 am and did the ruten cold chain management and ledger book
balancing, we were allocated to the immunization clinic where we added in the immunization
process of the children and clinical routine examination of children under 6 weeks and
development.

WEEK FOUR
06/02/23
We reported as usual at 8 am and did the ruten cold chain management and ledger book
balancing, we were allocated in the mch clinic where we aided in the monitoring of pregnant
women and health education to the new anc clients.
07/02/23
We reported as usual at 8 am and did the ruten cold chain management and ledger book
balancing, later on, we had the privilege to attend a schmt meeting where all the members of the
sub-county team were present. where we reviewed the 2021 and 2022 progress of the clinics on
delivires coverage, fourth anc coverage, immunization coverage and first anc attendance to each
facility. once the meeting come to a close in the afternoon we had a brief lunch and we did the
vaccine distribution to the dispensaries team that come in the evening and filling of the vaccine
orderings.
08/02/23
We reported as usual at 8 am and did the ruten cold chain management and ledger book
balancing, we were then taken by our schpn to Nairobi for ordering and receiving of vaccines
that were to be distributed to the dispensers with the sub-county. we took a look at the online

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immunization ordering system. we went back to the sub-county facility after receiving and
storing the new vaccines and recorded the temperatures and the new orders.
09/02/23
We reported as usual at 8 am did the ruten cold chain management and ledger book balancing,
and attended the morning services after which we dispaassed in our allocated zone in the mch in
the evening we had a CME which the student nurses and clinical offers were taught on the health
system management of a facility.
10/02/23
We reported as usual at 8 am and did the ruten cold chain management and ledger book
balancing, we compiled our report evaluated and handed it over to our schpn for review and
approval.

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SUPPORT SUPERVISION AT KAITI SUB-COUNTY
Program/ Areas supervised
⮚ Reproductive health
⮚ EPI
⮚ Epidemiology
⮚ IMCI clinic
⮚ Finacial managent of the faclity
⮚ Correct documentation of each file, maternity immunization, sub-county, outpatient
⮚ Cervical screening of the facility
⮚ Commodities of the medication in the facility
⮚ Environmental hygiene of the facility
⮚ Waste management of the facility
⮚ Contact with the community health volunteers

Purpose of supervision
Integrated supportive supervision
Key findings
⮚ Up-to-date page summary and complete documentation
⮚ All staffs were on duty
⮚ Incomplete progress charts
⮚ Unprocessed instruments
⮚ No emergency trays
⮚ Lack of enough colour-coded bins for waste segregation
Recommendations
⮚ Update all progress charts
⮚ Use 5S to organize maternity

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 ⮚ Indicate commodity balances in the family planning register
⮚ Process and store instruments properly
⮚ Prepare emergency trays
⮚ Improve proper waste handling and segregation

EXPERIENCE ACHIEVEMENTS
During our sub-county public health nursing experience, we learned different management
aspects that encompass quality healthcare delivery.
We also got to;
⮚ Learn different management styles in the working environment.
⮚ Process of stocking vaccines and drugs and preventing understocking.
⮚ Learn about beneficial core dependence between different sectors of water and health.
⮚ Learn about different levels of health care within the county.
⮚ Process of support supervision and its importance.
⮚ able to participate in supportive supervision visits
⮚ we met the administrative team of the sub-county when we attended the schtm.

⮚ we can attend different CMES gain a wide range of knowledge and improve our skills.

CHALLENGES
⮚ some facilities were far
⮚ poor road to the facilities
⮚ there were no barrazś planned in the course of our rotation.

CONCLUSION:
⮚ With the help of SCPHN Mrs Mary Mwangi, we were able to achieve most of our goals
more conveniently.

RECOMMENDATION

⮚ CHVs are motivated since they play a major role in the community by giving them a
token.
⮚ The county government should employ enough staff in its health facilities.

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SPECIAL THANKS
First and foremost we thank the almighty for taking us through the experience and coming to a
successful end. We appreciate members of the public health office, SCHRN, SCPHN, SCPHO
for their roles, support and guidance.
We give special thanks to our public health nurse Mrs. Mary Mwangi and the in charge of the
mother-child clinic for their continuous support in achieving our goals
We also like to thank the Kenya medical collage for allowing us the chance to participate in the
sub-county experience

CONCLUTION
Our sub-county experience was of great benefit to us, it has been a good exposure to the way of
life here in kauti sub county enabling us to learn and asses the areas of concern in matters of
health, we met our objectives successfully as required by the school as well with the help of our
SCHPN Mrs Mary Mwangi. We were able to gain knowledge on the organisational structure and
devolution and county leadership structures influence the management of the hospitals as the
county provides funding and logistics of products. We have been able to gain knowledge on the
general aspect of management of a facility which we can apply later on in life to improve the
health sector and propel Kenya towards vision 2030.

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