REPUBLIC OF KENYA

Reversing the Trends

The Second National Health Sector Strategic Plan

ANNUAL OPERATIONAL PLAN 5

July 2009–June 2010

Ministry of Public Health Ministry of Medical

and Sanitation Services
Afya House
PO Box 30016 – General Post Office Afya House
Nairobi 00100, Kenya PO Box 30016 – General Post Office
Email: [email protected] Nairobi 00100, Kenya
Website: www.health.go.ke Email: [email protected]
Website: www.health.go.ke

i
Any part of this document may be freely reviewed, quoted, reproduced or
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or used in conjunction with commercial purposes or for profit.

Reversing the Trends: The Second National Health Sector Strategic Plan of
Kenya – ANNUAL OPERATIONAL PLAN 5: JULY 2009–JUNE 2010

Published by: Technical Planning and Monitoring / Coordination Departments

Afya House
PO Box 3469 - City Square
Nairobi 00200, Kenya
Email: [email protected]

Annual Operational Plan 5 – 2009/10 ii

 http://www.health.go.ke

Annual Operational Plan 5 – 2009/10 iii

Foreword

T
his is the fifth Annual Operation plan (AOP 5) of National
Health Sector Strategic Plan II (NHSSP II). It builds and
improves on previous AOPs in terms of accuracy,
specificity, measurability and being realistic. It emphasises on
Specific Ministries Strategic thrusts which are aligned to the
pillars of the Vision 2030.

The plan is based on 8 principles that include timeliness of

planning process, standardised indicators, a mixed top down
bottom up target setting approach, focus on specific planning
units, and harmonisation of plans with budget, linkage of
planning process output, linkage with National Priorities and
linkage with Resource Based Management framework (RBM).
The planning process is institutionalised in the health sector
and linkages between planning and budgeting have improved.

Key focus areas of access, equity, quality, capacity and

institutional framework will be achieved through a devolution
approach that will allocate funds and responsibility for delivery
of health care to hospitals, health centres and dispensaries,
thereby empowering Kenyan households and ensuring
community involvement.

During the implementation period, the Health Sector intends to

strengthen accessibility and quality of health care services
through building the capacity of managers on leadership and
change management, enhanced commodity management,
institutional strengthening, organisational restructuring and
strengthening primary health care services.

The sector has established sound partnership with

implementing partners through their Network HENNET, private
sector and Development Partners. Coordination and
governance structures are well established and working. Four
new members became signatories to the Code of Conduct
signifying growing confidence and good cooperation between
the sector and its partners.

A comprehensive mechanism for monitoring the Code of

Conduct has also been put in place. With CoC, reporting from

Annual Operational Plan 5 – 2009/10 iv

development partners need to be improved to facilitate
effective planning and take forward the process of putting in
place the Joint Financing Arrangements. This will allow GoK
more flexibility to utilise owns funds in areas not covered by
donors funds.

The ongoing global economic slowdown that peaked during

AOP 4 implementation will have an impact on the ability to
deliver on the sector’s planned interventions. Government’s
own ability to mobilize local resources to finance its planned
budget is challenged particularly from sectors directly reliant
on global inflows, such as tourism.

Finally, it is important to note that most of the targets for

service delivery under NHSSP II might not be achieved and
hence the need to redouble the efforts to achieve the set
targets.

Mark K. Bor, EBS Prof. James L. Ole Kiyiapi CBS

Permanent Secretary Permanent Secretary
Ministry of Public health and Sanitation Ministry of Medical Services

Annual Operational Plan 5 – 2009/10 v

Executive Summary

The framework
The AOP 5 planning process, principles, and priority setting has been informed by The
Kenya Vision 2030, the First Medium Term Plan (2008-2012), the second National Health
Sector Strategic Plan (NHSSP II), Joint Programme of Work and Funding, the ‘Roadmap for
Acceleration of implementation of interventions to achieve the Objectives of the NHSSP II,
the Investment Plans for the Ministries of Public Health and sanitation and Medical Services
and the lessons learnt from AOP 4 planning process.

The process
The planning of AOP5 was through a consultative effort. The
main principles that guided the development of the AOP 5 were
timeliness of the planning process, standardized set of
indicators for sector planning and performance monitoring,
mixed top down and bottom up approach to target setting,
focus on specific planning units by service delivery levels,
bottom-up planning; harmonization of the AOP 4 planning and
budgeting processes; linkage of national priorities to
provincial, district and health facility level planning and
linkage of planning with the Government’s Results Based
Management framework.

Based on the above principles, the plan development process

with its timeframe was developed and adopted by the HSCC.
The development process included; revision of planning and
consolidation formats, planning and performance monitoring
indicators; development of planning and appraisal guidelines
and the facilitation manuals; capacity building of members of
planning teams for the different levels of the health system;
development of plans; consolidation at district, provincial and
national levels, peer and vertical appraisal of consolidated
plans and approval of the AOP 5 by the HSCC.

The plan is an improvement to the previous AOPs in terms of;

improved accuracy of sector targets; improved outputs for
management support in terms of specificity, measurability,
accuracy and being realistic. The main challenges are: lack of
a comprehensive resource envelope to guide the planning units
on the available resources for the implementation of the plan;

Annual Operational Plan 5 – 2009/10 vi

and the huge amount of technical and financial resources
required for the bottom-up planning process.

The objectives and priorities

The overall objective guiding delivery of health services during
AOP 5 is to improve the efficiency and effectiveness of the
utilization of available resources, at the implementation level.
This it will attain through scaling up delivery of priority services
for the achievement of NHSSP II objectives, accomplished
through the following specific objectives:
- Scale up strategies for acceleration of implementation of
NHSSP II, as outlined in the Road Map
- Addressing the impact of post election events on delivery
of health services
- Strengthening the governance and partnership processes
- Development of NHSSP III or review/extension of the
NHSSP II
- Development of the new policy framework for the health
sector

The overall priorities for the sector during AOP 5 will be:
1. Continue the scale up of delivery of targeted health
services, in line with reduced sector performance seen
following Post Election Violence. Specific focus shall be
on immunization, Malaria, and TB services.
2. Scale up epidemic control efforts, particularly in relation
to cholera, H1N1 2009, and polio outbreaks
3. Elaborate the framework to guide the hospital sector
reforms, and initiate roll-out of identified quick wins
4. Roll out the process of establishing a model health
centre in each constituency
5. Complete the restructuring process of the National
Hospital Insurance Fund
6. Elaborate the new Health Policy Framework, to guide the sector
towards supporting Vision 2030 attainment
7. The Restructuring of KEMSA by implementation of the task force
recommendations.

The Service delivery Indicators

The Health Sector identified 31 service delivery indicators to be monitored by each
life cycle cohort. As with AOP 4, these have defined by level and ownership from the
national, provincial, district, and facility levels. Efforts are being made to harmonize
Service Delivery Indicators and targets with the Performance Contract Service

Annual Operational Plan 5 – 2009/10 vii

Outcomes to ensure appropriate alignment between Government, and sector
priorities.

The management support for delivering AOP 5 targets

There are 12 targets for efficiency, finance and governance for the sector to be
achieved by implementing this plan. In addition there are outputs set to be delivered
by the national and provincial management support structures. As with the service
delivery targets the management support indicators for AOP 5 have been aligned
with the Performance Contracts of the Ministries.

The Governance of AOP 4 implementation

The health sector coordination and partnership structures for AOP 5 will remain to be
the Health Sector Coordinating Committee, Provincial, District and Divisional Health
Stakeholder fore. The existing signed Code of Conduct will remain the partnership
guiding document. The stewardship for the health sector coordination and
partnership will be provided jointly by the Ministries of Public Health and Sanitation,
and of Medical Services. As such both ministries will work in collaboration and will
be represented equally in the relevant coordination structures.

The governance and partnership processes for AOP 5 have built on the lessons learnt
from the progress so far made on the implementation of strategies aimed at
strengthening partnership for the sector. There are eleven sector governance priority
interventions for AOP 5, aimed at further strengthening of governance and
partnership processes. These priority sector interventions are informed by the
lessons learnt from progress to date on the implementation of NHSSP II strategies for
fostering coordination and partnerships amongst health sector stakeholders.
However, special attention will be given to the following: Development of sector
policy and strategic documents, Joint Financing Agreement, Public Private
Partnership policy; Joint performance monitoring including monitoring adherence to
the Code of Conduct and social accountability; and capacity building for effective
sector leadership and management.

The Financing of AOP 5

The financial resources required for the implementation of the plan is 94 billion
Kenya Shillings. The total financial resources available are 110 billion Kenya
Shillings, of which Ksh -40 billion is on budget, 61 billion off budget, 9 billion is sector
generated. The apparent over-funding is driven by the significant amounts of off-
budget resources, which are usually earmarked for particular uses that may not
necessarily represent the most effective use of the resources. As a result, the sector
still has significant gaps in financing some of its priorities.

Annual Operational Plan 5 – 2009/10 viii

Contents
Foreword ..................................................................................................................................iv
CHAPTER 1: INTRODUCTION........................................................................................12
Focus on Specific Planning Units by Level.....................................................................22
Objectives in AOP 5.........................................................................................................26
Priorities for AOP 5..........................................................................................................26
SECTION II: Work Plans........................................................................................................35
Provincial level plans for Service Delivery and Management Support...........................50
Central Province Health Plans....................................................................................................................50
Eastern Province Health Plans...................................................................................................................55
4.1.4North Eastern Province Health Plans.................................................................................................62
Western Province Health Plans..................................................................................................................68
Nairobi Province Health Plans...................................................................................................................74
Coast Province Health Plans......................................................................................................................77
Nyanza Province Health Plans...................................................................................................................80
Rift Valley Province Health Plans..............................................................................................................86
Public Health and Sanitation management support..........................................................96
Medical Services management support .........................................................................124
Deliverables from parastatals ........................................................................................142
Kenya Medical Supplies Agency.............................................................................................................142
Kenya Medical Research Institute ...........................................................................................................143
National Hospital Insurance Fund ...........................................................................................................146
Kenya Medical Training College ..........................................................................................................146
Kenyatta National Hospital .....................................................................................................................150
Moi Teaching and referral Hospital ........................................................................................................155
Cross-Cutting systems and support services..................................................................163
Human Resources for Health...................................................................................................................163
General Administration............................................................................................................................164
Technical planning and monitoring .........................................................................................................164
Policy and Planning .................................................................................................................................166
Sector Governance ..................................................................................................................................167
Public Financial Management .................................................................................................................169
Accounts ..................................................................................................................................................171
Procurement .............................................................................................................................................172
Performance Monitoring and Health Information Systems ....................................................................173
Internal Audit ..........................................................................................................................................174
Health Care Finance ................................................................................................................................174
Information, Communication Technology ..............................................................................................175
.......................................................................................................................................176
SECTION III: GOVERNANCE AND FINANCING OF THE AOP 5.........................177
Annex 1: Detailed breakdown of resource requirements, financing and financing gap for
AOP 5.................................................................................................................................197

Annual Operational Plan 5 – 2009/10 ix

List of Abbreviations
AIDS Acquired immune deficiency IFMIS Integrated financial
syndrome management information system
ANC Antenatal care IMCI Integrated management of
AOP Annual operational plan childhood illness
ART Anti-retroviral therapy IMR Infant mortality rate
CDF Constituency Development Fund IPT Intermittent prophylactic
CFO Chief Financing Officer treatment (for malaria)
CHW Community health worker JPWF Joint Programme of Work and
CHEW Community health extension Funding
worker JSP Joint Support Programme
CORP Community-owned resource KEPH Kenya Essential Package for
person Health
CP Chief Pharmacist KEMSA Kenya Medical Supply Agency
DCH Division of Child Health KENWA Kenya Network of Women with
DEH Division of Environmental Health AIDS
DFID Department for International KEPI Kenyan Expanded Programme of
Development Immunization
DHP District health plan KNH Kenyatta National Hospital
DHSF District Health Stakeholder Ksh Kenya shilling
Forum LBW Low birth weight
DHMB District Health Management LLITN Long-lasting insecticide treated
Board bed net
DHMT District Health Management MCH Mother and child health
Team MDGs Millennium Development Goals
DMOH District Medical Officer of Health MDR Multi drug resistant
DMST District Medical Services Team M&E Monitoring and evaluation
DMS Director of Medical Services MMR Maternal mortality ratio
DMSO District Medical Services Officer MOMS Ministry of Medical Services
DOMC Division of Malaria Control MOPS Ministry of Public Health and
DRH Division of Reproductive Health Sanitation Services
DSRS Department of Standards and MMU Ministerial Management Unit
Regulatory Services MOU Memorandum of understanding
EHS Essential Health Services MTEF Medium-term expenditure
EMMS Essential Medicines and Medical framework (3-year rolling plan)
Supplies MTPP Medium-term procurement plan
ERS Economic Recovery Strategy (for MTRH Moi Teaching and Referral
Wealth and Employment Hospital
Creation) NASCOP National AIDS and STD Control
EU European Union Programme
FBO Faith-based organizations NBTS National Blood Transfusion
FP Family planning Service
GFATM Global Fund to Fight AIDS, TB NGO Non-government organization
and Malaria NHSSP II Second National Health Sector
GOK Government of Kenya Strategic Plan 2005–2010
GBV Gender Based Violence NLTP National Leprosy and TB
HBC Home-based care Programme
HIV Human immune deficiency virus NPHLS National Public Health
HMIS Health management information Laboratory Services
system PAC Principal Accounts Controller
HQ Headquarters (generally refers to PDMS Provincial Director of Medical
MOH) Services
HRD Human Resource Development PEPFAR President’s Emergency Plan for
HRH Human resources for health AIDS Relief
ICT Information and communication PFM Public finance and management
technology PGH Provincial General Hospital
IDSR Integrated disease surveillance PHMT Provincial Health Management
and response Team
IEC Information, education and PME Performance-based monitoring
communication and evaluation

Annual Operational Plan 5 – 2009/10 x

PMST Provincial Medical Services Team Sida Swedish International
PMTCT Prevention of mother-to-child Development Cooperation Agency
transmission (of HIV) TB Tuberculosis
PMO Provincial Medical Officer TOR Terms of reference
PS Permanent Secretary TOT Training/trainer of trainers
PU Procurement Unit VCT Voluntary counselling and
RBM Results-based management testing
RH Reproductive health VHC Village health committee
RRI Rapid results initiative WHO World Health Organization
WRA Women of reproductive age

Annual Operational Plan 5 – 2009/10 xi

 SECTION I: PRINCIPLES AND
PRIORITIES

CHAPTER 1: INTRODUCTION

K
enya’s health sector adopted the development of annual operational plans
(AOPs) as a means to ensure that the Second National Health Sector
Strategic Plan (NHSSP II – 2005–2010)1 is implemented. An AOP defines the
year’s priorities, targets, activities and resources, on the basis of the ideals,
strategies and targets spelt out in NHSSP II and the Joint Programme of Work and
Funding (JPWF) for 2006–2010, as well as on the lessons learnt from the previous
year. This annual operational plan is the fifth in the series. In addition to NHSSP II
and the JPWF, Kenya Vision 2030, MTP 2008-2010 and the ‘Roadmap for
Acceleration of Implementation of Interventions to Achieve the Objectives of the
NHSSP II2 informed the priorities of this plan. These documents together with
lessons learnt from the implementation of AOP 4 form the basis of AOP 5.

1.1 Recap of the Vision 2030

The Kenya Vision 2030 drives the national development agenda for the country.
It is a vehicle for accelerating the country’s transformation of the country from
low income into a rapidly industrializing middle-income nation by the year 2030.
It specifies strategies for achieving the following economic, social and
governance targets:
• To maintain a sustainable economic growth of 10% per year over the next
25 years
• A just and cohesive society enjoying equitable social development in a
clean and secure environment
• An issue-based, people-centred, result-oriented and accountable
democratic political system

Kenya’s Vision 2030 for health is to provide equitable and affordable health care
at the highest affordable standard to all citizens, involving (among other things)
the restructuring of the health care delivery systems in order to shift the
emphasis to preventive and promotive health care. Key focus areas of access,
equity, quality, capacity and institutional framework will be achieved through a
devolution approach that will allocate funds and responsibility for delivery of
health care to hospitals, health centres and dispensaries, thereby empowering
Kenyan households and social groups to take charge.

1
Ministry of Health, Reversing the Trends – The Second National Health Sector
Strategic Plan of Kenya: NHSSP II – 2005–2010, September 2005.
2
Ministry of Public Health, Ministry of Medical Services, Roadmap for Acceleration of
Implementation of Interventions to Achieve the Objectives of the NHSSP II , December
2007.

Annual Operational Plan 5 – 2009/10 12

1.2 Recap of the 1st Medium Term Plan, 2008 – 2012
The first MTP, elaborates policies, reform measures, projects and programmes
that the Kenya’s Grand Coalition Government is committed to implement during
the period 2008-–2012 in line with the Vision 2030.The MTP health sector
objectives are to:

1. Reduce under-five mortality from 120 to 33 per 1,000 live births;

2. Reduce the maternal mortality ratio (MMR) from 410 to 147 per 100,000
live births.
3. Increase the proportion of birth deliveries by skilled personnel from the
current 42% to 90%
4. Increase the proportion of immunized children below one year from 71%
to 95 %
5. Reduce the number of cases of TB from 888 to 444 per 100,000 persons.
6. Reduce the proportion of in-patient malaria fatality to 3 % and
7. Reduce the national adult HIV prevalence rate to less than 2%.

The MTP flagship projects for health are rehabilitation of health facilities,
strengthening the Kenya Medical Supply Agency (KEMSA), fully implementing the
Community Strategy, de-linking the health ministries of health from service
delivery, building the human resource capacity and developing equitable
financing mechanisms.

1.3 Recap of NHSSP II 2005-2010

NHSSP II outlines the health sector strategies aimed at achieving the national
development priorities defined by the Economic Recovery Strategy 2003–2007
(ERS) of the Government of Kenya (GOK); and the international Millennium
Development Goals (MDGs). The NHSSP II goal is to reduce inequalities in health
care services and reverse the downward trend in health-related outcome
indicators. Five strategic objectives were set for the realization of this goal:
 Equitable access to health services increased
 The quality and responsiveness of services in the The KEPH Life-Cycle
sector improved Cohorts
 The efficiency and effectiveness of service 1. Pregnancy and the
delivery improved newborn (up to 2 weeks
 The fostering of partnerships enhanced of age)
 The financing of the health sector improved 2. Early childhood (2
weeks to 5 years)
The main innovations of NHSSP II in terms of service 3. Late childhood (6–12
delivery are the definition of the Kenya Essential years)
Package for Health (KEPH)3 and the re-definition of 4. Youth and adolescence
service delivery levels – most particularly the inclusion of Level 1 services
(community level) as part of the service delivery units. In order to deliver the
essential health services effectively, core support systems to be strengthened
are also articulated.

1.4 Recap of JPWF 2006 -2010

3
Ministry of Health, Reversing the Trends: The Second National Health Sector
Strategic Plan of Kenya – The Kenya Essential Package for Health, July 2007.

Annual Operational Plan 5 – 2009/10 13

The JPWF guides the activities and investment decisions of Government and its
health sector partners in support of the implementation of NHSSP II. The priorities
of the JPWF are as follows:
 To increase access to health services by rolling out the Community Strategy 4
that will initiate the
establishment of Level 1
(community-based) health
6.
activities in all districts and Tertiary/
expand these activities during national
the next four years to 50% of referral
the households in each district. hospitals

 To strengthen health service 5.

delivery through increased Secondary/region
coverage and effectiveness of al hospital
the KEPH with particular 4.
Primary/district
attention to levels of care 2–4 hospital
by:
 Developing and
3.
implementing the national Health centre
Human Resource
Management Plan, 2.
 Improving service Dispensary
quality, and
1.
 Ensuring the regular
Community (village/household/family)
supply of pharmaceuticals
and equipment.
Figure 1.1: KEPH levels of care – Communities are
To improve financing in the health the foundation of the pyramid
sector by:
 Promoting pro-poor resource allocation practices for
enhanced GOK funding to the health sector while strengthening public finance
and management (PFM), resource based monitoring (RBM), and a
performance based M&E system (PM&E) as ways of mobilizing additional
resources from and within the sector envelope,
 Building on the learning from experiences with alternative
risk-pooling financing mechanisms for health, and
 Creating an enabling environment for private sector
participation and contribution to health financing.

To foster stewardship and partnership for good governance through policy

dialogue, effective organization, improved coordination and better management
arrangements for the attainment of consensus on common working
arrangements in the sector.

4
Ministry of Health, Taking the Kenya Essential Package for Health to the
Community: A Strategy for the Delivery of LEVEL ONE SERVICES, April 2006. The
Community Strategy is complemented by training curricula developed specifically for
the cadres of health care providers that work at the community level.

Annual Operational Plan 5 – 2009/10 14

1.5 Recap of the Roadmap for Acceleration of
Implementation of Interventions to Achieve the
Objectives of the NHSSP II
The Roadmap for Acceleration of Implementation of Interventions to Achieve the
Objectives of the NHSSP II outlines agreed priority interventions to be
implemented during the second half of the NHSSP II as per the findings of the
NHSSP II mid-term review. The summary of the priority interventions agreed by
health sector stakeholders are outlined in Table 1 below:

Table 1: Roadmap priority interventions

Strategi Agreed priority Interventions
c
objectiv
e
Increase  Support to ensure universal access to maternal and neonatal health services for
equitable cohort 1, involving demand creation and supply side interventions such as free
access to delivery, skilled attendants, effect referral and other emergency obstetric care
health components.
services  Comprehensive implementation of guides and frameworks for cohorts 4 and 6.
 Strengthen implementation of existing service delivery efforts for child health for
cohorts 2 and 3, with a particular focus on coordination.
 Accelerate Kenya Essential Package for Health (KEPH) dissemination. throughout
the sector.
 Develop a strategy to influence the implementation of KEPH outside the health
sector.
 Strengthen public-private partnerships in delivery of services, particularly in
underserved areas, through improving formal frameworks and facilitating access
to the HSSF.
Improve  Roll out of service charter, to be displayed publicly containing information on
the services, standards, complaints, and the mechanisms to redress.
quality  Development and implementation of country specific hospital reforms to support
and and complement services at the primary care level.
respon-  Re-categorization and accreditation of health facilities in line with KEPH to guide
siveness the identification of inputs required within the context of existing KEPH Norms
of and Standards.
services  Update and implementation service delivery clinical and management guidelines.
 Creating facility based incentives to improve quality of services such as
institutionalizing processes for recognition and reward.
 Put in place national strategy for integrated supportive supervision, involving
clear definitions and implementation arrangements and linkages to annual plans
and performance appraisal, and incorporating new service delivery guidelines
 Fast track leadership and management capacity strengthening initiatives in
accordance with the decentralization of management in the sector, including in-
service training and patient centred accountability.
Foster  Strengthen sector coordination and participation structures at all levels.
partner-  Monitor adherence to COC principles and obligations, including the development
ships in of aid effectiveness indicators and targets and integrate their measurement in
improving sector annual reviews.
health  Joint support and responsibility to strengthen common management
and arrangements, to ensure use of country systems for support.
delivering  Ensure partners are providing coordinated and demand driven technical
services assistance and cooperation.
 Support implementation of common monitoring tools and systems including
utilization of the Joint Review Missions for review and planning of sector
interventions.
 Develop mechanisms for generation, sharing, and use of information with
implementing partners.
 Build the capacity of coordinating secretariats for partnership (HENNET and

Annual Operational Plan 5 – 2009/10 15

Strategi Agreed priority Interventions
c
objectiv
e
private sector).
 Development partners increasingly channelling funds through joint financing
arrangements and using in-country systems.
 Establish and implement coordination mechanism for partner missions to the
country.
 Coordination and pooling of capacity development support particularly for
systems strengthening.
Improve  Fast tracking implementation of HRH initiatives.
the  Strengthening the management and availability of commodities and supplies.
efficiency  Alignment of infrastructure, communication and ICT strategies to ensure they
and effectively support service delivery.
effective-  Strengthening of the public financial management systems.
ness of  Strengthen use of strategies for bottom up planning and budgeting.
service  Scale up use of performance monitoring mechanism (including HMIS).
delivery
Improve  Establish mechanisms to increase availability of resources.
financing  Improve budget management and efficient and equitable resource allocation and
of the utilization, particularly developing costing frameworks, improving pro-poor
health resource allocation formulas, instituting cost-effectiveness analysis to aid
sector prioritization, availing finance/cost information to the public, and incorporating all
sources for expenditure tracking.
 Complete and implement health care financing strategy.
 Implement HSSF, through more comprehensive district budgeting, finalization of
guidelines, training, and ensuring fiduciary risk is low.
 Implement the shadow budget as a means to link planning and budgeting
processes for entire sector.
 Improve predictability of resources by holding partners accountable to provide
information on their frameworks and budgets, and quarterly disbursement data.

1.6 Status of implementation of AOP 4

1.6.1 Performance against AOP 4 specific
objectives
The main goal of the annual operational plan for 2008/09 was to accelerate
delivery of defined priority services for the achievement of NHSSP II objectives
whose specific objectives were to:

 Improve demand for health services by scaling up implementation of the

comprehensive Community Strategy across the country.
 Scale up cost-effective disease prevention interventions in areas contributing
to the highest burden of ill health.
 Improve quality of health services by initiating hospital reforms that include
elaboration of a comprehensive referral strategy.
 Initiate innovative mechanisms to improve sanitation and hygiene practices
across the country.
 Finalize financing reforms with a focus on equitable mechanisms to protect
the poor from catastrophic expenditures.
 Ensure timely availability of essential medicines and supplies.
 Strengthen capacity for delivery of health interventions.
 Initiate and implement a sustainable integrated supportive supervision
system.

Annual Operational Plan 5 – 2009/10 16

 Ensure implementation of governance and partnership strengthening
initiatives across all levels of service delivery.

Review of the preliminary results of AOP 4 service delivery indicates that supply
of adequate services remains a challenge, though demand for care remains high.

On improving quality of health services by initiating health reforms, there are

number of areas that the ministry of Medical services have identified hospital
referral system, institutional structure, e-health and medical supply chain as
areas for health reform. Technical work is on going to elaborate strategies for
these identified areas.

On initiating innovative mechanisms to improve sanitation and hygiene practices,

there was no progress noted in this area.

On finalizing financing reforms, a familiarization tour was undertaken which has

informed the development of the Social Health Protection Strategy which is in the
draft form.

On strengthening governance and partnership initiative, the following wing were

achieved:
 Joint annual review was undertaken
 Joint sector planning has been undertaken
 The framework for monitoring the code of conduct for the partnership of
health sector stakeholders has been developed
 Resources for strengthening partnership were mobilised through DFID, WHA
and the World Bank
 Health Sector Coordinating Committee and Provincial stakeholder forum had
been operational.
 Joint bottom-up (from community and rural facilities) planning instituted.

1.6.2 Issues that affected AOP 4 implementation

In general, the implementation of AOP 4 was negatively affected by a number of
factors that were beyond the control of the health sector, major ones being the
reorganisation of the Government health care system, reallocation of financial
resources, new and re-emerging diseases.

1.6.2.1 Re-organization of the Government health

care system
Despite efforts to minimise the effects of the reorganisation of the Government
health care system to the delivery of health services by government units,
following teething problems negatively influenced the availability of services and
speedy implementation of reforms:
• Creation of new management structures resulting into creation of new
offices and redeployment of a lot of staff thereby diverting resources
meant for planned activities
• After the reallocation of government resources to the two ministries
resulted into some grey areas in responsibility, i.e. on who is responsible
for which services by programmes, coupled with lack of collaboration by
the different offices belonging to the different ministries.

Annual Operational Plan 5 – 2009/10 17

 • Innovative reforms whose implementation required the review and
approval of central government and or parliament had to taken back to
the drawing table.

1.6.2.2 Re-allocation of financial resources

Due to other competing government priorities such as resettlement of internally
displaced persons, food shortage, government reforms, the approved
Government budget allocation of resources to the two ministries was affected,
the ministry’s budget was not executed as per the expected cash flow and the
funds allocated to health were also reduced.

1.6.2.3 New, and re-emerging conditions

There were outbreaks of diseases, such as cholera, polio and measles during the
implementation of the AOP 4. The scare of an outbreak of swine influenza H1N1
becoming a pandemic made the ministries put in place mechanisms for
preparedness. These events results in diverting time and resources meant for
planned activities thereby affecting negatively the implantation of AOP 4
activities.

1.7 Emerging issues relevant to AOP 5 planning

priorities and process
A number of events took place during the implementation of AOP 4 that guided
the development of AOP 5. The main ones were the restructuring of the two
Ministries of Health, development of ministerial Mid-term Strategic Plans (MTP),
the creation of new districts, and effects of economic down turn.

1.7.1 Ministerial investment plans

Following the reorganization of the Ministry of Health, the two new ministries had
to develop ministerial strategic plans, with pre-designed planning formats, in
addition to existing health sector strategic plan. The strategies and targets of
these strategic plans informed the priorities of AOP 5.

1.7.2 Reorganization of the Government health

services
The decision on how to share the resources allocated to the health sector to the
two ministries took longer than anticipated. As such the determination of the
resource envelope for AOP 5 was not done on time for the planning units to plan
within the resource envelope. The planning units, therefore, planned without
knowing the actual resources available to them

1.7.3 New districts

Following the formation of new districts by Government, new public health and
medical services offices have been created. The number of planning units to be
involved in planning, were therefore, increased and this had an effect on the
required funds for the planning process.

1.7.4 Economic downturn and implications for

health

Annual Operational Plan 5 – 2009/10 18

The ongoing global economic slowdown that peaked during AOP 4
implementation will have an impact on the ability to deliver on the sector’s
planned interventions. Expected resources, particularly from the donors, are less
predictable, as a result of the changing priorities of their parent countries. In
addition, Government’s own ability to mobilize resources to finance its planned
budget is at risk due to reduced ability to raise local resources, particularly from
sectors directly reliant on global inflows, such as tourism.

Annual Operational Plan 5 – 2009/10 19

CHAPTER 2:KEY PRINCIPLES OF THE AOP 5
PLANNING PROCESS

J ust as the annual operational plans refine and focus the broad objectives for a
particular year, each AOP has provided incremental improvements to both
focus and process. The lessons learnt from the development of previous plans
have been informing the focus and process of developing successive AOPs. AOP
5 has similarly benefited from the earlier experiences.

2.1 Lessons learnt from AOP 4 planning process

Despite the improvements in the process, planning for AOP 4 had some inherent
weaknesses:

• Difficulty in adherence to the planning cycle: The planning units were

given very little time for training and for the development of the plans due
to post election skirmishes. This gave the planning units unnecessary
strain.
• Frequent changes to the planning and consolidation formats: In order to
come up with a plan that complies with the re-organisation of MOH into
the two ministries, the planning tools were revised hurriedly and in the
advanced stage of the planning process. Planning units therefore faced
problems adopting and using the rapidly changing planning and
consolidation formats especially due content and structure of the formats.
There was misunderstanding on the definition of some indicators, which
indicators to be used for planning and for performance monitoring of
AOPs.
• Inaccuracy of the baselines and targets: The district, provincial and
national service delivery baselines and targets were derived through the
consolidation of health facility baselines and targets i.e. through the
bottom-up approach. This approach resulted in having inaccurate targets
for a good number of indicators. The problem of defining target
populations for health facilities, which was compounded by the formation
of new districts with unclear physical boundaries, was more to blame for
failure of the bottom-up approach to target setting. The inaccuracy of
baselines and targets affected the quality of the AOP 4.
• Linking national and provincial/district priorities: There a number of
documents that are outlining sector priorities and priorities i.e. NHSSP II,
JPWF, the ‘Roadmap’, and other programme specific documents. There
was challenge in linking these priority strategies and interventions to
provincial and district plans.
• Large amount of required resources for planning process: The deepening
of the bottom-up planning to involve all rural health facilities and
communities called for intensive and extensive capacity building and
consensus building meetings. As such the process required a lot of
financial resources. Some districts and/or provinces found it difficult to
mobilize the required resources, which eventually affected the level of
involvement, and quality of plans developed.

Annual Operational Plan 5 – 2009/10 20

 • Lack of a comprehensive resource envelope: It was not possible to
determine all available resources for implementation of the AOP 4 from
the different actors. FBOs and NGOs did not declare the resources they
had for the implementation of their activities related to the targets they
have set themselves to contribute to the AOP 4 targets. It was also not
possible to allocate all resources declared by Development Partners as to
the different planning units or to specific programme activities. As such
the actual amount of resources available could not be determined with
confidence. This resulted into an AOP 4 with a huge financial gap

As a result of these observed weaknesses of AOP 4 development, the following

lessons learnt formed the basis for the principles of the AOP 5 development
process:

• A realistic planning timetable that links with the Medium Term Framework
(MTF), that is closely monitored and that is communicated timely to the
planning units is critical in facilitating the timely development of plans by
planning units.
• Standardized and well understood indicators for planning and monitoring
of AOPs need to be developed to guide the planning process
• The bottom-up approach to target setting needs to be reviewed to
improve the accuracy of the AOP targets
• There is need to improve linkage between priorities developed at the
different levels of planning with the priorities outlined in different strategic
plans and frameworks and available resources

2.2 AOP 5 planning process:

Principles for AOP5 Planning process

On the basis of these lessons, the following principles drove the AOP 5 planning
process:

2.2.1 Timeliness of the planning process

The AOP timeline that takes into consideration the annual planning, MTEF and
the performance contracting processes to be developed and communicated to
the planning units for guiding on the milestones for the planning process.

2.2.2 Standardized set of indicators for planning and sector

performance monitoring
The health sector agreed to maintain a small set of core planning and
performance monitoring indicators. These are the indicators that the sector will
use to guide it on whether the interventions for a given cohort result area are
having an impact or not. They are not meant to inform on progress in a
respective program area.

2.2.3 Target setting for different indicators

The target setting process in AOP 5 has changed from a purely bottom up
process, to a mixed bottom up and top down process. This is because of the
disharmony between the indicator achievements got from the bottom up process

Annual Operational Plan 5 – 2009/10 21

and the nationally agreed targets for specific indicators. As a result, in AOP 5, the
nationally agreed targets were first agreed. Achievement for each province was
then determined based on its population, previous performance and its existing
capacity to deliver. Negotiations were held with all the provinces on these
targets, till common agreement was reached. This process was then repeated for
districts, and facilities respectively.

Focus on Specific Planning Units by Level

In line with the Health Sector Services Fund (HSSF), the roll out of direct
financing to implementation units will be institutionalized. This entails
comprehensive roll out of the AOP planning process at the community and facility
levels, following on the process that was initiated in AOP 4. All health facilities
and community units to have individual plans for them to benefit from the fund.
Thus, planning to focus on the following planning units:

a. Community Units
b. Health Facilities (levels 2 – 6)
c. District, and provincial management team plans from each Ministry
d. Programs / divisions from each Ministry
e. Parastatals and other semi autonomous health bodies

2.2.4 Linkage of planning process outputs

The AOP 5 continued to deepen the principle of bottom up planning that has
guided the sector throughout implementation of the NHSSP II. How the plans
developed by different planning units will contribute, through consolidation
process, to the sector AOP 5 is outlined in the Fig 1 below:

INTEGRATED
AOP 5; 2009/10

Integrated Provincial plan Integrated Parastatal

(8) Departmental plan plans

PHMT & Integrated Level 5 &6

PMSMT plan District plan facility plan

Division /
DHMT & Level 4 program plan
Integrated Level 2 DMSMT plan facility plan
& 3 facility plan

Level 2 & 3 Community

facility plan unit plan

Annual Operational Plan 5 – 2009/10 22

Figure 1: Schema of AOP 5

The Consolidated plans are therefore as follows:

a. Integrated Health facility plans: Made up of plans of the
community unit, and level 2&3 facility planning units
b. Integrated district plans: Made up of plans of the consolidated
Level 2 and 3 facility plans in the district, plus the planning unit plans of
the level 4 facilities, and respective ministry District Management units.
c. Integrated provincial plans: Made up of plans of the
consolidated district plans in the province, plus the planning unit plans of
the level 5 and 6 facilities and respective Ministry provincial management
units
d. Integrated departmental plans: Made up of the plans of the
divisions and programs within each department of each Ministry
e. Integrated AOP 5 plan: Made up of the consolidated plans of the
provinces (8) and departments, plus the parastatal planning units

2.2.5 Harmonization of the AOP 5 plans and budget process

This entails determination of sector resource envelope prior to commencement of
the planning process. This process is not only to captured Government and on-
budget resources as defined in the medium-term expenditure framework (MTEF),
but also the off-budget resources available for delivery of the sector priorities.

2.2.6 Linkage of National priorities to provincial, district and health

facility level planning
In order to ensure linkage between central and provincial/district level planning,
the following information was compiled at the central level and circulated to the
respective levels to guide their planning:
 National level targets for the agreed service delivery indicators so as to guide
the provinces, districts and facilities in developing their service delivery
targets.

 Service standards for different interventions. These were to guide on which

activities needed to be implemented for the different interventions for the
KEPH.

 Planned national level activities to be carried out at provincial, district and

facility levels.

 Available additional financing from national programmes and projects that

were not captured in the resource envelope communicated to the lower
levels.

 Existing planning formats to needed to be revised to ensure that bottom-up

planning actually starts at the bottom – the community – and that the district
service plans are developed from consolidating facility plans.
 Hospital planning formats needed to be developed to facilitate the
formulation of hospital-specific plans.

Annual Operational Plan 5 – 2009/10 23

 Training needed to be organized an expanded to ensure that members of the
planning units at the different levels have acceptable quality training that
would facilitate bottom-up planning process.
 An accurate estimated resource envelope needed to be developed and
communicated in good time.
 Equity, gender and human rights principles needed to be stressed that they
become part and parcel of the AOP development process.

2.2.7 Improved linkages with Government’s Results Based Management

Framework
In line with the need to improve accountability, and link budgets to priorities, the
Governments results based management framework (RBMF) to be incorporated
into the AOP planning process. This ensures clarity is provided in terms of value
for money achieved from the interventions that are to be implemented. It also
ensures the sector is able to assess how well it is focusing its resources on those
programs that will enable it achieve its objectives.

2.3 The AOP 5 Planning process

From the agreed principles for AOP 5 outlined above, the terms of reference for
AOP 5 development process was developed and adopted in November 2008. The
AOP 4 planning and consolidation formats and the planning and sector
performance indicators were reviewed in November 2008. The AOP 5 Planning
and Appraisal Guidelines and a Facilitation Manual for trainers were developed,
thereby ensuring standardized training and plans. These planning documents
were circulated to the provinces and districts in December 2008.

In December 2008, planning teams consisting of five members from each

province underwent a five-day update of the planning process. These teams in
turn updated district and levels 4–5 hospital planning teams. The district planning
teams in turn updated level 2 and 3 health facility planning teams. The training
of hospital and rural health facilities included FBOs and NGOs and to lesser
extent private health facilities.

The level 2 and 3 units developed their respective health facility plans, which
included the community (level 1) activities. These plans together with level 4
hospitals were consolidated at the district level and together with the district
management support plans formed the district health plans. The district health
plans were in turn consolidated at provincial level and together with L5, L6, and
provincial management support plans formed the provincial plans. The
consolidation of provincial and headquarters management support plans was
done in May 2009. Appraisal of provincial plans and draft AOP 5 plans were done
by both peers and stakeholders in May 2009.

In addition to maintaining the AOP 4 planning achievements, AOP 5 method of

setting service delivery targets has greatly improved the accuracy of the sector
AOP 5 targets. The outputs for the management support plans are more specific,
measurable, accurate and realistic as compared to the previous OPs which will
make performance monitoring for management support easier than before.

2.4 Challenges in the AOP 5 planning process

Annual Operational Plan 5 – 2009/10 24

Notwithstanding the achievements described above, a number of challenges
arose during the planning process. The main ones are:

 Lack of a comprehensive resource envelope: It has not been possible to

determine all available resources for the implementation of AOP 4 from the
different actors. Due to the reorganisation of the Government health system,
the MTEF and on-budget resource envelope was not determined and
communicated to the planning units. FBOs and NGOs did not declare the
resources they have for implementing their activities for achieving the targets
they have set themselves to contribute to the AOP 4 performance. It has also
not been possible to develop the shadow budget due to uncertainty on the
available resources by all health sector stakeholders. The actual amount of
resources available could, therefore, not be determined with confidence and
planning units went on plan using needs or historical budget allocation as a
guide.

 Large amount of required resources for planning process: The split of hospitals
from districts and the creation of new management structures for the Ministry of
Medical services at district and provincial levels, the increased departments and
divisions at the headquarters (all these resulting from the reorganisation of the
Government health services) and the creation of new districts health office (in
response to the creation of new districts), resulted into increased number of staff
required to be trained at provincial and national levels hence the substantial increase
on the resources for training and other logistics. In addition, most provinces and
districts found it difficult to mobilize the required resources for training and
supervision.
 Capacity of districts to plan
The newly formed districts and the upgraded facilities staff had inadequate capacity to plan.The
managegement structures were not in place. Some of the existing management units had inadequate
management capacity.

Annual Operational Plan 5 – 2009/10 25

Chapter 3:Goals, Objectives and Priorities

T
he goal of AOP 5 will be to re-focus the sector towards implementation of
key strategies lagging behind in attainment of NHSSP II objectives. This will
enable the sector realise its objectives, guided by the priorities outlined in
the roadmap for acceleration of NHSSP II implementation and the respective
investment plans. The stewardship function of Government linking the Ministries
of Health will be further operationalised, with emphasis on joint implementation
support.

Objectives in AOP 5
The main objective of AOP 5 is to improve the efficiency and effectiveness of the
utilization of available resources, at the implementation level. This will be
accomplished through the following specific objectives:
 Scale up strategies for acceleration of implementation of the NHSSP II, as
outlined in the sector’s roadmap
 Address implications of the post election events on service delivery, to enable
services revert to their expected status
 Operationalise the governance, and partnership processes, as has been
envisioned in the respective Ministerial strategic plans
 Develop the policy framework for the Health sector

Priorities for AOP 5

The overall priorities for the year focus on the following key interventions:
1. Continue the scale up of delivery of targeted health services, in line
with reduced sector performance seen following Post Election
Violence. Specific focus shall be on immunization, Malaria, and TB
services.
2. Scale up epidemic control efforts, particularly in relation to cholera,
H1N1 2009, and polio outbreaks
3. Elaborate the framework to guide the hospital sector reforms, and
initiate roll-out of identified quick wins
4. Roll out the process of establishing a model health centre in each
constituency
5. Complete the restructuring process of the National Hospital
Insurance Fund
6. Elaborate the new Health Policy Framework, to guide the sector
towards supporting Vision 2030 attainment

The stewardship of these priorities will be in line with the respective mandates of
the 2 Ministries. Coordination of stewardship for the cross cutting priorities will be
through the inter ministerial committee to be set up by the 2 Ministries.

3.1.1 Key deliverables for Public Health and Sanitation

Annual Operational Plan 5 – 2009/10 26

These have been synthesized by the Ministry of Public Health and Sanitation
through consultations amongst its departments, and provinces. The resultant
areas of focus, key deliverables, and planned scope of interventions are
highlighted in the table below.

Key deliverables for Public Health and Sanitation in AOP 5

NHSSP II Strategic Specific goal Key deliverables
objective thrust
Increase Improve Increase the proportion of Complete GIS mapping for health
equitable equitable communities that live infrastructure
access to access to public within 5 km of functional Operationalise 130 each of non functional
health health services health facility from 52% GoK CDF and new facilities
services to 62% Carry out 20 clinics each of nomadic,
outreaches/mobile clinics and clinics in
congregate settings
Operationalise School health program in
1,250 schools
Establish 1,050 functional community units
Put in place communication systems in
1,500 level 2 facilities
Increase proportion of Initiate 2 strategies for demand creation
skilled attendant for services
deliveries from
42% to 60%
Improve Improve the Reduce the vacancy rate Recruit 11,822 new staff
quality and quality of public by 40%
the health and Proportion of health Train 14,485 health workers
responsivenes sanitation workforce trained
s of services services increased by 100%
in the sector 50% of level 2, 3 and Renovate 1,058 facilities and provide them
other public health with preventive maintenance
facilities rehabilitated and
adequately equipped
Reduce proportion of Provide 2,272 facilities with adequate
facilities reporting stock- stock levels of medicines, commodities
outs by 100% and supplies
Increase number of Set up functional integrated surveillance
districts with functional and response systems at facility and
surveillance systems by community levels
30% Upgrade 20 laboratories to perform tests
of public health importance
Support 20 districts to build their capacity
to detect and respond to public health
emergencies
Provide capacity to at least 200 faciliites,
and 5 community units to adequately
report
Carry out 5 operational researches
Increase sanitation Implement the environmental and hygiene
coverage from 46% to policy and strategy
66%
Increase the number of Increase number of households using
households utilizing safe tyreated water to 850,000
water by 20%
Increase number of Implement health care waste guidelines
facilities with health care
waste management
system from 20% to
100%

Annual Operational Plan 5 – 2009/10 27

 NHSSP II Strategic Specific goal Key deliverables
objective thrust
Increase client Support implementation of citizens charter
satisfaction by 50% in at least 1,204 facilities
Reduce the incidences of Follow up implementation of food safety
food borne diseases/ policy, strategy and Cap 254 and 242
illnesses by 5%
Reduce mortality due to Create at least 20 disaster response teams
emergency to below around the country
1/10,000 persons at risk
per day.
Increase the utilization of Support 70% of level 2 and 3 facilities
cost-effective RH services have adequate capacity to provide RH
by 50% services
Increase the utilization of Support 35% of level 2 and 3 facilities to
cost-effective child provide IMCI and other child health care
healthcare services by services
50%
Reduce new HIV Finalize communication strategy
infections by 50%
Increase TB case Establish MDR centre
detection and treatment
to 90%
Reduce Malaria incidence Distribute key malaria control
to 15% through utilization interventions to 60% of target populations
of cost effective control (pregnant women, <5’s, and IRS)
measures
Reduce the incidence of Provide at least 80% of children < 5’s with
malnutrition in children Vitamin A s
<5 years by 30%
Foster Foster To strengthen governance Operationalize the governance structures
partnerships partnerships in structures at the 6 levels at sub national level
in improving improving by 2012 Establish anticorruption units at provincial
health and Public Health levels
delivering service delivery
services . Develop operational plans and reports for
all planning units
Assess client satisfaction with public health
services
Initiate review legal chapters of the legal
framework governing public health and
sanitation
Improve coordination and Finanlize mechanisms for joint funding of
partnership arrangements services with willing partners
at all levels Finalize operationalisation of coordination
and partnership arrangements at sub-
national levels
Improve the Improve Reduce vacancy rate by Recruit at least 11,000 health workers
efficiency and efficiency of 60%
effectiveness public health Increase the proportion of Train 5,061 support, and 14,678 technical
of service system staff who are trained as staff in various skills
delivery per the government
training policy by 50%
Increase the proportion of Promote at least 1,185 support and 1,104
employee job satisfaction technical staff in various skills
to 90% Provide at least 3 incentive awards each at
the HQ, provincial, district L2/3 levels
Increase the availability Train at least 9,731 staff in ICT
and utilization of ICT by Provide at least 2 provinces with boosters
staff by 60% for ICT
Automate at least 4 systems (HRIS,

Annual Operational Plan 5 – 2009/10 28

 NHSSP II Strategic Specific goal Key deliverables
objective thrust
HMIS,LMIS IFMIS)
Improve provision and Develop a Transport policy
utilization of transport Purchase at least 150 vehicles
services by 50 % Purchase at least 1 motorboats
Purchase at least 400 motorbikes, and
35,000 bicycles
Support maintenance of at least 80
automobiles
100% disposal of Support 150 districts dispose old assets
obsolete, unserviceable
and surplus assets
annually
Improve Improve Ensure all facilities Initiate process to determine needs based
financing of financing of the receive financial resource allocation mechanisms
the sector public health resources based on needs
and sanitation by 2012
services To increase efficiency in Analyse proportion of allocated funds used
utilization of resources for their intended purpose
Operationalize HSSF
Initiate OBA allocation
Utilise service costing instrument in 40% of
facilities
To increase financial Engage with NHIF on improving financing
resources to MOPHS by to Public Health and sanitation services
20% over a period of five Engage with GoK on improving financing to
years. Public Health and sanitation services
Engage with DP’s on improving financing
to Public Health and sanitation services
Engage with sub national levels on
improving financing to Public Health and
sanitation services

3.1.2 Key deliverables for Medical Services

The Ministry of Medical Services has synthesized these through a rigorous

internal consultative process. The areas of focus, key deliverables and planned
scope of interventions are highlighted in the table below.

Key deliverables for Medical Services in AOP 5

NHSSP II Strategic Specific goal Key deliverables
objective thrust
Increase Strengthen Set up functional Build capacity of 50% of hospitals in emergency
equitable emergency emergency and preparedness
access to preparedness disaster preparedness Set up emergency response teams in at least 15
health and disaster response teams in hospitals
services management. hospitals Train at least 40% of medical staff in hospitals on
emergency response and disaster management
Develop hospitals guidelines and standard
operation procedures in emergency preparedness
and response
Ensure adequate Provide hospitals with emergency and disaster
support for response kits
emergency and Ensure hospitals have emergency capability
disaster response in
hospitals
Improve Institute Capacity to offer Update the National Referral Strategy

Annual Operational Plan 5 – 2009/10 29

 NHSSP II Strategic Specific goal Key deliverables
objective thrust
quality and medical adequate, quality cost Categorize GoK and FBO facilities in line with norms
the services efficient referral and standards
responsiven reforms that services in all Establish zonal health referral district
ess of will ensure high hospitals in the Put in place 24 hour functional communication
services in quality services. country systems between facilities for 75% of hospitals
the sector Put in place functional ambulances in all hospitals
Adequate capacity for Develop a training policy
leadership and man- Complete Leadership and Management training for
agement to optimize all Mid Level managers
health services
delivery in Kenya
Functional Revise Health regulations
governance and Institutionalize performance contracting system at
accountability all level 4 & 5
systems at all levels Ensure accounting units functioning in line with
of the Ministry HSSF guidelines
Application of ICT in Develop e-health policy, and assess E-readiness
the provision and Develop quality assurance standards
management of Train Health workers’ in various disciplines of
information and telemedicine
services in all level 4–
6 facilities
All level 5 and 6 Develop National Medical Tourism Policy and legal
facilities upgraded to framework
provide specialized Set up burns units in two hospitals
level 6 services. Accredit at least 2 level 5 health facilities using the
framework for accreditation
Establish Trauma centres in 2 level 5 facilities
Establish an Oncology centre
Establish communication linkages between level
5&6 facilities, and international health care
institutions
Functional Health Develop Health Service Commission policy and
Service Commission appropriate legislation
Quality of hospital Revise Hospital standards and norms
services improved by Map catchment populations for all hospitals
at least 50%, as Develop comprehensive clinical support supervision
measured technically, and monitoring tools
and by clients Hospitals carry out clinical audits to assess quality
of hospital processes and outputs
Develop emergency care framework developed
Set up hospital governance and management
structures in at least 60 hospitals
Develop updated standards and procedures for
hospital quality assurance
Initiate classification of facilities using a star system
Level 5 hospitals l Develop policy on hospital autonomy
autonomy Establish functional Hospital boards
Develop service agreements for accountability
Institute and Implement quality Implement KQAM standards in all hospitals
enforce assurance and
appropriate standards
regulatory performance
measures for measurement
medical framework (KQAM)
services. Develop accreditation Develop accreditation standards for health facilities
standards for the
health sector
Review the Public Develop the public health act amendment bill

Annual Operational Plan 5 – 2009/10 30

 NHSSP II Strategic Specific goal Key deliverables
objective thrust
Health Act to ensure
quality medical
service delivery
Strengthen health Initiate e-learning for continuous professional
professional capacity development (CPD) of health care professionals
through e-learning
Enhance regulatory Inspect facilities for compliance to established
services for quality health standards
medical care
Integrate health professional standards and norms
in the Kenya Professional Health Authority Act
Regulate alternative Review the current legislation of alternative
medicine practice medicine practice
Coordinate and Disseminate the National health research policy
regulate health
research
Kenya National Health Revise KNHP I, and develop draft KNHP II
Policy 1994 (KNHP)
revised, new policy
adopted and
implementation plan
developed.
Foster Institute Planning, monitoring Develop bottom up joint annual plans and reports
partnerships structures and and evaluation tools for all planning units in the sector
in improving mechanisms for and mechanisms Revise Performance M&E framework
health and improved utilized at all levels of Review quarterly and annual sector progress
delivering alignment, the sector
services harmonization Common Hold joint planning and monitoring reviews at all
and arrangements for levels of the sector
Government alignment of planning, Review adherence to Code of Conduct
ownership of budgeting and Hold quarterly stakeholder meetings at national,
planned monitoring systems in provincial and district levels
interventions. use across whole
sector
Use of Government Develop Joint Financing Agreement
procedures and
systems by at least
60% of donors
Inter Ministerial Strengthen inter-ministerial coordinating structures
coordinating process
and structures in
place and functional
by 08/09
Framework in place to Develop draft of the PPP policy framework
guide partnership
with IP’s (PPP) by
09/010
Availability of quality Provide data capture and summary tools to all
health information reporting units
from 90% of the Automate Hospitals health information systems
reporting units for Ensure hospitals all have key Human resources for
evidence-based health information management
decision making
Improve the Have reliable Revise/adopt KNDP Revise KNDP with an implementation plan
efficiency access to and develop an
and essential, safe implementation plan
effectivenes and affordable for its use
s of service medicines and Provide KEMSA with Prepare revised KEMSA policy paper (sessional
delivery medical the autonomy to paper)

Annual Operational Plan 5 – 2009/10 31

 NHSSP II Strategic Specific goal Key deliverables
objective thrust
supplies that perform its legal
are mandate as the Transfer of all procurements for medical
appropriately agency to procure commodities to KEMSA
regulated, warehouse and Ensure KEMSA procurement is compliant with Public
managed and distribute medical Procurement and Disposal Act 2005 and the
utilized. commodities primarily regulations of 2006
to public health sector Develop Integrated and comprehensive MTPP for
in accordance with medical commodities
good distribution Develop guidelines for EMMS procurement for
practices emergencies and disasters
Ensure 100% compliance with international
warehousing standard operating procedures (SOPs)
Ensure 100% compliance with good distribution
procedures
Evidence-based Establish institutional Medicines and Therapeutic
selection of essential Committees (MTC) in all level 4 – 6 hospitals
medicines and Develop new Essential Medical Supplies List (EMSL)
medical supplies in Develop draft pre and in service Essential Medicines
the health sector and Medical Supplies (EMMS) curriculum

Quantification of Establish Logistics management and information

EMMS institutionalized system (LMIS) at all health facilities
at all KEPH levels.
Transparent, account- Ensure 100% compliance of Institutional
able and timely procurement with the Public Procurement and
procurement of EMMS Disposal Act 2005 and the regulations of 2006
at institutional level
(only for bridging
gaps)

Ensure secure Assess status of storage infrastructure in health

institutional EMMS facilities
storage infrastructure Implementation of assessment reports on storage
with product quality SOPs from health facilities
assurance
Achieve optimal Develop EMSL & formularies
therapy through good Develop guidelines for good prescribing and
prescribing and dispensing practice (GPP and GDP)
dispensing practices
Ensure safe and Review and update guidelines on safe disposal of
environmentally pharmaceutical waste
friendly disposal of
EMMS waste
Educate the public to Develop IEC guidelines for the promotion of
ensure that EMMS are appropriate EMMS use
appropriately utilized Develop final documents for the annual operational
by clients licenses/permits for EMMS promotion and
advertisement
Mobilize adequate Complete financial agreement on pooled EMMS
financial resources for procurement and distribution
procurement and Develop annual integrated EMMS procurement and
distribution of EMMS distribution budget
Rationalize EMMS Review and update medicines donation guidelines
donations (to include medical supplies)
Improve Increase the % of Update Infrastructure policy, norms and standards
infrastructure, level 4–6 facilities that Develop Infrastructure development and
equipment and meet the minimum maintenance plan
ICT investment norms on hospital Acquire title deeds for at least 50% of Hospitals

Annual Operational Plan 5 – 2009/10 32

 NHSSP II Strategic Specific goal Key deliverables
objective thrust
and preventive buildings and land Construct perimeter fences for at least 50% of
maintenance. from 37% to 70% hospitals
Ensure Two sources of water available in at least
50% of all hospitals
Ensure adequate sanitation available for at least
50% of all hospitals
Ensure at least 60 hospitals have two sources of
electricity
Establish functional Incinerators in 100 hospitals
Increase the % of Develop equipment policy, norms and standards
level 4–6 facilities Develop equipment investment and maintenance
equipped as per plan (FBO/ GOK facilities)
norms from 37% to Disseminate guidelines on management of medical
70% equipment and plants
Carry out annual medical equipment and plants
audit in all hospitals
Install Oxygen generating plants in 8 hospitals
Provide level 4–6 with Develop transport policy, norms and standards
adequate transport Develop transport development and maintenance
for utility and plan (FBO/GOK facilities)
ambulance services
Procure Utility vehicles for 30 hospitals
Procure staff vans vehicles for 20 hospitals
Procure 70 supervision vehicles for zonal medical
services
Procure at least one ambulance for 40 hospitals
Procure one vehicle for each province
Provide appropriate Develop Ministerial ICT strategy for health services
ICT in 30% of the Develop E-health policy
hospitals by 2012 Support 10 hospitals with ICT infrastructure
Implement E-health package in 8 hospitals
Train 100 ICT Health personnel on ICT
Develop and Institutionalize HRH Finalize HRH strategic plan
manage the planning and policy Develop recruitment and deployment policy
health work framework Disseminate national HRH training policy
force. Ensure adequate Develop annual recruitment and deployment plan
numbers of equitably Analyse staff workloads
distributed and Assess facilities against HR norms
appropriately skilled
and motivated health
workers
Enhance the Develop HRH manpower plan
development of Develop Policy paper and legislative framework for
human capacity to a National Health Education Commission
meet the health Develop Policy paper and legislative framework for
needs of the a National HRH training fund
population Review institutional quality standards for medical
training institutions
Finalize Human resource development information
system
Develop HRD plan
Improve retention of Put in place a Staff retention strategy
health workers at all
levels
Institutionalize Institutionalize PAS
performance
management systems
Improve human Disseminate guidelines on HRM&D in hospital
resource management

Annual Operational Plan 5 – 2009/10 33

 NHSSP II Strategic Specific goal Key deliverables
objective thrust
management systems Develop succession management plan
and practices Initiate strategies for improved application of ICT in
HR management
Implement strategies to improve the working
environment for health workers
Improve Establish an Develop a financing Finalize Health Financing strategy
financing of equitable strategy that ensures
the health financing social protection
sector system that Conduct actuarial study for identifying the poor
ensures social Expand contributors Increase membership of NHIF to 4.31 million
protection, to NHIF from 2.2 Increase revenue collection for NHIF to 16.6 bn
particularly for million to 9.6 million
the poor and persons
vulnerable. Reduce number of Develop a tax rebate policy on HCF
households facing Review reimbursement scheme
catastrophic health Amend the NHIF Act
expenditures
Increase the amount Carry out public expenditure tracking survey, 2009
of resources reaching Carry out financial audits in at least 79 hospitals
point of use from 40%
to 70%

Annual Operational Plan 5 – 2009/10 34

 SECTION II: Work Plans
Chapter 4: Service Delivery priorities and
targets

S
ervice delivery remains the main focus and the key reason for the
existence of the health sector. Over the last four years of implementation
of annual operation plans (AOPs), significant progress has been made to
consolidate efforts and services with the aim of maintaining the health of the
population and improving those services that respond to ill health. This is in line
with the NHSSP II goal of reversing the trends in health indicators. Results
expected during the period of NHSSP II have been also defined in the joint
programme of work and funding (JPWF).

This chapter elaborates the deliverables in service delivery that the sector is
working towards in AOP 5. The deliverables have been presented for the national
level (by ownership and level), provincial level (by each district) and for the
community level. All other sections of the AOP plan outline strategies and efforts
that aim to support and improve the efforts in service delivery. Moreover, all the
inputs (financial, human resource, infrastructure, commodities and other
materials) to the health sector are geared towards better service delivery in line
with the NHSSP II and MDGs targets.

4.1 Service delivery baselines and targets

AOP 5 service delivery targets are geared towards attainment of the set NHSSP II
targets which have been defined. Over its four years of implementation, NHSSP II
has focused on making available tools and frameworks needed to deliver a
comprehensive KEPH. During the implementation of AOP 1, AOP 2, AOP 3 and
AOP 4, the backbone of activities was:
 Scaling up delivery of defined cost-effective interventions, such as in disease
control areas of malaria, TB and HIV, and in key intervention programmes like
maternal and child health.
 Initiating interventions in areas where gaps have been identified. These are
by level (comprehensive community services at level 1), and cohort (services
for cohorts 4 and 6).
 Acceleration and consolidation of implementation of KEPH

Baselines and targets for each level of service delivery have been outlined in the
subsequent tables.

4.1.1 Service delivery priorities

In order to improve people’s health, priorities in AOP 5 have been defined by the
various levels of service delivery points. This is as a follow up to the findings the
NHSSP II midterm review that revealed weaknesses that required immediate and
sustained interventions as elaborated in the Roadmap for Acceleration of
Implementation of interventions to achieve the objectives of NHSSP II. The
overall priority during AOP 5 is to consolidate and sustain the
implementation of the KEPH across the sector, particularly at levels 1–4. This

Annual Operational Plan 5 – 2009/10 35

is based on the framework put in place during the first four years of NHSSP II.
This will be attained through the following strategies:
 Ensure universal access to maternal, child and neonatal health services
(cohort 1), involving demand creation and supply-side interventions such as
free delivery, skilled attendants, effective referral and other emergency
obstetric care components.
 Reduce morbidity and mortality from malaria by accelerating implementation
of the National Malaria Strategy, which has been revised in line with NHSSP II,
particularly targeting cohorts 2, 3 and 5.
 Strengthen implementation of existing service delivery efforts for child health
for cohorts 2 and 3, with a particular focus on coordination.
 Accelerate implementation of TB control initiatives (cohort 5).
 Accelerate the implementation of the Community Strategy (level 1) by
institutionalizing the community health worker structure, providing behaviour
change communication, scaling up outreach services, etc.
 Roll out the service charter, to be displayed publicly, containing information
on services, standards, complaints and mechanisms for redress.
 Implement service delivery clinical and management guidelines.
 Implement facility-based incentives to improve quality of services such as
institutionalizing processes for recognition and reward.

These priorities have formed the basis for the indicators and targets described
below.

4.1.2 Indicators for AOP 5

The indicators used in the planning process of AOP 5 are the defined health
sector set of core indicators as outlined in the Health Sector Indicator and
Standard Operation Procedures manual. These indicators were selected to serve
as guide for quantifying performance and progress across the sector. Specific
indicators are used to provide information on expected progress for each result.
The trends in indicators represent the summation of expected targets from all
the districts. The indicators that are defined have been distributed for various
groups namely:
• Cohorts (Cohort 1 to 6)
• Efficiency
• Finance
• Governance

The set of the core indicators is built on indicators that were used to monitor the
implementation of AOP 5. Significant progress was made in improving the
understanding and interpretation of indicators by the different planning units, to
improve on data quality. As a result, the quality of information has continued to
improve. There are however still a few discrepancies, particularly relating to
indicators for which vertical programs have separate collection systems. This is
more so for HIV, and TB indicators, where the vertical program focal persons at
the districts are not linking adequately with the HMIS integrated information
process. This however, is not a main problem with RH and immunization, where
the integration is much better.

The improvement in quality of indicator trends from each planning unit will
continue to be an ongoing endeavour.

Annual Operational Plan 5 – 2009/10 36

4.1.3 Targeted results for Service Delivery
The planning of service delivery data focused on two major areas: service
delivery by KEPH level (1–6) and by agency/ownership. In the same way,
monitoring of AOP 5 will focus on KEPH level and agency. The distinction of KEPH
levels defines and addresses the priorities of the two ministries and will focus on
the roles and contribution of each ministry towards the delivery of care.
Baselines and targets of service delivery data are presented by ownership and
levels of care, giving the contribution of each level and agency to the overall
service delivery.

The anticipated results of AOP 5 are measured by different defined health

performance indicators. The set baselines and targets for the defined sector
indicators for each of these results are outlined for levels 1–6. The targets will be
realized by interventions at the health facilities, with management support
provided at the different management levels.

We highlight the activities by the different service delivery constituents to ensure

achievement of the AOP 5 goals and objectives. The remainder of the chapter
presents the anticipated results, outputs and activities relating to service
delivery, and the related management support from the districts, provinces and
national levels. Administrative and other essential backup support from
respective ministries and areas is highlighted in the succeeding chapters.

The AOP 5 service delivery data are organized by province and presented in the
following categories:
 National AOP 5 Service delivery baselines and targets with NHSSP II targets
 Service delivery baselines and targets by KEPH level of care
 Service delivery baselines and targets by ownership (GOK, FBO/NGO and
private)
 Indicators for level 1 services
 Service delivery baselines and targets by province

Annual Operational Plan 5 – 2009/10 37

 4.1.3.1 National AOP5 Targets for Service Delivery
Indicator of Performance Eligible Baseline Target HSSP II
Cohort Output Measurement Popula 2010
tion NO. % No. %
Women of Reproductive Age 3,5 40.5 4,4 51.2 60
(WRA) receiving Family Planning 8,719,64 29,327 62,200
(FP) Commodities: 0
Pregnant women attending at 5 32.1 48.8 80
least 4 ANC visits: 1,666,08 34,007 812,856
4
Newborns with Low Birth Weights 3.3 1.6
(LBW) –(less than 2500 grams) 1,425,58 47,540 23,030
5
Mothers are kept Pregnant women distributed with 6 39.1 7 47.7
healthy before and LLITNs 1,666,10 50,697 95,477
during pregnancy 4
Pregnant women receiving two 41.5 9 55.5
Cohort 1,729,19 716,835 58,960
doses of Intermittent Presumptive
1: 6
Therapy (IPT2)
pregnan 26.6 60.8 50
cy HIV infected pregnant women
who received preventive 276,391 73,393 168,089
delivery,
newborn antiretroviral therapy to reduce
(up to 2 the risk of mother -to -child
weeks) transmission (PMTCT).
Deliveries conducted by skilled 5 33.6 7 47.4 90
health attendants in health 1,653,98 55,632 84,755
Mothers are able to facilities. 5
have normal Maternal Deaths Audited
deliveries 3,705 2,166
Fresh still births in the health
facility 7,479 3,569
All newborns (up to Newborns receiving BCG: 1, 69.7 1,4 85.5 95
2 weeks) receive 1,646,14 147,502 07,949
protection against 9
immunizable and
other conditions
Children under one (1) year of 1,0 71.8 1,2 88.8 95
Children receive age immunized against Measles: 1,402,82 07,833 45,262
protection against 0
immunizable Children under one (1) year of 1, 74.2 1, 84.7 100
diseases age fully immunized: 1,402,82 040,816 188,698
0
Children under 5 years (< 5 yrs) 3,0 52.5 3,7 64.1
attending Child Welfare Clinic 5,897,78 99,109 83,260
(CWC) for growth monitoring 9
services (new cases)
Children under 5 years (< 5 yrs) 9.7 6.7

Cohort attending Child Welfare Clinic 6,070,68 589,341 405,219

(CWC) who are underweight 0
2: Early
Childhoo Children less than 5 years (< 5 2,4 41.5 3, 58.6 80
d yrs) receiving Vitamin A 5,924,09 56,635 471,105
Children are able to 2
survive childhood supplement
Children under five years of age 1,4 24.4 1, 32.6
illnesses
(< 5 years) distributed with Long 5,944,97 47,927 936,180
Lasting Insecticide Treated Nets 3
(LLITNs)
Under 5 years treated for 3,3 54.7 3, 59.9
malaria, 6,190,59 88,540 710,160
5
Infant Mortality Rate (IMR)
Facility Infant Mortality Rate (IMR)
- 5,588 3,806
School children correctly de- 3,9 49.7 5, 63.6 80
Cohort 3
Healthy lifestyle is wormed at least once in the year: 8,043,78 99,299 113,909
Late 5
adopted amongst
childhoo Schools with adequate sanitation 803.1
children 1354.8
d facilities: 8,666 117,409 69,595
Cohort 4 Behaviour change Health facilities providing youth 10.4 60
Adolesc is promoted friendly services 4,886 507
ent amongst

Annual Operational Plan 5 – 2009/10 38

 Indicator of Performance Eligible Baseline Target HSSP II
Cohort Output Measurement Popula 2010
tion NO. % No. %
adolescents that
leads to healthy
lifestyle
Adolescents are
able to survive
common health
conditions affecting
them
Population Counselled and Tested 2 3, 5,5 24.9
for HIV: (VCT, PITC, DTC, HBCT) 2,256,19 171,783 14.3 47,136
8
Adults and elderly
are practising a Condoms distributed: 33,9 62,
- 62,279 710,180
healthy lifestyle 45.0
Households sprayed with 1, 2,6
Insecticide Residual Spray (IRS). 5,810,37 618,192 27.9 16,384
4
Adults and children with 2,3 245.6
Cohort 5 941,962 187,656 13,623
&6 advanced HIV infection started 19.9
Adultho on Anti Retroviral Therapy (ART):
Adults and children with 8 62.6 8 60.9
od and 1,320,05 26,092 04,392
Elderly. Adults and elderly advanced HIV infection receiving
are able to survive Anti Retroviral Therapy (ART) 2
common health TB case detection rate 113119 11877 55
conditions affecting 5
them Tuberculosis cure rate: 29175 75
Percentage of emergency surgical
cases operated within one hour 48,156 37,578
Cold surgical cases operated on
within one month. 31,323 81,579
Human resource Doctor Population ratio: 2 0.1 0.0
9,975,96 1 2,704
available to 1 ,659
increase access to 0.0 0.0
Nurse Population ratio: 29
health services ,965,963 13,821 14,362
Essential medicines Health facilities without all tracer 18.4 5.7 80
and medical drugs for greater than 2 weeks 4,524 832 260
supplies are (> 2 weeks)
available to
increase access to
health services
Clients satisfied with services: 2 4,1 16.3 5,4 21.5
5,169,79 07,856 04,012
Quality of health
Efficienc 2
services improved
y Average Length of Stay (ALOS):
- 7 6
Utilization rate of Out Patient 1 11, 71.9 12, 76.2
Attendants (OPD) - Male: 6,228,92 667,453 371,295
Utilization of health 9
services improved Utilization rate of Out Patient 1 14,2 80.4 14,7 83.3
Attendants (OPD) -Female: 7,703,03 29,364 44,629
6
Health facilities that submit 32.0 75.8
timely, accurate reports to 5,613 1,796 4,254
Monitoring and
national level.
evaluation 32.9 78.6
Health facilities that submit
improved 5,623 1,853 4,417
complete, accurate reports to
national level.
% GOK budget allocation to 22,7 50,8
Financial allocation primary health facilities (L2 & L3) 03,478 70,837
Finance
to health Improved % GOK budget allocation for 2,2 10,5
drugs 02,016 40,593
Governance Districts with Functional Health 22.4 100.0
Governa 148 33 148
structures Stakeholders Forum (DHSF):
nce
strengthened

Annual Operational Plan 5 – 2009/10 39

4.1.3.2 AOP5 Target for service delivery by province
Indicator North Eastern Central Coast Rift valley
Eligible Baseline Target Eligible Baseline Targ Eligible Baseli Target Eligible Baseline Target
Populatio Population et Populat ne Popula
n ion tion
Pregnancy, Delivery and the
Newborn (up to 2 weeks)
Women of Reproductive Age (WRA) 334,147 13,275 21 1,007,215 682,398 7 699,8 299 375,666 2,278, 723,772 1,020,303
receiving Family Planning (FP) Commodities: ,304 94,730 80 ,822 057
Pregnant women attending at least 4 ANC 67,008 13,907 18 136,282 75,452 162,6 50 105,110 438 143,287 223,56
visits: ,920 96,760 51 ,582 ,918 1
Newborns with Low Birth Weights (LBW) – 67,008 325 136,282 11,324 175,3 1,645 388 14,896 4,94
(less than 2500 grams) 156 5,920 48 3,137 ,081 8
Pregnant women distributed with LLITNs 67,008 11,882 19 136,282 34,252 162,6 8 114,368 438, 172,895 290,57
,719 67,721 51 6,912 938 3
Pregnant women receiving two doses of 67,008 15,889 22 136,282 76,072 162,6 92 114,017 438, 185,486 285,06
Intermittent Presumptive Therapy (IPT2) ,100 82,516 51 ,728 938 3
HIV infected pregnant women who received 785 37 21,685 3,912 52,0 78,520 136 23,612 32,94
preventive antiretroviral therapy to reduce 122 5,345 31 6,836 ,468 1
the risk of mother -to -child transmission
(PMTCT).
Deliveries conducted by skilled health 67,008 9,893 14 136,282 95,911 162,6 40 68,989 437 154,167 239,54
attendants in health facilities. ,034 104,828 51 ,668 ,041 7
Maternal Deaths Audited 28 - 129 196 2,912 1,65
- 83 59 - 337 - 9
Fresh still births in the health facility 165 - 1,191 35,0 277 2,036 1,79
16 757 54 963 - 9
Newborns receiving BCG: 54,436 33,496 38, 136,282 83,853 162,6 11 154,233 438, 257,722 361,36
762 102,052 51 0,823 938 3
Children under one (1) year of age 54,926 28,494 36, 130,757 99,445 130,1 7 109,842 374, 257,539 330,87
immunized against Measles: 086 113,675 20 4,191 385 2
Children under one (1) year of age fully 54,926 26,420 32, 130,757 102,167 130,1 80 102,219 374, 306,747 324,50
immunized: 800 107,576 20 ,242 385 3
Children under 5 years (< 5 yrs) attending 247,287 53,613 72, 458,435 309,908 502,5 396 412,948 1,467, 673,478 1,046,866
Child Welfare Clinic (CWC) for growth 227 312,272 58 ,808 332
monitoring services (new cases)
Children under 5 years (< 5 yrs) attending 247,287 19,410 14 635,137 60,638 499,0 14 64,224 1,467, 148,697 93,46
Child Welfare Clinic (CWC) who are ,003 55,046 24 9,341 055 6
underweight
Children less than 5 years (< 5 yrs) 247,287 60,159 84, 533,255 274,420 442,5 206 187,394 1,481, 484,273 1,016,41
receiving Vitamin A supplement 024 307,871 74 ,072 627 6
Children under five years of age (< 5 years) 247,287 27,116 73 549,663 93,506 442,4 136 224,382 1,483, 359,166 727,11
distributed with Long Lasting Insecticide ,215 125,879 48 ,228 398 4
Treated Nets (LLITNs)
Under 5 years treated for malaria, 247,287 140,377 140, 811,075 359,014 441,9 20 274,188 1,468, 569,825 888,58
698 288,174 04 9,211 152 5
Infant Mortality Rate (IMR) - - -
- - - - - - - - -
Facility Infant Mortality Rate (IMR) 13 - 783 314 2,397 1,25
- 10 371 - 157 - 7
School children correctly de-wormed at 417,249 63,128 117 700,630 752,234 7 789,8 370 492,887 2,215 926,328 1,398,18
least once in the year: ,225 54,634 31 ,819 ,101 5
Schools with adequate sanitation facilities: 446 94 2 - 2,289 1,770 101,879 52,93
,152 2,702 - 1,677 - 0
Health facilities providing youth friendly 14 8 835 133 21 16 5
services 5 60 101 15 1,729 1 11
- - - 21,66
- - - - - - - - 6
Population Counselled and Tested for HIV: 948,022 32,224 88 3,342,851 442,731 1,2 1,230,4 167 441,698 5,204, 924,206 1,429,51
(VCT, PITC, DTC, HBCT) ,215 51,542 41 ,529 662 6
Condoms distributed: 79,847 154, - 4,794,588 6,2 1,214 3,360,305 13,917,786 15,665,099
- 780 78,430 - ,678 -
Households sprayed with Insecticide 221,548 22,951 54, 785,812 25,620 468,4 839 1,465,627 1,296, 616,516 617,86
Residual Spray (IRS). 293 31,955 61 ,109 133 2
Adults and children with advanced HIV 13,790 258 37,768 17,595 285,1 2 2,111,803 323, 49,637 79,61
infection started on Anti Retroviral Therapy 427 19,594 91 3,100 333 3

Annual Operational Plan 5 – 2009/10 40

(ART):
Adults and children with advanced HIV 13,790 334 37,768 65,732 86,6 99 225,448 487, 112,012 115,63
infection receiving Anti Retroviral Therapy 744 67,417 65 ,587 282 5
(ART)
TB case detection rate 3021 3172 10774 11313 21186 22245 21098 22153
Tuberculosis cure rate: 720 3245 5992 5420
Percentage of emergency surgical cases 1,152,930 70 - 21,035 1 5,227 412 6,129 5,24
operated within one hour 73 19,683 - 1,068 ,075 1
Cold surgical cases operated on within one 1,152,930 796 - 9,387 39,753 1,618, 6,868 14,09
month. 908 19,063 - 5,022 865 1
Doctor Population ratio: 1,301,385 83 93 4,047,562 1,004 3,292,39 232 8,108, 18 2
2 000 1 84
382 120
Nurse Population ratio: 1,291,387 624 435 4,047,562 3,644 3,292,39 744 8,108, 3,067 3,43
3,580 2 399 000 5
Health facilities without all tracer drugs for 14 18 835 122 9 15
greater than 2 weeks (> 2 weeks) 0 17 92 91 221 1,227 2 76
Clients satisfied with services: 1,399,871 10 1,279,539 108,121 3,292,39 234 922,487 8,108, 2,098,703 2,623,419
- 12,321 2 ,581 000
Average Length of Stay (ALOS): 7 6 6 5 6 6 5
- - 5
Utilization rate of Out Patient Attendants 671,938 479,383 481, 2,422,103 2,457,059 2,0 1,561,4 801 972,535 3,795, 3,280,641 3,159,099
(OPD) - Male: 824 63,530 46 ,289 182
Utilization rate of Out Patient Attendants 727,933 537,955 529, 2,569,493 2,696,267 2,1 1,691,5 1,033, 1,200,796 4,413, 4,040,189 4,118,90
(OPD) -Female: 648 67,231 66 373 712 1
Health facilities that submit timely, accurate 14 103 835 443 347 88 1,1
reports to national level. 0 123 615 730 51 1,551 4 24
Health facilities that submit complete, 14 100 835 442 337 98 1,3
accurate reports to national level. 0 123 578 730 52 1,551 6 01
% GOK budget allocation to primary health 333,000 1,666, 28 22,355,698 43,5 1 48,004 1,070, 1 2,000,008
facilities (L2 & L3) - 000 86,958 3 4,734 008 4
% GOK budget allocation for drugs - 28 2,116,745 4,5 85 29,460 1 6,000,009
- - 11,089 3 ,256 10 4
Districts with Functional Health 1 10 11 13 1
1 11 - 11 13 5 43 4 43
Stakeholders Forum (DHSF):

Annual Operational Plan 5 – 2009/10 41

 Indicator Eastern Nairobi Nyanza Western
Eligible Baseline Target Eligible Baseli Targ Eligible Baseli Targe Eligible Baseli Targe
Populati Populati ne et Populati ne t Populati ne t
on on on on
Pregnancy, Delivery and the Newborn (upto 2
weeks)
Women of Reproductive Age (WRA) receiving Family 1,375 652,89 800,516 84 35 39 1,17 48 5 1,00 31 5
,505 3 8,051 2,606 5,730 6,093 9,982 33,140 0,691 4,579 20,810
Planning (FP) Commodities:
Pregnant women attending at least 4 ANC visits: 28 84,9 126,727 14 6 24 19
0,770 08 5,882 2,403 72,095 1,085 61,704 86,415 3,488 41,764 83,268
Newborns with Low Birth Weights (LBW) –(less than 27 5,4 3,136 14 24
1,899 10 5,882 2,629 2,640 1,085 8,001 2,389 - 1,818 2,196
2500 grams)
Pregnant women distributed with LLITNs 28 137,8 149,599 14 24 10 19 10 1
0,770 21 5,882 500 2,591 1,085 0,973 11,756 3,488 5,462 39,150
Pregnant women receiving two doses of Intermittent 28 93,8 124,663 14 3 24 1 25 12
0,770 29 5,882 2,602 43,616 1,085 95,140 35,373 6,580 5,089 151,612
Presumptive Therapy (IPT2)
HIV infected pregnant women who received preventive 1 5,7 7,981 2 2
6,189 92 10,426 6,506 7,357 2,994 0,526 21,158 15,813 6,172 14,664
antiretroviral therapy to reduce the risk of mother -to
-child transmission (PMTCT).
Deliveries conducted by skilled health attendants in 28 72,7 104,799 14 7 23 19
0,770 39 5,882 1,085 81,528 0,863 61,198 85,884 3,488 49,971 85,147
health facilities.
Maternal Deaths Audited 55
- 82 - 1 - - 110 8 - 106 106
Fresh still births in the health facility 1,2 463
- 73 - 530 - - 640 - - 681 257
Newborns receiving BCG: 27 181,1 227,833 14 11 1 24 20 2 19 16 1
3,386 54 5,882 5,665 36,544 1,085 0,762 18,782 3,488 4,027 68,381
Children under one (1) year of age immunized against 20 154,0 178,311 1 9 1 21 1 1 1 1 1
8,337 27 18,914 0,308 11,374 3,223 62,517 98,232 72,159 41,312 66,870
Measles:
Children under one (1) year of age fully immunized: 20 155,8 173,880 1 8 1 21 15 1 1 1 1
8,337 57 18,914 6,064 07,010 3,223 2,090 90,832 72,159 31,229 49,879
Children under 5 years (< 5 yrs) attending Child 1,03 574,53 656,787 48 7 8 53 55 82 47 6
8,331 0 3,800 1,678 99,278 73,111 9,369 7,076 6,934 9,725 25,806
Welfare Clinic (CWC) for growth monitoring services
(new cases)
Children under 5 years (< 5 yrs) attending Child 1,03 99,9 82,028 48 1 8 4 82 4
8,331 63 3,800 8,222 36,134 73,111 3,336 26,836 6,934 9,734 33,482
Welfare Clinic (CWC) who are underweight
Children less than 5 years (< 5 yrs) receiving Vitamin A 1,035 518,6 570,257 48 16 20 8 39 66 82 3 4
,503 53 3,800 1,669 3,740 73,111 0,260 4,099 6,934 61,129 37,305
supplement
Children under five years of age (< 5 years) distributed 1,03 393,8 449,379 48 8 2 82 22 3
8,331 61 3,800 3,547 5,442 73,111 11,311 11,368 6,934 3,192 19,402
with Long Lasting Insecticide Treated Nets (LLITNs)
Under 5 years treated for malaria, 1,03 608,83 420,815 48 4 8 80 8 82 65 8
8,331 9 3,800 5,066 59,833 73,111 2,986 18,330 6,934 3,222 19,537
Infant Mortality Rate (IMR) -
- - - - - - 143 - - - -
Facility Infant Mortality Rate (IMR) 1,7 1,727
- 72 - - - - 181 19 - 285 108
School children correctly de-wormed at least once in the 1,19 865,00 817,929 80 2 97 60 72 94 39 7
0,836 9 8,264 8,104 86,458 3,468 2,716 9,800 8,406 0,961 16,790
year:
Schools with adequate sanitation facilities: 7,0 7,862
8,220 08 - 323 197 - 3,751 1,594 - 388 388
144
1,017 129 251 36 24 696 19 28 112 6 45
Health facilities providing youth friendly services -
- - - - - - - - - - -
Population Counselled and Tested for HIV: (VCT, PITC, 4,270 545,57 708,901 2,01 21 2 3,37 33 57 1,86 51 8
,098 5 8,313 2,592 01,272 9,373 1,890 7,509 2,438 5,036 48,482
DTC, HBCT)
Condoms distributed: 2,549,52 14,217,527 43 6,79 9,16 4,16 13,78
- 5 - 9,064 85,097 - 9,319 6,603 - 7,472 2,339
Households sprayed with Insecticide Residual Spray 99 46,0 152,439 80 77 2 46
4,028 59 9,055 9,851 10,360 1,957 40,371 12,782 3,379 17,715 71,066
(IRS).
Adults and children with advanced HIV infection started 5 20,6 28,395 10 1 3
2,646 34 0,502 0,584 9,088 77,318 4,535 38,797 51,414 31,313 25,906
on Anti Retroviral Therapy (ART):

Annual Operational Plan 5 – 2009/10 42

 Indicator Eastern Nairobi Nyanza Western
Eligible Baseline Target Eligible Baseli Targ Eligible Baseli Targe Eligible Baseli Targe
Populati Populati ne et Populati ne t Populati ne t
on on on on
Adults and children with advanced HIV infection 5 87,3 75,779 25 26 2 12 37
8,321 80 9,221 7,785 12,794 - 5,098 9,230 7,005 68,164 97,345
receiving Anti Retroviral Therapy (ART)
TB case detection rate 15312 16078 18589 1951 21794 22884 8508 8933
8
Tuberculosis cure rate: 3970 5131 4569 1693

Percentage of emergency surgical cases operated within 4,6 3,887

- 54 - 18 19 - 3,346 - - 1,836 3,448
one hour
Cold surgical cases operated on within one month. 4,8 5,191
- 97 - 840 470 - 2,411 - - 1,102 2,102
Doctor Population ratio: 154 3,25 339 5,37 4,59 94 108
- 143 8,427 0,558 128 7,637
402 152
Nurse Population ratio: 2,3 3,796 3,25 5,37 4,59
- 97 8,427 1,345 1,335 0,558 1,684 - 7,637 662 1,037
Health facilities without all tracer drugs for greater than 37
1,045 110 372 55 12 704 112 1 110 42 16
2 weeks (> 2 weeks)
Clients satisfied with services: 1,065,50 1,241,087 1,12 5,37 4,59 60 6
- 8 1,795 - - 0,558 - - 7,637 0,933 04,699
Average Length of Stay (ALOS):
- 7 6 - 7 6 - 6 6 - 6 5
Utilization rate of Out Patient Attendants (OPD) - Male: 2,632 1,656,04 1,550,071 1,77 88 93 2,54 1,09 2,11 83 1,00 1,0
,304 6 2,584 7,966 4,825 1,105 8,572 4,068 2,267 6,497 95,343
Utilization rate of Out Patient Attendants (OPD) -Female: 3,15 1,941,32 1,748,898 1,48 1,327 1,42 2,74 1,29 2,20 91 1,35 1,3
3,512 2 5,843 ,707 1,073 5,583 4,812 9,269 5,394 7,739 48,814
Health facilities that submit timely, accurate reports to 940
1,066 271 372 28 202 606 9 584 313 7 319
national level.
Health facilities that submit complete, accurate reports 2 936
1,044 28 372 28 202 606 10 585 345 7 355
to national level.
% GOK budget allocation to primary health facilities (L2 8,890 3,56
33 31 - - - 1,100 - - 53 1 0,977
& L3)
% GOK budget allocation for drugs 34
35 - - - - 1,100 - - 7 1 1
Districts with Functional Health Stakeholders Forum 28
28 0 3 2 3 20 2 20 19 - 19
(DHSF):

Annual Operational Plan 5 – 2009/10 43

 4.1.3.3 AOP5 Target for service delivery by ownership
Indicator of Performance Eligible Nationa Nation GoK FBO NGO PRIVATE
Measurement Populati l al Target % Target % Targ % Targe %
on Baselin Target et t
Output e
Women of Reproductive Age (WRA) 4,462 71.3 1,40 31.5 1.9 332 7.4
receiving Family Planning (FP) 8,719,640 3,529,327 ,200 3,183,581 7,773 84,923 ,372
Commodities:
Pregnant women attending at least 4 81 63.7 331 40.7 3% 6 7.7
ANC visits: 1,666,084 534,007 2,856 518,036 ,206 23,107 2,577
Newborns with Low Birth Weights 23 61.4 243, 105 2% 8.5
(LBW) –(less than 2500 grams) 1,425,585 47,540 ,030 14,150 400 6.9 466 1,958
Pregnant women distributed with 79 69.0 300, 37.8 1% 36 4.6
LLITNs 1,666,104 650,697 5,477 549,056 903 10,405 ,520
Pregnant women receiving two doses 958 64.4 335 35.0 2% 5.4
of Intermittent Presumptive Therapy 1,729,196 716,835 ,960 617,218 ,552 20,045 51,755
Mothers are (IPT2)
kept healthy HIV infected pregnant women who 16 71.2 37 22.6 2% 1 8.2
before and received preventive antiretroviral 276,391 73,393 8,089 119,600 ,986 3,544 3,704
during therapy to reduce the risk of mother
pregnancy -to -child transmission (PMTCT).
Deliveries conducted by skilled health 78 65.2 306, 39.1 2% 60 7.7
attendants in health facilities. 1,653,985 555,632 4,755 511,643 494 12,096 ,288
Mothers are 96.2 1.9 0.4
Maternal Deaths Audited 0%
able to have - 3,705 2,166 2,084 42 3 9
normal Fresh still births in the health facility 3 81.4 11.5 2% 10.
deliveries 42,148 7,479 ,569 2,904 411 78 383 7
All newborns Newborns receiving BCG: 1,40 69.7 359, 25.6 2% 9 6.7
(up to 2 1,646,149 1,147,502 7,949 981,690 892 23,792 4,585
weeks)
receive
protection
against
immunizable
and other
conditions
Children Children under one (1) year of age 1,24 69.9 309, 24.9 1% 7 5.7
receive immunized against Measles: 1,402,820 1,007,833 5,262 870,115 469 18,430 1,027
protection Children under one (1) year of age 1,18 69.6 308, 26.0 2% 7 6.0
against fully immunized: 1,402,820 1,040,816 8,698 827,100 730 18,168 1,381
immunizable
diseases
Children under 5 years (< 5 yrs) 3,783 2, 69.6 1,17 31.0 1% 16 4.3
attending Child Welfare Clinic (CWC) 5,897,789 3,099,109 ,260 632,567 4,246 44,708 3,730
for growth monitoring services (new
cases)
Children under 5 years (< 5 yrs) 40 77.2 90 222. 1% 1 4.9
attending Child Welfare Clinic (CWC) 6,070,680 589,341 5,219 312,650 0,711 3 4,347 9,753
who are underweight
Children less than 5 years (< 5 yrs) 3,47 2, 70.8 1,13 32.7 2% 18 5.4
receiving Vitamin A supplement 5,924,092 2,456,635 1,105 458,046 5,249 53,566 7,554
Children under five years of age (< 5 1,93 1 70.9 1,043, 53.9 1% 8 4.2
years) distributed with Long Lasting 5,944,973 1,447,927 6,180 ,372,249 644 27,439 1,941
Insecticide Treated Nets (LLITNs)
Children are Under 5 years treated for malaria, 3,71 65.2 1,103 29.7 1% 18 4.9
6,190,595 3,388,540 0,160 2,419,781 ,394 44,472 1,130
able to
Infant Mortality Rate (IMR)
survive - 143 - - - - -
childhood Facility Infant Mortality Rate (IMR) 3 87.4 6.7 0% 0.3
illnesses - 5,588 ,806 3,328 254 2 11
Healthy School children correctly de-wormed 5,11 3, 72.1 1,339, 26.2 2% 208 4.1
lifestyle is at least once in the year: 8,043,785 3,999,299 3,909 688,082 908 86,197 ,901
adopted Schools with adequate sanitation 6 83.6 14.0 0% 0.6
amongst facilities: 8,666 117,409 9,595 58,154 9,753 192 422
children
Behaviour Health facilities providing youth
change is friendly services 4,886 507 7,293 14 23
promoted
amongst
adolescents
that leads to
healthy

44
lifestyle
Adolescents 2 0.0 0.0 0% 0.0
are able to - - 1,666 1 - - -
survive
common
health
conditions
affecting
them
Population Counselled and Tested for 5,54 68.4 3,743 67.5 1 2% 24 4.4
HIV: (VCT, PITC, DTC, HBCT) 22,256,19 3,171,783 7,136 3,794,517 ,417 29,369 5,785
8
Adults and Condoms distributed: 62,71 42 68.2 2,313, 3.7 6 1% 2,218 3.5
elderly are - 33,962,27 0,180 ,747,915 429 38,016 ,536
practising a 9
healthy Households sprayed with Insecticide 2,61 2 91.8 85 32.7 1% 5 2.0
lifestyle Residual Spray (IRS). 5,810,374 1,618,192 6,384 ,401,357 6,177 27,864 1,163
Adults and children with advanced 2,31 2 90.9 227, 9.8 1% 2 0.9
HIV infection started on Anti Retroviral 941,962 187,656 3,623 ,103,970 449 12,887 1,128
Therapy (ART):
Adults and children with advanced 804 65.3 84, 10.5 4% 29 3.6
HIV infection receiving Anti Retroviral 1,320,052 826,092 ,392 525,078 304 30,453 ,346

Adults and Therapy (ART)

elderly are TB case detection rate 1131 118
able to 19 775
survive Tuberculosis cure rate: 291
common 75
health Percentage of emergency surgical 3 43.5 26.4 0% 1.0
conditions cases operated within one hour 1,565,005 48,156 7,578 16,343 9,918 67 369
affecting Cold surgical cases operated on within 8 74.9 3 4.6 0% 0.5
them one month. 2,771,795 31,323 1,579 61,107 ,782 57 430
Human Doctor Population ratio: 2 55.0 2702 198 0% 0.2
resource 29,975,96 ,704 1,489 601. 12 6
1 1659 1
available to
Nurse Population ratio: 1 68.4 5,371 374 2% 13.
increase 29,965,96 13,821 4,362 9,822 ,638 02.0 217 1,935 5
access to 3
health
services
Essential Health facilities without all tracer 71.4 285. 1% 0.8
medicines drugs for greater than 2 weeks (> 2 4,524 832 260 185 740 2 2 2
and medical weeks)
supplies are
available to
increase
access to
health
services
Clients satisfied with services: 5,40 3 73.6 5,937 109. 2% 308, 5.7
Quality of 25,169,79 4,107,856 4,012 ,976,501 ,995 9 111,104 283
health 2
services Average Length of Stay (ALOS):
improved - 7 6 5 5 4
Utilization rate of Out Patient 12,37 9 74.5 3,47 28.1 2 2% 50 4.1
Attendants (OPD) - Male: 16,228,92 11,667,45 1,295 ,216,454 1,156 19,373 5,185
Utilization of 9 3
health 11 76.3 3,827, 26.0 2 55 3.8
Utilization rate of Out Patient 14,74 2%
services Attendants (OPD) -Female: 17,703,03 14,229,36 4,629 ,249,382 268 60,896 8,247
improved 6 4
Monitoring Health facilities that submit timely, 4 69.4 25.4 3% 6.8
and accurate reports to national level. 5,613 1,796 ,254 2,953 1,080 110 288
evaluation Health facilities that submit complete, 66.5 24.0 2% 6.1
improved accurate reports to national level. 5,623 1,853 4,417 2,938 1,060 107 271
% GOK budget allocation to primary 50,87 50 99.9 0.0 0% 0.0
Financial 1,071,225 22,703,47 0,837 ,814,873 1,100 - -
allocation to health facilities (L2 & L3)
8
health % GOK budget allocation for drugs 10,54 8, 75.9 0.0 0% 0.0
Improved 1,183 2,202,016 0,593 004,928 1,100 - -
Governance Districts with Functional Health 100.7 13.5 0% 0.0
structures Stakeholders Forum (DHSF): 148 33 148 149 20 - -
strengthene
d

Annual Operational Plan 5 – 2009/10 45

 4.1.3.4 AOP5 Target for service delivery by level of care
Indicator of Performance Eligible level 2 &3 level 4 level 5 level 6
Measurement Populat Baseline Targe % Baseline Targ % Bas Targ % Basel Targ %
ion t et elin et ine et
Output e
Women of Reproductive Age 3,529,3 2 33. 71 9.0 112, 1.3 0.1
(WRA) receiving Family 8,719,640 27 ,956,95 9 1,884 786,8 67,18 904 10,813 11,21
7 26 8 8
Planning (FP) Commodities:
Pregnant women attending at 1 534,0 27. 15 13.2 27, 1.6 0.2
least 4 ANC visits: ,666,084 07 452,057 1 7,451 220,2 20,09 247 3,860 3,986
27 2
Newborns with Low Birth 47,5 0.7 1 0.5 1 0.1 0.1
Weights (LBW) –(less than 1,425,585 40 9,647 7,379 7,130 2,870 ,291 830 855
2500 grams)
Pregnant women distributed 650,6 27. 189, 11.0 20, 1.2 0.0
with LLITNs 1,666,104 97 451,832 1 403 183,2 17,73 745 - -
23 2
Pregnant women receiving two 716,8 31. 185 12.7 29, 1.7 0.0
doses of Intermittent 1,729,196 35 547,641 7 ,674 219,8 18,47 959 418 439
84 3
Mothers are Presumptive Therapy (IPT2)
kept HIV infected pregnant women 73,3 37. 24, 17.3 2, 0.7 0.1
healthy who received preventive 276,391 93 103,187 3 348 47,91 2,758 072 148 155
3
before and antiretroviral therapy to reduce
during the risk of mother -to -child
pregnancy transmission (PMTCT).
Deliveries conducted by skilled 555,6 21. 183, 13.8 62,3 3.8 1.2
health attendants in health 1,653,985 32 358,267 7 944 228,4 50,46 98 18,894 19,64
Mothers are 52 0 3
facilities.
able to Maternal Deaths Audited 3,7
have - 05 269 1,736 1,720 141 29 116 120
normal Fresh still births in the health 7,4 4.1 2 1.7 1.1 2.0
deliveries facility 42,148 79 1,737 ,077 710 1,467 473 1,359 855
All Newborns receiving BCG: 1,147, 50. 284, 20.5 58, 3.5 1.0
newborns 1,646,149 502 826,839 2 388 336,9 43,82 226 16,523 17,19
15 2 9
(up to 2
weeks)
receive
protection
against
immunizabl
e and other
conditions
Children Children under one (1) year of 1 1,007,8 55. 213, 19.1 24,8 1.8 0.3
receive age immunized against ,402,820 33 778,486 5 922 267,7 19,83 40 4,342 4,545
07 1
protection Measles:
against Children under one (1) year of 1 1,040,8 53. 208, 18.5 23, 1.7 0.3
immunizabl age fully immunized: ,402,820 16 743,053 0 994 259,7 18,56 599 4,323 4,525
e diseases 13 5
Children under 5 years (< 5 3,099,1 2 38. 785 14.4 86, 1.5 0.2
yrs) attending Child Welfare 5,897,789 09 ,251,60 2 ,378 848,8 74,16 485 9,003 9,416
0 72 9
Clinic (CWC) for growth
monitoring services (new
cases)
Children under 5 years (< 5 6 589,3 4.5 123 1.2 5, 0.1 0.2
yrs) attending Child Welfare ,070,680 41 275,987 ,559 71,80 7,940 738 12,257 12,62
4 1
Clinic (CWC) who are
underweight
Children less than 5 years (< 5 5 2,456,6 2, 39. 540, 10.9 49, 0.8 0.1
yrs) receiving Vitamin A ,924,092 35 330,439 3 385 646,9 33,54 572 4,395 4,607
12 8
supplement
Children under five years of 5 1,447,9 1 20. 382, 7.1 29, 0.5 0.0
age (< 5 years) distributed ,944,973 27 ,202,78 2 323 420,1 22,56 250 - -
9 24 7
with Long Lasting Insecticide
Treated Nets (LLITNs)
Under 5 years treated for 3,388,54 2 33. 877, 13.5 49, 0.8 0.0
malaria, 6,190,595 0 ,073,10 5 209 837,3 62,73 975 2,463 2,556
Children are 0 77 6
able to Infant Mortality Rate (IMR)
survive - 143 - - - - - - -
childhood Facility Infant Mortality Rate 5,5 3,
illnesses (IMR) - 88 1,038 422 1,444 1,261 1,113 - -
Healthy School children correctly de- 8 3,999,29 3, 40. 67 13.3 72, 0.9 0.0
lifestyle is wormed at least once in the ,043,785 9 274,028 7 1,731 1,072, 58,12 677 - -
618 6
adopted year:
amongst Schools with adequate 117, 698 6, 92.0 1.1 0.0
children sanitation facilities: 8,666 409 60,556 .8 962 7,969 47 92 - -
Behaviour Health facilities providing 5.1 0.2 13
change is youth friendly services 4,886 507 157 247 6 9 6,194 6,380 0.6

Annual Operational Plan 5 – 2009/10 46

 Indicator of Performance Eligible level 2 &3 level 4 level 5 level 6
Measurement Populat Baseline Targe % Baseline Targ % Bas Targ % Basel Targ %
ion t et elin et ine et
Output e
promoted
amongst
adolescents
that leads
to healthy
lifestyle
Adolescents
are able to - - - - - - 1 - -
survive
common
health
conditions
affecting
them
Population Counselled and 22 3,171, 3 14. 746, 5.0 138, 0.6 0.2
Tested for HIV: (VCT, PITC, ,256,198 783 ,301,36 8 736 1,119, 118,3 050 36,274 37,53
5 059 83 3
DTC, HBCT)
Condoms distributed: 33,962,27 32 8,008, 2 502,
Adults and - 9 ,104,19 983 15,90 43,96 590 3,904 4,099
elderly are 3 4,427 6
practising a Households sprayed with 1,618, 2 39. 309, 4.8 7, 0.1 0.0
healthy Insecticide Residual Spray 5,810,374 192 ,281,13 3 391 279,2 4,453 381 - -
2 51
lifestyle (IRS).
Adults and children with 187,6 232 67 10.0 6, 0.7 0.1
advanced HIV infection started 941,962 56 2,190,5 .5 ,819 94,27 8,946 197 684 718
11 5
on Anti Retroviral Therapy
(ART):
Adults and children with 826,09 28. 303, 15.2 85, 6.5 0.4
advanced HIV infection 1,320,052 2 378,349 7 629 200,4 99,52 695 4,468 4,691
46 7
receiving Anti Retroviral
Adults and Therapy (ART)
elderly are TB case detection rate
able to Tuberculosis cure rate:
survive Percentage of emergency 48,1 0.1 17 0.6 14, 0.9 0.0
common surgical cases operated within 1,565,005 56 1,876 ,644 10,10 16,17 720 - -
health one hour 0 8
conditions 31,3 0.2 1 1.9 7, 0.3 0.0
Cold surgical cases operated
affecting on within one month. 2,771,795 23 5,476 3,212 51,99 5,875 882 12 20
them 8
Human Doctor Population ratio: 2 165 0.0 8 0.0 0.0 0.0
resource 9,975,961 9 135 08 1,102 125 220 220
631
available to Nurse Population ratio: 29, 13, 0.0 4 0.0 0.0 0.0
increase 965,963 821 6,579 ,752 3,925 2,659 703 1,860 1,847
access to
health
services
Essential Health facilities without all 8 4.2 0.7 0.0 0.0
medicines tracer drugs for greater than 2 4,524 32 192 289 33 2 1 - -
and medical weeks (> 2 weeks)
supplies are
available to
increase
access to
health
services
Clients satisfied with services: 2 4,107,8 12. 1,461 6.6 129, 0.5 0.0
Quality of 5,169,792 56 3,171,2 6 ,609 1,662, 73,84 227 - -
health 62 836 4
services Average Length of Stay (ALOS): 2 6 5
improved - 3 7 6 7 6
Utilization rate of Out Patient 16 11,667,4 7 48. 3,126, 16.4 291, 1.8 2 1.7
Attendants (OPD) - Male: ,228,929 53 ,877,47 5 669 2,667, 362,7 749 274,32 83,12
Utilization 0 278 88 5 0
of health 1 14,229,36 9 54. 3,986, 18.8 292,8 1.7 2 1.3
Utilization rate of Out Patient
services Attendants (OPD) -Female: 7,703,036 4 ,556,55 0 404 3,330, 374,1 43 229,82 37,30
improved 8 610 34 1 6
Health facilities that submit 1, 65. 4.1 0.2 0.0
timely, accurate reports to 5,613 796 3,664 3 191 229 7 11 - 2
Monitoring national level.
and Health facilities that submit 1, 64. 4.1 0.2 0.0
evaluation complete, accurate reports to 5,623 853 3,611 2 181 228 7 11 1 2
improved national level.
Financial % GOK budget allocation to 22,703,47 46, 434 347, 399. 0.0 0.0
allocation primary health facilities (L2 & 1,071,225 8 531,068 3.7 738 4,283, 9 6 - - -
805
to health L3)
Improved % GOK budget allocation for 2,202,0 7 674 85 249 0.0 39 0.0
drugs 1,183 16 ,975,46 173 ,255 29,46 0.3 - - 5,000,0 -

Annual Operational Plan 5 – 2009/10 47

 Indicator of Performance Eligible level 2 &3 level 4 level 5 level 6
Measurement Populat Baseline Targe % Baseline Targ % Bas Targ % Basel Targ %
ion t et elin et ine et
Output e
7 .1 0 00
Governance Districts with Functional Health 62. 37.8 0.0 0.0
structures Stakeholders Forum (DHSF): 148 33 93 8 18 56 0 - - -
strengthene
d

Annual Operational Plan 5 – 2009/10 48

 Indicators for level 1 service
PROVINCE Indicator 1: Indicator 2: Indicator 3: Indicator 4:
number of number of number of number of
households people treated dialogue days community
visited to for minor for claiming action days
deliver health ailments rights
messages.

Baseli Target Baseli Target Baseli Target Baseli Target

ne ne ne ne
Central 59,856 194,823 8,258 174,480 511 1,240 185 1,050
North Eastern 9,537 65,639 82,593 374,711 55 737 40 622
Coast 2,280 50,784 64 51,805 2 101 290 390
Eastern 13,105 69,663 15,810 73,920 95 474 102 726
Nairobi 100 1,600 200 4,260 2 44 3 18
Nyanza 47644 68523 3312 135535 78 780 85 332
Western 14285 294554 1211 203339 9 663 5 600
Rift Valley 36652 366852 85348 885751 1395 2858 246 2670
Total 183,45 1,112,4 196,79 1,903,8 2,147 6,897 956 6,408
9 38 6 01

Annual Operational Plan 5 – 2009/10 49

 Provincial level plans for Service Delivery and Management
Support

Central Province Health Plans

4.1.3.5 Priorities for the province

• Strengthen implementation of community strategy

• Improve maternal and child health services
• Establish youth friendly centers’ and services in L1, L2 & L3
• Improve access and utilization of health services in the province
• Provide comprehensive care for HIV/AIDs, TB, Malaria and NCD clients
• Improve work place environment
• Strengthen Capacity building
• Enhance youth health friendly services
• Establish geriatric health services
• Increasing vector control with particular emphasis on Tunga
penetrans(jiggers)
• Strengthen governance structures

4.1.3.6 Central province Service Delivery targets

Indicators Kiambu Kiambu Muranga Muranga Nyandaru Nyandarua Nyeri
Gatundu East West North South Kirinyaga a North South Nyeri North South Thika
Percentage of Women of Reproductive Age (WRA) 45108 88338
11,838 59,779 98,977 116,306 64,729 60,898 69,454 77,678 101,625
receiving Family Planning (FP) Commodities:
Percentage of pregnant women attending at least 4997 14342
9,067 6,760 5,467 11,420 8,316 11,118 5,728 8,825 10,721
4 ANC visits:
Percentage of Newborns with Low Birth Weights 54 244
344 971 247 566 1,990 334 77 309 784
(LBW) –(less than 2500 grams)
Percentage of pregnant women distributed with 7572 10667
2,198 1,969 7,022 12,810 2,030 5,540 4,148 44 13,721
LLITNs
Percentage of pregnant women receiving two 7281 9189
8,617 4,376 7,239 8,848 6,804 4,696 6,006 6,816 12,644
doses of Intermittent Presumptive Therapy (IPT2)
Percentage of HIV infected pregnant women who 195 626
239 832 135 475 708 258 329 795 753
received preventive antiretroviral therapy to
reduce the risk of mother -to -child transmission
(PMTCT).
Percentage of Deliveries conducted by skilled 9828 11492
5,629 6,728 11,273 11,454 7,261 6,381 7,443 11,897 15,442
health attendants in health facilities.
Percentage of Maternal Deaths Audited 0 10
- - 1 - 5 1 - 12 30
Percentage of fresh still births in the health 0 100
82 95 4 172 - 4 28 161 111
facility
Percentage of Newborns receiving BCG: 7380 15914
8,438 2,505 9,262 13,602 57 6,550 9,842 13,060 15,442
Percentage of Children under one (1) year of age 6313 13024
4,466 8,230 10,880 12,602 16,726 6,305 9,595 10,819 14,715
immunized against Measles:
Percentage of Children under one (1) year of age 6313 13024
11,382 2,626 10,880 12,602 8,300 7,161 9,597 10,976 14,715
fully immunized:
Percentage of Children under 5 years (< 5 yrs) 16247 73048
4,888 8,267 15,964 18,075 14,964 21,763 47,418 40,364 51,274
attending Child Welfare Clinic (CWC) for growth
monitoring services (new cases)
Percentage of Children under 5 years (< 5 yrs) 467 1661
7,397 6,459 1,775 6,856 20,910 531 6,053 1,801 1,136
attending Child Welfare Clinic (CWC) who are
underweight
Percentage of Children less than 5 years (< 5 yrs) 20080 25400
9,077 16,477 37,337 39,703 31,565 15,981 41,809 32,839 37,603
receiving Vitamin A supplement
Percentage of children under five years of age (< 14893 13600
8,415 6,711 7,175 42,174 2,638 4,572 5,985 5,000 14,716
5 years) distributed with Long Lasting Insecticide
Treated Nets (LLITNs)
Percentage of under 5 years treated for malaria, 10805 29798
1,256 14,174 27,608 83,033 17,617 10,654 26,703 26,061 40,465

Annual Operational Plan 5 – 2009/10 50

 Indicators Kiambu Kiambu Muranga Muranga Nyandaru Nyandarua Nyeri
Gatundu East West North South Kirinyaga a North South Nyeri North South Thika
Infant Mortality Rate (IMR) 0 0
- - - - - - - - -
Facility Infant Mortality Rate (IMR) 10 0
- - - - - - 19 260 82
Percentage of school children correctly de- 52462 120118
15,432 13,500 116,979 96,768 17,772 55,480 72,552 101,484 92,087
wormed at least once in the year:
Percentage of schools with adequate sanitation 140 421
26 120 15 875 500 15 308 210 72
facilities:
Percentage of Health facilities providing youth 19 0
15 59 139 5 4 1 5 2
friendly services 0 0
- - - - - - - - -
Percentage of population Counselled and Tested 24216 11455
51,589 19,900 6,807 30,802 19,411 16,063 1,007,301 35,613 28,385
for HIV: (VCT, PITC, DTC, HBCT)
Number of condoms distributed: 1076952 168236
2,417 287,790 799,800 1,500,000 260,049 162,400 21,539 799,247 1,200,000
Percentage of Households sprayed with 946 1028
105 3,641 7,518 5,000 2,923 505 2,262 5,699 2,328
Insecticide Residual Spray (IRS).
Percentage of adults and children with advanced 1295 1591
1,052 750 740 1,151 433 777 6,471 3,652 1,682
HIV infection started on Anti Retroviral Therapy
(ART):
Percentage of Adults and children with advanced 11571 1821
885 2,450 1,232 2,287 4,616 1,268 811 14,226 26,250
HIV infection receiving Anti Retroviral Therapy
(ART)
TB case detection rate 526 1071 1252 834 1760 679 355 768 1024 1903
1142
Tuberculosis cure rate: 182 336 262 316 322 488 160 87 182 257 653
Percentage of emergency surgical cases operated 864 1400
- 1,150 394 1,610 35 394 812 11,372 1,652
within one hour
Percentage of cold surgical cases operated on 334 8260
- 95 1,834 1,372 - 1,834 34 3,050 2,250
within one month.
Doctor Population ratio: 19 34
60 17 4 30 8 4 221 99 54
Nurse Population ratio: 164 412
2 243 136 479 940 46 31 626 501
Percentage of Health facilities without all tracer 0 0
31 - - - 17 - 40 3 1
drugs for greater than 2 weeks (> 2 weeks)
Percentage of clients satisfied with services: 1 0
8,709 180 - - 284 - 3,141 6 -
Average Length of Stay (ALOS): 8 6
5 5 5 6 5 5 7 6 5
Utilization rate of Out Patient Attendants (OPD) - 106967 221034
60,037 82,295 178,814 519,233 266,469 107,080 148,438 178,080 195,083
Male:
Utilization rate of Out Patient Attendants (OPD) 114811 313314
44,362 130,924 167,917 755,049 132,334 110,378 1,640 190,419 206,083
-Female:
Percentage of health facilities that submit timely, 14 0
- 81 67 171 34 - 76 160 12
accurate reports to national level.
Percentage of health facilities that submit 2 0
- 81 67 171 34 - 51 160 12
complete, accurate reports to national level.
% GOK budget allocation to primary health 0 0 3
- - - - 55,928 3,859,485 1,769,851 7,901,690 4
facilities (L2 & L3)
% GOK budget allocation for drugs 3 0
- 2,400,000 - - 135,663 - - 1,975,423 -
Percentage of districts with Functional Health 1 1
1 1 1 1 1 1 1 1 1
Stakeholders Forum (DHSF):

4.1.3.7 Central Provincial Health Management Support plan

Result Area Output Time frame Respons Costs / Revenue Source Gap
Q1 Q Q Q ible budget
2 3 4 person
1.Planning 2010-2011 AOP developed X X PDPHS, 1,580,000 1,580,000 GOK
PHRIO
2. Quarterly review reports from X X X X PHRIO 400,000 400,000
Performanc all DHMTs
e Quarterly supportive X X X X PHRIO 160,000.0 160,000.0 UNICEF
monitoring supervision by PHMT members 0 0
and All districts L2 & L3 facilities X X X X PDPHS 1,600,000 400,000 PSI
evaluation supervised on quarterly basis 1,200,000 GOK
and selected L1 units
all DHMT performance X PDPHS 50,000.00 50,000.00

Annual Operational Plan 5 – 2009/10 51

Result Area Output Time frame Respons Costs / Revenue Source Gap
Q1 Q Q Q ible budget
2 3 4 person
appraisal carried out twice a
year
quarterly analysis of data to X X X X PHRIO - -
fast track set targets done
evidence based practices X X X X PRO 320,000.0 320,000.0
disseminated and utilized 0 0
3. Human staff rationalization carried out X PPO 20,000.00 20,000.00
Resource improved work climate and X x PNO 500,000.0 500,000.0
Manageme staff morale by providing 0 0
nt and annual awards and recognition
developme capacity to respond to nutrition X
nt issues increased x
transition of level-3 to level 4 X X X X PHAO 200,000.0 200,000.0
supported 0 0
5 mandatory CMEs for all PHMT X X X X PHAO 350,000.0 350,000.0
members on professional 0 0
development supported
Staff shortage in rural facilities x X X PDPHS 70,479,60 2,000,000 VHIDA
and CCCs alleviated through 4 69,250,81 ICAP
renewal of support from 8
capacity project
Two refresher training courses PHAO 200,000.0 200,000.0
for drivers held 0 0
Mid level management training X X x P/LOG 1,500,00. 1,500,00.0
on EPI carried out 00 0
Sustained(weekly) health talks X X X PHEO 120,000.0 120,000.0 PSI
through Kangema FM station X 0 0
on Family planning, quality
assurance and healthy living
styles
All World Health days observed X X X X 325,000.0 325,000.0 PSI
0 0
All DHEOs trained on listening X PHEO 200,000.0 200,000.0 PSI
skills 0 0
Essential
medicines
and
supplies
Capacity IEC materials for Malaria X X X X
Building campaign designed and
distributed to all districts
6.Infrastruc Ceramic floor maintained X X X X PHAO 100,000.0 100,000.0
ture quarterly to the required 0 0
developme standard
nt and All L-2 and L-3 facilities X X X X PHAO 50,000.00 50,000.00
maintained supported to develop
infrastructure and development
master plans
adequate casualty facilities in X X PDPHS - -
Sagana H/Center developed
Repair and scheduled X X X X PHAO 300,000.0 300,000.0
maintenance of communication 0 0
systems carried out
quarterly servicing and X X X X PHRIO 120,000.0 120,000.0
payment of internet services 0 0
well maintained ICT equiment, X X X X PHRIO 200,000.0 200,000.0
printers and copiers 0 0
scheduled servicing & X X X X PHAO 500,000.0 500,000.0

Annual Operational Plan 5 – 2009/10 52

Result Area Output Time frame Respons Costs / Revenue Source Gap
Q1 Q Q Q ible budget
2 3 4 person
maintenance of vehicles, repair 0 0
as need arises
7. Management boards identified X PDPHS 10,000.00 10,000.00
Governanc & gazetted
e annual stakeholders forum held X PDPHS 350,000.0 350,000.0
0 0
thematic quarterly stake X X PHEO 80,000.00 80,000.00 PSI
holders meetings held X X
8.Emergen co-ordinated emergency X PPHO 100,000.0 100,000.0
cy response teams revitalized 0 0
preparedne between the 2 ministries
ss and all staff sensitized on X X X PNO 200,000.0 200,000.0
response emergency response and 0 0
preparedness
9.Financial Procurement X X PHAO 100,000.0 100,000.0
Manageme entities/committees 0 0
nt established
hold quarterly review meetings X X X X PDPHS 400,000.0 400,000.0
with implementing partners 0 0
10. 15 TOTs trained on research X X 400,000.0 400,000.0
Operational methods 0 0
and other
research

4.1.3.8 Central Provincial Hospital Management Support

Result Output Timeframe Respons Costs / Revenue Unfun

Area Q Q Q Q ible budget Amount Sour ded
1 2 3 4 Person ce
Planning 2010-2011 AOP developed X X PDMS, 1,650,0 1,650,00
PHRIO 00 0
Performan Quartely thematic meetings X X X PNO 300,000 300,000.
ce with stakeholders held .00 00
monitoring quarterly review of reports with X X X X PDMS 400,000 400,000.
and respective district heads .00 00
evaluation conducted
All districts L4 & L5 facilities X X X PDMS 1,200,0 1,200,00
supervised on quarterly basis 00 0
quarterly analysis of data to fast X X X X PHRIO - -
track set targets
evidence based practices X X X X PNO 600,000 600,000
disseminated and utilized
Staff performance appraisal X X PDMS 30,000. 30,000.0
carried out twice a year 00 0
Human staff rationalization carried out X X PPO 100,000 100,000.
Resource .00 00
Manageme improved work climate and staff X X PNO 500,000 500,000.
nt & morale .00 00
Developme transition of level-3 to level 4 X X X PHAO 200,000 200,000.
nt supported .00 00
Capacity 5 days mandatory CME for X x x x PHAO 350,000 350,000.
Building PMSTsupported .00 00
two refresher training for drivers X PHAO 200,000 200,000.
hold two refresher training for X .00 00
drivers held

Annual Operational Plan 5 – 2009/10 53

Result Output Timeframe Respons Costs / Revenue Unfun
Area Q Q Q Q ible budget Amount Sour ded
1 2 3 4 Person ce
Essential
Medicines
and
supplies
Infrastruct Offices for all PMST established X X X PHAO 400,000 400,000.
ure and equipped x .00 00
developme All L-4 and L-5 facilities X X X PHAO 350,000 350,000.
nt & supported to develop .00 00
Maintenan infrastructure and development
ce(Equipm master plans
ent, Casualty facilities in Thika and X X PDMS 300,000 300,000
communic PGH Nyeri improved
ation & Scheduled Repair & x x x x PHAO 500,000 500,000
transport) maintenance of communication
systems carried out
quarterly servicing and payment X X X X PHRIO 200,000 200,000
of internet services
well maintained ICT equipment, X X X X PHRIO 200,000 200,000
printers and copiers
scheduled servicing & X X X X PHAO 1,200,0 1,200,00
maintenance of vehicles, repair 00 0
as need arises
Governanc Management boards identified X X PDMS 100,000 100,000.
e and gazetted .00 00
annual stakeholders forum held PDMS 250,000 250,000.
.00 00
Emergency Emergency response teams X X PPHO 700,000 700,000
preparedn revitalized
ess and Emergency response teams X X X PNO 100,000 100,000.
response sensitized on emergency .00 00
response and preparedness
Financial Facility Procurement X X PHAO 100,000 100,000.
manageme entities/committees established .00 00
nt hold quarterly review meetings X X X PDMS 400,000 400,000.
with implementing partners X .00 00
Operation Staff sensitised and X X X X PNO 500,000 500,000
& other encouraged to carry out
research specific research and cultivate a
system culture of evidence based
practice
15 TOTs trained on research X X 500,000 500,000
methods
Total 11,330, 11,330,
000.00 000.00

Annual Operational Plan 5 – 2009/10 54

 Eastern Province Health Plans

4.1.3.9 Priorities for the province

• Strengthen referral system

• Increase utilization of FP services
• Increase birth by skilled attendants
• Initiate and enhance youth friendly services in all health facilities
• Sensitization of communities on effects of drug and substance abuse
• Scale up implementation of community strategy
• Improve health services for the elderly
• Strengthen governance structures
• Reduce malnutrition
• Improve school health programs
• Improve TB,HIV/AIDS, Malaria services

4.1.3.10 Service Delivery targets for Eastern province

Indicators Mer Maku
Imen u eni
ti Kibw Kyuz Macha Mbeer Sout Mwin Tiga Chal Igem laisa
South ezi o kos e h gi nia bi be Isiolo kitui mis
Percentage of Women of 27,310 43,482 16,09 76,746 36,140 28,4 31,1 32,1 59,2 7, 56,3 1,008 37,547
Reproductive Age (WRA) 4 53 83 84 579 54 606 25
receiving Family Planning
(FP) Commodities:
Percentage of pregnant 2,261 6,470 5,5 10,057 4,524 1 8,0 4,0 9, 2, 8, 1,503 7,090
women attending at least 4 63 ,881 50 23 452 445 194 856
ANC visits:
Percentage of Newborns - 132 4 10
with Low Birth Weights (LBW) - 25 110 231 65 67 2 767 83 332 18 0
–(less than 2500 grams)
Percentage of pregnant 2,042 18,118 6,1 18,780 4,999 5, 10,42 7,3 8, 3, 6, 82 5,609
women distributed with 67 775 8 76 361 427 429 294 9
LLITNs
Percentage of pregnant 1,969 11,646 3,1 9,12 5,487 2, 9,7 5,3 7, 2, 6, 1,095 7,466
women receiving two doses 99 8 957 43 64 573 440 855 294
of Intermittent Presumptive
Therapy (IPT2)
Percentage of HIV infected 127 608 4 1, 31
pregnant women who 199 47 58 375 433 154 2 507 96 068 11 4
received preventive
antiretroviral therapy to
reduce the risk of mother -to
-child transmission (PMTCT).
Percentage of Deliveries 219 6,470 2,8 11,558 2,834 5, 4,6 4,6 13,7 3, 5, 43 4,13
conducted by skilled health 33 574 21 94 484 75 145 535 7 0
attendants in health
facilities.
Percentage of Maternal - -
Deaths Audited - 4 - 9 8 1 2 3 1 - - 4
Percentage of fresh still - 64 3
births in the health facility - - 22 27 - 35 - - 7 41 - 6
Percentage of Newborns 4,589 23,294 6,0 12,936 8,497 5, 10,46 10,7 1,8 21,7 4, 18, 2,490 14,320
receiving BCG: 63 260 7 28 09 92 301 819
Percentage of Children 2,784 19,904 5,4 12,364 7,052 3, 7,0 8,2 1,0 13,3 3, 13, 2,072 9,387
under one (1) year of age 50 172 16 07 85 44 600 916
immunized against Measles:
Percentage of Children 2,794 22,856 5,3 12,627 7,052 3, 8,4 8, 1,0 13,2 3, 4, 1,964 9,289
under one (1) year of age 84 201 02 541 85 40 300 388
fully immunized:
Percentage of Children 14,443 93,176 1,7 44,803 23,259 11, 21,8 19,7 3,25 37,0 9, 56,4 6,844 19,336
under 5 years (< 5 yrs) 98 063 12 93 5 31 445 23
attending Child Welfare
Clinic (CWC) for growth
monitoring services (new

Annual Operational Plan 5 – 2009/10 55

 Indicators Mer Maku
Imen u eni
ti Kibw Kyuz Macha Mbeer Sout Mwin Tiga Chal Igem laisa
South ezi o kos e h gi nia bi be Isiolo kitui mis
cases)
Percentage of Children 131 5,790 4,370 3,663 2,0 6,7 2,1 4, 3, 6, 2,598 9,446
under 5 years (< 5 yrs) 664 520 77 59 70 109 654 376
attending Child Welfare
Clinic (CWC) who are
underweight
Percentage of Children less 12,080 46,588 12,20 49,003 9,828 10,3 25,08 38,6 2,7 22,8 6, 49,8 5,795 18,980
than 5 years (< 5 yrs) 7 27 6 21 13 74 783 12
receiving Vitamin A
supplement
Percentage of children under 7,353 32,612 21,04 39,230 13,729 16,9 37,08 28,96 20,7 6, 17,6 1,079 14,907
five years of age (< 5 years) 5 03 4 6 217 71 492 22
distributed with Long Lasting
Insecticide Treated Nets
(LLITNs)
Percentage of under 5 14,443 27,952 10,6 22,630 20,319 14,3 15,44 33,78 1,6 46,4 8, 23,9 2,061 23,598
years treated for malaria, 71 86 9 5 28 19 306 12
Infant Mortality Rate (IMR) - -
- - - - - - - - - - - -
Facility Infant Mortality Rate - 94 7
(IMR) - - - - 16 - - 231 - - - 0
Percentage of school 15,000 47,694 27,90 127,672 6,677 17,4 46,93 10,97 12,5 29,2 83,6 2,754 7,13
children correctly de-wormed 8 34 - 5 2 49 04 00 9
at least once in the year:
Percentage of schools with 200 4,304 2 34
adequate sanitation facilities: 107 00 - 253 - 285 - 171 29 - - 7
Percentage of Health - 2 2
facilities providing youth 18 2 - 5 5 1 3 6 5 6 10 9
friendly services
- -
- - - - - - - - - - - -
Percentage of population 3,600 7,248 8,8 22,938 19,21 191,0 5,3 15,5 6, 21,9 1,577 20,197
Counselled and Tested for 13 1 60 - 64 - 32 217 63
HIV: (VCT, PITC, DTC, HBCT)
Number of condoms 710,000 200,000 73,04 1,75 311,360 2 34,86 235,52 392,00 380,30 11,018 57,420
distributed: 3 2 ,151 - 6 - 3 0 2
Percentage of Households 1,000 1,740 17,50 19, 20,09 2,6 6,00 8, 74
sprayed with Insecticide 3 - - 718 4 82 0 - 120 856 30 1
Residual Spray (IRS).
Percentage of adults and - 2,432 3,6 1,00 2 2, 3, 4, 1,37
children with advanced HIV 07 3 68 908 655 120 100 265 200 500 20 0
infection started on Anti
Retroviral Therapy (ART):
Percentage of Adults and - 7,449 5,600 6 1, 17,0 4, 5,093
children with advanced HIV 532 06 - 176 568 100 06 800 600 40
infection receiving Anti
Retroviral Therapy (ART)
TB case detection rate 109
526 0 206 1899 599 606 956 394 553 707 1932 - 911
Tuberculosis cure rate: 157
164 226 52 411 168 162 167 - 180 126 506 - 246
Percentage of emergency - 118 1 40
surgical cases operated 134 - 42 - - 182 - 312 - 1 3 2
within one hour
Percentage of cold surgical - 118 2,1 2 9
cases operated on within one 52 - 08 10 - 101 - 276 - 1 - 0
month.
Doctor Population ratio: - 6
- 14 9 - - 3 - - 8 - - 7
Nurse Population ratio: - 420 21
137 - - - - 221 32 - 180 - - 0
Percentage of Health - -
facilities without all tracer 12 - - - - 5 - - 8 - 3 5
drugs for greater than 2
weeks (> 2 weeks)
Percentage of clients - 310,588 114,66 306,242
satisfied with services: 6 - - - - 359 - - 100 1 -
Average Length of Stay 5 5 6 6 6 5 7 6 6 5
(ALOS): 7 6 8
7
Utilization rate of Out 58,000 166,682 55,38 319,464 30,481 61,8 90,67 73,65 13,56 19,6 20,358
Patient Attendants (OPD) - 2 06 5 3 3 - 75 - -
Male:
Utilization rate of Out 90,000 237,600 68,69 203,198 33,327 67,8 133,17 130,38 14,46 24,8 27,647
4 54 0 4 9 - 76 2 -

Annual Operational Plan 5 – 2009/10 56

 Indicators Mer Maku
Imen u eni
ti Kibw Kyuz Macha Mbeer Sout Mwin Tiga Chal Igem laisa
South ezi o kos e h gi nia bi be Isiolo kitui mis
Patient Attendants (OPD)
-Female:
Percentage of health 55 52 2
facilities that submit timely, 79 54 38 27 51 27 12 24 31 96 13 8
accurate reports to national
level.
Percentage of health 55 52 2
facilities that submit 79 56 38 27 51 27 12 24 31 96 13 6
complete, accurate reports
to national level.
% GOK budget allocation to - - 8,8
primary health facilities (L2 & 76 - - - - - - - - - - -
L3)
% GOK budget allocation for - -
drugs 23 - - - - - - - - - - -
Percentage of districts with 1 1
Functional Health 1 1 1 1 1 1 1 1 1 1 1 1
Stakeholders Forum (DHSF):

Indicators Meru
Mboo Moyal Imenti Muto Marsa Centra Thara Garba
ni e Nzaui Yatta Embu North Kangundo mo Maara bit l Mwala ka tula
Percentage of Women of 15,693 3,77 17,945 23,767 86,238 63,250 31,78 12,362 23,213 3,196 19,847 29,600 13,178 2,764
1 2
Reproductive Age (WRA)
receiving Family Planning (FP)
Commodities:
Percentage of pregnant women 3,81 3,064 3,346 6,189 6,287 11,02 3,1 5,264 2,59 1,059 9 3,584 3,253 7
4 3 64 5 49 68
attending at least 4 ANC visits:
Percentage of Newborns with 2
22 39 37 - 82 33 111 81 55 27 14 - 58 46
Low Birth Weights (LBW) –(less
than 2500 grams)
Percentage of pregnant women 3,269 3 5,057 6,034 6,11 6,98 5,1 3,268 3,40 24 2,070 5,14 2,746 1,12
93 4 8 03 6 7 5 4
distributed with LLITNs
Percentage of pregnant women 4,359 1,96 5,329 5,881 6,398 5,04 4,8 3,708 2,59 1,067 1,49 2,850 3,089 7
4 2 88 4 0 88
receiving two doses of
Intermittent Presumptive Therapy
(IPT2)
Percentage of HIV infected 1 46 4 4 5 2 1
- 40 48 4 61 34 741 88 160 51 55 98 06 37
pregnant women who received
preventive antiretroviral therapy
to reduce the risk of mother -to
-child transmission (PMTCT).
Percentage of Deliveries 4,359 1,76 1,48 92 9,233 7,10 2,1 1,97 2,86 6 2,01 4 3,089 3
8 7 8 7 49 6 6 31 4 86 98
conducted by skilled health
attendants in health facilities.
Percentage of Maternal Deaths
- 5 - - 9 4 6 - - - - - - -
Audited
Percentage of fresh still births in
- 39 - - 56 65 21 7 5 - 10 - 27 -
the health facility
Percentage of Newborns 5,885 5,288 9,294 8,690 11,502 10,11 5,6 5,279 3,1 2,130 3,799 4,400 6,095 1,17
0 32 91 2
receiving BCG:
Percentage of Children under 6,277 3,81 5,17 6,797 8,93 6,20 5,9 5,948 3,29 1,61 3,745 5,250 4,805 1,18
8 5 1 9 02 8 5 9
one (1) year of age immunized
against Measles:
Percentage of Children under 6,277 3,676 5,253 6,908 8,977 6,40 6,1 5,809 3,29 1,577 3,745 5,950 4,672 1,06
9 38 8 7
one (1) year of age fully
immunized:
Percentage of Children under 5 39,232 18,382 28,998 31,757 19,322 33,263 20,53 21,695 13,54 8,803 7,858 27,000 19,767 4,15
4 1 4
years (< 5 yrs) attending Child
Welfare Clinic (CWC) for growth
monitoring services (new cases)
Percentage of Children under 5 5,885 5,656 8 4,458 2,847 1,94 2,098 9 85 2 1,00 1,730 6
12 2 578 42 4 41 0 58
years (< 5 yrs) attending Child
Welfare Clinic (CWC) who are
underweight
Percentage of Children less than 31,386 9,050 31,228 41,779 27,047 16,203 27,50 21,11 9,66 3,432 4,34 17,450 14,825 4,542
2 0 6 1
5 years (< 5 yrs) receiving
Vitamin A supplement
Percentage of children under five 5,885 2 15,624 34,680 16,581 25,789 25,31 4,839 12,382 95 11,063 17,500 17,296 3,17
83 4 8 3
years of age (< 5 years)
distributed with Long Lasting
Insecticide Treated Nets (LLITNs)

Annual Operational Plan 5 – 2009/10 57

 Indicators Meru
Mboo Moyal Imenti Muto Marsa Centra Thara Garba
ni e Nzaui Yatta Embu North Kangundo mo Maara bit l Mwala ka tula
Percentage of under 5 years 3,923 5,656 3,692 16,711 28,868 28,478 13,80 1,42 17,97 1,534 9,807 8,84 9,884 4,663
7 1 1 1
treated for malaria,
Infant Mortality Rate (IMR)
- - - - - - - - - - - - - -
Facility Infant Mortality Rate 5 5
45 - - - - 175 - 83 0 - - - 12 -
(IMR)
Percentage of school children 38,142 5,499 9,854 58,478 49,953 30,250 98,43 24,192 26,318 3,790 17,681 9,294 10,499
9 -
correctly de-wormed at least
once in the year:
Percentage of schools with 2 1 3 3 1
00 19 38 12 63 155 426 171 30 15 - - 12 26
adequate sanitation facilities:
Percentage of Health facilities
2 4 19 2 1 7 1 4 4 - 4 2 - 1
providing youth friendly services
- - - - - - - - - - - - - -
Percentage of population 32,039 30,793 140,068 9 33,836 62,368 46,41 2,500 8,78 4,71 20,179 2,568
10 6 9 - 6 -
Counselled and Tested for HIV:
(VCT, PITC, DTC, HBCT)
Number of condoms distributed: 69,418 9 67,565 119,673 194,620 10,893,396 360,072 2,500 84,662 15,270
17 - - - -
Percentage of Households 6,043 3 9,834 12,623 12,000 1,33 20,582 3,61 35 1,23 1,500 3,733
14 6 788 8 5 0 -
sprayed with Insecticide Residual
Spray (IRS).
Percentage of adults and 8 4 4 78 7 1,09 1,55 6 2 3 4 20 1
72 71 58 4 00 2 25 1 25 31 00 58 0 80
children with advanced HIV
infection started on Anti
Retroviral Therapy (ART):
Percentage of Adults and 1,76 1,57 5 1,26 3 20,570 1,60 1,42 30 5 7 25 3
7 1 79 1 00 968 0 7 0 00 76 0 41
children with advanced HIV
infection receiving Anti
Retroviral Therapy (ART)
TB case detection rate 8 31
- 39 - 623 1041 553 644 - 104 2 425 - 271 40
Tuberculosis cure rate: 6
- 167 - 192 217 180 184 - 15 3 138 - 57 14
Percentage of emergency 3 1,42 2 1
- 53 80 - - 6 379 00 - 34 20 - - -
surgical cases operated within
one hour
Percentage of cold surgical cases 1,04 2 46 2
- - 80 - - 9 218 25 - 3 00 - - -
operated on within one month.
Doctor Population ratio:
- - - - - 67 18 - 12 - 10 - - 0
Nurse Population ratio: 3 2 1,87
- 2 - - - 22 116 - 03 14 5 - - 64
Percentage of Health facilities
- - - - 3 1 - - - - - - - -
without all tracer drugs for
greater than 2 weeks (> 2 weeks)
Percentage of clients satisfied 28,930 202,953 223,210 25,078 2 28,714
- - - - 46 - - - -
with services:
Average Length of Stay (ALOS): 6 5 7 6 5 4 6 5 5
5 5 5 6 6
Utilization rate of Out Patient 40,801 35,349 101,530 58,604 30,193 133,200 74,40 62,772 66,412 16,054 21,014
3 - - -
Attendants (OPD) - Male:
Utilization rate of Out Patient 53,042 124,316 63,194 39,344 162,641 74,40 82,978 78,174 18,841 20,724
20 3 - - -
Attendants (OPD) -Female:
Percentage of health facilities
19 2 34 42 35 57 26 25 30 10 21 25 18 8
that submit timely, accurate
reports to national level.
Percentage of health facilities
19 - 34 42 35 56 26 25 30 10 21 25 18 8
that submit complete, accurate
reports to national level.
% GOK budget allocation to
- - - - - 3 - - - 10 - - - -
primary health facilities (L2 & L3)
% GOK budget allocation for
- 0 - - - 0 - - - 10 - - - -
drugs
Percentage of districts with
1 1 1 1 1 1 1 1 1 1 1 1 1 1
Functional Health Stakeholders
Forum (DHSF):

4.1.3.11 Eastern Provincial Health Management Support

Annual Operational Plan 5 – 2009/10 58

Result Outputs Responsible Respons Costs Budge Source Gap
Person ible t
Area Q1 Q2 Q3 Q4 person
1. 2010-2011 AOP developed X X PDPHS 3.0M 3.0M GOK, APHI A
II, ICAP, AMREF,
Planning

Annual Operational Plan 5 – 2009/10 59

Result Outputs Responsible Respons Costs Budge Source Gap
Person ible t
Area Q1 Q2 Q3 Q4 person
2. HMIS tools printed and distributed X X X X PHRIO, 2.7M 2.7M GOK, APHIA II,
PHAO ICAP, AMREF,
Performan performance targets standards and X
ce guidelines printed and distributed to
monitorin all districts
support supervision in level 2 and X X X PDPHS, 800,00 800,00 GOK, APHIA II,
g and 3 facilities in all districts carried out PHAO 0 0 ICAP, AMREF
evaluation
Capacity furniture and equipment for the X PHAO 2.0M 2.0M
new offices procured
building vehicles for new districts purchased X 100.00 100.00
0 0
Establish internet access for PMO X - -
office
vehicle inventory established X - -
Fuel purchased X X X X 2.0M 2.0M FIF
3. Human staff data base established X PDPHS, 440,00 440,00 GOK, APHIA II.
PHRM 0 0
Resource districts supported to carry out
Managem quantification of commodities
ent and Training in team building done X X X
developm
ent
4.
essential
medicines
and
supplies
6.infrastru PMOs office block completed X PDPHS, 6.5M 6.5M GOK
cture 5 Motor vehicles maintained X X X X 1.0M 1.0M
developm Office equipment maintained X 600,00 600,00
ent and 0 0
maintaine
d
7. quarterly stakeholders forum X X X X PDPHS 800.00 800.00 GOK, APHIA II,
convened 0 0 ICAP, AMREF,
Governan
ce guidelines on DHMT/DHMB 1.2M 1.2M
operations’ disseminated FIF
monthly meetings with boards held -
8. emergency preparedness teams X PDPHS, 900.00 900.00 GOK, APHIA II,
across the province operationalised PPHO, 0 0 ICAP, AMREF,
emergenc PDSC, P
y Resource for emergency response X Log. 1.2M 1.2M FIF
preparedn mobilised from the central
government done
ess and IDSR trainings conducted X X 900.00 900.00
response 0 0
9.Financia finances for level 2 and 3 disbursed X X X X PDPHS, 1.2M 1.2M FIF.
to all the districts PHAO
l
Managem
ent

Annual Operational Plan 5 – 2009/10 60

Result Outputs Responsible Respons Costs Budge Source Gap
Person ible t
Area Q1 Q2 Q3 Q4 person
10. areas in need of operational X
research identified
operation operations’ research in areas of PDPHS, 1.2M 1.2M GOK, APHIA II,
al and TB,HIV, nutrition and RH carried out ICAP, FIF
other
research

4.1.3.12 Eastern Provincial Hospital Management Support

Result Area Output Timeframe Responsi Costs Budg Source Gap

Q1 Q2 Q Q4 ble et
3 Person
1. Planning 2010-2011 AOP x x PDMS,PNO 3M 3M GOK/APHIA
COMPLETED IN TIME ,PHAO, /OTHER
PMRO PARTINERS
2. Performance Quarterly support X X x X PDMS 4.0M 4.0M GOK/APHIA II
monitoring and supervision done FIF/Other partners
evaluation Quarterly review meetings
held
3. Human Redistribution of the x X X x HRMO/ - - GOK
Resource available staff done
Management 10 CPDs made functional, X X X x PDMS, 3.6M 3.6M GOK/APHIA II
and 6 PHMT trained on senior PNO MSH/FIF/OTHER
development Management 2 MNH PARTNERS
trainings conducted
Train 12 workers on X x PDMS, 300,0 300,0 GOK/FIF
emergency preparedness. PNO 00 00 GOK/FIF

Capacity
building
6.infrastructure PMOS block completed X X PDMS/PDO 6M 6M GOK/APHIA
development PH II/FIF/PLAN,
and maintained STANDARDIZED X X X X PPHO 100,0 100,0 GOK/APHIA II/FIF
INFRASTRUCTURAL PLANS 00 00
DEVELOPED
3 theatres operational zed X X x X PDMS 3,0M 3,0M GOK/APHIA II/FIF
7. Governance HMTS, HMBS and deputies X X X X PDMS 1M 1M GOK/APHIA II/FIF
Trained on governance
8. emergency Functional emergency X X MED, 5M 5M
preparedness plan in place SUP& HAO
and response HMTs emergency kit s
purchased
9.Financial Utilization of X X X PDMS, 600,0 600,0 GOK/FIF/APHIA II
Management financesincreased PHAO 00 00
10. operational data quality audit in 5 PDMS 1.0M 1.0M GOK/FIF/APHIA
and other facilities conducted II/PATH
research

Annual Operational Plan 5 – 2009/10 61

4.1.4 North Eastern Province Health Plans

4.1.4.1 Priorities for the province

• Improve maternal and child health

• Scale up implementation of community strategy
• Strengthen integrated outreach services
• Strengthen referral system
• Strengthen health education
• Improve school heath programs
• Improve work environment
• Establish youth friendly centres
• Strengthen health services for the elderly
• Community sensitization and mobilization
• Strengthen capacity building
• Strengthening of governance structures
• Strengthening clinics for nomadic populations

4.1.4.2 Service Delivery targets for the province

Indicators Wajir Wajir Wajir Wajir Mandera Mandera Mandera
Garissa Lagdera Fafi Ijara South West East North West Central East
Percentage of Women of Reproductive Age 4752 1876 1,30 1,20 1,96 52 2,84 1,43 2,08 2,82 50
(WRA) receiving Family Planning (FP) 2 8 0 1 1 3 1 9 1
Commodities:
Percentage of pregnant women attending at 4488 1454 1,12 81 1,34 1,40 2,66 1,21 2,51 85 1,05
least 4 ANC visits: 3 3 7 0 3 1 2 2 7
Percentage of Newborns with Low Birth 73 8 - 1 1 - 2
Weights (LBW) –(less than 2500 grams) 8 9 2 6 4 3 3
Percentage of pregnant women distributed 982 1005 50 2,50 61 76 3,92 1,67 2,79 2,78 2,18
with LLITNs 0 0 2 4 0 3 2 2 9
Percentage of pregnant women receiving 5330 1494 1,51 1,13 1,59 70 4,45 1,39 2,36 1,30 79
two doses of Intermittent Presumptive 5 8 1 6 8 9 7 6 6
Therapy (IPT2)
Percentage of HIV infected pregnant women 39 8 1 4
who received preventive antiretroviral 3 0 3 2 1 6 3 2 5
therapy to reduce the risk of mother -to
-child transmission (PMTCT).
Percentage of Deliveries conducted by 3576 1106 24 73 1,22 60 2,22 69 1,78 1,38 45
skilled health attendants in health facilities. 4 1 5 9 8 9 3 3 0
Percentage of Maternal Deaths Audited 12 9 - 1 1 1 - - 1
9 2 5 1 3 2
Percentage of fresh still births in the health 7 4 - - - - - - -
facility 3 2
Percentage of Newborns receiving BCG: 6509 2829 1,61 3,33 3,55 2,51 6,91 3,45 1,95 4,08 2,00
9 2 2 2 0 9 1 9 0
Percentage of Children under one (1) year 4986 2750 2,40 3,04 3,67 1,22 5,88 3,91 3,49 3,29 1,42
of age immunized against Measles: 2 7 5 1 1 5 0 4 5
Percentage of Children under one (1) year 4352 1610 1,56 2,23 3,06 1,70 5,68 3,82 4,82 2,55 1,39
of age fully immunized: 0 5 2 9 3 3 1 5 0
Percentage of Children under 5 years (< 5 15122 4311 6,24 4,55 6,36 4,23 12,71 5,51 5,51 4,54 3,11
yrs) attending Child Welfare Clinic (CWC) for 9 0 9 0 0 3 4 3 6
growth monitoring services (new cases)
Percentage of Children under 5 years (< 5 4701 1608 3 65 12 3,02 81 2 2,06 68 27
yrs) attending Child Welfare Clinic (CWC) 8 0 2 5 1 8 5 1 4
who are underweight
Percentage of Children less than 5 years (< 15325 9488 4,68 6,50 6,85 2,29 16,07 9,60 4,19 7,31 1,68
5 yrs) receiving Vitamin A supplement 2 1 9 0 4 8 7 4 6
Percentage of children under five years of 3876 5629 50 10,50 1,28 71 8,11 19,87 7,74 7,95 7,04
age (< 5 years) distributed with Long 2 0 0 3 0 2 1 0 2
Lasting Insecticide Treated Nets (LLITNs)
Percentage of under 5 years treated for 19959 24323 8,59 13,00 14,69 5,16 18,00 5,61 14,67 9,08 7,57
malaria, 1 1 8 9 8 4 7 6 2

Annual Operational Plan 5 – 2009/10 62

 Indicators Wajir Wajir Wajir Wajir Mandera Mandera Mandera
Garissa Lagdera Fafi Ijara South West East North West Central East
Infant Mortality Rate (IMR) 0 0 - - - - - - - - -
Facility Infant Mortality Rate (IMR) 2 8 - - - - - - - - -
Percentage of school children correctly de- 12694 12631 4,92 5,23 20,52 6,90 13,67 20,10 10,77 4,39 5,37
wormed at least once in the year: 5 7 3 0 0 5 5 1 4
Percentage of schools with adequate 2004 30 2 1 2 2 1
sanitation facilities: 2 5 6 1 4 8 3 7 2
Percentage of Health facilities providing 14 4 1 1
youth friendly services 1 2 4 4 4 0 2 4 1
0 0 - - - - - - - - -
Percentage of population Counselled and 21285 5584 3,00 1,50 2,79 3,04 3,94 8,06 11,76 25,23 2,00
Tested for HIV: (VCT, PITC, DTC, HBCT) 0 0 2 8 0 5 3 8 0
Number of condoms distributed: 17407 30781 5,16 12,00 7,07 2,97 10,79 6,20 43,96 17,91 50
1 0 9 3 7 0 3 9 0
Percentage of Households sprayed with 7095 5262 77 5,00 99 1,26 20,26 1,90 6,00 79 4,95
Insecticide Residual Spray (IRS). 5 0 2 5 4 0 0 0 0
Percentage of adults and children with 199 17 1 6 11 -
advanced HIV infection started on Anti 2 2 7 6 0 9 5 0
Retroviral Therapy (ART):
Percentage of Adults and children with 199 25 7 1 7 5 7 22 -
advanced HIV infection receiving Anti 8 2 0 6 2 5 7 0
Retroviral Therapy (ART)
TB case detection rate 750 420 150 1 39 812 59 182 641
22 6 7
Tuberculosis cure rate: 172 111 43 25 11 1 192 10 4 36 120
0 0
Percentage of emergency surgical cases 71 0 - - - - - - - -
operated within one hour 2
Percentage of cold surgical cases operated 0 0 - - - 90 - - - -
on within one month. 2 6
Doctor Population ratio: 5 6 - - 8 -
6 3 1 1 3
Nurse Population ratio: 67 32 6 3 8 - - - 8 6 1
0 5 2 0 3 6
Percentage of Health facilities without all 0 0 - - -
tracer drugs for greater than 2 weeks (> 2 1 5 1 5 1 4
weeks)
Percentage of clients satisfied with services: 0 0 - - - - - - - - -
Average Length of Stay (ALOS): 6 5 5 5 5 4 6 6 4 5
4
Utilization rate of Out Patient Attendants 77833 46463 39,92 32,50 52,26 21,00 87,31 29,15 29,15 40,42 25,79
(OPD) - Male: 6 4 0 0 2 4 0 8 4
Utilization rate of Out Patient Attendants 91934 61620 38,96 35,21 55,19 31,95 87,85 28,18 33,56 43,30 21,85
(OPD) -Female: 2 0 9 0 9 5 3 8 8
Percentage of health facilities that submit 21 10 1 1 1 1 1 1
timely, accurate reports to national level. 0 3 4 4 2 2 7 4 6
Percentage of health facilities that submit 21 10 1 1 1 1 1 1
complete, accurate reports to national level. 0 3 4 4 2 2 7 4 6
% GOK budget allocation to primary health 0 0 - - - - - - 1,666,00 - -
facilities (L2 & L3) 0
% GOK budget allocation for drugs 0 0 - - - - - - - - -
Percentage of districts with Functional 1 1
Health Stakeholders Forum (DHSF): 1 1 1 1 1 1 1 1 1

4.1.4.3 North Eastern Provincial Health Management Support

Result Output Time frame Responsi Costs / Revenue Gap

Area Q Q Q Q ble budget Amount Source
1 2 3 4 person
1.Plannin AOP 2010-2011 developed and X X X X PMO 1,680,0 1,200,0 GOK/ APHIA
g forwarded 00 00 II/ UNICEF
GOK/ APHIA
480,00 II/ UNICEF
0
Dissemination of national X X X PMO 230,00 230,00 GOK/APHIA II

Annual Operational Plan 5 – 2009/10 63

Result Output Time frame Responsi Costs / Revenue Gap
Area Q Q Q Q ble budget Amount Source
1 2 3 4 person
policies and guidelines on X 0 0
various health interventions
done
PHSF strengthened through X X X X PMO 1,000,0 1,000,0 GOK/ APHIA
quarterly stakeholders meeting 00 00 II/
UNICEF/MERL
IN
2. Renovation of existing room X X PHAO 700,00 700,00 GOK/APHIA II
Infrastru and put furniture, shelves, 0 0
cture internet, photocopier, computer
develop and literature material done
ment Procurement of 1desktops, 10 X X X X PMO 1,200,0 1,200,0 GOK/GTZ/
and laptops and 1printers and 00 00 APHIA II
mainten modems done
ance 8 offices renovated and X X X PHAO 1,000,0 1,000,0 GTZ
(Equipm recarpeted and air conditioned 00 00
ent, Transport system enhanced by X X X X PHAO 600,00 600,00 GOK/DANIDA
communi maintance of all vehicles 0 0
cation Communication system X PMO 3,000,0 3,000,0 CDC/GOK
and strengthened through Intranet 00 00
Transpor connection and network the
t) districts ,VHF radio
maintenance and repair
Procurement, installation and X PASCO 2,000,0 2,000,0 APHIA II
equipping a preferb to house 00 00
VCT centre done
3. Equitable distribution of staff in X X X X PMO 100,00 100,00 GOK
Human the province done 0 0
resource Establishment and maintain X X X X PHAO 0 0 GOK
manage staff databases for all cadres
ment Establishment of an award X X X X PHAO 200,00 200,00 GOK/ APHIA
scheme for best performing 0 0 II/ UNICEF
health workers for all cadres
MDR Training of health workers PTLC 500,00 500,00 APHIA II
done 0 0
Improved RH services by X X X X PRHC 4,000,0 4,000,0 GOK/ APHIA
training 33TOTs and 150 H/W 00 00 II/
on intergrated RH commodity UNICEF/GTZ
management
Training of H/W on Post X X PRHC 2,400,0 2,400,0 GOK/ APHIA
abortion care(22 TOTs and 60 00 00 II/
H/W) done UNICEF/GTZ
Training of H/W on Cervical X X PRHC 2,400,0 2,400,0 GOK/ APHIA
cancer screening(22 TOTs and 00 00 II/
60 H/W) done UNICEF/GTZ

5. quarterly support supervisory X X X X PMO 960,00 960,00 GOK/APHIA

Performa visits on TB/HIV/AIDS by PHMT 0 0 II/DTLD
nce Development of an Integrated X PMO 240,00 240,00 GOK/APHIA II
monitori supervisory checklist done 0 0
ng and 4Annual world events X X PTLC,PAS 800,00 800,00 GOK/APHIA II
evaluatio marked(malaria TB,AIDS, ,CO 0 0
n Mentorship)
Training and dissemination of X X X PMO 600,00 600,00 GOK/APHIA II
PHMT and DHMT members on 0 0
the supervisory checklist done
quarterly review meetings X X X X PMO 1,500,0 1,500,0 GOK/APHIA II
( TB, HIV/AIDS, RH, Disease 00 00

Annual Operational Plan 5 – 2009/10 64

Result Output Time frame Responsi Costs / Revenue Gap
Area Q Q Q Q ble budget Amount Source
1 2 3 4 person
Surveillance) and biannual
stakeholders forum carried out
Biannual Staff Appraisal done X X PHAO 500,00 500,00 GOK/APHIA II
0 0
6. suggestion box put up X X X X PHAO 2,550,0 2,550,0 GOK/APHIA II
Operatio and exit interviews at all 00 00
nal and health facilities conducted
other Staff satisfactions survey X HR&IO, 2,200,0 2,200,0 GOK/APHIA II
research conducted PHAO 0 0

7. Provide copies of COR to all X PHAO 100,00 100,00 GOK

Governa departments 0 0
nce Timely distribution of official X X X PHAO 280,00 280,00 GOK
circulars done 0 0
Monthly departmental and HMT X X X X PHAO 120,00 120,00 GOK
meetings held 0 0
Quarterly HMB meetings X PMO 400,00 400,00 GOK
held 0 0
8. targets for proper financial X PHAO 280,00 280,00 GOK/APHIA II
Financial management set 0 0
Manage all bank charges on PHMT GOK X PHAO 300,00 300,00 GOK
ment funds 5% of the total cleared 0 0
9. Train 11 districts DHMT's and X PDSC 1,500,0 1,500,0 GOK/APHIA
Emergen 16 PHMT members on IDRS 00 00 II/UNICEF/WH
cy O/KRCS
prepared Distribution of IDRS reporting X X PDSC 300,00 300,00 GOK/APHIA
ness and tools for surveillance and 0 0 II/UNICEF/WH
response outbreaks in the province done O/KRCS
Timeliness and completeness of X X X X PDSC 120,00 120,00 GOK/APHIA
IDSR reports monitored-Weekly 0 0 II/UNICEF/WH
and monthly O/KRCS
11 districts DHMT's and 16 X PDSC 250,00 250,00 GOK/APHIA
PHMT members on Rapid 0 0 II/UNICEF/WH
ResponseTeam trained O/KRCS
Contingency plan for disaster in X X 550,00 550,00 GOK/APHIA
place X X PDSC 0 0 II/UNICEF/WH
O/KRCS

4.1.4.4 North Eastern Provincial Hospital Management Support

Result Output Time frame Respon Costs / Revenue Gap

Area Q Q Q Q4 sible budget Amount Source
1 2 3 person
Planning AOP 2010-2011 developed X X PDMS 480,000 480,000 GOK/
and submitted APHIA II/
UNICEF
Dissemination of national X X X PDMS 230,000 230,000 GOK/APHIA
policies and guidelines on X II
various health issues done
Quarterly stakeholders X X X X PDMS 1,000,00 1,000,00 GOK/
meetings held to strengthen 0 0 APHIA II/
PHSF UNICEF/ME
RLIN
2. Renovation of existing room X X PDMS 700,000 700,000 GOK/APHIA
Infrastruct and put furniture, shelves, II
ure internet, photocopier,

Annual Operational Plan 5 – 2009/10 65

Result Output Time frame Respon Costs / Revenue Gap
Area Q Q Q Q4 sible budget Amount Source
1 2 3 person
developm computer and literature
ent and material done
maintenan 1desktops, 10 laptops X X X X PDMS 1,200,00 1,200,00 GOK/GTZ/
ce and 8 printers procured 0 0 APHIA II
(Equipme 8 offices renovated X X X PDMS 1,000,00 1,000,00 GTZ
nt, and recarpeted and air 0 0
communic conditioned
ation and All vehicles maintained X X X X PHAO 600,000 600,000 GOK/DANI
Transport) DA
Intranet connection and X PDMS 3,000,00 3,000,00 CDC/GOK
network the districts ,VHF 0 0
radio maintenainace and
repair
Functioning VCT Centre X PASCO 2,000,00 2,000,00 APHIA II
0 0
3. Human Staff equitably distributed in X X X X PDMS 100,000 100,000 GOK
resource the province
managem Advocacy with the PDMS 100,000 100,000 GOK
ent govermnent and multinational
and regional partners
Establishment and X X X X PHAO 0 0 GOK
maintainance of staff
databases for all cadres
Establishment of an award X X X X PHAO 200,000 200,000 GOK/
scheme for best performing APHIA II/
health workers for all cadres UNICEF
4. MDR Training of health X PTLC 500,000 500,000 APHIA II
Capacity workers done
building Training of H/W on X X X X PRHC 4,000,00 4,000,00 GOK/
Intergrated Reproductive 0 0 APHIA II/
Commodity management UNICEF/GT
(33TOTs and 150H/W) done Z
Training of H/W on Post X X PRHC 2,400,00 2,400,00 GOK/
abortion care(22 TOTs and 60 0 0 APHIA II/
H/W) done UNICEF/GT
Z
Training of H/W on Cervical X X PRHC 2,400,00 2,400,00 GOK/
cancer screening(22 TOTs and 0 0 APHIA II/
60 HW) done UNICEF/GT
Z
4 world days marked(TB, X X X PTLC,PA 800,000 800,000 GOK/APHIA
Malaria,AIDS and mentorship) SCO,PD II
MS
5. Quarterly PHMT support X X X PDMS GOK/APHIA
Performan supervisory visits carried out II
ce quarterly supportive X X X X PDMS 960,000 960,000 APHIA
monitorin supervision on TB/HIV/AIDS 11/DTLD
g and carried out
evaluation Integrated supervisory X PDMS 240,000 240,000 GOK/APHIA
checklist developed II
dissemination of PHMT and X X X X PDMS 600,000 600,000 GOK/APHIA
DHMT supervisory checklist II
done
quarterly review meetings X X X X PDMS 1,500,00 1,500,00 GOK/APHIA
( TB, HIV/AIDS, RH, Disease 0 0 II
Surveillance) and biannual
stakeholders forum carried
out

Annual Operational Plan 5 – 2009/10 66

Result Output Time frame Respon Costs / Revenue Gap
Area Q Q Q Q4 sible budget Amount Source
1 2 3 person
Quarterly review of AOP 5 X X PDMS 1,200,00 1,200,00 GOK/
done 0 0 APHIA II/
UNICEF
Biannual Staff appraisal done X X PHAO 500,000 500,000 GOK/APHIA
II
6. Client satisfaction survey X X X X PHAO 2,550,00 2,550,00 GOK/APHIA
Operation conducted 0 0 II
al and Staff satisfaction survey done X HR&IO, 2,200,00 2,200,00 GOK/APHIA
other PHAO 0 0 II
research
7. copies of COR to all X PHAO 100,000 100,000 GOK
Governan departments provided
ce All official circulars distributed X X X PHAO 280,000 280,000 GOK
Monthly departmental and X X X X PHAO 120,000 120,000 GOK
HMT meetings held
Quarterly HMB meetings held X X X X PMO 400,000 400,000 GOK
8. targets for proper financial X PHAO 280,000 280,000 GOK/APHIA
Financial management set II
Managem all bank charges on PHMT X PHAO 300,000 300,000 GOK
ent GOK funds 5% of the total
paid
9. 11 districts DHMT's and 16 X PDSC 1,500,00 1,500,00 GOK/APHIA
Emergenc PHMT members trained on 0 0 II/UNICEF/
y prepared on IDRS WHO/KRCS
preparedn IDRS reporting tools for X X PDSC 300,000 300,000 GOK/APHIA
ess and surveillance and outbreaks in II/UNICEF/
response the province distributed WHO/KRCS
Timely and complete weekly X X X X PDSC 120,000 120,000 GOK/APHIA
and monthly IDSR reports II/UNICEF/
submitted WHO/KRCS
11 districts DHMT's and 16 X PDSC 250,000 250,000 GOK/APHIA
PHMT members trained on II/UNICEF/
Rapid Response, Team for WHO/KRCS
Rapid response formed
established
Contingency plan for disaster X PDSC 250,000 250,000 GOK/APHIA
in place II/UNICEF/
WHO/KRCS
Dissemination of national X X X X PDSC 300,000 300,000 GOK/APHIA
policies and guidelines on II/UNICEF/
various health interventions WHO/KRCS

Annual Operational Plan 5 – 2009/10 67

 Western Province Health Plans

4.1.4.5 Priorities for the province

• Strengthen referral system

• Scale up implementation of community strategy
• Improve maternal and child health
• Promote health education
• Promote school health programs
• Improve Disease control and prevention
• Establish youth friendly services
• Strengthen PPP
• Strengthen Capacity building
• Improve health services quality and efficiency
• Combating TB,HIV/AIDS and malaria

4.1.4.6 Service Delivery targets for Western province

Bungoma Bungoma Bungoma Bungoma Kakamega

Indicators East North South West Bunyala Busia Emuhaya Hamisi South
Percentage of Women of Reproductive Age (WRA) 34742 35717 46848 18000 7918 38434 18969 35557 10642
receiving Family Planning (FP) Commodities:
Percentage of pregnant women attending at least 4000 7056 3737 2500 1104 6038 1420 7056 1269
4 ANC visits:
Percentage of Newborns with Low Birth Weights 123 78 507 50 59 162 8 109 8
(LBW) –(less than 2500 grams)
Percentage of pregnant women distributed with 8280 7629 11557 7500 2169 16115 6555 7599 4322
LLITNs
Percentage of pregnant women receiving two 6294 7913 7569 6500 2449 10230 2559 6513 3586
doses of Intermittent Presumptive Therapy (IPT2)
Percentage of HIV infected pregnant women who 618 2362 516 250 275 2103 279 3678 320
received preventive antiretroviral therapy to
reduce the risk of mother -to -child transmission
(PMTCT).
Percentage of Deliveries conducted by skilled 7056 7416 7224 2000 1670 6141 2240 7056 1583
health attendants in health facilities.
Percentage of Maternal Deaths Audited 8 2 2 4 0 42 0 0 0
Percentage of fresh still births in the health 0 24 0 15 0 2 15 0 0
facility
Percentage of Newborns receiving BCG: 13392 11039 17936 3480 3462 20397 7653 5402 5330
Percentage of Children under one (1) year of age 10017 8321 15349 11500 2686 16397 7272 7172 4480
immunized against Measles:
Percentage of Children under one (1) year of age 10017 5383 16812 10220 2589 14781 6783 7172 4268
fully immunized:
Percentage of Children under 5 years (< 5 yrs) 31242 36563 32572 20000 10747 74080 26568 31232 10818
attending Child Welfare Clinic (CWC) for growth
monitoring services (new cases)
Percentage of Children under 5 years (< 5 yrs) 1776 176 4859 1000 247 7297 614 1249 203
attending Child Welfare Clinic (CWC) who are
underweight
Percentage of Children less than 5 years (< 5 yrs) 20821 22234 41445 20150 4496 56454 15516 20821 17371
receiving Vitamin A supplement
Percentage of children under five years of age (< 16657 17027 30439 16660 8030 32399 16301 16657 13635
5 years) distributed with Long Lasting Insecticide
Treated Nets (LLITNs)
Percentage of under 5 years treated for malaria, 23040 23593 65993 20800 11174 69944 18714 20821 16386
Infant Mortality Rate (IMR) 0 0 0 0 0 0 0 0 0
Facility Infant Mortality Rate (IMR) 0 0 0 0 0 15 0 0 0
Percentage of school children correctly de- 33640 0 27365 43326 0 89625 11510 43326 17783
wormed at least once in the year:
Percentage of schools with adequate sanitation 0 0 0 0 21 92 0 69 44
facilities:
Percentage of Health facilities providing youth 1 6 0 2 0 18 0 3 3

Annual Operational Plan 5 – 2009/10 68

 Bungoma Bungoma Bungoma Bungoma Kakamega
Indicators East North South West Bunyala Busia Emuhaya Hamisi South
friendly services 0 0 0 0 0 0 0 0 0
Percentage of population Counselled and Tested 51264 51741 15814 50000 10784 25765 14780 51264 14435
for HIV: (VCT, PITC, DTC, HBCT)
Number of condoms distributed: 1820000 0 173136 200000 0 55123 193564 200000 146457
0
Percentage of Households sprayed with 5747 0 675 12500 11991 2501 0 5748 10314
Insecticide Residual Spray (IRS).
Percentage of adults and children with advanced 1853 5848 1288 480 1474 5262 865 2759 728
HIV infection started on Anti Retroviral Therapy
(ART):
Percentage of Adults and children with advanced 5966 0 24136 1350 2850 30738 2255 7356 1338
HIV infection receiving Anti Retroviral Therapy
(ART)
TB case detection rate 1347 523 802 366 2 154 260 713
00 1054
Tuberculosis cure rate: 102 147 141 70 195 48 68 156
40
Percentage of emergency surgical cases operated 0 0 2056 0 0 18 66 0 0
within one hour
Percentage of cold surgical cases operated on 0 0 1172 0 0 55 4 0 0
within one month.
Doctor Population ratio: 0 0 0 0 0 8 0 11 10
Nurse Population ratio: 0 44 0 0 0 323 0 104 117
Percentage of Health facilities without all tracer 0 2 0 0 0 0 0 5 0
drugs for greater than 2 weeks (> 2 weeks)
Percentage of clients satisfied with services: 0 0 0 0 0 18406 0 183905 106844
Average Length of Stay (ALOS): 4 6 5 7 6 6 5 6 6
Utilization rate of Out Patient Attendants (OPD) - 59223 112229 68427 103083 41550 11276 54445 103447 45794
Male: 4
Utilization rate of Out Patient Attendants (OPD) 65804 104375 82244 109053 51330 12584 68233 114941 61050
-Female: 4
Percentage of health facilities that submit timely, 0 13 22 17 17 23 24 10 17
accurate reports to national level.
Percentage of health facilities that submit 14 13 22 17 17 23 24 13 17
complete, accurate reports to national level.
% GOK budget allocation to primary health 14 0 0 0 0 0 0 0 0
facilities (L2 & L3)
% GOK budget allocation for drugs 0 0 0 0 0 0 0 0 0
Percentage of districts with Functional Health 1 1 1 1 1 1 1 1 1
Stakeholders Forum (DHSF):

Indicators Kakameg Kakameg Kakameg Mt. Teso Teso

a Central a East a North Lugari Elgon Mumias Samia Vihiga North South
Percentage of Women of Reproductive Age 30274 58602 21967 10370 41128 26500 10880 35557 20800 17905
(WRA) receiving Family Planning (FP)
Commodities:
Percentage of pregnant women attending at 7009 3371 2586 888 8269 9988 2620 7056 3900 3401
least 4 ANC visits:
Percentage of Newborns with Low Birth 106 0 42 538 0 219 12 65 40 70
Weights (LBW) –(less than 2500 grams)
Percentage of pregnant women distributed 11662 4203 6694 0 8762 14471 4300 7599 5200 4533
with LLITNs
Percentage of pregnant women receiving 10768 3360 4403 39567 8809 7711 3360 6513 9300 4208
two doses of Intermittent Presumptive
Therapy (IPT2)
Percentage of HIV infected pregnant women 686 0 253 72 291 1060 455 1068 200 178
who received preventive antiretroviral
therapy to reduce the risk of mother -to
-child transmission (PMTCT).
Percentage of Deliveries conducted by 7268 2520 2135 7442 2982 4300 1620 7056 4200 3238
skilled health attendants in health facilities.
Percentage of Maternal Deaths Audited 0 0 0 0 0 0 0 0 36 12
Percentage of fresh still births in the health 173 0 7 0 0 0 0 16 5 0
facility
Percentage of Newborns receiving BCG: 15348 5905 8132 4642 4209 15382 4600 9770 6150 6152
Percentage of Children under one (1) year 10670 4986 6605 12936 9593 15382 4300 8000 5700 5504
of age immunized against Measles:
Percentage of Children under one (1) year 10837 5036 6491 1568 9036 15382 4300 8000 5700 5504
of age fully immunized:
Percentage of Children under 5 years (< 5 54928 23855 57808 59794 31445 37232 13600 31232 15000 27090
yrs) attending Child Welfare Clinic (CWC) for
growth monitoring services (new cases)
Percentage of Children under 5 years (< 5 802 363 200 2079 3152 0 1020 1249 2300 4896

Annual Operational Plan 5 – 2009/10 69

Indicators Kakameg Kakameg Kakameg Mt. Teso Teso
a Central a East a North Lugari Elgon Mumias Samia Vihiga North South
yrs) attending Child Welfare Clinic (CWC)
who are underweight
Percentage of Children less than 5 years (< 20254 16670 22618 18448 31276 37232 13800 29000 16000 12699
5 yrs) receiving Vitamin A supplement
Percentage of children under five years of 23883 23030 14627 0 26336 21900 9820 16657 8000 7344
age (< 5 years) distributed with Long
Lasting Insecticide Treated Nets (LLITNs)
Percentage of under 5 years treated for 38352 10136 18656 20200 17336 45708 19700 20821 45423 312740
malaria,
Infant Mortality Rate (IMR) 0 0 0 0 0 0 0 0 0 0
Facility Infant Mortality Rate (IMR) 64 0 18 0 0 0 0 6 5 0
Percentage of school children correctly de- 44751 53003 25886 67576 53821 53327 0 43326 12045 96480
wormed at least once in the year:
Percentage of schools with adequate 74 32 0 0 0 0 1 0 10 45
sanitation facilities:
Percentage of Health facilities providing 0 0 2 0 0 1 1 2 1 5
youth friendly services 0 0 0 0 0 0 0 0 0 0
Percentage of population Counselled and 7796 0 15585 15708 22097 34565 7620 51264 40800 0
Tested for HIV: (VCT, PITC, DTC, HBCT) 0
Number of condoms distributed: 141000 63863 7810000 290754 60915 800000 44200 600000 20002 487200
0
Percentage of Households sprayed with 1644 0 501 0 3485 2000 8000 5747 20 193
Insecticide Residual Spray (IRS).
Percentage of adults and children with 1055 0 224 0 0 1200 1611 759 500 0
advanced HIV infection started on Anti
Retroviral Therapy (ART):
Percentage of Adults and children with 4527 0 530 462 0 2980 2650 7356 1500 1351
advanced HIV infection receiving Anti
Retroviral Therapy (ART)
TB case detection rate 691 - 191 336 232 466 310 621 248 248
Tuberculosis cure rate: 150 - 57 76 41 119 59 108 36 36
Percentage of emergency surgical cases 1296 0 12 0 0 0 0 0 0 0
operated within one hour
Percentage of cold surgical cases operated 866 0 5 0 0 0 0 0 0 0
on within one month.
Doctor Population ratio: 0 0 0 0 11 0 0 33 3 8
Nurse Population ratio: 0 0 0 0 65 0 0 245 55 84
Percentage of Health facilities without all 0 0 0 0 0 0 0 2 0 7
tracer drugs for greater than 2 weeks (> 2
weeks)
Percentage of clients satisfied with services: 40 0 135 0 7833 0 0 181917 20000 85619
Average Length of Stay (ALOS): 5 6 7 4 6 5 5 6 6 5
Utilization rate of Out Patient Attendants 51300 28050 74676 12908 31681 63868 0 30986 51200 49712
(OPD) - Male:
Utilization rate of Out Patient Attendants 86524 29949 88313 18136 32948 135088 0 38496 79400 57086
(OPD) -Female:
Percentage of health facilities that submit 28 14 0 48 17 22 10 20 9 8
timely, accurate reports to national level.
Percentage of health facilities that submit 28 14 18 48 17 22 10 20 9 9
complete, accurate reports to national level.
% GOK budget allocation to primary health 0 0 18 356094 0 0 0 0 1 0
facilities (L2 & L3) 4
% GOK budget allocation for drugs 0 0 0 0 0 0 0 0 1 0
Percentage of districts with Functional 1 1 1 1 1 1 1 1 1 1
Health Stakeholders Forum (DHSF):

4.1.4.7 Western Provincial Health Management Support

Result Output Timeframe Responsibl Costs / Revenu Sourc Gap

Area Q Q Q Q e person budge e e
1 2 3 4 t
1. AOP I of NHSSP III developed X X PDPHS/ 8,000,0 8,000,0 GOK/
Planning PHRIO 00 00 DPs
2. Review meetings held with PDPHS 500,00 500,000
Performan minutes 0
ce 18 support supervision with x x x x GOK/D
monitorin reports for Ps

Annual Operational Plan 5 – 2009/10 70

Result Output Timeframe Responsibl Costs / Revenu Sourc Gap
Area Q Q Q Q e person budge e e
1 2 3 4 t
PMTCT,ART,VCT,PITC,HCBC,STI X X x PDPHS 817860 817860 GOK/D
,VMMC, PWP, BLOOD,SAFETY 0 0 Ps
RH IMC DVI, IDSR
MALARIA,TB,WASH,Community
,strategy,LLINs,Sanitation,
done
national consultative / review x X X x PDPHS 2,000,0 2,000,0 GOK/D
meeting attended 00 00 Ps
g and
quarterly Performance review X x X X PDPHS 6,600,0 6,600,0 GOK/D
evaluation
meetings held 00 00 Ps
Procurement, printing and PHRIO 500,00 500,000 GOK/D
distribution of M&E tools done 0 Ps
Generation and dessimination PHRIO 120,00 120,000 GOK/D
of Performance reports 0 Ps
done
Quarterly Feedback to the X x X X logistician 40,000 40,000 GOK/D
district done Ps
3. Human ?frequency CPD for PHMT x x x x PDPHS 500,00 500,000 GOK/D
Resource and DHMT held 0 Ps
Managem PHMT and DHMT appraised PDPHS/ 500,00 500,000 GOK/D
ent and quarterly HRM 0 Ps
developm Scientific conference attended X PHMT 2,700,0 2,700,0 GOK/D
ent and policies, BCC,IEC material Members,P 00 00 Ps
and guidelines disseminated DPHS
Quarterrly recognition of best x X X x PDPHS/HRM
performers
Quarterly Deployment of staff x X X x PDPHS
40 trainings on access uptake x x x x PASCO/PDS 118,68 118,680 GOK/D
and delivery of quality C 0,000 ,000 Ps
HIV/AIDS care done
5. Well maintained and equipped x X X x PHRIO/PASC 3,970,0 3,970,0 GOK/D
Infrastruct PHMT offices procurement of O 00 00 Ps
ure computers,accessories,scanner
developm s,modems,phones,internet,furn
ent and iture, laballing of offices,
maintaine hehicle mntanance
d.
cold room in KEMSA Kakamega x logistician 100,00 100,000 GOK/D
I installed 0 Ps
6. Health sector stake holder for X X X X 2,800,0 2,800,0 GOK/D
Governan a held 00 00 Ps
ce Policies, BCC,IEC materials
and guide lines disseminated
to all stakeholders
Formation of DHMBs
Disaster Conduct quarterly Malaria x x x x PPHO 1,000,0 1,000,0 GOK/D
Preparedn Surveillance 00 00 Ps
ess and
response
8.Financia EEC and financial audit x x x x PDPHS/PHA 200,00 200,000 GOK/D
l conducted O 0 Ps
Managem
ent
9. operational research 5,000,0 5,000,0 GOK/D
Operation conducted 00 00 Ps
al and

Annual Operational Plan 5 – 2009/10 71

Result Output Timeframe Responsibl Costs / Revenu Sourc Gap
Area Q Q Q Q e person budge e e
1 2 3 4 t
other
research
TOTAL 161,38 161,38 GOK/D
BUDGET 8,600 8,600 Ps

4.1.4.8 Western Provincial Hospital Management Support

Result Area Output Time frame Responsi Costs / Revenue Gap

Q Q Q Q ble budget Amoun Source
1 2 3 4 person t
1. Planning AOP plan in place- X X
2. 12 supportive supervision to X X X X PDMS/PH 2,000, 2,000,0 DPs
Performance L4 & 5 Facilities done RIO 000 00
monitoring Quarterly Consultative and X X X X PDMS 7,800, 7,800,0 GOK/DPs
and review meetings held 000 00
evaluation Malezi bora X X PDMS 12,300 12,300, PDMS
,000 000
Quarterly consultative X X X X PCO 1,500, 1,500,0 GOK/DPs
meeting with the chiefs at 000 00
national headquarters
World Health celebrations, x x x x PDMS 2,000, 2,000,0 GOK/DPs
i.e world TB, Breastfeeding, 000 00
HIV, Malaria, Nursing
Report written X X X X PDMS 2,000, 2,000,0 GOK/DPs
000 00
Data collection tools and X X HRIO 300,00 300,00 GOK/DPs
reports in place 0 0
Staff quarterly returns done X X X X PMLT 2,000, 2,000,0 GOK/DPs
000 00
HRM 800,00 800,00 GOK/DPs
0 0
3. Human Staff rationalized quarterly X X X X PDMS 0 0 GOK/DPs
Resource Staff appraised and PDMS 300,00 300,00 GOK/DPs
Manageme motivate 0 0
nt and 60 trainings done in varies X X X X PDMS 101,97 101,97 GOK/DPs
developme health skills 8,000 8,000
nt 15 PHMT attend annual X PDMS 6,000, 6,000,0 GOK/DPs
scientific conferences 000 00
6.infrastruc Purchase and service of X X X X PDMS/PH 2,000, 2,000,0 GOK/DPs
ture 0ffice equipment/Furniture AO 000 00
developme and stationery done
nt and Partitioning of the registry X HRM 300,00 300,00 GOK/DPs
maintenanc done 0 0
e Maintaining workforce X X X X PDMS 1,200, 1,200,0 CDC
informatics system done 000 00 envoy
Purchase of 2 X PDMS 6,000, 6,000,0 DPs
000 00
Cold room in KEMSA X X X X Logistici 1,000, 1,000,0 DPs
Kakamega 1 installed an 000 00
7. Health sector stake holder X X X PDMS 2,000, 2,000,0 DPs
Governance fora held 000 00
X X X PDMS 100,00 100,00 DPs
0 0
Dissemination policies, X X PHAO(M 1,300, 1,300,0 DPs
BCC,IEC materials and guide OMS) 000 00
lines done

Annual Operational Plan 5 – 2009/10 72

 Formation of DHMBs done PHAO(M 140,00 140,00 DPs
OMS) 0 0
8. emergency Malaria Surveillance X PDMS 20,000 20,000 GOK/DPs
preparedness conducted
and response
EEC meetings held X X X PDMS 1,800, 1,800,0 GOK/DPs
9.Financial 000 00
Management financial audit conducted X X X X PDMS 100,00 100,00 GOK/DPs
X 0 0
10. Conduct operational X X X PDMS 5,000, 5,000,0 GOK/DPs
operational research 000 00
and other
research

Annual Operational Plan 5 – 2009/10 73

Nairobi Province Health Plans

4.1.4.9 Priorities for the province

• Scale up implementation of community strategy

• Improve disaster preparedness
• Improve maternal and child health
• Promote Health education
• Strengthen School health programs
• Improve youth friendly services
• Ensure environmental sanitation and water safety
• Enhance Disease surveillance
• Improve youth friendly services
• Strengthen governance structures
• Strengthen PPP
• Strengthen Capacity building
• Strengthen nutritional surveillance

4.1.4.10 Service Delivery targets for the province

Indicators Nairo Nairo
bi bi Nairobi
North West East
Percentage of Women of Reproductive Age (WRA) receiving Family 107,219 102002 186,509
Planning (FP) Commodities:
Percentage of pregnant women attending at least 4 ANC visits: 23,690 25609 22,796
Percentage of Newborns with Low Birth Weights (LBW) –(less than 2500 72 4 2,564
grams)
Percentage of pregnant women distributed with LLITNs 0 0 2,591
Percentage of pregnant women receiving two doses of Intermittent 19,766 16079 7,771
Presumptive Therapy (IPT2)
Percentage of HIV infected pregnant women who received preventive 2,895 1395 3,067
antiretroviral therapy to reduce the risk of mother -to -child
transmission (PMTCT).
Percentage of Deliveries conducted by skilled health attendants in 35,630 33464 12,434
health facilities.
Percentage of Maternal Deaths Audited 0 0 -
Percentage of fresh still births in the health facility 0 0 -
Percentage of Newborns receiving BCG: 43,646 44062 48,836
Percentage of Children under one (1) year of age immunized against 33,858 28941 48,575
Measles:
Percentage of Children under one (1) year of age fully immunized: 29,626 28857 48,527
Percentage of Children under 5 years (< 5 yrs) attending Child Welfare 31,037 27428 40,813
Clinic (CWC) for growth monitoring services (new cases)
Percentage of Children under 5 years (< 5 yrs) attending Child Welfare 5,798 3128 27,208
Clinic (CWC) who are underweight
Percentage of Children less than 5 years (< 5 yrs) receiving Vitamin A 42,623 93096 68,021
supplement
Percentage of children under five years of age (< 5 years) distributed 0 0 5,442
with Long Lasting Insecticide Treated Nets (LLITNs)
Percentage of under 5 years treated for malaria, 0 5417 54,416
Infant Mortality Rate (IMR) 0 0 -
Facility Infant Mortality Rate (IMR) 0 0 -
Percentage of school children correctly de-wormed at least once in the 12,027 9826 64,605

Annual Operational Plan 5 – 2009/10 74

 Indicators Nairo Nairo
bi bi Nairobi
North West East
year:
Percentage of schools with adequate sanitation facilities: 0 0 197
Percentage of Health facilities providing youth friendly services 18 6 -
0 0 -
Percentage of population Counselled and Tested for HIV: (VCT, PITC, 58,782 121354 21,136
DTC, HBCT)
Number of condoms distributed: 0 55278 29,819
Percentage of Households sprayed with Insecticide Residual Spray 0 100 10,260
(IRS).
Percentage of adults and children with advanced HIV infection started 4,100 3833 1,155
on Anti Retroviral Therapy (ART):
Percentage of Adults and children with advanced HIV infection 142,136 36138 34,520
receiving Anti Retroviral Therapy (ART)
TB case detection rate 0 6810 -
Tuberculosis cure rate: 7441 6568 3526
Percentage of emergency surgical cases operated within one hour 2056 1463 1046
Percentage of cold surgical cases operated on within one month. 0 470 -
Doctor Population ratio: 0 20 44
Nurse Population ratio: 24 390 921
Percentage of Health facilities without all tracer drugs for greater than 0 12 -
2 weeks (> 2 weeks)
Percentage of clients satisfied with services: 0 0 -
Average Length of Stay (ALOS): 6 6 5
Utilization rate of Out Patient Attendants (OPD) - Male: 244,280 195525 495,020
Utilization rate of Out Patient Attendants (OPD) -Female: 255,554 175478 990,041
Percentage of health facilities that submit timely, accurate reports to 74 28 100
national level.
Percentage of health facilities that submit complete, accurate reports to 74 28 100
national level.
% GOK budget allocation to primary health facilities (L2 & L3) 0 0 -
% GOK budget allocation for drugs 0 0 -
Percentage of districts with Functional Health Stakeholders Forum 1 1 1
(DHSF):

4.1.4.11 Integrated Nairobi Province Health Management Support and hospital

management Plan

Annual Operational Plan 5 – 2009/10 75

Result Area Output Timeframe Responsibl Costs / Revenue Source Gap
Q1 Q2 Q3 Q4 e Person budget
1. Planning 1.. AOP for 2010-2011 developed X X PDPHS & 1,241,7 1,241,700 UNICEF
PDMS,PHAO,P 00 NHMB
HRIO,PHMT FIF
APHIA II
2.Consensus on provincial AOPfor X PDPHS & 150,000 150,000 APHIA II
2010-2011 achieved.. PDMS
2. 1. Well maintained offices, motor X X X X PPHO &PHAO 1,620,0 1,620,000 FIF
Infrastructu vehicles and equipment available 00 APHRC
re, for PHMT/ PMST use
developme 2. Repair and maintenance of All X X X X 2,820,0 2,820,000 GOK &
nt and motor vehicles, regular service of PHAO 00 FIF
maintenanc office equipment and other utilities
e x x x PHRIO 523,000 523,000 APHIA II /
(equipment, 2. All departments computerized APHRC
communica and networked(3laptops, 1LCD,
tion and 10PDA,networking of all computers
Transport within PMOs office)
3. A clear provincial inventory in X X PHAO 10,000 10,000 FIF
place and Idle assets disposed.
4. Water dispensers available in all X PHAO 50,000 50,000 FIF
head of department offices
3. Human A well motivated and disciplined X X X X DEPT HEADS - - -
Resource workforce in place.(timely X PHAO 360,000 360,000 FIF
Manageme performance appraisal)
nt Hire and maintain 6 casuals to X X X X PHAO 504,000 504,000 GOK
include 3 drivers and 3 cleaners
Scheduled PHMT/PMST disciplinary X X X X PHAO - - -
meetings
Quarterly review of staff X PHAO - - -
deployment
2. An updated Human resource X PHAO - - -
database in place
4. Capacity Training needs data base in place x Training 10,,000 10,,000 FIF
building coordinator
Quarterly dissemination of policies, X X X X Training 450,000 450,000 FIF
guidelines and IEC materials to all coordinator NHMB
PHMT/PMST staff APHIA II
Continuous professional monthly X X X X Training 190,00 190,00 APHIA II
updates for all PHMT/PMST staff coordinator
done
monthly PHMT/PMST training X X X X Training - - -
committee meetings held coordinator
10 PHMT/PMST members attend X X PDMS/PDPHS 174,000 174,000 GOK
professional scientific conferences
and congress
15 PHMT/PMST members trained X X Training 375,000 375,000 AMREF
on leadership and management Coordinator
30 PHMT/ PMST members on X Training AMREF
Operational Research management coordinator 375,00 375,000
trained 0
5 staff on basic computers X X Training 150,000 150,000 FIF
packages trained coordinator/H
AO
10 PHMT/PMST members in X Training 750,000 750,000 AMREF
monitoring and evaluation.trained coordinator
12 PHMT/PMST on Proposal Writing X Training 300,00 300,000 APHRC
And Resource Mobilization trained coordinator 0
20 PHMT/DHMT on community X PPHO 500,000 500,000 KIDDP
strategy trained
35 PHMT/ PMST /DHMT/HMT/DMSTS X HAO 113,000 113,000
on NHMB
financial management trained
15 PHOs on PHAST, accomplished X PPHO 225.000 225.000 UNICEF
trained
15 PHOs on Urban participatory X X PPHO 225,000 225,000 UNICEF
Appraisal trained
20 staff on alcohol and drug abuse X 300,000 300,000 NACADA
prevention and rehabilitation UNICEF
76
Annual Operational Plan 5 – 2009/10
trained
20PHMT,PMST/DHMT on X Training 150,000 150,000 FIF
performance improvement coordinator
approach concept trained
 Coast Province Health Plans

4.1.5.1 Provincial Public Health and sanitation Priorities

• Scale up implementation of community strategy

• Health promotion
• Disaster preparedness
• Improve quality of delivery of health care services
• Capacity building
• Improve youth friendly services
• Establish school health programs Improve
• Improve Maternal and child health
• Ensuring food security
• Controlling HIV/AIDS,TB,Malaria
• Disease surveillance
• Improving quality of health services
• Controlling vector borne diseases specially malaria,Filiriasis and
schistosomiasis

4.1.5.2 Service Delivery targets for the Coast province

Indicators Mombasa Kilindini Kilifi Kaloleni Msambweni Kwale Kinango Lamu Malindi Taita Taveta Tana Tana
Delta River
Percentage of Women of Reproductive Age (WRA) receiving 19,626 51848 44733 32405 26009 37960 11430 29548 52923 12649 10802 9509 19,626
Family Planning (FP) Commodities:
Percentage of pregnant women attending at least 4 ANC visits: 9,060 16008 13362 9630 4280 9425 2726 9258 6893 3267 3210 3151 9,060

Percentage of Newborns with Low Birth Weights (LBW) –(less 96 237 304 148 66 128 102 126 206 61 49 45 96
than 2500 grams)
Percentage of pregnant women distributed with LLITNs 10,535 14223 12341 8889 10793 11900 2787 11629 7204 3102 2693 2582 10,535

Percentage of pregnant women receiving two doses of Intermittent 8,169 11853 10302 7408 7493 12866 2418 8430 21020 2773 2469 2488 8,169
Presumptive Therapy (IPT2)
Percentage of HIV infected pregnant women who received 12,566 22757 19688 14224 316 494 282 1577 215 182 4822 463 12,566
preventive antiretroviral therapy to reduce the risk of mother -to
-child transmission (PMTCT).
Percentage of Deliveries conducted by skilled health attendants in 5,329 9482 8261 2819 3634 4913 2930 7212 3226 2417 1975 1653 5,329
health facilities.
Percentage of Maternal Deaths Audited 2 0 0 1 2 0 15 168 0 0 0
- -
Percentage of fresh still births in the health facility 6 0 0 13 0 0 0 254 0 0 0
- -
Percentage of Newborns receiving BCG: 14,424 22520 19556 14074 6417 15524 3366 16944 1205 3856 4692 4321 14,424

Percentage of Children under one (1) year of age immunized against 6,939 15717 13627 9822 6019 10086 2991 9852 1190 2911 3647 2937 6,939
Measles:
Percentage of Children under one (1) year of age fully immunized: 7,884 15395 12831 9246 5830 9541 2978 9473 7266 2782 3082 2774 7,884

Percentage of Children under 5 years (< 5 yrs) attending Child 25,066 21602 45522 32980 14658 69347 10333 64217 36434 8229 9859 9915 25,066
Welfare Clinic (CWC) for growth monitoring services (new cases)

Percentage of Children under 5 years (< 5 yrs) attending Child 6,972 44388 747 471 0 4646 150 1169 1456 279 143 418 6,972
Welfare Clinic (CWC) who are underweight
Percentage of Children less than 5 years (< 5 yrs) receiving Vitamin 6,210 9124 26421 11778 15689 39741 3871 19270 17350 5965 3926 3782 6,210
A supplement
Percentage of children under five years of age (< 5 years) 16,980 17585 39034 28269 12564 0 9076 37562 6721 9593 1967 6983 16,980
distributed with Long Lasting Insecticide Treated Nets (LLITNs)
Percentage of under 5 years treated for malaria, 25,012 14088 39034 28269 12064 35114 9076 29155 32603 6282 8608 8636 25,012

Infant Mortality Rate (IMR) 0 0 0 0 0 0 0 0 0 0 0

- -
Facility Infant Mortality Rate (IMR) 0 0 0 0 1 0 0 310 0 0 0
- -
Percentage of school children correctly de-wormed at least once in 0 64718 46915 26110 1114 15026 225280 43973 10426 15639 11590
the year: - -
Percentage of schools with adequate sanitation facilities: 705 300 0 0 0 95 214 59 8 0 0 0 705

Annual Operational Plan 5 – 2009/10 77

 Percentage of Health facilities providing youth friendly services 1 0 0 1 0 2 3 0 0 12 0
- -
0 0 0 0 0 0 0 0 0 0 0
- -
Percentage of population Counselled and Tested for HIV: (VCT, 101001 65594 40229 21135 13028 15234 66852 9500 11567 14127 12458
PITC, DTC, HBCT) - -
Number of condoms distributed: 111237 743864 540000 240000 46984 168164 681193 86861 240037 180000 270849
- -
Percentage of Households sprayed with Insecticide Residual Spray 813346 27306 0 8780 460994 6325 0 132521 4390 6585 4880
(IRS). - -
Percentage of adults and children with advanced HIV infection 33,107 1817267 1530 531 260 596 161 313 253510 548 174 130 33,107
started on Anti Retroviral Therapy (ART):
Percentage of Adults and children with advanced HIV infection 160,609 2165 3120 1452 645 1131 423 2147 679 323 484 389 160,609
receiving Anti Retroviral Therapy (ART)
TB case detection rate 1 1
5997 3480 840 754 1129 567 438 234 1147 193 62 231
544
Tuberculosis cure rate: 1780 3
1025 256 135 247 37 90 62 217 47 46 82
143
Percentage of emergency surgical cases operated within one hour 1,774 0 0 0 0 1104 0 0 1300 180 0 0 1,774

Percentage of cold surgical cases operated on within one month. 35,284 0 0 0 0 548 0 0 1421 100 0 0 35,284

Doctor Population ratio: 6 0 0 0 0 5 2 0 12 7 0 0 6

Nurse Population ratio: 12 0 0 0 113 16 258 192 111 0 42

- -
Percentage of Health facilities without all tracer drugs for greater 0 0 0 0 0 0 0 6 1 1 1
than 2 weeks (> 2 weeks) - -
Percentage of clients satisfied with services: 0 320835 237052 0 123395 22603 0 0 52678 79017 58557
- -
Average Length of Stay (ALOS): 4 6 15 0 0 5.3333333 0 0 5 0 0 0 4
3
Utilization rate of Out Patient Attendants (OPD) - Male: 61,094 0 163348 118526 0 106998 13996 64303 155473 33339 39509 38649 61,094

Utilization rate of Out Patient Attendants (OPD) -Female: 115,169 0 183756 133342 0 106405 44447 104636 165220 36765 44447 45246 115,169

Percentage of health facilities that submit timely, accurate reports to 40 17 0 19 19 23 39 80 8 12 15 4 40

national level.
Percentage of health facilities that submit complete, accurate reports 40 17 0 19 19 23 29 80 8 12 15 4 40
to national level.
% GOK budget allocation to primary health facilities (L2 & L3) 47,998 0 0 0 0 0 0 0 6 0 0 0 47,998

% GOK budget allocation for drugs 29,454 0 0 0 0 0 0 0 6 0 0 0 29,454

Percentage of districts with Functional Health Stakeholders Forum 1 1 1 1 1 1 1 1 1 1 1 1 1

(DHSF):

4.1.5.3 Coast Provincial Health Management Support

Result Output Timeframe Responsib Costs/ Reven Source Gap

Area Q1 Q2 Q Q4 le Person budge ue
3 t
1. Planning AOP Developed X X PDPHS 1,460,0 1,460,0 APHIA II
00 00
2. Quarterly HMIS supervision to 13 X X X X PHIO 1.600,0 1.600,0 APHIA
Performanc Districts done 00 00 II/DANIDA
e EPI/IDSR /PTLC Quarterly Supervision X X X X PEPIL/PDSC 3,420,0 3,420,0 WHO/
monitoring done /PTLC/PDP 0 0 GOK/
and HS KNCV
evaluation integrated supervision to the 13 X X X X PDPHS 2,400,0 2,400,0 GOK
districts conducted 00 00
integrated M&E tool developed X PHRIO 200,00 200,00 APHIA II
0 0
M&E Department established X PHRIO
Quarterly review meetings held X X X X PHIO/PTLC/ 8,122,0 8,122,0 APHIA II/
PHRIO/PHA 00 00 KNCV/GOK
O/PASCO/P /FIF
CO/PPHN/P
MLT,PDHS
District DVBD stations audited X X X PMLT 200,00 200,00 FIF
0 0
EQA in TB/ Malaria done X PMLT 1,800,0 1,800,0 GLOBAL

Annual Operational Plan 5 – 2009/10 78

 Result Output Timeframe Responsib Costs/ Reven Source Gap
Area Q1 Q2 Q Q4 le Person budge ue
3 t
00 00
3. Human Employee satisfaction X PHRM/PHA 700,00 700,00 GOK
Resource enhanced(award best perfomers) O 0 0
Manageme Timely submission of PAS forms & X X X PHRM 90,000 90,000 FIF
nt and Wealth declaration done
Developme Ensure up-to-date staff data base. X X X X PHRM 0 0
nt
4. Capacity - Skills and competencies of X X X X PHIO,PP,PA 84,404, 84,404, DANIDA
Building H/workers improved.(1,144 HW SC0,PHRIO, 000.00 000.00
trained for various skills) PPHN,PPHO
,PMLT,PHR
M,PDSC,PE
PIL,PTO
6. Essential
medicines
and
supplies
7. - Improved working environment(8 X X PHIO 400,00 400,00 APHIA
Infrastructu computer purchased) 0 0 II/DANIDA
re Re-programming of the HMIS X X X PHIO 1,000,0 1,000,0 DANIDA/A
developme program to conform to new tools 00 00 PHIA II
nt and done
maintenanc - Printing of 2,000,000 HMIS data X X PHIO 5,000,0 5,000,0 APHIA
e, collection tools done 00 00 II/DANIDA
equipment, office equipment & internet and X X PHAO,PDP 1,555,0 1,555,0 FIF/GOK
communica Stationery, well serviced office in HS,PTO 00 00
tion & place
Transport Establishment of 15 hotlines X PTO 400,00 400,00 FIF
numbers for ambulances done 0 0
Maintenance of vehicles done X X X X PTO 1,200,0 1,200,0 FIF/GOK
00 00
Governing structures in place(Service X X PHAO 0 0
charter, Committees, DHSF in place)
9. Establishment of Preparedness team X PDSC 0 0
Emergency at both Provincial & District level
preparedne done
ss and Emergency protective gear X PDSC 350,00 350,00 FIF
response available 0 0
Quarterly drills on emergencies X X X X PDSC 200,00 200,00 FIF
conducted 0 0
Co-ordination & support on X X X X PPHO 0 0 -
emergencies
10. Quarterly supervision to the districts X x x X PHAO NIL NIL
Financial to monitor the usage of HSSF
Manageme 52 staff trained on government PHAO 200,00 200,00 FIF
nt procurement procedures 0 0
relevant tools on financial X X X X PHAO 100,00 100,00 FIF
management purchased and used 0 0
11. Research ethical committee X PDPHS NIL NIL -
Operational established
and other 5 Research Proposals in place X PTLC 600,00 600,00 DANIDA
research 0 0

Annual Operational Plan 5 – 2009/10 79

 Coast Provincial Hospital Management Plan

Result area Outputs Responsib Time Cos Budg Un

ility frame t et
Q1 Q2 Q3 Q

1. Planning 2010-2011 Plan developed PDMS/PHRI X X

O
2. PERFORMANCE – M&E Quarterly review meetings PMST X X X X

Support supervisory visits to facilities level PMST X X X X

3,4,5
3. HUMAN RESOURCE Staff rationalization done PDMS X X
MANAGEMENT &
DEVELOPMENT Improved work climate & staff morale PDMS X X

4. CAPACITY BUILDING Trainings PMST X X X X

5. INFRASTRUCTURE Establish and equip PMST offices PHAO/PDMS X X X

DEVELOPMENT &
MAINTENANCE OF Internet Services (Procure & Service PHAO/PD/M X X X X
EQUIP./TRANSPORT S
Scheduled servicing & maintenance & repair PHAO/PDMS X X X X
of vehicles
Procurement /Maintenance of ICT equipment, PHAO/PHRI X X X X
Printers & Copiers O
6. GOVERNANCE Management boards identification & PDMS/PHAO X
gazettement
Annual stakeholders forum PDMS X

7 EMERGENCY Co ordinate emergency response teams PDMS/PNO X X

PREPAREDNESS &
RESPONSE
Sensitize staff on emergency response and PDMS/PNO X X X X
preparedness
8 FINANCIAL Supervise & monitor financial resource PHAO X X X X
MANAGEMENT utilization in hospitals
Hold quarterly meetings with implementing PDMS X X X X
partners/Attend ministerial meetings
9 OPERATION & OTHER Quarterly analysis of data to fast track set PMST X X X X
RESEARCH SYSTEM targets
Evidence based practices disseminated & PNO X X X X
utilized
TOT’s trained on research methods PMST X X

Nyanza Province Health Plans

4.1.5.4 Priorities for the provincial -Public health and sanitation

• Strengthen referral system
• Scale up implementation of community strategy
• Improve maternal and child health
• Improve water safety and sanitation
• Improve emergency preparedness and response to disease outbreaks
• Capacity building
• Increase ART and FP uptake
• Establish school health programs
• Strengthen governance structures
• Managing vector control e.g. Malaria

Annual Operational Plan 5 – 2009/10 80

 • Reducing malnutrition
• Improving quality of health services
• Vector control eg Malaria
• Ensuring emergency preparedness and response to disease outbreaks
• Ensuring safe water and sanitation

4.1.5.5 Service Delivery targets for Nyanza province

Indicators Bondo Borabu Gucha Homa Bay Kisii Kisii Kisumu Kisumu East Kuria Kuria
South Central West East West
Percentage of Women of Reproductive Age (WRA) receiving Family 24, 48,4 11, 6, 20,6
Planning (FP) Commodities:
807 7,186 63 29,812 482 52,248 20,972 28,812 498 62
Percentage of pregnant women attending at least 4 ANC visits: 6 1, 3,
4,803 1,000 ,341 3,937 249 4,422 2,643 6,977 1,011 336
Percentage of Newborns with Low Birth Weights (LBW) –(less than 2500
grams)
11 - 18 120 - 593 64 669 - -
Percentage of pregnant women distributed with LLITNs 1,
7,301 - - - 266 33 - - 256 -
Percentage of pregnant women receiving two doses of Intermittent 8, 2, 2, 4,
Presumptive Therapy (IPT2)
8,928 1,626 903 6,117 439 10,329 5,149 11,871 382 213
Percentage of HIV infected pregnant women who received preventive
antiretroviral therapy to reduce the risk of mother -to -child transmission
(PMTCT). 1,524 91 325 1,342 82 475 437 2,057 18 46
Percentage of Deliveries conducted by skilled health attendants in health 6 1, 1 2,
facilities.
4,632 634 ,166 4,578 075 10,507 2,473 8,926 ,016 894
Percentage of Maternal Deaths Audited

- - - - - - - - - -
Percentage of fresh still births in the health facility

- - - - - - - - - -
Percentage of Newborns receiving BCG: 12 17, 3, 2, 6,
,237 2,037 874 14,452 683 19,225 5,756 15,899 907 048
Percentage of Children under one (1) year of age immunized against 1 18 3, 3, 6,
Measles:
2,125 2,569 ,171 12,501 976 15,585 5,121 12,196 015 139
Percentage of Children under one (1) year of age fully immunized: 1 17, 3, 2, 5,
1,425 2,492 653 9,131 909 16,626 4,846 11,433 768 839
Percentage of Children under 5 years (< 5 yrs) attending Child Welfare 33, 52,0 9, 5, 14,2
Clinic (CWC) for growth monitoring services (new cases)
594 5,301 79 30,839 788 18,209 13,367 34,798 041 86
Percentage of Children under 5 years (< 5 yrs) attending Child Welfare 7,
Clinic (CWC) who are underweight
1,548 56 88 1,654 157 266 701 1,337 - 573
Percentage of Children less than 5 years (< 5 yrs) receiving Vitamin A 36, 49, 16,3 6, 21,
supplement
627 9,698 132 51,092 24 27,490 24,306 49,533 309 173
Percentage of children under five years of age (< 5 years) distributed 4,
with Long Lasting Insecticide Treated Nets (LLITNs)
- - - - 604 91 - - 000 500
Percentage of under 5 years treated for malaria, 45, 34,0 8, 9, 15,9
083 5,961 74 50,263 609 38,128 26,557 36,701 087 77
Infant Mortality Rate (IMR)

- - - - - - - - - -
Facility Infant Mortality Rate (IMR)

- - - - - - 12 - - -
Percentage of school children correctly de-wormed at least once in the 40 41, 20,2 15,0
year:
,021 17,78 308 40,935 54 17,629 20,816 35,681 08 -
3
Percentage of schools with adequate sanitation facilities:
1,555 - - - 8 - - - - -
Percentage of Health facilities providing youth friendly services
0 - 0 0 1 0 0 0 26 -

- - - - - 1 - - - -
Percentage of population Counselled and Tested for HIV: (VCT, PITC, 24, 8,
DTC, HBCT)
246 2,795 - 63,729 048 - 17,367 6,160 - -
Number of condoms distributed: 395,6 62,3
74 40,70 - 101,767 91 - 210,688 1,085,53 - -
1 2
Percentage of Households sprayed with Insecticide Residual Spray (IRS). 14 114,8 4,
,663 1,000 36 - - - 4,199 3,300 980 -
Percentage of adults and children with advanced HIV infection started
on Anti Retroviral Therapy (ART):
6,566 180 - 1,658 232 - 120 2,064 - -
Percentage of Adults and children with advanced HIV infection receiving
Anti Retroviral Therapy (ART)
- - - - 76 - - - - -
TB case detection rate 807 1742 1521 635 3310 327
2203 - 76 -
Tuberculosis cure rate: 339 242 355 319 141 716 1 58
- 42 73
Percentage of emergency surgical cases operated within one hour

Annual Operational Plan 5 – 2009/10 81

 Indicators Bondo Borabu Gucha Homa Bay Kisii Kisii Kisumu Kisumu East Kuria Kuria
South Central West East West
- - - - - - - - - -
Percentage of cold surgical cases operated on within one month.

- - - - - - - - - -
Doctor Population ratio:

- - - - - - - - - -
Nurse Population ratio:

- - - - - - - - - -
Percentage of Health facilities without all tracer drugs for greater than 2
weeks (> 2 weeks)
- - - - 1 - - - - -
Percentage of clients satisfied with services:

- - - - - - - - - -
Average Length of Stay (ALOS): 5 5 5 8 5 7 6 4
5 5
Utilization rate of Out Patient Attendants (OPD) - Male: 127 35,47 114 284,02 - 252,893 94,717 186,170 - -
0 1
Utilization rate of Out Patient Attendants (OPD) -Female:

187 33,04 107 310,345 - 245,840 100,845 223,458 - -

4
Percentage of health facilities that submit timely, accurate reports to
national level.
45 11 33 34 10 32 15 37 14 23
Percentage of health facilities that submit complete, accurate reports to
national level.
45 11 33 34 10 32 15 38 14 23
% GOK budget allocation to primary health facilities (L2 & L3)
- - - - - - - - - -
% GOK budget allocation for drugs
- - - - - - - - - -
Percentage of districts with Functional Health Stakeholders Forum
(DHSF):
1 1 1 1 1 1 1 1 1 1

Indicators Manga Masaba Migori Nyamira Nyando Rachuncho Rongo Siaya Gucha South Suba
Percentage of Women of Reproductive Age (WRA) receiving Family 34, 36,9 40,
Planning (FP) Commodities: 9,947 21,757 28,470 821 39,912 31 33,554 615 8,890 27,300
Percentage of pregnant women attending at least 4 ANC visits: 2, 6, 10,
2,956 6,577 5,911 028 5,870 471 3,961 399 1,419 5,104
Percentage of Newborns with Low Birth Weights (LBW) –(less than
2500 grams) 28 92 191 155 13 - 39 376 5 14
Percentage of pregnant women distributed with LLITNs
317 55 1,408 - 250 74 - - 796 -
Percentage of pregnant women receiving two doses of 4, 7, 12,
Intermittent Presumptive Therapy (IPT2) 3,996 6,537 10,870 376 8,739 828 8,350 332 2,711 7,676
Percentage of HIV infected pregnant women who received 1 4
preventive antiretroviral therapy to reduce the risk of mother -to 16 238 2,204 268 1,589 ,182 1,842 ,591 1,285 1,545
-child transmission (PMTCT).
Percentage of Deliveries conducted by skilled health attendants in 5, 4, 7,
health facilities. 1,137 3,747 6,749 007 3,890 626 5,699 755 868 3,503
Percentage of Maternal Deaths Audited
- - 8 - - - - - - -
Percentage of fresh still births in the health facility
- - - - - - - - - -
Percentage of Newborns receiving BCG: 11, 13, 20,9
4,701 8,817 15,624 093 15,330 100 14,055 86 6,535 8,424
Percentage of Children under one (1) year of age immunized 11, 11, 14,
against Measles: 4,863 9,351 14,008 167 13,230 741 14,109 656 6,430 7,279
Percentage of Children under one (1) year of age fully immunized: 10, 8, 14,
4,791 9,069 15,865 941 12,606 375 13,385 472 8,384 6,821
Percentage of Children under 5 years (< 5 yrs) attending Child 15, 30,0 30,5
Welfare Clinic (CWC) for growth monitoring services (new cases) 18,132 27,463 40,489 750 80,769 63 64,554 27 8,611 23,417
Percentage of Children under 5 years (< 5 yrs) attending Child 1,
Welfare Clinic (CWC) who are underweight 763 2,155 2,952 339 571 403 2,195 2 1,706 1,369
Percentage of Children less than 5 years (< 5 yrs) receiving 29, 30, 49,0
Vitamin A supplement 16,411 30,012 40,989 436 49,409 121 75,123 53 11,052 40,809
Percentage of children under five years of age (< 5 years)
distributed with Long Lasting Insecticide Treated Nets (LLITNs) 996 65 4,064 - - 7 - - 1,040 -
Percentage of under 5 years treated for malaria, 32, 34,2 99,7
173,03 19,818 41,851 218 41,484 08 66,762 85 9,841 28,885
8
Infant Mortality Rate (IMR)
- - - - - - - - - -
Facility Infant Mortality Rate (IMR)
- - - - 3 - 2 2 - -
Percentage of school children correctly de-wormed at least once in 27, 29,0 115,3
the year: 24,435 57,644 45,984 700 49,711 81 75,772 26 29,599 25,113
Percentage of schools with adequate sanitation facilities:
- - - - 16 - - - 15 -
Percentage of Health facilities providing youth friendly services

Annual Operational Plan 5 – 2009/10 82

 Indicators Manga Masaba Migori Nyamira Nyando Rachuncho Rongo Siaya Gucha South Suba
- 0 - 0 0 - 0 0 0 0

- - - - - - - - - -
Percentage of population Counselled and Tested for HIV: (VCT, 28, 12,8 45,3
PITC, DTC, HBCT) 14,730 16,029 50,264 439 30,000 20 44,927 04 9,139 203,512
Number of condoms distributed: 124, 321,48 120,3
23,075 159,05 151,465 498 130,826 8 231,179 32 76,614 5,931,324
0
Percentage of Households sprayed with Insecticide Residual Spray 8, 5, 5
(IRS). - 11,598 80 642 24,036 182 1 ,137 14,989 139
Percentage of adults and children with advanced HIV infection 2, 14,
started on Anti Retroviral Therapy (ART): 1 - 3,110 252 4,000 250 1,274 094 190 2,806
Percentage of Adults and children with advanced HIV infection
receiving Anti Retroviral Therapy (ART) - - 9,154 - - - - - - -
TB case detection rate 500 2219 658 1,492 2571 148 252 84 882
- 9 7
Tuberculosis cure rate: 180 347 128 361 407 2 454 121 2
141 91 30
Percentage of emergency surgical cases operated within one hour
- - - - - - - - - -
Percentage of cold surgical cases operated on within one month.
- - - - - - - - - -
Doctor Population ratio:
- - - - - - - - - -
Nurse Population ratio:
- - - - - - - - - -
Percentage of Health facilities without all tracer drugs for greater
than 2 weeks (> 2 weeks) - - - - - - - - - -
Percentage of clients satisfied with services:
- - - - - - - - - -
Average Length of Stay (ALOS): 5 5 5 7 6 5 6 5 6
4
Utilization rate of Out Patient Attendants (OPD) - Male: 75,430 65,767 218,542 200,054 129,155 - 245,54 - 147,746 178,316
7
Utilization rate of Out Patient Attendants (OPD) -Female: 188,
98,355 75,781 216,695 485 124,597 - 235,234 - 155,311 200,985
Percentage of health facilities that submit timely, accurate reports
to national level. 14 25 41 34 37 46 29 48 13 43
Percentage of health facilities that submit complete, accurate
reports to national level. 14 25 41 34 37 46 29 48 13 43
% GOK budget allocation to primary health facilities (L2 & L3)
- - - - - - - - - -
% GOK budget allocation for drugs
- - - - - - - - - -
Percentage of districts with Functional Health Stakeholders Forum
(DHSF): 1 1 1 1 1 1 1 1 1 1

4.1.5.6 Nyanza Provincial Public Health and Sanitation Health Management

Support

Result Output Time frame Responsible Costs / Revenu Source Gap

Area Q1 Q2 Q3 Q4 budget e
1. Annual operational plan 1 X X Epidemiologist/P 1,412,20 1,412,2 EHS,AMR
Planning (NHSSP III) developed HRIO 0 00 EF
2. Improved communication and X X X X PHRIO,PHAO 1,600,00 1,600,0 2comps
Infrastruc equipment for PHMT (10 0 00 FHI,
ture, and desktops,5laptop and FACES,G
maintena accelessories, office TZ,NRHS
nce workstations,communication
(equipme equipment,ICT equipments
nt, Improved work enviroment X X X X PHAO 160,000 160,000
communi 1 utility vehicle procured and X X X X PHAO JICA
cation others maintained and fully X PHAO JICA
and operational
Transport
)
3. Human Adherence to staffing norms- x x x x Prov personnel CDC (to
Resource quarterly rational staff officer consult),
Managem deployment distribution GTZ

Annual Operational Plan 5 – 2009/10 83

Result Output Time frame Responsible Costs / Revenu Source Gap
Area Q1 Q2 Q3 Q4 budget e
ent
4. Increased number of skilled and X X X X Prov Med 33,445,4 33,445, GTZ,
Capacity motivated personel (500 trained Engineer,PMO 00 400 AMREF,m
building on various skills) Epi ildmay,liv
logistician,PASCO erpool
,PTLC,PCO,PPHN, vct,CMM
PROV B),CDC,M
NUTRITIONIST,PD SH,FHI,A
SC,RH MREF
coordinator,prov. APHIA II
lab
technolo,PHRIO
5. biannual consultations with CRH x x RH coordinator 157400 157400
Performa training coordinators done
nce annual VCT site licensing and X PASCO liverpool
monitorin accreditation done vct,
g and NASCOP
evaluatio annual sentinel surveillance and x PASCO 500,000 500,000 NASCOP,l
n drug resistance survey iverpool
undertaken vct
monthly reviews with prisons X X X X PASCO 120,000 120,000 mildmay
HBC team
Dissemination of of data X X X X PHRIO All
collection tools done partners
Laboratory CD4 Network Prov. Laboratory 1280000 128000 APHIA
meetings (2 meeting of held techn. 0
Support Supervision during X X Prov. Nutritionist 504,140 504,140 APHIA
malezi bora weeks (June &Nov
09) provided
Baby Friendly Hospital Initiative Prov. Nutritionist • •
ASSESSSMENT(BFHI) carried out
monthly x x x x PASCO 528,00 528,00 FHI
Provincial Male Circumcision 0 0
task force meetings held
Quarterly AOP 5 Performance x x Provincial 8,180,40 8,180,4 EHS
reviews done epidemiologist 0 00
Quarterly PHMT integrated x x x x Program 5,880,00 5,880,0
support supervision coordinators 0 00
Program specific Quarterly x x Provincial 980,000 980,000 EHS
Supervisory epidemiologist
visits(MMC,HIV,TB,RH,EPI/diseas
e surveillance) done
biannual Data Quality Audit x PHRIO 189,200 189,200
(DQA) carried out
quarterly EQA (HIV/Malaria/TB) x x x x Prov. Laboratory 480,400 480,400
undertaken techn.
Support supervision to district X X Provincial 480,400 480,400
implementing LDP provided epidemiologist
level 4-6 Hospitals assessed on X X PNO 504,140 504,140
Implementation of (quality
care)Nursing Process
Biannual National PTLC review X X X X Provincial FHI
meetings attended epidemiologist
Biannual National PTLC review 189,200 189,200
meetings attended
quarterly meetings with district X X program/dept 7,680,00 7,680,0 FHI,AMRE
coordinators of program heads 0 00 F(HBC),E
(HIV/ART/TB/Disease HS,APHIA
surveillance/EPI/RH/PMTCT) ,CDC

Annual Operational Plan 5 – 2009/10 84

Result Output Time frame Responsible Costs / Revenu Source Gap
Area Q1 Q2 Q3 Q4 budget e
undertaken
Quarterly meetings with X X 910,480 910,480
DMSO/DMOH held
Quarterly physiotherapy X X 176,000 176,000 disbility
meetings held serv.
Prog
_2qtrs(ph
ysio)
Biannual meetings on Voluntary 960,000 960,000 FHI
Male Circumcision held-
annual bulletin developed 125,000 125,000
6. Increased utilization of evidence X Provincial 296,600 296,600
Operation in decision making Epidemiologist
al and X PNO 627,750 627,750
other PARTO
research X PTLC
X X X X Provincial
Epidemiologist
PMO FHI
X Provincial 189,200 189,200 CDC,NRH
Epidemiologist
X X X X PMO
7.Govern All Management boards and X x PHAO program
ance team functional coordinators
All international and national X X X X PHAO/program 20,000 20,000 APDK(dis
health days observed coordinators ability),H
RHS,amr
ef (TB)
quarterly/biannual stakeholders X X program EHS
meetings for the following coordinators, (RH),FHI(
programs(HIV/ART/MMC/HBC/PM Prov occup vmc)
TCT/TB/RH/water & sanitation) Therapist, PPHO
are held PMO
Quarterly meetings with PASCO parto
stakeholders for various
programs held
8. Installation of FIS in 5 district X X X X PHAO
Financial hospitals done d FIF collection
manage improved
ment
9. Surveillance for disease trends X X X X PDSC 0 0
Emergen for diarrhoea,malaria for
cy emergency preparedness and
prepared response done
ness and 4facility Emergency disaster X PNO/PPHN 176,000 176,00
response preparedness teams in 4 0
facilities (2 level 4 and 5)
established
emergency response committee X PMO,PDSC 250,000 250,000
and fund established

Annual Operational Plan 5 – 2009/10 85

 Rift Valley Province Health Plans

4.1.5.7 Priorities for the province

• Improving quality of health services

• Strengthening referral system
• Improving maternal and child health
• Strengthen implementation of community strategy
• Controlling HIV/AIDS,malaria and TB
• Strengthening school health programs
• Improving environmental health services
• Strengthen health promotion
• Strengthen home based care
• Establish youth friend services
• Establish geriatric health services
• Strengthen governance s structures
• Reducing malnutrition

4.1.5.8 Service Delivery targets for the Rift Valley province

Indicators Eldoret Eldoret Kericho Nakuru Narok Turkana Molo East Sotik Loitoktok Nandi Turkana Wareng kajiado Keiyo
West East South Central Pokot North North
Percentage of Women of Reproductive Age 43,377 62,099 63,167 93,876 5,662 6,787 69,306 775 10,748 15,964 21,319 - 37,315 53,745 11,98
(WRA) receiving Family Planning (FP) 2
Commodities:
Percentage of pregnant women attending 9,763 11,440 11,462 11,522 7,143 1,688 7,331 1,207 6,038 2,921 3,004 - 5,220 9,485 4,244
at least 4 ANC visits:
Percentage of Newborns with Low Birth 366 550 205 284 18 - 106 26 16 7 22 - 134 22 235
Weights (LBW) –(less than 2500 grams)
Percentage of pregnant women distributed 16,201 24,054 19,123 7,761 7,232 3,274 - 2,270 7,015 6,230 4,671 - 12,866 14,257 8,980
with LLITNs
Percentage of pregnant women receiving 12,201 19,054 13,389 14,676 6,250 2,706 15,252 475 6,602 5,934 6,099 - 12,866 7,322 4,448
two doses of Intermittent Presumptive
Therapy (IPT2)
Percentage of HIV infected pregnant 5,320 2,660 2,049 964 131 271 222 30 260 115 6,498 - 1,123 810 247
women who received preventive
antiretroviral therapy to reduce the risk of
mother -to -child transmission (PMTCT).
Percentage of Deliveries conducted by 9,722 15,354 17,413 24,466 1,786 2,273 6,990 461 2,444 6,304 4,243 - 10,069 8,345 3,609
skilled health attendants in health
facilities.
Percentage of Maternal Deaths Audited - - 16 10 - - - - 2 - - - - - -
Percentage of fresh still births in the - - 164 231 4 4 187 - 16 2 16 - - 23 2
health facility 0
Percentage of Newborns receiving BCG: 16,811 21,634 15,414 18,624 6,755 8,377 19,276 2,667 7,104 5,925 6,741 - 10,268 16,385 8,51
5
Percentage of Children under one (1) year 13,411 18,209 17,423 20,638 6,036 4,708 19,635 1,735 7,571 5,778 1,785 - 9,223 19,385 7,885
of age immunized against Measles:
Percentage of Children under one (1) year 13,411 18,209 17,414 18,410 5,362 3,144 20,013 1,735 7,571 5,778 1,775 - 9,223 19,385 7,735
of age fully immunized:
Percentage of Children under 5 years (< 5 53,513 64,449 51,789 76,398 8,262 6,712 29,085 6,507 10,133 18,692 23,668 - 23,170 48,659 39,330
yrs) attending Child Welfare Clinic (CWC)
for growth monitoring services (new
cases)
Percentage of Children under 5 years (< 5 1,458 - 12,947 5,968 85 2,790 804 2,334 59 773 1,386 - 515 3,194 8,990
yrs) attending Child Welfare Clinic (CWC)
who are underweight
Percentage of Children less than 5 years 38,649 65,939 51,789 47,246 4,818 9,249 93,759 9,053 7,194 19,913 18,815 - 43,170 67,680 8,240
(< 5 yrs) receiving Vitamin A supplement
Percentage of children under five years of 46,648 68,099 51,789 14,924 21,058 1,394 - 8,283 6,087 12,446 23,833 - 36,023 33,841 2,040
age (< 5 years) distributed with Long
Lasting Insecticide Treated Nets (LLITNs)
Percentage of under 5 years treated for 65,972 82,798 46,736 4,975 6,508 11,532 736 2,657 5,333 3,437 375 - 51,461 45,416 29,266
malaria,
Infant Mortality Rate (IMR) - - - - - - - - - - - - - - -
Facility Infant Mortality Rate (IMR) - - 78 703 - - - - 11 - - - - - -
Percentage of school children correctly de- 77,333 256,000 64,312 44,638 18,695 7,855 40,508 7,795 11,579 26,473 1,464 - 29,297 38,970 14,250
wormed at least once in the year:
Percentage of schools with adequate 242 472 198 166 179 18 270 15 49 145 271 - 209 200 460
sanitation facilities:
Percentage of Health facilities providing 7 16 9 10 6 3 - 4 4 14 - 34 6 100 -
youth friendly services
- - - - - - - - 21,666 - - - - - -
Percentage of population Counselled and 26,537 31,069 61,458 74,624 55,030 8,753 103,575 9,970 12,500 32,011 - - 27,582 75,087 8,285
Tested for HIV: (VCT, PITC, DTC, HBCT)
Number of condoms distributed: - - 7,000,000 - 386,846 24,000 815,800 126,520 4,680 100,000 - - 231,000 165,575 325,500
Percentage of Households sprayed with 22,676 - 45,069 - 15,887 165 - 300 11,856 1,484 13,299 - 21,164 - 7,352
Insecticide Residual Spray (IRS).
Percentage of adults and children with 396 - 1,209 4,096 1,271 183 258 2,838 204 6,293 - - - 1,412 1,53
advanced HIV infection started on Anti 0

Annual Operational Plan 5 – 2009/10 86

 Indicators Eldoret Eldoret Kericho Nakuru Narok Turkana Molo East Sotik Loitoktok Nandi Turkana Wareng kajiado Keiyo
West East South Central Pokot North North
Retroviral Therapy (ART):
Percentage of Adults and children with - - 7,252 12,485 1,392 255 1,323 - 292 5,645 - - - 1,887 2,11
advanced HIV infection receiving Anti 5
Retroviral Therapy (ART)
TB case detection rate 149 239 2129 711 1 2 984 1119
4 297 936 5 426 64 58 86 568 38 219
Tuberculosis cure rate: 38 90 3 1 1 159 84 11 380
5 282 604 131 22 82 42 45 95 47
Percentage of emergency surgical cases - - 390 - - - 45 - 230 800 - - - - -
operated within one hour
Percentage of cold surgical cases operated - - 450 - - - 224 - 219 800 - - - - -
on within one month.
Doctor Population ratio: - - 41 25 1 - - 6 - 8 - - - - -
Nurse Population ratio: 185 - 392 655 93 16 - 9 35 273 - - - - -
Percentage of Health facilities without all - - - 24 - - 3 - 29 - - - - - -
tracer drugs for greater than 2 weeks (> 2
weeks)
Percentage of clients satisfied with - - 80 497,487 14,930 - 513,544 8,925 148,018 91,056 - - - - -
services:
Average Length of Stay (ALOS): 5 5 4 5 4 4 6 5 4 4 6 7 6 5
5
Utilization rate of Out Patient Attendants 273,646 - 138,881 134,177 66,296 42,592 51,284 15,632 40,250 38,146 - - 25,230 6,140 192,350
(OPD) - Male:
Utilization rate of Out Patient Attendants 273,646 354,681 166,760 204,539 86,399 45,360 65,821 20,138 42,530 50,509 - - 26,752 8,883 193,23
(OPD) -Female: 1
Percentage of health facilities that submit 50 38 - 78 35 - 48 - 39 12 16 35 30 - 2
timely, accurate reports to national level. 4
Percentage of health facilities that submit 50 38 - 78 41 - 65 - 42 17 25 44 37 - 2
complete, accurate reports to national 4
level.
% GOK budget allocation to primary health - - - - - - - - - - - - - - -
facilities (L2 & L3)
% GOK budget allocation for drugs - - - - - - - - - - - - - - -
Percentage of districts with Functional 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Health Stakeholders Forum (DHSF): 1

Indicators Turkana Baringo Baringo Bomet Buret Central Naivasha West Laikipia North Nandi Kipkelion Koibatek Kwanza Laikipia
South North Pokot Pokot West Pokot Central East
Percentage of Women of Reproductive Age 14,915 21,4 22,650 21,498 7,110 3,249 10,516 8,647 30,593 44,8 5,068 50,500 7,854 5390 1687
(WRA) receiving Family Planning (FP) 26 31
Commodities:
Percentage of pregnant women attending 7,147 1, 1,884 2,046 2,744 946 6,958 2,430 5,872 10,6 1,260 14,705 2,481 2437 403
at least 4 ANC visits: 719 52
Percentage of Newborns with Low Birth - 17 - 516 - 120 - 105 3 102 563 128 0 0
Weights (LBW) –(less than 2500 grams) 85 15
Percentage of pregnant women distributed 6,353 8,4 6,816 7,577 3,346 1,524 6,822 3,714 14,638 11,7 5,385 5,253 2,611 1745 470
with LLITNs 73 04
Percentage of pregnant women receiving 6,352 4,5 3,890 3,589 3,195 2,015 3,820 2,485 12,837 6,0 4,008 14,006 4,412 2978 2878
two doses of Intermittent Presumptive 29 51
Therapy (IPT2)
Percentage of HIV infected pregnant 397 3 203 346 494 88 502 829 462 5 63 1,216 173 83 6
women who received preventive 63 63
antiretroviral therapy to reduce the risk of
mother -to -child transmission (PMTCT).
Percentage of Deliveries conducted by 6,749 4,4 1,367 4,912 102 768 4,695 2,738 6,942 10,0 3,891 10,506 4,957 968 2273
skilled health attendants in health facilities. 94 52
Percentage of Maternal Deaths Audited - - - 1 - - - 1,599 - 8 - 0 0
6 2
Percentage of fresh still births in the health 28 - - - 4 - 28 - 831 53 1 0
facility 46 2 -
Percentage of Newborns receiving BCG: 7,996 6,7 6,357 7,373 3,239 2,953 4,918 3,942 13,346 11,9 3,654 16,082 7,078 6307 2361
77 77
Percentage of Children under one (1) year 6,148 6, 5,696 6,925 3,829 2,005 4,718 3,937 11,69 15,8 5,466 11,368 8,519 6540 2670
of age immunized against Measles: 241 1 35
Percentage of Children under one (1) year 6,092 6, 5,552 4,692 3,829 1,728 4,718 3,937 11,69 15,4 5,466 11,369 8,519 6540 2648
of age fully immunized: 241 1 09
Percentage of Children under 5 years (< 5 23,824 15,4 3,552 18,695 12,415 4,495 18,670 10,91 21,951 82,8 13,014 53,215 24,072 11324 6806
yrs) attending Child Welfare Clinic (CWC) 68 8 61
for growth monitoring services (new cases)
Percentage of Children under 5 years (< 5 44 274 304 273 1,114 813 559 2,977 1,2 962 1,662 583 1247 220
yrs) attending Child Welfare Clinic (CWC) 651 29
who are underweight
Percentage of Children less than 5 years (< 25,412 18,3 20,222 17,159 17,969 6,091 14,670 9,918 35,513 33,9 15,215 27,077 22,942 17993 8582
5 yrs) receiving Vitamin A supplement 54 61
Percentage of children under five years of 12,706 18, 4,111 27,159 3,239 1,604 5,065 11,18 18,782 41,3 15,612 5,544 24,328 5910 5396
age (< 5 years) distributed with Long 145 9 12
Lasting Insecticide Treated Nets (LLITNs)
Percentage of under 5 years treated for - 25,2 13,429 30,874 15,625 4,341 3,193 13,054 23,222 29,52 7,818 35,928 32,571 37174 22080
malaria, 05 8
Infant Mortality Rate (IMR) - - - - - - - - - - - 0 0
- -
Facility Infant Mortality Rate (IMR) - - - - - - - 142 - 20 61 0 12
84 -
Percentage of school children correctly de- 64,410 12,7 5,442 6,965 7,180 3,855 24,675 4,000 14,834 26,60 - 47,949 - 42873 14649
wormed at least once in the year: 49 8
Percentage of schools with adequate - 86 371 12 99 291 13 1,662 1 25,088 310 20,259 24 42
sanitation facilities: 58 8 65
Percentage of Health facilities providing - 2 1 2 2 5 9 64 6 145 7 1
youth friendly services 4 1 2
- - - - - - - - - - - 0 0
- -
Percentage of population Counselled and 18,918 51,8 8,673 31,298 - 5,173 21,553 14,396 19,217 6,68 7,959 175,054 18,505 34100 856
Tested for HIV: (VCT, PITC, DTC, HBCT) 73 0
Number of condoms distributed: 21,600 300,7 66,300 56,056 - - 47,940 - 134,613 1,618,8 32,078 219,619 156,217 407827 42600
50 87
Percentage of Households sprayed with - 28,5 - 34,085 13,385 1,088 573 1,376 56,093 13,872 9,975 6,436 6236 0
Insecticide Residual Spray (IRS). 13 -
Percentage of adults and children with 128 27,5 156 756 - 144 767 50 2,519 6 - 10,686 284 0 23
advanced HIV infection started on Anti 28 20
Retroviral Therapy (ART):

Annual Operational Plan 5 – 2009/10 87

 Indicators Turkana Baringo Baringo Bomet Buret Central Naivasha West Laikipia North Nandi Kipkelion Koibatek Kwanza Laikipia
South North Pokot Pokot West Pokot Central East
Percentage of Adults and children with - 1, 216 756 - 169 767 8 1,800 26,6 - 26,715 682 269 56
advanced HIV infection receiving Anti 891 1 14
Retroviral Therapy (ART)
TB case detection rate 946 28 174 1,1 240 2 0 498
- 582 87 1258 1013 - 1129 2 87 49
Tuberculosis cure rate: 147 3 21 2,00 61 4 0 122
- 51 78 293 - 7 277 71 40 1 7
Percentage of emergency surgical cases 370 - - - - 176 - 150 652 1,024 336 0 0
operated within one hour - -
Percentage of cold surgical cases operated 588 - - - - 99 - 3,525 - 722 295 0 0
on within one month. - -
Doctor Population ratio: 2 - - - - - - - - 8 - 0 0
7 18
Nurse Population ratio: 149 - - - 16 12 - - 3 34 35 110 0 0
92 54
Percentage of Health facilities without all - - - - - - - - - - - 0 0
tracer drugs for greater than 2 weeks (> 2 3 -
weeks)
Percentage of clients satisfied with - 123,8 - 190,303 - - - - 3 209,45 - 35,010 2 0 0
services: 79 1
Average Length of Stay (ALOS): 4 5 5 6 7 6 5 5 6 6 5 5 6 6
6
Utilization rate of Out Patient Attendants 74,658 77,4 74,328 40,229 33,118 31,962 36,851 25,786 55,650 311,1 35,108 229,860 87,197 48577 30125
(OPD) - Male: 40 99
Utilization rate of Out Patient Attendants 111,988 94,6 94,599 76,666 40,478 31,962 38,411 26,873 56,250 445,93 42,095 259,915 129,851 72866 34653
(OPD) -Female: 30 8
Percentage of health facilities that submit - 20 12 1 25 39 30 - 24 50 28 40 0
timely, accurate reports to national level. 32 44
Percentage of health facilities that submit - 26 14 1 34 44 37 - 24 69 37 46 0
complete, accurate reports to national 32 44
level.
% GOK budget allocation to primary health - 2,000,00 - - - - - - - - - - 0 0
facilities (L2 & L3) 0 -
% GOK budget allocation for drugs - 6,000,00 - - - - - - - - - - 0 0
0 -
Percentage of districts with Functional 1 1 1 1 1 1 1 1 1 1
Health Stakeholders Forum (DHSF): 1 1 1 1 1

Indicators Maraket Nandi Nandi Trans Tinderet Laikipia Nakuru North Narok Samburu Samburu Transmara Trans Laikipia
East South Nzoia North North Central North Nzioa West
East West
Percentage of Women of Reproductive Age (WRA) 29326 23845 21969 21493 24024 1397 31590 19577 7001 2186 3675 17652 64512
receiving Family Planning (FP) Commodities:
Percentage of pregnant women attending at least 4 6562 6424 7998 4867 2768 475 7858 6291 2716 2481 1069 4154 13746
ANC visits:
Percentage of Newborns with Low Birth Weights 87 99 84 0 104 0 110 86 200 22 0 42 172
(LBW) –(less than 2500 grams)
Percentage of pregnant women distributed with 9771 8934 8430 2845 700 325 4321 10354 2000 860 304 6924 14440
LLITNs
Percentage of pregnant women receiving two doses 5166 15130 7430 5152 3174 818 8771 8473 4483 1457 1876 7434 11380
of Intermittent Presumptive Therapy (IPT2)
Percentage of HIV infected pregnant women who 396 1983 267 343 557 57 116 1141 241 112 116 139 985
received preventive antiretroviral therapy to reduce
the risk of mother -to -child transmission (PMTCT).
Percentage of Deliveries conducted by skilled health 6864 3959 6895 9724 4320 204 7321 5296 3397 795 1401 2938 7540
attendants in health facilities.
Percentage of Maternal Deaths Audited 0 2 0 0 0 0 0 1 0 0 0 4 8
Percentage of fresh still births in the health facility 0 4 7 0 21 0 10 0 0 7 0 16 74
Percentage of Newborns receiving BCG: 10838 8424 8824 7868 5284 912 10418 10062 4610 2045 2220 6737 14265
Percentage of Children under one (1) year of age 11648 320 6741 7346 4994 684 7959 10061 3965 1552 1908 8570 10114
immunized against Measles:
Percentage of Children under one (1) year of age 11641 320 6741 8311 4994 684 7959 10061 4249 1555 1908 8370 10114
fully immunized:
Percentage of Children under 5 years (< 5 yrs) 30738 32660 24962 10732 14822 1975 34620 31772 12277 3555 5538 18782 42786
attending Child Welfare Clinic (CWC) for growth
monitoring services (new cases)
Percentage of Children under 5 years (< 5 yrs) 1020 7841 881 25866 570 20 346 339 767 362 674 565 0
attending Child Welfare Clinic (CWC) who are
underweight
Percentage of Children less than 5 years (< 5 yrs) 25609 25090 23494 16924 12092 1174 27720 33890 12277 3955 5172 20798 31629
receiving Vitamin A supplement
Percentage of children under five years of age (< 5 29575 25090 17620 28924 97 50 0 17268 6250 1436 738 24870 48629
years) distributed with Long Lasting Insecticide
Treated Nets (LLITNs)
Percentage of under 5 years treated for malaria, 21377 28366 20498 28155 4462 685 10396 29654 10742 6596 5169 28455 42786
Infant Mortality Rate (IMR) 0 0 0 0 0 0 0 0 0 0 0 0 0
Facility Infant Mortality Rate (IMR) 0 95 15 0 0 0 0 0 0 0 0 36 0
Percentage of school children correctly de-wormed 13803 77736 25864 23800 5777 2165 21166 41012 4118 6910 4158 229878 26440
at least once in the year:
Percentage of schools with adequate sanitation 301 214 145 207 57 15 60 112 30 26 34 62 168
facilities:
Percentage of Health facilities providing youth 1 6 2 2 2 4 1 17 1 4 1 1 5
friendly services
0 0 0 0 0 0 0 0 0 0 0 0 0
Percentage of population Counselled and Tested for 114191 189560 18575 3430 18511 4391 44997 42753 6143 5935 7192 17317 15785
HIV: (VCT, PITC, DTC, HBCT)
Number of condoms distributed: 81000 189560 300000 0 162780 21500 150005 57025 2000 60000 45243 311578 2000000
Percentage of Households sprayed with Insecticide 0 38700 27000 37044 0 100 0 19977 1404 14 339 40120 142280
Residual Spray (IRS).
Percentage of adults and children with advanced 0 1156 381 25 1098 0 257 830 511 252 131 537 11084
HIV infection started on Anti Retroviral Therapy
(ART):
Percentage of Adults and children with advanced 0 1156 2742 25 2170 0 526 7793 999 924 174 1469 4995
HIV infection receiving Anti Retroviral Therapy (ART)
TB case detection rate 320 166 329 48 0 511 517 382 202 234 1604 282
Tuberculosis cure rate: 76 0 62 59 3 0 141 126 144 31 70 286 71
Percentage of emergency surgical cases operated 0 0 644 0 94 0 0 180 0 40 0 100 10
within one hour
Percentage of cold surgical cases operated on within 0 0 312 0 312 0 0 6355 0 150 0 30 10
one month.
Doctor Population ratio: 0 14 4 102 12 8 0 0 6 3 3 6 10
Nurse Population ratio: 0 132 319 0 173 41 0 0 80 46 46 128 10

Annual Operational Plan 5 – 2009/10 88

 Indicators Maraket Nandi Nandi Trans Tinderet Laikipia Nakuru North Narok Samburu Samburu Transmara Trans Laikipia
East South Nzoia North North Central North Nzioa West
East West
Percentage of Health facilities without all tracer 0 4 0 0 3 0 0 0 0 0 0 0 10
drugs for greater than 2 weeks (> 2 weeks)
Percentage of clients satisfied with services: 0 568596 0 12234 3220 6100 0 40531 33132 51110 37605 38192 10
Average Length of Stay (ALOS): 6 4 5 6 4 5 5 5 6 7 6 6 6
Utilization rate of Out Patient Attendants (OPD) - 109669 206746 119203 3600 31368 4158 69150 84726 50734 32021 20530 20233 190249
Male:
Utilization rate of Out Patient Attendants (OPD) 114146 216746 147636 4335 35734 14563 92917 84726 29684 35314 24669 27763 194244
-Female:
Percentage of health facilities that submit timely, 25 102 30 15 25 10 20 18 20 10 26 40 33
accurate reports to national level.
Percentage of health facilities that submit complete, 20 102 37 18 31 10 25 32 30 7 35 52 33
accurate reports to national level.
% GOK budget allocation to primary health facilities 0 0 0 0 0 0 0 0 0 8 0 0 0
(L2 & L3)
% GOK budget allocation for drugs 0 0 0 0 0 0 0 0 0 9 0 0 0
Percentage of districts with Functional Health 1 1 1 1 1 1 1 1 1 1 1 1 1
Stakeholders Forum (DHSF):

4.1.5.9 Rift Valley Provincial Health Management Support

Result Output Timeframe Respon Costs / Revenue Source Gap

Area Q Q Q Q sible budget
1 2 3 4 person

1. Aop for 2010/2011 Developed X X PDPHS, 10,764,00 10,764,00

GOK
Planning PHMT 0 0
2. supervisory checklist for Public health X X PDHS 7,000,000 7,000,000 GOK
Performa and sanitation department developed /PHMT / Partners
nce and harmonized
monitorin supervisory schedule developed X PHMT
g and guidelines on supervision adopted X X X X PHMT 150000 150000 GOK
evaluatio and Disseminatied / Partners
n monthly integrated supervisory X X X X 3,880000 3,880000 GOK
visits to the districts conducted /APHIA11
/UNICEF
quarterly feedback reports to the X X 100,000 100,000 GOK
district disseminated / Partners
Quarterly review meetings with X X X X PHMT 12,000,00 12,000,00 GOK /WHO
districts, programmes and 0 0 /APHIAII
partners.conducted /DFID
M&E tools Printed, and istribution X X X X PHRIO 9,260,000 9,260,000 GOK
health workers Sensitized on / Partners
reporting tools
half yearly data quality assessment X X X X PHMT 750,000 750,000 GOK
(Audit) for 4 days in 12 districts by 5 / Partners
PHMT members conducted
3. Human provincial human resource data base X PHMT 520,000 520,000 GOK
Resource established / Partners
Manage Harmonization and distribution of PHMT 40,000 GOK
ment and staff through PMO’s done X X X X
develop Requisition for extra staff to reinforce X X X X GOK
ment exist workforce in the hard to reach /Capacity,
areas of the province ie UNICEF,
PHMT
Nurses,PHT,HRIO,Nutrition. 1,000,600, 1,000,600 AMPATH,
000. ,000. UNFPA,
APHIA II
Staff appraised quarterly X X X X PHMT 50,000 50,000 APHIA 11
Introduce staff motivation scheme& X 350,000 350,000 APHIA 11
PHMT
award
Capacity building X X 250,000 250,000 GOK
PHMT
/Partners
X X X X 1,000,000 1,000,000 GOK
PHMT
/partners
X X X PPHO 1,500,000 1,500,000 GOK

Annual Operational Plan 5 – 2009/10 89

Result Output Timeframe Respon Costs / Revenue Source Gap
Area Q Q Q Q sible budget
1 2 3 4 person
/PPHN / Partners
X GOK
1,500,000 1,500,000
/Partners
4.
essential X X X X PDPHS, 1,708,000 1,708,000 GOK
medicine PPHO,P / GOK/
s and HRIO,PH Partners
supplies AO
X X X X PDPHS 17,000,00 17,000,00 GOK
/PHMT 0 0 / Partners
7. 1. IMPROVED SERVICE DELIVERY AT X X X PDPHS 2,784,700 2,784,700 GOK
Governan ALL LEVESL OF CARE. /PPHO /Partners
ce X X PDPHS 1345000 1345000 GOK
/PHAO / Partners
PDPHS/ 3450000 3450000
X PDPHS 2,784,700 2,784,700 GOK
/PPHO /Partners
Annual commemoration days marked X X X X PDPHS 1000,000 1000,000 GOK
/PHMT /Partners
X X X X PDPHS 600000 600000 GOK
/Partners
8. Provincial District Disaster response X PPHO 44,000 44,000 HSSF,
emergen team with TOR established. Red cross
cy Emergency disaster response fund X X X X PDPHS 800,000 800,000 HSSF and
prepared used in the coordination of stake- Partners
ness and holders during disaster response
response established.
Outbreak Rapid Response Teams X X X X PDSC 300,000 300,000 HSSF
(RRT) functional at Provincial &
District level.
post-epidemic evaluations to assess X X X X PDSC 60,000 60,000 HSSF
the Link between Surveillance
information and action conducted

IDSR reporting tools for

surveillance/outbreaksdistributed
Capacity PHMT, 28DHMT, health workers X 2,848,000 2,848,000 GOK,
Building trained malaria and PDA Merlin,
APHIA 11
Timeliness and completeness of X X X X PDSC 120,000 120,000 HSSF
IDSR reports monitored (weekly &
monthly) distributed
Trends monitored on priority IDSR X X X X PHRIO 60,000 60,000 HSSF
targeted diseases
Preparation and monitoring of weekly X X X X PDSC/ 80,000 80,000 HSSF
and monthly trends done PHRIO
Monthly and Quarterly feedbacks o X X X X PDSC
IDSR conducte
monthly integrated supervisory visits X X X X PDSC 3,266,400 3,266,400 HSSF,
to districts conducted WHO
quarterly IDSR meetings with District X X X X PDSC 5,975,600 5,975,600 WHO
Disease Surveillance teams (DDSTs)
held
IDSR reporting tools for X PDSC 100,000 100,000 HSSF
surveillance/outbreaks distributed
annually
ICT equipments/furniture procured,
and installed working environment

Annual Operational Plan 5 – 2009/10 90

Result Output Timeframe Respon Costs / Revenue Source Gap
Area Q Q Q Q sible budget
1 2 3 4 person
improved and office fully operational
10 Vehicle maintained and
operational,and 3 procured

Infrastruc All fully maintained and operational X X X X PDPHS 1,200,000 1,200,000 HSSF
ture, 5 PDAs (Treo) for PHMT purchased PDPHS 100,000 100,000 HSSF
communi
c&
T/port

9.Financi biannual trainings/Sensitization of X X X PDPHS 1200000 1200000 GOK

al 8PHMT/ DHMTS for two days on /PHAO /Partners
Manage financial management undertaken
ment .Set target for financial effective X PDPHS 30000 30000 GOK
management and Ensure that funds /PHAO
are properly utilized
biannual trainings/Sensitization of X X X PDPHS 1200000 1200000 GOK
8PHMT/ DHMTS for two days on /PHAO /Partners
financial management undertaken
10. survey on the factors influencing PDPHS 2,200,000 2,200,000 GOK
operation immunization/other health activities /PHMT / Partners
al and in 6 districts in the province
other conducted-
research Study Conducted in 4 hard to reach X X PDPHS 1,600,000 1,600,000 GOK
districts ie Turkana,Samburu,West /PPHO /WHO
Pokot and Molo to establish factors /PHRIO /APHIA
that would motivate staff to work in
these areas.
TOTAL 1,127,102, 1,127,102
S 400 ,400

4.1.5.10 Rift Valley Provincial Hospital Management Support

Result Output Time frame Responsi Costs / Revenue Source Gap

Area Q Q Q Q ble budget
1 2 3 4 Person
1. AOP 6 developed X X HQ, PDMS 779,000 779,000 GOK
Planning
Monitorin Updating and adoption of supervisory X PDMSO 250000 250000 GOK
g and checklist done / PHRIO
supervisi quarterly integrated supervision of 58 X X X X PMSHMT 6,240,48 6,240,48 APHIA II,
on of District and sub district hospitals in Rift 0 0 WRP, GOK
performa Valley with the PMSHMT done
nce Performance contracts preparation and X X X X PDMSHMT 75,000 75,000 GOK
follow up with 58 DMSO and Med Sup PGH
(2 meetings) done
client exit interviews at selected X X PDMS 140,000 140,000 GOK/
facilities conducted twice in a year APHIA II
quarterly review meetings with X X X GOK/
DMSHMT to share and give feedback PARTNERS
on their performance conducted
given
regular feedback reports to X X X X PMSHMT/ 1080000 1080000 GOK
districts/Hospitals after supervision given Program 0 0 /Partners
Officers
policy guidelines and IEC materials X X X PHRIO/

Annual Operational Plan 5 – 2009/10 91

Result Output Time frame Responsi Costs / Revenue Source Gap
Area Q Q Q Q ble budget
1 2 3 4 Person
collected and distributed PMHMT
half yearly data quality assessment/Audit X X PHMT 4,800,00 4,800,00 APHIA II
for 5 days in selected hospitals conducted 0 0
Data Quality Self Assessment done X PHRIO/ 300000 300000 APHIA II
program
offices
all medical documents centrally X X X PPHRIO/ 250000 250000 APHIA II/
(registers) printed PMHRIO GOK
quarterly integrated supervision of 58 X X X PMSHMT 6,240,48 6,240,48 APHIA II,
District and sub district hospitals in Rift 0 0 WRP, GOK
Valley with the PMSHMT conducted
Performance contracts preparation and X PDMSHMT 75,000 75,000 GOK
followed up with 58 DMSO and Med Sup
PGH (2 meetings)
client exit interviews twice a year in X X PDMS 140,000 140,000 GOK/
selected facilities conducted APHIA II
quarterly review meetings with X X GOK/
DMSHMT to share and give feedback PARTNERS
on their performance conducted
regular feedback reports to X X X X PMSHMT/ 1080000 1080000 GOK
districts/Hospitals after supervision given Program 0 0 /Partners
Officers
Feedback reports to districts and to MOH X PHMT 75,000 75,000 GOK
Hqs done /Partners
Departmental meetings held X X X X PHRIO/All GOK
depts /Partners
Review and avail reporting tools in all X All HOD 250000 250000 GOK
departments done APHIA II
Collection and distribution of policy X X X PHRIO/
guidelines and IEC materials done PMSHMT
half yearly data quality assessment/Audit X X PHMT 4,800,00 4,800,00 APHIA II
for 5 days in selected hospitals conducted 0 0
Data Quality Self Assessment done X PHRIO/ 300000 300000 APHIA II
program
offices
all medical documents centrally X X PHRIO APHIA II
(registers) printed
3. Human Training database and award scheme in X X X X PHAO,all 544,000 544,000 GOK/partn
Resource place to motivate workforce HODS ers/APHIA
Managem II
ent and
developm
ent
6.infrastr 2 vehicle procured and others maintained, X X X X PMO, 424000 424000 GOK/
ucture communication, office furniture/materials HODs,PD Partners/A
developm and ICT equipments procured. MS,PHRIO PHIA II
ent and
maintainc
e
8. 5 day training for 12 PMST members and 3 X PDMST 700000 7000000
emergen DMST members from 58 districts on
cy emergency preparedness and outbreak
prepared management undertaken
ness and
response
GRAND 46,206, 46,206,4
TOTALS 480 80

Annual Operational Plan 5 – 2009/10 92

 Chapter 5: National Management Support
priorities and targets

M
anagement support priorities in AOP 5 are summarized from the plans of
respective planning units at the national level. For functions of the Ministry
headquarters, the priorities are summarized by function, corresponding with
departments in the respective Ministries. On the other hand, for functions of parastatals,
the priorities are maintained as such. Finally, for cross cutting administrative functions,
the priorities are summarized for both Ministries in one section, but with clear
responsibilities across the Ministries for their implementation. In line with this, the
management support is captured in 3 sub sections
a) Technical management support deliverables: Support from technical program
areas. This is summarized for Public Health & Sanitation, and Medical Services
separately
b) Administrative management support deliverables: Support of administrative
support programs to facilitate service delivery. This is summarized in one area,
due to the cross cutting nature of outputs, but specific responsibilities highlighted
for each output
c) Parastatals deliverables: This is summarized for each of the 6 parastatals. Service
delivery deliverables for the 2 parastatals providing direct health care (KNH,
MTRH) are also captured in the service delivery indicators highlighted in chapter 4.
Monitoring indicators for management support progress are the same as the
management support indicators in the performance contracts of both Ministries in Health.
These are highlighted in the table below.

Performance Contract Framework 2009/2010

Annual Operational Plan 5 – 2009/10 93

CRITERIA CATEGORY UNIT Medical Services Public Health &
sanitation
Baseline Target Baseline Target
FINANCIAL & STEWARDSHIP
(i) Compliance with set budget %
levels
(ii) Cost reduction/savings Ksh
Million
(iii) A-in-A Ksh
Million
(iv)Utilization of allocated funds %
(v) Development Index (DE/RE) %
(VI) Debt Equity Ratio (BF/OE) %

SERVICE DELIVERY
i). Development of service delivery %
charter
(ii) Customer Satisfaction %
(iii) Service Delivery Innovations No.

NON-FINANCIAL
(i) Development of a strategic plan %
ii) Corruption Eradication %
iii) Inventory of idle assets %
iv) Disposal of idle assets.
iv) ISO Certification %
(v) Prevention of HIV Infections %
(vi) Statutory Obligations %

OPERATIONS
1. Outputs/Outcome (see
indicators in Chapter 4)
2. Project Implementation
(i)Timeliness %
(ii) Quality %
(iii) Relevance %
(iv) Cost efficiency %
(iv) Completion rate %
3 Fulfilment of Performance %
Contract
4.Commitment to State
corporations %

DYNAMIC/QUALITATIVE
INDICATORS
(a) Organizational capacity
i) Skill Development %.
ii) Training needs
assessment
ii) Automation (IT) %
iii) Work Environment %
b) Employee satisfaction %
c) Repair and maintenance %
d) Safety measures %
e) proportion of Pension %
Documents submitted to P.
Dept nine months before the
retirement annually
f) Proportion of Research cases %
completed

Annual Operational Plan 5 – 2009/10 94

CRITERIA CATEGORY UNIT Medical Services Public Health &
sanitation
Baseline Target Baseline Target
g) Prevention of Drug & %
Substance abuse

Annual Operational Plan 5 – 2009/10 95

Public Health and Sanitation management support

The Public Health and Sanitation focuses on implementation of Disease Prevention and
Health Promotion Interventions based in the Kenya Essential Package for Health (KEPH)
approach. Implementation will be through the following technical departments:
1. Primary Health
2. Disease Prevention and Control
3. Family Health
4. Sanitation and Environmental Health
5. Health Promotion
6. Technical Planning and Monitoring

In addition, the Public Health and Sanitation has the International Health Unit, Disaster
Preparedness and Response, and radiation protection board. The work plans for the
service delivery departments are highlighted in the rest of the section.

5.1.1 Primary Health Services

Primary Health Services (PHS) is geared towards promoting the essential health care
targeting clients at community, dispensary and health centres (level 1, 2 and 3
respectively). The focus at level 1 is to empower communities to be involved in managing
their own health especially on preventive and promotive services. The department of PHS
has a role of developing policies and guidelines in supporting these services in addition to
coordinating various programmes targeting the same clients.
The table below outlines the main outputs for the department.

Result Outputs Responsi Time frame Cost/ Revenue Gap

area bility Q Q2 Q3 Q4 Budg Amou Source
1 et( M) nt
1.Policy Prototype building plans for levels 1, 2, DHA x x x
formulati 3 developed Printed and Disseminated.
on and Quality service Management guidelines DSQA x x x x 2.05 0 2.05
strategic developed, printed and Disseminated
planning; Norms and standards reviewed, printed DSQA X x 2.12 0 2.12
and disseminated
Referral service guidelines DHFS x x x 2.40 0 2.40
disseminated
Drug kit contents based on regional DCLM x x 0 0.00
needs reviewed, printed and
disseminated
Guidelines on facility management DHA X X X X 3.00 0 3.00
developed
Health facilities management guideline DHA x x 2.30 0 2.30
developed, printed and disseminated
Long and short term training guidelines DPHS x x 1.80 0 1.80
developed, printed, and disseminated
Infection prevention control policy DFHS x x x x 6.80 0 GOK, 6.80
guidelines developed and disseminated Partners
communication strategy for community DCHS x x x x 30.00 30 GOK, 0.00
strategy guidelines developed, printed KDDP,
and disseminated UNCEF,GA
VI,Global
funds
A plan for buffer and emergency stocks DCLM x 20.00 0 20.00
developed.
2. Infrastructure developed according DHA X X X X 3.50 0 3.50
Ensuring plan
security 7 supervision vehicles and 1 lorry DPHS x x 38.00 0 38.00
for procured
commodi Assessment for Medical Equipment and DFHS/DHA X X X X 2.00 GOK, 2.00

Annual Operational Plan 5 – 2009/10 96

 infrastructure requirement for Level 1 KIDDP
and 2 in the districts done.
Commodities quantified (based on DCLM x x 1.6B 1.6B
demand) and procured
2% of level 2 & 3 health infrastructure DHA x x x x 0.00
improved
In-Patient food and rations availed DFHS X X X X 31.20 31.20
Bedding and linen purchased DFHS X X X X 40.50 40.50
Equipment based on gaps procured DFHS X X X X 2.462 2.46B
B
Pending bills of water, patients food & DPHS x x 50.00 50.00
electricity cleared
ties & 7500 CHW kits procured and DCHS x x x 75.00 GOK,GAVI, 75.00
supplies. distributed KIDDP,UNI
CEF
Stalled projects completed DHA X X X X 0.00
Installation of solar & electricity DHA X X X X 0.00
conducted
7500 bicycles procured and distributed DCHS x x x 52.00 GOK,GAVI, 36.00
16.00 KIDDP,UNI
CEF
750 motor cycles procured and DCHS x x x 225.0 GOK,GAVI, 45.00
distributed 0 180.0 KIDDP,UNI
0 CEF
3. Monitoring and evaluation framework DPHS x x x x 1.40 1.40
Performa for the Department developed and
nce disseminated
Monitorin Performance contracting DSQA x x 1.40 1.40
g and institutionalized.
evaluatio Supportive supervision conducted DPHS x x x x 8.00 8.00
n. Staff performance report developed DSQA/HRM x X 0.00
Review of Annual performance for the DSQA x x x x 2..73 2.73
department 2
Inventory for commodities inspected DCLM x x x x 8.00 8.00
Inventory of assets/liabilities updated DHA x x x x 0.00
Pilferage and loss of commodities DCLM x x x x 8.00 8.00
reduced target by 50%
CHIS operationalised DCHS x x x x 30.00 30 GOK,GAVI, 0.00
KIDDP,UNI
CEF
Annual consultative meeting with DPHS x x GOK 3.20
PHMTs 3.20
4.Capacit Office operations strengthened (18 Head, x x 8.05 GOK 8.05
y computers /12 laptops, 3 printers, 2 DPHS
strengthe photocopier 1 tele- fax machines, office
ning and furniture procured).
retooling Model Health Centre built in each DPHS X X X X 4,2B 4.2B GOK 0
of constituency built
manage 20% of Health workers Capacity on e- DSQA x x x x 20 0.00
ment government improved
support, 20% of Health workers Capacity on DSQA x x x x 14.66 5.00 GOK 9.66
and leadership and Quality management
service improved
delivery Newly appointed managers inducted DHA/DFHS x x x x 2.43 2.43
staff
30 TOTs at provincial and national DCLM x x 15.00 15.00
levels trained on drug & substance
abuse
3 LOCAL & INTERNATIONAL BENCH DPHS x x x x 12.00 GOK 12.00
MARKING CONFERENCES attended ( per
person)
200 pharmaceutical tech/650 Clinical DHA/HRM x x x x 0.00
officers/300 nurses/ 600 la b tec/ 600
nutrition officers /600 health
records/1500 CHEWS /clerks/drivers
employed and posted
Training needs assessment for officers DPHS x x 2.43 GOK 2.43
in level 1, 2 &3 developed.

Annual Operational Plan 5 – 2009/10 97

 500 Newly recruited staff inducted DPHS X X X X 0.00
750 CHEWS trained on motor cycle DCHS x x x x 30.00 30 GOK,GAVI, #VALU
riding and first aid KIDDP,UNI E!
CEF
Capacity building on HSSF conducted DFHS X X X X 30.00 30.00
5. level 1,2 &3 referral system DHFS/DCH x x x x 0.00
Resource strengthened S
mobilizati New partnership and support frontiers DHFS x x x x 0.00
on and developed
coordinat Proposal for grants written and DPHS x x x x 15.00 15.00
ion of submitted for funding
Partners
6. Clients satisfaction survey report DSQA x x x x 0.00
Operatio compiled
ns and Outsourcing of support services DHA x x 5.00 5.00
other conducted
research. Operation research on CHWs retention, DCHS x x 25.00 10.00 GOK,GAVI, 15.00
CBHIS,youth friendly services, and CHW KIDDP,UNI
kits conducted CEF

5.1.2 Disease Prevention and Control

The departmental plan is geared towards fulfilling its mandate of promoting health and
quality of life by preventing and controlling disease, injury and disability.

Result area Outputs Responsi Time frame Cost/ Revenue Gap

bility Q Q Q Q Budg Amou Source
1 2 3 4 et nt
Ksh.
(M)
Policy Policy Guidelines for Eye care Services DPOS X X X 3.5 GOK - 2.0m
formulation Utilized and evaluated
and strategic TB/HIV treatment guidelines reviewed DLTLD X 0.37 0.37 CDC
planning and printed
Infection Prevention and Control TOT DLTLD x 1m 1m CDC
manual developed
IEC materials printed and distributed. DLTLD x 1m 1M CDC
Control guidelines for vector borne and DVBND X X 6.5 GOK
neglected tropical diseases finalized
3Disease control guidelines finalized DDSR X X X X 7m 7m GOK,WH
O,
UNICEF,C
DC
Communication strategy on outbreak DDSR/DHP X X X X 5m 5m WHO,
control formulated UNICEF,
UNOCHA
National malaria diagnostic policy DOMC X X X X WHO/DFI
developed and disseminated 2 D
IVM policy and guidelines developed DOMC X X X X WHO/DFI
and disseminated 3,75 D
Malaria epidemic preparedness and DOMC X X X X
prevention strengthened .78 DFID
Policy document developed and DOMC X X X X
printed 3 DFID
National Malaria Treatment guidelines DOMC X X X X
updated 3 PMI/DFID
National NCD Prevention and Control DNCD X X X X 7 GoK/DP
strategy finalized
Diseases Management Guidelines for DNCD X X X X 10.6 GoK/DP
service providers for Diabetes and
Epilepsy finalized
Guidelines for the implementation of DNCD X X X X 7.18 GoK/DP
Tobacco Control Act finalized
Three HIV /AIDS policy guidelines NASC OP X X 7.8 GOK
reviewed /CDC
Divisional operations encompassing DPHL X X X X 0 Nil

Annual Operational Plan 5 – 2009/10 98

Result area Outputs Responsi Time frame Cost/ Revenue Gap
bility Q Q Q Q Budg Amou Source
1 2 3 4 et nt
Ksh.
(M)
Government Policies
Divisional strategic and work plan DPHL X X X X 0 Nil
developed
Contribution to OPCW effected DPHL X X X X .7
Conferences and International DPHL X X X X 1,2
meetings reports produced
A printed draft bill for implementation DPHL X X X X
of Chemical Weapons Convention by
2010
Policies, SOPs, guidelines and plans on NASCOP X X X X WHO,
HIV/AIDS prevention, treatment and USG,
care are updated and disseminated LVCT
Training materials for HIV/AIDS NASCOP X X X X WHO,
prevention, treatment and care are USG,
developed LVCT
Health worker job aids, advocacy/IEC NASCOP X X X X WHO,
and patient education materials for USG,
HIV/AIDS prevention, treatment and LVCT
care are developed and distributed
Ensuring A printed draft bill for implementation ............ X X 0
security for of Chemical Weapons Convention by
commodities 2010
& supplies. Adequate laboratory supplies and NASCOP X X X X 26 UNICEF
commodities procured
Adequate laboratory supplies procured DVBND X 46.2 GoK
AL available at health facilities DOMC X X X X GF
660 R4/PMI
IRS conducted in 16 epidemic prone DOMC X X X X GF/PMI/G
districts 160 OK
LLINs available for distribution at DOMC X X X X
health facility 720 PMI/GFR4
Supplementary feeds for PLWAs for 60 NASCOP X X USAID/AE
new sites procured D/NHP/G
PK/UNICE
80 F/WFP
Ensure the distribution list of lab DLTLD x x x x 15m 15m CDC
reagent is available.
Ensure that lab technical specification
of reagent is available.
Ensure that anti-TB drugs distribution x 120m 120m GOK
list is available. x 78m 78m TOWA
DLTLD x 10m 10m GDF

Anti-TB drugs and lab commodities x x x x 7.2m 7.2m GOK

distributed
Ensure medical supplies /buffer stocks DDSR/KEM X X X 68M 68M WHO
are available as per procurement SA
/response plans
Disease trends developed and reports 38.5 CDC/WH
shared O/GoK/FE
LT
District surveillance system X X X X
strengthened
Multiyear HIV/AIDS commodity plans NASCOP X X X X GOK,
and procurement schedules are USG, CF,
developed and continually updated WHO
HIV/AIDS commodities supply is NASCOP X X X X GOK,
constantly monitored and LMIS USG, CF,
strengthened WHO
HIV/AIDS commodities are quality NASCOP X X X X GOK,
assured through batch testing, post- USG, CF,
market surveillance and WHO
pharmacovigilance

Annual Operational Plan 5 – 2009/10 99

Result area Outputs Responsi Time frame Cost/ Revenue Gap
bility Q Q Q Q Budg Amou Source
1 2 3 4 et nt
Ksh.
(M)
HIV/AIDS commodities are procured NASCOP X X X X GOK,
and distributed to facilities and other USG,
service sites GFATM,
CF
Performance Improved services Delivery, and use of DPOS X X X X 1.1M SSI/OEU/
Monitoring information GOK/FHF
and Support supervision undertaken in 5 DNCD X X X X 8 GoK
evaluation. provinces
Supportive supervision for DVBND X X X 12.5 GOK
entomological and parasitological
surveillance and training undertaken
M&E, service documentation, NASCOP X X X X 2.8 GOK,
supervision and mentorship and USG,
referral tools for HIV/AIDS are WHO
developed, printed and distributed
Routine drug efficacy monitoring DOMC X X X X DFID/GFR
system strengthened 20 4
Insecticide Resistance Monitoring DOMC X X X X 3. GFR4
Annual malaria report 2009 DOMC X X X X
disseminated .52 DFID
Performance monitoring and DOMC X X X X GFR4/DFI
evaluation supported. 6 D
Timeliness and completeness of DDSR X X X X 7M
IDSR reports ( Weekly )raised 5%
from 76 %to 81% 7M WHO
Trends monitored on Priority IDSR DDSR X X X X 7M
GOK/WH
targeted diseases 7M O/CDC
Weekly Epidemiological Feedbacks DDSR X X X 18M
GOK/WH
provided 18M O/CDC
Quarterly supportive supervision DDSR X X X X 7.14M
GOK/WH
undertaken 7.14M O
Outbreaks responded by RRTs at DDSR X X X 15.5M
all levels as per the guidelines 15.5M GOK
TB/HIV data collection tools revised, DLTLD x 6.32 6.32m CDC
Printed and Distributed m
LMIS tools Revised and printed and DLTLD x x x x 1.5m 1.5 MSH
distributed to SDPs
Support supervisory field visits DLTLD x x x x 18m 3m CDC
conducted
EQA activities conducted DLTLD x x x x 8m 8m TB CAP
DTLC Quarterly review meeting DLTLD x x x x 19m 19m TB CAP
conducted
PMTCT and other HIV/AIDS NASCOP x x x x
programmes are reviewed and results
shared
Partner, international and feedback NASCOP x x x x
monitoring reports are prepared and
submitted
Supervisory, mentorship and NASCOP x x x x
assessment support visits to provinces,
districts and service sites are
conducted
Mapping of HIV services, sites, at-risk NASCOP x x x x
populations and inventory for
equipment and trained staff conducted
HIV drug resistance surveillance and NASCOP X X X X
monitoring is conducted
HIV/AIDS strategic information NASCOP x x x x
database is strengthened and kept up
to date
Capacity 5 Laptops and 10PDA procured DLTLD x 0.9m 0.9m CDC

Annual Operational Plan 5 – 2009/10 100

Result area Outputs Responsi Time frame Cost/ Revenue Gap
bility Q Q Q Q Budg Amou Source
1 2 3 4 et nt
Ksh.
(M)
strengthening Routine MDR Surveillance in place DLTLD x x x x 3m 3m TB CAP
and retooling HCWs trained on MDRTB DLTLD x x 2.3m 2.3m CDC
of Programme staff offered Master x x 1.5M 1.5M CDC
management training DLTLD
support and
service Health care workers trained in NASCOP x x x x 109m 109m GOK,
delivery staff HIV/AIDS prevention, treatment and USG,
care WHO,
UNICEF
Heath care workers trained on IPC IPC x TB CAP
Health care workers trained on TB HIV DLTLD x x x x 7.2m 7.2 MSH
commodity management
Health professionals and Community DNCD X X X X 30.5 GoK
capacity for prevention and control of
NCDs strengthened
Strengthened capacity for vector borne X X X X 14 GOK
and neglected diseases in10 districts
Capacity of 4 provincial labs NASCOP X X 5.6 CDC
strengthened to support DBS
validation
Capacity on TB HIV for Health care DLTLD X X X X
workers and disciplined forces
strengthened
Strengthened Capacity for prompt DDSR X X X X 32M 32M WHO
detection & effective response by
health workers in 20 districts
Divisional staff trained on management DDSR X X X X 500,0 500,00 GOK
,leadership , essential statistical 00 0
package and mapping
NASCOP office functioning is NASCOP X X X X
maintained and staff
development/participation in country
and international meetings supported
HIV/AIDS prevention, treatment and NASCOP X X X X
care service delivery and advocacy
national campaigns are conducted
Laboratory networking for referral of NASCOP X X X X
PCR and other HIV/AIDS related tests is
maintained
Resource Partners Support for prevention of DPOS X X X X 1.6M SSI
mobilization blindness increased GOK
and Funding gaps narrowed DVBND X X X 2
coordination Two stakeholders forums for NCD held DNCD X X 7 GOK
of partners Joint quarterly consultative and NASCOP X X X X 1.25 CDC
planning meetings held with
stakeholders
Funding gap narrowed DLTLD X X X X 0.5
Operations of technical working DOMC 2 GFR4/DFI
groups(TWG) strengthened D
Coordination meeting X X X X .12 WHO
CDC
Funding gap narrowed DLTLD x x x x 0 0

Quarterly coordination meetings for DDSR X X X X 1.12M 1.12M WHO/CD

IDSR/AI held C
Operations DPOS X X X X 6.6 GOK/OEU
and other Baseline trachoma surveys in 4 /AMREF/E
research. districts and interventions conducted C
Survey on diabetes KAP carried out DNCD X X 10.2 GOK
Mapping and baseline survey vector DVBND X X X 14 GOK
borne and neglected diseases
conducted
HIV sentinel surveillance, survey, NASCOP X X X 30 CDC

Annual Operational Plan 5 – 2009/10 101

Result area Outputs Responsi Time frame Cost/ Revenue Gap
bility Q Q Q Q Budg Amou Source
1 2 3 4 et nt
Ksh.
(M)
research and modelling studies are
conducted and their results
disseminated
Data Quality assessment conducted DLTLD X X 1 CDC
Affordable Medicines Facility DOMC X X X X .1 GF R4
Capacity for ACSM strengthened DOMC X X X X 3 DFID
Risk factors survey report for influenza X X X X 2 IOM,
WHO,
CDC,
FAO
Rotavirus serotypes/genotypes DDSR/NDS X X 1.2M 1.2M WHO
circulating in Kenya defined C

Annual Operational Plan 5 – 2009/10 102

 5.1.3 Family Health
Family health departmental plan is aimed at improving the well being of children,
adolescents, women and families. The department endevours to develop policies and
strategies that will translate into specific public health programme activities geared
towards improving the general health of the family.

Core Results (outputs) to be Resp Timeline Total Unfun

function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

Policy Child Health Policy DCA X X X X 6,700,00 1,200,000 WHO 1,600,0

Formul finalized and disseminated H 0 3,900,000 UNICEF 00
ation
and Child Survival Strategy DCA X X X X 1,000,00 1,000,000 GOK
Strategi launched and disseminated H 0
c
Plannin Implementation plan of DCA X X X X 1,000,00 780,000 WHO 220,00
g; child survival strategy H 0 0
developed
National School Health DCA X X 10,500,0 10,500,00 MOE, 0
Policy and guidelines H 00 0 JICA
disseminated and
implementation structure
established
School Health Strategy DCA X X X X 1,600,00 600,000 WHO 1,000,0
and Implementation Plan H 0 00
developed
Child health package for DCA X X 2,000,00 400,000 WHO 1,600,0
pre-service training H 0 00
institutions developed and
disseminated.

Orientation Package on DCA X X X X 4,300,00 400,000 WHO 3,900,0

Child Health Rights H 0 00
developed and
disseminated
Guidelines and IEC DCA X X X X 59,800,0 28,200,00 MOE, 31,600,
materials for 7 Child H 00 0 WHO 000
Health areas UNICEF,
developed/printed ( IMCI GOK
Case Mx, cIMCI, School
Health, Community
Newborn, Facility
Newborn,
Child Enhanced
and Adolescent DCA X X 1,000,00 0 1,000,0
Health business plan H 0 00
reviewed
Capacity of DCH to carry DCA X X X X 13,850,0 - - 13,850,
out its obligations H 00 000
strengthened

Annual Operational Plan 5 – 2009/10 103

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

National Guidelines for Nutrit X X 350,000 GOK, WHO, 3

IYCF and HIV reviewed ion UNICEF 5
0
,
0
0
0
3 Strategies finalized Nutr X X X 10,500,0 7,350,000 GOK, 3 3,150,0
(Micronutrient deficiency ition 00 UNICEF 2 00
control, Nutrition 7
Monitoring, Capacity and
Evaluation System,
Nutrition Communication)
5 Nutrition guidelines Nutr X X X X 20,300.0 7,310,000 GOK, 3 12,990,
developed ition 00 UNICEF, 2 000
/updated MI 7
1 Policy legislation Nutr X X X X 1,700,000 1,500,000 UNICEF 3 300,0
initiated ition GOK 2 00
7
2 Food fortification Nutr X X X 40,000,00 40,000,00 UNICEF 3 0
standards developed ition 0 0 GOK, 2
WFP 7
Vaccination policy DVI X X X X 2,000,00 2,000,000 0
disseminated to 0 WHO/UNI
stakeholders CEF
Guidelines on other vaccine 0
preventable diseases 6,100,00
produced and disseminated DVI X X X X 0 6,100,000 WHO
Development of 17 DRH X X X X 2,700,00 PC, WHO,
policies/strategies initiated 0 USAID,
FHI, EHB,
UNFPA,
FCI, GTZ
JHPIEGO/
UNICEF,
GDC
8 policy/strategy/ training DRH X X X X 35,000,0 PC, WHO,
documents finalized 00 USAID,
FHI, EHS,
UNFPA,
FCI, GTZ
JHPIEGO,
20 policy, strategy/training DRH X X X X 30,000,0 PC, EHS,
documents Launched / 00 USAID,
disseminated FHI,
WHO,
GTZ,
UNFPA,
FCI,
JHPIEGO,
Engender

Annual Operational Plan 5 – 2009/10 104

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

Health/UN
ICEF

Business plan 2010-2011 DRH X 3,500,00 GTZ,

developed 0 EHS/UNI
CEF
DRH newsletter DRH X GTZ
developed/disseminated
28 different policy, strategy Head X X X X 60,330,0 PC, WHO,
and/or training documents DRH 00 USAID,
printed FHI, EHS,
UNFPA,
FCI.JHPIE
GO
Job aids and IEC materials DRH 20,000,00 PC,
on RH developed 0 USAID,
FHI, EHS,
WHO,
GTZ,
UNFPA,
FCI.JHPIE
GO,
Engender
Health
6,000 RH registers (),6,000 DRH X 76,000,0 MSH,
Outreach registers () 1.2 00 USAID,
million Maternal Child UNFPA/U
booklets printed NICEF
$40,000
Training materials on GBV DRH X X X X 7,500,00 7,500,000 GDC
IEC materials developed 0

GBV survey findings DRH X X X X 2,500,00 2,500,000 GDC

disseminated 0

Ensurin Zinc sulphate tablets KEM X X X X 24,000,0 3,300,000 GOK 20,700,

g available for treatment of SA, 00 000
Security childhood diarrhoea DCA
for H
Public Praziquantel available for KEM X X X X 15,000,0 0 - 15,000,
Health deworming school children SA, 00 000
Commo in Bilharzia-prone areas DCA
dities H
Micronutrient supplements Nutrit X X 109,000, 104,000,0 UNICEF, 3 5,000,0
& supplementary and ion 000 00 WHO, 2 00
therapeutic foods procured GOK,WFP 7
and distributed
Anthropometric equipment Nutrit X X 36,000,0 30,000,00 GOK,UNI 3 6,000,0
procured and distributed ion 00 0 CEF 2 00

Annual Operational Plan 5 – 2009/10 105

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

Procure and maintain office Nutrit X X X 1,300,00 0 1,300,0

equipment ion 0 00
Forecasting of routine
emergency and new
vaccines and injection
equipment completed DVI x 5,000 5,000 GOK
Vaccines and injection 332,71
equipment procured and 664,715, 33,400,00 GOK/UNI 5,135
distributed x 135 0 CEF
National Cold Chain DVI 15,500,0 15,500,
Inventory conducted x x 00 0 UNICEF 000
Additional cold chain DVI
equipment for the new
vaccines procured and 80,180,0 50,000,00
installed x X X X 00 0 GOK 0
Cold chain equipment DVI 6,500,00 0
maintained X X X X 0 6,500,000 GOK
FP commodities procured Head X X X X 1,000,00 500,000,0 GOK,WB, 200,00
DRH 0,000 00 USG,UNF 0,000
300,000,0 PA,KfW
00
Kits for community DRH X X GOK, EHS
midwives procured UNFPA,
MNH equipment for level 2 DRH X X X X GoK, EHS,
and 3 procured GTZ,
UNFPA
VIA/VILLI consumables, 2 DRH X X X X 10,000,0
colposcopy, assorted 00
theatre equipments, 4
mammograms and 2
ultrasound machines
procured
Procure YFS equipment. DRH X GTZ
ASK show/public service DRH X 10,000,00 GTZ
week conducted 0
Monitor Child and Adolescent DCA X X X X 11,500,0 - - 11,500,
ing of Health implementation H 00 000
perform status established and
ance, documented.
and School health M/E tools DCA X X X X 2,900,00 800,000 MOE 1,000,0
supervis finalized and disseminated H 0 00
ion; Quality & sustainable DCA X X X X 7,000,00 - - 7,000,0
Health standards H 0 00
maintained in children’s
homes
Situation analysis on DCA X X X X 2,300,00 1,600,000 WHO 700,00
adolescent health H 0 0
conducted.

Annual Operational Plan 5 – 2009/10 106

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

3 Technical support and Nutrit X X X 3,800,00 1,760,000 GOK 3 1,040,0

Supervisory visits ion 0 2 00
conducted 7
3Nutrition reports produced Nutrit X X X X 1,250,00 1,050,000 GOK, 3 200,00
ion 0 UNICEF 2 0
7
Routine Immunization data
by levels maintained DVI X X X X 50,000 50,000 GOK 0
Vaccines monitoring tools 32,000,0 32,000,00
procured and distributed DVI X 00 0 GOK 0
Vaccines monthly Physical
stock taking done DVI 10,000 10,000 GOK 0
National routine GOK
immunization module (EPI GAVI 500,00
Info 2008) updated. DVI X X X X 500,000 0 WHO 0
Quarterly RH Commodity USAID,
Logistics supervision done DRH X X X X 600,000 MSH
JHPIEGO,
Quarterly integrated UNFPA,
supervision done (all GTZ, EHS,
provinces at least once in a 2,6000,0 GOK,
year) DRH X X X X 00 WHO
JHPIEGO,
UNFPA,
GOK, FHI,
8 follow up visits per year 3,440,00 GTZ,
and 1 per quarter conducted DRH X X X X 0 EHS,WHO
quarterly reports on MNH
service delivery DRH X X X X EHS, GTZ,
3,000,00
No. of YFSs branded DRH X X 0 GTZ
PRC trainees met and 1,800,00
experiences shared DRH X 0 GTZ
Inventory of training
models and audiovisual
equipment at DTCs
documented DRH X 20,000 GoK
Joint annual review 3,000,00
conducted DRH X 0 GTZ
DRH AOP5 quarterly
progress report developed DRH X X X X
RT cancer indicators
integrated in RH M&E 1,500,00
tools DRH X 0
Capacit 96 HWs trained on IMCI DCA X X X X 8,000,00 8000,000 GOK, 0
y Facilitation skills H 0 UNICEF

Annual Operational Plan 5 – 2009/10 107

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

strength 1044 health workers trained DCA X X X X 124,200, 42,800,00 UNICEF, 81,400,
ening on various IMCI case H 000 0 WHO, 000
and management skills GOK
retoolin
g of Train 75 PHMTS/DHMTS DCA X X X X 2,400,00 600,000 WHO 1,800,0
manage on Essential newborn care H 0 00
ment Train 240 HWs on DCA X X X X 12,000,0 800,000 WHO 11,200,
support, Essential Newborn Care H 00 000
and 20 ORT Corners DCA X X X X 1,400,00 1,400,000 GOK/UNI 0
service established/strengthened H 0 CEF
delivery
staff; 400 Stakeholders DCA X X X X 8,000,00 4,000,000 UNICEF/ 4,000,0
(including PHMT/DHMTs) H 0 WHO 00
oriented on community
IMCI briefing package
Rapid Assessments on the DCA X X X X 10,000,0 3,600,000 WHO/UNI 6,400,0
key care family practices H 00 CEF 00
conducted in 10 districts.
Participatory planning DCA X X X X 8,000,00 4,500,000 UNICEF 3,500,0
training for CHWs on H 0 00
community dialogue
conducted in 20 districts.
TOTs and CHW in 10 DCA X X X X 14,000,0 5,000,000 UNICEF 9,000,0
districts trained on IMCI H 00 00
home case management
50 Hws trained on CAH/ X X X 2,360,00 - - 2,360,0
community maternal and DRH 0 00
newborn care
CHWs in 10 districts DCA X X X 4,750,00 - - 4,750,0
trained on community H/DR 0 00
maternal and newborn care H
2 sessions of Malezi Bora DCA X X X X 32,000,0 14,800,00 UNICEF, 18,200,
activities conducted H/ 00 0 WHO, 000
nationwide. DHP GOK
Comprehensive school DCA X X X X 5,000,00 2,500,000 JICA 2,500,0
health activities H/M 0 00
implemented in selected OE
districts in Coast Province
5 million School-age DCA X X X X 18,500,0 6,500,000 MOE 12,000,
children de-wormed H, 00 000
MOE
School health clubs DCA X X X X 10,000,0 2,000,000 MOE 8,000,0
established/ strengthened H,DB 00 00
VD,
MOE
Hygiene and sanitation DCA X X X X 3,600,00 3,600,000 MOE 0
standards improved within H, 0
school. MOE
DEH

Annual Operational Plan 5 – 2009/10 108

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

&S,

National level stakeholders DCA X X X X 1,500,00 - - 1,500,0

trained on identification & H 0 00
referral of children with
disabilities and special
needs
5 Training courses for Nutrit X X X 11,200,0 8,500,000 UNICEF, 2,700,0
PHMTS and TOTs ion 00 MI, WHO 00
National level officers Nutr X X 2,360,00 800,000 UNICEF 1,560,0
capacity strengthened ition 0 00
Districts trained on Target
setting Vaccine forecasting
and micro-planning for EPI 2,600,00
improvements. DVI X X 0 2,600,000 WHO 0
Integrated tools for
vaccines preventable illness
developed. DVI X X 200,000 200,000 GoK 0
Data quality self
assessment to 16 districts 3,300,00 WHO
conducted. DVI X X 0 3,300,000 GOK 0
DVI Quarterly newsletter 0
developed and 1,000,00
disseminated DVI X X X X 0 1,000,000 GOK
Health workers skills on 8,450,00
demand creation enhanced. DVI X X 0 8,450,000 WHO 0
Transport, supplies and
communication systems 2,861,66
efficient DVI X X X X 7 2,861,667 GOK 0
DVI officers updated on
government administrative
procedures and other
relevant education. DVI X X X 45,000 45,000 GOK 0
Media clips prepared and 1,700,00 GOK/UNI
transmitted DVI X X X X 0 1,700,000 CEF 0
2 new GBV centres 1,000,00 GDC,USA
established DRH X X X X 0 1,000,000 ID
JHPIEGO,
2,500,00 WHO,EN
RCO curriculum revised DRH X X X X 0 2,500,000 GENDER
Training needs assessment
conducted DRH X X X X GDC
DRH staff trained on 14 DRH X X X X 2,290,00 DPs
different courses 0
1 training conducted for DRH X 450,000
service providers and MTC
tutors on EC

Annual Operational Plan 5 – 2009/10 109

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

4 trainings conducted in DRH X X X X 8,000,00

Samburu district (FGM) 0
2 provinces trained on D4D DRH X X 1,500,00
0
Health workers trained on DRH X X X X 50,700,0 PC, WHO,
15 reproductive Health 00 USAID,
Areas. FHI, EHS,
UNFPA,
FCI.JHPIE
GO, GTZ
80 pre-service lecturers DRH X X 6,000,00 WHO
updated on MNH 0
8 provinces oriented on DRH X X 5,600,00 UNICEF,
MDR 0 EHS
Mombasa, KNH, Nairobi DRH X X X X 1,000,00 GTZ
Womens Hospital and Moi 0
Referral supported
Setting, distribution, DRH X X 300,000
moderation and marking of
CRH exams, plus
procurement of certificate
seal
District level CHWs DRH X X X X 1,000,00 WHO
training supported 0
District level development DRH X X X X 1,000,00 KfW
of IEC/BCC materials 0
supported
Accurate data submitted to DRH X X X X 5,000,00 MSH
DRH by districts 0
Community structures to DRH X X X X 1,000,00 KfW
implement RH 0
interventions strengthened
LMIS Unit at KEMSA DRH X 2,000,00 USAID/F
supported to facilitate 0 HI/MSH
Receiving and processing
of Data/Report
Districts have functional DRH X 3,000,00 MSH
LMIS system in place 0
Districts trained in LMIS DRH X 3,000,00 MSH
0
Capacity to carry out DRH DRH X X X X 18,960,2 GoK, EHS,
obligations strengthened 00 GTZ/FHI,
USAID,
MSH
Districts supported on DRH X X X X 1,000,00 1,000,000 GDC
training of CHWS 0

Annual Operational Plan 5 – 2009/10 110

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

Districts supported on DRH X X X X 40,000,0 40,000,00 GDC

IEC/BCC materials 00 0
development
Community structures DRH X X X X 35,000,0 35,000,00 GDC
involved in implementation 00 0
of RH interventions
strengthened
Contract developed and DRH X X X X 2,000,00 GoK/GTZ/
implemented 0 JICA
Increased uptake of RH DRH X X X X 700,000 700,000 KfW
services (Social
franchising)
Increased uptake of RH DRH X X X X 700,000 700,000 KfW/UNI
services (Financing Output CEF
Based Approach)
Resourc Quarterly Child Health DCA X X X X 20,000 - - 20,000
e Inter-Agency Coordination H
mobiliza Committee (CHICC)
tion and Meetings conducted
coordin 2 sessions of Malezi Bora DCA X X X X 20,000,0 9,200,000 UNICEF, 10,800,
ation of activities conducted and H, 00 WHO, PSI 000
partners documented nationwide. DHP,
DFH
HMI
S,
Proposals for 3 poorly DCA X X X X 200,000 - - 200,00
resourced areas in child and H 0
adolescent health
developed and supported.
6 Coordination Meetings Nutrit X X X X 85,000 85,000 GOK 3 -
Held ion 2
7
2 World Events marked Nutrit X X 1,000,00 1,000,000 UNICEF, -
ion 0 MI
2 resource mobilization and Nutrit X X 2,700,00 200,000 GOK 3 2,500,0
implementation documents ion 0 2 00
7
Annual Work plan and DVI X 10,000 10,000 GOK 0
MTEF preparation done
RHICC (4), FP TWG (4), DRH X X X X PC,
FP logistics (4), MNH USAID,
TWG (4), MIP TWG (4), FHI, EHS,
ASRH TWG (4), RT WHO,
cancer TWG (4), Gender GTZ
and Rights (4) UNFPA,
FCI.JHPIE
GO,
Annual Meeting DRH X 1,000,00
0

Annual Operational Plan 5 – 2009/10 111

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

National Youth Week, DRH X 11,000,0 GTZ

National Cervical Cancer 00
Week, National Breast
Cancer Month, World
Contraception Day, Public
Service Week and ASK
show celebrated
Operati Report on status of Health X X X 10,000,0 8,000,000 WHO, 2,000,0
ons and Facility-based IMCI 00 UNICEF 00
other available
research Health status of school- DCA 10,000,0 10,000,00 MOE 0
. aged children established H,DV 00 0
BD,K
EMR
I,MO
E
Operations research DCA X X X X 27,000,0 8,000,000 UNICEF, 12,000,
conducted in 4 priority H/H 00 GOK 000
areas including Child MIS
health rights & Malezi
Bora
Micronutrient study done Nutrit X 30,000,0 2,100,000 UNICEF, 3 27,900,
ion 00 GOK 2 000
7
2 Annual Assessments Nutrit X X X 4,800,00 1,100,000 GOK 3 3,700,0
done ion 0 2 00
7
Pilot project in two districts
to integrate outreach
activities with one civil
responsibility activity- GOK/UNI
notification of births DVI X X X 100,000 100,000 CEF 0
2,0 GOK/WH 2,000,0
Batch testing at all level DVI X X X 00,000 0 O 00
1.Community Midwifery, DRH X X X X 4,525,00 FHI, PC,
2.Usage of Magnesium 0 EHS
Sulphate, 3.Uptake of CA
screening services as an
integrated approach in
maternal health, 4.Data for
decision making
1.Maternity waiting shelter, DRH X X X X 1,000,00 KfW, EHS
2.Motorcycle ambulances, 0
3.OBA,
1.RT cancers, 2.Mapping DRH X X X X 15,000,0
of RH TOTs 00
1.testing model for linking DRH X X X X 4,000,00 FHI, PC
HIV and FP clients to ART 0
and STI, 2.menstrual
beliefs and use of

Annual Operational Plan 5 – 2009/10 112

 Core Results (outputs) to be Resp Timeline Total Unfun
function achieved onsib cost Budget distribution ded
area le Q Q Q Q Amount Source
perso 1 2 3 4
n

menstrual cups,
3.integration of HIV/FP
service delivery model for
the youth in Kenya
provision on DMPA by DRH X 5,000,00 FHI
CBDs 0
Cotrimoxazole use study NAS X X 4,620,00 4,620,000 UNICEF
COP 0

5.1.4 Disaster preparedness and response

The mandate of the department is to manage mass population health emergencies so as
to reduce public health impacts of natural and manmade disasters and hazards. During
2008/09 planning period, the department has defined the following outputs:

Result Outputs Respo Time Frame Cost/Bud Revenue Gap

Area nsibili Q1 Q2 Q3 Q4 get Amount Source
ty
Policy Policy /Strategic Plan Developed DE&D X X X 420,000 1,420,000 UNFPA 1,000,00
formulati Disseminated M 0
on and Emergency and disaster DE&D X X X 2,730,000 3,230,000 UNFPA 500,000
strategic preparedness and response (EPR) M
planning guideline developed
+disseminated
Operational guidelines for DE&D X X X 1,365,000 3,365,000 UNFPA 2,000,00
provincial and district M 0
management teams
Ensuring Defined emergency and disaster DE&D X 280,000 3,280,000 UNFPA 3,000,00
security kit /RH for GBV in place M 0
for public Purchase emergency and DE&D X X X X 5,000,000 15,000,00 WHO, 10,000,0
health disaster materials/ equipment. M 0 UNFPA/UNI 00
commodi Transport CEF
ties
Monitorin Enhanced quarterly supervision DE&D X X X 1,350,000 2,350,000 GOK, WHO, 1,000,00
g of M UNFPA 0
performa Disaster mapping/ data collection DE&D X X X 1,000,000 4,500,000 GOK, WHO, 3,500,00
nce and tools developed M /UNICEF 0
supportiv
e
supervisi
on
Capacity Emergency and disaster DE&D X X X 1,000,000 4,000,000 GOK 3,000,00
strength committees trained on EPR M 0
ening (No.8)
Technical teams trained in X X X 1,000,000 5,000,000 GOK, 4,000,00
emergency and disasters (No.8) WHO/UNIC 0
EF
IEC materials distributed DE&D X X 1,500,000 3,500,000 GOK, WHO, 2,000,00
M UNFPA 0
First AID trainings DE&D X X X X 2,000,000 6,000,000 GOK 4,000,00
M 0
Trauma and burns training DE&D X X X X 1,000,000 4,000,000 GOK 3,000,00
M 0
Basic life support and referral DE&D X X X 1,000,000 6,000,000 GOK 5,000,00
trainings M 0
Staff sensitisation and awareness DE&D X X X X 1,000,000 7,000,000 GOK, WHO, 6,000,00
M UNFPA 0

Annual Operational Plan 5 – 2009/10 113

Result Outputs Respo Time Frame Cost/Bud Revenue Gap
Area nsibili Q1 Q2 Q3 Q4 get Amount Source
Trainings/conferences on ty
DE&D X X X 10,000,00 20,000,00 GOK, WHO, 10,000,0
disasters and prevention M 0 0 UNFPA 00
mechanisms
Data collection tools printed and DE&D X X X 1,750,000 3,750,000 GOK 2,000,00
disseminated M WHO, 0
UNFPA
Total 36,495,0 96,495,0 60,000,0
00 00 00

5.1.5 Environmental health and Sanitation

The outputs planned for are geared towards improving the living environment in an effort
to reduce health risks for all Kenyans, through implementation of sanitation and hygiene,
household water and safety, surveillance, food safety and quality control, port health
services (including implementation of IHR 2005), occupational health and safety, vector
control and enforcement of existing legal framework.

Result Outputs Responsi Timeframe Cost Revenue Gap

area bility Q Q Q Q /Budge Amou Source
1 2 3 4 t(M) nt (M)
Policy National Environmental DSH X X X 20.5 20.5 GOK, UNICEF,
formulati Sanitation and Hygiene policy WHO
on and implemented
strategic Occupational and Safety policy OHS X 15 15 GOK,WHO,
planning developed. UNICEF,
National sanitation and hygiene DSH X X X 8.2 8.2 GoK/ UNICEF
strategic and investment plan
developed.
Create awareness on WHO global OHS X X 3 3 WHO
plan of action on workers health
2008-2017
Adoption of occupational Health OHS X 1 1 WHO
manual for primary health care
workers
Specifications and standards on OHS X X X 0.5 0.5 WHO/WB
Health Care Waste Management CDC.
(HCWM) developed.
National Guidelines on HCWM OHS X X X 2.5 2.5 WHO/WB
developed. CDC.
1 draft policy on port health Div. PHS X 1.2 1.2 GOK/WHO
services developed
1 strategic plan for IHR Div. PHS X 0.75 0.75 WHO /
developed AFENET
Work plan on Tobacco Control CPHO X 0.3 0.3 GOK/W
developed HO
Tobacco control regulations CPHO/OHS X X X 3.5 3.5 GOK/ ILA/WHO
developed
National Food Safety Policy FSQC X 5 5 GOK,WHO,
developed FAO, UNIDO
Amended Food, Drugs and FSQC X X X 5 5 GOK / UNIDO
Chemical Substances Act CAP
254 (Food Law)
Adaptation of the new food safety FSQC x x 20 20 GOK,WHO,
inspection manual FAO, UNIDO,
GTZ
National Environmental Health PC&H X X X 1.5 1.5 GOK
and safety policy developed and
disseminated
Draft Guidelines for Vector, DVC X X X 5 5 GOK/WHO
Vermin and rodents control
developed
Security Districts supported with materials WSS X X 217.9 217.9 GOK

Annual Operational Plan 5 – 2009/10 114

Result Outputs Responsi Timeframe Cost Revenue Gap
area bility Q Q Q Q /Budge Amou Source
1 2 3 4 t(M) nt (M)
for public and equipment for improvement
health of Environmental Health Services
commodi Airports, Seaports and Frontiers PHS X X X X 8 8 GoK
ties and Borders supported with
vaccination cards and vaccines
for vaccination against
internationally notifiable diseases
5 vehicles procured for Port Div. PHS X 15 15 GOK
Health Services
Equipments, insecticides and 50 50 GOK/WHO/UNI
protective gears procured CEF
Monitorin Improved monitoring and CPHO X X X X 15 15 GOK, UNICEF,
g of evaluation of DEH activities WHO
performa Quarterly support supervision in CPHO X X X X 10 10 GOK
nce 8 provinces done by all divisions
Capacity Sanitation and Hygiene tailored DSH X X 2 2 GOK, UNICEF,
strengthe IEC materials developed & WHO
ning distributed in 149 districts
Incidences of trachoma reduced DSH X X 6 6 UNICEF, GoK
Capacity of 20 districts enhanced WSS X X X 331 331 GOK, UNICEF,
to implement WASH activities WHO
Incidences of hygiene related DSH X X X X 40 40 GOK/WSP/
diseases reduced UNICEF
20 District Hospital waste OHS X X X 12 12 GOK/WB/JSI,C
management facilities replaced DC
with installation of incinerators
Reinstate sanitation facilities in DSH X X X 32.5 32.5 GOK/ UNICEF
newly resettled IDP homes
DEH has the capacity to carry out CPHO X X 3 GOK, WHO
EIA
Tobacco Control Board CPHO X X X X 12.5 No funding 12.5
operationlized
PHOs/PHTs updated on sanitation CPHO X 1.3 1.3 GOK, WHO
and hygiene

10 ports/frontier points supported Div. of PHS X 0.3 0.3 GOK

with 3 computers each
60 Staff trained on IHR Div. PHS X 5 5 GOK/WHO
Points of entry offices capacity X 5 5 GOK
strengthened
20 Districts and community focal 7 7 GOK
point persons for vector control
identified and well equipped.
Advocacy toolkits and Education FSQC X X 60 60 GOK,WHO,
Package for prevention of food FAO
borne diseases.
Advocacy toolkits and Education 20 20 GOK
package for prevention of Env.
Pollution
Resource 12 Quarterly stakeholders DSH, DVC, X X X X 5.5 5.5 GOK, UNICEF
mobilizati meetings on vector control held. PHS
on and Active ESHWG in place at DSH, PHS X X X X 0.8 0.8 GOK, UNICEF,
coordinat national level for sanitation, IHR WHO
ion and FSQC working groups
Participation in local and CPHO X X X X 6 6 GOK, Donors
international fora on
Environmental Health and
Sanitation
Improved participation by 0.6 0.6 GOK
stakeholders
Funding proposals for IHR and Div. PHS X 0.1 0.1 GOK/WHO
vector control interventions and DVS
ready
Operatio Households infested with CPHO X X X X 11 11 UNICEF, GoK
ns and fleas/jiggers fumigated in 10

Annual Operational Plan 5 – 2009/10 115

Result Outputs Responsi Timeframe Cost Revenue Gap
area bility Q Q Q Q /Budge Amou Source
1 2 3 4 t(M) nt (M)
other districts
research Mapping reports for 4 district PCH X X X 10 10 No Funding
available
National strategic plan on sound OHS X X 1 1 GOK/ WHO
management of pesticides
Developed
Health workers safety report on OHS X X 5 5 GOK/WB
healthcare waste availed.
Health and environment strategic OHS X X 0.5 0.5 GOK/WHO
plan on climate change
developed.
Survey reports on IHR Capacity Div PHS X 4 4 GOK and
Assessment and community's and DVC partners
uptake on intergraded Vector
Management (IVM)activities
ready and shared with
stakeholders

Kenya Total Diet Study FSQC X X X X 10 No funding 10

conducted
Operational studies/research on FSQC X X 5 No funding 5
food safety
Prompt SPS Notifications on Food FSQC X X X 5 5 GoK, UNIDO
Safety
A survey on food borne diseases FSQC X X X 1 No funding 1m
conducted
Mapping reports of all major PC&H X X X X 1 1 GOK
pollution sources in the Republic

5.1.5 International Health

The office of International Health Relations (IHR) was established in March 2005. The
main functions of the unit under the new organization structure include leadership in
international health awareness creation and opportunities within Kenya as well as
serving and promoting the interests of Kenya on the regional and international health
scenes
The specific outputs for 2008/2009 are detailed in the matrix below

Annual Operational Plan 5 – 2009/10 116

 budget
timefram
RESULT Outputs Responsi

gap
AREA ble
person

e
Q Q Q Q cost amount source
I 2 3 4
Policy Kenya foreign IHR X X X X 1M 1M GOK
formulatio health policy
n and developed
strategic
planning;
Monitoring Monthly IHR X X X X 240,000 240,000 GOK
of Ministerial briefs
performan on IHR activities
ce, and held
supervisio
n;
Completion of 2 IHR 1M 1M GOK
Joint Commission
of Cooperation
Quarterly IHR X X X X 2M 2M GOK -
stakeholders
meeting held
Capacity 25 officers IHR X 2M 0.5 GOK -
strengthen trained on 1.5 Rockeffeller
ing and International Foundation –
retooling Health diplomacy
of
managem
ent
support, 20 government IHR x 0.5m 0.5m WTO
and officers trained
service on TRIPS and its
delivery flexibilities
staff;
Office equipment X 1.2m 1.2m GOK
procured (4 fully
equipped
workstations)

IHR web page ICT X GOK

developed
Resource 7th Global Health IHR X 67M 56,507,1 GOK 10,492,8
mobilizatio Promotion 45 55
n and Conference held
coordinati
on of
partners
East African IHR X 636,000 636,00 GOK -
Health and
Scientific
Conference in
Kigali, Rwanda
( 10 officers )
attended

Timely Payment IHR X X X X 10,055,3 4255335 GOK 5,800,00

of subscription 35 0
fees – WHO,
ECSA, OPCW,
FCTC

Coordination of IHR X X X X GOK

Inter-govern-
mental
Annual Operational Plan 5 – 2009/10
negotiations 117

TOTAL 83,631,3 67,338,4 16,292,8

35 80 55
5.1.6 Health Promotion
This is a new department established to enhance health promotion activities within the Ministry of Public Health and
Sanitation. During 2008/9 the department has outlined specific outputs along the result areas of policy and planning,
capacity development, performance monitoring and evaluation. The matrix below shows the detailed output and
budgets for the department.

Result area Outputs Responsibility Time frame Cost Budget Unfund

ed
Q Q Q Q Amoun Sourc
1 2 3 4 t e
Policy The National Division of X X X X 1,250,0 563,00 GOK 687,000
formulation health promotion Advocacy & Policy 00 0
and strategic policy developed UNICE
F
planning; and launched.
WHO
The National Division of X X X X 1,500,0 500,00 GOK 1,000,0
health promotion Advocacy & Policy 00 0 00
strategy UNICE
F
developed,
WHO
launched and
disseminated
Radio Division of Social X X X X 33,600, 5,093,7 UNICE 28,506,
programmes for Marketing 000 00 F 300
disease
WHO
prevention and
USAID
promotion of CDC
healthy lifestyle MEDIA
produced and
aired monthly.
National Health Division of Social X X 1,500,0 300,00 GOK 1,200,0
Communication Marketing 00 0 00
Strategy HSSF
WHO
launched and
disseminated to
stakeholders.
The National Division of Social X 500,00 500,00 GOK NIL
Health Marketing 0 0
communication WHO
UNICE
technical
F
working group
established and
officially
launched
Messages for Division of X X X X 2,200,0 900,00 GOK 1,300,0
specific Advocacy & Policy 00 0 WHO 00
programmes UNICE
F
produced and
WORL
disseminated D-
VISIO
N
World Health Division of X X X X 10,000, 300,0 WHO 6,570,3
Days(20) Advocacy & Policy 000 00 GOK 98
commemoration 3,129,6
02
s organized and
launched
Trade fair and Division of Social X X X X 3,260,0 801,46 GOK 2,458,5
Exhibition Marketing 00 5 35
activities
organized and
held

Annual Operational Plan 5 – 2009/10 118

Result area Outputs Responsibility Time frame Cost Budget Unfund
ed
Q Q Q Q Amoun Sourc
1 2 3 4 t e
Co-ordination of Division of Social X X X X 4,200,0 250,00 GOK 3,050,0
social Marketing 00 0 UNICE 00
mobilization & 900,00 F
0
communication
activities for
disease
prevention and
control done.
Monitoring of Quarterly Divisions X X X X 1,504,0 450,00 GOK 554,000
performance, Provincial 00 0 UNICE
and supervisory 500,00 F
0
supervision visits(32)
conducted
Biannual All Divisions X X 3,600,0 533,33 GOK 2,566,6
Performance 00 3 UNICE 67
review meetings 500,00 F
0
with HPOs
conducted.
Capacity Refresher Division of Program X X 250,00 GOK 250,000
strengthenin courses for Setting 0
g and Health
retooling of Promotion
management Officers
support, and undertaken.
service Training of Division of Program X X X X 2,000,0 500,00 GOK 1,500,0
delivery staff; Health Setting 00 0 00
Promotion
Officers on
Social
mobilization and
communication
skills done
Enhanced Division of Program X X 2,000,0 1,000,0 UNICE 1,000,0
knowledge and Setting 00 00 F 00
skills of 3 HPO
on Health
Promotion
practices
Skills for Division of Program X X 1,500,0 1,500,0
research Setting 00 00
developed and
enhanced
Resource Network of Division of X X 1,000,0 300,00 GOK 700,000
mobilization health journalists Advocacy & Policy 00 0
and formed and
coordination facilitated to
of partners support public
awareness and
advocacy for
health
interventions (2
workshops)
Biannual Division of Social X X 400,00 400,000
meetings with Marketing 0
communications
stakeholders
held.
Hospital Division of X X X X 11,000, 8,367,0 GOK 2,633,0
stationery Advocacy & Policy 000 00 00

Annual Operational Plan 5 – 2009/10 119

Result area Outputs Responsibility Time frame Cost Budget Unfund
ed
Q Q Q Q Amoun Sourc
1 2 3 4 t e
printed
Operations Community Division of Program X X X X 1,850,0 250,00 GOK 1,600,0
and other Based health Setting 00 0 00
research. promotion
initiative
implemented in 2
pilot districts and
an end of year
evaluation
conducted.
Operational Division of Program X X X X 3,500,0 GOK 3,500,0
research to Setting 00 UNICE 00
inform health F
promotion
programmes
conducted
TOTALS 86,614 25,638 60,975
,000 ,100 ,900

5.1.7 Radiation Protection

This is a statutory body established under the Radiation Protection Act (Cap. 243 - laws of
Kenya) 1984. The Board collaborates with the IAEA on matters of Radiation Protection,
Nuclear - Safety & Security on behalf of the Government. It is further mandated to
enforce the Radiation Protection Act (cap. 243 laws of Kenya) for the protection of public
and radiation workers from dangers of Ionizing Radiation. The key functions of the Board
include but not limited to inspection of Radiation Facilities to ensure protection of Public,
Radiation Workers and the Environment from dangers due to Ionizing Radiation, licensing
of Radiation Workers, Facilities, Dealers in Radiation, devices and Radioactive Materials
and radiological and Nuclear Emergency Planning & Response.

The outputs expected during this year (2009/10) are as detailed here below:

RESULT Cost BUDGET

OUTPUT RESPONSIBILITY TIMEFRAME UNFUNDED
AREA
Q1 Q2 Q3 Q4 Amount Source
Radioactive waste
Policy management
RPB x x 400,000 GOK
formulation, (RWM) policy
legislation developed
and strategic Radioactive waste
planning Management RPB x x 150,000 GOK
regulations
National
emergency
RPB x 100,000 GOK
response guide
developed
Strategic plan
RPB x 200,000 GOK
2008-2012
Board Staffing RPB/MOPHS HRM x - GOK
establishment
developed

Annual Operational Plan 5 – 2009/10 120

 Food & consumer
products
RPB x 150,000 GOK
regulations
reviewed
Security and
insurance services
for Board
Security for RPB x x x x 1.5M GOK
equipment and
public health
other assets
assets and
contracted
radiation
Physical security
facilities
upgrades for high
RPB x x x 5M IAEA
activity radiation
sources
Departmental
quarterly and x x x x - GOK
annual reports
Safe consumer
products free from RPB x x x x 600,000 GOK
radio contaminants
Licensed radiation RPB
facilities (Safety
x x x x 4.5M GOK
and Security of
sources)
Licensed radiation RPB
x x x x - GOK
Performance workers
Monitoring Combating illicit RPB
trafficking of
x x x x 2.5M GOK
radioactive/nuclea
r materials
Monitored RPB
radiation workers x x x x 750,000 GOK
for radiation doses
Calibrated RPB
radiation detection G.O.K
x x 600,000
and measurement /CLIENTS
equipment
Recruitment RPB/MOPHS x 8M GOK
Decentralized RPB/MOPHS
Radiation Control
x 4M GOK
services to
Capacity regional offices
strengthening
Trained and RPB/MOPHS
skilled officers 3,000,00
x x x x GOK
and support 0
personnel
Availability of RPB
radiation
x 15M GOK
measuring
instruments
Scheme of service
MOPHS HRM x x x x - GOK
for RPO’s in place
Draft scheme of
RPB/HRM, MOPHS x x x x - GOK
service for RPTS
Utilization of
National and
RPB/MOPHS x x x x 800,000 GOK/IAEA
Resource International
mobilization expertise
and Regional offices
coordination opened in Msa,
RPB x x x x 4M GOK
Ksm, Garissa &
JKIA/ICD
Operations Research on
and other aspects of
RPB x x x x 1.5M
research radiation
protection
Country radiation
RPB xx
Map
Training in MSc & RPB/MOPHS x x x x 5M GOK /IAEA
Post graduate

Annual Operational Plan 5 – 2009/10 121

 Diploma studies
and research
Implementation of
RPB x x x x - GOK/IAEA
research findings
Research on
radiation levels in
the environment RPB x x x x 750,000
and consumer
products
Safety and
Development security of
(Constructio radioactive and
RPB/MOPHS x x x x 200M 150 M GOK/Donors
n of nuclear materials
CRWPF) and radioactive
waste

Annual Operational Plan 5 – 2009/10 122

 5.1.8 GOVERNMENT CHEMISTS DIVISION
The Government Chemist is charged with the responsibility of supporting forensic services and carrying out
toxicological investigations. The annual operation plans output for the division as elaborated in the table
below;

RESULT OUTPUT RESPONSIBILIT TIME FRAME COST AVAILABLE BUDGET BUDGET

AREA Y Q Q Q Q BUDGET SOURCE GAP
1 2 3 4
Policy Divisional Government X X 800,000 Nil NOT YET 800,000
formulation operations Chemists Division FUNDED
and strategic encompassing (GCD)
planning Government
Policies
Divisional GCD X X X X 500,000 Nil NOT YET 500,000
strategic and FUNDED
work plan
Contribution to GCD/PAC X 750,000 665,007 GOK 84,993
OPCW
Conferences GCD X X X X 250,000 103,748 GOK 146,252
and GCD X X X X 3,000,000 1,050,000 GOK 1,950,000
International
meetings
A printed draft X 2,000,000 Nil NOT YET 2,000,000
bill for FUNDED
implementation
of Chemical
Weapons
Convention by
2010
Security for Adequate GCD X X X X 26,000,000 17,799,437 GOK 8,200,563
public health laboratory
commodities supplies

GCD X X X X 2,000,000 689,747 GOK 1,310,253

GCD X X X X 400,000 210,753 GOK 189,247

5,000,000 Nil NOT YET 5,000,000

FUNDED

GCD/ HQS X X X X 1,800,000 Nil NOT 1,800,000

FUNDED

Performance Improved work X X X X 300,000 43,660 GOK 256, 340

monitoring performance

Annual Operational Plan 5 – 2009/10 123

 X X X X 1,000,000 Nil GOK 1,000,000

Resource Increased GCD/HQS X 800,000 Nil NOT YET 800,000

mobilization resources for FUNDED
and our
coordination commodities
and
rehabilitative
activities
Capacity Provision of GCD X X X X 5,000,000 1,909,241 GOK 3,090,759
strengthening utilities

Maintenance GCD X X X X 13,000,000 2,557,845 GOK 10,442,155

and repair of
resources
Purchase of X X X X 2,000,000 915,243 GOK 1,084,757
supplies
20,000,000 Nil NOT 20,000,000
FUNDED
Provision of GCD X X X X 1,000,000 944,346 GOK 955,654
transport GCD X X X X 3,500,000 2,319,807 GOK 1,189,193
Strengthening GCD X X X X 1,500,000 372,309 GOK 1,127,691
human resource
Skills GCD/HQS X X X X 3,000,000 Nil GOK 3,000,000
enhancement
for all staff
Enhance human GCD/HQS X X X X GOK
resource
capacity
Operational Availability of GCD X X X X
and other data from all
research areas of
operations
New areas of GCD X X X X
operations
TOTAL 94,500,000 29,581,143 64,918,857

Medical Services management support

Medical Services is about managing health needs of a community, paying special

attention to the social context of disease and health. It complements the Public Health
interventions, by ensuring essential medical care is made available as needed, when
needed, and in appropriate amounts. Its goal is therefore to improve lives through
responding to the legitimate health needs of the population in Kenya.

Annual Operational Plan 5 – 2009/10 124

 The provision of Medical Services is primarily the mandate of the Ministry of Medical services.
It also provides stewardship and coordinates delivery of medical services in the health sector
in a manner that supports attainment of the overall NHSSPII objectives. The Ministry has
several priorities as outlined in the Ministry’s strategic plan 2008/2012. The priorities include;
• Institute medical services reforms that will ensure high quality services
• Have reliable access to essential, safe and affordable medicines and medical supplies
that are appropriately regulated, managed and utilised
• Establish an equitable financing system that ensures social protection, particularly for
the poor and the vulnerable
• Institute structures and mechanisms for improved alignment , harmonization and
Government ownership of planned interventions
• Improve infrastructure, equipment and ICT investment and preventive maintenance
• Institute and enforce appropriate regulatory measures for medical services
• Development and management of the health workforce

The provision of Medical services is coordinated through seven technical areas namely
surgery and rehabilitation services, medicine, standards and regulatory services, Nursing,
Forensic and diagnostic services, pharmacy and technical administration departments. The
departments have planned for various activities for the year 2009/2010 which are aligned
with the Ministry’s priorities. The various plans are outlined in the following sections;

5.1.9 Surgery
The department of surgery and rehabilitative services is charged with the responsibility of
overseeing and supporting the delivery of surgical and rehabilitative services in the
health sector. The department’s core activities are as outlined below.
• Develop, disseminate and oversee the implementation of national standards and
norms on best practices in surgery and rehabilitation services
• Monitor and evaluate the provision of quality surgical & rehabilitation services in
all hospitals
• Undertake capacity strengthening and retooling of management, support and
service delivery staff
• Ensure security for the relevant medical commodities and supplies
• Ensure availability of appropriate and functional infrastructure and skills to deliver
quality surgical and rehabilitative services
• Ensure implementation of the National Referral Strategy, particularly establishing
effective linkage within the various levels of care (district to regional to referral
hospitals)
• Ensure implementation of regular medical audits of all surgical and rehabilitative
services in the hospitals
• Coordinate the provision of ophthalmic services in the country

Result Results (outputs) to be Responsible Timeline Total cost Budget Distribution Unfun
Area achieved Q1 Q2 Q3 Q4 ( Kshs) Budget Source Amo ded
code unt
Policy Disability Survey Report Physiotherapy, X X X X 1,500,000 2210801
formulation disseminated OT,
and Orth o Tech
strategic Disability act and UN Physio,OT, Ortho X X X X 3.2M NCPWD/SA 2M
planning convention and rights for Tech. GAS/GOK 1.2M
persons with disability
disseminated

PWDs categorized & Physiotherapy X X X X 500,000 2210801

Annual Operational Plan 5 – 2009/10 125

Result Results (outputs) to be Responsible Timeline Total cost Budget Distribution Unfun
Area achieved Q1 Q2 Q3 Q4 ( Kshs) Budget Source Amo ded
code unt
recommended for registration
Strategic plan for Clinical Clinical Services X X X X 2,400,000 GOK/ DPs 2,400,0
Officers developed. & stakeholders 00
Policy Guidelines for Eye Ophthalmic X X 2,000,000 GOK 2,000,0
care services produced and Services 00
distributed
Clinical guidelines Head, Surgery X X X X 500,000 GOK 500,00
disseminated for utilisation 0
Guidelines on Infection Dental Services
Prevention & Control in X X X 2,000,000 GOK/DPs
Dental Practice developed
All PDMS’s sensitised on Head ,Surgery
MOMS strategic plan X X X 500,000 GOK 500,00
-2008/2012 0
Equipment in L4&L5 Physiotherapy, X X 400,000 400,00
audited Dental Services 0
Procurement & distribution of Surgical/ENT, GOK/
Ensuring all relevant commodities Ob/Gyn, Physio, X X X 361,335,500 DPs 361,33
security for tracked OT, Ortho Tech, 5,500
public Dental,
health Ophthalmic,
commodities Clinical Services.
Ensure Zithromax worth 3.5 Ophthalmic 3.5B 2211001 GOK/OEU/ 3.5 B Nil
billion Ksh procured and Services X X X X AMREF/EC/
distributed Pfizer Inc
1400 stethoscopes & 700 Clinical Services X X X X 20,000,000 20,000,
diagnostic kits in place 000
Quarterly supportive Surgical/ENT, X X X X 6,520,000 2210300 GOK/ 6,520,0
supervision visits carried out Ob/Gy, Physio, 2211201 DPs 00
Monitoring OT, Ortho Tech, 2220101
of Dental,
performanc Ophthalmic,
e and Clinical Services.
supervision Half yearly consultative Surgical/ENT, X X 300,000 2210801 GOK 300,00
meetings with Provincial Ob/Gy, Physio, 0
teams held OT, Ortho Tech,
Dental,
Ophthalmic,
Clinical
150 staff recruited OT Ortho Tech, X X GOK
Capacity Phyio
strengthenin Surgical/ENT, X X X X 60,350,000 2210700 GOK 60,350,
g and Ob/Gy, Physio, 000
retooling of 500 staff trained OT, Ortho Tech,
managemen Dental,
t support, Ophthalmic,
and service Clinical Services.
delivery Emergency response teams in Head, Surgery X X 1,000,000 ICRC
staff 7 hospitals established
Surgical/ENT, X X X X 1,000,000 GOK 1,000,0
Office equipment procured Ob/Gy, Physio, 00
OT, Ortho Tech,
Dental,
Ophthalmic,
Clinical Services.
Resource Clinical X X X X 2,160,000 2,160,0
mobilization Additional resources for Head, Obs/Gynae 00
and service delivery mobilized OT
coordinatio Ophthalmic, Ortho
n of Tech
partners
Operations A survey on ANC attendants Obstetrics / X X X 500,000 2210502 GOK/
and other actually delivering in Level V Gynecology DPs
research. hospitals in Kenya carried out
Impact of RH clinical officers Clinical Services X X X 2,000,000 GOK/ 2,000,0
on MNCH in 70 Level IV DPs 00

Annual Operational Plan 5 – 2009/10 126

Result Results (outputs) to be Responsible Timeline Total cost Budget Distribution Unfun
Area achieved Q1 Q2 Q3 Q4 ( Kshs) Budget Source Amo ded
code unt
hospitals established.
Total 3,962,945,500 462,94
5,500

NB: a) Procurement of Zithromax (Kshs 3.5Billion) has been factored - a donation from Pfizer Inc.

5.1.10 Standards and Regulatory Services

The Department proposes to undertake activities that will contribute to hospital reforms
with the aim of strengthening quality management in line with the ISO 9001:2008
standard that will eventually lead to certification. In order to improve personnel
performance, regulation of medical alternative medicine practice will be stepped up.
Continuing professional development for the major medical cadres will continue to be
emphasized and institutionalized. E-health activities will be introduced in service delivery
in a phased manner through telemedicine while promoting health tourism at the same
time. Coordination of health research will be undertaken in collaboration with
stakeholders.

Annual Operational Plan 5 – 2009/10 127

Result Outputs Responsi Time frame Total Budget Unfunde
Area ble cost d
Person Q Q Q Q Amoun Source Code
1 2 3 4 t
Policy Quality Management draft QAS x x x 3,000, _ Source 221130 3,000,00
Formula policy developed 000 for 0 0
tion and Funding
Strategi An accreditation QAS x x x x 4,800, _ Source 221130 4,000,00
c framework developed 000 for 0 0
Planning Funding
Accreditation tools for QAS x x x x 2 147 214767 Back-up 221130 Nil
health facilities developed 670 0 Initiative 0
Draft Health Research Research x x x x 1,500, _ GOK 221080
Policy in place 000 0
National Health Training e-Health, x x x x 5,000, 5,000,0 Capacity 221130 Nil
Policy in place 000 00 project 0
Implementation plan for CPD and x x x 1,200, 1,200,0 Capacity 221130 Nil
the training policy Regulatio 000 00 project 0
developed n
Guidelines for alternative x x x x 5,000, _ GOK 221010 5,000,00
medicine practice in place 000 0 0
Inventory of the x x x 4,000, _ GOK 221130 4,000,00
alternative medicine 000 0 0
practitioners facilities in
place
National e-Health Strategic x x x x 7,600, _ GOK 221010 7,600,00
Plan in place. 000 0 0
Joint inspections with x x x x 19,350 _ GOK 221010 19,350,0
boards and councils carried ,000 0 00
out
Capacity QM incorporated into basic QAS x x x x 5,086, 5.006.3 BACKUP 221130 Nil
Strength training 370 70 INTIATIV 0
ening E
Retoolin Composite CPD data base e-Health x 5,000 5,000,0 CAPACIT 221130 Nil
g of established CPD & 000 00 YPROJEC 0
manage Regulatio T
ment n.
support Key health professional e-Health x x x x 5 000, _ GOK 221010 5,000,00
and association officials trained CPD & 000 0 0
service on the use of CPD data Regulatio
delivery base and software Roll out n.
staff the implementation of CPD
database. established
DSRS staff trained in QAS x x 5 000 _ GOK 221010 5,000,00
Accreditation 000 0 0
Soft ware and database for QAS x x x 1,279, 1,279,2 BACKUP 221130 Nil
Quality Management 220 20 INTIATIV 0
/Accreditation developed. E
KQAM Model launched and QAS x 4 000 _ Source 221130 4,000,00
disseminated. 000 for 0 0
Funding
QM Coordinator/TOT in QAS x x 1 000 _ Source !,000,000
place at the provincial 000 for
level Funding
Award of CPD points QAS x x x x 2 000 _ GOK 221130 2,000,00
based on demonstrated 000 0 0
effort to adhere to
guidelines piloted
Quarterly Monitoring and QAS x x x x 1 000 _ GOK 221130 1,000,00
evaluation of use of 000 0 0
available standards,
guidelines and protocols
carried out
Work on ISO 9001 in HQ QAS x x x x 20,000 _ GOK 221030 20,000,0
and the Provincial ,000 0 00
Headquarters completed
and a consolidated Quality
Master Plan developed

Office space and Research x 4, 000, _ GOK 221130 4,000,00

equipment for the 000 0 0
Research & Dev. Division
availed
Resourc Annual and quarterly DSRS x x x x 1 000 _ GOK 221010 1,000,00
e supervision conducted 000 0 0
Mobiliza
tion and
Coordin
ation of
Annual
partners Operational Plan 5 – 2009/10 128
Total Kshs. 15,513, Kshs85,
111 260 950,000
463
260
 5.1.11 Medicine
The departments AOP5 Plan is based on the core priorities of the Ministry of Medical
services. In addition the department of Medicine has several core functions from which
the AOP5 plan is based. The core functions of the department are;
• Coordinate medical services at the district/provincial hospitals and link them with
national referral hospitals
• Conduct planning and coordination, policy formulation, provision of therapeutic &
supplementary feeds Supervise of inpatient feeding & nutrition and dietetic
services
• Ensure availability of quality and adequate radiography services in hospitals
• Coordinate, monitor and evaluate the medical social services provided in the
country
• Address social factors that affect health
• Provide and coordinate quality mental health services

The department’s AOP5 planned outputs are as outlined in the following table;

Core outputs Respons Time frame Cost Budget Unfund

functio ible Q1 Q2 Q3 Q4 Amoun Source ed
n area person t
Clinical guidelines disseminated Internal
Policy Medicine
formula MOH basic pediatric protocols Revised and HDP 3,000,0 3,000,0
tion and 10,000 copies printed 00 00
strategi MOH basic pediatric protocols disseminated HDP X X 500,000 500,000
c to all facilities
plannin National mental health policy document DOMH X x 1,300,0 1,300,0
g; finalized 00 00
National mental health policy disseminated DOMH X X X
Guidelines for inpatient feeding developed Nutrition x x x 200,000 GOK 200,000
and disseminated
Nutrition guidelines on management of acute Nutrition x x 200,000 GoK 200,000
malnutrition disseminated. UNICEF
Integrated IYCF training curriculum reviewed Nutrition x x x 350,000 UNICEF 350,000
WHO
A standard tool for assessment of BFHI Nutrition x x 300 000 GoK 300 000
developed UNICEF
WHO
Standards and guidelines for medical social Head , X X X X 250,000 250,000
work developed MSW
Protocol/ Guidelines on Medical Imaging Radiogra x x x
Services Developed and disseminated by June phy 1,750,0 1,750,0
2010. 00 500,000 00
Radiogra x x
Radiographers bill in place phy 150,000 150,000
Personnel Radiation Monitoring Program Radiogra x x x 300,.00 300,.00
Monitored. phy 0 GOK 0
Protocol for use in Radiation Personnel Radiogra x x x
Monitoring and Safety printed and phy
disseminated. 300,000 GOK 300,000
Radiography personnel sensitized on Radiogra x x x 2,400,0 2,400,0
appropriate Radiation safety phy 00 GOK 00
Develop QA/QC Protocols for Medical Radiogra x
Imaging developed phy
300,000 GOK 300,000
Monitoring and Evaluation of the Radiogra x x x
Implementation of QA/QC in Medical Imaging phy 2,400,0 2,400,0
carried out 00 GOK 00
Personnel Radiation Monitoring Carried-out Radiogra x x
for Medical Imaging Staff. phy 200,000 GOK 200,000

Annual Operational Plan 5 – 2009/10 129

 Core outputs Respons Time frame Cost Budget Unfund
functio ible Q1 Q2 Q3 Q4 Amoun Source ed
n area person t
Ensurin 1.Psychotropic drugs procured and availed in A X X X X 50,000, 50,000,
g all health facilities PS/CP/KE 000 000
security MS
for 1 EEG and 5 ECT machines procured and PS/CP/KE X X X X 10,000, 10,000,
public distributed to level 5 and 6 health facilities MSA 000 000
health Procurement and distribution of Nutrition x x 2M GOK 2M
commo anthropometric equipments (Height scale/
dities; length mats, BMI-wheels, weighing scales)
Supplementary and therapeutic feeds Nutrition x x x 3M GOK 3M
procured and distributed
Procurement of office chairs, tables, Nutrition x x x 3M GOK 3M
computers
Revised CHANIS tools acquired and Nutrition x x x 3M GOK 3M
distributed
1. Adequate X-ray Supplies in All Medical Radiogra x 160,022 GOK 160,022
Imaging Facilities. phy ,500 ,500
Monitori Joint Quarterly supervision visits conducted Internal x x x x 500,000 GOK 500,000
ng of Medicine
perform Medical audits conducted Internal
ance, Medicine
and Paediatric Clinical care audit tool developed HDP X
supervis Assessment of pediatric hospital care carried HDP
ion; out in 8 level 4 facilities and documented
Assessment of Quality of new born care in 8 HDP X
level 4 facilities carried out
Quarterly support monitoring and evaluation DOMH X X X X 500,000 500,000
of mental health services conducted.
Quarterly Kenya Board of Mental health PS/DMS/D X X X X 5000,00 5000,00
meetings held and board inspection visit done MH 0 0
Conduct baseline assessment on in-patient DCN x
feeding
Conduct quarterly supportive supervision to DCN X X X X
hospitals to assess and strengthen clinical
nutrition service delivery
Quarterly Support supervisory visits MSW X X X X 300,000 300,000
Radiography services Supervisory Tool Radiogra x x x x 1,183,5 GOK 1,183,5
Established and Operationalised phy 30 30
Health workers trained in various All X 9,250,0 GOK 9,250,0
disciplines(….). 00 00
Capacit Mmed,(25)
y training on essential newborn care(128)
strength psychiatric nursing (15)
ening MA in Medical Sociolgy(2),
and TOT on integrated IYCF course,
retoolin MSC course in Clinical nutrition and Dietetics,
g of on new growth curves and CHANIS analysis,
manage management of Diabetes,
ment in-patient feeding,
support, Emerging new Medical Imaging
and Technologies(12)
service Computeised tomography skills(5).
delivery radiation dosimetry(7)
staff; ETAT(256)

Office equipment procured i.e laptop, PS/Procur X X X X 1,700,0 1,700,0

desktops, scanners, printers, photocopier ement 00 00
Procure a vehicle for the division PS/procur 2,000,0 2,000,0
ement 00 00

National and international training forums DCN x x x x 1.5M GOK 1.5M

attended
lactation management centers established in DCN x x GOK
the regional referral hospitals

Annual Operational Plan 5 – 2009/10 130

 Core outputs Respons Time frame Cost Budget Unfund
functio ible Q1 Q2 Q3 Q4 Amoun Source ed
n area person t
Put in formal request for recruitment of 100
medical social workers
Staffing norms for radiographers reviewed in Radiogra x x x x 4,200,0 GOK 4,200,0
line with the current medical imaging trends phy 00 00
Resourc Forum for Engagement of ministry DOM X X X X 500000 GOK 500000
e management, specialists and professional
mobiliza associations created
tion and Forum for addressing paediatric care formed HDP x X
coordin World mental health day observance planned PS/DMS/D X X 1000,00 1000,00
ation of and commemorated countrywide MH 0 0
partners monthly Nutrition Technical Forum of KFSSG DCN x x x x 20,000 GOK 20,000
convened
quarterly National inpatient feeding steering DCN x x x x 20,000 GOK 20,000
committees held
Hold bi-annual Clinical nutrition committee DCN x x 20,000 GOK 20,000
meetings
Conduct bi-annual review meeting with the DCN x x 40,000 GOK 40,000
Provincial Clinical Nutrition Officers
Operati Electronic diabetic patient data record DOM,NCD x 500,000 GOK 500,000
ons and developed ,HMIS
other
researc
h. Psychosocial support offered and MSW X X X X 66,000 66,000
collaboration with other service providers
Preterm babies feeding interventions HDP X X X X
implemented in hospitals.
Electronic inpatient record tool piloted in 2
hospitals
Bi-annual food security and nutrition DCN x x 3.5M GOK 3.5M
assessments carried out and report
disseminated
QA/QC Programs disseminated in Medical Radiogra x x x x
Imaging Facilities phy 100,000 GOK 100,000
Monitoring and evaluation of Implementation Radiogra x x x 2,400,0 2,400,0
of QA/QC in medical imaging carried out. phy 00 GOK 00
2. Regular Reports on Imaging Activities Radiogra x x x x
Reviewed and Analyzed Monthly. phy 500,000 GOK 500,000
3. Radiology Services improved by reducing Radiogra x x x x
Patient Waiting Time (From Request to phy 2,000,0 2,000,0
Results) 00 GOK 00
Ensure that Standard and Ethical Imaging Radiogra x x x x
Procedures are Adhered to. phy GOK

5.1.12 Nursing
The Nursing department AOP5 is based on the core functions which are aligned to the
overall Ministry’s priorities of the department. The departments core function are;
 Advising the Government on nursing policies.
 Planning, implementing, monitoring, evaluating and directing nursing services
 Planning monitoring and evaluating nursing education
 Monitoring and evaluation of nursing services
 Developing and reviewing nursing policies, standards, and guidelines
 Planning and deploying and reviewing deployment of nursing staff
 Overseeing procurement and managing distribution of non-pharmaceutical supplies
and medical instruments
 Conducting and disseminating operational research findings on nursing

The activities planned for during the year 2009/2010 are as outlined in the following
table.

Annual Operational Plan 5 – 2009/10 131

Annual Operational Plan 5 – 2009/10 132
Result Outputs Responsible Cost Budget Unfu
area Unit Q Q Q Q Amoun Source nded
1 2 3 4 t
Policy Previous policy drafts finalised Division of X X X
formulatio administration
n and Nursing training curricula NCK/ Division X X -
strategic reviewed of education
planning; In service nursing Education Division of X X X 2.6M Gok
Policy education&
Guidelines finalised Division of
Administration
Continuing Education for nurses Division of X X X X 2.4M Gok
monitoring tool developed and education*
disseminated to 7PGHs and
40% district Hospitals
Nursing training projection for Division of X X x - -
09/10 developed education
Check list of protective gear Division of X 0.2m Gok
for isolation wards developed Nursing
commodities
and logistics
Check list for Equipment in Division of X 0.2M Gok
isolation wards developed Nursing
commodities
and logistics
Check list for Equipment for Division of X 0.2M Gok
maternity and casualty Nursing
developed commodities
and logistics
Monitoring tools for non Division of X X 0.2 Gok
pharmaceuticals developed Nursing
commodities
and logistics
Non pharmaceutical essential Division of X X 0.2M* Gok
list developed Nursing
commodities
and logistics&
Division of
Administration
Ensuring Non Pharm Specification Division of X 0.6M Gok
security reviewed Nursing
for public commodities
health and logistics
commoditi Inventory of equipments and Division of X X X X x 0.3 M Gok
es; non pharm in isolation wards Nursing
developed commodities
and logistics
Distribution lists of non pharm Division of X X X X x 0.05m Gok
developed Nursing
commodities
and logistics
Quantification of Non pharms Division of 2m Gok
done Nursing
commodities
and logistics
Monitoring Supervision in 6 districts in Division of X X X X x 2m Gok
of each province carried out Administration
performan Assessment of the current Division of Gok
ce, and status of the equipment in Nursing
supervisio maternity, Operating theatres commodities
n; and Casualty done and logistics
* Audit on quality of non Division of 1M Gok
pharms done Nursing
commodities
and logistics
PNO& PPHN,CNO office Division of X X X X X 3.2M Gok
Quarterly meetings held Administration
Facilities Non pharm inventory
developed
A report of number of hospitals X X X X .2m Gok
with nurses deployed to
manage Non Pharm

Capacity 170 nurses trained on various Division of X X X X x 40.7m Gok/dev

strengthen courses e.g. Training in Nursing elopme
ing and Quantification and specification commodities nt
retooling of Non pharmaceuticals, Mid and logistics& partners
of level management courses, Division of
managem psychiatric nursing, diploma in education
entAnnual Operational
paediatric Plan 5 – 2009/10
nursing, Peri- 133
support, operative nursing,
and .
service
delivery
 5.1.13 Forensic and Diagnostic services

The department of Forensic and Diagnostics services AOP5 is as summarized in table

5.15. The plan is based on the department’s core function as well as the overall Ministry
of Medical services priorities. The core functions of the department include;

 Advising the government on issues related to medical laboratory services

 Deploying medical laboratory technologists and technicians throughout the country
 Purchasing and distributing laboratory chemicals/reagents throughout the country
 Providing reference services in the country
 Managing and coordinating laboratory services countrywide
 Developing and reviewing of national laboratory services
 Ensure availability of safe blood in hospitals
 Planning and budgeting for laboratory service
 Overseeing the medico legal services and pathology services.
 Managing quality control of laboratory services
 Managing laboratory data
 Evaluating new laboratory equipment, reagents and techniques
 Supporting heath programmes through the implementation of medical laboratory
policy
 Evaluating medical laboratory services in medical institutions.

Annual Operational Plan 5 – 2009/10 134

 Time frame Cost Budget Unfunde
RESULT Responsib
Outputs Q Q Q Q Amou Sour d
AREA le person
1 2 3 4 nt ce
Electronic LIMS piloted in
Policy selected sites, and
formulation extended according to a NPHLS X X X X 3.0 2.0 CDC 1.0
and strategic national plan
planning; Revision of guidelines and
standards NBTS X 0.5 CDC 0.5
Ensuring Ensuring availability of X X X X 8 0 GOK 8
security for malaria test reagents. DDFS
public health TTI test reagents availed NBTS X X X X 18 13 CDC 5
commodities; 8 Hospital Transfusion
Committees (HTCs) formed NBTS X X X 8 2 CDC 6
Ensure availability of utility
vehicles. NBTS X X X X 21 21 CDC 0

A model hospital NBTS X X X X 42 0 GOK 42

transfusion unit developed
6 RBTC incinerators NBTS X X X 6 6 CDC 0
renovated
A roadmap for NBTS self NBTS X X X X 3 0 GOK 0
sustainability developed
Blood bags availed
NBTS X X X X 150 75 CDC 75
A monitoring & evaluation X GOK 1.0
tools to assess laboratory DDFS 1.0 0
services developed
Midterm and end term 0.2
review of laboratory DDFS X X 0.2 0
services conducted
Monitoring
Training in use of CDC 0.5
performance
laboratory information DDFS 1 0.5
and
tools conducted
supervision
Develop and implement
manual laboratory data DDFS X 2.0 0 APHL 2.0
procedures and tools
Report on national X 1.5
laboratory services DDFS 1.5 0
capacity
Resource Regular source of income DDFS X X X X 2.0
mobilization to ensure provision of
and supplies & other essential 2.0 0
coordination components of a properly
of partners functional laboratory
Provision of QA schemes established at X
standardised DDFS & implemented at
quality provincial/ district / l RBTC 8.0
laboratory laboratories, and VCT sites,
DDFS 8.0 0
services according to established
strengthened timeline
throughout
kenya
Training of pathologist in DDFS X X X X
10 0 10
forensic pathology
Capacity
3 doctors trained on NBTS X X X
strengthening
transfusion medicine
Additional staff recruited NBTS X

Annual Operational Plan 5 – 2009/10 135

 5.1.14 Pharmacy

• Division of Kenya National Pharmaceutical Policy (KNPP) Development

and Coordination (DoKNPP D&C)
Will serve as the KNPP Implementation Unit coordination, monitoring & evaluation and
reporting of KNPP implementation when the policy revision is finalized.
• Division of Administration, Pharmaceutical Human Resources
Management & Development (DoAPHRM&D)
Coordinates the human resources planning, development, induction, deployment,
supervision & performance appraisal and continuing professional development
• Division of Essential Medicines and Medical Supplies Management
(DoEM&MSM)
Coordinates medicines budgeting and procurement planning, selection, quantification,
technical & commercial evaluation, procurement, distribution, storage, inventory
control of essential medicines and medical supplies in the public sector.
• Division of Medicines Information & Appropriate Medicines Utilization
(DoMI&AMU)
Coordinates initiatives to support Appropriate Medicines Utilization such as the
support for the development and operations of national and institutional Medicines &
Therapeutic Committees and the preparation, periodic update and dissemination of
medicines & therapeutic information documents (e.g. SCG, KEML, KNF)
• Division of Medicines Regulation & Quality Assurance (DoMR&QA)
Acts as liaison between the department and the PPB and NQCL, KEMSA and other
national agencies involved in medicines quality assurance.
• Division of Clinical Pharmaceutical Services (DoCPS)
Coordinates the development, provision and the monitoring & evaluation of Clinical
Pharmaceutical Services, which seeks to influence the way patients use the medicines
dispensed to them.
• National Quality Control Laboratory (NQCL)
Acts as the reference laboratory for the analysis for the quality of medicines and
medical devices in the country
• Pharmacy and Poisons Board (PPB)
Regulates the trade in medicines and the practice of pharmacy

Result Outputs Responsible Person Activity Timeline Cos Reve Sourc Unfu
Area Q1 Q2 Q3 Q t/ nue e of nded
4 bud Fundi
get ng
Policy KNPP finalized Division of KNPP X 2.60
Formulat Development and mill.
ion and Coordination
KNPP Printed and Division of KNPP X X 3. 0

Annual Operational Plan 5 – 2009/10 136

Strategic disseminated Development and mill.
Planning Coordination
KNPPIP developed and Division of KNPP X X 2.3
adopted Development and mill.
Coordination
KNPP Baseline Division of KNPP X 3.0
Assessment Development and mill.
Coordination
PPB legally established Registrar PPB X X X X 1.5
as a State Corporation mill.
National Division Of Medicines X 3.0
Pharmaceutical Quality Regulation and mill
Assurance Framework Quality Assurance
(NPQASF) finalised and
adopted.
Implementation Plan Division Of Medicines X 4.0
for NPQASF developed Regulation and mill
Quality Assurance
Disseminate Division of KNPP X 2.5
Monitoring Medicines Development and mill
Prices and Availablity Coordination
(MMePA) survey
findings to the
Ministries in Health
and stakeholders
Medicines donation Division of Essential X X X X 2.5
guidelines reviewed, Medicines and mill
revised, adopted and Medical Supplies
disseminated Management

Ensuring National Medicines and Division of Medicines X X X X 2.0

Security Therapeuitcs Information and mill
for Committee (NMTC) Appropriate
Public operationalized Utilization
Health Medicines and Division of Medicines X X X X 2.5
Commodi Therapeutic Information and mill
ties Committees (MTC) Appropriate
established and Utilization
operationalized in
Level 5 Hospitals
Standard Clinical Division of Medicines X X 2.25
Guidelines(SCG) 3rd Information and mill
Edition finalised and Appropriate
adopted Utilization

Essential Medicines Division of Medicines X X 1.3

List (EML) 4th Edition Information and mill.
developed and Appropriate
adopted Utilization

SCG and EML Division of Medicines X X 0.75

disseminated Information and mill.
Appropriate

Annual Operational Plan 5 – 2009/10 137

 Utilization

Supply Chain Division of Essential X 0.3

Oversight Committee Medicines and mill.
established and Medical Supplies
operationalized Management
Facility EMMS Storage Division of Essential X X X X 1.5
infrastructure Medicines and mill.
assessed Medical Supplies
Management

Guidelines/SOP for Division of Essential X X X X 2.5

disposal of non- Medicines and mill.
serviceable Medical Supplies
pharmaceuticals Management
developed
Monitori Assesssment of the Division of Essential X 3.0
ng of Pull System of EMMS Medicines and mill.
Performa Supply conducted Medical Supplies
nce and Management
Supervisi KNPPIP M & E Plan Division of KNPP X 1.0
on developed Development and mill
Coordination
Eight (8) Support Head of Department X X X X 0.5
supervisory visits mill
conducted one per
province

Job Descriptions for all Division of X X 1.0

Pharmaceutical HR Administration, mill
developed and Pharmaceutical
disseminated Human Resources
Management and
Development
Capacity Human Resource Division of X X X 3.0
Strength Development Plan Administration, mill.
ening developed Pharmaceutical
and Human Resources
Retoolin Management and
g of Development
Manage Human Resource Division of X 1.5
ment Management Administration, mill
Support guidelines developed Pharmaceutical
and and adopted Human Resources
Service Management and
Delivery Development
Staff Ministry's Norms and Division of X X 2.0
Standards for Administration, mill
pharmaceutical HR Pharmaceutical
and services revised Human Resources
for effective service Management and
delivery Development

Annual Operational Plan 5 – 2009/10 138

 An increased Division of X X X X -
authorized Administration,
complement for Pharmaceutical
Pharmaceutical HR Human Resources
Management and
Development
Existing established Division of X X X X 3.5
complement vacancies Administration, mill
for pharmaceutical Pharmaceutical
technologists filled. Human Resources
Management and
Development
Resource Improved Head of Department X X X X 1.0
Mobilizatio communication and mill
n and awareness on
Coordinati pharmaceutical policy
on of and activities
Partners Continued support to Division of Essential X X X X
FBO dispensaries Medicines and
Medical Supplies
Management
Operation Guidelines for Division of Clinical X X X X 1.5
s and Medicine Utilization Pharmaceutical mill
Other operations research Services
Research developed.

5.1.15 Technical Administration

The outputs planned for by the Technical administration department for AOP5 are based on the
department’s core functions which are outlined below;
 Coordinating implementation of projects in infrastructure development and maintenance
 Coordinating provision of health information for use in planning and management
 Coordination and support for management of medical equipment and plants
 Overseeing development and dissemination of policy guidelines on equipping health facilities,
provision of technical support services and improvements in management of health
information.
 Coordinating departmental staff training

Technical administration services outputs for AOP5

RESULT output Respo TIME FRAME COST BUDGET G
AREA nsible A
perso P
n Q Q Q Q AMOUNT SOURC
1 2 3 4 E
Policy Professional manual for CHAO x x 50’000 50000 GOK
formulation health administration
and compiled

Annual Operational Plan 5 – 2009/10 139

 RESULT output Respo TIME FRAME COST BUDGET G
AREA nsible A
perso P
n Q Q Q Q AMOUNT SOURC
1 2 3 4 E
strategic Professional manual for CHAO x x 200000 200000 GOK
planning; health administration
disseminated
Infrastructure norms and CHAO x x 500000 500000 Partner
standards for hospitals
reviewed
Health equipment policy H/BE x x x 10,000,000
developed

Medical equipment H/BE x x x

maintenance and operation WHO/G
guidelines Disseminated 10,000,000
OK
Ensuring Vehicle needs for level 4 CHAO x x 10,000 10000 GOK
security for and 5 hospitals quantified
public
health Infrastructure upgrading CHAO x x 50,000 50000 GOK
commoditie needs for standardization
s; of level 4 hospitals
quantified
11 level 5 facilities and 50 H/BE x x x 350,000,000
level 4 facilities equipped
as per KEPH standard

350,000,000 GOK
Electric power systems H/BE x x x x 100,000,000 100,000,000 GOK
upgraded in 11 levels 4
hospitals
25 hospitals rehabilitated H/BE x x x x 174,000,000 174,000,000 GOK/SI
MED/JI
CA

Mortuary cold rooms in 8 H/BE x x 134,300,000

hospitals rehabilitated
X-ray cables supplied to 8 H/BE x x
hospitals 134300000 GOK

Essential spares for H/BE x x x x 20,000,000 20,000,000 GOK

maintenance of medical
equipment availed
Monitoring
of quarterly performance CHAO x x x x 100,000 100000 GOK
performanc review meetings with
e, and Provincial Health
supervision; Administrative Officers held
Implementation of Project CHAO x x x x 2,506,000 2,506,000 GOK
for improvement and H/BE
construction of Hospitals
monitored
Follow up on H/BE x x x x 3500000 GOK
implementation of
maintenance guideline
carried out in 35 level 4 and
11 level 5 facilities
Capacity
strengtheni

Annual Operational Plan 5 – 2009/10 140

 RESULT output Respo TIME FRAME COST BUDGET G
AREA nsible A
perso P
n Q Q Q Q AMOUNT SOURC
1 2 3 4 E
ng and 80 and 46 staff trained in x x 5,000,000 5,000,000 GOK/Pa
retooling of specialized equipment and rtners
manageme health technology
nt support, management respectively
and service
delivery
staff;

Annual Operational Plan 5 – 2009/10 141

Deliverables from parastatals
There are six parastatal organisations under MOMS and MOPS, all being semiautonomous
institutions (state corporations) governed by a board management (BOM).These
parastatals will be expected to pursue the following to improve their operations:
• Become client centred & responsive to the needs of the populations and the
challenges of the millennia.

• Becoming cost effective, adopting private sector principles such as result

based management.

• Leaders in resource mobilisation to fully finance their operations.

The broad mandate of the six is to facilitate, augment, and enable credible service
delivery to both ministry of medical services and that of public health and sanitation. This
mandate is achieved through training, research, offering technical logistical support and
setting of standards to be translated in service delivery. The parastatals include KEMSA,
KEMRI, NHIF, KNH, MTRH, & KMTC.

Kenya Medical Supplies Agency

Kenya Medical Supplies Agency has evolved over the last 5 years as a key player in
procurement, warehousing and distribution of medical supplies and equipment.
Strengthening KEMSA to be a strategic procurement unit for the health sector is a key
initiative in vision 2030, KEMSA aims at strengthening its procurement system by linking
all procuring arms of MOMS, MOPS and partners. It also targets to improve efficiency in
its procurement and distribution systems. By application of efficient procurement
procedure and distribution systems coupled with capitalizing on economies of scale,
KEMSA aims at bringing down the cost of medical supplies to public health facilities.

KEMSA AOP5

RESULT Outputs Respon Time Frame Cost Budg Unfun

AREA sibility et ded
QT QT QTR QTR Amo Source
R R 3 4 unt
1 2
Policy Multi year
Formulati contracts in
on & place.
Strategic Stable
Planning. supplies.
Optimized
warehouse
utilization.
Phased
Commercial
ization for
Revenue
generation.

Annual Operational Plan 5 – 2009/10 142

 Centralized
dispatch of
commoditie
s
Operation Enterprise Ksh MCA/
s and Resource 135,3 GOK
other Planning 88,14 MCA/
researche (ERP) 0 GOK
s. system
installed
Resource Customer
mobilizati Relationshi
on and p
coordinati Manageme
on of nt (CRM)
partners. module in
place &
functional.
Interactive
Website
access
Monitorin Performanc
g of e Contract
performa Quarterly
nce, and reports
supervisi done.
on Quarterly
review
meetings
held
Capacity Office MCA/
strengthe automation GOK
ning and & regional
retooling real time
of connectivity
managem
ent
support
and
service
delivery
staff.
Ensuring Commodity MCA/
security Bar-coding. GOK
of Public GPS
health tracking of
Commodit commoditie
ies s

Kenya Medical Research Institute

Annual Operational Plan 5 – 2009/10 143

 Kenya Medical Research Institute is the key research arm for the health sector. Its
mandate is:

1. To conduct research in human health.

2. To co-operate with other organizations and institutions of higher learning in

training programmes and on matters of relevant research.

3. To liaise with other relevant bodies within and outside Kenya carrying out
research and related activities.

4. To disseminate and translate research findings for evidence-based policy

formulation and implementation.

5. To co-operate with the Ministry of Medical Services, the Ministry responsible for
research, the National Council for Science and Technology and the Medical
Science Advisory Research Committee on matters pertaining to research
policies and priorities.

6. To do all such things as appear necessary, desirable or expedient to carry out

its functions.

During the AOP 5, the key interventions will be:

Result Outputs Responsibili Time frame Cost Budget Unfu

area ty Q1 Q Q3 Q Amoun Sourc nded
2 4 t e
Policy formulation and strategic planning
Researc
h
Progra
mmes
Infectiou 50 New research KEMRI X X X X 4,126,420,
s disease protocols developed ALL 299
10 projects completed RESEARCH
40 manuscripts OFFICERS
submitted or published
papers
50 abstracts submitted
to conferences;
6 dissemination
workshops held

Parasitic 40 New research KEMRI X X X X 594,873,05

diseases protocols developed ALL 7
8 projects completed RESEARCH
40 of manuscripts OFFICERS
submitted or published
papers
50 abstracts submitted
to conferences;
3 of dissemination
workshops held

Annual Operational Plan 5 – 2009/10 144

 Result Outputs Responsibili Time frame Cost Budget Unfu
area ty Q1 Q Q3 Q Amoun Sourc nded
2 4 t e

Biotechn 10 New research KEMRI X X X X 267,759,75

ology protocols developed ALL 0
3 projects completed RESEARCH
5 manuscripts OFFICERS
submitted
or published papers
10 abstracts submitted
to conferences;
2 dissemination
workshops held

Public 30 New research KEMRI X X X X 1,602,466,

Health protocols developed ALL 148
9 projects completed RESEARCH
55 manuscripts OFFICERS
submitted or published
papers
30 abstracts submitted
to conferences;
4 dissemination
workshops held

Capacity strengthening and retooling of

management support, and service delivery
staff
Training
ITROMID # of registered Masters KEMRI X X X X 214,500,00
students Graduate 0
#of PhD enrolled Program
# of Masters completed Coordinator
#of PhD completed
ESACIPA # of regional courses KEMRI X X X X 37,600,000
C conducted ESACIPAC
#of International
courses conducted
OTHER # of Industrial KEMRI X X X X 0
TRAININ attachment students Training
G # of staff trained Officer
( certificate, diploma,
degrees)
Resource mobilization and coordination of
partners
Producti # of test kits produced KEMRI X X X X 27,046,434
on Unit # of distributes/sold Production
(Internal QTY of disinfectant Manger
Revenue produced Marketing
Generati QTY of disinfectant Manager
on) distributed/sold
#of Taq Polymerase
units produced
# of Taq Polymerase
sold
Operations and other research
REACH- # of stakeholders KEMRI X X X X 20,320,000
PI meetings held DD (R&T)
#of Policy briefs REACH-PI

Annual Operational Plan 5 – 2009/10 145

 Result Outputs Responsibili Time frame Cost Budget Unfu
area ty Q1 Q Q3 Q Amoun Sourc nded
2 4 t e
produced Country
# of Policy briefs Coordinator
disseminated
# of policy briefs
adapted and in use
ICT # of LAN established KEMRI X X X X 396,517,50
# of WAN established SPICT 0
# of Website updates
Ensuring security for public health
commodities
ENGINE # of projects KEMRI X X X X 346,189,30
ERING & undertaken Head 0
Mainten # of preventive Engineering
ance maintenance carried Centre
out Directors
# of repairs carried out
Monitoring of performance, and supervision
HUMAN # of Skills development KEMRI X X X X 1,909,023,
RESOUR # of Team Building DDA &F 122
CE & activities AD(P)
ADMINI # of Open Days held
STRATI # of administrative
ON trainings
MONITO Establishment of KEMRI X X X X 40,000,000
RING & integrated M&E System DD (R&T)
EVALUA # of reports generated DD (A&F)
TION # of feedback and AD (M&E)
synthesis meetings held AD (RA)
# of internal review
workshops held
TOTAL 9,545,115
,610

National Hospital Insurance Fund

The main mandate of NHIF is creation of a National health insurance scheme (with
contributions from employers and employees) in order to promote equity in Kenya`s
health care financing as envisaged in vision 2030. During AOP 5, the focus will be on:

Kenya Medical Training College

Kenya Medical Training College (KMTC) is a Semi–Autonomous Government Agency
(SAGA) under Ministry of Medical Services and managed through a Board of
Management. The college is mandated through an Act of Parliament to train and develop
competent health professionals for the nation. This is one of the strategic Government
training institutions because over 80 percent of co-medical and health related workers
both in public and private health sectors countrywide are graduates from of the
institution.

The current student population of 14,896 distributed among 52 programmes conducted

within 17 Departments ranges from Certificate, Diploma to Higher National Diploma. The
college has an annual turnover of 3,500 graduates who are employed both in the country

Annual Operational Plan 5 – 2009/10 146

and overseas hence contributing to improvement of the country’s GDP. The college is
served by an establishment of 2,495 staff members.

The college on its part has reviewed training programmes by integrating Kenya Vision
2030 strategies and Millennium Development Goal initiatives and factored the same in
the revised Strategic Plan 2008/2012.

The college AOP 5 will consolidate all its operations by maximizing the use of existing
human resource and physical facilities during the implementation of integrated training
programmes. This is in response to Kenya’s health Vision 2030 flagship project strategy
“to develop an integrated health infrastructure plan to guide investment in the health
sector countrywide.” It is envisaged that as the college consolidates its activities it shall
effectively deliver quality trainings according to the needs of the Customers.

Annual Operational Plan 5 – 2009/10 147

Annual Operational Plan 5 – 2009/10 148
 RESULT Outputs Responsibl Time frame Costs budg source Budget Unfund
AREA e person QI Q Q Q et code ed
2 3 4
Revised KMTC X Internal
Strategic Plan 2008- Revenue
2012 disseminated to CEO A.I.A and
all colleges and 1M GOK 1M
2M
Departments Grant
X X X X
Annual Operational
Internal
Plan (AOP5)
10M 42.7 Revenue 194 32.7M
implemented in 28
M A.I.A
colleges
4,000 students X Internal
CEO
recruited into the 10 25 Revenue 15 M
college. A.I.A
Training manuals for X X X X
Policy
all academic Internal
formulation DDA/PRINCI
programmes 5M 20M Revenue 15 M
and PAL/HOD
developed and A.I.A
strategic
disseminated
planning;
Policy for expansion of X X X
80-
training sites CEO 70M GOK 30 M
100 M 00001
promoted Grant
Implementation of X X X
college Transport
Policy including 48.4 Internal
Provision of utility CEO/RA Revenue 100 3.2M
51.6M
vehicles and A.I.A
maintenance
supported
Rehabilitation and X X X
maintenance plan CEO/PRINCI
supported in all PALS
colleges
28 Colleges are X X X
Internal
Ensuring supported to improve 30 M
CEO/DDFA 69 M Revenue 221 39M
security for learning environment
A.I.A/DP
public for students
health Provision of food and X X X X
commoditie related requirements 429.4 Internal
PRINCIPAL 450 M 162 20.6M
s; for students M A.I.A
accommodation
Learning and teaching X -
process Internal
DDA 24M 24M
appropriately A.I.A
monitored
Maintenance of ISO X X X X
9001-2008 KEBS Internal
Certification CEO 2.5M 5M Revenue 2.5M
monitored in al l A.I.A
Monitoring
colleges supported
of
Customer satisfaction X Internal
Performanc
baseline survey DDA 5M Revenue 5M
e and
carried out A.I.A
supervision
Monitoring, X X X 1.5M
measuring and DDA Internal
2.5 M 1M
improving customer A.I.A
satisfaction
Quarterly X X X
performance contract
reports shared in all
colleges
In-service courses X X X
137.8
for targeted health CEO/DDA GOK/DP 094 100 M
M
workers carried out 37.8M
Refresher training X X X
programmes for 1.5M
Internal
staff on
CEO 5M Revenue 3.5M
integration and
A.I.A
adoption
Annual of Vision
Operational Plan 5 – 2009/10 149
2030 done
ICT infrastructure X X X
Internal
improved in level 1 2.1M
CEO/DDFA 10 M Revenue 220 7.9M
 Kenyatta National Hospital
Kenyatta National Hospital (KNH) is the premier referral, teaching and research hospital
in Kenya. It was founded in 1901 and since then, has expanded its services to become
the second largest Hospital in Sub-Saharan Africa. It was a department of the Ministry of
Health until 1987 when, through Legal Notice No.109 of 1987, it became a State
Corporation. In 1991 July it started effectively functioning as a Parastatal.

KNH has 50 wards, 20 out-patient clinics, 24 theatres (16 specialized) and an Accident &
Emergency Department. Out of the total bed capacity of 1800, 225 beds are for the
Private Wing. There is a Doctors Plaza consisting of 60 suites for various consultant
specialities. The average bed occupancy rate in some wards goes to 300 per cent. In
addition, at any given day the Hospital hosts in its wards between 2,500 and 3,000
patients. On average the Hospital caters for over 80,000 in-patients and 500,000 out-
patients annually.

In line with the MoMS and MoPHS strategic thrusts and the identified key flagship
projects, KNH has re-aligned its strategic focus to address the following key areas;
improving the quality of specialised health care, participate in national health planning
and reinvigoration of the referral system, skills improvement amongst managers in
leadership and management. KNH will also integrate a Health Management Information
System (HMIS) to aid in information flow among health care providers.

The contents of KNH inputs to this health sector Annual Operational Plan 5 (AOP5) is
derived from the second KNH strategic plan 2008-2012 (KNHSP II). The KNH Strategic
Plan 2008 – 2012 was developed in line with Kenya’s Vision 2030, Ministry of Medical
Services Strategic Plan 2008-2012 and Millennium Development Goals among other
policy documents. The aim of the vision is to create a globally competitive and
prosperous country with a high quality of life by the year 2030 and KNH recognizes her
critical role in keeping the citizens of this country, together with our foreign visitors,
healthy in order to achieve the national aspirations.

Service delivery deliverables

COHORT Results area Indicator of Performance Measurement Baseline Targets
(09/2010)
Cohort 1: Mothers are kept Percentage of Women of Reproductive Age (WRA)
pregnancy healthy before and receiving Family Planning (FP) Commodities: 6817 7022
delivery, during pregnancy Percentage of pregnant women attending at least 4
newborn ANC visits: 3388 3490
(up to 2 Percentages of Newborns with Low Birth Weights (LBW)
weeks) -Less than 2500 grams) 830 855
Percentage of pregnant women distributed with LLITNs Service not offered
Percentage of pregnant women receiving two doses of
interminent Presumptive Therapy (IPT 2) Service not offered
Percentage of HIV infected pregnant women who
received preventive antiretroviral therapy to reduce the
risk of mother- to-child transmission. (PMTCT)
Percentage of Deliveries conducted by skilled health
Mothers are able attendants in health facilities 9658 9945
to have normal Percentage of Maternal Deaths Audited 116 120
delliveries Percentage of fesh still births in the health facility 830 855
All newborns (up Number of Newborns receiving BCG: 7521 7747
to 2 weeks)
receive protection
against

Annual Operational Plan 5 – 2009/10 150

COHORT Results area Indicator of Performance Measurement Baseline Targets
(09/2010)
immunizable and
other conditions
Cohort 2: Children receive Percentage of children under one(1) year of age
Early protection against immunized against measles: 722 744
Childhood immunizable Percentage of children under one(1) year of age fully
diseases immunized: 703 724
Children are able to Percentage of children under 5 years (<5 yrs) attending
survive childhood Child Welfare Clinic (CWC) for growth monitoring
illnesses services (new cases) 1887 1945
Percentage of children under 5 years (<5 yrs) attending
Child Welfare Clinic (CWC) who are underweight 12105 12469
Percentage of Children less than 5 years (<5 yrs)
receiving Vitamin A supplement 413 426
Percentage of children under 5 years of age (<5yrs) Service not offered
distributed with Long Lasting Insecticide Treated Nets
(LLITNs)
Percentage of under 5 years treated for malaria 1551 1598
Infant Mortality Rates (IMR) 1262 1300
Cohort 3 Healthy lifestyle is Percentage of school children correctly de-wormed at
Late adopted amongst least once in the year Service not offered
childhood children Percentage of schools with adequate sanitation
facilities: Service not offered
Cohort 4 Behaviour change is Percentage change of Health facilities providing youth 6193 6379
Adolescent promoted amongst friendly services
adolescents that
leads ot healthy
lifestyle
Adolescents are able
to survive common
health conditions
affecting them
Cohort 5 & Adults and elderly Percentage of population Counselled and Tested for
6 Adulthood are practising a HIV: (VCT, PITC, DTC, HBCT) 27758 28591
and Elderly. healthy lifestyle Number of condoms distributed:
Percentage of Households sprayed with Insecticide Service not offered
Residual Spray (IRS).
Adults and elderly Percentage of adults and children with advanced HIV
are able to survive infection started on Anti Retroviral (ART):
common health Percentage of Adults and children with advanced HIV
conditions affecting infection receiving Anti Retroviral Therapy (ART):
them TB case detection rate 5% 5.20%
Tuberculosis cure rate: All detected TB cases at KNH
are reffered to their local
Health centre
Percentage of emergency surgical cases operated
within one hour
Percentage of cold surgical cases operated on within
one month.
Efficiency Human resource Doctor Population ratio: 214 220
available to increase Nurse Population ratio:
access to health
services 1793 1847
Essential medicines Percentage of Health facilities without all tracer drugs
and medical supplies for greater than 2 weeks (>2 weeks)
are available to
increase access to
health services 2 weeks 2 weeks
Quality of health Percentage of clients satisified with services:
services improved Average Length of Stay (ALOS): 10 days 9.4 days

Annual Operational Plan 5 – 2009/10 151

COHORT Results area Indicator of Performance Measurement Baseline Targets
(09/2010)
Utilization of health Utilization rate of Out-patient Attendants (OPD) -Female 272031 280120
services improved Utilization rate of Out-patient Attendants (OPD) - Male 227385 234206
Percentage of health facilities that submit timely, KNH is a level 6 Health facilit
accurate reports to national level. and does submit its reports t
HMIS
Monitoring and Percentage of health facilities that submit complete
evaluation improved accurate, reports to national level. 100%
Finance Percentage of GOK budget allocation to primary health
Financial allocation facilities (L2 & L3) Not applicable
to health impoved Percentage of GOK budget allocation for drugs Kshs. 395 million
Governance Goverance structures Percentage of districts with Functional Health
strengthened Stakeholders Forum (DHSF)

Annual Operational Plan 5 – 2009/10 152

COHORT Results area Indicator of Performance Measurement Baseline Targets
(09/2010)

Annual Operational Plan 5 – 2009/10 153

MANAGEME
NT SUPPORT
Intervention Key output / Respo Timeframe Cost Available Source Gap/surpl
area priorities nsible (Budge resources of us
person t) Kshs. funds
s Q1 Q Q3 Q4 Kshs. ‘Millions’ Kshs.
2 ‘Millio ‘Millions’
ns’
Maintenance of New equipment HoDs, X X X 38.7 18.48 IF 20.2175
buildings, acquired for HE,
equipment and Radiology, SPM
vehicles laboratories and
Surgery

Double the CCU DD/CS X X 200 30 IF/DPs 170

beds , HE,
SPM
Completed Hod, X 40 2.3 IF 37.7
refurbishment and HE,
expansion works SPM
at mausoleum
Completed DD/CS X 10 5 IF 5
rehabilitation , HE,
works on oxygen SPM
pipe
Completed Hod, X X X X 210 IF/DPs 210
expansion works HE,
of Cancer SPM
Treatment Centre
Phased CAO, X X X X 28 31 IF -3
modernization of HE,
lifts-four of them SPM

Installed and CAO, X X 42 42 IF 0

commissioned HE,
new PABX SPM
equipment
Installed and CAO, X X 20 27 IF/DPs -7
commissioned HE,
new laundry drier SPM
and sluicing
equipment
Installed and DD/CS X X X X 25 10 IF 15
commissioned , HE,
modern Theatre SPM
lights

Procurement Reviewed KNH SPM X X 0.25 0 IF 0.25

and Procurement
management of Manual
drugs

Annual Operational Plan 5 – 2009/10 154

Monitoring of Performance CEO,D X X 0.2 0 IF 0.2
performance, management D/CS,
and Supportive policies DD/AF
 Moi Teaching and referral Hospital

Moi Teaching and Referral Hospital (MTRH) is the second national referral hospital in
Kenya after Kenyatta National Hospital (KNH). The hospital is located along Nandi road in
Eldoret town, Uasin Gishu District in the Rift Valley province, Kenya. It started as a small
cottage hospital in 1920 with a capacity of 60 beds, and evolved into a fully-fledged
referral facility with a capacity of 560 beds. As an institution, MTRH comprises of the
National Referral Hospital and the Moi University School of Medicine.

The Moi Teaching and Referral Hospital was accorded the status of a referral and
teaching facility by Legal Notice No. 78 of 12th June, 1998 under the State Corporations
Act (Cap 446) and the first Hospital Board gazetted on 29th June, 1999. Core priorities
during AOP 5 are highlighted below.

SERVICE DELIVERY ANNUAL PERFORMANCE TARGETS

Cohort Result Areas Indicators of Baselin Target Activitie
Performance e (08/09) (09/10) s
Measurement
Cohort 1: Mothers are Percentage of Women 2908 3,635
pregnancy kept healthy of Reproductive Age
delivery, before and (WRA) receiving Family
newborn (up to during Planning (FP)
2 weeks) pregnancy Commodities:
Percentage of 8098 10,122
pregnant women
attending at least 4 ANC
visits:
Percentage of 572 715
Newborns with Low Birth
Weights (LBW) –(less
than 2500 grams)
Percentage of 2770 34,625
pregnant women
distributed with LLITNs
Percentage of -
pregnant women
receiving two doses of
Intermittent Presumptive
Therapy (IPT2)
Percentage of HIV 310 387
infected pregnant women
who received preventive
antiretroviral therapy to
reduce the risk of mother
-to –child transmission
(PMTCT).
Mothers are Percentage of 5914 7392
able to have Deliveries conducted by
normal skilled health attendants
deliveries in health facilities.
Percentage of 16 12
Maternal Deaths Audited

Annual Operational Plan 5 – 2009/10 155

 Percentage of fresh 90 67
still births in the health
facility
All newborns Percentage of 6808 8510
(up to 2 weeks) Newborns receiving BCG:
receive
protection
against
immunizable
and other
conditions
Cohort 2: Children Percentage of 750 937
Early receive Children under one (1)
Childhood protection year of age immunized
against against Measles:
immunizable Percentage of 672 685
diseases Children under one (1)
year of age fully
immunized:
Children are Percentage of 2152 22195
able to survive Children under 5 years
childhood (< 5 yrs) attending Child
illnesses Welfare Clinic (CWC) for
growth monitoring
services (new cases)
Percentage of 214 267
Children under 5 years (<
5 yrs) attending Child
Welfare Clinic (CWC) who
are underweight
Percentage of 930 1162
Children less than 5 years
(< 5 yrs) receiving
Vitamin A supplement
Percentage of 1444 1805
children under five years
of age (< 5 years)
distributed with Long
Lasting Insecticide
Treated Nets (LLITNs)
Percentage of under 5546 6932
5 years treated for
malaria,
Infant Mortality Rate 112 140
(IMR)
Cohort 3 Healt Percentage of school
Late hy children correctly de-
childhood lifestyle wormed at least once in
is the year: Service Not offered
adopted
amongst
children
Percentage of schools
with adequate sanitation Service Not offered
facilities:

Annual Operational Plan 5 – 2009/10 156

 Cohort 4 Behaviour change Percentage of Baseline Target Activiti
is promoted Health facilities (08/09) (09/10) es
amongst providing youth
adolescents that friendly services
leads to healthy
lifestyle
Adolescent Adolescents are
able to survive
common health
conditions
affecting them
Cohort 5 & Adults and elderly Percentage of 86567 108208
6 are practising a population
Adulthood healthy lifestyle Counselled and
and Tested for HIV:
Elderly. (VCT, PITC, DTC,
HBCT)
Number of 840,000 1050000
condoms
distributed:
Percentage of
Households
sprayed with
Insecticide
Residual Spray
(IRS).
Adults and elderly Percentage of 11,976 14970
are able to survive adults and
common health children with
conditions advanced HIV
affecting them infection started
on Anti Retroviral
Therapy (ART):
Percentage of 48,005 60006
Adults and
children with
advanced HIV
infection
receiving Anti
Retroviral
Therapy (ART)
TB case 66% 80%
detection rate
Tuberculosis 86% 90%
cure rate:
Percentage of
emergency
surgical cases
operated within
one hour
Percentage of

Annual Operational Plan 5 – 2009/10 157

 cold surgical
cases operated
on within one
month.
Efficiency Human resource Implementation 100% 100%
available to of the
increase access to institutional
health services service delivery
charter 1,364
Doctor 106 124
Population ratio:
Nurse Population 660 735
ratio:
Essential Percentage of
medicines and Health facilities
medical supplies without all tracer
are available to drugs for
increase access to greater than 2 Not
health services weeks (> 2 Applicable
weeks) to MTRH
Quality of health Percentage of 70% 75%
services improved clients satisfied
with services:
Average Length 7 6.8
of Stay (ALOS):
Utilization of Utilization rate of 100% 100%
health services Out Patient
improved Attendants (OPD)
- Male:
Utilization rate of 100% 100%
Out Patient
Attendants (OPD)
-Female:
Automation Reviewing of the 100% 100%
existing Hospital
ICT policy
Service delivery Activation of - 100%
innovation Telemedicine
with Indiana
University
Monitoring and Percentage of
evaluation health facilities
improved that submit
timely, accurate
reports to
national level.
Percentage of
health facilities
that submit
complete,
accurate reports
to national level.
Finance Financial allocation % GOK budget 1,145,295, 1,731,909,
to health Improved allocation to 475 000
health facilities

Annual Operational Plan 5 – 2009/10 158

 % GOK budget NOT
allocation for APPLICABL
drugs E TO MTRH
Governanc Governance Percentage of
e structures districts with
strengthened Functional Health NOT
Stakeholders APPLICABL
Forum (DHSF): E TO MTRH
Vision 2030 SP Implementation 100% 100%
of Institutional
Vision 2030
based Strategic
Plan 2008-2012
Anti – corruption Implementation 100% 100%
of the Corruption
prevention plan
Safety Implementation 89% 93%
of OHS policy
Institutional public Resolving public - 100%
complaints complaints
committee
Gender Developing a - 100%
Mainstreaming framework/policy
to guide Gender
Mainstreaming
activities.
Disability Formulation of a - 100%
Mainstreaming Disability
Mainstreaming
Strategy

Annual Operational Plan 5 – 2009/10 159

 MTRH MANAGEMENT SUPPORT PLAN

Interve Key Activities Respons Timeframe Cost Availa Gap/sur

ntion output / ible Q Q Q Q (Budg ble plus
area prioritie persons 1 2 3 4 et) resour
s ces
Hospit An Conduct workshop to induct CEO x See See
al effective Hospital Board on their roles budget budget
manag and and responsibilities
ement transform Develop and review terms of CEO x ‘’ ‘’
to ational reference or Board
develo leadershi committees
p and p Hold regular reviews of the CEO x ‘’ ‘’
maintai policy framework
n an Review and endorse plans Planning x ‘’ ‘’
effectiv (annual operational plans and Head
e strategic plans)
strateg Determine the nature and CEO x ‘’ ‘’
ic frequency of information to
leaders be furnished to the Board
hip
Develop calendar for Board BOM x ‘’ ‘’
meetings secretari
at
Hold Board meetings as per BOM x x x x ‘’ ‘’
calendar secretari
at
Develop and recommend to CEO/ x ‘’ ‘’
Ministry of Medical Services BOM
the criteria for Board secretari
appointments at
Hold joint retreats for Board BOM x ‘’ ‘’
and staff secretari
at
Develop a curriculum for DDFA x ‘’ ‘’
regional training in Health
Service Management
Annually, conduct Board self- BOM x ‘’ ‘’
evaluation
Hold staff retreats and DDFA x x x x ‘’ ‘’
meetings
Functiona Review and make x ‘’ ‘’
l recommendations for the CEO
institutio amendment of Legal Notice
nal No. 78 of 1998 and No. 56 of
collaborat 2002
ion Follow up recommendations CEO x ‘’ ‘’
between with Ministry of Medical
MTRH Services
and Moi Hold consultative meetings BOM x x ‘’ ‘’
Universit with Moi University for MRTH
y and representation on University
other Council
institutio Hold consultative meetings BOM x x ‘’ ‘’
ns with Moi University to
harmonize plans for training,

Annual Operational Plan 5 – 2009/10 160

 research and capacity
building
Hold consultative meetings BOM x x ‘’ ‘’
with Moi University and other
health-allied institutions on
training and research
facilities improvement and
utilization
Complian Hold workshop to train Board CEO x ‘’ ‘’
ce with and senior management on
the performance contract
performa Sign the performance M&E x ‘’ ‘’
nce contract documents
contract Identify and set targets and M&E/ x ‘’ ‘’
for state develop indicator of CEO
corporati compliance
ons Approve targets and CEO x ‘’ ‘’
indicators (by the
management)
Take corrective measures as CEO x ‘’ ‘’
required
An Review draft code of conduct HR Head x x x x ‘’ ‘’
enforced
code of Submit draft to the Board for HR Head x x x x ‘’ ‘’
conduct discussion and approval
Active Develop calendar of meetings HR Head x x x x ‘’ ‘’
participat for each group of staff
ion in Develop standard agenda for HR Head x x x x ‘’ ‘’
decision each category of staff
making Hold regular meetings for the HR Head x x x x ‘’ ‘’
various categories of staff
Write and disseminate HR Head x x x x ‘’ ‘’
minutes
Review implementation of DDFA x x x x ‘’ ‘’
decisions
A Develop internal audit Internal x ‘’ ‘’
strengthe programme to cover issues of Auditor
ned and compliance and efficiency
functional Develop audit timetable to Internal x ‘’ ‘’
internal ensure coverage of all Auditor
audit functions/departments
service Hold regular meetings to Internal x x x x ‘’ ‘’
review internal audit reports Auditor
Acquire adequate working DDFA x ‘’ ‘’
space
Acquire necessary equipment Internal x ‘’ ‘’
for audit team Auditor
Assess and address audit Internal x ‘’ ‘’
staff capacity and Auditor
development needs
Ensure Management Legal x x x x ‘’ ‘’
complies with relevant legal Head
regimes
Ensure Management is Legal x x x x ‘’ ‘’
properly and regularly Head
advised legally
Review agreements, Legal x x x x ‘’ ‘’
contracts and service bonds Head

Annual Operational Plan 5 – 2009/10 161

 Hold meeting to assess legal Legal x x x x ‘’ ‘’
issues and actions required Head
Hospit Output: Conduct workshop to induct BOM X
al An Hospital Board on their roles
board effective and responsibilities
to and Develop and review terms of BOM x
develo transform reference or Board
p and ational committees
maintai leadershi Hold regular reviews of the BOM x
n an p policy framework
effectiv Determine the nature and BOM x x x x
e frequency of information to
strateg be furnished to the Board
ic Develop calendar for Board BOM x x x x
leaders meetings secretari
hip at
Hold Board meetings as per BOM x x x x
calendar
Develop and recommend to BOM x
Ministry of Medical Services
the criteria for Board
appointments
Hold joint retreats for Board BOM x
and staff
Annually, conduct Board self- BOM x
evaluation
Hold workshop to train Board BOM x
and senior management on secretari
performance contract at
Submit draft to the Board for BOM x
discussion and approval secretari
at

Annual Operational Plan 5 – 2009/10 162

 Cross-Cutting systems and support services
This section will highlight the main cross cutting priorities and outputs of management
support systems for 2008/09. The departments and divisions in both Ministries of
Public Health and Sanitation and Medical Services will have different structures that
are doing more or less similar systems support

Functions that will help strengthening a health system that will support the lower
levels of management will be given priority for both Ministries. Consequently, this
section will only reflect the responsibility in both ministries as they develop a health
system that will be operational across the whole sector. Where there is divergence
from this general rule, then divisional plans are reflected.

The input systems include human resources, commodities, infrastructure and

equipment while the support systems include planning, performance monitoring,
commodity supply management, financial management, procurement.

Human Resources for Health

The delivery of quality and accessible health services is highly dependent on the
numbers, skills, distribution and management of health workers. In the last two
decades, Kenya’s health indicators including life expectancy, infant mortality and
maternal mortality have deteriorated. The acute shortage, inequitable distribution
and inadequate skills of health workers have been contributory to this negative trend.
The health workforce is inequitably distributed and staff shortages are particularly
acute in hard-to-reach regions. .

Ministries of Medical Services and Public Health and Sanitation Human

resource for Health
RESULT OUTPUTS RESPO TIME FRAME BUDGET SOURC TOTAL
AREA NSI- Q1 Q2 Q3 Q4 E OF BUDGET
BILITIE FUNDS (Kshs)
S
Policy HRH strategic plan finalized DDHRM GOK 10,000,0
formulation X X X X 00
and strategic Human Resource Recruitment DDHRM GOK 5,000,00
planning & Deployment Policy 0
Developed X X X
Performance Appraisal DDHRM GOK 30,000,0
System developed and 00
Institutionalized X X X X
Capacity Additional Health Workers and DDHRM GOK/GA 1,500,00
Strengthenin support staff recruited and &HODS VI/DANI 0
g deployed X X X X DA
Promotions/Upgrading DDHRM GOK 3,000,00
Decisions reviewed and 0
implemented X X X X
HRH Strategic plan developed DDHRM 20M GOK//DP 20,000,0
and Implemented X X X X 00
DDHRM 26.5M GOK 2,750,00
SMS Problem Solving System 0
Established USG 24,750,0
X X X X 00
DDHRM GOK 83,000,0
Schemes of Service Reviewed
&HODS X X X X 00
Staff Trained on various skills DDHRM X X X X GOK 63,417,0

Annual Operational Plan 5 – 2009/10 163

 (HR Development) 00
Performance Number of staff by cadre DDHRM - -
monitoring reported X X X X -
and Number of trained staff (CPD) DDHRM - -
evaluation by cadre reported X X X X -
Staff appraisal report DDHRM - -
submitted X X X X -
Support supervision report DDHRM GOK 10M
submitted X X X X 5M
Employee satisfaction survey DDHRM GOK 3.8M
conducted WHO
X X 3.8M DFID
Report on Dispensary cases DDHRM - -
submitted X X X X -
Operations Skills inventory report DDHRM GOK 3,500,00
and other developed 0
research X X X X
166,417
TOTALS ,000

General Administration
As a department responsible of facilitation and administrative support to medical care
service providers to the people of Kenya, we are committed to ensuring timely
provision of support services and facilitation as required.

Result area Output Timeframe Responsi Bud Sourc Gap/

ble get e surpl
Person us
Q Q Q Q4
1 2 3
1.Policy formulation and a) Anti-corruption policy x x x x ADM 1m GOK
strategic planning; developed.
Transport policy within MOH
developed
3. Performance Project progress implementation x x x x ADM/HRM 5m GOK 10m
Monitoring and supervised
evaluation.
4.Capacity a)different cadres trained on x x x x ADM/HRM 15m GOK 20m
strengthening short courses
b)new utility vehicles Procured X X X X 150m 300m

c)Anti-corruption code of conduct X X X X ADM/CHA 5m GOK 10m

for the ministry reviewed and O
implemented
a)Information on drug and X X X X ADM/HRM 3m GOK
substance abuse disseminated 3M
B) Staff trained on behavioural X X X X ADM/HRM 3M GOK 3M
change communication through
HIV/AIDs programme.
c) Condom dispensers installed at X X X X ADM/HRM 3m 20m
strategic locations for staff.

Technical planning and monitoring

In the last four years the health sector has institutionalized a bottom up planning
process that links strategic plan with the budgeting process with the participation of
not only all levels of managers in the two Ministries but also other actors (both
implementing and development partners). Strengthening this planning process for

Annual Operational Plan 5 – 2009/10 164

 sector will remain one of the priorities of both ministries. It is prudent that the two
ministries continue to work with the same planning process and timelines to simplify
the transaction cost at provincial levels and below. The development of the AOP as a
sector plan (including activities of ministries of medical services and public health and
sanitation) implementing and development partners) will continue as before. The
Kenya Health Policy Framework will be reviewed jointly and the development of
NHSSP III will be initiated.

Result Outputs Responsibility Time frame Cost Budget Unfund

area Q Q Q Q Amount Source ed
1 2 3 4
Planning process Technical X 1000000 1000000 IHP/EHS
Policy reviewed. planning
and division
strategi Planning tools and Technical X 1200000 1200000 IHP/WH
c formats for AOP planning O
plannin revised and approved division
g for use
AOP 2010/2011 Technical X 12000000 1200000 DFID/EH
developed. planning 0 S &
division DANIDA.
Performance contracts Technical X 2000000 2000000 G.O.K
developed and signed. planning &
monitoring /
MMU.
Clinical guidelines Technical X X X 22000000 17,00000 WHO 5,000,0
disseminated. planning, MOMS 0 00
Service charter Technical 2000000 800,000 DFID’IH 120000
implemented in levels planning and P 0
4 and 5 facilities coordination,
MOMS
Capacit Planning entities Technical X 10000000 2,000,00 WHO/DF 8,000,0
y orientated on the planning 0 ID EHS 00
strengt next AOP planning departments
hening process
20 TPMT trained on Technical X X X X 10000000 1000000 IHP
planning & monitoring planning 0
Office equipment Technical 3000000 3000000 G.O.K
procured. planning
ICT equipment Technical 3000000 3000000 IHP
procured. planning
Managers at all levels Technical X 1M 2M WHO/DF 8M
trained on planning ID
Performance departments
contracting
Perform Quarterly reviews Technical X X X X 1M 2M WHO/DF 8M
ance done planning and ID
Monitori monitoring
ng departments
Quarterly Performance Technical X X X X 1M 2M WHO/DF 8M
Reports Developed. planning and ID
monitoring
departments
Joint Annual OP5 Technical X 12M 12M WHO/DF 8M
Report developed planning and ID/IHP/D
approved and monitoring ANIDA.
launched. departments

Annual Operational Plan 5 – 2009/10 165

 Quarterly supportive Technical X X X X 12M 12M IHP 12M
supervision carried planning and
out. monitoring
departments
Resourc Proposal to GF on Technical X X X 2M WHO
e Health Systems planning DFID
Mobiliza Strengthening departments WB
tion and developed and
Coordin submitted
ation of
Partner
s.
5 proposals developed Technical X X X x 10000000 1000000 IHP
& approved. planning 0
departments
Total 69,000,00 42,800,0 26,200,
0 00 000

Policy and Planning

The major outputs that are planned in the AOP 5 in planning and policy department on
will focus on the development of the 2009/10 public expenditure reviews, the
development of MTEF for 2010/11, following up the implementation of performance
contracts on quarterly basis and training of departments and division on the ISO
certification. The key priorities are:
• Guide investment in the health sector.
• Formulate and analyze policies for the sector.
• Assist in the budgetary preparation.
• Conduct Operation Research and Survey
Timeline Cos BUDG Unfun
Q Q Q Q ts ET ded
RESULT Responsibil 1 2 3 4 (millio SOURCE
AREA OUTPUTS ity n)
Policy Draft Kenya Health Policy x x X x DANIDA, 21
formulati Framework developed. DPPD/DTPC 35 14 DFID, WHO
on and relevant Health Acts reviewed DANIDA/G.
strategic DPPD/DTPC 132 5 O.K
planning Capital investment guide and X
investment plan developed 8 8 GTZ, DFID
Strategy and Framework to X
guide Hospital autonomy USAID,
developed DPPD/DTPC 30 20 WHO
HSSF plan rolled out to levels 1 X X X X DANIDA 30
23 DPPD/DTPC 50 20 WB, GOK,
Health sector financing Strategy X x 10
developed DPPD 20 10 GTZ, WB
Hospital Services Fund launch X X
and implementation DPPD/DTPC
Annual Procurement Plan for X X WORLD
EMMS developed DPPD/DTPC 5 5 BANK
Monitorin health sector M & E system X x x x DANIDA, 11
g of reviewed and refined DPPD/DTPC 15 4 WHO
Performa Staff trained on M&E DPPD/DTPC X X 10 3.5 DANIDA
nce Shadow budget developed DPPD/DTPC X X 4 4 WB
Capacity Level 2 & 3 managers trained DPPD/PHS X X 116 WB /

Annual Operational Plan 5 – 2009/10 166

 Timeline Cos BUDG Unfun
RESULT Responsibil Q Q Q Q ts ET SOURCE ded
AREA OUTPUTS ity 1 2 3 4 (millio
building on facility management. n) DANIDA
Operation Geospatial distribution of health X X X X
Research facilities. DPPD/HMIS 15 15 Italian,GTZ
and Client satisfaction surveys X
Surveys conducted DPPD/DHRM 8 8 DFID, WHO
All managers of health X X X X
facilities (level 3 and 5) trained DPPD/MOPH
on ISO 9000:2008 S
A booklet on the health sector X X
facts and figures developed DPPD 3 3 WHO
Costing model for healthcare X
services disseminated DPPD
Resource allocation criteria X X
reviewed. DPPD, CFO 5 5 DANIDA
National Health Accounts X
system developed and
institutionalized DPPD
HRH planning and policy X X
framework developed and
institutionalized DPPD/DHRM
Resource annual budget and resource X X
Mobilizati mobilization of 12% of the fiscal
on and budget(ERS target) submitted in DPPD/FINAN
Coordinat time to Treasury CE
ion of hospital business plans Costed X X X
Partners and predictable DPPD/DTPC
Health Sector and PER REPORTS X
Institutionalized Program based X X
budget developed and DPPD/FINAN
institutionalized CE

Sector Governance
The descriptive section on sector Governance is provided in Chapter 6. The
deliverables are presented in the table below.

Result Outputs Responsibil Time frame Cost Budget Unfunded

area ity Q1 Q2 Q3 Q4 Amount Source
Policy and Framework to guide Policy and X X 3,180,00 DFID
strategic pooled funding Planning 0
planning arrangements (Joint departmen GOK
Financing Agreement) ts
Developed
Draft NHSSPIII Technical X X 22.5M 22.5M DFID,IHP
developed planning
monitoring
/ policy
and
planning.
Sector resource Policy and X 4,450,00 GOK

Annual Operational Plan 5 – 2009/10 167

Result Outputs Responsibil Time frame Cost Budget Unfunded
area ity Q1 Q2 Q3 Q4 Amount Source
framework (shadow planning 0
budget developed) departmen DPs
developed ts
Public Private Policy and X X X 30M 30M Italian,GT
Partnership policy planning Z,WHO.
developed departmen
ts
Curriculum on Technical X X 10M GTZ
leadership and planning
management MOMS/ WHO
developed (Pre and in Primary
service and senior Health
mangers) Dept
LDP reviewed and Technical X X 10M GTZ
rolled out in the planning
Kenyan context MOMS/Pri WHO
mary
health JICA
Depart
L&M Curriculum Technical X X 5M GTZ
disseminated planning
MOMS/Pri WHO
mary
health
Depart
Draft L&M Strategy Technical X 5M GTZ
paper reviewed in line planning
with training policy MOMS/Pri X WHO
mary
health
Depart
Hospital Reform Technical X X 7.5M DFID/IHP
Strategy developed planning
and
coordinatio
n, MOMS
Institutional framework Technical X - - -
structures reviewed planning
(MoMs & MoPHS) departmen
t/policy
planning
Commodities and Technical X X X 25M MSH
supplies Enterprise planning
Resource Programme departmen GTZ
(ERP) Developed t/policy
planning WHO
Referral strategy Technical X X 10,000,0 10,000,0 DFID/EHS
disseminated planning 00 00
and
Coordinati
on MOMs
Capacity Partnership and Technical X X 6,000,00
building coordination structures planning, 0
reviewed at all levels. MOMS
PHC,
MOPHS
100 Senior managers Technical X 18M MSH
(HQ & Provincial level) planning
trained in leadership departmen GTZ

Annual Operational Plan 5 – 2009/10 168

Result Outputs Responsibil Time frame Cost Budget Unfunded
area ity Q1 Q2 Q3 Q4 Amount Source
and change t MOMs/
management Primary WHO
Health
Deprt
200 managers Technical 20M MSH
(Districts) trained in planning
leadership and change departmen GTZ
management t MOMs/
Primary WHO
Health
Deprt
Technical staff Technical X X X X 4M MSH
sensitized on Health planning
Systems departmen GTZ
strengthening. t
WHO
Governance and Technical X X X X 15M MSH
Management planning
structures (HMB, DMB departmen GTZ
etc) reviewed. t
WHO
Monitorin Adherence to the Code Technical X 3,260,00 3,260,00 WHO
g of Conduct reviewed as planning 0 0
performan part of AOP 4 reporting departmen
ce ts
Operation Inter sectoral Technical X X 6,000,00 6,000,00 DfID/
s and collaboration on planning 0 0 WHO
other initiatives that affect departmen
research health outcomes. ts
Assessment of 3 Level Technical X X X X 5M USG
five facilities for planning
initiation of departmen GTZ
commodities and ts
supplies ERP WHO
conducted
Leadership and Technical X 5M USG
Management training planning
needs assessment departmen WHO
report disseminated. ts
MOMs/PH
D
Study on the Technical X X 10M GTZ
effectiveness of the planning
leadership and departmen USG
management skills ts
practice in MOMs/PH WHO
performance D
improvement
conducted

Public Financial Management

Public Financial Management aims to ensure that public funds are managed in an
effective and efficient manner through coordination of financial matters in the
ministry. The core functions are:

Annual Operational Plan 5 – 2009/10 169

 1. Budget preparation
a. Analysing financial and management reports for planning and budgeting
purposes
b. Implementation of Treasury guidelines
c. Compilation of requirements from departments
d. Submission of ministry’s requirements to treasury
e. Prioritisation of ministry’s requirements

2. Budget implementation and control

 Preparation of ministry’s cash requirement projections
 Preparation of disaggregated budget
 Issuance of AIEs
 Preparation of AIE financing schedules
 Compilation and review of pending bills
 Vetting of commitments (LPOs, LSOs and imprest)
 Preparing responses to audit issues.

Outputs to be delivered during AOP 5 are highlighted in the table below.

Annual Operational Plan 5 – 2009/10 170

 Medical and Public Health and Sanitation finance

Result Area Outputs Respons Costs Budg Sourc Unfun

ible Q Q Q Q et e ded
person 1 2 3 4
Financial CFO GOK
Policy and
Management
strategic
Reports
planning
submitted X X X X
Operational AIE’s system CFO X X X X 5M GOK
and other computerized
researches
Resources Ministerial CFO X X X X 1M GOK
mobilization budget-MTEF,
and Annual and
coordination district budgets
developed
Monitoring of CFO 2M GOK
performance Financial
and reports
supervision analysed X X X X
Timely CFO 2M GOK
disbursement
reports of funds
Capacity to AIE holders
strengthening submitted X X X

Accounts
The core functions relating to accounts are:
• Direction , control and coordination of Accounting matters
• Management and control of Government Financial reporting system to ensure
delivery of timely management decisions
• Coordination of Accounting Unit operations; requisition of Exchequer Funding
and Grants.
• Funds disbursement to authorized beneficiaries
• Annual Accounts, follow-up of Audit reports and Public Accounts Committee
submissions.
• Administration and deployment of Accounts staff in Ministry; Training and
Development of Accounts Staff in Ministry.

Medical Services and Public Health and Sanitation accounts

RESULT OUTPUT RESOUR TIME FRAME COST SOURCE Gap/surpl
AREA CE Q1 Q2 Q3 Q4 OF FUND us
Policy 1. HSSF Act gazetted CHAO x 4M
formation & G.O.K
strategic x
2. HSSF rolled out to Health Facilities
Planning

Annual Operational Plan 5 – 2009/10 171

Capacity 1. 8 officers trained in Senior PAC/DDH x 8M G.O.K
Strengthenin Management & Professional Courses RM
g
2. 10 officers trained in Middle
Management, Supervisory &
x x X
Professional courses.

3. Train 10 officers in lower levels

trained in
4. Computer courses computers,
Printers & Photocopiers purchased
Operations & Appropriation & Project Accounts PAC x 5M G.O.K 2,500,00
Other prepared and submitted to 0
Research Controller & Auditor General

1. salaries paid by 30th of each month PAC X X X X 2.8M G.O.K 1,400,00

0
2. Funding of AIE transferred to Health PAC X X X x 6M G.O.K 3,000,00
facilities through Electronic Transfer 0
to Facility Accounts
Performance 1. A in A collection and expenditure PAC X X X x 6M G.O.K 3,000,00
and Returns submitted 0
Maintaining 2. Responses to Audit Queries report PAC X X x 3.2M G.O.K 1,600,00
submitted 0

Procurement

In the roadmap for NHSSP II acceleration, the main priorities in procurement systems
strengthening are the establishment of the functional procurement committees at all
levels, developing the annual medium term procurement plan and the development
and of procurement tracking systems that will show the efficiency and effectiveness of
the procurement system. The key outputs will therefore be:

 Accelerate the implementation of the procurement improvement plan

 Delineate procurement responsibilities between the ministry PU and other
procurement organization including KEMSA
 Establish the various committees currently pending (NMTC)
 Urgently mark on capacity building in procurement and accountability

Medical Services Public Health and Sanitation procurement

Result Area Output Responsibl Timeframe Costs Budget(Ksh.) Source Gap/surplus
e Person Q1 Q2 Q3 Q4
1.Policy Medium Term CPO X X X x 1,400,000.00 GOK
formulation and Procurement Plan (MTPP)
strategic developed
planning; annual operational plan CPO X X X x
developed
2. Ensuring Annual procurement request CPO X X X x
security for schedules developed
commodities &
supplies.
Performance Supervisory reports on the CPO X X X x 1,000,000 GOK
Monitoring and district and provinces
evaluation. submitted.
4.Capacity provinces and districts CPO X X X x 5,000,000 GOK
strengthening updated on new
and retooling of procurement regulations
management
support, and
service delivery
staff;

Annual Operational Plan 5 – 2009/10 172

 6. Operations Quarterly market surveys CPO X X X x X 1,000,000 GOK
and other for major commodities,
research. supplies and equipment.
conducted

Performance Monitoring and Health Information Systems

Strengthening of health information is a key priority for the health sector and thus for
both ministries (Public Health and Sanitation/Medical Services). This will support
evidence based decision making and monitoring of implementation of planned
activities.

Resp Timeframe Budget

onsib Source Unfund
Result le Q Q Q Q of ed
area Outputs 1 2 3 4 Cost Amount funds
HMIS policy Printed and 1,125,0 1,125,0
Disseminated HMIS X 00 00 HMN
Policy and HMIS Strategic plan Printed and 1,125,0 1,125,0
Strategic Disseminated HMIS X 00 00 HMN
Planning 4,257,5 4,257,5 4,257,5
M&E framework endorsed
HMIS x x 00 00 Gap 00
2,499,5 2,499,5 DANID
Medical Data dictionary developed HMIS x x 00 00 A
health facility records with Unique GOK,
identified codes updated HMIS x 20,000 20,000 Voxiva
7,627,0 7,627,0 DANID
HMIS software developed HMIS x x 00 00 A
HMIS software Rolled out in all 34,925, 34,925, DANID 25,000,
provinces HMIS x x 000 000 A 000
9,079,7 9,079,7 DANID 5,000,0
HRIOs trained on use of software HMIS x x 00 00 A 00
National Health information portal
developed and FTP supported in 8,586,5 8,586,5 DANID 6,500,0
100% of the districts HMIS x x x x 00 00 A 00
HMIS integrated tools printed and 68,000, 68,000, DANID 60,000,
distributed HMIS x x x 000 000 A 000
23,300, 23,300, GOK, 15,000,
Motor bikes purchased HMIS x x x x 300 300 NSS 000
GOK,
Managers and HMIS staff trained in NSS,
Capacity data management and use of 10,014, 10,014, DANID 5,000,0
strengthen information HMIS x x x x 000 000 A 00
ed Projects database developed MMU X
Monitoring DANID
and A,
Evaluation Annual and quarterly reports 4,760,0 4,760,0 GOK,
submitted HMIS x x 00 00 NSS
DANID
19,200, 19,200, A,
AOP 5 monitored HMIS x x x x 000 000 GOK
Quarterly and annual Performance MMU X X X X
Contracts implementation reports
submitted.
Service Charter implementation MMU/ X X X X
reports submitted. TPMD

Annual Operational Plan 5 – 2009/10 173

 IPAS implementation monitoring MMU X X X X
report submitted.
Operations DANID
and other A,
Researche Quality Assurance of data 2,944,0 2,944,0 GOK,
s management conducted HMIS x 00 00 HMN
123,
197,463 197,463 007,50
Total ,500 ,500 0

Internal Audit
The core functions relating to internal audit are:
Internal audit provides assurance and consultancy services to the Permanent
Secretary and other managers and its key functions include:-

 Reviewing the existing procedures in the Ministry.

 Evaluating the effectiveness of internal control system and ascertain whether
they are functioning.
 Carrying out spot checks on areas such as revenue and Appropriation in Aid.
 Reviewing budgetary reallocation process to ensure legislative and
administrative compliance.
 Ensuring that revenue, AIA and other receipts due to the government are
collected and banked promptly.
 Carrying out a pre-audit of all documents used in initiating commitment and
expenditure and in effecting payments such as AIE’s, LPO’s and contract
agreements.
 Reviewing and pre-auditing Annual Appropriation Accounts, Fund Accounts and
annual audited statements.
 Ensuring that the government’s physical assets, plant and equipment, supplies,
stores etc are appropriately recorded in the relevant registers and are kept
under safe custody.

RESULT OUT PUT RESOUR TIME FRAME COST SOURCE BUDGET

AREA CE OF FUND (unfund
ed)
Q Q Q Q
1 2 3 4
Capacity 1. Auditors trained CIA x x x 5M GOK 3,000,00
strengthenin on performance 0
g improvement
2. computers CIA x x GOK 2,000,00
purchased 0
Monitoring 10 Audit reports CIA x x x x 6M GOK 5,950,00
and produced 0
Evaluation
TOTAL 10,950,
000

Health Care Finance

Priority areas in AOP 5 are:

Annual Operational Plan 5 – 2009/10 174

 • Development of integrated guidelines for Health Sector Services Fund;
• Orientation and training HMTs, FCs and RHFTs on HSSF guidelines;
• Monitoring implementation of HSSF;
• Enhancing collection efficiency of NHIF receipts and user charges through
systems automation;
• Building capacity in planning, budgeting and priority setting to ensure good
governance, team orientation and cohesive strategic direction for facilities;

Result Area Outputs Respo Activity Costs Bud Sou Unfund

nsibili timeline get rce ed
ty Q Q Q Q
1 2 3 4
Policy formulation resource allocation x x x x 3M GO
and strategic criteria reviewed CFO/CE K
planning Financial Management CFO x X X X - GO
Reports submitted K
Amenity ward guidelines Technic X 1.2 GOK/
disseminated al team million USAID
from
the HCF
Operational and AIE’s system CFO x x x x 2.5M GO
other researches computerized K
cost sharing performance DHCF X 800,00 GOK
needs assessment survey 0
conducted
Resources Ministerial budget-MTEF, CFO x x x x 0.5M GO
mobilization and Annual and district K
coordination budgets completed
Increased Revenue collection DHCF X x x x 8millio HCF
n
CFO x x x x 1M GO
Financial reports analyzed K
Cost sharing work plans HCF X X X X HCF
2009-2010 financial year TEAM
adopted
Monitoring of Cost sharing work plans HCF X X X X HCF
performance and 2009-2010 financial year TEAM
supervision adopted
Capacity Funds to AIE holders CFO X X X X 1M GO
strengthening and released in time K
retooling of HMB and HMT updated on HCF X X X X 2 GOK/
management cost sharing Secretar million DANI
support and service iats DA
delivery staff

Information, Communication Technology

The key deliverables for the unit during AOP 5 will focus on:
- Improving number of sites connected to the internet
- Maintain servicing of computers in use
- Ensure computers are adequately functioning, and
- Strengthen capacity for ICT officers, and Health Workers in ICT
These are planned to be delivered as in the table below.

Result Outputs Responsi Time Cost / Reven Gap

Annual Operational Plan 5 – 2009/10 175

Area ble Frame budge ue
t Amoun Sourc
t e
Capacit sites connected ICT X X X X
y
strengt
hening

i) computers ICT X X 1.8m GOK

serviced and
antivirus
installed
i) officers trained ICT/HRM X X X X 1m GOK
in ICT basics

Annual Operational Plan 5 – 2009/10 176

SECTION III:GOVERNANCE AND FINANCING OF THE
AOP 5

Chapter 6: Governance of Implementation of AOP

5
The strengthening of the Governance process of the health sector continues to be
pursued by the sector constituents. The Kenya Health Sector Wide Approach
(KHSWAp) continues to form the basis for guiding improvements in Governance and
partnership process for all the partners. In this chapter, we first highlight the status of
the Governance process in health, implications, and therefore areas of focus during
AOP 5.

6.1 Progress in sector Governance

The Governance and partnership processes in AOP 4 were built on the processes the
sector had initiated in NHSSP II, adjusted to cater for the changes due to the post
election events. By the time of the AOP 4, the sector had achieved the following:
- Formalization of the partnership and coordination process, with a Code of
Conduct and partnership structures defined from the national through to
community level
- The sector had held its Mid Term Review of the NHSSP II in October 2007, and a
roadmap for acceleration of implementation of NHSSP II objectives defined
- Application of the framework to guide a comprehensive sector MTEF (shadow
budget)
- Institutionalization of the annual operational planning process as the
comprehensive tool for planning and monitoring operational deliverables in the
sector
- Initiation of leadership and management capacity strengthening initiatives for
mid level managers
- Further integration of the performance contracting process into the planning
and monitoring of the sector
- Scaling up social accountability measures, with annual client satisfaction, and
expenditure tracking processes

In line with the sector changes that occurred following the post election events, and in
line with the need to deepen the sector governance initiatives, the following were
targeted for focus during AOP 4.
- Modification of the sector partnership and coordination processes in line with
the changes in Government stewardship through the 2 Ministries in Health
- Re-organization of the strategic planning process to accommodate Ministerial,
and other constituent partner investment planning tools
- Restructuring of the Annual Operational Planning and Monitoring processes to
better reflect the modified priorities for the 2 Ministries in Health

The progress with the defined sector governance priorities during AOP 4 is highlighted
below.

Annual Operational Plan 5 – 2009/10 177

 1. Elaboration of the strategic priorities and functioning of each of the
sector constituent partners. An investment plan has been elaborated for
each Ministry in Health. These will form the basis for prioritization by each
Ministry in its annual planning process, and investments made during the
period 2008 – 2012.
2. Ensuring the partnership structures are adequately functioning at all
the levels of care. These are at the National (HSCC); Provincial (PHSF);
District (DHSF); Divisional (DivHSF) and Community (CHC). The role, and input
from each Ministry is elaborated in its Strategic plan. At the national level, the
HSCC managed to have 3 out of its 4 scheduled meetings, and a steering
committee established to take forward and monitor implementation of issues
arising from the HSCC. These however were held late, and as a result of the
many Governance issues pending tended to have numerous agenda items that
needed to be discussed. The use of the HSCC as a central coordination and
partnership structure was therefore limited, and many parallel processes, and
reviews continued in the sector. bringing the outputs of these processed and
reviews into the overall sector will need to be a focus for the coming year. At
the sub national levels, these partnership structures were functioning at various
degrees. No significant effort was placed in AOP 4 to support their improved
functioning. The creation of new districts, and the weak harmonization of
structures of the 2 Ministries in Health also affected the ability of the sector to
support establishment of functional coordination and partnership structures at
the sub national level.
3. Process of monitoring of adherence to the Code of Conduct has to be
initiated. The tool to monitor CoC adherence was developed, for quarterly and
annual review. The tool shall form the basis for monitoring coordination and
partnership process in the AOP 4 report.
4. Completion of the Joint Financing Agreement. A review was carried out on
financial management, and procurement processes, with clear
recommendations made on how to progress towards the JFA. However, follow
up of these recommendations, and overall JFA development is still not
achieved.
5. Review of Kenya Health Policy Framework and elaboration of a new
framework. The process was initiated in AOP 4, with participation of both
Ministries in Health. This will be accelerated during AOP 5.
6. Elaboration of the 3rd strategic plan, the NHSSP III. The sector partners
recognize the fact that NHSSP II is planned to end in 2010. Consensus on how
to move forward is still being generated. This needs to take into consideration a
number of issues, such as (1) the fact that the Ministries investment plans have
just been completed, (2) the need to align the NHSSP III with the Governments
other strategic planning processes (MTP), that are up to 2012, (3) the fact that
the sector is yet to achieve most of the NHSSP II objectives, and roadmap
priorities whose implementation was derailed during the post election period.
7. The operationalising of the shadow budget. This continued to be a
challenge during AOP 4 implementation. The predictability of funding from
many partners was negatively affected as a result of the impacts of the post
election events. This makes it difficult to provide more accurate information to
the planning units on available resources. In addition, the process of simplifying
the shadow budget tools is still ongoing.
8. Elaboration of the Public Private Partnership Policy. The process is
progressing, albeit at a slow pace. Discussions on priorities, and focus of the

Annual Operational Plan 5 – 2009/10 178

 policy have been held with key constituents, including the private for profit
sector.
9. Elaboration of mechanisms for collaboration with other sectors
affecting health outcomes. Improved collaboration with health related
sectors, such as water, education, gender, HIV and others were to be explored.
This is however not yet achieved. It is anticipated that analysis and definition of
influencing strategies to guide implementation of initiatives in other Ministries
affecting health outcomes will to be carried out and strategy on how to
influence these sectors at all levels of management.
10. Monitoring adherence to underlying principles in health, particularly
equity, gender and human rights. This was not initiated. It would form part
of the review of the policy framework.
11. Comprehensive leadership and management training for mid level managers.
This has been successfully initiated, with ongoing trainings for national, and sub
national mid level managers.
12. Scale up measures of social accountability. Client satisfaction, and
expenditure tracking survey are now carried out annually. However, better
mechanisms for dissemination and follow up of recommendations are needed
to improve impact of these.
13. Build consensus on mechanism to take forward recommendations from
stakeholder consultation processes. The sector has numerous reviews, and
processes that are still ongoing that make follow up of their recommendations
difficult. This is in spite of having in place a Joint quarterly, and Annual Review
process. Separate review and planning processes are still used by many
partners, limiting the impact of the joint processes.

6.2 Priorities for Governance, and partnership

strengthening
The focus during AOP 5 in sector governance and partnership will be on strengthening
the technical governance and partnership processes. Operationalisation of existing
tools and structures will form the key thrusts in governance and partnership
processes. The interventions as a result will be similar to those of AOP 4, but with an
emphasis on improving their operationalisation. These will include the following.
1. Strengthening partnership structures at all the levels of care. Specific
focus will be placed on operationalising the structures at the National (HSCC);
Provincial (PHSF); District (DHSF); Divisional (DivHSF) and Community (CHC)
levels. Frequency of meetings, and agendas shall be adjusted to cater for all
pending issues to ensure renewed confidence in the utilization of these
partnership and coordination structures. Specific justification of parallel
monitoring and follow up processes will be emphasized. Guidelines, and
support will be provided to the sub national levels to ensure their coordination
and partnership structures are also functioning. This is more urgent as they
form the basis for inter ministerial collaboration at these levels.
2. Process of monitoring of adherence to the Code of Conduct has to be
initiated. The tool to monitor CoC adherence will be applied in full during AOP
5.
3. Completion of the Joint Financing Agreement. The process of completion
of the JFA shall be reviewed, and accelerated to ensure this gets operational
during the AOP 5.

Annual Operational Plan 5 – 2009/10 179

 4. Review of Kenya Health Policy Framework and elaboration of a new
framework. The process of review of the current policy framework will be
completed in AOP 5, and development of the next one initiated.
5. Elaboration of the 3rd strategic plan, the NHSSP III. The sector will take
forward the process to ensure there is a sector wide strategic tool guiding its
investments. This is through one of 3 possible options
a. Development of the NHSSP III immediately,
b. Development of an interim NHSSP up to 2012 to allow for alignment of
the next NHSSP III with the Government’s strategic processes
c. Extension of NHSSP II up to 2012 to allow the sector time to implement
the strategic objectives as planned, and align the strategic plan with
other strategic processes
6. The operationalising of the shadow budget. The sector will continue to
apply this tool, but in a manner that is simplified to enable improved utilization.
7. Elaboration of the Public Private Partnership Policy. The process will be
accelerated during AOP 5.
8. Elaboration of mechanisms for collaboration with other sectors
affecting health outcomes. The sector will review this process, with an aim
of putting in place a feasible mechanism to influence health related sectors.
9. Monitoring adherence to underlying principles in health, particularly
equity, gender and human rights. This will be carried out as part of the
policy review.
10. Comprehensive leadership and management training for mid level
managers. This will be scaled up during AOP 5.
11. Scale up measures of social accountability. Client satisfaction, and
expenditure tracking survey will continue, with added focus on the
dissemination process to ensure outputs and recommendations are well
integrated into the sector.

Annual Operational Plan 5 – 2009/10 180

Chapter 7:Cost and financing estimates for
AOP 5

T he financing of the health sector is one of the flagships of Vision 2030 and hence

the need to put in place mechanisms to improve financing of the sector. This chapter
expounds on the sector financing status and highlight innovative ways of financing
healthcare being explored to ensure required resources are made available. The
resource requirements by level of care and by inputs, the various sources of funds
including government, donors, and provide a simple analysis of the financing gap.

Health financing mechanisms are often delineated into the three main functions they
are supposed to fulfill collection of revenues, pooling of funds and purchase of
services

7.1 Health Financing Priorities

Key parameters guiding the health care financing approach in the Health Sector in
Kenya are as follows:
1. The ability of public resources to finance health services is limited by the low
tax base; a function of the size of the economy relative to wealthier countries,
and the limited ability to collect taxes.
2. Donor financing provides a main source of financing for public, and FBO/NGO
health care providers, particularly for recurrent expenses of the system
3. The health services are provided by a wide range of healthcare providers in the
public and private sectors including drug sellers, GPs, NGOs and government
clinics and hospitals. Government plays both a service delivery function
through management of its own facilities, and a coordination function through
regulation and partnering with other service providers.
4. There is a predominance of out of pocket spending by households to finance
their healthcare needs. This is in the form of direct payments, payment into an
insurance scheme, or by purchase of a 'health card' that gives access to
services for a defined period of time.

The Health Care Financing approach will be implemented with these parameters in mind. It
will aim to achieve the following 4 strategic priority areas:
1. Putting in place a sector wide Health Care Financing Policy
2. Improving Financial access to health care, particularly by the poor and vulnerable
3. Initiating fiscal decentralization of financial management through implementation
of the HSSF
4. Continual revision of the resource allocation criteria to ensure allocative efficiency,
and equity in resource availability
Health Care Financing Priorities as outlined in the ‘Roadmap’
• Establish
These priorities are mechanism
reflected in theto priorities
increase resources flowing
for health into financing
care the sector that were
• Improve budget management and efficient and equitable resource
agreed on following the NHSSP
allocation II Mid Term
and utilization Review.
through developing costing frameworks, pro-poor
resource allocation formulae, availing finance/cost information to the public
and incorporating all sources for expenditure tracking
• Complete and implement healthcare financing strategy.
•
Annual Operational Implement HSSF, through more comprehensive district budgeting,181
Plan 5 – 2009/10
finalization of guidelines, training, and ensuring that fiduciary risk is low.
• Implement the shadow budget as a means to link planning and budgeting.
• Improve predictability of resources by holding partners accountable to
Healthcare Financing Strategy
The sector has been discussing a Health Financing Strategy for the sector, which
should be completed during this AOP 5. It involves a number of analytical pieces of
work, such as a costing study, National Health Accounts updating, Public Expenditure
and Service Delivery Survey, to mention but a few. Outputs from this process will need
to be related to the ongoing planning and budgeting processes, to ensure they inform
coming budgets, and planning processes. The process, however, requires a better
understanding of donor funding for health. It is important for the sector to conduct a
systematic and comprehensive analysis of the donor projects with respect to
composition, flow of funds and compatibility towards JFA. In the same manner, the role
of, and support to the private sector needs to be unpackaged, to guide elaboration of
a coherent approach to supporting the sector. Additionally, a national task force on
macroeconomics and health will be instituted, to guide policy and resource allocation
advocacy.

Improving financial access to Healthcare

In line with the Vision 2030, a number of initiatives are being implemented in the
sector that are all aimed at improving financial access to health services, particularly
by the poor and vulnerable. Implementation of Output Based Approach to Aid has
been piloted in Nyanza province, for safe motherhood program. The sector will, in AOP
5, agree on how to take forward lessons learnt from this approach, as part of the
Health Financing Strategy. Other initiatives that will be prioritized in AOP 5 would
include further discussion on initiation of the Social Health Insurance Scheme,
initiation of dialogue on a proposed civil servants health scheme, review of the
existing waiver and reimbursement systems and development of guidelines that will
stimulate the restructuring of NHIF with emphasis on administrative efficiency.

Implementation of the Health Sector Services Fund

The process to initiate the Health Sector Services Fund was extensively carried out
during AOP 3, leading to gazettement of required legislation to guide its
implementation within the Financial Management Act, 2007. The sector will in AOP 4
focus on development of an implementation plan, and guidelines to ensure adequate
training has been carried out to allow for initiation of funds transfer by January 2009.
The Implementation of activities through HSSF is expected to start in July 2009.
The Medical Services Fund guidelines will be developed in AOP 5

Review of the Resource Allocation Criteria

The resource allocation criteria continue to be used as a mechanism to ensure
allocative efficiency, and equity in resource availability. Further modifications are
being discussed, particularly to ensure it addresses disparities in hard to reach areas,
improved equity in allocation, and allocations to higher level facilities (hospitals).

Annual Operational Plan 5 – 2009/10 182

These Health Financing approaches are all aimed at improving the availability of
financing, plus the efficiency, equity and effectiveness of mobilized resources. These
should enable the sector have required resources to implement its planned
interventions.

The remaining sections of this chapter elaborate on the financing situation for the AOP
5. Information on the costing, financing and financing gap analysis is directly derived
from the work elaborating the shadow budget for the health sector in 2009/10. This
shadow budget used the MTEF framework to bring together all resources available in
the sector for health related activities, at the different levels of care. The key
emerging issues during the costing, and financing process for AOP 5 are:
• There is need for harmonizing methodology for generating resource estimates.
Not all requirements are derived using the MTEF framework. Plus, information
on CSO’s, CBO’s and some FBO’s may not be completely reflected in the
respective district/provincial/national level plans.
• The process to generate, and characterize the off-budget resources is still a
difficult one. There is need for better adherence to timelines and the framework
utilised.
• The Information on total financing comes too late in planning process, for it to
guide planning as expected. Plans are, as a result, based on estimates of
resources, as provided in previous year. This is so for both public, and non
public resources

7.2 Resource requirements during AOP 5

The costs of the AOP5 has been collected from the submissions of various levels of
health service delivery units (levels 1-6) and the various management units (HMTs
DHMTs, PHMTs and central level). This costing was based on the MTEF approach of
determining the unit costs, and quantities for each task needed to deliver a planned
intervention. The outputs have been collated here, and were also utilised in
determining the sector requirements in the MTEF process, plus the Ministry resource
requirements in their respective strategic plans.

The costing categories are defined based on the MTEF categories of personnel
emoluments, commodities and supplies, infrastructure (including equipment and ICT),
and operations and maintenance (O&M). This categorization is consistent with the
functional categories used in the overall MOH planning and budgeting framework.

Most of the districts and provinces and central level departments in both Ministries
have gaps in putting these resource requirements together, mainly from two angles.
First, though the planning format provided a room to reflect the costs (estimated
resource requirements) by different level of care and management, the actual district
plans in service delivery do not show the breakdown of costs by levels of care. Hence
it has not been possible to show the cost of delivering health services by levels of
care. Second, districts reflected the costs by different cost categories (budget codes),
but it was found extremely difficult to consolidate these categories in this AOP. The
details of the cost categories therefore can be referenced from each district health
plan, provincial summaries or program area.

From the respective sources of information, the total resource requirements the sector
needs to deliver its planned outputs in 2009/2010 financial year are highlighted in the

Annual Operational Plan 5 – 2009/10 183

table below. It should be emphasized that these are representative of the entire
sector, and not just the Government requirements.

Estimated Cost of service Delivery and Management, 2009/10, in ‘000.000

Ksh
Infrastruc
Level of care Area of support Commodi ture, incl.
HRH/PE ties O&M eq. Total
1.1 Management
1. National support 968 0 6,066 230 7,264
level 1.2 Service
Delivery 7,380 103 3,952 3,156 14,591
2.1 Management
2. Provincial support 117 0 972 0 1,088
level 2.2 Service
delivery 3,985 4,582 902 324 9,793
3.1 Management
3. District support 422 0 1,329 682 2,432
level 3.2 Service
Delivery 12,150 17,411 2,434 3,087 35,083
4. Health 4.1 Service
Facility delivery 5,293 12,138 3,380 1,373 22,185
5. Community
level 626 0 950 104 1,680
6. Unclassified Unclassified 0 0 0 0 0
Total 30,940 34,235 19,985 8,957 94,117
Total 33% 36% 21% 10% 100%
Level 6 38% 0.5% 46% 15% 100%
% Level 5 38% 42% 17% 3.0% 100%
contribution Level 4 34% 46% 10% 10% 100%
Level 2&3 24% 55% 15% 6.2% 100%
Level 1 37% 0.0% 57% 6.2% 100%

Overall resource requirements are estimated at 94 billion. This represents an

increment of 15 billion above the AOP 4 resource requirements. This increment is
largely due to better reflection of resource requirements, particularly for the national
level parastatals, plus additional priorities in the sector due to the post election events
and the subsequent split of the Ministry of Health.

As shown above, medical commodities and Supplies represent the largest cost item in
the sector, responsible for 36% of the overall requirements. The HR related costs
come next, at 33% of the total resource requirements. The rest represent a combined
31% of requirements. This is a reflection of the increased commodity and supply
requirements that the sector is facing since introduction of new interventions to target
the high disease burden in the country. These new commodities are high cost, as
opposed to the past when they were relatively more affordable. Drugs and supplies to
manage HIV, MDR/XDR TB, malaria, new vaccines, emerging health threats, and other
newly introduced intervention areas are largely responsible for this.

As a proportion of total requirements at each level, O+M is the highest cost category
at levels 1 and 6; while Commodities and Supplies are the major cost drivers at levels
2 – 5.

The detailed cost breakdown is presented in Annex 1.

Annual Operational Plan 5 – 2009/10 184

1.1 Resources required for Personnel emoluments
The requirements for personnel emoluments are high at the central level, with KNH
contributing to 20% of the total requirements for the sector. Some key level 6 units,
such as NHIF, KEMSA, KEMRI and KMTC are not included, as reliable estimates could
not be deduced from the respective parastatal plans. 41% of the PE resource
requirements are at the district level (level 4), followed by the national level at 27% of
the total requirements. The levels 2 + 3 only represent 17% of the total resource
requirements. This is a reflection of the concentration of service delivery staff at the
district and national levels. On the other hand, it is also a reflection on the high cost of
staff cadres at these levels.

1.2 Resources required for Commodities and Supplies

The commodities and supplies resource requirements are highest at levels 2 – 4. 51%
of the total requirements are at the district (level 4), followed by 41% at levels 2+3.
The proportion of commodities and supplies requirements at level 6 is rather low,
especially when compared against the related PE requirements.

1.3 Resources required for Operations and maintenance

The O+M requirements are significant at levels 1 and 6, where they represent 57%
and 44% of the level’s requirements respectively. The high O+M requirements at the
level 6 are more at the management support function, as opposed to service delivery
where PE is high. This is a reflection of the roles and functions of service delivery and
HR at this level, with an increase in O+M occasioned by the increased activity and
services provided at this level.
50% of the sector’s O+M requirements are at level 6, followed by the district (level 4)
level, and the facility (level 2+3) at 19% and 17% respectively.

1.4 Resources required for Infrastructure including equipment

Infrastructure requirements are highest at level 4 and 6, where they represent 10%
and 15% of the total resource requirements for each level. This is in line with the high
cost of infrastructure investments at these levels, plus the large number of facilities
for each. Provincial level investment in infrastructure is low.
42% of the total requirements for infrastructure are at the district (level 4), with 38%
at the national level.

Annual Operational Plan 5 – 2009/10 185

7.3 Available resources and financing
The estimates of financial resources were derived based on information from three
main sources:

 MTEF approved estimates for 2009/10, as available in Ministry of Finance. These

are the Government, together with the on budget donors that are providing their
information and resources through the Government channels. As this was provided
late in the planning process, districts and provinces developed their plans based
on MTEF information made available in the previous financial year.
 Off budget funds by donors that will be available during AOP 5 for Government,
and implementing partner support. This represents additional resources that are
not traditionally captured in the MTEF, for various reasons. The information was
collated from the donor sources, and not the implementation level. This was
because there is limited / patchy information on available resources at the
implementation level. It however makes it more difficult to align actual resources
to priorities in the respective planning units. For those with information from the
donor agencies, this information has been included in their respective plan.
 Sector internally generated resources, captured at all levels from the submitted
plans at all the different levels of the sector. These relate to cost sharing, NHIF,
LATF and CDF resources.

All these sources of financing were collated in the shadow budget. The total resource
requirements arising are presented in the table below.

Available resources, for different cost categories in AOP 5 (millions kshs)

Infrastruc
Level of care Area of support Commodi ture, incl.
HRH/PE ties O&M eq. Total
1.1 Management
1. National support 1,421 0 10,099 735 12,254
level 1.2 Service
Delivery 4,165 75 3,206 546 7,992
2.1 Management
2. Provincial support 117 0 102 156 374
level 2.2 Service
delivery 1,738 5,688 6,566 583 14,574
3.1 Management
3. District support 422 0 381 598 1,401
level 3.2 Service
Delivery 7,533 27,925 12,660 7,986 56,104
4. Health 4.1 Service
Facility delivery 3,480 2,685 5,115 6,107 17,387
5. Community
level 0 5 255 104 364
6. Unclassified Unclassified 0 0 0 0 0
Total 18,875 36,378 38,382 16,815 110,450
Total 17% 33% 35% 15% 100%
Level 6 28% 0.4% 66% 6% 100%
% Level 5 12% 38% 45% 4.9% 100%
contribution Level 4 14% 49% 23% 15% 100%
Level 2&3 20% 15% 29% 35.1% 100%
Level 1 0% 1.4% 70% 28.6% 100%
Source: MTEF/SHADOW BUDGET 2009/10

Annual Operational Plan 5 – 2009/10 186

 Overall, from the shadow budget, over 110 billion kshs is available for support to the
sector’s interventions during AOP 5. Of this, 52% is available to support district (level
4) activities, 18% national level activities, 16% for level 2+3 activities, 10% for level 5
activities, and 0.3% for level 1 activities.

Resources for O+M represent the highest amounts available (35%), followed by
Commodities (33%), PE (17%), and finally infrastructure (15%). The O+M resources
are most available, in relation to total available resources, at levels 1, 5 and 6,
commodities and supplies at level 4, and infrastructure at level 2+3. This is a
reflection of the increasing investments in infrastructure at the lower levels, and on
ensuring supplies and commodities is available at level 4.
As earlier highlighted, these represent the total volume of resources available for the
sector during 2009/10. These will be utilized by various implementing agencies –
Government, NGO’s, FBO’s, CSO’s and others who are supporting health related
activities. It will continue to remain a challenge to ensure these resources are being
efficiently utilized.

A detailed breakdown of available resources by services at different levels for each of

the 3 major sources of funds is provided in Annex 1.

7.3.1 On – budget (MTEF) resources

The on-budget resources as indicated in the printed estimates are represented below.

ON-BUDGET RESOURCES FOR HEALTH SECTOR, 2009 – 2010 (million kshs)

Infrastruc
Commodi
Level of care Area of support HRH/PE O&M ture, incl. Total MOPHS MOMS
ties
eq. MTEF MTEF
1.1 Management
1. National
support 1,421 0 1,753 735 3,909 1,080 2,829
level
1.2 Service Delivery 4,065 4 72 456 4,597 9 4,587
2.1 Management
2. Provincial
support 117 0 102 0 218 111 108
level
2.2 Service delivery 1,738 1,157 305 422 3,622 133 3,489
3.1 Management
3. District
support 422 0 381 0 802 367 435
level
3.2 Service Delivery 7,533 2,753 731 6,684 17,702 383 17,318
4. Health
4.1 Service delivery
Facility 3,480 283 599 5,054 9,416 8,196 1,220
5. Community
level 0 0 171 0 171 171 0
6. Unclassified Unclassified 0 0 0 0 0 0 0
Total 18,775 4,197 4,113 13,351 40,437 10,450 29,986
%
contribution Total 46% 10% 10% 33% 100% 26% 74%

Just over 40 billion is approved for expenditure during the current MTEF, according to
the Ministry of Finance records, representing 42% of the total resource requirements,
and 37% of the available resources. Of these MTEF resources, 26% is for Public Health
and Sanitation interventions and 74% for Medical Services. The Personnel emoluments

Annual Operational Plan 5 – 2009/10 187

represent the major resource category for the MTEF, at 47%, followed by resources for
infrastructure at 32% of the total. PE is the main category being financed at levels 4 –
6, infrastructure at levels 2 & 3, and O+M at level 1.

These resources represent both Government’s own resources, and on-budget donor
resources.

The personnel emoluments, at over 18 billion kshs, include resource estimates being
utilized at the Semi Autonomous Government Agencies (KNH, and MTRH). Resources
for the other agencies could not be estimated. (Resources for Commodities and
supplies include both EMMS commodities, plus the public health commodities to be
supported from MTEF resources. These are mainly to be utilized at the district and
provincial levels. The O+M resources are mainly to be utilized for management related
interventions at each level, with the national level consuming the largest share. This is
however a low share as compared to the overall MTEF resources available.
Infrastructure resources are largely allocated for the levels 2 – 5.

The respective planning units have disaggregated these resources in their plans in the
best possible way they could, given the information available at the time of planning.
The information in these plans will continue to be improved as more information is
provided on financing, and as capacity in financial planning is improved as part of the
HSSF process roll out.

The actual contributions by different sources of financing to the on budget support are
highlighted in the table below.

Allocation to on budget resources, by partner characterization (millions)

Financer
categorizat
ion Source of funds MOPHS MOMS TOTAL
7,752.0 25,828. 33,580.
Government of Kenya 9 55 64
Denmark 137.00 68.50 205.50
United Kingdom - - -
1,098.0
Germany 398.00 700.00 0
United States of America - - -
1,455.0 1,900.3
Japan 445.30 0 0
European Union - - -
CoC
signatory World bank - - -
UNFPA 110.00 7.50 117.50
UNICEF 879.16 - 879.16
UNAIDS - - -
World Health Organization - - -
ADB - 16.00 16.00
France - - -
Italy - 137.00 137.00
HENNET - - -
CHAK/KEC - - -
CoC non ADF 328.79 - 328.79
signatory GAVI - - -

Annual Operational Plan 5 – 2009/10 188

 Global Fund - - -
OPEC 400.00 - 400.00
SIDA - - -
BADEA - 550.00 550.00
Belgium - 1.45 1.45
Kuwait - 200.00 200.00
Saudi fund - 200.00 200.00
WFP - 278.26 278.26
Netherlands - - -
China - 544.00 544.00
10,450. 29,986. 40,436.
Total 33 26 59

There are 28 recognized partners in the sector, of whom 16 have signed up to the
Code of Conduct. From all these, Government resources represent 83% of the total on
budget resources, while donor on budget support represents the remaining 17%.

The sector has not yet finalized a Joint Financing Agreement, which is the framework
some of the donor agencies prefer to utilize to guide channeling of their resources.
However, it should be noted that already, 8 out of the 16 Code of Conduct signatories
have on budget resources. Seven (7), out the 13 donor agencies signatory to the Code
of Conduct have on budget resources. there are an additional 12 partners in health
not yet signed up, of whom 12 are already providing on budget resources, even in the
absence of a Joint Financing Agreement. It should, however, be noted that these on
budget resources are not equal to general budget support. The bulk of these are
earmarked for particular investments in the sector. It is largely the Government
resources that are fungible, allowing for shift of these towards identified priority areas

The analysis of service delivery allocation also show that from the total resources
available for service delivery (levels-1-5) at provincial levels and below, 55% was
allocated for levels 1-3 while the remaining 45% is allocated for levels 4-5.

Annual Operational Plan 5 – 2009/10 189

 PROVINCIAL BUDGET SUMMARY FOR O+M RESOURCES IN CURRENT AOP 5 PLANS

North
Rift Valley Provincial
Level /Source Central Coast Eastern Nairobi Eastern Nyanza Western
Province Total
Province
46,508,670.0 135,167,909.
Level 1 83,036,267 58,049,388 109,264,270 0 16,540,900 68741900 517,309,304
0 00
218,218,071. 85,399,238.0 1,017,973,63
Level 2 148,854,095 132,177,150 339,205,138 416,488 11,254,014 82449439
00 0 3
104,954,654. 32,412,478.0
Level 3 141,506,234 61,449,367 141,965,062 494,436 120627075 603,409,306
00 0
300,411,674. 140,040,708. 1,919,769,44
Level 4 442,401,406 583,722,632 49,200,000 53,923,658 350069365
00 00 3
280,454,293.
Level 5 124,379,405 250928329 57,420,300 - 50000000 763,182,327
00
Level 6 28649562.72 98780102 - - 0 127,429,665
DMST (management 34,432,536.0
101,178,108 2,928,000 140,412,408 2,413,937.00 24326672 305,691,661
support) 0
DHMT (management 248,790,989. 98,819,520.0 1,023,406,45
161,252,254 96,751,847 249,377,484 1,795,204 166619159
support) 00 0 7
PMST (management 526,272,389.
5,330,000 0 2242804 39,880,000 1,200,000.00 0 574,925,193
support) 00
PHMT (management 85,674,543.2 21,720,794.0 39,880,000.0 135,167,909.
112,295,000 2225458 - 0 396,963,704
support) 0 0 0 00
1,293,612,31 1,865,245,68 1,202,952,28 1,187,712,68 7,250,060,69
Total 463,650,752 155,154,492 218,898,872 862,833,610
2 1 8 7.00 4

GOK Resources reflected in respective provincial plans, by levels of Care

North
Rift Valley Provincial
Level /Source Central Coast Eastern Nairobi Eastern Nyanza Western
Province Total
Province
82,956,066.6 10,133,300.0 13,657,766.0
Level 1 8,858,814 37,928,422 0 12,330,635 165,865,004
1 0 0
298,218,880. 119,514,380.
Level 2 23,533,710 61,764,235 0 29,248,297 532,279,502
20 00
111,650,188. 57,821,128.0
Level 3 24,830,029 40,547,706 0 8,399,014.00 8,684,436 251,932,502
97 0
397,359,309. 21,085,658.0 152,969,593.
Level 4 114,953,161 7,200,000 35,157,232 728,724,953
00 0 00
43,449,769.0 27,370,300.0 61,073,835.0
Level 5 20,296,583 0 174,375,914 326,566,401
0 0 0
Annual Operational Plan 5 – 2009/10 190
 15,678,707.7
Level 6 34,578,389 - 0 50,257,097
2
DMST (management 98,234,125.0
27,152,351 2,328,000 0 1,933,937.00 6,008,980 135,657,393
support) 0
DHMT (management 137,835,374. 106,226,814.
44,928,007 38,786,235 1,662,058 24,066,641 353,505,129
support) 40 00
PMST (management 12,000,000.0
1,730,000 0 202,952 4,970,000.00 115,496,221 134,399,173
support) 0
PHMT (management 11,000,000.0
223,725 13,420,000 388,558 4,970,000.00 - 12,330,635 42,332,918
support) 0
1,196,382,4 76,928,272. 2,721,520,0
Total 266,506,380 194,774,598 44,031,957 525,197,453 417,698,991 0
21 00 72

Annual Operational Plan 5 – 2009/10 191

7.3.2 Off-budget resources

As earlier highlighted, a significant amount of sector resources are off-budget. This

implies they are not captured within the MTEF resource allocations. There are many
reasons for this. However, for the sector to adequately know and utilize resources
available, it is important for it to characterize these resources. These resources are
used to support other implementers in the sector, in addition to Government.

The shadow budget is the framework used for this. It basically applies the MTEF
framework to these off-budget resources, to allow comparison analysis. Over time, the
ability to capture these resources has improved. The table below highlights the
available resources that are off-budget, as provided by the respective partners.

Infrastruc
Commodit
Level of care Area of support HRH/PE O&M ture, incl. Total
ies
eq.
1.1 Management
1. National
support 0 0 8,345 0 8,345
level
1.2 Service Delivery 0 0 0 0 0
2.1 Management
2. Provincial
support 0 0 0 0 0
level
2.2 Service delivery 0 4,248 5,902 0 10,150
3.1 Management
3. District
support 0 0 0 0 0
level
3.2 Service Delivery 0 24,040 11,037 947 36,023
4. Health
4.1 Service delivery
Facility 0 2,403 4,149 209 6,760
5. Community
level 0 5 84 0 89
6. Unclassified Unclassified 0 0 0 0 0
Total 0 30,696 29,516 1,156 61,367
%
contribution Total 0% 50% 48% 2% 100%

The total AOP 5 off-budget resources that could be captured totaled 61 billion kshs.
This is just over the 56 billion available during the past financial year. They represent
the major source of financing for the AOP 5, at 63% of resource requirements, and
55% of the overall available financing. Of these resources, half (50%) is available for
commodities and supplies, while 48% is planned for O+M related activities.
Information on PE support from these on budget resources was not readily available.

Together with the on-budget resources, the total resources available from respective
partners are highlighted in the table below.

National level information on DP’s contribution to the health sector

financing for the financial year 2009/2010, Kshs million
On budget resources Overall total
TOTAL MTEF (on
MTEF (on Off budget) plus
MOPHS MOMS budget) budget off budget
CoC Government of 7,752. 25,828
signatory Kenya 09 .55 33,580.64 33,580.64
Denmark 137.00 68.50 205.50 294 499.68
United Kingdom - - - 4,125 4,125.08
Germany 398.00 700.00 1,098.00 1093.37 2,191.37

Annual Operational Plan 5 – 2009/10 192

 On budget resources Overall total
TOTAL MTEF (on
MTEF (on Off budget) plus
MOPHS MOMS budget) budget off budget
United States of
America - - - 52,601 52,601.09
1,455.0
Japan 445.30 0 1,900.30 1,900.30
European Union - - - 239 239.39
World bank - - - -
UNFPA 110.00 7.50 117.50 117.50
UNICEF 879.16 - 879.16 879.16
UNAIDS - - - -
World Health
Organization - - - 1,493 1,493.32
ADB - 16.00 16.00 16.00
France - - - -
Italy - 137.00 137.00 107 244.00
HENNET - - - -
CHAK/KEC - - - -
ADF 328.79 - 328.79 328.79
GAVI - - - -
Global Fund - - - -
OPEC 400.00 - 400.00 400.00
SIDA - - - -
CoC non BADEA - 550.00 550.00 550.00
signatory Belgium - 1.45 1.45 1.45
Kuwait - 200.00 200.00 200.00
Saudi fund - 200.00 200.00 200.00
WFP - 278.26 278.26 468 745.98
Netherlands - - - 947 946.80
China - 544.00 544.00 544.00
10,450. 29,986. 61,367.
Total 33 26 40,436.59 95 101,804.54

The amounts available for the different input categories, by sources of off budget
resources, are further highlighted in the table below

National level information on DP’s contribution to the health sector

financing for the financial year 2009/2010, by input category, Kshs million
Infrastructu
HRH/PE Commodities O&M Total
Source of funds re, incl. eq.
GDC 0 368 725 0 1,093
USG 0 21,429 24,255 0 45,685
WFP 0 468 0 0 468
DFID 0 1,701 2,216 209 4,125
EU 0 38 201 0 239
Clinton Foundation 0 6,599 318 0 6,917
World Bank 0 0 0 0 0
Italian Cooperation 0 0 107 0 107
WHO 0 0 1,493 0 1,493
Netherlands 0 0 0 947 947
DANIDA 0 93.19 201 0 294
Total 0 30,696 29,517 1,156 61,368

The USG represents the overwhelming bulk of these resources (75%). This presents a
skewed picture. Without the USG resources, the total off budget resources is only 15

Annual Operational Plan 5 – 2009/10 193

billion kshs. This is only 16% of the total resource requirements, and 24% of the
available financing.

These resources are largely earmarked for use in one of the major health programs in
the country. The distribution of these resources across the key program areas is
highlighted in the table below.

Allocation of off – budget resources, by key program area, kshs million

Malaria Reproducti Immuniz TB &
HIV/AIDS control ve Health ation Leprosy Others Total
GDC 67 1,026 1,093
USG 42,084 1,565 1,813 223 45,685
WFP 468 468
DFID 1,710 1,315 380 721 4,125
EU 97 108 34 239
Clinton
6,917 6,917
Foundation
World Bank - -
Italian
107 107
Cooperation
WHO 334 334 70 306 167 283 1,493
Netherlands 947 947
DANIDA 294 294
51,783 3,214 3,395 306 389 2,280 61,368
84% 5% 6% 0% 1% 4% 100%

Over 84% of these resources are earmarked for HIV/AIDS related interventions,
followed by reproductive health interventions at 6%. Improved allocative and technical
efficiency in use of these off-budget resources should improve on the availability of
resources for the sector.

7.3.3 Sector generated resources

As highlighted earlier, the sector generated resources represent expected financing to

be self generated. These are finances from cost sharing, NHIF re-imbursements, LATF,
and CDF5 . These resources are highlighted in the table below.

Sector generated resources by level of care

Infrastruct
Commodit
Level of care Area of support HRH/PE O&M ure, incl. Total
ies
eq.
1.1 Management
support 0 0 0 0 0
1. National level
1.2 Service
Delivery 100 71 3,134 90 3,395
2.1 Management
2. Provincial support 0 0 0 156 156
level 2.2 Service
delivery 0 283 359 160 802
3.1 Management
support 0 0 0 598 598
3. District level
3.2 Service
Delivery 0 1,132 892 355 2,379
4.1 Service
4. Health Facility
delivery 0 0 368 844 1,211
5. Community 0 0 0 104 104

5
NHIF resources would also be reflected here

Annual Operational Plan 5 – 2009/10 194

 level
6. Unclassified Unclassified 0 0 0 0 0
Total 100 1,486 4,753 2,308 8,646
Total 1% 17% 55% 27% 100%
Level 6 3% 2.1% 92% 3% 100%
Level 5 0% 30% 37% 33.0% 100%
% contribution
Level 4 0% 38% 30% 32% 100%
Level 2&3 0% 0% 30% 69.7% 100%
Level 1 0% 0.0% 0% 100.0% 100%

These represent 9% of the total resource requirements for AOP 5, with most used for
O+M (55%) and infrastructure investments (27%). The O&M resources are mainly
from cost sharing sources. On the other hand, the infrastructure investments are
being made through the LATF and CDC sources. NHIF reimbursements are highlighted
at Commodities and Supplies for level 4 – 6 service delivery6. There is scope for
additional resources, through the CDF for the sector. Details on contributions towards
these sector generated resources are available in the respective plans.

7.4 Financing gaps for AOP 5

The resource gaps for AOP 5 are based on the difference between the resource
requirements, and the available resources. The overall resource gaps are highlighted
in the table below.

AOP 5 overall sector financing gaps, kshs million

Total Total Infrastruct
Financi
Level of care Area of support requirem availabl Commodi ure, incl.
ng gap
ents e funds HRH/PE ties O&M eq.
1.1 Management
7,264 12,254 -4,990
1. National support (453) - (4,032) (505)
level 1.2 Service
14,591 7,992 6,599
Delivery 3,215 29 746 2,610
2.1 Management
1,088 374 715
2. Provincial support - - 870 (156)
level 2.2 Service
9,793 14,574 -4,781
delivery 2,247 (1,106) (5,664) (258)
3.1 Management
2,432 1,401 1,032
3. District support - - 948 83
level 3.2 Service -
35,083 56,104
Delivery 21,022 4,617 (10,514) (10,226) (4,898)
4. Health 4.1 Service
22,185 17,387 4,798
Facility delivery 1,813 9,453 (1,735) (4,734)
5. Community
1,680 364 1,316
level 626 (5) 695 -
6. Unclassified Unclassified 0 0 0 - - - -
110,45 (16,33 (18,39
Total 94,117 0 4) 12,065 (2,143) 8) (7,858)

At a macro level, the sector appears to have over 16 billion kshs more than it requires.
This is especially seen for service delivery at the district and provincial levels, plus
national level management support.

6
Estimates are based on last expenditure figures for NHIF 92006/07 FY). These are
disaggregated based on estimates of 5% at national level (3% KNH, 2% MTRH), 20% at
provincial level, and 75% at district level hospitals

Annual Operational Plan 5 – 2009/10 195

Looking at the composition, it is only PE that has a financing gap, of over 12 billion
kshs.

This picture is skewed, as most of the available financing (minus Government

resources) are largely earmarked for particular programs, or even activities. This is so
for both on budget, and off budget resources. There is therefore a significant
possibility of over-financing of some areas of support, leading to possible inefficiencies
in resource allocation and use.

As highlighted in the previous section, the USG resources contribute significantly to

the overall available resources, and therefore reduction in the financing gap. In the
absence of the USG resources, the situation changes significantly, to a financing gap
of 31 billion kshs. In this scenario, there is a financing gap of 19 billion kshs for
commodities, and a gap of 7 billion kshs for O+M.

The persistent apparent surplus of resources in infrastructure is a result of lack of

standardized infrastructure investment standards, leading to different partners using
different methods to determine requirements, and their planned support.

Gap analysis highlights the fact that, even though there is an overall surplus of
resources in the sector, there are still gaps in financing for key areas of priority. The
apparent surplus, for example, in C+S, and O+M are largely a result of significant
earmarked USG resources. There are therefore still underlying financing gaps in the
sector, with possible relative over-funding of other areas.

If the sector were in complete control of prioritization of use of these resources, then it
would significantly reduce its existing financing gaps. However, it is limited as most of
its resources are off-budget and earmarked, meaning there is little scope for making
these resources more fungible, and directing them to poorly financed priorities. In the
Health Financing Strategy that the sector is developing, there is need to put emphasis
on ways to ensure allocative, and technical efficiency is prioritized, as there is clearly
scope for freeing up significant resources if those available are appropriately allocated
for priorities.

Annual Operational Plan 5 – 2009/10 196

 Annex 1: Detailed breakdown of resource
requirements, financing and financing gap for
AOP 5
AOP 5 detailed breakdown for resource requirements (Millions kshs)
Infrastruc
Area of
Level of care Commodi ture, incl.
support
Focus of support HRH/PE ties O&M eq. Total
Total Management support 968 - 6,066 230 7,264
MoH HQ Public Health Professional
Services 150 - 312 - 461
1.1
MOH HQ Medical Services
Manage
Professional Services 224 - 468 - 692
ment
MOH HQ Administrative support 594 - 508 30 1,132
support
KMTC - - 4,778 150 4,928
1. National
KEMRI - - - 50 50
level
KEMSA - - - - -
Total Service Delivery 7,380 103 3,952 3,156 14,591
KNH 6,058 42 3,376 3,066 12,542
1.2
Moi TRH 976 28 522 90 1,616
Service
Management of Emergencies - 11 - - 11
Delivery
Mental Health Services 346 21 54 - 421
Unclassified - - - - -
2.1 Total Management support 117 - 972 - 1,088
Manage PHMT professional services 25 - 397 - 422
ment PHT professional services 91 - 575 - 666
support Hospital Management - - - -
Total Service Delivery 3,985 4,582 902 324 9,793
Immunizations (incl. CH) - 156 5 15 176
2. Provincial
RH, incl FP - 132 57 17 206
level
2.2 HIV/Aids - 2,126 78 - 2,204
Service TB - 225 113 - 338
delivery Malaria - 145 89 - 234
Provincial health services 3,985 1,798 559 293 6,635
EMMS - 592 - - 592
Other supplies - 1,206 - - 1,206
Total Management support 422 - 1,329 682 2,432
3.1
DHMT professional services 25 - 1,023 682 1,730
Manage
DHT professional services 396 - 306 - 702
ment
Hospital Management - - - - -
support
Unclassified - - - - -
Total Service Delivery 12,150 17,411 2,434 3,087 35,083
Immunizations (incl. CH) - 467 4 45 516
3. District
RH, incl FP - 382 164 48 594
level
HIV/Aids - 6,137 226 - 6,363
3.2
TB - 650 327 - 976
Service
Malaria - 419 257 - 676
Delivery
Hospital Service Delivery - - - - -
District health services 12,150 9,357 1,456 2,995 25,957
EMMS - 5,898 - - 5,898
Other supplies - 3,459 - - 3,459
L-2/3 Rural Services 5,293 12,138 3,380 1,373 22,185
Immunizations (incl. CH) - 2,491 53 240 2,784
RH, incl FP - 686 295 86 1,067
HIV/Aids - - 406 - 406
4.1
4. Health TB - 1,168 587 - 1,755
Service
Facility Malaria - 5,077 463 - 5,540
delivery
Environmental Health 305 285 335 116 1,040
Rural health care services 4,988 2,432 1,241 931 9,593
EMMS - 2,059 - - 2,059
Other supplies - 373 - - 373
5. L-1 Community Services 626 - 950 104 1,680

Annual Operational Plan 5 – 2009/10 197

Community
level Community H. Services 626 - 950 104 1,680
6.
Unclassified Unclassified funds -
Total 30,940 34,235 19,985 8,957 94,117

Annual Operational Plan 5 – 2009/10 198

 AOP 5 detailed breakdown for total available resources
Level of Area of Commoditie Infrastructu
care support Focus of support HRH/PE s O&M re, incl. eq. Total
Total Management support 1,421 - 10,099 735 12,254
MoH HQ Public Health Professional
Services 80 - 6,247 - 6,327
1.1 MOH HQ Medical Services
Manage Professional Services 488 - 2,581 - 3,068
ment MOH HQ Administrative support 852 - 218 287 1,358
support KMTC - - 777 155 932
1. KEMRI - - - 203 203
National
KEMSA - - 276 68 344
level
Other (Specify) - - - 22 22
Total Service Delivery 4,165 75 3,206 546 7,992
KNH 3,217 42 2,605 412 6,276
1.2
Moi TRH 948 28 596 134 1,707
Service
Management of Emergencies - - 5 - 5
Delivery
Mental Health Services - - - - -
Unclassified - 4 - - 4
Total Management support 117 - 102 156 374
2.1 PHMT professional services 25 - 86 117 228
Manage PHT professional services 91 - 16 39 146
ment Hospital Management - - - - -
support Unclassified - - - - -
Other (Specify) - - - - -
Total Service Delivery 1,738 5,688 6,566 583 14,574
2. Immunizations (incl. CH) - - 15 - 15
Provinci RH, incl FP - 54 208 - 262
al level HIV/Aids - 4,157 4,790 - 8,947
2.2 TB - - 152 - 152
Service Malaria - 32 384 - 415
delivery Provincial health services 1,738 1,445 1,016 583 4,782
EMMS - - - - -
Other supplies - 5 5 - 10
Unclassified - - - - -
Other (Specify) - - - - -
3.1 Total Management support 422 - 381 598 1,401
Manage DHMT professional services 25 - 342 543 911
ment DHT professional services 396 - 38 55 490
support Hospital Management - - - - -
Total Service Delivery 7,533 27,925 12,660 7,986 56,104
Immunizations (incl. CH) - - 46 - 46
3.
RH, incl FP - 294 269 - 563
District
HIV/Aids - 23,557 9,840 - 33,397
level 3.2
TB - - 136 - 136
Service
Malaria - 179 389 - 568
Delivery
Hospital Service Delivery - - - - -
District health services 7,533 3,896 1,980 7,986 21,395
EMMS - - - - -
Other supplies - 10 357 947 1,314
L-2/3 Rural Services 3,480 2,685 5,115 6,107 17,387
Immunizations (incl. CH) - - 214 - 214
RH, incl FP - 425 1,382 - 1,807
HIV/Aids - - 2,360 - 2,360
4.1 TB - - 19 - 19
4. Health
Service Malaria - 1,894 118 - 2,012
Facility
delivery Environmental Health - - - - -
Rural health care services 3,480 283 1,007 6,107 10,876
EMMS - - - - -
Other supplies - - - 209 209
Other (Specify) - 83 16 - 99
5. L-1 Community Services - 5 255 104 364
Commun
ity level Community H. Services - 5 255 104 364
Total 18,875 36,378 38,382 16,815 110,450

Annual Operational Plan 5 – 2009/10 199

 AOP 5 detailed breakdown for MTEF resources
Infrastruct
Level of Area of
Commodit ure, incl.
care support
Focus of support HRH/PE ies O&M eq. Total

Total Management support 1,421 - 1,753 735 3,909

MoH HQ Public Health Professional
Services 80 - 405 - 486
MOH HQ Medical Services
1.1 Professional Services 488 - 77 - 565
Manage
MOH HQ Administrative support 852 - 218 287 1,358
ment
KMTC - - 777 155 932
support
1. KEMRI - - - 203 203
National KEMSA - - 276 68 344
level Unclassified - - - - -
Other (Specify) - - - 22 22
Total Service Delivery 4,065 4 72 456 4,597
KNH 3,117 - 55 412 3,583
1.2
Moi TRH 948 - 12 44 1,004
Service
Management of Emergencies - - 5 - 5
Delivery
Mental Health Services - - - - -
Unclassified - 4 - - 4
Total Management support 117 - 102 - 218
2.1 PHMT professional services 25 - 86 - 111
Manage PHT professional services 91 - 16 - 108
ment Hospital Management - - - - -
support Unclassified - - - - -
Other (Specify) - - - - -
Total Service Delivery 1,738 1,157 305 422 3,622
2.
Immunizations (incl. CH) - - - - -
Provinci
RH, incl FP - - - - -
al level
HIV/Aids - - - - -
2.2
TB - - - - -
Service
Malaria - - - - -
delivery
Provincial health services 1,738 1,157 305 422 3,622
EMMS - - - - -
Other supplies - - - - -
Unclassified - - - - -
Total Management support 422 - 381 - 802
3.1
DHMT professional services 25 - 342 - 367
Manage
DHT professional services 396 - 38 - 435
ment
Hospital Management - - - - -
support
Unclassified - - - - -
Total Service Delivery 7,533 2,753 731 6,684 17,702
3. Immunizations (incl. CH) - - - - -
District RH, incl FP - - - - -
level HIV/Aids - - - - -
3.2
TB - - - - -
Service
Malaria - - - - -
Delivery
Hospital Service Delivery - - - - -
District health services 7,533 2,753 731 6,684 17,702
EMMS - - - - -
Other supplies - - - - -
L-2/3 Rural Services 3,480 283 599 5,054 9,416
Immunizations (incl. CH) - - - - -
RH, incl FP - - - - -
HIV/Aids - - - - -
4.1
4. Health TB - - - - -
Service
Facility Malaria - - - - -
delivery
Environmental Health - - - - -
Rural health care services 3,480 283 599 5,054 9,416
EMMS - - - - -
Other supplies - - - - -
5. L-1 Community Services - - 171 - 171
Commun
ity level Community H. Services - - 171 - 171
Total 18,775 4,197 4,113 13,351 40,437

Annual Operational Plan 5 – 2009/10 200

Annual Operational Plan 5 – 2009/10 201
 AOP 5 detailed breakdown for off-budget resources
Infrastruc
Level of Area of
HRH/P Commodi ture, incl.
care support
Focus of support E ties O&M eq. Total
Total Management support - - 8,345 - 8,345
MoH HQ Public Health Professional
Services 5,842 5,842
1.1
MOH HQ Medical Services
Manage
Professional Services 2,504 2,504
ment
MOH HQ Administrative support -
1. support
KMTC -
National
KEMRI -
level
KEMSA -
Total Service Delivery - - - - -
1.2 KNH -
Service Moi TRH -
Delivery Management of Emergencies -
Mental Health Services -
Total Management support - - - - -
2.1 PHMT professional services -
Manage PHT professional services -
ment Hospital Management
support Unclassified -
Other (Specify) -
Total Service Delivery - 4,248 5,902 - 10,150
2. Immunizations (incl. CH) - - 15 - 15
Provinci RH, incl FP - 54 208 - 262
al level HIV/Aids - 4,157 4,790 - 8,947
2.2 TB - - 152 - 152
Service Malaria - 32 384 - 415
delivery Provincial health services - 5 353 - 358
EMMS - - - - -
Other supplies - 5 5 - 10
Unclassified -
Other (Specify) -
3.1 Total Management support - - - - -
Manage DHMT professional services -
ment DHT professional services -
support Hospital Management -
Total Service Delivery - 24,040 11,037 947 36,023
Immunizations (incl. CH) - - 46 - 46
3.
RH, incl FP - 294 269 - 563
District
HIV/Aids - 23,557 9,840 - 33,397
level 3.2
TB - - 136 - 136
Service
Malaria - 179 389 - 568
Delivery
Hospital Service Delivery - - - - -
District health services - 10 357 947 1,314
EMMS - - - - -
Other supplies - 10 357 947 1,314
L-2/3 Rural Services - 2,403 4,149 209 6,760
Immunizations (incl. CH) - - 214 - 214
RH, incl FP - 425 1,382 - 1,807
HIV/Aids - - 2,360 - 2,360
4.1 TB - - 19 - 19
4. Health
Service Malaria - 1,894 118 - 2,012
Facility
delivery Environmental Health - - - - -
Rural health care services - 40 209 249
EMMS - - - - -
Other supplies - - - 209 209
Other (Specify) - 83 16 - 99
5. L-1 Community Services - 5 84 - 89
Commun
ity level Community H. Services - 5 84 - 89
6.
Unclassif
ied Unclassified funds - - -
Total - 30,696 29,516 1,156 61,367

Annual Operational Plan 5 – 2009/10 202

Annual Operational Plan 5 – 2009/10 203
 AOP 5 detailed breakdown for Sector generated resources
Infrastruct
Level of Area of
Commodit ure, incl.
care support
Focus of support HRH/PE ies O&M eq. Total

Total Management support - - - - -

MoH HQ Public Health Professional
Services -
MOH HQ Medical Services
1.1 Professional Services -
Managemen MOH HQ Administrative support -
t support KMTC -
1. KEMRI -
National
KEMSA -
level
Unclassified -
Other (Specify) -
Total Service Delivery 100 71 3,134 90 3,395
KNH 100 42 2,550 0 2,692
1.2 Service
Moi TRH 0 28 584 90 703
Delivery
Management of Emergencies 0 0 0 0 -
Mental Health Services - - - - -
Total Management support - - - 156 156
PHMT professional services 0 0 0 117 117
2.1
PHT professional services 0 0 0 39 39
Managemen
Hospital Management - - - - -
t support
Unclassified - - - - -
Other (Specify) - - - - -
Total Service Delivery - 283 359 160 802
2. Immunizations (incl. CH) - - - - -
Provincia RH, incl FP - - - - -
l level HIV/Aids - - - - -
TB 0 0 0 0 -
2.2 Service
Malaria 0 0 0 0 -
delivery
Provincial health services 0 283 359 160 802
EMMS - - - - -
Other supplies - - - - -
Unclassified - - - - -
Other (Specify) - - - - -
Total Management support - - - 598 598
3.1
DHMT professional services - - - 543 543
Managemen
DHT professional services - - - 55 55
t support
Hospital Management - - - - -
Total Service Delivery - 1,132 892 355 2,379
Immunizations (incl. CH) - - - - -
3.
RH, incl FP - - - - -
District
HIV/Aids - - - - -
level
3.2 Service TB - - - - -
Delivery Malaria - - - - -
Hospital Service Delivery - - - - -
District health services - 1,132 892 355 2,379
EMMS - - - - -
Other supplies - - - - -
L-2/3 Rural Services - - 368 844 1,211
Immunizations (incl. CH) - - - - -
RH, incl FP - - - - -
HIV/Aids - - - - -
4. Health 4.1 Service TB - - - - -
Facility delivery Malaria - - - - -
Environmental Health - - - - -
Rural health care services - - 368 844 1,211
Unclassified - - - - -
Other (Specify) - - - - -
5. L-1 Community Services - - - 104 104
Communi
ty level Community H. Services - - - 104 104
Total 100 1,486 4,753 2,308 8,646

Annual Operational Plan 5 – 2009/10 204

 AOP 5 detailed breakdown for financing gap
Infrastruc
Level of Area of
HRH/ Commodi O& ture, incl.
care support
Focus of support PE ties M eq. Total

(4,03 (4,99
Total Management support (453) - 2) (505) 0)
MoH HQ Public Health Professional (5,93 (5,86
Services 69 - 5) - 6)
1.1 MOH HQ Medical Services (2,11 (2,37
Manage Professional Services (264) - 3) - 6)
ment MOH HQ Administrative support (259) - 290 (257) (226)
support 4,00 3,99
KMTC - - 1 (5) 6
1. KEMRI - - - (153) (153)
National
KEMSA - - (276) (68) (344)
level
Other (Specify) - - - (22) (22)
3,21 6,59
Total Service Delivery 5 29 746 2,610 9
2,84 6,26
1.2 KNH 1 0 771 2,654 6
Service
Moi TRH 28 (0) (74) (44) (90)
Delivery
Management of Emergencies - 11 (5) - 6
Mental Health Services 346 21 54 - 421
Unclassified - (4) - - (4)
Total Management support - - 870 (156) 715
2.1 PHMT professional services - - 311 (117) 195
Manage PHT professional services - - 559 (39) 520
ment Hospital Management - - - - -
support Unclassified - - - - -
Other (Specify) - - - - -
2,24 (5,66 (4,78
Total Service Delivery 7 (1,106) 4) (258) 1)
Immunizations (incl. CH) - 156 (10) 15 160
2. RH, incl FP - 78 (151) 17 (56)
Provinci (4,71 (6,74
al level HIV/Aids - (2,031) 2) - 4)
2.2 TB - 225 (39) - 186
Service Malaria - 114 (295) - (181)
delivery 2,24 1,85
Provincial health services 7 353 (457) (290) 3
EMMS - 592 - - 592
1,19
Other supplies - 1,201 (5) - 6
Unclassified - - - - -
Other (Specify) - - - - -
1,03
3.1 Total Management support - - 948 83 2
Manage
DHMT professional services - - 681 138 820
ment
DHT professional services - - 267 (55) 212
support
Hospital Management - - - - -
4,61 (10,2 (21,0
Total Service Delivery 7 (10,514) 26) (4,898) 22)
Immunizations (incl. CH) - 467 (42) 45 471
RH, incl FP - 88 (105) 48 31
3.
(9,61 (27,0
District
HIV/Aids - (17,420) 4) - 34)
level
3.2 TB - 650 190 - 840
Service Malaria - 240 (131) - 109
Delivery Hospital Service Delivery - - - - -
4,61 4,56
District health services 7 5,461 (525) (4,991) 2
5,89
EMMS - 5,898 - - 8
2,14
Other supplies - 3,448 (357) (947) 5
4. 4.1 L-2/3 Rural Services 1,81 9,453 (1,73 (4,734) 4,79
Health Service 3 5) 8

Annual Operational Plan 5 – 2009/10 205

 2,57
Immunizations (incl. CH) - 2,491 (161) 240 0
(1,08
RH, incl FP - 261 7) 86 (740)
(1,95 (1,95
HIV/Aids - - 3) - 3)
1,73
TB - 1,168 568 - 5
3,52
Facility delivery
Malaria - 3,183 345 - 7
1,04
Environmental Health 305 285 335 116 0
1,50 (1,28
Rural health care services 8 2,149 235 (5,175) 3)
2,05
EMMS - 2,059 - - 9
Other supplies - 373 - (209) 164
Other (Specify) - (83) (16) - (99)
5. 1,31
Commu L-1 Community Services 626 (5) 695 - 6
nity 1,31
level Community H. Services 626 (5) 695 - 6
12,0 (18,3 (16,3
Total 65 (2,143) 98) (7,858) 34)

Annual Operational Plan 5 – 2009/10 206