community strategy
for delivery of level one
services
Level II
Lecture
By
Waithaka P.M.
Background
There has been continued deterioration of health status
parameters for Kenya populations as reflected by various
studies and surveys.
As a result the Kenya government current policy
indicated that it will ensure accessible affordable and
quality health care to all Kenyans.
The government of Kenya has initiated several reforms
in its operations for effective health care delivery.
The national health sector strategic plan (NHSSP II)
2005-2010 proposed the community care as the core for
delivery of Kenya essential package for health KEPHS.
National health policy
National health
policy
National Health Sector
Strategic plan II
(2005-2010)
KEPHS
Annual operational plans
Main elements of implementation
plan
The main elements of implementation
plans include;
Creating linkages from NHSSPII to the
overall development objectives as
expressed in the Economic Recovery
Strategy for Wealth and Employment
Creation 2003-2007 (ERSWEC), and the
achievements of the Millennium
Development Goals (MDGs).
Renewing attention to the right to health care
and the importance of good health at the
household, family and community level.
Introducing the Kenya Essential Package for
Health (KEPH), this integrates all health
programes into a single package to improve the
health of the population in the different stages
in their life cycle and incorporates the various
systems that will support KEPH.
Proposing to change the governance of the
sector by institutionalising and improving the
relations between MoH and all stake holders.
KEPHS include
Reproductive health
Demand for RH services expanded and
services scaled up, commodity security
ensured, policy environment and systems
strengthened, capacity and motivation of
human resources enhanced.
Malaria
Management and coordination of malaria
control programme enhanced, timely
availability of necessary commodities ensured.
Environmental health
Vector surveillance and control in high risk
areas
supervision visits and surveys conducted
policies on sanitation and hygiene available
and distributed
sanitation data base developed and training
provided.
Mental health
Clear policy framework on mental health
adequate mental health services provided as
part of KEPH
Child health
Services scaled up,
policy environment and systems
strengthened,
capacity to deliver services enhanced,.
Kenya Expanded Programme of
Immunisation (KEPI)
Immunisation coverage increased (63-75%
full immunisation coverage-FIC),
all districts with no- stock outs,
TT coverage for pregnant women increased
by 10%, strengthened surveillance for Vaccine
preventable diseases (VPD).
Health promotion
Development of policy and strategic
guidelines,
human resource capacity building, programme
monitoring and evaluation.
HIV/AIDs (National AIDs/STD Control
Programme- NASCOP)
Training at all levels and in all NASCOP
coordinated programmes supported and
carried out,
scaling up of programmes and activities in
VCT, PMTCT, STI,ART, blood safety
programmes and condom strategy
Tuberculosis Control Programme
Reduction of the impact of HIV on TB,
prevention of TB among PLWHA,
maximise case finding, integrated TB control services
in to DHMT system.
Nutrition
Planning and coordination mechanisms improved
capacity to deliver services
evaluation and quality assurance mechanism
improved.
Communicable Disease Control /Integrated
Disease Surveillance and Response
Capacity to detect, report and respond to health
emergencies strengthened.
Division of child services
Access and demand for quality rural health
services expanded.
Division of Ophthalmic services
Quality of service improved,
functional equipment and instruments for
service delivery ensured,
human resource capacity building,
primary eye care activities integrated into PHC
activities.
Dental Health
Strengthened monitoring and evaluation
commodity procurement, and logistic
management systems.
Division of nursing
Improved systems and management for
provision of quality nursing care.
National Blood Transfusion Services
(NBTS)
Capacity strengthened, i.e. management,
collection-processing-distribution, staff
response, quality and safety monitored.
National Public Health Laboratory Services
(NPHLS)
Policy defined, commodity security ensured,
lab working environment up to standards,
staffing norms implemented.
Drug Inspection
Pharmaceutical dispensed according in
accordance with regulations (drug storage,
dispensing, disposal and accountability issues)
Radiology Services
imaging services available in all facilities as
per norms an standards
The six KEPHS Levels of care
6
Tertiary
hospital
5
Secondary hospitals
(Provincial Hosp)
4
Primary hospitals
(District Hosp)
3
Health centers, maternities, nursing homes
2
Dispensaries/clinics
1
Community: village/household/families/individuals
Health care providers on various
levels
Level one; community owned resource persons
Level two; registered comprehensive nurses,
community health extension workers.
Level three; nursing staff, clinical officers, lab
technicians, pharmaceutical technologists,
community oral health officers.
Level four, five and six; above staff plus, medical
officers, radiographers, pharmacists, dentists.
Carders of health service providers
at level one
1. Community oriented resource persons
(CORPS)
Members of the community
Selected by community for the responsibility
Trained on basic health issues e.g. antenatal,
malaria control, water treatment, disease
prevention, IGAs etc.
Work on voluntary basis – given token of
appreciation by community and NGOS when
involved in projects.
2. Community Health extension worker
- health professional
- trained to work /serve at community level
- examples – community nurses and public
health technicians.
level one operational structure
One level one unit will have;
Catchments of 5,000 people
50 community oriented resource persons
(CORPS)
2 community health extension workers
(CHEWs)
One CHEW will supervise and support 25
CORPS
One CORP to serve 20 households approx
100 people.
One level 1 unit
CHEW CHEW
25 25
CORPs CORPs
1 CORP 1 CORP
20 20
houses houses
House hold structure
In each household members are
categorized in to cohorts based on their
health needs.
This make it easy for service delivery
especially for the CORPS who are right at
the village level of service delivery
Cohorts
Cohort one
Comprise pregnancy, delivery and newborn
for the first two weeks.
Services include
Exclusive breast feeding education
Information on safe pregnancy
Pregnancy monitoring, referral incase of
complications
New born care information
Professional Supervised home delivery
Cohort two
Comprise Early child hood from two weeks
to 5 years.
Service Needs include
Promote IMCI activities
Conduct deworming
Mobilize for early childhood development (ECD)
Dissemination of Health messages on ECD
Support nutrition awareness
Promote food and nutrition security
Monitor growth and development
Cohort three
Comprise late child hood 5 to 12 years old
Service needs include;
Promote gender sensitive school health
activities
Educate children on healthy lifestyle and
psycho social development
Inform teachers and parents on school
health
Promote child-to- child approach to healthy
lifestyle
Cohort four
Comprise adolescents and youth (13-24 yrs)
Service needs include;
Equip youth in and out of school with knowledge and
life skills.
Facilitate a supportive environment to promote healthy
life style for them selves and community.
Initiate youth friendly centers in collaboration with
GOK,NGO, Private institutions etc
Raise awareness on disease causation, control and
prevention especially STI/HIV/AIDs
Provide family life education
Cohort five
Adult 25 – 59 years
Service needs include;
Educate on non communicable diseases
control
Care for chronically ill
Disseminate key health messages for
promotion and adoption of healthy lifestyles
Assist in ensuring household food security
Promote participation on community actions
for health.
Cohort six
Elderly persons 60+ yrs
Educate community and families on old age
illnesses, impairments, disabilities.
Inform on how to improve quality of life and
sources of care.
Advocate for the development of social
support systems for the elderly.
Develop community home based care for the
elderly persons with chronic illnesses.
Summary
This structure is currently being
implemented in community level of service
provision for effective health service
provision.
It is a more preventive and promotive
approach than has previously been for this
level.
It is aimed at achieving the national health
goal and policy of accessible, affordable
quality health for all.
Tutorial questions
Describe the current levels of KEPHS
implementation (15 marks)
Describe the health services providers and
their roles at a level one service delivery
unit (10 marks)
Discuss the various cohorts and their
health care needs in a community (20
marks)
Kwisha
Fini
Finito
finish
