Isiolo County MOH Strategic Plan Full Book

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
(Maximum of 5 per chal- area
Sanitation and Improving access Improving quality of lenge – see Annex 1) code
hygiene (Where applicable) care
(Where applicable) -Community Services 1.1
Nutrition services -Low literacy levels - Functionalize existing com- 2.2
-Nomadic lifestyle -Traditional medicine munity units and establish
Pollution control -Inadequate health -Unskilled deliveries new ones 2.2
Housing promotion activities -Inadequate community -Up scaling of Latrine cover- 1.1
-Low latrine coverage health units age 1.10
-Community lead Total Sani-
tation (CLTS) approach
- Deliberate Health Promo-
tion campaigns

-Harsh climatic condi- -Inadequate nutritional Warehousing/Storage of 5.2
tions staffing health products
-High poverty levels -Inadequate knowledge -Monitoring and evaluation
-Inconsistencies in nutri- - Lack of appropriate of services 4.1,
tional commodity and equipment -Information management –
therapeutic feed supply - Staff attitude Routine, Surveys
-Inadequate staffing. -Strengthen collaboration 4.3,
- Inadequate funding for with other stakeholders 4.6, 4.7
nutrition activities - Recruit more nutrition
officers 7.5
- Scale up High Impact Nu-
trition Interventions 3.1
- Training – OJT and In 1.10
service 1.4, 3.4

-No clear waste disposal -Shortage of public -Construction of incinera- 2.1
sites/infrastructure health staff tors/ burning chamber in
- Inadequate sewerage -Lack of environmental every HF 5.1
treatment plant impact assessments -Procurement of required 3.1
-Poor community aware- - Weak enforcement of health products 7.5
ness on pollution. PH and NEMA laws -Recruit more public health
-Lack of pollution moni- technicians and officers
toring units -Improve linkages with
NEMA

-Nomadic lifestyle -Communal ownership - Information dissemination 4.7
-Lack of awareness on of land (trust land) -Strengthen collaboration
housing standards -Lack Structures and with concerned stakeholders 7.5
-Poverty systems to approve – Ministry of lands, plan-
building plans across the ning; county government
county
-Lack of a policies ad-
dressing housing needs
-Lack of a proper
surveying and physical
planning

40

Policy Objec- Services Challenges (hindrances to attaining desired Priority Investment areas to Invest-
tive School health outcomes) address challenges ment
(Maximum of 5 per chal- area
Food fortification Improving access Improving quality of lenge – see Annex 1) code
Population manage- (Where applicable) care -Information dissemination
ment (Where applicable) -Enhance School WASH 4.7
Road infrastructure -Inadequate hygiene and other health promotive 4.8,
and Transport and environmental in- - Inadequate infrastruc- activities
frastructure in schools ture required for stand- -Data collection on school 4.4
ard food preparation health interventions 4.4
-Inadequate sanitary – Surveillance 5.1
facilities in school -Procurement of required 4.8
-Inadequate hand-wash- health products 4.4
ing facilities -Establish school health 3.1
-Inadequate water sup- clubs
ply in school -Data collection: Surveil- 4.2
lance 4.1
-Lack of awareness on -Inadequate skills and -Recruitment of new staff
benefits of fortification capacity at county 4.7
-Lack of structures to level to monitor fortified -Data collection: vital events 1.2
assess and monitor of foodstuffs -Data collection – routine
standards of fortified -Inadequate reproduc- health information 6.2
foods tive health education at -Information dissemination
-Poor health education the community -Outreach services
on population manage-
ment -Roads repairs and - Advocate for Resource
-Culture and beliefs maintenance mobilization towards proper
-Lack of awareness on road construction
the benefits of child
spacing
-FP commodities man-
agement at primary
facilities
-Inadequate resource
allocation
-Inappropriate use of
allocated
-Poor road networks to
rural facilities

* Challenges are those problems within control of the unit to manage. They form the basis for the planned activities, and should
therefore have achievable solutions.

www.isiolo.go.ke 41

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

3.1.2 Management support

Area of System Key challenges – where appli- Priority Investment areas to address chal- Investment
Strategic plan- cable*
ning Inadequate baseline data lenges area code

Ensuring se- Untimely and rushed planning (Maximum of 5/challenge – see Annex 1)
curity for com- Inadequate skills in planning
modities and Resource constraints Recruit more data clerks 3.1
supplies Sensitization of healthcare workers on 1.4
Inadequate storage capacity at all data management 1.3
levels Regular support supervision 4.1
Poor inventory management Strengthening of DHIS 4.6
Development institutional capacity tools
Shortage of security personnel
Poor quantification of supplies Set planning schedules/ road maps 7.5

Capacity building health managers on 3.6
strategic planning at all levels

Resource mobilization 6.2
Stakeholders mapping 7.1
Effi ritization of activities 6.2
6.4

Creation of storage space for all health 5.2
facilities 5.4
Installation of temperature controlling
systems

Procure inventory management tools for 3.4
all departments/ facilities 5.5
Establish and Regular update of inventory 5.4
Capacity building for staffs 5.4
Regular audit of stocks

Recruit more security staffs and procure- 3.1
ment officers 1.4
On job training on commodity manage- 7.5
ment.
Creation of commodity and security com-
mittees

Push supply systems Establish and maintain a pull system 5.5
Expired drugs, storage and de-
struction procedures. Institute expired drug disposal procedures 5.4
Enhance good inventory management
Supply of short expiry drugs. practices 5.3

Developing SOP on drug receipts 5.3
Institute use of drug expiry charts 5.4

42

Area of System Key challenges – where appli- Priority Investment areas to address chal- Investment
cable*
lenges area code
Performance Erratic managerial meetings
monitoring, (Maximum of 5/challenge – see Annex 1)
and evaluation
Proper scheduling of managerial meetings 7.3
Establish standard performance evalua-
tion criteria 7.5

Irregular supportive supervision Conducting regular supportive supervision 1.3
(quarterly)

Inadequate data analysis and in- Proper data analysis 4.6
formation sharing Information dissemination/feed back 4.7
In adequate funding for M & E
initiatives Provision of adequate funding 6.2
Limited information sharing.
Use data for decision making 4.6
Encourage data sharing 6.5

Lack of motivation among staff Develop a performance based reward sys- 3.5
tem.

Capacity No clear supervision check list Develop and avail standard supervision 4.8
strengthening check list
and retooling Inadequate fund
of Health Staff In adequate skills Resource mobilization & coordination 6.2

Establish training needs assessment 3.1
In service training

Resource mo- No stakeholders analysis/ map- Conduct stakeholders forums on quarterly 7.2
bilization and ping in place basis
coordination of -Unflexible partner policy and
partners funding criteria. - Development of MoU’s and Joint work 7.5
plans. 7.5
- Development of a county specific Part-
nership Framework.

In adequate advocacy -Develop advocacy packages 7.5
- Equip CHMT’s with advocacy skills 7.5
- Establish coordination frame work for 7.5
partners to align themselves.
- Strengthening ACSM coordination forum 7.5

In adequate resource Resource mobilization 6.2
Inadequate knowledge and skills
Operations, to conduct operational research -Enhance use of Operational research -for 4.5
and other re- evidence based decision making 4.8
search -Equip Health managers with research 4.8
skills
-Establish a research unit in the County

-Inadequate data collection -Improve data collection for research. 4.5
-Strengthen surveillance system in the 4.6
county.

Lack of proper data analysis Develop data demand, use, storage and 4.6
security at all levels.

Poor surveillance systems Establishment of department of standard 4.4
and research at county level.

www.isiolo.go.ke * Challenges are those problems within control of the unit to manage. They form the basis for the planned activities, and should therefore have achievable solution4s.3

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

3.2 Strategic focus and Objectives

The overall goal of this plan is to improve health outcomes within the county. This will be achieved through the
attainment of six Kenya Health Policy objectives namely:-

• To eliminate communicable conditions
• To halt, and reverse the increasing burden of non-communicable conditions
• To reduce the burden of violence and injuries
• To provide essential medical services
• To minimize exposure to health risk factors
• To strengthen collaboration with health related sectors.
The plan will lead to identified specific objectives that will address policy objectives within the county.

3.2.1 County Mission and Vision Statements

Vision
To be a model county health system providing efficient and cost effective health services to the residents of Isiolo
County and beyond.

Mission
To offer quality healthcare and programs that set community standards, exceed clients’ expectations and are pro-
vided in a manner that is caring, responsive, equitable, convenient, cost-effective, accessible and culturally accept-
able to the people of Isiolo County.

CORE VALUES
Accountability

• Accept our individual and team responsibilities and meet our commitments.
• Take responsibility for our performance in all of our decisions and actions.
• We expect to be judged by the successful execution of our commitments
Innovation
• Celebrate creativity and open-minded thinking.
• We are advocates and instruments of positive change.
• Being innovative builds competitive advantage and creates new opportunities
Teamwork
• Work together to meet our common goals
• Leverage the abilities of all team members
Commitment
We strive to be the best, and we work continuously to improve our performance and exceed
expectations.
Transparency
We operate with open communication and processes
Integrity
• Do what we say
• Communicate with transparency
• Deal fairly and honestly with the public and one another

44

3.2.2 Specific Objectives

Policy Objective Specific strategic Objectives

Eliminate Communicable conditions 1. To establish 25 new CUs and functionalize the 18 existing community units in county by
December 2017.

2. To increase immunization coverage from 72% to 90% by 2017

3. To ensure that all health facilities have functional and reliable cold chain equipment by
2017

4. Increase TB cure rate from 90% to 100%

5. Improve TB contact tracing from 0% to 50%

6. Increase defaulter tracing of TB patients from 7% to 100%

7. Increase TB diagnostic centers from 5 to 15 by 2017

8. Increased uptake of ARV prophylaxis for eMTCT among mothers and HIV exposed infants.

9. Increase proportion of mothers testing positive who deliver under skilled care

10. Reduce maternal to child transmission rate

11. Increase number of HIV infected children on ARV

12. Strengthen linkage to HIV care to those who test positive
13. To increase voluntary HIV counselling and testing by 5 % per annum.
14. To reduce ART defaulter rates by 10% per annum
15. Increase Latrine coverage from 47% to 80% by the year 2017

16. To strengthen detection, reporting and response to IDSR priority diseases.

Halt, and reverse increasing burden 17. Enhance detection and management of kalazar and other neglected tropical diseases from
of Non communicable conditions 0% to 100% by 2017

18. To improve case detection, reporting and response of cholera and other diarrheal diseases
from 20% to 80% by 2017

19. Elimination of trachoma by restoring sight through, mass drug administration, specialist
treatment and eye care

1. To engage other stakeholders in improving food security within the county during the
5years

2. Strengthen health promotion and education on NCD at all levels of healthcare by 2017
3. Promote early detection, screening and diagnosis of NCD
4. Set up four well equipped and accessible diagnostic and treatment centers by 2017
5. Set up one palliative and rehabilitative center by 2017
6. Advocate for bylaws that promote healthy lifestyle
7. Improve data demand, analysis, storage, use and security on NCD’s at all levels of care.
8. Develop a comprehensive EHR and networking for all sub county
9. Capacity building on DHIS, ICD, EHR and M&E
10. Conduct quarterly DQA verification, dissemination and support supervision
11. To maintain regular quarterly supply of nutritional supplements to all the 45 health facili-

ties in county by December 2014.

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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

Policy Objective Specific strategic Objectives

Reduce the burden of Violence & 1. To develop and use a monthly data collection tool for reporting violence and injuries by
Injuries June 2014
Provide essential Medical services
2. Establish fully functional accident and emergency units (casualty) in four hospitals by 2017
Minimize exposure to health Risk
factors 3. Establish community based rehabilitation center by 2017
Strengthen collaboration with
Health Related Sectors 4. To increase advocacy and collaboration with other ministries and government departments
concerned with law enforcement on gender and child abuse during the five year period.

5. To increase number of community health workers and Community health Committee
members trained on violence and injuries from 0 to 500 and CHC from 0 to 25 by Dec 2017

1. Construct ICU, NBU, blood bank, warehouse, at the county referral hospital by 2017
2. Establish basic obstetric care equipment for all primary level facilities, comprehensive ob-

stetric care equipment for all secondary level facilities by 2017.
3. Carry out continuous capacity building on emerging health related issues at all tiers.
4. Ensure consistent supply of essential medicines and commodities on a quarterly basis.
5. Upscale KQMH model for health to all levels of health care delivery.
6. Establish a functional reverse referrals in Merti, Garbatulla and Oldonyiro by 2017
7. Increase access to primary services by upgrading 13 dispensaries to Health centers status by

2017
8. Operationalize all the 6 constructed unopened facilities in the county and construct 8 new

dispensaries in 2 Garbatulla, 3Merti, 3 isiolo by 2017
9. Increase access to specialized services by upgrading Merti HC, Kipsing HC, Baasa HC and

Sericho HC health facilities to hospital status by 2017.
10. Improve referral services by rehabilitating 6 ambulances and acquiring 7 by 2017
11. Establish well equipped diagnostic laboratory in 6 hospital and 13 health centers.
12. Increase laboratory network from 9 facilities to 30 by 2017
13. Procure standard lab equipment for 30 laboratories by 2017.
14. To equip the 1 county referral hospital theatre, operationalize Merti and Garbatulla theatres

and establish theatre facilities in other 3 proposed hospitals by 2017
15. Increase facilities conducting deliveries from 20% to 80% by 2017
16. To increase the number of community outreach services offered from 180 to 960 outreach-

es by Dec 2017
17. Establish well equipped imaging departments in 6 hospitals by 2017
18. Recruit 200 new nurses, 5 pharmacists,20 pharmaceutical technologist, 30 clinical offi-

cers, 10 medical officers, 20 public health officers, 50 laboratory technologist, 30 HRIOs,10
consultants, 17 X Ray technologists, 40 nutritionists, 15 physiotherapists, 15 occupational
therapists, 5 dentists , 50 clerks, 10 drivers, 6HR officers, 6 HAO, 10 health education officers
20 medical engineers and 10 cooks, 50 support, 10 plaster technicians, 10 orthopedic techni-
cians and 10 social workers staff by 2017
1. To continuously facilitate and strengthen comprehensive disease surveillance activities
within the county by December 2017.
2. Develop and display SOP’s on occupational safety hazards in all health facilities
3. Conducting risk analysis and risk assessments in all facilities
4. To strengthen health promotion & education on all health risk factors
5. Promote health facility, school , and community WASH programme activity
6. Develop proper Solid waste management
1. To strengthen the health Stakeholders’ Forums on quarterly basis by December 2017
2. To partner with health actors in mobilizing resources required to carry out the activities to
be carried out within the five years
3. To engage stakeholders in mobilizing financial resources for the establishment of 30 com-
munity health units December 2017
4. Promote public private partnerships at all levels of care.

46

3.3 Sector targets

3.3.1 Scaling up provision of KEPH services targets

Policy KEPH Services # units currently providing Strategic Plan targets
Objective service

Eliminate Immunization Commu- Primary Hospitals Commu- Primary Hospitals
nity care nity care
3 7
0 39 0 56 7
43 56 7
Communica- Child Health 0 39 3 0 56 7
ble Conditions Screening for communicable conditions 0 56
0 39 3

Antenatal Care 0 39 3

Prevention of Mother to Child HIV 0 39 3 0 56 7
Transmission 43 56 7
5 39 3 43 56 7
Integrated Vector Management 43 56 7
5 39 3 0 01
Good hygiene practices 0 39 3
0 00
HIV and STI prevention

Port health

Control and prevention neglected tropi- 0 00 43 56 7
cal diseases

Halt, and Health Promotion & Education for
reverse the NCD’s 0 39 3 43 56 7

rising burden Institutional Screening for NCD’s 0 4 3 43 56 7
of non com- Rehabilitation
municable Workplace Health & Safety 0 01 0 07
conditions Food quality & Safety
0 39 3 0 56 7

0 00 0 01

0

Reduce the Health Promotion and education on 5 18 3 43 56 7
burden of violence / injuries
violence and Pre hospital Care
injuries 0 0 0 43 56 7

OPD/Accident and Emergency 0 01 0 56 7

Management for injuries 0 39 3 43 56 7

Rehabilitation 0 01 0 07

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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

Policy KEPH Services # units currently providing Strategic Plan targets
Objective service

Provide es- General Outpatient Commu- Primary Hospitals Commu- Primary Hospitals
sential health Integrated MCH / Family Planning ser- nity care 3 nity care 7
services vices
Accident and Emergency 0 39 0 56
Emergency life support
Maternity 0 39 3 0 56 7
Newborn services
Reproductive health 0 0 3 43 56 7
In Patient
Clinical Laboratory 0 0 3 43 56 7
Specialized laboratory
Imaging 0 12 3 0 56 7
Pharmaceutical
Blood safety 0 02 0 17 7
Rehabilitation
Palliative care 0 39 3 43 56 7
Specialized clinics
Comprehensive youth friendly services 0 6 3 0 17 7
Operative surgical services
Specialized Therapies 0 6 3 0 21 7

0 00 0 01

0 01 0 0 7

0 39 3 0 56 7

0 00 0 56 7

0 01 0 0 7

0 00 0 01

0 01 0 0 7

0 00 0 07

0 01 0 0 7

0 00 0 07

Health Promotion including health Edu-
cation 5 39 3 43 56 7
Minimize 39 3
exposure to Sexual education 5 39 3 43 56 7
health risk 39 3 43 56 7
factors Substance abuse 5 01 43 56 7
0 56 7
Micronutrient deficiency control 5

Physical activity 0

Strengthen Safe water 5 39 3 43 56 7
collaboration Sanitation and hygiene 5
with health Nutrition services 5 39 3 43 56 7
related sec- Pollution control 0
tors Housing 0 39 3 43 56 7
School health 0
Water and Sanitation Hygiene 5 0 0 43 56 7
Food fortification 0
Population management 0 6 3 0 56 7
Road infrastructure and Transport 0
0 0 43 56 7

39 3 43 56 7

00 0 01

00 0 01

00 0 01

48

3.3.2 Service outcome and output targets for achieve-
ment of County objectives

Objective Indicator Targets (where applicable)

Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

% Fully immunized children 164,366 170,024 175,726 181,782 188,044
72% 77% 82% 87% 92%
% of target population re- N/A N/A N/A N/A N/A
ceiving MDA for schistoso-
miasis

% of TB patients completing 20.5% (79) 45% 60% 75% 100%
treatment 100% 100% 100% 100% 100%
100 100 100 100 100
% HIV + pregnant mothers 15% 25% 35% 45% 55%
receiving preventive ARV’s 80% 90% 95% 95% 100%
Eliminate Commu- % of eligible HIV clients on
nicable Conditions ARV’s

% of targeted under 1’s pro-
vided with LLITN’s

% of targeted pregnant
women provided with
LLITN’s

% of under 5’s treated for h 25% 55% 65% 70% 100%
diarrhea 27% 30% 35% 40% 45%
62.75% 67% 70% 75% 80%
% School age children de-
wormed

% of Children under five
years supplemented with
Vitamin A

% of children under five 16.7% 45% 50% 65% 80%
years supplemented with
zinc

% of adult population with No Data No Data No Data No Data No Data
BMI over 25 0% 15% 20% 25% 305

Halt, and reverse % Women of Reproductive 0.1% 5% 10% 15% 20%
the rising burden age screened for Cervical 0.7%
of non-communi- cancers 0.8% 5% 10% 16% 18%
cable conditions % of new outpatients with 8.2%
mental health conditions 20.8 %
% of new outpatients cases
with high blood pressure

% of patients admitted with 3% 5% 8% 10%
cancer

% of children under five with 7% 6.5% 6% 5%
acute malnutrition (wasting)

% of children under five 19% 17.5% 16.5% 15%
years who are stunted

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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

Objective Indicator Yr 1 Targets (where applicable) Yr 5
17.2 % Yr 2 Yr 3 Yr 4 5%
% of children under five 13.2% 9% 6.5% 80%
years who are under weight 47%
52% 575 68% 5%
% of pregnant women who
take iron and folic supple- 0
ments for at least 90 days
during pregnancy 5%

% of pregnant and lactating 20.5% 17%% 14.5% 10% 5%
women with a MUAC < 21 2%
cm receiving supplementary 75%
food 55%

% new outpatient cases at- 0 000 1.00%
tributed to gender based 0.5
violence 0.5
1%
Reduce the burden % new outpatient cases at- 38.4% 30% 20% 10% 3.0
of violence and tributed to Road traffic Inju- 10%
injuries ries 10.0
10%
% new outpatient cases at- 17.9% 10% 7% 5% 25%
tributed to other injuries 55%
2% 0
% of deaths due to injuries 48% 2% 2% 2% 0
55% 60% 65%
% deliveries conducted by 37%
skilled attendant

% of women of Reproductive 40% 45% 50%
age receiving family plan-
ning

% of facility based maternal 1.18% 1.10% 1.05% 1.00%
deaths 1.0 0.5
8.0 0.5
Provide essential % of facility based under five 1.74 1.5 1.3% 1.1%
health services deaths 5.0 4.0
8% 9%
% of newborns with low 18 13 20% 15%
birth weight 20% 15%
15% 20%
% of facility based fresh still 2% 1.5% 40% 50%
births 0 0
0 0
Surgical rate for cold cases 7.1 6.0
5.9% 7%
% of pregnant women at-
tending 4 ANC visits

% population who smoke Approximated 25%
at 30% 30%
Minimize expo- % population consuming 8%
sure to health risk alcohol regularly Approximated
factors % infants under 6 months on at 40%
exclusive breastfeeding 4.1%
% of Population aware of risk
factors to health 30% 35%
% of salt brands adequately
iodized 00
Couple year protection due
to condom use 00

50

Objective Indicator Targets (where applicable)
Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
Strengthen col- % population with access to 30% 35% 40% 45% 50%
laboration with safe water
health related sec- % under 5’s stunted 1.4% 1.2% 1.1% 1% 0.9%
tors % under 5 underweight 13% 10% 7% 5% 3%
School enrollment rate
% of households with la- 0 0000
trines 43% 45% 50% 53% 55%
% of houses with adequate
ventilation 0 0000
% of classified road network
in good condition 0 0000
% Schools providing com-
plete school health package 0 0000

INVESTMENT OUTPUTS

Improving access Per capita Outpatient utiliza- 0 0000
to services tion rate (M/F)
38%
% of population living within 48% 68% 80% 90%
5km of a facility 1%

% of facilities providing 1% 5% 15% 20% 35%
BEOC
40%
% of facilities providing 96% 5% 15% 20% 30%
CEOC
92%
Bed Occupancy Rate 8.5% 45% 50% 55% 60%
97% 98% 99% 100%
% of facilities providing Im- 90%
munization
0
Improving quality TB Cure rate 95% 97% 99% 100%
of care 15% 25% 50% 65% 100%
% of fevers tested positive for
malaria

% maternal audits/deaths 94% 96% 98% 100
audits

Malaria inpatient case fatal- 0000
ity

Average length of stay 10% 7% 6% 5%
(ALOS)

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Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

3.3.3 Sector input and process targets for achievement of
County objectives

Orientation Intervention area Milestones for achievement Annual targets Yr 3 Yr 4 Yr 5
area Milestone Yr 1 Yr 2 0 00
Community services 99 5 32
Service delivery Outreach services Strengthen18 semi functional CHUs 5 10 240 240 240
Supportive supervision Establish 25 functional CHUs 240 240
to lower units Conduct 240 outreaches per year 16 16 16
On the job training of Quarterly support supervision 16 16 16 16 16
Health workers to im- 16 16
prove skills Purchase of on Job Training materials for health 1 1-
Emergency Preparedness workers to continuously improve skills -1
- --
Patient Safety initiatives Establish KALAZAR diagnostic and manage- -5 160 --
ment center at Merti, Garbatulla and Sericho - 160
Develop and roll out an emergency prepared- 2m 2m 2m
ness and response plan and roll out to sub coun- 2m 2m 2 1-
ties 12 120 120 120
Train 320 health workers on IDSR 120 120 77
Establish contingency Funds for emergency sup- 00
plies for emergency outbreak response 55
Construct incinerators in 6 hospitals
Purchase coded bins for 56 Facilities 30 0

Burning Chambers in 36 health facilities 77 8 72 72
Sand Buckets ( Year one only) 46 0 0
PRN PRN
Continuously Therapeutic committee Construct 35 Placenta Pits 5 10 10
improve Qual- meetings and follow up 25 25 50 00
ity of Care at Clinical audits (including Purchase and install 130 Fire extinguishers in 23 72 72 72 00
service delivery maternal death audits) facilities PRN PRN PRN
points Referral health services Support therapeutic committee meetings on 6 00 3m 3m
monthly basis in 6 facilities 2 32 33
Establish and capacity Form and strengthen maternal/neonatal death 3m 3m 3m
build a county depart- audit committees. 2 33 24 24
ment of standards and Rehabilitate 6 broken down ambulances in the 24 24 24
regulatory services county 0 11 11
Purchase 7 new Ambulances
Set aside funds for operation and maintenance 0 25 35 35 35
of Ambulances
No of functional theatre 1, 2 non operational
Conduct monthly reverse referrals by specialist
to Merti, Oldonyiro and Garbatulla
The county has a department on quality and
standards with 3 QI TOTs
Quality Improvement Coaches

52

Orientation Intervention area Milestones for achievement Annual targets Yr 3 Yr 4 Yr 5
area Establish a department Milestone Yr 1 Yr 2
of Standards and Quality 3 33
Health In- assurance in every tier 3+ Each Tier 3 to have a functional multi-disci- 03
frastructure facility plinary department on Quality Assurances and 40 All All
(physical in- Establish and support Standards 0 23 300 Tier Tier
frastructure, facility based rapid 0 150 4 2 and 2 and
equipment, problem solving im- Each facility to have a Work Improvement 02 0 above above
transport, ICT) provement teams (WITs/ Team of 3-15 members inclusive of community 33 1
QITS**) representative(s) -1 300 300
Quality Improvement 0 11
Coaching Coaches to make at least one monthly QI coach- -1 - 00
Physical infrastructure: ing per facility with documentation on visit -2 - 11
construction of new Construct 8 new dispensaries with staff houses 1- √
facilities Operationalize 6 unopened CDF facilities √ 00
Upgrade 4 HC to hospital status √ √ --
Physical infrastructure: Facelift for the county referral hospital -√ √
expansion of existing Construct perimeter fence round the county √ --
facilities referral hospital √ √
completion of mental unit at IDH √ --
Renovate , equip and operationalize Merti and √ √
Garbatulla Hospitals √ --
County Health Administration Block (one sto- √√ √
rey) √√ √ √√
Fully equip Isiolo county referral Hospital the- √√ √
atre √ √
Procure and run Nomadic clinics in the 3 sub √√ √
counties √ 3 √
Construct and equip ICU 6 bed unit
Construct and equip Renal 6 bed unit 55 √ √√
Construct and equip NBU at County referral √√
hospital. √√ √√
Construct and equip Blood transfusion center
at Isiolo √√
Construct and equip a modern pharmaceutical √√
warehouse at Isiolo
Construct and equip 20 modern clinical labora- √√
tories 53
Construct and equip maternity units in 40
health facilities
Construct and equip imaging departments at 5
new hospitals
Modernize and acquire MRI, CTscan, Xray ma-
chines for the imaging department at County
referral hospital.
Construct 1 medical training college at Isiolo
Upgrade 13 dispensaries to health centers

Fully equip the casualty department at Isiolo
county referral hospital

www.isiolo.go.ke

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

Orientation Intervention area Milestones for achievement Annual targets
area Milestone Yr 1 Yr 2 Yr 3

Physical infrastructure: All facilities routinely maintained with major √ √√ Yr 4 Yr 5
Maintenance renovations based on assessment/need √√

Equipment: Purchase Purchase of solar equipment - lighting and solar

fridge @ 400,000 for 30 facilities √ √√ √√
√√ √√
Equipment: Purchase (50m per annum, alloca- √
tion for facilities will be based on needs)

Equipment: Mainte- Purchase of short wave diathermy √
nance and repair IUCD insertion kits 30 kits 30
Maternity Delivery packs 54
Equipment: Maintenance and repair (10m per 2 2 21
annum, allocation for facilities will be based on 3 √ √ √√
needs)
All facilities to have specific maintenance/ser- √
vice contracts for all major equipment

Transport: purchase 2 motorbikes per community unit x 34
(450,000)
16 13 13 13 13

Purchase of 10 utility vehicles 44 1 1
Functionalization of existing utility vehicles (8)
Transport: Maintenance The county to have service contracts for all ve- √ 45 88
and repair hicles 6
ICT equipment: Pur- Based on needs assessment (laptop and desk- 10 110 50 30
chase top) computer with printers based on needs
assessment (200 computers) 3 20
ICT equipment: Mainte- Automation of Isiolo county hospital, Garbatul- √
nance and repair la, Merti and 3 new hospitals √ 33 1
10 Photocopier machines and 10 LCD projectors √ √√
in all tier 3 hospitals, CHMT, DHMT
Install internet router at all tier 3 hospitals and √√
The county to have service contracts for ICT
equipment

Health Work- Recruitment of new staff Baseline staff 415 (existing staff)
force Recruit new staff target 600 different staff cad-
Personnel emoluments res
for existing staff Emoluments for existing staff for 5 years 100 200 100 100 100
Pre-service training Baseline salary 241m per year.(Million) 242M 243M 244M 245M
In service trainings Baseline 0 242 243 244 245 245.5
Staff motivation Train 100 students (pre- service) 0
Baseline – 30 data available 15 30 25 25 20
In-service training for at least 150staffs in 5 yrs √
Initiate staff motivation system for415 staffs 35 35 35 30
working in Isiolo yearly @ ksh5000 √√ √√

54

Orientation Intervention area Milestones for achievement
area Routine Data Collection
Milestone Annual targets
Health infor- Data Collection for Vital
mation events Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
Health Information In- - - --
novations Printing of data collection and reporting tools 56 1 1-
Monitoring and surveil- for 56 HFs 1 2 22
lance - --
Data Analysis Introduction of Electronic Medical Records Sys- - 2 3 33
Data collection: Re- tem in tier 3 Health Facilities - - --
search 3 - --
Information dissemina- Data storage, data bank and back up 2 - - --
tion - 10 10 10
Enhance Data Demand and use in all levels 56 56 56 56
5 30 --
Internet Connectivity 3 56 56 56
10 2 22
M&E Plan developed (AWP) 1 56 4 44
4 44
Training on DHIS, 1CD-10, EHR, M&E, Data Man- 56 30 4 44
agement and use and ICT
56 15 15 15
Provision of Laptops, Tablets and Desktop com- - 12 12 12
puters 2 √ √√

Provision of Airtime 10 √ √√

Introduce Mobile Phone reporting System for 56 - --
Births and Deaths √ √√
√ √√
E-Health, Geographical Information System - √ √√
(GIS) √ √√
36 36 36
Monitoring of Vital Events by use of Information 56
Technology

Evidence Based Surveys 2

District Based Meetings and Quarterly Review 3 4
Meeting 4 4
Quarterly Data Quality Audit and Verification 4 4
Train key health information personnel in ana-
lytical Data Packages (SPSS, EPI INFO, STATA 15 15
etc.) 12 12
Monitoring of Vital Events by use of Information √ √
Technology
Introduce Mobile Phone reporting System for √ √
Births and Deaths
Capacity built health workers on DHIS, 1CD-10, - -
EHR, M&E, Data Management and use and ICT √ √
Provision of Laptops, Tablets and Desktop com- √ √
puters √ √
Conduct Community Dialogues Meetings to √ √
sensitize public on heath burdens in the com- 36 36
munity.
Facilitated Feedback to all levels by County and
DHMT Teams
Introduce Mobile Phone reporting System for
Births and Deaths
Monitoring of Vital Events by use of Information
Technology
Introduce Mobile Phone reporting System for
Births and Deaths
Monitoring of Vital Events by use of Information
Technology
Monthly information dissemination meetings

www.isiolo.go.ke 55

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

Orientation Intervention area Milestones for achievement Annual targets Yr 3 Yr 4 Yr 5
area Procurement of required Milestone Yr 1 Yr 2 4 44
health products √ √√
Health Prod- Procure county health product on quar- 44 √ √√
ucts terly basis TARGET 250M per year(arvs, drugs, √
nonpharm,HIV kits ,lab reagents) quantity de-
pending on needs √√
Creation of county pharmaceutical information √
management system (PMIS) & LMIS) √√
Develop an Essential Medicines List and Formu-
lary for use by all county Health Facilities.
Creation of County Laboratory Information
system(CLMIS)
Procurement of therapeutic and supplementary
nutrition commodities

Warehousing / storage Construct one county warehouse for health √
of health products products

Upgrade commodity stores in 3 hospitals. 11 1

Construct commodity stores in 35 rural health 6 7 8 7 7
facilities

Upgrade commodity stores in 26 rural health 5 56 55
facilities in the county

Distribution of health Draw up an annual distribution schedule for all √ √√ √√
products health products in the county
Monitoring rational use √√ √√
of health products Distributing health products to County health √ 40% 60% 80% 100%
facilities on quarterly basis 44 44
150 150
Improve ICT connectivity in all the GOK facilities 20% √ 150 150

Conduct quarterly supportive supervision 4

Train 150 HCW annually from the county health
facilities on commodity management 150

Establish and operationalize a County Medi-
cines and Therapeutics committee

Establish and operationalize a county health √
commodities security team

Health Financ- Costing of health service Conduct budget preparation 1 11 11
ing provision 2 22 22
Resource mobilization Initiate fund raising strategies 1 11 11
Health expenditure Have a well-coordinated and mapped stake-
reviews holders system in place 4 44 44
Quarterly financial audits
11 11
Leadership and Annual health stake- Information dissemination done through DHIS 1 44 44
Governance holders meeting 4
Quarterly Coordination Data sharing in 56 GOK/FBO facilities 12 12 12 12
meetings during monthly meetings 12
Monthly management Conduct monthly management meetings in 56
meetings facilities

56

SECTION 4: IMPLEMENTATION ARRANGEMENTS

Coordination framework

The sector coordination framework relates to how the County Government, through the Ministry for Health shall
organize itself to coordinate and lead the delivery of the defined health package. The Constitution of Kenya rede-
fined the new roles and responsibilities of the National and County governments. This redefinition of functions
requires reorganization and alignment of the existing stewardship arrangements within the sector as stipulated in
KHSSP 2012-2017. This is covered in two major areas.

• Leadership and governance framework to support implementation of the health plan in Isiolo County.
• Monitoring and Evaluation to follow up implementation of planned strategies.
The focus of this coordination framework is built around three thematic areas of focus.
1. Health stewardship and management-this relate to the improvement needed in executing the management

function of the county through County health management team.
2. Health Governance relates to assuring appropriate functioning of the institutions by which the authority of

the State is exercised. These address the regulatory and legal functions that all actors in the sector have to
adhere to, and are built around the legal and regulatory framework.
3. Health Partnership-focus on the inter-relations and coordination of different actors working towards the
attainment of the overall Health goals. Focus is on implementation of a common framework, and establish-
ment and making of functional County Health Stakeholders forum that allows partners to engage in the
health service provision.
For proper coordination of various functions in the county, there shall be various technical departments which
shall have the following as their functions:
1. Developing the strategic approach for the area it is responsible for. This includes defining outcome targets,
and required investments (across seven orientations) needed to achieve the desired impact.
2. Monitor implementation of the Strategic approach by different implementing units - achievement or lack of
it, of agreed targets
3. Mobilize resources for implementation for different implementation units
4. Develop annual targets to be reached, based on known resource envelope
5. Develop guidelines to guide service delivery by implementing units
6. Develop, and facilitate implementation of a research agenda/ protocols to ensure evidence based decision
making

www.isiolo.go.ke 57

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

4.1.1 Management structure (Organogram for County
Health Management)

County Executive
Chief Officer of Health
County Director of Health

Clinical Health Finance and Planning
Service Prevention and Administration Monitoring and

Promotion Evaluation

4.1.2 Partnership and Coordination structure and
actions

Governance of the sector will take cognizance of the need for mutually beneficial partnership between all sector
players. Health sector is not a highland of its own. Mobilizing all stakeholders through Public private partnership in-
itiatives will be strengthened. All partners including the Ministry of health, external partners such as WHO, UNICEF,
DANIDA and USAID, internal partners such as APHIA plus IMARISHA, ACF, IMC, KRCS, World vision and FH Kenya
among others, private and FBO health providers, other Government departments, County political leadership, oth-
er individual and corporate leaders will be put on board through elaborate coordination mechanism.
A stakeholder’s analysis will be carried out using the 4W matrix to establish who does What, Where, When and at
what cost. There shall be a county health stakeholder’s forum that will be constituted to coordinate oversight the
activities of all health sector players. The forum which comes up with its own leadership will develop clear TOR that
will guide its operations. The team will meet on quarterly basis. The stakeholder’s coordination mechanism will
also be replicated at sub county level. The initiative will go a long way in improving coordination of interventions,
reduce duplication and wastefulness, and serve as an avenue for resource mobilization and sharing ideas including
show casing best practices.

58

4.1.3 Governance structure and actions (County Govern-

ment and its support)

The County Department for Health is a standalone department with a County Executive Committee Member for
Health who is responsible for the overall coordination and management of County Health Services. There is County
a Chief Officer for Health (COH), who will be the overall Chief Accounting Officer for Health. The COH will report
to the CEC Member responsible for Health, who in turn reports to the Governor. Working with the COH will be the
County Director for Health (CDH), who will be the technical head for health services within the County. The CDH
will work closely with the COH to ensure effective management of resources within the Department to achieve
health objectives laid out in this Plan. The CDH will exercise his/her their functions through the three technical
heads working under his supervision charged with clinical, preventive and administrative functions of the depart-
ment.
A County Health Management Team (CHMT) will be constituted, headed by the County Director of Health. This
team’s main responsibility will be to ensure the implementation of the County strategic plan and Annual Work
Plans. The team will meet monthly, and its operations guided by clear terms of reference approved by the Chief
Officer of Health. It will define areas of responsibility for each County Referral Hospital and Sub-county Referral
Facilities. The CHMT will plan, supervise, coordinate, and monitor service delivery in this area.
The county health management team will coordinate health services at the county level and will have an imple-
menting arm at the sub - county level to oversee service provision in all levels at their respective sub - counties.
Hospitals will have hospital management teams to supervise health service provision and ensure that services of-
fered are of the highest attainable standards. Primary health care facilities will be headed by technical staff. Service
provision at the community level will be overseen by community health extension officers who will supervise the
community health workers.
For effective governance and social accountability to the community, county and sub county hospitals will have
health management committee and primary health facilities will have facility management committees. Service
provision at the community level will be overseen by community health committees. Their main responsibility will
be to represent the community at the various tiers of service provision ensuring the rights-based approach in health
care delivery is realized. They will oversee implementation of activities and approve budgets and assist in resource
mobilization for health services.

1. Health Good WIll Ambassador, Isiolo County: An emminent personality from the county, of such training, ex-
posure and experience to be able to provide high level advocacy and resource mobilization for health sector.

2. Friends of Health, Isiolo County: These are distinguished professionals of diverse backgrounds including
health and other high level management experience, head hunted and selected because of outstanding ca-
reer in defined line and is willing to give back to the society through structured engagements.

3. County Health Resource Mobilization Council, Isiolo County: In an effort to supplement the limited resourc-
es available to the health sector through the county, there shall be an established County Health Resource
Mobilization Council which will develop resource mobilization strategy and conduct high level resource mo-
bilization towards scale up of health service delivery.

The health sector will develop a policy document that will establish and operationalize the above organs.

www.isiolo.go.ke 59

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

4.2 Monitoring and Evaluation Plan

This M&E chapter focuses on how the sector will at- measuring progress against set targets. The indicators,
tain the stewardship goals needed to facilitate achieve- which will be three in number, will be used in two ways:
ment of the HIS investment priorities. In order for the
county to track the progress performance, there will be a. Sector-wide indicators:
an evaluation plan with detailed criteria for measur- These indicators will be used to inform on progress at
ing performance. M&E will be done at the operations the strategic level. Collection and monitoring of pro-
and strategic level. At the strategic level the monitoring gress will be the responsibility of the entire health sec-
process will be in line with monitoring support towards tor.
the strategic objectives of the overall health sector. On
the other hand, the operational monitoring will focus b. Programme indicators:
on monitoring progress towards the strategic priorities These are indicators used by various program areas to
using one monitoring framework and indicator interve- inform progress towards programme objectives. The
tions to measure progress. number will depend on the particular programme area.
Monitoring of progress will be the
Strategic Monitoring responsibility of the respective programme area.
Strategic monitoring will be done at the midterm and
end term of this plan period while mid-term review will c. County specific indicators:
coincide with the formal articulation of the strategic These are indicators that will be unique to the county for
policy objectives of the health sector. It will include:- monitoring the progress on the county specific interven-
tion targets. The overall purpose of the M&E framework
• Reviewing progress made and identifying the cha is to improve on the accountability of the Health Sector.
lenges and strategies for acceleration of program This shall be achieved through a focus on strengthen-
activities and ing of the County capacity for information generation,
validation, analysis, dissemination and use through ad-
• Incorporating any realignment of the strategic dressing the priorities as outlined in the Health Infor-
priorities with the policy framework. The process mation System investment section of this document.
of strategic monitoring will be done jointly by all These stewardship goals are:
stakeholders including the health partners in the
county. Each level of service delivery will carry out 1. Supporting the establishment of a common data
its own monitoring and evaluation. architecture for the health sector

Operational monitoring 2. Enhancing sharing of data and promoting informa-
This will be continuous activity carried out on monthly, tion use at all levels
quarterly and annual basis. It will focus on monitoring
progress against interventions and activities set out 3. Improving the performance monitoring and review
in the annual work plans. Indicators will be utilized in processes at county, sub county and facility levels

60

Comprehensive Monitoring and Evaluation Plan

A Comprehensive M&E Plan will be developed clearly needs in the county, the timeline and the human
defining the extent of investment and support that the resources that will be devoted to implementing the
County will put in place to ensure the realization of this M&E strategies
strategy. The Monitoring and Evaluation Plan to be de- • Outline activities that will support the health infor-
veloped shortly after the completion and adoption of mation systems at all levels
this strategy will: • Describe an evaluation plan that addresses how
and when the baseline assessments will be con-
• Provide a brief description of the county health vi- ducted and when the mid-project and end-line
sion and strategy and its results framework evaluations will be conducted
Detailed M&E operational plans will be developed at
• Describe the components of health management departmental, section and health facility level that will
system including the process and implementation be used as an internal document to provide additional
strategy to collect, analyze and use health data as guidance health leaders and staff on M&E activities and
well as the county’s M&E needs by program area/ responsibilities.
strategic objectives.

• It will describe the range of activities that will be
undertaken to satisfy those health sector data

4.2.1 Data architecture

The county M&E unit will carry the mandate of estab- and challenges experienced in implementation. This
lishing and overseeing the common data architecture by will form basis of plans of the upcoming quarter for each
use of DHIS platform for aggregate data and Electronic health care level.
Health Records System. This will ensure the presence of In the last quarter the annual performance meeting
a coordinated information generation; data and infor- quarterly reports will be reviewed which will form the
mation sharing and efficiencies are maximized in data basis for annual performance and identify new priori-
and information management. The health sector has ties/targets for planning implementation in the subse-
identified sector indicators for monitoring and evaluat- quent year.
ing the implementation of county Health Sector Strate- In addition to the annual performance report, there will
gic and Investment Plan (HSS&IP). The common data be special surveys such as patient exit surveys, quality
architecture will provide the data sources for these indi- audits, research and assessment which shall be conduct-
cators as defined in the health sector indicator manual. ed by the Sub County and County Health Management
The county Monitoring and evaluation unit shall be Teams in collaboration with development partners.
strengthened and information system in the various
departments integrated for production of monthly,
quarterly and annual reports using data from the DHIS
and other credible sources. The county M&E unit will be
directly linked to each health facility in the county and
aggregate all health data at the central resource center.
At the end of each quarter, performance reports will be
analyzed to assess progress and highlight challenges in
implementing the various activities outlined in this stra-
tegic plan. To ensure performance reporting is accurate
and timely, the different levels of health system in Isiolo
County shall compile their reports on a monthly basis
and submit them by the 5th day of the following month.
The report will then be presented to the sub-County and
County Health Teams, together with other stakeholders
in the health sector to review progress and identify gaps

www.isiolo.go.ke 61

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

4.2.2 Data and statistics service delivery. In order to achieve an acceptable
level of evidence based decision making, it is ex-
The sector recognizes the fact that different data is used pected that facilities will be able to analyze its data
by different actors for their decision making processes (selfassessment) self before the same is shared
and investment decisions. For this, data need to be with other stakeholders including the sub county
translated into information that is relevant for decision- level.
making and use by county citizens. Data will be pack- • Quarterly Performance Review
aged and disseminated in formats that are determined Quarterly report shared with CHMT, SCHMT, Pri-
by the needs of the stakeholders. mary health care facility and community unit level.
The County health sector recognizes that data use in de- • Annual status of health in Isiolo County
cision making is important. Thus they seek ways to pack- Annual Performance reports will be shared with
age it and disseminate it appropriately to its stakehold- CHMT, SCHMT, Primary health care facility and the
ers and other partners in the County. This will be done community unit level.
as follows:

• Sharing service delivery expectations
Data sharing will be done at different levels of

4.2.3 Performance Monitoring and Evaluation

• All performance reviews and evaluations will con- meetings. The discussion will focus on a review of the
tain specific, targeted and actionable recommen- findings and the agreed action points. The final report
dations; the process will be outlined in the County will be submitted to the next level of reporting.
Health M&E framework
Annual Work Plan
• All institutions will provide a response to the During the five year strategic period the health manage-
recommendation(s) within a stipulated timeframe. ment team shall implement the activities through an
annual work planning at different levels.
• All the planning units and institutions will be re- The planning and M&E unit which will be formed at
quired to maintain implementation tracking Plan the sub county and county levels and will translate data
and information according to the targets set and perfor-
• The implementation of the agreed actions will be mance review through various communication channels
monitored by the planning and M&E unit at all to disseminate the information to all the stakeholders.
levels with coordination and oversight from County The plan shall be shared through the county assembly
Health Management. and County government.

Monitoring and Evaluation of Health activities in Isiolo Joint Assessments at the Community level
County will be conducted annually and quarterly based A community unit’s stakeholder forum will be responsi-
on Data collection, dissemination and performance ble for the joint assessment at the community level. All
analysis. health actors at community level will be expected to: 1)
The sector recognizes the fact that different data is used Strengthen the community health committees 2) The
by different actors for their decision making processes community stakeholder forums for which are the key
and investment decisions. For this, data need to be forums for joint assessment at the community level 3)
translated into information that is relevant for decision- revitalize the community dialogue and action days.
making and use by county citizens. Data will be pack- The meetings above shall in line with the sector plan-
aged and disseminated in formats that are determined ning and performance review cycle. Quarterly meet-
by the needs of the stakeholders. ings will be held to review the performance of the units
against the indicators and targets developed. The M and
Quarterly Performance Review Reports E results are expected to be used to sensitise the com-
At all levels a performance review reports will be pro- munity and accountability through community barazas
duced outlining the performance against the strategic and other forums.
objectives outlined in this plan. The reports will be dis-
cussed by the health management teams including all
the stakeholders at the quarterly performance review

62

SECTION 5: RESOURCE REQUIREMENTS AND
FINANCING

5.1 Resource requirements

The county requires adequate resources financial allocation for it to realize universal access to essential care pack-
age that need to be improved through stronger partnership among the Government, civil society, and consumers.
The county’s concern is to focus on how well the system will meet the expectation of the clients by improving access
to financial resources and thus quality services achieved.

The county will involve concepts
such as long term cost effective-
ness, maintenance of quality, eq-
uity of resource allocation and to
observe effectiveness in providing
health services. Sustainability is
focused by designing and imple-
menting a model of healthcare
financing that is affordable, con-
sidering cost containment, prior-
itizing special cohort. These can be
realized by focusing sustainability
of health systems, generation of
demand of services and health
care providers willingness to prac-
tice healthy behavior hence sus-
tainability of demand.
The county requires a system that
favors financial sustainability by
allocating sufficient reliable fund-
ing to maintain the planned health
services. The planning team will
follow the planning process that
provides enabling environment
to sustain achievements through
stakeholders analysis and to devel-
op sustainable county health re-
source envelop to sustain planned
health services within the county.

www.isiolo.go.ke 63

Orientation Intervention Units Qty Rate ( Kshs) Total Annual
area resource re-
4,500,000 quirements
Service delivery Community Strengthen 18 semi functional 18 500,000 25,000,000 Yr 2 Yr 3 Yr 4 Yr 5
services community units 25 1,000,000 12,000,000 Yr 1 4,500,000 0 00
Outreach services Establish 25 functional com- 1200 10,000 20,000,000 4,500,000
Supportive su- munity units 80 250,000 12,000,000
pervision to lower Conduct integrated outreach 80 150,000 2,500,000 5,000,000 10,000,000 5,000,000 3,000,000 2,000,000
units visits 5 500,000
On the job train- Quarterly support supervision 2,500,000 2,400,000 2,400,000 2,400,000 2,400,000 2,400,000
ing by 8 trainings 500,000 10,000,000
Emergency 2,000,000 4,000,000 4,000,000 4,000,000 4,000,000 4,000,000
preparedness On job training of health work- 3 9,000,000
planning ers to continuously improve 6 3,000,000 12,000,000 2,400,000 2,400,000 2,400,000 2,400,000 2,400,000
skills 36 2,000,000 18,000,000
Patient Safety Develop emergency prepared- 35 500,000 3,500,000 0 2,500,000 0 0 0
initiatives ness and response plan and roll 100,000
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18out to sub counties 1,250,000 1,250,000 0 00
642,000,000 2,000,0002,000,000 2,000,000 2,000,000
Train 320 health workers(80%)
on IDSR 0 3,000,000 3,000,000 3,000,000 0
Secure contingency funds for
emergency preparedness-Pro- 2,000,000 4,000,000 4,000,000 2,000,000 0
cure and preposition emer- 4,000,000 3,500,000 3,500,000
gency supplies for outbreak 3,500,000 3,500,000 1000,000 500,000 500,000
preparedness
Establish kalaazar diagnostic 500,000 1000,000
and treatment centre at Merti,
Garbatula & Sericho
Construct an incinerator in 6
hospitals
Construct burning chambers all
primary facilities
Construct placenta pits in facili-
ties (35)

Orientation Intervention Units Qty Rate ( Kshs) Total Annual www.isiolo.go.ke 65
area resource re-
quirements
Purchase and install fire 130 30,000 3,900,000 Yr 2 Yr 3 Yr 4 Yr 5
extinguisher in 23 facilities (6 Yr 1 750,000 1,500,000 900,000 0
hospitals & 17 HCs) 600 750,000
Purchase coded bins for all 360
Therapeutic com- health facilities 1000 120,000 120,000 120,000 120,000 120,000 120,000
mittee meetings Support monthly therapeutic - 3,000 1,080,000 216,000 216,000 216,000 216,000 216,000
and follow up committee meetings in all
Clinical audits hospitals 6 - 500,000 100,000 100,000 100,000 100,000 100,000
(including mater- Form and strengthen maternal/ 7
nal death audits) neonatal audit committee at - 500,000 3,000,000 3,00,000 0 0 00
Referral health all tiers 9,000,000 63,000,000
services Rehabilitate the 6 broken down 180 - 15,000,000
ambulance
Purchase new ambulance for 18,000,000 27,000,000 18,000,000 0 0
referral services
Set aside funds for operation 3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
and maintenance of ambu-
lances 100,000 18,000,000 3,600,000 3,600,000 3,600,000 3,600,000 3,600,000
Conduct monthly reverse
referrals by specialists to Merti,
Garbatula and Oldonyiro

Health Infra- Physical in- Construct new dispensaries 8 5,000,000 40,000,000 10m 20m 5m 5m
structure (physi- frastructure: Complete with staff houses
cal infrastruc- construction of
ture, equipment, new facilities
transport, ICT

Operationalize 6 unopened 6 1m 6m 3m 3m
CDF built facilities

Orientation Intervention Units Qty Rate ( Kshs) Total Annual
area resource re-
quirements
Yr 2 Yr 3 Yr 4 Yr 5
Yr 1 50m 50m 50m 50m

Upgrade 4 health centres to 4 50m 200m
hospital status 50m 50m
50m 50m
Renovation/Facelift Isiolo 1 3m 3m 50m
county referral hospital 2.5m 5m

Construct perimeter fence 1 15m 15m 0 50m 0 00
around Isiolo DH 5m 25m 0 00
0 00
Completion of mental unit in 1 50m 50m 3m
IDH - 12m
50m 0
Renovate, equip and opera- 2 5m 0
tionalize Merti and Garbatula 50m 0
theatres 50m 0
30m 30m
Fully equip the theatre at Isiolo 1 0 5m 10m 0 0
county referral hospital 15m 15m 5m 5m 5m 5m 5m

All facilities to have specific all
contract maintenance for all
major equipment.
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
66County Administration block 10 25m25m 00
for county health department 0 3m
00
Procure and run Nomadic clin- 3 3m 3m 3m
ics in the 3 sub counties

Construct and equip 6 bed 1 25m 25m 0
ICU unit in the county referral
hospital

Construct and equip 6 bed renal 1 00 0 25m 25m
unit in county referral hospital 00
0 15m
Construct and equip new born 1 25m 25m 0
unit at county referral hospital

Construct and equip blood 1 15m 0 0
transfusion centre at Isiolo
county referral

Construct and equip a modern 1 00 15m 0 0
pharmaceutical warehouse at
county referral hospital

Orientation Intervention Units Qty Rate ( Kshs) Total Annual www.isiolo.go.ke 67
area resource re-
quirements
Construct and equip laboratory 20 10m 200m Yr 2 Yr 3 Yr 4 Yr 5
units in 20 health facilities 5m 200m Yr 1 46m 50m 50m 50m
50m 250 4m
40m 40m 40m
Construct and equip maternity 40 500m 500m 40m 40m
units in 40 health units 50m 50m 50m
1.4m 80m
Construct and equip imaging 5 50m 50m
departments at 5 new hospitals
and modern equipment

Mordernize and acquire 1 50m 150m 150m 100m 100m
MRI,CTscan and imaging ma-
chine at county referral hospital

Physical infra- All facilities routinely main- 56 45m 5m 10m 10m 10m
structure: Main- tained with major renovation 20m 25m 27.5m 30.25m 33m
tenance base on assessment

Physical infra- Upgrade 13 dispensaries to 13 5m 65m 13m 13m 13m 13m 13m
structure expan- Health centres
sion of excisiting 1 250m 100m 100m 50m
faclities Construct 1 medical training 30 12m 2.4m 2.4m
Equipment: college at Isiolo 400,000 2.4m 2.4m 2.4m
Purchase -Purchase of solar equipment
- lighting and solar fridge @
400,000 for 30 facilities

Equipment: Note. all 10m 50m 10m 10m 10m 10m 10m
Maintenance and For other equipments cost was
repair combined with construction in
infrastructure table above.
Equipment: Maintenance and
repair (10m per annum, alloca-
tion for facilities will be based
on needs)

Orientation Intervention Units Qty Rate ( Kshs) Total Annual
area resource re-
quirements
Transport: pur- Transport: purchase 68 4,5000 30.6m Yr 2 Yr 3 Yr 4 Yr 5
chase -Target – 2 motorbikes per com- 10 8m 80m Yr 1 5.85m 5.85m 5.85m 5.85m
Transport: munity unit x 34 (450,000) 7.2m
Maintenance and -Purchase of 10 utility vehicles all 100,000 10m
repair (Land Cruiser) @8m (CHMT -1; 333,000 - 32m 32m 8m 8m
ICT equipment: DHMTs – 3; 1 per Hospital x 2) 6 - 20m
Purchase -Functionalization of existing 20 - 6m 2m 2m 2m 2m 2m
utility vehicles 200 30M 20m
ICT equipment: Transport: Maintenance and 6 2m - --
Maintenance and repair 2.5Bn
repair -The vehicles to have service 242m
contract for 3M
All vehicles
Automation of Isiolo County
Referral Hospital,
Automation of GDH
Automation of Merti Dist Hosp
and 3 more new hospitals
Purchase 10 LCD and Photo-
copiers in all
Purchase of lap tops and desk
tops with printers based on
needs.
Install Full time Internet router
for all tier 3 hospitals
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18 20m
686m

2m 10m 5m 3m

1m - - 1m

Health Work- Recruitment of Recruitment of new staff 600 500m 500m 500m 500m 500m
force new staff (600-different carders) in 5 - 243M 244M 245M 7.5M 6M
years 100 5.75m 6M 7.5M

Personnel emolu- Emoluments of existing staff
ments for exist- for 5 years
ing staff

Pre-service train- Target 100 students @
ing Ksh.300000 for 5yrs

Orientation Intervention Units Qty Rate ( Kshs) Total Annual www.isiolo.go.ke 69
area resource re-
quirements
In service train- Target 150 staffs for training in 150 450,000 67.5m Yr 2 Yr 3 Yr 4 Yr 5
ings 5 years @Ksh.450000 415 5000 Yr 1 15.75M 15.75M1 15.75M 13.5M
Staff motivation Performance based rewards 415 11m 6.75M
staff @5000 2.2M 2.2M 2.2M
10m 2.2M 2.2M

Health informa- Data collection: Registers 10,000 1000 9.6m 2m 2m 2m 2m 2m
tion routine health
Printing of data collection and 19,200 500 10m 1.92m 1.92m 1.92m 1.92m 1.92m
information reporting tools for 56 facilities. reams 50,000 2m 2m 2m 2m 2m
Equipments for electronic 0.8m
Data collection: Medical Records in all tier 3 200 40,000 3m 100,000 0.2m 0.4m 0.1m -
vital events computer 60,000 2m 1m 1m 1m - -
(births, deaths) printers with scanners 20 5,000 185,000 - 2m - - -
Data collection: laptops 50 600,000 12m 185,000 - - - -
health related connectivity 2.4m 2.4m 2.4m 2.4m 2.4m
sectors Mobile phones 37 250,000 222,000
ICT Equipments Maintenance 5m 2.5m 44,400 44,400 44,400 44,400 44,400
& repair 37 1m 15m - 1.5m 0.5m 0.5m -
Airtime 10 5m 5m - 3m 6m 6m
High Frequency Radio 3 15m 1m 1m 1m 1m 1m
Data storage ,bank and back up 5 1000 - 5m 5m 5m -
M$E –AWP develop,5 trainings 15 50,000 0.5m
Training on DHIS,ICD-10 and 100,000 100,000 100,000 100,000 100,000
EHR-5trainings each. 0.64m
Forms BI&D1logistics support
1.95m
Sensitize CUs on births report- 32 0.1m 0.2 0.1m 0.1 0.1m
ing 39 150,000 0.45m 0.45m 0.45m 0.45m
Intersectoral collaboration
meetings

Orientation Intervention Units Qty Rate ( Kshs) Total Annual
area resource re-
quirements
Data collection: Surveillance reporting tools 200 500 500,000 Yr 2 Yr 3 Yr 4 Yr 5
Surveillance 49m Yr 1 100,000 100,000 100,000 100,000
Data collection: 30m 100,000
Research 75m 11m 11m 11m
Nutrition survey 30 1.6m 30m 4.5m 11m
Data analysis 40m 9m 9m 9m
Coverage survey 30 1m 10m 3m 9m 16.9 16.9 16.9
Information dis- Operational research 30 2.5m 9m 7.5m 16.9 9m 9m 9m
semination Impact/evaluation research 30 1m 4.8m 3m 9m 5m 5m 5m
Mentorship/OJTquaterly for 5 20 visits - 1.05B 5m 5m
years. 2m 2m 2m
Integrated DQA for all 20 50,000 500m 2m 2m
CHMT,DHMT TO 56 FACILITIES 960,000 1.8m 1.8m 1.8m
Monthly information dissemi- 180 meet- - 1.8m 1.8m
nation meetings ings 1M 960,000 960,000 960,000
CNTF 60 960,000 960,000
-
Health Products Procurement ofIsiolo County Health Strategic & Investment Plan 2013/14 - 2017/18Procure county health productDepend---50m 250m250m250m250m
required health 70on quarterly basis TARGETing with100m
products 250M per year(arvs, drugs, non- needs.
pharm, HIV ,lab reagents 500m
Procurement of therapeutic 100m 100m 100m 100m 100m
and supplementary nutrition
commodities

-- -- -
1M 1M 1M
Distribution of Cost of distributing health 5M 1M
health products products to county health facili- -- -
ties on quarterly basis - -- -
-
Draw up an annual distributon
schedule for all health products -
in the county

Establish and operationalize -
a county Health commodities
security team

Orientation Intervention Units Qty Rate ( Kshs) Total Annual www.isiolo.go.ke 71
area resource re-
5m 15 quirements
Train 150 Health workers an- 150 1.5m 3m Yr 2 Yr 3 Yr 4 Yr 5
nually on commodity manage- 3m 1m 2m Yr 1 5m 5m 5m -
ment 2m -
Creation of county pharmaceu- 20 5m
tical information management - 1.5m 1.5m - -
system (PMIS) & LMIS) 100,000
Purchase of County Laboratory 500,000 2m
Information system(CLMIS)
Monitoring tools 1m 1m 1m 1m 1m
rational use of Conduct quarterly supportive
health products supervision
(CHMT&DHMT)

Develop an essential Medicines 100,000 100,000 100,000 100,000
and list and Formulary for use
by all County Health facilities - 500,000 - - -
Establish and operationalize a
county medicines and Thera-
peutic committee

Health Financ- Costing of health Purchase of software for finan- 1m 1m 1m
ing service provision cial management 200,000
Resource mobili- Conduct budget preparation 5 800,000 200,000
zation Initiate fund raising strategies 8 100,000 1m 100,000 200,000 200,000 200,000 200,000
200,000 100,000 100,000 100,000 100,000
Health expendi- Have a well-coordinated and 5 25m 200,000
ture reviews mapped stakeholders inventory 1m 200,000 200,000 200,000 200,000
in place

Quarterly finacial audits 25 5m 5m 5m 5m 5m

Orientation Intervention Units Qty Rate ( Kshs) Total Annual
area resource re-
quirements
Leadership and Annual health Information dissemination 5 1M 5m Yr 2 Yr 3 Yr 4 Yr 5
Governance stakeholders through DHIS 20 1m 60m Yr 1 1m 1m 1m 1m
meeting a 56 5000 1.4 1m
Quarterly Coordi- Data sharing in 56 GOK/FBO
nation meetings facilities during monthly meet-
ings
Monthly man- Conduct monthly management
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18agement meet- 3m 3m 3m 3m 3m
72ings
280,000 280,000 280,000 280,000 280,000

5.2 Available financing and financing gapsCategory Source of fundsEstimatedPurpose (tick where appropriate)*
Amounts
This section details available financing and financing gaps.Service deliv- HumanHealth In- HealthHealthHealth Fi- Un-specified
350,000,000 ery Resources frastructure Informa- Leader- nancing
5.2.1 Secured and probable resources ship
245,000,000 tion
www.isiolo.go.ke 73
Public County Government
Sources
National Government
HSF/HSSF 8,400,0000 5,880,000 2,520,000 662,404 170,000 8,470,595
LATF 32,000,000 16,758,992 5,784,376 153,633
User fees

Constituency Development
Fund
Other (specify)

Develop- International Medical 15,900,000 15,900,000
ment Corps(IMC)
Partners 20,222,241 20,222,241
FBO Aphia Imaarisha
ACF 20,000,000 5,400,0000 6,400,000 5,700,0000 2,500,000
World Vision
Kenya Red Cross
UN agency (UNICEF)
UN agency (WFP)
Food For The Hungry(FH)
PSI
Child Fund
Catholic Dioceses Of Isiolo
Al-Falah Islamic Centre
Anglican Church of Kenya
(ACK) Diapensary

Other (specify)

TOTAL

Orientation Intervention area Year 1 Year 2 Financing gaps Year 4 Year 5
Service delivery 4,500,00 4,500,000 0 0
Community services 2,400,000 2,400,000 Year 3 2,400000
Outreach services 0 0 0 4,000,000 4,000,000
Supportive supervision to lower units 2,4000,0000 2,400,000 2,400,000 2,400000 2,400,000
On the job training 0 0 4,000000 0 0
Emergency preparedness planning 120,000 120,000 2,400,000 120,000 120,000
Patient Safety initiatives 216,000 216,000 2,500,000 216,000 216,000
Therapeutic committee meetings and follow up 100,000 100,000 120,000 100,000 100,000
Clinical audits (including maternal death audits) 0 0 216,000 0 0
Referral health services 100,000
0
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
Health Infrastructure (physical infra- Physical infrastructure: construction of new facilities 10,000,000 20,000,000 5,000,000 5,000,000 5,000,000
5.2.2 Distribution, and financing gapsstructure, equipment, transport, ICT)
Physical infrastructure: expansion of existing facilities 3,000,000
74Physical infrastructure: Maintenance5,000,0003,000,000000
Equipment: Purchase 5,000,000 5,000,000 5,000,000 5,000,000 5,000,000
Equipment: Maintenance and repair 144,000,000 10,000,000 0 0 0
Transport: purchase 7,200,000 286,000,00 345,000,000 290,000,000 265,000,000
Transport: Maintenance and repair 2,000,000 37,850,000 37,850,000 13,850,000 13,850,000
ICT equipment: Purchase 8,000,000 2,000,000 2,000,000 2,000,000 2,000,000
ICT equipment: Maintenance and repair 1,000,000 30,000,000 5,000,000 3,000,000 0
0 0 1,000,000 0

Health Workforce Recruitment of new staff 5,000,000 5,000,000 5,000,000 5,000,000 5,000,000
Personnel emoluments for existing staff 0 321,360,000 331,000,800 340,930,824 351,158,748.72
Pre-service training 5,750,000 6,000,000 7,500,000 7,500,000 6,000,000
In service trainings 6,750,000 15,750,000 15,750,000 15,750,000 13,500,000
Staff motivation 2,200,000 2,200,000 2,200,000 2,200,000 2,200,000

Health information Data collection: routine health information 10,649,400 22,064,400 22,264,400 20,964,400 9,364,400
Data collection: vital events (births, deaths) 200,000 300,000 200,000 200,000 200,000
Data collection: health related sectors 150,000 450,000 450,000 450,000 450,000
Data collection: Surveillance 7,600,000 20,100,000 20,100,000 20,100,000 20,100,000

Orientation Intervention area Year 1 Year 2 Financing gaps Year 4 Year 5 www.isiolo.go.ke 75
10,500,000 25,900,000 25,900,000 25,900,000
Health Products Data collection: Research 7,000,000 7,000,000 Year 3 7,000,000 7,000,000
Health Financing Data analysis 1,800,000 1,800,000 25,900,000 1,800,000 1,800,000
Leadership and Governance Information dissemination 7,000,000
1,800,000 21,384,770
Procurement of required health products 3,000,000
Warehousing / storage of health products 190,000,000 195,700,000 20,157,100 20,761,913 35,566,078
Distribution of health products 3,000,000 3,000,000 3,000,000 3,000,000 427,693
Monitoring rational use of health products 31,600,000 32,548,000 33,524,440 34,530,173
380,000 391,400 403,142 415,236 450,204
Costing of health service provision 5,672,564
Resource mobilization 400,000 412,000 424,360 437,091 5,627,544
Health expenditure reviews 5,040,000 5,191,200 5,346,936 5,507,344
5,000,000 5,150,000 5,304,500 5,463,635 600,000
Annual health stakeholders for a 400,000
Quarterly Coordination meetings 600,000 600,000 600,000 600,000 1,219,200
Monthly management meetings 400,000 400,000 400,000 400,000 1,800,000
Annual Work Planning and reporting 1,219,200 1,219,200 1,219,200 1,219,200
1,800,000 1,800,000 1,800,000 1,800,000

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

5.3 Resource mobilization strategy

5.3.1 Strategies to ensure available resources are

sustained

The planning team will ensure the following 4. The planning team will ensure improving efficiency
1. Secured resources: The planning team to adhere to by shifting funds to areas where greatest impact is
requirements of the source of financing for plan- possible (allocate efficiency) and maximizing use
ning and monitoring and evaluation of available fund (Technical efficiency)
2. Probable resources: the planning team to develop
proposals and other requirements by specific 5. Establishment of a quality assurance Committee in
sources to secure the resources all facilities and ensure their functionality
3. The planning team to address the financing gaps
focusing to mobilize required resources using ad- 6. Establish procurement committees in the facilities
vocacy communication of deliverables to oversee procurement processes so that stand-
ards are met.

5.3.2 Strategies to mobilize resources from new sources

Several feasible strategies will be put in place to lobby and lobby for their support of some of the health
for resources from different sources in order to address projects within the county
the existing financing gap shown above. These include: 4. Proper problem analysis and widely shared with all
stakeholders
1. Stakeholders analysis/mapping to discuss and 5. Lobbing for NHIF approval for all the referral facili-
share among them as per their area of interest. ties and health centers so as to boost the financing
mechanism from services provided
2. Development of annual work plan and shared with
partners

3. Development of proposals to the willing partners

5.3.3 Strategies to ensure efficiency in resource

utilization

There is need to emphasize efficiency to ensure spend- possible minimum resources. The standards set out in
ing the least amount to generate desired health out- the Laws of Kenya will guide procurement and other ac-
put or generating maximum amount of health outputs tivities in order to facilitate accountability and efficiency
with available resources. The county ensures that health in managing the resources.
systems is producing health services in quantities and
qualities that society needs guided by allocative effi-
ciency and producing it to the lowest possible cost hence
technical efficiency observed.
The county planning unit will come up with a team that
will follow monitoring of the activities, the inputs, pro-
cess, output, outcome and impacts. Routine monitoring
activities will be carried out at the different stages of
each planned activity, at a frequency set out by the plan-
ning team, with and aim of achieving the targets at the

76

ANNEX 1: INVESTMENT AREAS SCOPE, AND CODES

Code Orientation Code Intervention area
1 Service delivery 1.1 Community services
1.2 Outreach services
2 Health Infrastructure
1.3 Supportive supervision to lower units
3 Health Workforce 1.4 On the job training
4 Health information 1.5 Emergency preparedness planning
5 Health Products 1.6 Patient Safety initiatives
1.7 Therapeutic committee meetings and follow up
1.8 Clinical audits (including maternal death audits)
1.9 Referral health services
1.10 Other
2.1 Physical infrastructure: construction of new facilities
2.2 Physical infrastructure: expansion of existing facilities
2.3 Physical infrastructure: Maintenance
2.4 Equipment: Purchase
2.5 Equipment: Maintenance and repair
2.6 Transport: purchase
2.7 Transport: Maintenance and repair
2.8 ICT equipment: Purchase
2.9 ICT equipment: Maintenance and repair
2.10 Other
3.1 Recruitment of new staff
3.2 Personnel emoluments for existing staff
3.3 Pre-service training
3.4 In service trainings
3.5 Staff motivation
3.6 Other
4.1 Data collection: routine health information
4.2 Data collection: vital events (births, deaths)
4.3 Data collection: health related sectors
4.4 Data collection: Surveillance
4.5 Data collection: Research
4.6 Data analysis
4.7 Information dissemination
4.8 Other
5.1 Procurement of required health products
5.2 Warehousing / storage of health products
5.3 Distribution of health products
5.4 Monitoring rational use of health products
5.5 Other

www.isiolo.go.ke 77

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18

Code Orientation Code Intervention area
6 Health Financing 6.1 Costing of health service provision
6.2 Resource mobilization
7 Leadership and Gov- 6.3 Health expenditure reviews
ernance 6.4 Other
7.1 Annual health stakeholders for a

7.2 Quarterly Coordination meetings
7.3 Monthly management meetings
7.4 Annual Work Planning and reporting
7.5 Other

78

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements www.isiolo.go.ke 79
10,000,000.00
Community ser- Strengthen 20 20 500,000.00 25,000,000.00 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
vices semi functional 25 1,000,000.00 12,000,000.00 5,000,000.00 5,000,000.00 - - -
Outreach services community units 1200 10,000.00 20,000,000.00 5,000,000.00
Supportive su- Establish 25 func- 80 250,000.00 12,000,000.00 2,400,000.00 10,000,000.00 5,000,000.00 3,000,000.00 2,000,000.00
pervision to lower tional community 80 150,000.00 2,500,000.00 4,000,000.00
units units 5 500,000.00 2,400,000.00 2,400,000.00 2,400,000.00 2,400,000.00 2,400,000.00
On the job training Conduct integrat- 8 train- 2,500,000.00 - 4,000,000.00 4,000,000.00 4,000,000.00 4,000,000.00
ed outreach visits ings 500,000.00 10,000,000.00
Emergency prepar- Quarterly support 2,000,000.00 1,250,000.00 2,400,000.00 2,400,000.00 2,400,000.00 2,400,000.00
edness planning supervision by 3 9,000,000.00 2,000,000.00
3,000,000.00 2,500,000.00 - --
On job training -
of health workers 1,250,000.00 - --
to continuously 2,000,000.00 2,000,000.00
improve skills 2,000,000.00 2,000,000.00
Develop emer-
gency prepared- 3,000,000.00 3,000,000.00 3,000,000.00 -
ness and response
plan and roll out
to sub counties
Train 320 health
workers(80%) on
IDSR
Secure contingen-
cy funds for emer-
gency prepar-
edness-Procure
and preposition
emergency sup-
plies for outbreak
preparedness
Establish kalaazar
diagnostic and
treatment centre
at Merti, Garbatu-
la & Sericho

Table 4 Tabulation of costs

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements
2,000,000.00 12,000,000.00
Patient Safety Construct an 6 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
initiatives incinerator in 6 2,000,000.00 4,000,000.00 4,000,000.00 2,000,000.00 -
hospitals
Therapeutic com-
mittee meetings Construct burning 36 500,000.00 18,000,000.00 3,500,000.00 3,500,000.00 4,000,000.00 3,500,000.00 3,500,000.00
and follow up chambers all pri-
Clinical audits (in- mary facilities
cluding maternal
death audits) Construct 35 100,000.00 3,500,000.00 500,000.00 1,000,000.00 1,000,000.00 500,000.00 500,000.00
Referral health placenta pits in
services facilities (35)

Purchase and 130 30,000.00 3,900,000.00 750,000.00 750,000.00 1,500,000.00 900,000.00 -
install fire extin-
guisher in 23 fa-
cilities (6 hospitals
& 17 HCs)

Purchase coded 600 1,000.00 120,000.00 120,000.00 120,000.00 120,000.00 120,000.00 120,000.00
bins for all health 3,000.00 216,000.00 216,000.00 216,000.00 216,000.00
facilities

Support monthly 360 1,080,000.00 216,000.00
therapeutic com-
mittee meetings
in all hospitals
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
80Form and--500,000.00100,000.00100,000.00100,000.00100,000.00100,000.00
strengthen ma-
ternal/neonatal
audit committee
at all tiers

Rehabilitate the 6 500,000.00 3,000,000.00 3,000,000.00 -- --
6 broken down
ambulance

Purchase new 7 9,000,000.00 63,000,000.00 18,000,000.00 27,000,000.00 18,000,000.00 - -
ambulance for
referral services

Set aside funds - - 15,000,000.00 3,000,000.00 3,000,000.00 3,000,000.00 3,000,000.00 3,000,000.00
for operation and
maintenance of
ambulances

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements www.isiolo.go.ke 81
100,000.00 18,000,000.00
Conduct monthly 180 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
reverse referrals 3,600,000.00 3,600,000.00 3,600,000.00 3,600,000.00 3,600,000.00
by specialists to
Merti, Garbatula
and Oldonyiro

Physical infrastruc- Construct new 8 5,000,000.00 40,000,000.00 10,000,000.00 20,000,000.00 5,000,000.00 5,000,000.00
ture: construction dispensaries Com-
of new facilities plete with staff

houses

Operationalize 6 1,000,000.00 6,000,000.00 3,000,000.00 3,000,000.00
6 unopened CDF
built facilities

Upgrade 4 health 4 50,000,000.00 200,000,000.00 50,000,000.00 50,000,000.00 50,000,000.00 50,000,000.00
centres to hospital
status

Renovation/ 1 50,000,000.00 50,000,000.00 50,000,000.00
Facelift Isiolo
county referral
hospital

Construct perim- 1 50,000,000.00 50,000,000.00 0 50,000,000.00 0 00
eter fence around 00
Isiolo DH 00

Completion of 1 3,000,000.00 3,000,000.00 3,000,000.00 0
mental unit in
IDH

Renovate, equip 2 2,500,000.00 5,000,000.00 5,000,000.00 00
and operational-
ize Merti and Gar-
batula theatres

Fully equip the 1 15,000,000.00 15,000,000.00 0 5000000 10000000 0 0
theatre at Isiolo
county referral
hospital

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements
5,000,000.00 25,000,000.00
All facilities to all Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
have specific con- 5,000,000.00 5,000,000.00 5,000,000.00 5,000,000.00 5,000,000.00

tract maintenance
for all major
equipment.

County Admin- 1 50,000,000.00 50,000,000.00 0 25,000,000.00 25,000,000.00 0 0
istration block
for county health
department

Procure and run 3 - 12,000,000.00 0 3,000,000.00 3,000,000.00 3,000,000.00 3,000,000.00
Nomadic clinics in
the 3 sub counties

Construct and 1 50,000,000.00 0 0 0 25,000,000.00 25,000,000.00 0
equip 6 bed ICU
unit in the county
referral hospital

Construct and 1 50,000,000.00 0 0 00 25,000,000.00 25,000,000.00
equip 6 bed renal
unit in county
referral hospital
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
82Construct and150,000,000.00 00025,000,000.0025,000,000.00 0
equip new born
unit at county
referral hospital

Construct and 1 30,000,000 30,000,000.00 0 15,000,000.00 15,000,000.00 0 0
equip blood trans-
fusion centre
at Isiolo county
referral

Construct and 1 15,000,000.00 15,000,000.00 0 0 15,000,000.00 0 0
equip a modern
pharmaceutical
warehouse at
county referral
hospital

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements www.isiolo.go.ke 83
10,000,000.00 200,000,000.00
Construct and 20 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
equip laboratory 40 4,000,000.00 46,000,000.00 50,000,000.00 50,000,000.00 50,000,000.00
units in 20 health 5
facilities 5m 200,000,000.00 40,000,000.00 40,000,000.00 40,000,000.00 40,000,000.00 40,000,000.00
Construct and 1
equip maternity 50,000,000.00 250,000,000.00 50,000,000.00 50,000,000.00 50,000,000.00 50,000,000.00 50,000,000.00
units in 40 health 56
units 500,000,000.00 500,000,000.00 50,000,000.00 150,000,000.00 150,000,000.00 100,000,000.00 100,000,000.00
Construct and
Physical infrastruc- equip imaging 1,400,000.00 80,000,000.00 45,000,000.00 5,000,000.00 10,000,000.00 10,000,000.00 10,000,000.00
ture: Maintenance departments at 5
new hospitals and
modern equip-
ment
Mordernize
and acquire
MRI,CTscan and
imaging machine
at county referral
hospital
All facilities
routinely main-
tained with major
renovation base
on assessment

Physical infrastruc- Upgrade 13 13 5,000,000.00 65,000,000.00 20,000,000.00 25,000,000.00 27,500,000.00 30,250,000.00 33,000,000.00
ture expansion of dispensaries to 13,000,000.00 13,000,000.00 13,000,000.00 13,000,000.00 13,000,000.00
excisiting faclities Health centres

Construct 1 1 250,000,000 100,000,000.00 100,000,000.00 50,000,000.00
medical training 30
Equipment: Pur- college at Isiolo 400,000 12,000,000.00 2,400,000.00 2,400,000.00 2,400,000.00 2,400,000.00 2,400,000.00
chase -Purchase of
solar equipment -
lighting and solar
fridge @ 400,000
for 30 facilities

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements

Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
10,000,000.00
Equipment: Main- Equipment: all 10,000,000.00 50,000,000.00 10,000,000.00 10,000,000.00 10,000,000.00 10,000,000.00
tenance and repair Maintenance and
repair (10m per
annum, alloca-
tion for facilities
will be based on
needs)

Transport: pur- Transport: pur- 68 45,000 30,600,000.00 7,200,000.00 5,850,000.00 5,850,000.00 5,850,000.00 5,850,000.00
chase chase Target – 2
motorbikes per
community unit x
34 (450,000)

-Purchase of 10 10 8,000,000.00 80,000,000.00 - 32,000,000 32,000,000 8,000,000.00 8,000,000.00
utility vehicles 2,000,000.00 2,000,000.00
(Land Cruiser)
@8m (CHMT -1;
DHMTs – 3; 1 per
Hospital x 2)
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18
84-Functionalization
of existing utility
vehicles

Transport: Mainte- Transport: Main- all 10,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00
nance and repair tenance and re-
pair -The vehicles
to have service
contract for

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements www.isiolo.go.ke 85
20,000,000.00
Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
- 20,000,000.00 - -
ICT equipment: Automation of 6
Purchase Isiolo County
Referral Hosp,
Automation of
GDH Automation
of Merti Dist Hosp
and 3 more new
hospitals

Purchase 10 LCD 20 6,000,000.00 6,000,000.00
and Photocopiers 200
in all 100,000 20,000,000.00 2,000,000.00 10,000,000.00 5,000,000.00 3,000,000.00
Purchase of lap
tops and desk
tops with printers
based on needs.

ICT equipment: Install Full time 6 333,000 2,000,000.00 1,000,000.00 - - 1,000,000.00
Maintenance and Internet router for 600 -
repair all tier 3 hospitals - 2,500,000,000.00 500,000,000.00 500,000,000.00 500,000,000.00 500,000,000.00 500,000,000.00
Recruitment of Recruitment 100
new staff of new staff 150 - 242,000,000.00 243,000,000.00 244,000,000.00 245,000,000.00
(600-different
Personnel emolu- carders) in 5 years 30,000,000.00 3,000,000.00 5,750,000.00 6,000,000.00 7,500,000.00 7,500,000.00 6,000,000.00
ments for existing Emoluments of
staff existing staff for 5 450,000 67,500,000.00 67,500,000.00 15,750,000.00 15,750,000.00 15,750,000.00 13,500,000.00
Pre-service train- years
ing Target 100
students @
In service trainings Ksh.300000 for
5yrs
Target 150
staffs for train-
ing in 5 years @
Ksh.450000

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements
11,000,000.00
Staff motivation Performance 415 5000 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
Data collection: based rewards 415 10,000 1000 10,000,000.00 2,200,000.00 2,200,000.00 2,200,000.00 2,200,000.00 2,200,000.00
routine health staff @5000 500
information Registers 9,600,000.00 2,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00
50,000
Printing of data 19,200 10,000,000.00 1,920,000.00 1,920,000.00 1,920,000.00 1,920,000.00 1,920,000.00
collection and reams 75,000
reporting tools for 40,000 15,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00
56 facilities. 200 60,000 800,000.00
Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18Equipments for205,0003,000,000.00100,000.00200,000.00400,000.00100,000.00-
86electronic Medical50600,0002,000,000.001,000,000.00
Records in all tier 37 185,000.00 - 1,000,000.00 1,000,000.00 - -
3 hospitals 250,000 12,000,000.00 185,000.00 2,000,000.00 - - -
Purchase comput- 37 5,000,000.00 2,400,000.00 - - - -
ers 10 1,000,000.00 222,000.00 2,400,000.00 2,400,000.00 2,400,000.00 2,400,000.00
printers with 3 5,000,000.00 2,500,000.00 44,400.00
scanners 5 15,000,000.00 - 44,400.00 44,400.00 44,400.00 44,400.00
laptops 15 5,000,000.00 - 1,500,000.00 500,000.00 500,000.00 -
connectivity 15,000,000.00 1,000,000.00
Mobile phones - 3,000,000.00 6,000,000.00 6,000,000.00 1,000,000.00
ICT Equipments -
Maintenance & 1,000,000.00 1,000,000.00 1,000,000.00
repair
Airtime 5,000,000.00 5,000,000.00 5,000,000.00
High Frequency
Radio
Data storage
,bank and back up
M$E –AWP de-
velop,5 trainings
Training on
DHIS,ICD-10 and
EHR-5trainings
each.

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements www.isiolo.go.ke 87
500,000.00
Data collection: Forms Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
vital events (births, BI&D1logistics 100,000.00 100,000.00 100,000.00 100,000.00 100,000.00

deaths) support

Sensitize CUs on 32 1000 640,000.00 100,000.00 200,000.00 100,000.00 100,000.00 100,000.00
births reporting 50,000 1,950,000.00 150,000.00 450,000.00 450,000.00 450,000.00 450,000.00

Data collection: Intersectoral 39 500
health related collaboration 1,600,000.00
sectors meetings 1,000,000.00
2,500,000.00
Data collection: Surveillance 200 1,000,000.00 500,000.00 100,000.00 100,000.00 100,000.00 100,000.00 100,000.00
Surveillance reporting tools - 49,000,000.00 4,500,000.00 11,000,000.00 11,000,000.00
30,000,000.00 3,000,000.00 9,000,000.00 9,000,000.00
Data collection: Nutrition survey 30 75,000,000.00 7500000 16,900,000.00 16,900,000.00 11,000,000.00 11,000,000.00
Research 30,000,000.00 3,000,000.00 9,000,000.00 9,000,000.00
40,000,000.00 5,000,000.00 5,000,000.00 5,000,000.00
Coverage survey 30 9,000,000.00 9,000,000.00
16,900,000.00 16,900,000.00
Operational 30
research

Impact/evaluation 30 9,000,000.00 9,000,000.00
research

Data analysis Mentorship/ 20 visits 5,000,000.00 5,000,000.00
OJTquaterly for 5
years.

Integrated 20 10,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00
DQA for all
Information dis- CHMT,DHMT TO 180 50,000 9,000,000.00 1,800,000.00 1,800,000.00 1,800,000.00 1,800,000.00 1,800,000.00
semination 56 FACILITIES meetings
Procurement of Monthly informa-
required health tion dissemina- 60 960,000 4,800,000.00 960,000.00 960,000.00 960,000.00 960,000.00 960,000.00
products tion meetings Depend- - 250,000,000.00 250,000,000.00
CNTF ing with 1,050,000,000.00 50,000,000.00 250,000,000.00 250,000,000.00
Procure county needs.
health product
on quarterly basis
TARGET 250M per
year(arvs, drugs,
nonpharm, HIV
,lab reagents

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements

Procurement of 500m 100,000,000.00 500,000,000.00 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
therapeutic and 100,000,000.00 100,000,000.00 100,000,000.00 100,000,000.00 100,000,000.00
supplementary
nutrition com-
modities

- - - - - -
1,000,000.00 1,000,000.00 1,000,000.00 1,000,000.00
Distribution of Cost of distribut- 5M 1,000,000.00
health products ing health prod- -
ucts to county
health facilities on
quarterly basis

Draw up an an- - -- --
nual distributon
schedule for all
health products in
the county

Isiolo County Health Strategic & Investment Plan 2013/14 - 2017/18Establish and---- -
88operationalize150
a county Health 3m 5,000,000.00 15,000,000.00 - 5,000,000.00 5,000,000.00 5,000,000.00 -
commodities 2m
security team 1,500,000.00 3,000,000.00 - 1,500,000.00 1,500,000.00 - -
Train 150 Health
workers annually 1,000,000.00 2,000,000.00 2,000,000.00
on commodity
management
Creation of county
pharmaceutical
information man-
agement system
(PMIS) & LMIS)
Purchase of
County Labora-
tory Information
system(CLMIS)
tools

Intervention area Units Qty Rate ( Kshs) Total Annual resource requirements www.isiolo.go.ke 89
5,000,000.00
Monitoring Conduct quar- 20 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
rational use of terly supportive 1,000,000.00 1,000,000.00 1,000,000.00 1,000,000.00 1,000,000.00
health products supervision
(CHMT&DHMT)

Develop an essen- 500,000.00 100,000.00 100,000.00 100,000.00 100,000.00
tial Medicines and
list and Formulary 500,000.00 - 500,000.00 - --
for use by all
County Health
facilities
Establish and
operationalize a
county medicines
and Therapeutic
committee

Costing of health Purchase of soft- 1m 1,000,000.00 1,000,000.00
service provision ware for financial 5
Resource mobili- management 8 100,000.00 1,000,000.00 200,000.00 200,000.00 200,000.00 200,000.00 200,000.00
zation Conduct budget 5 200,000.00 800,000.00 100,000.00 100,000.00 100,000.00 100,000.00 100,000.00
preparation 1,000,000.00 200,000.00 200,000.00 200,000.00 200,000.00 200,000.00
Health expendi- Initiate fund rais- 25
ture reviews ing strategies 5 1,000,000.00 25,000,000.00 5,000,000.00 5,000,000.00 5,000,000.00 5,000,000.00 5,000,000.00
Annual health Have a well- 1,000,000.00 5,000,000.00 1,000,000.00 1,000,000.00 1,000,000.00 1,000,000.00 1,000,000.00
stakeholders coordinated and
meeting a mapped stake-
holders inventory
in place
Quarterly finacial
audits
Information
dissemination
through DHIS