2013/14 - 2017/18
ISIOLO COUNTY
HEALTH STRATEGIC &
INVESTMENT PLAN
www.isiolo.go.ke MINISTRY OF HEALTH ISIOLO COUNTY GOVERNMENT
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
VISION
To be a model county health system providing efficient and cost ef-
fective health se vices to the residents of Isiolo County and beyond.
MISSION
To offer quality healthcare and programs that set community stand-
ards, exceed clients’ expectations and are provided in a manner that
is caring, responsive, equitable, convenient, cost-effective, accessible
and culturally acceptable to the people of Isiolo County.
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TABLE OF CONTENTS v
vi
ACRONYMS vi
Acknowledgement vii
Message from the County Executive Committee Member for Health Isiolo ix
Word from the Chief Officer of Health x
FOREWORD
Executive summary 1
1
SECTION 1: INTRODUCTION AND BACKGROUND 1
1.1 Purpose of this Investment Plan 2
1.2 Results framework 3
1.3 Focus and Mandate
1.3 Process of development and adoption of the strategic and investment plan 4
4
SECTION 2: SITUATION ANALYSIS 6
Location and Size 7
Physiographic and Natural Conditions 8
Administrative Sub-division (Sub-county, wards) 8
Demographic Features 9
Population Demographics 10
2.1.1 Catchment population trends 11
2.1.2 Population description 11
2.2 Health Status 12
2.2.2 Health Impact 13
2.2.3 Major causes of morbidity and mortality in County 14
2.2.4 Major risk factors causing morbidity and mortality in County 14
2.3 Health Services Outcomes and Outputs 16
2.3.2 Health Outcomes 17
2.3.3 Health Outcomes 18
2.4 Health Investments 20
2.4.2 Health Workforce 21
2.4.3 Health Infrastructure 22
2.4.4 Health Products 23
2.4.5 Recurrent Health Expenditures (previous year) 24
2.4.6 Health Information (previous year) 24
2.4.7 Health Leadership 25
2.4.8 Service Delivery
2.5 Issues and challenges with providing health services 27
27
SECTION 3: PROBLEM ANALYSIS, OBJECTIVES AND PRIORITIES 42
3.1.1 Health Services 44
3.1.2 Management support 44
3.2 Strategic focus and Objectives
3.2.1 County Mission and Vision Statements iii
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18 45
47
3.2.2 Specific Objectives 47
3.3 Sector targets 49
3.3.1 Scaling up provision of KEPH services targets 52
3.3.2 Service outcome and output targets for achievement of County objectives 57
3.3.3 Sector input and process targets for achievement of County objectives 57
SECTION 4: IMPLEMENTATION ARRANGEMENTS 58
Coordination framework 58
4.1.1 Management structure (Organogram for County Health Management) 59
4.1.2 Partnership and Coordination structure and actions 60
4.1.3 Governance structure and actions (County Government and its support) 61
4.2 Monitoring and Evaluation Plan 62
4.2.1 Data architecture 62
4.2.2 Data and statistics 63
4.2.3 Performance Monitoring and Evaluation 63
SECTION 5: RESOURCE REQUIREMENTS AND FINANCING 73
5.1 Resource requirements 73
5.2 Available financing and financing gaps 74
5.2.1 Secured and probable resources 76
5.2.2 Distribution, and financing gaps 76
5.3 Resource mobilization strategy 76
5.3.1 Strategies to ensure available resources are sustained 76
5.3.2 Strategies to mobilize resources from new sources 77
5.3.3 Strategies to ensure efficiency in resource utilization
ANNEX 1: INVESTMENT AREAS SCOPE, AND CODES 4
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TABLE OF FIGURES 8
9
Figure 1 location of Isiolo County in Kenya 91
Figure 2 Isiolo County Administrative Units Map 91
Figure 3 Isiolo County Population Pyramid 2013
Figure 4 Isiolo County Population Projection 5
Figure 5 Cost of CHSP as per orientation areas 6
Figure 6 Cost of implementing CHSP per year 7
LIST OF TABLES
Table 1 Health Facility Distribution by type -2013
Table 2 Isiolo County Administrative and Political Units and size
Table 3 Isiolo County Administrative and Political Units and Size
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ACRONYMS Action Against Hunger
Community Health Extension Worker
1. ACF Aids, Population and Health Integrated Assistance- Inte-
2. CHEW grated Marginal Arid Regions Innovative Socialized Health
3. APHIA Approach
County Health Management Team
PLUS Government Of Kenya
IMARISHA County Health Strategic Plan
4. CHMT Community Health Unit
5. GOK County Integrated Development Plan
6. CHSP Community led total sanitation
7. CHU Computer Tomography scan
8. CIDP Danish International Development Agency
9. CLTS District Health Information System
‘10. CT Scan District Health Management Team
11. DANIDA Economic Stimulus Package
12. DHIS Faith Based Organization
13. DHMT Food for the Hungry
14. ESP Garbatulla
15. FBO Home Based Care
16. FH Health Information Systems
17. GT Intensive Care Unit
18. HBC Isiolo District Hospital
19. HIS Information Education and Communication
20. ICU International Medical Corps
21. IDH Insecticide Residual Spray
22. IEC Kenya Demographic and Health Survey
23. IMC Kenya Medical Supplies Agency
24. IRS Kenya Health Policy
25. KDHS Kenya Health Sector Strategic Plan
26. KEMSA Kenya Quality Model for Health
27. KHP Kenya Red Cross Society
28. KHSSP Maternal and Child Health
29. KQMH Millennium Development Goals
30. KRCS Mission for Essential Drugs
31. MCH Medical Officer
32. MDGs Magnetic Resonance Imaging
33. MEDS Medical Training College
34. MO New Born Unit
35. MRI Non Communicable Diseases
36. MTC Non-Governmental Organization
37. NBU On Job Training
38. NCDs Outpatient Department
39. NGO Registered Clinical Officer
40. OJT Service availability and Readiness assessment mapping
41. OPD Trainer Of Trainers
42. RCO Terms of Reference
43. SARAM United Nations Children’s Fund
44. TOT United States Agency for International Development
45. TOR Water, Sanitation and Hygiene
46. UNICEF World Health Organization
47. USAID Youth Friendly Clinic
48. WASH
49. WHO v
50. YFC
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Acknowledgement
The process of developing Isiolo County Health Strate- tion. UNICEF gave immense technical and financial
gic plan could not be accomplished without inputs of support towards attainment of the CHSP. UNICEF was
diverse health and non-health professionals and stake- instrumental in development of Isiolo County health in-
holders in terms of technical and financial support. vestment case that formed critical basis of the just con-
Ministry of health headquarters organized training of cluded strategic planning. The investment case highly
county planning TOTS who later led and guided the informed the plan. True to their spirit of partnership,
planning process. For their foresight and efforts we say UNICEF also provided financial and technical support
thank you. along the various stages of CHSP. May God bless you
Isiolo County planning TOT consisted of a team of six abundantly.
(6) health professionals who lived true to the course Support and participation of other non-health actors
against all odds till finalization of this document. To Za- added lots of value to the process. The Governor of Isiolo
hara Adan, Abdullahi Jillo, Dr. Claver Kimathi, Stephen County, H E Hon. Godana Doyo spared time in his busy
Murangiri, Molu Huka and Wario Boru, Isiolo County schedule to grace and officially close the initial planning
Health Sector appreciate your effort and sacrifices and retreat. His personal presence raised participants’ spirits
shall remain indebted. Sharon Kirera, Wilson Aketch, beyond words. We thank you, your Excellency.
HRIO Hospital and Peter Mutanda joined the planning Mr Halake Tadicha, former CEC Health was always with
team to form a strong secretariat that drove the plan- us at the early stages of the plan. Your
ning agenda. leadership made us take off.
Aphia Plus Imarisha/AMREF funded the initial County CEC Incharge health services, Patrick Lesengei upon
Planning retreat that brought together all health man- joining the health sector took keen interest in finaliza-
agers and partner of the county. The retreat laid the ba- tion of CHSP. He made it his duty to keep track of pro-
sis for planning. They equally offered immense techni- gress and pushed for its logical conclusion. For your en-
cal support. We thank you. ergy and zeal, we say thank you.
To the Sub County HMT, representatives of major heal The County Planning office made representation during
facilities and CHMT, you helped lay the foundation and planning retreat. Their presence enabled us plan within
tempo for the plan. Your contribution made us better. the context of county planning frame work.
Other health partners such as KRCS, FH, IMC & ACF Finally, acknowledgement is due and is hereby made to
joined the retreat and made immense contribution. all those who in one way or another supported develop-
The role of UNICEF in this process deserves special men- ment of Isiolo CHSP.
Message from the County Executive Committee Member
for Health Isiolo
I am pleased to endorse the Isiolo county Health Strate- ing, promoting and supporting their well-being and
gic Plan for 2013/14 to 2017/18. The document links the more so Communities have access to effective, efficient
health operation in the county to the national policy and quality clinical health care and rehabilitation ser-
priorities and thus plan is set to strategize direction for vices.
health care in the county for the next 5 years. The Strate- The major public health concerns are non‐communica-
gic Plan has been developed to improve health hence a ble diseases, emerging and re‐emerging communicable
Sustainable Socio‐Economic Development. diseases, maternal and child health, and HIV/AIDS pan-
Across the six overall strategic objectives for health in demics or other disasters affecting the health and well‐
the Roadmap will address the health needs of the entire being of the community. There are other environmental
five cohorts as per Kenya Essential Package for Health factors that have an impact on health such as climate
(KEPH) hence: Communities are serviced by adequate change and these need appropriate consideration as
primary and preventive health services thereby protect- well. A major focus is to improve health indicators at all
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level of service deliveries including community level to where it will need to be saddled with career orientation
address MDG 4, 5, and 6. for our young workforce to improve on retention strate-
The conditions of NCD needs to be tackled through gies. Customer focus remains areas of major concern in
Health Promotion in its entity and to strategize dealing 2013/14 – 2017/18; this will be realized by increased out-
with how to reverse trends of; diabetes, hypertension, put from the investment in all the service delivery points
cardiovascular diseases and cancer that are on the rise hence addressing some of the work pressure.
in the region. The ministry will emphasize on wellness I therefore invite all the stakeholders as partners in
rather than treatment must evolve with High impact, health including NGO’s, donor agencies, other minis-
Low technology innovations. tries/departments and the private sector to work closely
A focus on human resource development and staff re- with the Ministry of Health towards achieving our vi-
tention will still be maintained and addressed in depth sion.
to meet the acute shortage of health professionals; as
this is vital to ensure sustainability in the delivery of Partrick Lesengei
health services to our people. The ministry will look County Executive Committee member for Health
forward on staff development by partnering with high
learning institution to ease access to learning facilities
Word from the Chief Officer of Health
Isiolo county health strategic plan, covering the period five (5), two of them being Kipsing and Gafarsa model
2013/2014 to 2017/2018 was developed through a consul- health centers built through economic stimulus pro-
tative process that involved the county and sub county gram as a vision 2030 flagship project. The county has
health management teams, representatives from ma- a total of thirty seven (37) dispensaries including FBO
jor public and private health facilities in the county, the and Private. Only 20% of health facilities in the County
county planning department and a strong team from (9 out of 45) offer maternity services. Population served
non-state actors (NGOs) supporting health services in by 80% of health facilities lack access to skilled deliver-
Isiolo County. The document in its chapters captures ies. The county has a long way to go before it reaps the
health sector situation analysis, establishes strategic benefit of Jubilee Government’s free maternity services.
objectives and identifies flagship projects or milestones The referral system has been ineffective. No single GOK
which are priority interventions to be considered for im- ambulance among the available six (6) is road worthy
plementation in the next five (5) years. Implementation currently. This is just but a snap preview of the grim real-
frameworks, financial requirements for attainment of ity of health services in Isiolo County. However, while the
the plan and resource mobilization strategies are also past provides valuable lessons, embracing the future is
detailed. more prudent for the sake of posterity.
Health sector in Isiolo County has suffered fifty (50) Under the new constitutional dispensation, health is
years of gross under investment by successive Govern- a basic right. As one of the key devolved function, the
ments. The situation has been compounded by health county government of Isiolo with support of stakehold-
leadership that has often not been responsive to the ers has a sole duty to ensure progressive realization of
needs of citizens. The resultant effect is overall under this right by its people. There is therefore urgent need
performance of health sector characterized by poor to turn around health care in Isiolo County so as to effec-
population access to both primary and specialized tively offer health services to the population. Develop-
health services in the County. ment of county health strategic plan is the first critical
Health infrastructure is generally rudimentary. There is step that provides a road map to help realize the dream.
only one county referral hospital which also has the only Our vision is
operating theatre in the County. Both Merti and Garbat- ‘To be a model county health system providing efficient and
ulla sub counties lack facilities with operating theatre. cost effective health services to the residents of Isiolo County
There are only two (2) other hospitals in the county; and beyond’. The mission is ‘To offer quality healthcare and
Garbatula being the only other GOK hospital with Ma- programs that set community standards, exceed clients’ ex-
tercare as the only private hospital. Health centers are pectations and are provided in a manner that is caring, re-
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
sponsive, equitable, convenient, cost-effective, accessible and broken down ambulances, Purchase seven (7)
culturally acceptable to the people of Isiolo County’. new ambulances in five years, Establish funds for
Among the key milestones and flagship projects prior- ambulance operation and maintenance at sub
itized in the plan over the next five (5) years include; county level and undertake a monthly session of
reverse referrals by consultants to Merti, Garbat-
1. Fix the basics in the existing delivery system. A ulla and Oldonyiro centers.
fully/optimal operating health delivery system 10. Establish integrated mobile health outreach ser-
offering basic health services uninterrupted in all vices for service delivery to pastoralists who are
existing health facilities accross the county. away from conventional health facilities. Procure
and operate three (3) nomadic clinic units.
2. Strengthening governance/leadership in health. 11. Routinely invest in maintenance of all health fa-
Establish a leadership that ensures delivery of cilities.
health goods & services to recipient community. 12. Invest in disease prevention & health promotion
Ensure transparent, responsive & accountable services so as to reduce the burden of communi-
leadership. cable & non-communicable diseases.
13. Strengthen institutional capacities in the county
3. Turn around Isiolo County referral hospital to ef- for emergency preparedness & response.
fectively serve the population- Fix leadership in 14. Have a vibrant monitoring & evaluation system
the hospital. Renovate, fence and better equip in place that can monitor progress over time
the hospital. Establish and equip the casualty, against targets, demonstrate results (achieve-
renal unit, new born unit and ICU unit among ments) & help improve performance. Automate
others. Provide MRI machine and CT scan among Isiolo county referral hospital.
other key equipment. Undertake proper clini- 15. Construct a mid-level medical training college
cians’ management—that services of consult- (MTC )in the county to take care of human re-
ants, M.Os, RCOs, nurses, laboratory, pharmacy sources needs for local consumption & beyond.
etc is organized & provided- for optimal service Effectively turning around health services requires lots
delivery to clients round the clock.Services by cli- of investment. The total cost of interventions in the plan
nicians will be a mandatory sacred duty require- amounts to 7,365,097,000. Kenya shillings over the five
ment than discretion. Their services should not (5) year period. Preview into past financing trends shows
only be offered but be seen to be offered. that Kenya has been allocating only about 7% of its GDP
to towards health services, a minimal investment in-
4. Improve access to specialized services by estab- deed. This also fell short of the spirit and provision of
lishing four (4) new hospitals at Merti, Basa, Seri- Abuja declaration, to which Kenya is a signatory, where
cho and Oldonyiro. African heads of states made a commitment to allocate
15% of its total revenue to health care. However, not all is
5. Improve access to primary services- Upgrade lost as the current government pledged to allocate 10%
thirteen (13) dispensaries to health Centre status of the country’s resources towards health care in the Ju-
complete with the physical infrastructure, equip- bilee manifesto.
ment and human resource. Construct and func- Health care is a capital intensive venture. Requirements
tionalize eight (8) new dispensaries in under- for physical facilities all over the county are enormous
served areas complete with staff houses. and costly. We cannot forever have Isiolo and Garbatula
as our only hospitals. Building an extra more hospital
6. Improve access to maternal health – Establish costs a fortune. We need at least four (4) more in outly-
maternity units in forty (40) health facilities. ing underserved areas. Health human resource is multi-
disciplinary, expensive to train and maintain. Our cur-
7. Expand laboratory network in the county by es- rent staffing is inadequate. We need more. Health care
tablishing laboratory units in twenty (20) health is technology dependent. There is demand for modern
facilities. medical equipment to effectively serve the client. One
(1) CT scan machine for Isiolo hospital is conventionally
8. Improve the situation of health human resource estimated at over 50m. We need this modern technol-
by rationalizing the existing human resource,
improving working conditions and recruiting ad-
ditional staff including; Consultants, Medical of-
ficers, Clinical officers, Nurses, Laboratory, Public
health officers, Pharmacists, Records officers and
Anesthetists among others. Support continuous
professional development among workers.
9. Strengthen referral network-Repair the six (6)
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ogy to remain relevant and competitive. As it stands to- and all the good people of Isiolo who are our esteemed
day in counties, health has the bulk of human resource clients. The health fraternity has made the first deci-
and therefore the highest wage bill. The operational cost sive step through development of the CHSP. But a plan
to run the entire system up to the lowest level is equally without financing will just remain one in the many
high. In terms of capital and recurrent costs, health is Kenya’s well written documents that gathers dust on
equal to none and should therefore be equated to none. the shelves. Kindly join us in actualizing this plan. We
This is just a brief to justifying a case for increased fund- are privy to the inherent challenges bedeviling health
ing for health. The county government should be alive sector in the county. We are equally conscious of what
to this stark reality when allocating the finite resources needs to be done to turn around the sector. The cost
towards meeting the infinite societal needs. involved is prohibitive. We have the road map, the will
The first one (1) year of this plan will mainly be used to and determination. We will act small and smart. We will
turn around all existing health facilities with view to start with small doable actions, what we call ‘quick wins’.
make them operate to full capacity so as to optimally We call for your support. With support of all stakehold-
serve the population. Health leadership at county, sub ers, we will then ‘go big’.
county and health facility levels will at this point be ad- Please walk this part with us. I promise you of our un-
dressed. The next two years and part of the fourth year of wavering commitment to this course. A healthy Isiolo
the plan will focus expansion of physical infrastructure, county will be productive, wealthy and globally com-
human resource, transport and equipment and scale up petitive.
of services to desired status. Part of the fourth year and God bless you
the fifth year will mainly dwell on consolidation of the
gains and addressing sustainability concerns. Wario Boru
This is health sectors appeal. Appeal to His Excellency County Chief Officer-Health Services
the Governor of Isiolo County and his government, to ISIOLO COUNTY
local health partners, bilateral and multilateral donors
FOREWORD
Isiolo county strategic plan was developed by a team which have been taken into consideration are:
comprising of DHMT,CHMT and Health partners from • Eliminate communicable conditions
Isiolo County. The process involved a formal induc- • Halt and reverse rising burden of non-communica-
tion on strategic planning, data gathering to form the ble conditions.
baselines in target setting and a weeklong retreat of all • Reduce burden of violence and injuries.
health sector players to generate the zero draft of the • Provide essential health services.
plan. The drafts was then subjected to a lean team of • Minimize exposure to health risk factors
planning secretariat to fine tune and generate a finer • Strengthen collaboration
draft that was further subjected to health stakeholders
culminating to the final version of Isiolo county strategic The process can be described as a bottom up approach
plan. to planning as the lower level facilities developed plans
We cherish the financial support of the USAID funded which were taken into consideration. The community
APHIA plus IMARISHA and UNICEF Kenya country of- level was the lowest planning unit and the highest was
fice who provided immense support in the various stag- the county referral facilities.
es of the planning process. Their technical support also This plan provides the road map towards better health
added lots value to the process. for the residents of Isiolo County. It helps answer the fol-
Isiolo County Health Strategic Plan was largely informed lowing strategic questions. Where are we? (Baseline),
by the Kenya health policy 2012-2017 and the constitu- where do we want to go? (Targets), how do we reach
tion of Kenya 2010 as guiding principles. The vision 2030, there? (Strategies) and how do we know that we are
Kenya’s blueprint for the development as well as the mil- getting there? (M&E framework that demonstrates pro-
lennium development goals have been taken into con- gress towards achievement of set goals)
sideration. The key objectives of the Kenya health policy
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
The Ministry of health, Isiolo county, hereby make appeal to all stakeholders in the county to support implemen-
tation of priority interventions as spelt in this strategic plan so as to help realize the vision ‘To be a model county
health system providing efficient and cost effective health services to the residents of Isiolo County and beyond’.
With support of all stakeholders, we can realize the set targets and go beyond.
Molu Huka
County Director-Health services- Isiolo County
Strengthen collaboration
Executive summary
This Isiolo County Health Strategy Plan (CHSP) 2013 – graphic features and a table indicating the current dis-
2018 is the first of its kind aligning itself to the National tribution of health facilities. It also provides the project-
Health sector priorities as defined in the Kenya Health ed population for the county up to 2018 with an annual
Policy Framework 2012 – 2030 and Vision 2030 flag- Growth rate of 3.7%. In section two, the GCHSP focuses
ship as affirmed by the Constitution of Kenya 2010. It is on the County situational analysis highlighting the gen-
guided by the overall vision of the national health sector eral health status, morbidity and mortality patterns. The
which aspires to be ‘a globally competitive, Healthy and section continues to outline baseline information from
productive nation’. The strategic plan provides the Coun- the impact, outcome and output indicators. The sec-
ty Health Sector (CHS) focus, objectives and priorities to tion demonstrates major risk factors causing morbidity
enable it move towards attainment of the Kenya Health and mortality in the County (in their order of priority).
Policy Directions and the Strategic plan 2012- 2017. It Further still, this section provides key Health system in-
provides a framework and a road map on how the me- vestments areas, and details of each key strategic area
dium term county health objectives will be achieved. It in health investments captured in subset of this section
will guide the County and Sub-counties on Annual work relating to: Health Workforce, Health Infrastructure,
plan prioritization that focus on health sector interven- Health Leadership, Health Products and Commodities,
tions in order to accelerate and attain better health Health Information and Service delivery Provision and
outcomes. It places emphasis on implementing inter- notable challenges to health care delivery in the coun-
ventions for better access to services; improve quality of ty. The strategic plan in section 3 outlines the problem
service delivery and prioritising seven investment areas. analysis, objectives and the key priorities of the county
It also states how the sector will monitor and guide at- strategic plan. It elaborates the strategic focus, the over-
tainment of the above priorities. all sector goal and objectives, mission and vision. In
This strategic plan has its vision as “a health system each of the specific objectives, various strategies have
providing efficient and cost effective health services to been proposed. The section also provides for the Sector
Isiolo County and beyond”, with a mission “To offer qual- inputs and processes with targets for achievement and
ity healthcare that exceed clients’ expectations in Isiolo the key milestones to achieve within the period.
County and beyond”. The county health sector aims to Section 4 stipulates the implementation arrangements,
attain a broad based health and health related services coordination framework, partnership coordination and
that will positively transform the health status of the Governance structure. The County strategic plan elabo-
people of Isiolo. Strong emphasis is laid on the even- rates the County’s implementation framework and the
tual implementation of interventions and prioritization organogram for the governance, coordination and man-
of services along the 7 investment Cohorts areas in line agement structures with different functions. The roles
with the Kenya Essential Package for Health (KEPH). and responsibilities of each stakeholder are also out-
The plan is done in Five key Chapters that cover specific lined. This section also gives the Monitoring and Evalua-
priorities areas as follows:-. tion framework as proposed by the Isiolo County Health
Section 1 outlines the purpose of this strategic and in- Strategic Plan to monitor the progress of the plan during
vestment plan as stipulated in the County Government the implementation period. A matrix with Key strategic
Act 2012. This section gives the background information inputs, outputs, Outcomes and Impact indicators have
of Isiolo County, the administrative units, the demo- been provided and one framework of monitoring the
x
progress.
The use of Health Information for evidence based decision making is encouraged at all levels and data quality audit
embraced for use at all levels of service delivery. The strategy has provided for evaluation criteria and it is expected
that both internal and external mechanisms will follow the timelines proposed in this plan. There will be Strong
linkages and data sharing with the national government as provided for in the County Government Act 2012 and
constitution 2010. This section will align the County government development monitoring to National government
M&E Health sector framework.
The last section relates to resources requirements and financing of the strategic plan for each objective area of
investments with the key priority interventions/ milestones. It shows the financing gaps and resource mobiliza-
tion strategies among others. The resultant total cost for this strategic plan is Kenya Shillings 7,365,097,000 This
is the amount required to facilitate the implementation of the key priorities in the health sector. The cost matrix
highlights the different areas of investments and sources of funding. Besides the resource mobilization strategies
highlighted in this section, it is expected that the governments will finance most of the budgeted activities while
different stakeholders are expected to fill the gaps.
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SECTION 1: INTRODUCTION AND BACKGROUND
1.1 Purpose of this Investment Plan
The county health strategic plan is a critical guide for Health Sector services provision. The plan enables the Coun-
ty to define and monitor critical interventions needed to attain its Health goals. It also guides the County during
budgeting of its resources and in resource mobilization for implementation of its defined priorities. The Health
Investment Plan is designed to get people more involved in their health care. By knowing more, you can make bet-
ter choices and save money. That is important as health care expenses continue to rise. The plan will detail priority
investments needed for optimal health serve delivery to the population. In addition, the plan will also;
1. Contribute towards the achievement of Millennium Development Goals (MDGs), Kenya Health Policy 2012-
2030 (KHP) and Vision 2030.
2. Help in prioritizing key health investment areas.
3. Accelerate health service delivery to the highest attainable standards.
4. Guide in monitoring targeted county health performance indicators.
5. Provide a framework and a road map on ‘how’ the medium term county health objectives will be achieved.
1.2 Results framework GOVERNMENT-WIDE
HEALTH SECTOR SPECIFIC KENYA HEALTH POLICY
(Long Term health intent for Kenya)
KENYA HEALTH POLICY
(Long Term health intent for Kenya)
KENYA HEALTH SECTOR STRATEGIC SECOND MEDIUM TERM PLAN
& INVESTMENT PLAN (5 year National Development tar-
(5 year National health targets, and gets and flagships)
investment targets)
INTEGRATED COUNTY
DEVELOPMENT PLAN
(5 year CountyDevelopment targets)
COUNTY COUNTY HEALTH STRATEGIC & COUNTY
SPECIFIC INVESTMENT PLAN SPECIFIC
PRIORITIES PRIORITIES
(5 year County health targets and investment
priorities)
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
BUDGET
Distribution of known or potential resources
OPERATIONAL PLAN
Annual targets and activities for implementation with available funds
PERFORMANCE CONTRACT
Annual Performance targets
1.3 Focus and Mandate
Kenya promulgated the constitution in the year 2010 which provided for the ‘highest attainable standards of health,
which includes right to health care services. The Constitution also led to devolution of various key functions, includ-
ing health to the county governments. Isiolo County is therefore mandated to establish proper framework withthe
aim of linking the plan with National policy objectives to achieve MDGs 4, 5, and 6 as well as vision 2030. The plan
focuses on identification, prioritization and coordination of investments in the health sector in the County. It pro-
vides for a governance structure which will provide overall direction and leadership for the health system, focusing
on planning and guiding resources to bring value to health system
Focus
The plan will focus on;
• Situation analysis of the county health systems
• Identifying, analysing and prioritising the needs
• Development of short-term and long-term investment and financing strategies
• Resource mobilization to deliver result
• Monitoring and Evaluation
Mandate
The mandate of plan is as follows;
• Improving service delivery so that health services are accessible, affordable and client centred
• Plan for the health investment to be carried out within the county and facilitate its implementation.
• In developing the county health investment plan, the planning unit has It will spearhead the county health sec-
tor to accomplish its mission and in turn be able to reach its vision as shown below:
2
1.4 Process of development and adoption of the strate-
gic and investment plan
The planning process went through an elaborate road map as detailed below;
1. Training of six (6) CHMT planning TOT by national team in a five (5) days’ workshop
2. Feed back to county leadership, including political leaders and the rest of CHMT with view to mobilize support
and consensus for the planning process ahead.
3. Resource mobilization by raising proposals so as to source for funds for planning
4. Stakeholders briefing meeting
5. Data gathering at sub county level
6. County health strategic planning retreat to generate the zero draft
7. Planning secretariat retreat to finalize the first draft
8. Stakeholders meeting to review and input into the first draft
9. Printing of the plan
10. Adoption, launch and dissemination of the CHSP
www.isiolo.go.ke 3
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
SECTION 2: SITUATION ANALYSIS
Location and Size
Isiolo County is located in the upper eastern region of Kenya. It borders seven counties with Garissa to the east, Wajir
to the north east, Meru to the south west, Samburu to the east and Marsabit to the north west, with Kitui and Tana
River counties to the south west and south east respectively. It covers an area of 44,174.1Km2 and lies between lati-
tude 10 58’N and 20 1’ S and longitude 380 34’E and 410 32’E.
Figure 1 location of Isiolo County in Kenya
Source: Kenya National Bureau of Statistics, 2013
4
Facility Sub County Type Agency Table 1 Health Facility
Distribution by type -2013
Garbatulla District Hospital GARBATULLA SUB COUNTY GOK
Sericho H/centre GOK 5
Kinna H/Centre Garbatulla Hospital GOK
Rapsu Dispensary GOK
Kulamawe Dispensary Garbatulla H/ Centre GOK
Barambate Dispensary GOK
Boji Dispensary Garbatulla H/ Centre GOK
Malka Daka Dispensary GOK
Gafarsa Dispensary Garbatulla Dispensary GOK
Muchuro Dispensary GOK
Iresaboru Dispensary Garbatulla Dispensary GOK
Madogashe Dispensary GOK
Eldera Dispensary Garbatulla Dispensary GOK
Badana Dispensary GOK
Garbatulla Dispensary
Merti District Hospital GOK
Malka galla Dispensary Garbatulla Dispensary GOK
Bulesa Dispensary GOK
Biliqo Dispensary Garbatulla Dispensary GOK
Merti catholic Catholic
Dadach basa Dispensary Garbatulla Dispensary GOK
Korbessa Dispensary GOK
Garbatulla Dispensary
IDH FBO
ACK Garbatulla Dispensary FBO
AIC GOK
Alfalah Garbatulla Dispensary FBO
APU Private
Catholic Disp Isiolo Garbatulla Dispensary GOK
Isiolo Central GOK
Eremet MERTI SUB COUNTY FBO
GK Prison GOK
Matercare Merti Hospital GOK
Complex Disp CBO
Kipsing Disp Merti Dispensary FBO
Leparua Merti Dispensary GOK
K/Juu Merti Dispensary CBO
Oldonyiro Merti Dispensary FBO
Narrapu Merti Dispensary CBO
Ngaremara Merti Dispensary CBO
Tupendane GOK
Pepo la Tumaini ISIOLO SUB COUNTY FBO
78 Tank Batt FBO
Kambi Garba Isiolo Hospital Private
Waso Dispensary Private
Iqra Maternity Home Isiolo Dispensary
Isiolo Med. Centre
Isiolo Dispensary
www.isiolo.go.ke Isiolo Health center
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Hospital
Isiolo Dispensary
Isiolo Health centre
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Health centre
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo Dispensary
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Physiographic and Natural Conditions
Isiolo County is principally a semi-arid area and receives capital.
an average rainfall of 275 mm per year. There are two The country has the potential of cashing in on future de-
main rainy seasons, the short rains from October to De- velopments in the hospitality industry after Isiolo town
cember and the long rains from March to May, with in- recently acquired the status of a resort city. The Sam-
terval of two dry spells between May- Sept and January buru and Shaba Game reserves, Buffalo Springs, Lewa
to March. Downs and the Meru National Park are popular tourist
Temperatures are generally high throughout the year, destinations. Nomadic pastoralist communities are very
ranging from minimum of between 12 degrees C to dominant in the country and contribute a large portion
a maximum of – 28 degrees C. Rainfall ranges from towards meeting the county’s demand for meat. Tra-
150mm to 650 mm per annum typical of ASALs in Kenya. ditional jewellery making also contributes to the local
The hottest months start in September through Janu- tourism market. As the gateway into Northern Kenya,
ary to March, while the months of April to August are the county has a large market for cereals, fruits and veg-
relatively cooler. An average of 9.5 hours of sunshine is etables.
received per day. Strong winds are also experienced be- Served by an airport and several airstrips, the county has
tween June to August with the rest of the months get- a range of hotels, restaurants, clubs and campsites that
ting calm winds. The road network is generally poor; cater to the varying needs of both locals and travelers to
however, the county has 11kms of Bitumen surface, 87.6 the region. River Ewaso Nyiro flows through the county
kms of gravel surface and the remaining 289.3kms of and is a critical source of water for the region’s wildlife,
earth surface. The county has 1 local Authority (County livestock and human consumption. (KNBS Isiolo (2013)
Council of Isiolo) and Isiolo Town is the administrative
Administrative Units
Isiolo County has only one local authority, Isiolo county council. The district has two constituencies: Isiolo North
Constituency and Isiolo South Constituency. The county is divided into six administrative divisions:
Table 2 Isiolo County Administrative and Political Units and size
Division Population* Urban pop.* Headquarters
Central 52,280 18,077 Isiolo
Garba Tula 7,010 1,883 Garba Tula
Kinna 7,133 3,572 Kinna
Merti 15,771 3,415 Merti
Oldonyiro 9,669 0
Sericho 8,998 1,277 -
Total 100,861 28,224
* 1999 census. Sources: [2], [3],
6
Administrative Sub-division (Sub-county, wards)
Isiolo County has three sub-counties which include: Isiolo, Merti and Garbatulla. The county is further
divided into10 wards as indicated in Table 1.
Table 3 Isiolo County Administrative and Political Units and Size
Sub-county Area (Km2) Wards
Isiolo 24,734 5
Merti sub county 4,045 2
Garbatulla sub county 15,395 3
44,174
Total 10
Figure 2 Isiolo County Administrative Units Map
www.isiolo.go.ke 7
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Demographic Features
Population Size and Composition
Isiolo County is composed of two (2) sub counties namely Isiolo and Garbatulla. It is important to note that Merti
forms part of Isiolo Sub County since the two form one constituency called Isiolo North. The total population of the
county is 164, 366 projected from 2009 census. Isiolo has 70.5% whereas Garbatulla has 29.5% of the total county
population. This population is projected to grow to 188044 by 2018 (Census 2009).
Population Demographics
Isiolo County has only one local authority, Isiolo county council. The district has two constituencies: Isiolo North
Constituency and Isiolo South Constituency. The county is divided into six administrative divisions:
Figure 3 Isiolo County Population Pyramid 2013
MALE
FEMALE
The above pyramid shows that Isiolo county population is more concentrated at the base. Majority of the popula-
tion is aged 20 years and below. There also more male than female in all the ages. The pyramid narrows as ages
increase meaning there are fewer people above the age of 60 years. More planning should concentrate on the youth
who form the bulk of the population.
8
2.1.1 Catchment population trends
SUB COUNTY Year 2013 Year 2014 Year 2015 Year 2016 Year 2017
1 Garbatulla Sub County 48,521 49,881 51,277 52,712 54,187
2 Merti Sub County 22,022 22,839 23,535 24,412 25,316
3 Isiolo Sub County 93,823 97,304 100,914 104,658 108,541
Total County population 164,366 170,024 175,726 181,782 188,044
Figure 4 Isiolo County Population Projection
Population
Year
Garbatulla Sub County
Merti Sub County
Isiolo Sub County
www.isiolo.go.ke 9
Description Population Target population
estimates Year Year Year Year Year
2014 2015 2016 2017
2013 188,044
36,311
1 Total population 164,366 170,024 175,726 181,782 6,736
32,561 33,766 35,015` 30,682
2 Total Number of Households 31,399 76,797
3 Children under 1 year (12 months) 3.71% 5,825 6,040 6,264 6,495 43,573
4 Children under 5 years (60 months) 16.9% 26,532 27,514 28,532 29.588 6,972
6,972
5 Under 15 year population 42.3% 66,409 68,866 71,414 74,057 6,881
34,495
6 Women of child bearing age (15 – 49 50,835
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18Years)24%37,67939,07340,51942,018 13,617
2.1.2 Population description7 Estimated Number of Pregnant3.84%6,0296,2526,483 6,723
Women 6,252 6,483 6,723
106,1706,3996,635
8 Estimated Number of Deliveries 3.84% 6,029 30,933 32,077 33,264
45,585 47,272 49,021
9 Estimated Live Births 3.79% 5,950 12,210 12,662 13,131
10 Total number of Adolescent (15-24) 19% 29,829
11 Adults (25-59) 28% 43,959
12 Elderly (60+) 7.5% 11,775
2.2 Health Status
Health status remains at suboptimal level with less than Nutrition being a key determinant of health remains a
50% of the population accessing healthcare in Isiolo. big challenge in the county with the prevalence of stunt-
Health indicators remain poor with the leading cause of ing being 20.8% and an expected reduction to 10% in
mortality being HIV/AIDS (4.2%) and Gunshots (13.4%). the five years, Wasting 8.2% and a reduction to 5% and
Leading causes of morbidity are Respiratory tract infec- Underweight at 17.2% and a reduction to 5%. Several
tion and Malaria. The major risk factor contributing to challenges continue to hinder the improvement of these
morbidity and mortality is unsafe sex. Life expectancy critical indicators. These challenges include; poor road
remains at 58.9 years. Maternal mortality rate currently networks, sociocultural practices, lack of skilled birth at-
stands at 48 deaths per 1,000. Under 5 mortality rate is at tendants, lack of specialized equipment to handle deliv-
56 deaths per 1000 live births. Infant Mortality rate is 43 eries, erratic drug supplies, among others highlighted in
per 1000 live births. Neonatal mortality rate is 31/1000 subsequent sections.
births.
2.2.2 Health Impact County Estimates
Impact level Indicators 58.9
Life Expectancy at birth (years) 11.7/1000
Annual deaths (per 1,000 persons) – Crude mortality 31/1000
Neonatal Mortality Rate (per 1,000 births) 43/1000
Infant Mortality Rate (per 1,000 births) 56/1000
Under 5 Mortality Rate (per 1,000 births) 48/1000
Maternal Mortality Rate (per 100,000 births) 12.8/1000
Adult Mortality Rate (per 100,000 births)
(Source: KDHS2009, MICS 2008/09)
www.isiolo.go.ke 11
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18Causes of deathCauses of ill health (disease or injury)
2.2.3 Major causes of morbidity and mortality in CountyNationalCounty-specificNationalCounty-specific
No Condition
Source; DHIS 2013No Condition1 HIV/AIDSNo ConditionNo Condition
1 HIV/AIDS 2 Gunshot 1 HIV/AIDS 1 Diseases of respiratory systems
122 Perinatal conditions3 Road Traffic Accident
3 Lower respiratory 2 Perinatal conditions 2 Rheumatism, Joint pains etc
4 Pneumonia
infections 3 Malaria 3 Confirmed Malaria
4 Tuberculosis
4 Lower respiratory in- 4 Diseases of skin
fections
5 Diarrhoeal diseases 5 Tuberculosis 5 Diarrhoeal diseases 5 Diarrhea Diseases
6 Malaria 6 Anaemia 6 Tuberculosis 6 Pneumonia
7 Cerebrovascular 7 Gastroenteritis 7 Road traffic accidents 7 UTI
disease
8 Ischaemic heart dis- 8 Meningitis 8 Congenital anomalies 8 Typhoid Fever
ease
9 Road traffic acci- 9 Cancer 9 Violence 9 Eye infections
dents
10 Violence 10 Hypertension 10 Unipolar depressive 10 Accidents, Fractures and injuries
disorders
Risk factors causing mortality2.2.4 Major risk factors causing morbidity and mortalityRisk factors causing morbidity
Nationalin County
No Condition County-specific National County-specific
1 Unsafe sex www.isiolo.go.ke 13
2 Unsafe water, sanitation No Condition No Condition No Condition
1 Unsafe Sex 1 Unsafe sex 1 Unsafe Sex
& hygiene
3 Suboptimal breastfeed- 2 High poverty and 2 Unsafe water, sanitation 2 High poverty and illiteracy lev-
illiteracy levels & hygiene els
ing
4 Childhood & maternal 3 Tribal conflicts 3 Childhood & maternal 3 Tribal conflicts
underweight
underweight
5 Indoor air population 4 Unsafe water, poor 4 Suboptimal breastfeeding 4 Unsafe water, poor sanitation &
sanitation & poor poor hygiene practices
6 Alcohol use hygiene practices
7 Vitamin A deficiency 5 Childhood & ma- 5 High Blood Pressure 5 Childhood & maternal under-
ternal underweight weight and micronutrient defi-
8 High blood glucose and micronutrient ciencies
deficiencies
9 High Blood Pressure
10 Zinc deficiency 6 Suboptimal breast- 6 Alcohol use 6 Suboptimal breastfeeding/com-
feeding/compli- plimentary feeding
mentary feeding
7 Unskilled maternal 7 Vitamin A deficiency 7 Unskilled maternal care/deliver-
care/deliveries and ies and neonatal care
neonatal care
8 Stigma, cultural 8 Zinc deficiency 8 Stigma, cultural practices and
practices and ta- taboos
boos
9 Poor health-seeking 9 Iron deficiency 9 Poor health-seeking behavior
behavior
10 Poor infrastructure 10 Lack of contraception 10 Poor infrastructure and access
and access to health to health services
services
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
2.3 Health Services Outcomes and Outputs
Isiolo County has a fairly distributed health facility network with a number of disadvantaged areas where clients
walk for over five kilometers to access health services contrary to WHO recommendations. Most of the facilities
require face lifting and regular preventive maintenance. However quality of service delivery is affected by an acute
shortage of staff across all cadres, inadequate supply of medical equipment and medical supplies/commodities.
2.3.2 Health Outcomes
Policy Objective Services # units currently providing service (where
applicable)
Community Primary care Hospitals
Eliminate Communi- Immunization Total = ____ Total = ____ Total = ____
cable Conditions Child Health 0 38 3
Screening for communicable conditions 0 42 3
Antenatal Care 0 42 3
Prevention of Mother to Child HIV Transmis- 0 42 3
sion 0 42 3
Integrated Vector Management
Good hygiene practices 0 00
HIV and STI prevention 0 42 3
Port health 0 42 3
Control and prevention neglected tropical dis- 0 00
eases 0 00
Halt, and reverse the Health Promotion & Education for NCD’s 0
rising burden of non Institutional Screening for NCD’s 0 42 3
communicable condi- Rehabilitation 0 01
tions Workplace Health & Safety 0 01
Food quality & Safety 0 00
0 00
Reduce the burden of Health Promotion and education on violence / 0 00
violence and injuries injuries
Pre hospital Care 0 00
OPD/Accident and Emergency 0 42 3
Management for injuries 5 42 3
Rehabilitation 0 01
Minimize exposure to Health Promotion including health Education 5 42 3
health risk factors Sexual education 5 42 3
Substance abuse 5 42 3
Micronutrient deficiency control 5 42 3
Physical activity 5 42 3
14
Policy Objective Services # units currently providing service (where
applicable)
Community Primary care Hospitals
Minimize exposure Health Promotion including health Education Total = ____ Total = ____ Total =
to health risk factors Sexual education ____
Substance abuse 5 42 3
Micronutrient deficiency control 5 42 3
Physical activity 5 42 3
5 42 3
5 42 3
Provide essential General Outpatient 0 42 3
health services Integrated MCH / Family Planning services 0 39 3
Accident and Emergency 0 33
Emergency life support 0 01
Maternity 0 10 3
Newborn services 0 02
Reproductive health 0 39 3
In Patient 0 53
Clinical Laboratory 0 25 3
Specialized laboratory 0 00
Imaging 0 01
Pharmaceutical 0 23
Blood safety 0 00
Rehabilitation 0 01
Palliative care 0 00
Specialized clinics 0 11
Comprehensive youth friendly services 0 00
Operative surgical services 0 01
Specialized Therapies 0 00
Strengthen collabo- Safe water 5 42 3
ration with health Sanitation and hygiene 5 42 3
related sectors Nutrition services 5 34 2
Pollution control 0 00
Housing 0 14 3
School health 5 42 3
Water and Sanitation Hygeine 5 42 3
Food fortification 0 00
Population management 0 00
Road infrastructure and Transport 0 00
www.isiolo.go.ke 15
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
2.3.3 Health Outcomes
Output area Intervention area Situation
Access Availability of critical inputs (Human Human resource- Acute shortage of staff across all
Resources, Infrastructure, Commodities) cadres.
Infrastructure- poor roads, inadequate and dilapi-
dated buildings, , shortage of staff houses, lack of
electricity, no water connection in most of facilities,
fences, communication, utility and ambulatory ve-
hicles and equipment.
Commodities Inadequate supplies – frequent stock
outs, erratic supply, push system, lack of enough stor-
age space, poor logistics management system at all
levels.
Functionality of critical inputs (mainte- Lack of elaborate maintenance plans, poor mainte-
nance, replacement plans, etc) nance and replacement of machines and equipment,
vehicles, buildings, water and electricity systems.
inadequate medical engineers, lack of service con-
tracts for major equipment’s, lack of preventive main-
tenance system, limited capacity for maintenance
amongst the technicians,
Readiness of facilities to offer services Inadequate specialized skills e.g. few anesthetists,
(appropriate HR skills, existing water / consultants.
sanitation services, electricity, effective No master plans in all facilities, no electricity and
medications, etc) water connections in most facilities, lack of backup
power in hospitals
Inadequate Essential drugs at all levels and lack of
oxygen for life support,
Emergency trays not in place in most facilities
Few and Nonfunctional CHUs in the County
Quality of care Improving patient/client experience Health Facility Management Committees are in place
Measures to improve client satisfaction not in place in
some facilities, e.g. suggestion box, client exit inter-
views.
Long waiting time for services
Inconsistent Clinic hours (opening and closing time)
Unsatisfactory Client privacy
Service charter not displayed in most facilities.
Inconsistent Health education.
Health worker’s negative attitude towards clients
Customer care desk are not there, where available not
utilized and manned by unskilled person
16
Output area Intervention area Situation
Quality of care Assuring patient/client safety (do no IPC in place e.g. hand washing facilities, sterilization
of equipments and waste disposal, gloves, provision
harm) of safety boxes inadequate.
No incinerators for sharps in most facilities, placenta
Assuring effectiveness of care pits.
No sputum collection areas at all levels
Best practices in place such as Counseling on drug
use and adherence, patient follow ups, HBC and de-
faulter tracing.
KQMH model in place but not fully rolled out in the
county.
Frequent stock outs of drugs, inadequate HR, poor ac-
cessibility.
Cultural believes and taboos affect health seeking be-
havior and adherence.
2.4 Health Investments
The county strategic plan for service delivery output aims at working towards delivering the expected results. The
investment is prioritized by identifying the inputs needed to achieve outputs guided by the health systems building
blocks framework.
Among the flagship projects within the county include;
• Two model health centers have been constructed but not fully operational operationalization of model health
centers,
• Thirty five (35) nurses and ten (10) CHEWs have been recruited per constituency through the ESP programme.
• Structures for community strategy are rudimentary with only 20 semi functional units in place.
• The county is yet to realize the benefits of free maternity services due to infrastructural challenges.
The health investment plan will follow the following steps;
1. Identification of the relevant interventions to be delivered in each building block.
2. Defining deliverables by quantifying time allocated focused for each intervention with defined annual target
that is possible.
The section gives a current reflection of health investments within the county and compare with norms and stand-
ard required to guide in planning.
www.isiolo.go.ke 17
No. / 10,000 persons Available by tier Required numbers Total gaps
No. Staff cadres No, avail- County National Hospitals Primary Commu- Hospitals Primary Commu- Hospitals Primary Com-
1 Medical officers able 0.0008 8 care nity 20 care nity 12 care munity
2 Consultants 0.0004 4 10 6
8 5
5
4 5
7
3 Dentists 1 0.0001 1 6 2
4 Dental Technologists 1 0.0001 1 6 2
5 Public Health Officers 25 0.0025 25 30 10
9
6 Public Health Technicians 18 0.0018 18 25 6
0.001 0 3 3
7 Health Promotion Officers 1 0.0004 1 4 6 29
20
8 Pharmacists 4 105
1
9 Pharm. Technologist 5 0.0002 3 12 5
14 150 6
10 Lab. Technologist 14 0.0014 4 76 2
11 Lab. Technician 4 0.0004
12 Orthopedic technologists 3 0.0003 3 4
0.0001 1 30
13 Nutritionists 1 00.0005 5 25
0 0 105
14 Nutrition technologist 5 0.0002 3 3
0.0005 5 10
15 Nutrition Technician 0 0.0002 2 8
0.0001 1 3
16 Radiographers 3
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/180.0007
17 Physiotherapists 5
2.4.2 Health Workforce 0
18 Occupational Therapists 2
180.0001
19 Plaster Technicians 1
Health Records & Informa-
20 tion Officers 7 7 15 8
Health Records & Informa- 0 0 30 30
tion Technicians
Medical engineering tech-
21 nologist 1 1 54
Medical engineering techni- 3 3
22 cians 0.003 0 6 4
0 10 2 2
23 Mortuary Attendants 0 0.001 4 10 0
3 6 2
24 Drivers 10 90 4 1
92 29 20
25 Accountants 4 0.0004 21 10
0.0003
26 Administrators 3 0.0009
27 Clinical Officers (specialists) 9
28 Clinical Officers (general) 11 0.0011
No. / 10,000 persons Available by tier Required numbers Total gaps www.isiolo.go.ke 19
No. Staff cadres No, avail- County National Hospitals Primary Commu- Hospitals Primary Commu- Hospitals Primary Com-
29 Nursing staff (KRCHNs) able 0.0117 95 care nity 250 care nity 133 care munity
30 Nursing staff (KECHN) 0.0101 76 150 49
117 22
86 10
Community Oral Health 1 0 0 0 3 3
32 Officers 11 0.0011 0 11 20 9
33 Secretarial staff / Clerks 0 0 00 0 0
34 Attendants / Nurse Aids 6 14 8
39 50 11
35 Cooks 6 0.0006
36 Cleaners 39 0.0039
37 Security
Community Health Extension 20 0.002 20 50 30
38 Workers (CHEWs) 0.002 2 5 3
0.0754 754
39 Social workers 2
40 Community Health Workers 754
41 Other (specify)
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
2.4.3 Health Infrastructure
Health Inputs & processes No. available No. / 10,000 persons Required Gaps
County National numbers
4
Physical Infrastructure
13
Hospitals 2 GK 0.00003 7 10
20
1 Private HC-0.0005 HC-17
DISP-0.0038 DISP-39 8
Primary Care Facilities HC-5 (incl.2 model HC)
0.0002 40 13
DISP-38 5
Community Units 20 NF CU 5
41
Full equipment availability for 5
13
Maternity 3-Fully Equiped. 0.0003 11 13
5
8-Not Equiped 0.0041 59 5
0.0001 6 5
MCH / FP unit 46 17
NA 6 64
Theatre 1-Fully Equiped 0.0000 41 10
0.0001 6 5
-2-Non Functional 0.0047 60
0.0009 22 8
CSSD -1-Not Equiped 0.0001 6 2
0.0001 6
Laboratory 28-Not fully Equiped 0.0001 6 0
0.0001 18 20
Imaging 1-Functional 0.0010 83
0.0001 11
Outpatients 47-Functional 0.0001 6
Pharmacy 9
Eye unit 1-Fully Functional
ENT Unit 1-Fully Functional
Dental Unit 1-Fully Functional
Minor theatre 1-Fully Functional
Wards 19-General Ward
Physiotherapy unit 1-Fully Functional
Mortuary 1-Fully Functional
Transport 6-Grounded 0.0006 8
Ambulances 1-Grounded 0.0001 3
1-Servivceable
Support / utility vehicles 50 0.0002 0
30 0.0003 50
Bicycles
Motor cycles
20
2.4.4 Health ProductsUnits of assessmentPharmaceuticalsPrivate Public Non pharmaceuticals Private
Public FBO NGO FBO NGO
www.isiolo.go.ke 210
Requirements from annual 35,469,508 503,027 0 0 172,129,57 150,890 0
quantification (kshs) 0
0 0
Amounts re- KEMSA 9,817,526.3 280,000 0 0 4,542,762.4 120,000 0
ceived in past MEDS 0 00 0 0 0 0
12 months Other 0
(kshs) (specify) 0 0 360,000 0 00
Amounts procured using 2,200,000 0 856,760 0 00
user fees in past 12 months
24764021.7 475027 240000 0 11,813,434.6 30,890 00
Gap / surplus (kshs) 26,585,996.7 783,027 360,000 0 34,044,921.1 270890 00
TOTAL
ItemIsiolo County Health Strategic & Investment Plan 2013/14 - 2017/18CalculationOther GoKSource of fundsLATFPartners (spec-
HSSF User fees CDF ify)
Amount Budgeted2.4.5 Recurrent Health Expenditures (previous year)4,748,844
Amount Received (A) 12,000,000 4,748,844 50,000,000 0.00 0.000 21,418,857
Expenditure 22(B) 7,455,5004,748,84445,326,15523,063,340384,00021,418,857
Expenditure accounted for (SOE’s sub- (C) 7,268,787 45,326,155 23,063,340 384,000
mitted)
Funds utilization rate (D) 7,268,787 4,748,844 45,326,155 23,063,340 384,000 21,418,857
Accounting rate (C/B X 100) 97.5% 100% 100% 100% 100% 100%
(D/C X 100) 100% 100% 100% 100% 100% 100%
2.4.6 Health Information (previous year)
Health information is the “nerve” of healthcare system tion and reporting tools (Registers and summary
in any setting. It has variously been referred to as the forms.
“Foundation”, “Glue” and ‘oil” keeping the Health system 2. Improve Data demand, use, storage and security at
running. As a country, there is a national health infor- all levels
mation system platform called DHIS2 that is used to 3. Develop a comprehensive EHR and networking for
link the county and national health sector. Isiolo County all County Referral, Sub Counties and ESP facilities.
faces major shortages in the area of Health Information • Capacity Building on
starting with human resource, tools, technology, and
physical infrastructure (space). DHIS
There are no data verification mechanisms, Data de- • ICD- 10 (Certification and Classification)
mand and use is also weak across all the players. There • EHR
is inadequate resource allocation towards supporting • M&E
evidence based practice, innovation and information • Data Management and Use of Information
management. None of the health facilities is automated • ICT
giving room for inefficiency and accountability problem • Monitoring of Vital events by use of IT
since Information is not easily generated. The Health In- 4. Health Information Infrastructure such as airtime,
formation System covers the following key areas: computers and physical infrastructure
5. Conducting Data quality audits, verification, de-
1. Information generation velop reports, dissemination, and support supervi-
2. Information validation sion.
3. Information analysis 6. Develop and Review Annual Work plans
4. Information dissemination 7. Enhance use of Operational research in HIS and
5. Information utilization Innovation (E-health, GIS, Cloud Computing, use of
mobile)
Key areas of investment HIS
1. Printing and distribution of integrated data collec-
Intervention Previous Previous Performance
1 Number of births reported in County year total year targets (targets / actual)
2 Number of deaths in County
2653 3309 80.2%
Facilities submitting Monthly HMIS information 262 0 N/A
3 in DHIS
4 Facility deaths certified using ICD-10 coding 42 42 100%
262 N/A 100%
Community deaths certified using Verbal Autop-
5 sies No Data No Data 0%
www.isiolo.go.ke 23
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
2.4.7 Health Leadership Previous Previous Performance
Intervention year total year targets (targets / actual)
Facility Management Committee meetings held
1 in past 12 months 100 184 54.3%
Quarterly stakeholder meetings held in past 12
2 months 2 16 12.5%
3 Annual Operational Plan available for past year
4 Annual stakeholders meeting held for past year 3 3 100%
5 Board meetings held in past 12 months
Biannual County Quality Improvement Review 01 0%
6 Meetings
8 8 100%
02 0%
2.4.8 Service Delivery Previous Previous Performance
year total year targets (targets / actual)
Intervention
32 70 45.7%
1 Outreaches carried out 0 12 0%
2 Therapeutic Committee meetings held in past 12
0 45 0%
months
3 Patient safety protocols / guidelines displayed in 45 45 100%
facility, and are being followed 0 45 0%
4 Health service charter is available, and is dis-
8 45 17.8%
played
5 Emergency contingency plans (including referral
plans) available
6 Functional Work Improvement Teams at all
Health Facilities
24
2.5 Issues and challenges with providing health services
The county’s health systems is largely affected by com- • Tier one services are weak due to slow implemen-
peting challenges, not meeting the standard norm in tation and uptake of community strategy in the
any of the orientation area as per the health systems county.
building blocks hence linking the six national policy area
is far from reach. The following are the main challenges • Prioritization of county health needs had been a
hindering the county to render quality health services to challenge due to lack of a strategic plan in place.
the community and to meet their priority needs;
• HMIS is still facing challenges where departments
• The referral hospital with an acute shortage of lack adequate equipment, personnel, skills and
essential requirements including non-functional space.
ambulances and no standard incinerator for waste
management. • Health workforce establishment not meeting the
standard and norms at every tier.
• All facilities in the county lack standard diagnostic
laboratories. • Health Infrastructure is limited and existing ones
not well maintained with no maintenance strategy
• The county lacks a blood transfusion center for in place.
blood safety.
• Governance and leadership is weak in the county.
• Essential health services such as reproductive • Low investment in healthcare over time.
health services, child health, specialized clinics, • Commodities are inadequate due to erratic supply ,
diagnostic imaging are not available hence leading
to avoidable costly referrals. poor inventory management and poor distribution
strategy (push system)
Environment Variable Strengths Weaknesses
Internal envi- Strategy / focus
ronment Structure for implementation • Policy guidelines in place • Lack of implementation plan
• Service charter available • Inadequate funds
Systems to support implementa- • Strategic document in place • Poor dissemination, Distribu-
tion • Multi sectoral approach strengthened- tion and use of policies and
CIDP in place. guidelines
Shared values within County
Management team • Availability of existing facilities • Limited working space
• County health governance structure • Lack of tittle deeds
• No available training institu-
in place.
• Enough land for expansion tion.
• Poor communication infra-
structure
• Lack of transport.
• Existing management systems in • Lack of management skills
place e.g. CHMT, DHMT. Facility health • Inadequate funds for running
committee. health systems.
• Policy guideline in place
• Partner support
• Coordination forums in place eg CHSF,
WESCOORD, CNTF, UNNGOHOD,CSG
• County Vision and mission • Poor coordination.
• Commitments
• Accountability
• Integrity
• Customer focus
• professionalism
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Environment Variable Strengths Weaknesses
Internal envi- Style of management / leadership • Participatory based leadership in place • Poor inter and intra commit-
ronment
Staff presence in all tiers of care tees consultation
External envi- • Supportive and facilitative supervision • Irregular meetings in place
ronment Skills amongst staff • Inadequate funding for sup-
in place
port supervision.
• Staff establishment in place • Inadequate staffing
• Committed and skilled staff • No rational distribution of
• Job security
• Staff development staffs
• Low staff morale.
• All staffs have basic training • Staff stagnation.
• No refresher training
• Knowledge gap
Opportunities Threats
Political issues • Presence of political will • Political interference
Economic issues – funding envi- • Devolution • Job insecurity
ronment • New constitution • Un clear frame work in devolu-
Sociological issues – societal val- • CIDP
ues / elements affecting manage- • Presence of donor support tion
ment of health • County government funding. • Insecurity due to irrational
Technological issues • Presence of health management com- distribution.
mittees • Dwindling partner resources.
Ecological issues – related capaci- • Poverty.
ties in other similar management • Community health units • Low health insurance coverage.
teams, e.g. from other Counties, • Community health workers • Poor service utilization
or other departments in the • Insecurity and vandalism
County • Access to current technology/digital • Poverty among service users
Legislative issues – legal frame- equipment. • Lack of ownership for the facil-
work
Industry issues – interest in health • DHIS ity by the community.
in County • ICT department as part of the county • Instances of Poor public rela-
structures. tions with health workers.
• Other enabling Acts such as NACADA, • Adverse cultural practices,
NEMA taboos, myths
• Lack ICT connection.
• Draft health bill • Inadequacy of computers and
• Constitution of Kenya (right to health)
• Jubilee manifesto accessories.
• Provision of good and quality products • Inadequate ICT skills
• Job creation at local level • Lack of electricity connection.
• Supplementation and fortification of • Weak linkages and enforce-
food. ment.
• Resistance to devolution by hu-
man resource for health.
• Pollution
• Counterfeit product
• Poor oversight of private prac-
titioners.
26
SECTION 3: PROBLEM ANALYSIS, OBJECTIVES AND
PRIORITIES
3.1 Problem analysis
Isiolo County is faced with numerous health challenges. However, the extent to which they impact the community
varies. Some of these challenges include; lack of equity in resource distribution, system inefficiencies, and persis-
tent poor quality services. The targets are set based on the health needs in order to meet the expected result.
The health strategic plan will focus on addressing the key issues and priorities affecting service delivery.
The following approaches are employed;
• Service delivery per cohort
• Management support analysis
3.1.1 Health Services
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive outcomes) address challenges ment
(Maximum of 5 per chal- area
Eliminate Immunization Improving access Improving quality of lenge – see Annex 1) code
Communicable (Where applicable) care
Conditions (Where applicable) -Outreach services 1.2
-Long distances to facili- -Maintenance of cold- -Community services 1.1
ties chain -On-job training 1.4
-Non-functional com- -Poor logistical man- -Equipment purchase 2.4
munity health units agement structures for -Equipment maintenance 2.5
-Shortage of staff supplies and repair
-Lack of funding for -Coming up with new facili- 2.1
outreaches -Cold chain manage- ties 3.1
-Nomadism ment and persistent -Recruitment of staff 1.1
- cold chain inefficiency breakdown. 1.3
-Shortage of vaccines -Vaccines potency -Community services
-Support supervision to 1.4
Child Health -Long distances to facili- -Unskilled deliveries and lower units 1.9
ties neonatal care -staff capacity building 5.1
-Non-functional com- -Poor sanitation and -Strengthening referral
munity health units hygiene practices system 2.2
-Cultural beliefs and -Sub-optimal quality of -procure required health
practices services during out- products
-poor referral system reaches -expansion of existing
-Single staff in facility -Poor infant and young facilities(pediatric ward)
prone to closure during child feeding practices
replenishment -Inadequate community
-Frequent essential health education
drugs and commodity -inadequate anthropo-
stock outs. metric equipment in
CWC
-inadequate pediatric
inpatient services
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive Screening for com- outcomes) address challenges ment
municable condi- (Maximum of 5 per chal- area
tions Improving access Improving quality of lenge – see Annex 1) code
Antenatal Care (Where applicable) care -Recruitment of new staff 3.1
(Where applicable) - Equipment: purchase 2.4
Prevention of -Long distances to facili- - Equipment: maintenance 2.3
Mother to Child HIV ties -Health workforce – and repair. 2.1
Transmission -Non-functional com- capacity and inadequate -Construction and equipping 2.2
Integrated Vector munity health units staff laboratories in high volume 1.4
Management -Poor Staff capacity and -Sub-optimally facilities. 6.2
Good hygiene prac- skills equipped laboratories. -Expansion of existing facili- 3.4
tices -unavailability of logis- -Lack of diagnostic ties( lab) 1.10
tics laboratories in most of -On-job training 1.1
-staff shortage the facilities -Resource mobilization
-Continuous quality im- 1.10
-Long distances to facili- -Variation in standards provement
ties of antenatal care - Community awareness 1.1
-Poor referral system - Poor creation 5.1
-Inadequate coverage of infrastructural hindranc- 5.1
outreach services es to handle perinatal Improvement of continuum 1.4
- Rigid Social cultural emergencies (ambu- of care 1.10
practices lance & theatre) -Anti-stigma campaign 1.1
-inadequate skills to -procurement of required 1.10
handle basic obstetric health products 5.1
emergencies
-social cultural practices. - Procurement of essential
-inadequate commodi- commodities
ties - Improve the skills of the
service providers
-Distance to the facility -Transition of care from School health programme
- Stigma ANC to PNC. Community services
-staff skill -lack of updates on School health
-stock out of health WHO guidelines (Infant - Awareness creation
products. Feeding in the context of -Procurement of H. com-
-illiteracy HIV/AIDS) modities
-inadequate community -Construction of latrines and
awareness advocate for use
-staff shortage
-Lack of essential pre- -Inadequately tech-
ventive commodities niques to apply IRS
-Creation of hand wash- -Avail clean water and
ing facilities in schools soap
Inadequate hygiene -demonstration on
commodities proper hand washing
-In adequate latrine -Strengthening health
coverage. clubs
-Lack of awareness on
harmful practices
-Inadequate techniques.
-Defecation in the bush
28
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive HIV and STI preven- outcomes)
tion address challenges ment
Improving access Improving quality of (Maximum of 5 per chal- area
(Where applicable) care
(Where applicable) lenge – see Annex 1) code
-Stigma -Inadequate knowledge
- Rigid socio cultural -Staff shortage - capacity building 1.4
practices -Procurement of health
-Inadequate test kits -Inadequate staff commodities(ARV) & CCC 5.1
-Inadequate access to trained on HIV care and service logistical materials 1.2
health services. PMTCT -Outreach HTC & Moonlight
-Inadequate awareness -Poor data collection HTC services
on HIV/STI activities. and use
-Inadequate access to -Noncompliance to care -Defaulter tracing and follow
logistical materials. and treatment among ups.
-Inadequate staff PLWHA. -Psychosocial group Support.
trained on HIV care and -Poor management 1.1
PMTCT of HIV and STI related -Training and updates(HCW
-Poor data collection health products. and Public)
and use -Inadequate supervision 1.4
-Noncompliance to care and support. -IEC material purchase.
and treatment among -Traditional healers W0rld AIDS DAY, awareness 5.1
PLWHA. making advantage of week support.
-Poor management HIV incurable status -Monitoring and evaluation.
of HIV and STI related thus exposed to seek -Recruitment of lay coun- 4.5
health products. alternative medications selors to complement the
-Inadequate supervision (AYAN) HCW. 3.1
and support. -Activating community Units
to assist in awareness and 1.1
follow ups. 3.5
-Incentives to the outstand-
ing
Port health -Lack the port health -Lack of special equip- -Establishment of the infra- 2.1
infrastructure ment’s structure
-Procurements of health 5.1
commodities 5.1
Control and preven- -Distance - Inadequate knowledge, Procurement of required 2.2
tion neglected tropi- -lack of skilled personnel kits health products. 3.4
cal diseases -lack of equipment -inadequate surveillance Expansion of existing facili- 4.7
systems. ties. 4.4
In service training
Information dissemination
Data collection on surveil-
lance
Halt, and re- Health Promotion & -Non-availability of -Inadequate Staff. -Deployment of new staff. 3.1
verse the rising Education for NCD’s Infrastructure. -Lack of Equipments -Procure and Supply of drugs 5.1
burden of non- -Lack of personnel. -Inadequate Skilled and medical supplies 3.4
communicable -Lack of Finances Staff. -Staff Training 5.1
conditions -Lack of Enough Drugs -Data collection for research 4.5
and medical supplies. -Purchase of equipment 2.4
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive Institutional Screen- outcomes)
ing for NCD’s address challenges ment
Rehabilitation Improving access Improving quality of (Maximum of 5 per chal- area
(Where applicable) care
(Where applicable) lenge – see Annex 1) code
-Lack of specialized NCD -Lack of equipment -Procurement of Equipment. 2.4
clinics -Lack of Skilled person- -Training of Staff to Impact 3.4
Shortage of essential nel the skills.
drugs and supplies -Lack of operational -Purchase of Essential Drugs 5.1
-Outreach Screening Research opportunities and Medical.
Services -Weak surveillance -Recruitment and Deploy- 3.1
-Lack of community system ment of staff 2.2
awareness. -Establishment of special- 1.9
- Inadequate investment ized clinics at tier 3 1.2
on NCD’s – screening -Strengthen screening and
and treatment. referral for NCD’s at all tiers.
Invest in mass screening of
NCD’s
-lack of rehabilitation --Lack of Equipment. -Recruitment of New staff. 3.1
centres -Shortage of Skilled Staff -Procurement of Equipment.
Lack of rehabilitation - Inadequate investment -Construction of rehabilita-
equipments in management and tion units in hospitals 2.4
Shortage of staff. rehabilitation services -Invest in Community aware-
for NCD’s ness creation on NCD’s 2.1
-capacity building of staff 1.1
1.4
Workplace Health & -Inadequate infection -lack of first aid skills by -Constructing a standard 2.1
Safety Prevention commodities staff infrastructure e.g modern
-Lack of equipment e.g. -Poor waste Disposal incinerators
firefighting equip. System -Provision of disposal guide-
-Inadequate funding to -shortage of Protective lines.
institute safety policies Equipments e.g. Gloves, -purchase of equipment and 1.4
boots, color coded bins commodities.
and liners. -establish exit emergency
-lack of emergency or doors in all work areas. 2.4
simulation exercise -first aid training of staff 1.4
-poor design of physical -provision of SOP.
infrastructure -Development of an emer- 1.10
-lack of disaster prepar- gency preparedness plan
edness plans 1.5
Food quality & -inadequate knowledge -Lack of Health Educa- - Community health Educa- 1.4
Safety on proper food quality tion tion. 5.5
and safety. -High Poverty Index. -Provision of subsidized 2.1
-Inadequate storage -Lack of quality food quality food. 4.1
facilities - Lack of Food lab - Construction of public 5.4
-poor food transporta- analysis health food lab. 4.6
tion practices. -unhygienic food han- -strengthen routine inspec-
-poverty & persistent dling practices. tion and reporting system.
drought -poor food inspection - create food quality and
system safety committees
-lack of baseline data on -data analysis
food quality and safety
30
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive outcomes)
address challenges ment
Improving access Improving quality of (Maximum of 5 per chal- area
(Where applicable) care
(Where applicable) lenge – see Annex 1) code
-Poor road network to
Reduce the Health Promotion facility -Inadequate capacity in -Physical infrastructure / 2.1, 2.2,
burden of and education on -lack of emergency and -terms of skills, equip- construction/expansion and 2.3
violence and violence / injuries trauma facilities ments -and staffing maintenance e.g. theatre 3.1, 3.2,
injuries -lack of efficient referral -poor enforcement of -In service training 3.4,
system relevant laws. -Procurement, warehousing, 5.1,
-Inadequate funding for -Poor referral system distribution and monitoring
emergency response. -Inadequate financial of health products 1.10
-Poor communication resources -strengthening conflict
network -Lack of health educa- resolution committees at
-Insecurity tion community level
-Poverty -Language barrier -strengthen HIS to capture
-Lack of community -repugnant social cul- data on violence & injuries
awareness on gender tural practices
based violence
Pre hospital Care -Poor infrastructure -Cultural barriers -Community and outreach 1.1, 1.2,
-Poor communication -Lack of awareness services 1.3
-Rigid culture -Inadequate community -Supportive supervision to
-Illiteracy based institutions lower units
-Poverty
-Ignorance
OPD/Accident and -Inadequate Infrastruc- -Inadequate -Emergency preparedness 1.5
Emergency ture capacity(skills, equip- -OJT 1.4
-Inadequate ments and personnel) -Referral health services 1.9
capacity(skills, equip- -Poor referral system -Therapeutic committees 1.7
ments and personnel) -Inadequate emergency -Equipments purchase and 2.4,2.5
-Poor referral system supplies maintenance
-Inadequate emergency -Inadequacy of technol- -ICT equipment purchase 2.8,2.9
supplies ogy and maintenance
-Poor emergency prepar- -Lack of disaster com- -Recruitment
edness mittees -In-service training
-Purchase of health products
Management for Inadequate Inadequate Emergency preparedness 3.1
injuries capacity(skills, equip- capacity(skills, equip- -OJT 3.4
ments and personnel) ments and personnel) -Referral health services
-Poor referral system -Poor referral system -Therapeutic committees 5.1
-Inadequate emergency -Inadequate emergency -Patient safety services 1.5
supplies supplies
1.4 1.6
1.9
1.7
1.6
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive
outcomes) address challenges ment
Rehabilitation
Improving access Improving quality of (Maximum of 5 per chal- area
(Where applicable) care lenge – see Annex 1) code
(Where applicable)
-lack of rehabilitative Absence of rehabilitative -Community and outreach 1.1
facilities facilities services 1.2, 1.3
-inadequate skilled -lack of skilled personnel -Supportive supervision 2.4,2.5
personnel -Lack of technology -Equipment purchase and
-Lack of technology maintenance 3.1
-Poor road network to -Recruitment of new staff
the facility
Provide es- General Outpatient -Distance to the facility. -Lack/inadequate -Outreach services 1.2
sential health -Shortage of personnel. services. -Construction of new HF.
services -prohibitive user fees. -In adequate infrastruc- -Recruitments of new staff 2.1
-long service waiting ture -Resource mobilization 3.1
time -inadequate staffs -Establish 30 6.2
-shortage of staff -inadequate Community community units 1.1
-staff attitude units -upgrading of health facili-
-operational hours -lack of community ties
awareness’
Integrated MCH / -Distance to the facility. -lack/inadequate ser- -Outreach services 2.2
Family Planning -Shortage of personnel. vices in many places -Construction of new HF 1.2
services -Social-cultural, -Inadequate infrastruc- and maintenance of existing 2.1
religious beliefs and ture ones
practices -Inadequate staff -Recruitments of new staff 3.1
-inadequate training/ -Lack of community -Health expenditure review 6.3
skills awareness -Community services
-inadequate supplies -Knowledge gap in -In-service training
-long service waiting health staff Procurement of MCH/FP
time -Lack of consistent sup- commodities &supplies
-staff attitude plies.
-operational hours - lack of equipment 1.1
- Unaffordable cost of
commodities e.g. FP 3.4
Accident and Emer- -Shortage of personnel. -Inadequate emergency -Construction of emergency 5.1
gency -inadequate training/ units in Garbatulla & units in Garbatulla & Merti 2.1
skills Merti. -Recruitments of orthopedic
-Inadequate supplies -Poor staff ratio & plaster staff 3.1
Infrastructure. -Inadequate Capacity -In-service training
building -Procurement of required 3.4
-Erratic supplies of health products.(emergency 5.1
drugs & commodities kits and equipments.) 2.5
-Poorly maintained -Maintenance and repair of
infrastructure ambulances
-Lack of specialists
32
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive Emergency life sup- outcomes)
port address challenges ment
Improving access Improving quality of (Maximum of 5 per chal- area
(Where applicable) care
(Where applicable) lenge – see Annex 1) code
-Shortage of personnel.
-inadequate training/ -Low staff ratio -Construction of ICU, casu- 2.1
skills -Inadequate supplies alty, renal units. 3.1
-inadequate supplies -low community Aware- -Recruitments of critical care 1.1
-lack of emergency unit/ ness staff
casualty -Low Capacity building - Sensitization of the public 3.4
-lack of ICU, renal, burns -inconsistent supplies on how to handle mass ac- 5.1
and trauma wards -few and poor mainte- cidents.
-inadequate ambulatory nance of ambulances -In-service training on criti-
services -lack of oxygen concen- cal care.
trators -Procurement of required
life support equipment e.g.
oxygen concentrators.
-Maintenance and repair of
life support machines
2.5
Maternity -Distance to the facility. -Shortage of staff in -Construction of new mater- 2.1
-Shortage of personnel. both skills & numbers. nity units 2.2
-User fees(private) -Low Community Aware- -Expansion of existing facili- 3.1
-Social-cultural believes ness ties 6.3
and practices -limited supplies -Recruitments of new staff 1.1
-inadequate training/ -Poor referral system -Health expenditure review 3.4
skills -Poor communication -Community services 5.1
-inadequate supplies/ systems. -In-service training 1.3
equipments -Poor integration of -Procurement of required 1.8
-poor referral services HINI. health products e.g. delivery 2.6
-poor communication packages) 2.7
- Limited maternity units -Support supervision 1.4
at the primary care level. -timely maternal death 2.4
-staff negative attitude audits 1.10
towards conducting -Purchase of ambulances
deliveries -Repair and maintenance of
-shortage of water and the existing ambulances
connection. -OJT
-lack of placenta pits and -installation of solar/ elec-
drainage systems tricity to all health facilities.
-lack of lighting in the -Establish maternal shelters
facility. at IDH
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive Newborn services outcomes)
address challenges ment
Reproductive health
Improving access Improving quality of (Maximum of 5 per chal- area
(Where applicable) care
(Where applicable) lenge – see Annex 1) code
-Distance to the facility. -Inadequate skilled -Construction of newborn 2.1
-Shortage of personnel. staffs for new born care. units at GT and Merti 2.2
-User fees(private) -Low Community aware- -Expansion of existing facili- 3.1
-Social-cultural believes ness. ties
and practices -Inconsistent supplies -Recruitments of new staff 1.1
-Inadequate skills -inadequate equipment with new born care skills 3.4
-inadequate supplies/ and poor maintenance -Community services 5.1
equipment -Poor referral systems. -In-service training 1.10
-poor referral services -Poor communication -Procurement of required
-poor communication systems. health products(incubators
-lack of NBU(Garbatulla -Poor integration of and resuscitators)
& Merti ) BFHI. -strengthening of BFHI
-Distance to the facility. -Inadequate RH services -Outreach services 1.2
-Shortage of personnel. and products -Construction of new HF. 2.1
-Social-cultural believes -Low ratio of staffs. -Recruitments of new staff 3.1
and practices. -Low community -aware- -Community services 1.1
-Inadequate training/ ness. -Training 3.4, 3.3
skills. -Low capacity building -Procurement of required 5.1
-Inadequate supplies. -Inconsistent and push health products
-Poor referral services. supplies of RH com- -Support supervision
-Poor communication. modities.
-Negative staff attitude -Poor referral system
-user fee.
1.3
In Patient -Shortage of personnel. -Poor distribution of -Construction of wards. 2.1
-Prohibitive user fees. staff -Recruitments of new staff 3.1
-inadequate supplies -Low Capacity building -Community services to 1.1
-Inadequate -Inconsistent supplies enhance linkage
space(wards) -poor referral system -In-service training 3.4
-Inadequate specialized -language barrier -Procurement of required 5.1
services -poor maintenance of health products e.g. beds, 1.3
-Few inpatient facilities. equipment and build- drugs, linen etc 1.8
E.g. Beds ings. -Support supervision 2.5
-staff/patient attitude -weak staff commit- -Clinical audits 1.10
ment- absenteeism -Equipment maintenance
-inadequate diagnostic and repair
equipment -Mobilization to join social
health insurance scheme
34
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive Clinical Laboratory outcomes)
address challenges ment
Specialized labora-
tory Improving access Improving quality of (Maximum of 5 per chal- area
Imaging (Where applicable) care
(Where applicable) lenge – see Annex 1) code
-Shortage of personnel. -Insufficient lab staffs -Construction of new lab 2.1
-High User fees. -Gaps in skills and facilities. 2.4
-Inadequate training/ knowledge. - Equipping existing labs. 3.1
skills -Inconsistent lab com- -Recruitments of new staff 1.4, 3.4
-inadequate supplies modities and supplies. -In-service and on job train- 5.1
-Lack of lab services in -Poor staff attitude ing.
most facilities -Lack of internal and -Procurement of required 1.3
-Lack of essential diag- external quality control. health products e.g. fridges,
nostic equipments - Weak Infection preven- reagent, microscopes.
- Lack of equipment tion control mechanisms -Support supervision.
maintenance and repair -Poor commodity man-
agement systems.
-No lab reporting tools
that conform to DHIS
-Shortage of personnel. -Insufficient lab staffs -Construction of new lab 2.1
-High User fees. -Gaps in skills and facilities.
-Inadequate training/ knowledge. - Equipping existing labs (4 2.4
skills -Inconsistent lab com- hosp.).
-inadequate supplies modities and supplies. -Recruitments of new staff 3.1
-Lack of lab services in -Poor staff attitude -In-service and on job train- 1.4, 3.4
most facilities -Lack of internal and ing. 5.1
-Lack of essential diag- external quality control. -Procurement of required
nostic equipments - Weak Infection preven- health products e.g. fridges, 1.3
- Lack of equipment tion control mechanisms reagent, microscopes and
maintenance and repair -Poor commodity man- special equipments.
agement systems. -Support supervision.
-No lab reporting tools
that conform to DHIS
-Distance to the facility. -Inadequate imaging -Construction of new imag- 2.1
-Shortage of personnel -facilities. ing facility at GT and Merti
-inadequate training/ -Shortage of skilled staff -Recruitments of new staff 3.1
skills -Inconsistent supplies -Procurement of modern 2.4
-Lack of imaging equip- -Lack of data collection diagnostic imaging equip- 2.5
ment’s and units tools ments
-High user fees -Lack of equipment - Equipment maintenance
maintenance and repair and repair (Service con-
tracts)
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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive
outcomes) address challenges ment
Pharmaceutical
Improving access Improving quality of (Maximum of 5 per chal- area
(Where applicable) care lenge – see Annex 1) code
(Where applicable)
-Shortage of personnel. -Poor staff ratio -Construction of new County 2.1
-User fees. -Higher user fee warehouse
-inadequate training/ -Inconsistent supplies of -Recruitment of new staff 3.1
skills pharmaceuticals - Maintenance of equip- 2.5, 2.3
-Frequent stock outs -Lack of therapeutic ments and buildings
- Limited working hours committee - Procurement of cold stor- 2.4
-Insufficient funding - Poor water quality for age and installation of fans
drugs reconstitution and AC. 1.4
-Lack of ICT integration OJT 1.3
to manage patient data Support supervision 1.10
-Lack of privacy Disposal of expired com- 1.7
- Limited storage space modities
- Lack of warehousing for Establish strong therapeutic
County supplies committees
- Lack of inventory tools
and other reporting
tools
- Language barrier
- Expired drugs – poor
retrieval and disposal
- Lack of equipments eg
tablet counters
Blood safety -Lack of County Blood -Lack of blood safety -Construction of new blood 2.1
Rehabilitation Transfusion Unit facility safety facility and blood
-Inadequate storage -Lack of blood banks bank at the county level. 2.4
facilities. -Shortage of staff -Purchase of modern blood
-Lack of resources. -Inadequate supplies screening equipments 1.3
-Lack of supplies and -Lack of modern screen- -Support supervision 1.4
commodities. ing equipments -OJT 1.10
-Public ignorance on -Lack of IQC and EQA - Enhance blood donation 2.1
donation - Shortage of transport campaigns in public and
-Shortage of blood facilities to satellite sites institutions 3.1
-Distance to the facility. for blood collection 1.2
-Shortage of personnel.
-inadequate training/ -Few rehabilitation Construction/establish of 2
skills facilities. rehabilitation centers(GT &
-Few OT/PT staff Merti)
-Recruitments of new staff,
OT/PT
-Initiation of rehabilitation
outreaches.
-Equipping existing OT/OP
units
2.4
36
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive outcomes)
address challenges ment
Palliative care
Improving access Improving quality of (Maximum of 5 per chal- area
Specialized clinics (Where applicable) care
(Where applicable) lenge – see Annex 1) code
-Distance to the facility.
-Shortage of personnel -Inadequate HBC -Establishment of hospice at 2.1
-inadequate training/ services county level.
skills -Inadequate staff with -Recruitments of new staff 3.1
-inadequate supplies – knowledge on HBC. -Community services 1.1
-Inadequate HBC com- -In-service training
-poor referral service. modities -Procurement of required
-Lack of screening facili- health products
ties
3.4
-Distance to the facility. - Lack of special clinics. Construction/establishing of 5.1
-Shortage of personnel. -Shortage of specialized specialized clinics at the sub 2.1
- Lack of special clinics staff. county level.
- High user fees - Inadequate space -Expansion of the existing 2.2
- Limited working hours/ - Inadequate equip- clinics. 3.1
days ment’s -Recruitments of new staff 1.10
- Staff absenteeism - Weak support supervi- - Promotion of health insur-
sion ance coverage
- Support supervision
- Integration of screening of
NCD’s at OPD
1.3
Comprehensive Distance to the youth Few(1) youth friendly Establish a comprehensive 1.10
youth friendly friendly facility services YFC at the county level. 2.1
services Lack of funds to con- Lack of equipment Establish YFC at the sub
struct YFC. Lack of IEC materials county level. 2.1
Lack of Youth Friendly Inadequate social mobi- -Procurement of necessary
Service related equip- lization on BCC YFC equipment 2.4
ment Low demand for com- - Development and distribu-
Shortage of staff modities tion of IEC materials 5.3, 2.8
Knowledge gap among - Awareness creation on YFC 1.10
youth on the existence - Strengthen community 1.1
of YFS linkage 1.3
- Support supervision to 1.9
strengthen YFC
- Strengthen heath referral
services
www.isiolo.go.ke 37
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive outcomes)
address challenges ment
Operative surgical
services Improving access Improving quality of (Maximum of 5 per chal- area
(Where applicable) care
(Where applicable) lenge – see Annex 1) code
-Distance to the facility.
-Shortage of personnel. -Only 1 functional -Operationalize the theatres 2.2
-High User fees. theater at Garba and Merti.
-inadequate training/ -Inadequate staff - Construction of theatre at 2.1
skills -Inconsistent supplies tier 3 3.1
-Inadequate supplies -Poor referral system -Recruitments of new staff 5.1
- Inadequate and -Procurement of required
-Inadequate operative nonfunctional surgical health products 2.6
surgical theatres equipment -Purchase of ambulances
- Shortage of surgical - Poor maintenance of -Repair and maintenance of
equipment surgical equipment the existing vehicles
Shortage of specialized - Poor referral systems
staff
2.7
Specialized Thera- -Distance to the facility. -Inadequate therapy -Establishment of special- 2.1
pies -Shortage of personnel. facilities. ized therapy units.
-User fees. -Inadequate staffs -Recruitments of new staff 3.1
-Social-cultural beliefs -Community services 1.1
and practices - Training of staff 1.4, 3.4
-inadequate training/ - Procurement of specialized
skills equipment
-Lack of specialized units
e.g. mental unit 2.4
- Limited specialized
equipments
Minimize Health Promotion Few and Nonfunctional Staff shortages Recruitment of staff 3.1
exposure to including health community units IEC materials Procurement of IEC materi- 5.1
health risk Education Distance from the facil- Lack of funding als 1.1
factors Sex education ity Weak CHIS Establish new units and
Nomadism way of Functionalize existing CHU’s
lifestyle Printing of CHIS tools
Transport
Cultural beliefs and Lack of Human resource Recruitment of staff 4.8
practices availability OJT training 3.1
Knowledge gap Inadequate updates Procurement of training 1.4
Lack of IEC materials materials 5.1
Fear to disseminate Transport means
facts by staffs Focus on gate-keepers: 2.7
Youth leaders, Church & 1.1
Muslim leaders
38
Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive Substance abuse outcomes)
Micronutrient defi- address challenges ment
ciency control
Improving access Improving quality of (Maximum of 5 per chal- area
Physical activity (Where applicable) care
(Where applicable) lenge – see Annex 1) code
Lifestyle
Peer pressure No backup from legal Intersectoral collaboration 7.5
Knowledge gap within fraternity Training of staffs 3.4
the community Lack of trained staff Construction of Rehabilita- 2.2
Lack of rehabilitation tion centres
centres Advocacy on substance
Weak law enforcement abuse
Distance Shortage of enough Focus on gate-keepers: 1.10
Poor dietary diversity stocks Youth leaders, Church & 1.1
Ignorance Inadequate nutrition Muslim leaders 5.1
Insufficient commodity staff Procurement of micronu- 3.1
supply Knowledge gap of trients
staff and community Recruitment of nutrition 3.4
Harsh environment members staff 1.4
Ignorance Poor Inter sectoral col- In service training of staffs 1.1
Low level of education laboration On job training 7.5
Poor integration of HiNi Health education at the 1.3
services at facility and community level 3.1
community level. Strengthen Inter sectoral
Lack of specialized staffs collaboration 2.1
eg physiotherapist Joint supportive Supervision
Lack amenities to lower level
Recruitment of staffs
Construction of social
amenities
Strengthen col- Safe water -Poor rainfall -Lack of protection of -Physical infrastructure 2.2
laboration with -Inadequate supply of water sources – advocate for expansion 2.4
health related water to the community -Lack of structures to (Improve water network, 7.5
sectors treat and/or monitor facility rain water collection 1.1, 1.10
quality of water infrastructure, watersource 1.10
-High saline content of protection) 5.1
water -Equipment – purchase
(PAQUA Labs)
-Improve collaboration
with sectors concerned with
water provision
- Promotion of HHWT
- Enhance water quality
surveillance.
- Procurement of water
treatment chemicals
www.isiolo.go.ke 39
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