Samburu county consolidated aprp and planning for department of health services

Health Sector Annual Performance report and priorities for Samburu County. 1
SAMBURU COUNTY GOVERNMENT.SAMBURU COUNTY GOVERNMENT.SAMBURU COUNTY GOVERNMENT.SAMBURU COUNTY GOVERNMENT.
DEPARTMENT OF HEALTH SERVICESDEPARTMENT OF HEALTH SERVICESDEPARTMENT OF HEALTH SERVICESDEPARTMENT OF HEALTH SERVICES
ANNUAL PERFORMANCE
REPORT AND PLAN FOR
IMPLEMENTATION OF HEALTH
SERVICES
COUNTY: SAMBURU
FINANCIAL YEAR FOR REPORT: 2013/2014
FINANCIAL YEAR FOR PLAN: 2014/2015

Contents
SECTION 1: INTRODUCTION ................................................................................................................4
1.1 Overview of the report .............................................................................................................4
1.2 Population Description .............................................................................................................4
1.3 Service provision capacity.........................................................................................................5
COUNTY PERFORMANCE FOR THE PREVIOUS YEAR..............................................................................7
SECTION 2: TRENDS AND ACHIEVEMENTS ..............................................................................................8
2.1 Health Status in the County ......................................................................................................9
2.2 Health Services Outcomes ......................................................................................................10
2.3 Health outputs ........................................................................................................................13
2.4 Health investments.................................................................................................................14
SECTION 3: KEY MILESTONES, ISSUES & CHALLENGES............................. Error! Bookmark not defined.
3.1 Health outcome milestones, issues and challenges .................. Error! Bookmark not defined.
3.2 Health output milestones, issues and challenges...................... Error! Bookmark not defined.
3.3 Health investments milestones, issues and challenges............. Error! Bookmark not defined.
SECTION 4: COUNTY HEALTH EXPENDITURE REVIEW...........................................................................27
4.1 Summary of Health Expenditures ...........................................................................................27
4.2 Health Expenditures by source of financing ...........................................................................27
4.3 Health expenditures by KEPH service area.............................................................................28
4.4 Health expenditures by investment areas..............................................................................29
SECTION 5: BEST PRACTICE IN SERVICE DELIVERY.................................................................................32
PLAN FOR HEALTH SERVICE PROVISION IN THE COMING YEAR........................................................34
SECTION 6: COUNTY BUDGET ................................................................... Error! Bookmark not defined.
SECTION 7: KEY TARGETS FOR THE COMING YEAR ...............................................................................36
7.1 Health Service improvement targets......................................................................................36
7.2 Health outcome targets..........................................................................................................38
7.3 Health output targets..............................................................................................................40
7.4 Health investment targets ......................................................................................................41
SECTION 8: KEY INTERVENTIONS FOR THE COMING YEAR...................................................................43
8.1 Health Outcome priorities ......................................................................................................43
8.2 Health Output priorities..........................................................................................................48
8.3 Health budget distribution and priorities for coming year.....................................................50
Annex 1: Process of developing the report.................................................................................................53

Foreword
The Constitution of Kenya 2010 provides for the highest attainable standards of health which
include the right to healthcare services including reproductive health care.
Vision 2030 aims to provide an efficient and high quality health care system with best standards.
In order to address these obligations the Kenya health policy has come up with 6 strategic
objectives and 7 orientations which indicates the areas in which investments need to be made to
improve health care. The KNHSSP II addressed the worsening health indicators as enumerated in
the end term review of KNHSSP 1. Though significant ground has been covered, a lot more
needs to be done. With the devolution of health services, the role of ensuring the various
constitutional provisions are met is now the responsibility of the County Government through the
county health department. The Annual Performance Review and Plan (APRP) therefore
operationalizes the health priorities of Samburu County as highlighted in the County Health
strategic Plan. This APRP has been developed through an extensive consultative process with
key stakeholders and has been developed as reference document to guide health service delivery
in the County
Irene Senei
County Minister of Health.
Samburu.

SECTION 1: INTRODUCTION
1.1 Overview of the report
This report is a comprehensive overview of overall performance of various indicators that
contributed to health care services within the County during the year under review 2013/2014.
This report covers performance on three key issues
• Health out puts which touches on the six key policy objectives
• Health outcomes which touch on Access of health care ,quality of health care and
demand creation for health care services.
• Health investment which includes infrastructure, health care financing, Health workforce,
service delivery systems, health leadership and Health information
Key events affecting health during the year
New / re-emerging threats in
the area of responsibility
Key health advocacy events held during the year
1 Drought 1 Breastfeeding week (1-8th
August 2013)
2 Jiggers menace 2 Health promotion
3 Insecurity 3 Supplementary immunization activities(SIAs)/
National Immunization days (NIDs)
4 Enormous emergence of
alcohol,drug and substance
abuse among the youths in
urban centres
4 Malezi bora weeks (November 2013/May 2014)
5 Increase in mental disorders 5 World AIDS day (1/12/2013)
6 Injuries from motorcycle
accidents
6 World Malaria Day (
7 Ebola 7 Global hand washing
8 World TB day (24th
march 2014)
9 World Toilet day (November 2013)
1.2 Population Description
The current projected population for 2014 based on the 2009 population census is 258,345. This
represents a population density of 13 persons per sq Km occupying 51,670 households. Children
under five years constitute 18.93% of the population; Women of Reproductive Age (WRA)
21.19% while the elderly 4.42%
Literacy level is still low particularly in the rural areas, where parents still prefer to engage their
children in herding of animals (primary school enrollment is at 46% of expected level of
enrollment)
The Samburu community is mainly pastoralists though a small proportion has started engaging in
other businesses and have settled in various trading centres scattered over the vast County

County Population description
Description Population estimates Population receiving services
1 Total population 258,345
2 Total Number of Households 51669
3 Children under 1 year (12 months) 3.60% 9300
4 Children under 5 years (60 months) 18.93% 48905
5 Under 15 year population 50.72% 131033
6 Women of child bearing age (15 – 49 Years) 21.19% 54743
7 Estimated Number of Pregnant Women 4.48% 11574
8 Estimated Number of Deliveries 3.93% 10153
9 Estimated Live Births 3.93% 10153
10 Total number of Adolescent (15-24) 20.23% 52263
11 Adults (25-59) 28.06% 72492
12 Elderly (60+) 4.42% 11419
*use county proportions
1.3 Service provision capacity
We have a total of 72 health facilities, which includes 1 County referral hospital, 1 faith based Hospital (Catholic
Hospital Wamba), 1 Sub County hospital,(Baragoi), 14 Health centres, 44 Dispensaries and 11 private clinics
Description Numbers Ownership
Public Faith Based Private NGO
Number of community units 18
Fully functional units 14
Partially functional units 4
Units not established 38
Number of health facilities by type Levels of care
Hospitals 3 2 1 0 0
Health Centres 12 9 2 0 1
Dispensaries 44 34 7 4 1
Clinics 11 0 0 11 0

COUNTY
PERFORMANCE
FOR THE
PREVIOUS YEAR
2013-2014.

SECTION 2: TRENDS AND ACHIEVEMENTS
2.1 Health Status in the County
Samburu County has not been performing well in some health indicators especially Maternal
newborn and Child Health. Many interventions have been introduced to improve these indicators
including free health services in all tier 2 facilities, free Maternity services in all facilities and
Performance Based Financing (PBF) .
Some improvement has been noted between 2011 and 2012 after introduction of the above
interventions with deliveries by skilled delivery at the facility increasing from 19.2% to19.8%,
Fully Immunized Child (FIC) from 58.8% to 68.9%, ANC fourth visit from 28.3% to 30.8%,
WRA receiving Family Planning (FP) commodities from 17.8% to 26.7%.However, differences
in the improvement varied from one Sub County to another.
Other interventions were also introduced to specifically address the high burden of diseases such
as HIV/AIDS, TB, and malaria. Notably, HIV/AIDS control programming showed progress,
with evidence of reducing incidence, prevalence, and mortality.
Although TB control was challenged by HIV co-infection, it also showed improvements with
key indicators as case notification, case detection and treatment successes. However, the
emergence of drug-resistant TB in the county is a key challenge.
Non communicable conditions represent an increasingly significant burden of ill health and
deaths due to; cardiovascular diseases, cancers, respiratory diseases, digestive diseases and
psychiatric conditions
Finally, injuries are relatively high in the county though under reported.
2.1.1 Estimated Health Impact
Impact level Indicators National estimates County estimates
Life Expectancy at birth (years) 63.52yrs 52*
Annual deaths (per 1,000 persons) – Crude mortality 8/1000 2*/1000 6/100,000
Client satisfaction Index
Neonatal Mortality Rate (per 1,000 births) 9/1000 11*/1000
Infant Mortality Rate (per 1,000 births) 40.71/1000 34*/1000
Under 5 Mortality Rate (per 1,000 births) 71/1000 50*/1000 5/100000
Maternal Mortality Rate (per 100,000 births) 360/100000 443*/100000
Adult Mortality Rate Male (per 100,000 births) 378/100000 483*/100000
Adult Mortality Rate Female (per 100,000 births) 358/100000

2.1.2 Ranking of top 10 causes of morbidity and mortality
Major conditions causing death Rank (1 – 10) Major conditions causing ill health Rank (1 – 10)
HIV/AIDS 1 HIV/AIDS 1
Perinatal conditions 2 Perinatal conditions 2
Lower respiratory infections 3 Malaria 3
Tuberculosis 4 Lower respiratory infections 4
Diarrhoeal diseases 5 Diarrhoeal diseases 5
Malaria 6 Tuberculosis 6
Cerebrovascular disease 7 Road traffic accidents 7
Ischaemic heart disease 8 Congenital anomalies 8
Road traffic accidents 9 Violence 9
Violence 10 Unipolar depressive disorders 10
Other (specify) Other (specify)
2.1.3 Ranking of major risk factors causing morbidity and mortality
Major risk factors causing death Rank (1 – 10) Major risk factors causing ill health Rank (1 – 10)
Unsafe sex 1 Unsafe sex 1
Unsafe water, sanitation & hygiene 2 Unsafe water, sanitation & hygiene 2
Suboptimal breastfeeding 3 Childhood & maternal underweight 3
Childhood & maternal underweight 4 Suboptimal breastfeeding 4
Indoor air population 5 High Blood Pressure 5
Alcohol use 6 Alcohol use 6
Vitamin A deficiency 7 Vitamin A deficiency 7
High blood glucose 8 Zinc deficiency 8
High Blood Pressure 9 Iron deficiency 9
Zinc deficiency 10 Lack of contraception 10
Other (specify) Other (specify)
2.2 Health Services Outcomes
3 Samburu County has 78 facilities providing different KEPH services. Three tier 3 facilities,
75 tier 2 facilities and 7 functional community units.
4 Though the County has three tier 3 facilities, none offers specialized services. Most tier 2
facilities do not offer some basic services like maternity and laboratory services due to lack
of equipments and infrastructure.
Trends in access to KEPH services
POLICY
OBJECTIVE
KEPH SERVICES Number of primary care
facilities providing service
Number of hospitals
providing service
Baseline Target Achieve
ment
ment
Accelerate reduction
of the burden of
Communicable
Conditions
Immunization 42 62 54 3 3 3
Child Health 69 69 69 3 3 3
Screening for communicable conditions 69 69 3 3 69 69
Antenatal Care 69 69 3 3 69 69
Prevention of Mother to Child HIV Transmission 69 69 37 3 3 3

POLICY
OBJECTIVE
Number of hospitals
providing service
ment
ment
Integrated Vector Management
Good hygiene practices 69 69 69 3 3 3
HIV and STI prevention 69 69 69 3 3 3
Port health N/A
Control & prevention neglected tropical diseases 0 0 0 1 3 1
Halt, and reverse the
rising burden of non-
communicable
conditions
Community screening for NCDs 0 20 18 0 0 0
Institutional Screening for NCD’s 69 69 69 3 3 3
Workplace Health & Safety 69 69 69 3 3 3
Food quality & Safety 69 69 69 3 3 3
Reduce the burden
of violence and
injuries
Pre hospital Care 17 18 69 3
Community awareness on violence and injuries 69 69 69 3 3 3
Disaster management and response 0 69 0 0 3 0
Provide essential
health services
Outpatients 69 69 69 3 3 3
Emergency 69 69 69 3 3 3
Maternity 69 69 69 3 3 3
In patient 9 69 14 3 3 3
Clinical laboratory 8 69 11 3 3 3
Specialized laboratory 0 0 0 0 3 0
Radiology 0 0 0 2 3 2
Operative services 0 0 0 2 3 2
Specialized therapy 0 0 0 0 0 0
Specialized services 0 0 0 0 3 0
Rehabilitation 0 0 0 3 3 0
Minimize exposure to
health risk factors
Health Promotion including health Education 69 69 69 3 3 3
Sexual education 69 69 69 3 3 3
Substance abuse 69 69 69 3 3 3
Micronutrient deficiency control 69 69 69 3 3 3
Physical activity 69 69 69 3 3 3
Strengthen
collaboration with
health related
sectors
Safe water 69 69 69 3 3 3
Sanitation and hygiene 69 69 69 3 3 3
Nutrition services 69 69 69 3 3 3
Pollution control 69 69 69 3 3 3
Housing 69 69 69 3 3 3
School health 69 69 69 3 3 3
Water and Sanitation Hygiene 69 69 69 3 3 3
Food fortification 69 69 69 3 3 3
Population management 69 69 69 3 3 3
Road infrastructure and Transport
Trends with Community Unit outcomes
Targeted improvement Baseline Target Achievement
Number of Households reached with health promotion messages, 7059 10467 57621(incl revisits)
Number of persons with ill health being followed up 32 95 690
Number of Households without functional toilets 2528 2255 57915(incl revisits)
Number of Community action days 14 44 175
Number of Households without hand washing facilities 3770 3246 56619(incl revisits)
Number of Persons referred to facility from Community Units 9012 6312 7695
Number of Community dialogue days held 55 47 336
Number of births occurring in the home environment 357 145 1948
Number of deaths occurring in the home environment 35 7 63
Number of deaths with verbal autopsies completed in Community 0 60

Trends with Health Outcomes
Policy Objective Indicator
Overall achievement Performance Achievement by level Achievement by ownership
Baseline Target Achievement Primary
care
Hospital Public Faith based Private
Accelerate
reduction of the
burden of
Communicable
Conditions
# Fully immunized children
5296 7825 6657 85%
# of target population receiving MDA for schistosomiasis
#DIV/0!
# of TB patients completing treatment
425 549 243 44%
# of Newly diagnosed TB cases
576 833 445 53%
# HIV + pregnant mothers receiving preventive ARV’s
51 484 51 11%
# of eligible HIV clients on ARV’s
1363 3693 7331 199%
# of targeted under 1’s provided with LLITN’s
1199 7641 *** #VALUE!
# of targeted pregnant women provided with LLITN’s
479 2290 85 4%
# of under 5’s treated for diarrhea
11128 8903 16681 187%
# School age children dewormed
13693 30952 36215 117%
Halt, and reverse
the rising burden of
non-
communicable
conditions
# of adult population with BMI over 25
41491 ***** #VALUE!
# women of reproductive age screened for cervical cancers
611 21655 ***** #VALUE!
# of new outpatients with mental health conditions
241 241 ***** #VALUE!
# of new outpatients cases with high blood pressure
**** #VALUE!
# of pregnant women receiving iron folate supplements
13660 9158 11762 128%
# of children under five attending CWC for growth monitoring(new cases)
552 382 0%
# of patients admitted with cancer
#DIV/0!
Reduce the burden
of violence and
injuries
# new outpatient cases attributed to gender based violence
49 404 ***** #VALUE!
# new outpatient cases attributed to road traffic accidents
1882 2649 5330(injuries
& RTA)
#VALUE!
# new outpatient cases attributed to other injuries
4605 3705 0%

care
# of facility deaths due to injuries
1 0 #DIV/0!
Provide essential
health services
# deliveries conducted by skilled attendant
2005 3369 2700 80%
# of women of Reproductive age receiving family planning
3788 16706 12441 74%
# of facility based maternal deaths (per 100,000 live births)
9 3 6 200%
# of facility based under five deaths (per 1,000 under 5 outpatients)
#DIV/0!
# of newborns with low birth weight
156 121 188 155%
# of facility based fresh still births (per 1,000 live births)
33 21 89 424%
Surgical rate for cold cases
267 #DIV/0!
# of pregnant women attending 4 ANC visits
2948 6368 3242 51%
Minimize exposure
to health risk
factors
# population who smoke
58,650 #DIV/0!
# population consuming alcohol regularly
#DIV/0!
# infants under 6 months on exclusive breastfeeding
#DIV/0!
# of Population aware of risk factors to health
25548 33212 0%
# of salt brands adequately iodised
#DIV/0!
# adult new attendances with Adult Mid Upper Arm Circumference above
normal
#DIV/0!
Couple year protection due to condom use
#DIV/0!
# of children between 6 – 11 months supplemented with Vit A
8377 8579 4903 57%
# of children between 12 – 59 months supplemented with Vit A
12043 23423 12529 53%
# of lactating mothers supplemented with Vit A
6583 9278 4671 50%
# of persons infected with jiggers
589 1796 0%
# of Households sprayed with insecticides
1517 11875 68 1%
Strengthen # population with access to safe water
51096 75644 0%

care
collaboration with
health related
sectors
# under 5’s stunted
2901 2766 0%
# under 5 underweight
10986 7311 0%
School enrollment rate
#DIV/0!
# women with secondary education
#DIV/0!
# of households with latrines
13533 16693 11262 67%
# of houses with adequate ventilation
17897 20454 0%
# of classified road network in good condition
#DIV/0!
# Schools providing complete school health package
32 0%

2.3 Health outputs
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County Health Output achievements
Policy
Objective
Indicator
Overall achievement Perform
ance
Achievement by level Achievement by ownership
ment
Primary
care
Hospital Public Faith
based
Private
Improving
access to
services
Per capita Outpatient utilization rate
# of population living within 5km of a
facility
76645 89419
# of facilities providing BEOC 50 69 58
# of facilities providing CEOC 2 3 2
Bed Occupancy Rate 60% 60% 13544(B
ed days)
# of facilities providing Immunization 40 44 56
Improving
quality of care
TB Cure rate 87% 88% 77%
# of fevers tested positive for malaria 30% 20% 10874
# maternal audits/deaths audits 100% 100% 100%
Malaria inpatient case fatality 2% 1% 1%
Average length of stay (ALOS) 3 days 3 days 3 days
Improving
demand for
services
# facilities with publicly displayed
service charters
100% 100% 100%
Per capita OPD utilization rate

2.4 Health investments
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_____________________________________________________________________________________________
_____________________________________________________________________________________________
Policy
Objective
Indicator
Overall achievement Perfor
manc
e
Achievement by
level
Achievement by ownership
Baseli
ne
Target Achievem
ent
Primary
care
based
Private
Service delivery
systems
# of functional community units 7 20 18
# outbreaks investigated within 48 hours
% of hospitals offering emergency trauma
services
100% 100% 100%
% hospitals offering Caesarean services 67% 100% 67%
% of referred clients reaching referral unit 100% 100% 100%
Health
Workforce
# of Medical health workers per 10,000 population 20 500/10000 20/10000
% staff who have undergone CPD
Staff attrition rate
% Public Health Expenditures (Govt and donor)
spent on Human Resources
Health
Infrastructure
# of facilities per 10,000 population 3
% of facilities equipped as per norms 0 100% 0
# of hospital beds per 10,000 population 250.1
spent on Infrastructure
Health Products % of time out of stock for Essential Medicines and
Medical Supplies (EMMS) – days per month
spent on Health Products
571 m
Health
Financing
General Government expenditure on health as %
of the total government Expenditure
Total Health expenditure as a percentage of GDP
Off budget resources for health as % of total
public sector resources
% of health expenditure reaching the end users
% of Total Health Expenditure from out of pocket
Health
Leadership
% of health facilities inspected annually 100% 80%
% of health facilities with functional committees 100% 100%
% of Counties with functional County Health
Management Teams
100% 100%
% of Health sector Steering Committee meetings
held at National level
N/A
% of Health sector steering committees meeting
held at county level
% of facilities supervised 100% 100% 100%
Number of counties with functional anti-corruption
committees
% of facilities with functional anti-corruption
committees
% of policies/document using evidence as per
guidelines
100% 100% 100%
% of planning units submitting complete plans
# of Health research publications shared with
decision makers

Policy
Objective
Indicator
Overall achievement Perfor
manc
e
Achievement by
level
Achievement by ownership
Baseli
ne
Target Achievem
ent
Primary
care
based
Private
% of planning units with Performance Contracts
% of County planning units with Performance
Contracts
Health
Information
# of sector quarterly reports produced and
disseminated.
% of planning units submitting timely, complete
and accurate information
% of facilities with submitting timely, complete and
accurate information
70% 100% 80%
spent on Health Information
Community Unit investments
Investment area Type of investment Baseline Target Achievement
Health
Workforce
Community Health Extension Worker 14 24 7
Trained Community Health Workers (Male) 62 128 54
Trained Community Health Workers (Female) 78 131 76
Other (specify)
Health
Infrastructure
Bicycles 35 250 17
Motor cycle 6 28 1
Mobile phone 1 5 1
Community boards 4 5 4
Other (specify)
Health Products Number of kits supplied in the past year 20 250 0
Health
leadership
Number of Committee meetings held in past 12 months 44 60 15
Number of committee meetings attended by all CHC members 5 60 13
Number of quarterly Community dialogue days 20 20 11
Number of committee meetings attended by other health partners in the
Community Unit in the past 12 months
4 60
0
Health
Information
Updated Household register for community 84 200 83
Number of Monthly reports sent to health facility in past year
Number of births included in Household register in past year 560 518 313
Number of deaths included in Household register in past year 10 42 43
Service
provision
First Aid skills - CHEWs 5 28 3
First Aid skills - CHWs 22 250 114
Emergency contingency plans (including referral plans) 2 5 0

SECTION 3: KEY MILESTONES, ISSUES & CHALLENGES
3.1 Health outcome milestones, issues and challenges
Health outcome milestones, issues and challenges
POLICY
OBJECTIVE
KEPH SERVICES Milestones achieved Key issues and challenges
Accelerate
reduction of the
burden of
Communicable
Conditions
Immunization • An increase of
immunizing facilities
from 45 to 56.
• Installation of solar
fridges by the County
Government.
• Eight National
immunization
campaign
• Eighteen functional
community units
• Many hard to reach
areas
• Poor road network.
• Inconsistent
outreaches due to lack
of funding, outreach
vehicles.
• Nomadic way of life.
• Formation of more
community units.
• Shortage of health
personnel.
Child Health
• Immunization
defaulter tracing
improved.
• Eighteen community
units
• Increased VAS
• Increased
immunization
coverage from 58% to
68%.
• Intensified growth
monitoring through
support from Partners.
(IMC and World
Vision)
-Mothers failing to bring their
children for child care services
-Distance
-Ignorance.
-Poor outreach services.
-Shortage of health personnel.
-All facilities not implementing
IMCI.
Screening for communicable conditions • All facilities in the
county are screening
for TB.
• Training of 60 CHVs
on TB defaulter and
contact tracing(trained
by CHAT)
• Inadequate
laboratories for
confirmatory
diagnosis.
• Shortage health
personnel.
• Poor community
health seeking
behavior.
• Inadequate
Community units.
Antenatal Care • Four ANC visit has
increased from 2948 to
3242. (28.3% to
30.8%)
• ANC attendance has
increased.
• Partner involvement is
still low.
• Late initiation of
ANC.
• Distance to health
facility is far.
Prevention of Mother to Child HIV
Transmission • Scale up of PMTCT
services has increased
• Inadequate supply of
Kits.
• Not all the facility are

POLICY
OBJECTIVE
offering PMTCT for
positive mothers.
• Distribution of
LLTNS for <5 and
pregnant mothers.
• Jiggers
campaign(1096 houses
sprayed against
jiggers)
• Bedbugs campaign
(1057 houses sprayed
against bedbugs)
Nets
• Inadequate supply on
anti-vectors chemicals
and PPEs.
• Poor living conditions
which are prone to
vector attacks.
Good hygiene practices
• Global hand washing
and World toilet days
celebrated
• Sensitization school
going children and
formation of health
clubs in several
schools. (More than
20).
• Lack of funding to
support hygiene
activities
• Water shortage.
• Few health personnel.
HIV and STI prevention • Distribution of
condoms
• Scale up of testing.
• Scale up of mother-
child prevention
• HIV prevalence has
decreased from 6% to
5.0%.
• World AIDS day
celebrated.
• Availability of ARVs
• Stigmatization
• Challenges of
outreaches
• Distance.
• Fear of unknown.
• Ignorance
• Integrations of HIV
and other services still
low.
Port health
Control & prevention neglected tropical
diseases • Trachoma surgeries
(TT)
• Health education.
• Inadequate funding
• Poor hygiene
practices.
• Scarcity of water.
• Fear of surgery
Halt, and reverse
the rising burden
of non-
communicable
conditions
Community screening for NCDs • Sensitization, health
education and referral.
• No much support of
NCDs screening by
CHVs in the
community units.
• Low capacity by
CHVs to do screening
Institutional Screening for NCD’s
• Initiation of cervical
cancer screening.
• Most facilities
screening NCDs.
• Most health workers
not trained on
screening of NCDs.
• Inadequate of
screening equipment
and re-agents.
Workplace Health & Safety
• Fire safety measures in
place.
• Inadequate
incinerators in most of
the facilities.

POLICY
OBJECTIVE
• IPC Control measures
in place.
• Construction of
incinerators in Wamba
and Maralal in county
referral.
• Presence of
Contingency plan.
• Availability of PEP.
• Inadequate equipment
for IPC
• Non-Adherence of
staff on IPC
• Inadequate PPE
materials.
Food quality & Safety • Routine inspection of
food premises.
• Seizure of
unwholesome food.
• Prosecution of
offenders.
• Licensing of food
premises.
• Food samples taken
for analysis
• Inadequate of pallets
for proper storage of
foods
• Inadequate storage
space of food (In
health facilities).
• Mushrooming of open
food premises in
market places.
Reduce the burden
of violence and
injuries
Pre hospital Care • CHVs trained on first
aid as part of
curriculum.
• Few community units
• Inadequate of CHVs
kits.
Community awareness on violence and
injuries
• Alternative Right of
Passage for girls.
• Peace building
meetings by partners
to prevent injuries
from clashes(NDMA,
COVA, CDM)
• Deep rooted culture on
FGM and gender
based violence.
Disaster management and response • County contingency
plan in place.
• Purchase of buffer
stocks for drugs by the
county government
• No adequate
sensitization and
implementation.
Provide essential
health services
Outpatients
• Provision of drugs by
county government
and donors.
• More referrals from
community units.
• Health education
• Shortage of staff.
• Inadequate
space/infrastructure.
• Delay in supply of
drugs.
Emergency • Procurement of 6
Ambulances by county
government.
• Availability of county
contingency plan
• Motor cycle
Ambulances by Mpesa
foundation
• Inadequate emergency
equipment.
• Inaccessibility due to
poor road
infrastructures.
• Poor communication
network coverage.
• No casualty
Deppartment
• Inadequate knowledge
of Life saving skills by
health care providers
Maternity • Increase number of
skilled deliveries.
• Shortage of staffs
• Inadequate maternity

POLICY
OBJECTIVE
• Supply of Maternity
equipment by
partners.(County
Government,
Redcross, AMURT,
AMREF)
• Construction of
maternity wards by
County Government,
MPESA Foundation at
Barsaloi
• Renovation of
maternities by partners
AMURT, Mpesa
Foundation
• Five functional
maternal shelters.
• Capacity building of
health worker through
BEMOC trainings.
ward.
• Inadequate of water in
the maternity.
• Some maternities not
meeting standards
• Influence by the TBAs
and elderly women.
• Inadequate of
individual birth plan.
In patient • Purchase of mattresses
and linen by the
National government
for Baragoi District
Hospital.
• Renovation of wards
by the county
government.
• Supply of drugs and
non-pharmaceuticals
• Inadequate inpatient
facilities in the county
leading to congestion
in the few available
wards.
• Staff shortage
Clinical laboratory
• Provision of reagents
by the county
government.
• provision of CD4
machine by Aphia
Imarisha
• Provision of
microscope by
National Government.
• Lab networking of
DBS for EID and viral
load.
• Construction and
equipping of a new
laboratory at Suguta
Health Center.
• Gen expert in Maralal.
• Inadequate
laboratories in the
county.
• Inadequate equipments
• Unreliable water
supplies in the
laboratories.
• Inadequate staffs.
Specialized laboratory None • Lack of special
laboratories.

POLICY
OBJECTIVE
Radiology • Ultrasound machine
• Purchase of X-ray
commodities
• Inadequate of
specialized
Radiological machines
and staff.
• Need for digital X-
rays
Operative services • Theatre equipment’s
bought by the County
Government
• Inadequate surgeons
• Inadequate of modern
theatre and modern
equipment
Specialized therapy • Scheduled dental
therapy at Maralal
Catholic dispensary.
• Dental services by
British Army
• Inadequate of
specialised therapies
in major hospitals.
Specialized services • Scheduled ophthalmic
services.
• Specialized services
like Paediatric,
psychiatry by AMREF
• Most specialised
services are not
available.
Rehabilitation • Ongoing rehabilitation
services like
physiotherapy,
occupational therapy,
nutrition, counselling
• Construction of
psychiatric ward
• Minimal rehabilitation
services due to lack of
infrastructure,
equipment and
personnel
• Staff shortages
Minimize exposure
to health risk
factors
Health Promotion including health Education • Continuous health
education and
promotion.
• Inadequate of health
promotion and
education departments
• Inadequate of
adequate community
units.
Sexual education • Trained youths on
AIDs and STIs.
• Safer sex practice.
• Distribution of
condoms.
• Advocacy against
FGM.
• Inadequate financial
support.
• Inadequate of IEC
materials e.g Video
deck, screen etc.
• Ignorance
• Lack of Youth friendly
center.
Substance abuse • All CHVs have trained
on drugs and
substance abuse.
• Lack of support.
• Inadequate IEC
materials e.g Video
deck, screen etc.
• Ignorance
• Lack of Youth friendly
center.
• Inadequate
sensitization and
community awareness
on substance abuse.
• Peer pressure.
• unemployment
Micronutrient deficiency control
• Supply of
micronutrient powder
(MNP) by
IMC/WORLD
VISION.
• Vitamin A
supplementation.
• Poor documentation
by health workers.
• Inadequate Vit A
supply.
• Inadequate of storage
space.

POLICY
OBJECTIVE
• Iron folic
supplementation.
• Scaling up under five
deworming.
• Scaling growth
monitoring.
Physical activity • CHVs have been
trained on physical
activity.
• Inadequate of trained
personnel and training
facility.
Strengthen
collaboration with
health related
sectors
Safe water • Provision of tanks by
the county
Government.
• Provision of
Aquatabs/chlorine
crystals.
• Water tracking.
• Inadequate tanks.
• Inadequate water
supply
• Drought.
Sanitation and hygiene • Triggering of 80
villages
• Three Open
Defecation Free
(ODF) villages.
• Increase latrine
coverage from 16% to
21%.
• 100 CHVs trained on
PHAST.
• Inadequate of follow
up
• Inadequate of funds.
• Persistent practice of
open defecation by the
community.
• Cultural taboos
Nutrition services
• Scaling up of child
growth Monitoring
services.
• Supplimentation of
Vit. A
• Health education
• Provision of Plumpy
Soy to PLHA and TB.
• Provision of
Plumpysup,
plumpynuts and F100
and F75 by IMC.
• Shortage of staff.
supplementary of
vitamin A.
• Ignorance- client sell
the supplements.
• Theft of nutrition
commodities
Pollution control • Construction of two
demont fort
incinerators for
medical waste disposal
in Wamba and Maralal
• Inadequate of
incinerators
• Poor waste disposal
practices.
• Lack of convectional
sewage treatment
plants in big towns.
Housing • Siting and approval of
building plans.
• Inspection of all
institutions for
registration.
• Ignorance on the
housing policies and
by-laws
• Lack of enforcement
of laws
• Non compliance
School health • Formation of health
clubs.
• Provision of
toilets/water tanks in
15 schools by World
• Inadequate latrine
coverage in most of
the schools.
• Most school lack
adequate supply of

POLICY
OBJECTIVE
Vision.
• Involvement of
schools in
commemorating
global health
campaigns.
• Health symposium
between schools.
• Provision of hand
washing facilities in
schools.
water.
• Inadequate hand
washing facilities in
schools.
Food fortification
Not done
No factories/technologies.
3.2 Health output milestones, issues and challenges
Health output milestones, issues and challenges
Output area Intervention area Key milestones achieved during the
year
Issues and challenges
Improving Access
to services
Availability of critical inputs
(Human, Resources, Infrastructure,
Commodities)
• Recruitment of health care
workers and drivers.
• Hospital renovation and
fencing.
• Construction of new
facilities.
• Supply of commodities.
• Purchase of equipment.
• Purchase of ambulances.
• Purchase of bicycles for
CHVs.
• Renovation of two major
hospital (Baragoi and
Maralal).
• Staff shortages – There is no
enough staffs as per the norms.
• Inadequate modern facilities e.g
Maternity, wards and theatre.
• Delay in supply of commodities.
Functionality of critical inputs
(maintenance, replacement plans,
etc)
• Obsolete equipment
replaced.
• Replacement of laundry
machine.
• Provision of solar fridges.
• Repair and maintenance of
broken-down vehicles
• Inadequate maintenance staffs.
• No maintenance unit in Samburu
east and Samburu North Sub-
counties.
• Inadequate spares for vaccines
fridges.
• Solar fridges batteries not
working

Output area Intervention area Key milestones achieved during the
year
Issues and challenges
Readiness of facilities to offer
services (appropriate HR skills,
existing water / sanitation services,
electricity, effective medications,
etc)
• Continuous capacity building
of existing human resource.
• Additional recruitment of
few staffs.
• Installation of solar power.
• Construction of sanitary
facilities in some facilities.
• Inadequate refresher
courses/training
• Inadequate staffs.
• Inadequate supply of water.
• Staff sharing sanitary facilities
with patients.
Improving
Quality of care
Improving patient/client experience • Adequate testing kits in all
facilities.
• Patient waiting time reduced.
• Proficiency testing
• Support supervision, OJT
and mentorship.
• Staff shortages.
• Inadequate infrastructures
• Inadequate equipment
• Inadequate updates.
Assuring patient/client safety (do no
harm)
• Infection prevention control
measures observed.
• Two facilities fenced –
Maralal dist. Hosp and
Baragoi
• Ignorance in terms of the
importance of services being
provided.
• Defaulting rate is high.
• Inadequate incineration.
Assuring effectiveness of care • Tracing of defaulters of
immunization, TB, 4ANC
and ART.
• Proper filing and
documentation.
• High defaulter rate.
• Inadequate enough computers
for documentation.
• Inadequate support for defaulter
tracing
• Inadequate supply of reporting
tools
Improving
demand for
services
Improving health awareness
amongst the communities
• Initiation of community units
linked to the facilities.
• Community health
education/ sensitization.
• Campaigns and integrated
medical outreaches
• Inadequate support for
sensitization.
• Lack public address system in
health education unit.
• No enough vehicles to reach
hard areas.
Improving health seeking behaviors
in the communities
• Establishment of community
units.
• Collaboration with health
partners in community
sensitization on BCC
• Health
education/sensitization
• Distribution of IEC
materials.
• Behavior change campaign
in schools and youths.
• Cultural practices like
herbal medicine
• Inaccessibility due to Poor
road networks
• Illiteracy.
• Inadequate support to tier
one.

3.3 Health investments milestones, issues and challenges
Health investments milestones, issues and challenges
Orientation
area
Intervention area Key milestones attained Issues / challenges
Service
delivery
Strengthening emergency and
referral services • Provision of Ambulances by
the county government.
• Capacity building of health
care providers on emergency
Obstetric and newborn care.
• Inaccessibility to some areas due to
poor road networks.
• Communication barriers- lack of good
network coverage.
• Far distance to referral facilities.
Strengthening outreach services • Outreaches with support
from County Government
and partners (, World
Vision, AMREF, AMURT).
• Inadequate funds and support leading to
inconsistency outreaches.
• Lack of four wheel drive vehicles for
outreaches.
Scaling up community services • Initiation of community
units
• Training of community
volunteers on community
based maternal and newborn
health.
• Supply of CBHIS reporting
tools to more than six units.
• Lack of sustainable mechanism of
CHVs motivation.
• Inadequate funds for rolling out
community units
• Inadequate tier one staffs.
• Inadequate infrastructures for
management of tier one
services(motorbikes and bicycles)
Improving Supervision and
mentorship
• Supervision, OJT and
mentorship done.
• No budgetary allocation thus
inconsistency in support supervision.
• Inadequate CHMT and SCHMT utility
vehicles.
Organization of facility services
(clinical audits, OJT, therapeutic
committee’s)
• One therapeutic committee
formed
• OJT done through support
from partners (IMC and
World vision).
.
• No clinical audits done.
• Inadequate funds for OJT.
•
Health
Infrastructure
(physical
infrastructure,
equipment,
transport,
ICT)
Improving availability, functionality
and readiness of physical
infrastructure (construction,
expansion, maintenance)
• Hospital fencing done.
• Renovation of wards and
maternity
dispensaries
• Construction of two
incinerators
• Expansion of Suguta Health
Centre and Barsaloi
dispensary by M-PESA
foundation
• Incomplete renovations and
construction
• Inadequate incinerators
• Inadequate allocation of funds.
and readiness of medical and
hospital equipment (purchase,
maintenance)
• Purchase and supply of
medical and hospital
equipment.
• Installation and maintenance
of solar vaccines fridges
• Shortage of medical equipment.
• Delay in supply.
and readiness of transport (purchase,
maintenance)
• Purchase of ambulance and
repair of broken down
vehicles.
• Inadequate motorbikes and bicycles
• Inadequate vehicles for outreaches.
and readiness of ICT (purchase,
maintenance)
• Installation of Electronic
Medical Records in Maralal
County referral.
• Computer illiteracy.
• Inadequate training on EMR system.
• Inadequate ICT personnel.

Orientation
area
• Initiation of EMONC
resource centre in Maralal
by Mpesa Foundation
Health
Workforce
Production of Health Workers (pre-
service training)
• Wamba Nursing training
School institution.
• Inadequate support for health worker
training.
• Not clear, how many nurses are
produced for the county
• No MOU with the institution
Attraction, retention and motivation
of health workers
• Presence of performance
based financing in Tier two.
• Community performance
based financing at Barsaloi
community unit.
- Hardship within the county
- No clear mechanism in staff motivation
and retention
- Delay in PBF funds release
Recruitment of required health
workers
• The county Government
absorbed all the 65 ESPs. • Staffing norms are not met.
Training, and development of health
workforce
• Capacity building of Health
care workers on commodity
management
• Financial supports on staff
capacity building
• Trainings by Funzo Kenya
on Rapid advice.
• Trainings on PMTCT by
Global Fund
• Inadequate funds.
Improving institution capacity for
health workforce management
• Health facility equipping
• Renovation and expansion
Health
information
Collection of routine data from
facilities
• Data reported timely
• Support by partners on
report submission (IMC and
World Vision)
• Inadequate reporting tools.
• Poor network- Modems and phones.
• Poor communication networking- roads
• Inadequate support for facility in
charges meeting.
Collection of data on health vital
events (births, deaths)
• Birth and death registration
done in some facilities.
• Awareness of the
importance of birth
registration.
• Scaling up of skilled
deliveries.
• Patient’s ignorance on the importance
of birth and death registration.
• Home deliveries and deaths are high.
Collection of data from surveillance • Scaling up data collection
from IDSR.
• Weekly submission of IDSR
report by most facility.
• Poor communication networks
• No budgetary allocation.
Collection of data from research • One KAP surveys on
nutrition done.
• 22 DHMT trained on
operational research.
• No research department in the county.
• More training needed to the lower
levels.
Collection of data from health
related sectors
• Attained good relation and
support with health partners.
• Sustainability due to funding issues.
Data validation and analysis • Ensured data completeness,
accuracy and timeliness.
• OJT on data capturing done
in the Sub counties.
• Poor network (in Baragoi) that hinders
data entry in the DHIS.
• No monitoring and evaluation
department in the county.
• Inadequate HRIOs
Information dissemination and use • Information is always
displayed for the staff to rate
themselves in most facilities.
• Inadequate funds to support health
information dissemination.
• Most of health workers are not trained

Orientation
area
• Information disseminated
have been used in Planning
and decision making.
• It is also used in resource
allocation and budgeting.
to use the DHIS.
-
Health
Products
Procurement of required health
products
• Purchase and supply of
drugs by the County
Government.
• Supply of vaccines by the
government
• Delay supply of health products.
Warehousing / storage of health
products • No damage of health
products due to storage
• Inadequate storage space both at the
County referral hospital and other
facilities.
Distribution of health products • Distribution of health
products by KEMSA and
MEDs.
• Inadequate funding for re-distribution
of health products in case of stock outs
Monitoring rational use of health
products
• Use of stock cards and bin
cards.
• Use of FIFO ( First in First
out)
• Inconsistence support supervision due
to lack of support.
Health
Financing
Costing of health service provision • Free maternity services and
free services at Tier two.
• Development of annual
work plan and strategic
plans.
• High service demand.
• Staff shortage.
• Non of Adherence to Annual Work plan
Mobilizing resources to improve
resource adequacy
• Proposal writing.
• Using cost sharing funds to
cater for other facilities
needs.
• Support from partners
• HSSF funds
• Response to proposal delayed.
• High rates of waivers.
Risk pooling and improving equity
• Encouraging communities to
register with NHIF.
• HSSF/PBF funds
• NHIF enrollment very low.
• Delay in release of the funds.
• NHIF claims refunds takes long.
Strategic purchasing and improving
efficiency in resource use
• Adherence to government
financing and procurement
policies and procedures.
• Delays in service deliveries.
Leadership
and
Governance
Health stewardship and county
management
• Formation of CHMT,
SCHMT, County Executive,
County health Boards
,HMT, FHMT and CHCs.
• Inadequate management refresher
courses.
• No clear county Organogram.
• Weak program based financing.
Health partnership and coordination • There is an existing County and
Sub-county Health Stakeholders
forum.
• Lack of common implementation plan.
Public Private Partnerships • No public private partnership • No county policy on public private
partnership
• No formalized partnership

Orientation
area
Health governance and linkage with
County system
• Formation of CHMT, SCHMT,
County Executive, County
health Boards ,HMT, FHMT
and CHCs.
• Lack of management refresher courses.
• No clear county Organogram.
• Weak program based financing.
SECTION 4: COUNTY HEALTH EXPENDITURE REVIEW
4.1 Summary of Health Expenditures
The County commences with an overall summary of health expenditures, from different sources. The sources
included are Public Sources of expenditures; Donor / development partners; Public Benefit Organizations
(FBO’s, NGO’s, CSO’s, etc). Information is derived from data that the different sources of health expenditure
have compiled.
Source of expenditures Total Estimated expenditures Expected resources (County strategic
Plan)
Public / Government expenditures 828,967,102 800,000,000
Total donor / partner expenditures 41,448,355.10 30,000,000
Household expenditures on User fees
Public Benefit Organizations
Other sources
Total 870,415,457.10 830,000,000
4.2 Health Expenditures by source of financing
The County presents the expenditure information, by specific source of financing. For each of the above-
mentioned sources, the expected actors in each are highlighted, with their total health expenditures reflected. The
section allows the County to compare different sources of funds and will highlight the major sources of financing
which include Samburu county government, HSSF, Constituency Development Fund, FMHSF, PBF, JICA, DANIDA,
AMREF, World Vision, Safaricom M-PESA Foundation among others.
Category Source of funds Total Health Expenditures for the year
Amount as cash Estimated amount in
kind
Government
Sources
County Government 630,000,000
National Government
HSSF 19,113,936
LATF
Constituency Development Fund 2,800,000
FMHSF 8,070,000

Category Source of funds Total Health Expenditures for the year
Amount as cash Estimated amount in
kind
PBF 2,200,000
Other (Partners)
Donors / Partners Africa Development Bank
Clinton Foundation
Danish Government (DANIDA)
UK Government (DfID)
European Commission
German Government (GIZ)
Italian Government
Japanese Government (JICA)
Netherlands Government
UN agency (UNAIDS)
UN agency (UNFPA)
UN agency (UNICEF)
UN agency (World Bank – WB)
UN agency (WHO)
US Government (USAID / APHIA 2)
Other (specify)
Households User fees / charges
Public Benefit
Organizations
NGO / CSO (specify) 41,448,355.10
Kenya Episcopal Conference (KEC)
Christian Health Association of Kenya (CHAK)
Supreme Council of Kenya Muslims (SUPKEM)
Other (specify)
TOTAL
4.3 Health expenditures by KEPH service area
Some sources of funds are only able to provide information by program area. The sub section allows this to be
reflected. Again, the information would come from the health actors in the County. For each health service area,
the County collates amounts of expenditures that were spent on it, by the different actors in the County.
Expenditures, by KEPH services
Policy Objective KEPH Services Expenditure (KES) by source TOTAL
Government Donor Us
er
fee
s
Public Benefit
Organization
Other
(specify)
Accelerate
reduction of the
burden of
Communicable
Conditions
Immunization 540,000
Child Health
Screening for communicable conditions
Antenatal Care
Prevention of Mother to Child HIV Transmission
Integrated Vector Management 400,000
Good hygiene practices 2,000,000
HIV and STI prevention 2,000,000
Port health 0
Control and prevention neglected tropical diseases 3,000,000
Halt, and reverse
Community screening for NCDs
Institutional Screening for NCD’s

Policy Objective KEPH Services Expenditure (KES) by source TOTAL
Government Donor Us
er
fee
s
Public Benefit
Organization
Other
(specify)
non communicable
conditions
Workplace Health & Safety
Food quality & Safety 3,000,000
Reduce the burden
of violence and
injuries
Pre hospital Care
Community management of violence and injuries
Disaster management and response
Provide essential
health services
Outpatients
Emergency
Maternity 8,070,000
In patient
Clinical laboratory 6,000,000
Specialized laboratory
Radiology
Operative
Specialized therapy
Specialized services
Rehabilitation
Minimize exposure
to health risk
factors
Health Promotion (including health Education)
Sexual education 500,000
Substance abuse 500,000
Micronutrient deficiency control 5,000,000
Physical activity
Strengthen
collaboration with
health related
sectors
Safe water 2,500,000
Sanitation and hygiene 1,000,000
Nutrition services
Pollution control 24,000,000
Housing
School health 9,300,000
Water and Sanitation Hygiene 180,000
Food fortification 0
Population management 1,200,000
Road infrastructure and Transport 85,000,000
TOTAL PROGRAM SPECIFIC EXPENDITURES
4.4 Health expenditures by investment areas
The sub section now highlights financing for different investment areas that the County needs to invest its health
resources. The information would come from the health actors in the County. For each investment area, the
County identifies the amounts of expenditures that were spent on it, by the different actors in the County. This is
collated together, to illustrate the resources that were available.
Orientation
area
Intervention area Expenditure (KES) by source TOTAL
Government Donor User fees Public Benefit
Organization
Other (specify)
Service delivery Strengthening emergency and referral services 23,000,000

Orientation
area
Organization
Other (specify)
Strengthening outreach services
1,200,000
Scaling up community services
Improving Supervision and mentorship 2,360,000
Organization of facility services (clinical audits, OJT,
therapeutic committee’s)
100,000
Health
Infrastructure
(physical
infrastructure,
equipment,
transport, ICT)
Improving availability, functionality and readiness of
physical infrastructure (construction, expansion,
maintenance)
17,000,000
medical and hospital equipment (purchase, maintenance) 7,000,000
transport (purchase, maintenance) 25,600,000
Improving availability, functionality and readiness of ICT
(purchase, maintenance) 23,000,000
Health
Workforce
Production of Health Workers (pre-service training)
1,000,000
Attraction, retention and motivation of health workers 800,000
Recruitment of required health workers
50,000,000
Training, and development of health workforce
2,000,000
Improving institution capacity for health workforce
management 1,000,000
Health
information
Collection of routine data from facilities
0
Collection of data on health vital events (births, deaths) 0
Collection of data from surveillance 600,000
Collection of data from research
Collection of data from health related sectors
Data validation and analysis 200,000
Information dissemination and use
Health Products Procurement of required health products 45,000,000
Warehousing / storage of health products 0
Distribution of health products
0
Monitoring rational use of health products
0
Health Financing Costing of health service provision
Mobilizing resources to improve resource adequacy
Risk pooling and improving equity
Strategic purchasing and improving efficiency in resource
use
Leadership and
Governance
Health stewardship and county management 2,360,000
Health partnership and coordination

Orientation
area
Organization
Other (specify)
Public Private Partnerships
Health governance and linkage with County system 5,000,000

SECTION 5: BEST PRACTICE IN SERVICE DELIVERY
This is a Section that allows the County to identify, and show case best practices in delivering health services. The
best practices fall in one of the three output categories: Improving access to services; improving demand for health
services; or improving quality of care.
Information should be shared with different service providers in the County – Government and non Government –
on the opportunity to share best practices prior to the planning retreat.
During the development of the report, the planning committee working group would review all the best practices
shared from different actors in the County, and select one best practice in each of the areas of improving access,
demand, or quality of care. The selected best practice would then be summarized in the report, using the same
information provided. The information covers the areas of:
- Effectiveness: Evidence the practice works, and achieved measurable results
- Efficiency: Evidence the practice produced results with a reasonable level of resources and time
- Relevance: Evidence the practice is focused on addressing a clear, priority health challenge
- Sustainability: Evidence the practice can be implementable over a long time without need for significant
additional resources
- Duplicability: Evidence the practice is able to be repeated elsewhere, in similar conditions
- Partnerships: Evidence there was involvement of different service delivery actors in implementation of
the practice
- Political Involvement: Evidence there was involvement of the political level in the planning / monitoring of
the practice
-
Summary of best practice
Area Information
Description of Best Practice Use of maternal shelters to access skilled delivery and the use of incentives
such as sanitary materials to encourage and motivate women of reproductive
age to seek skilled healthcare services. The objective of this initiative is in line
with achieving the millennium development goals number four( Reduce child
mortality) and five ( improve maternal and newborn health) and address the
Kenya Health Policy objective on the provision of essential health services
(KHP 2012-2030)
Dimension of Output1
Number of deliveries has shown a steady increase as a result of the initiatives
implemented at the Nachola Dispensary. The data is as follows:
Year 2012 number of deliveries : 1 (source DHIS)
Year 2013 number of deliveries : 21 ( source DHIS)
Year 2014 number of deliveries : 40 ( source DHIS)
Effectiveness: Evidence the
practice works, and achieved
measurable results
Despite the facility lacking a maternity unit, the maternal shelter initiative has
increased the access to skilled healthcare services. This in turn has greatly
improved the community attitude and perception towards skilled health care
services.
Efficiency: Evidence the practice With a minimum of Kshs 300 per mother as the incentive the initiative can be
1
Either (1) Access (Availability, functionality, or readiness), (2) Quality of care (improving client experiences, client
safety, or effectiveness of care), or (3) demand creation (Health Awareness, or Health Seeking behavior)

Area Information
produced results with a reasonable
level of resources and time
sustained. The presence of the maternal shelter at the facility has greatly
reduced the referral time.
Relevance: Evidence the practice
is focused on addressing a clear,
priority health challenge
The initiative is aimed at improving maternal and newborn health. The
initiative has improved the health seeking behavior among the pastrolist. The
attitude towards male assisted deliveries is positive.
Sustainability: Evidence the
practice can be implementable
over a long time without need for
significant additional resources
With a minimum of Kshs 300 per mother as the incentive the initiative can be
sustained however there is need for a modern maternal unit to be built so as to
sustain the gains that have been achieved with the initiative.
Duplicability: Evidence the
practice is able to be repeated
elsewhere, in similar conditions
Within the Samburu county the same initiative has been replicated in almost all
health facilities with success being noted at longewan, kisima and others.
The same initiative has been a benchmark to other neighboring pastoral
communities i.e. West Pokot and Turkana County CHMT.
Partnerships: Evidence there was
involvement of different service
delivery actors in implementation
of the practice
Health facility management committee, local administration, the community at
large, community health volunteers , healthcare staff and other stake holders.
Political Involvement: Evidence
there was involvement of the
political level in the planning /
monitoring of the practice
The leadership (MCA, Village elders and MP Samburu North) has been
supportive in the implementation of the initiative.

PLAN
FOR
HEALTH SERVICE
PROVISION IN THE
COMING YEAR
2014-2015

SECTION 6: COUNTY HEALTH BUDGET
Summary of County Health Budget
Category Source of funds Classified / earmarked budgets Unclassified
budgetsOrganization
of Service
Delivery
Health
Infrastructure
Health workforce Health
Information
Health
Financing
Health
Leadership
Health
Products
Government
Sources
County Government 39,170,000 171,640,000 340,640,000 3,550,000 2,000,000 1,000,000 32,000,000 590,000,000
National Government
HSF/HSSF
0 2,213,097.00 5,734,180.00 400,000.00 0 2,165,388.00 8,601,271.00 19,113,936.00
LATF
Constituency Development
Fund
Other (specify)
Donors /
Partners
Africa Development Bank
Clinton Foundation
Danish Government
(DANIDA)
UK Government (DfID)
European Commission
German Government (GIZ)
Italian Government
Japanese Government (JICA)
Netherlands Government
UN agency (UNAIDS)
UN agency (UNFPA)
UN agency (UNICEF)
UN agency (World Bank –
WB)
UN agency (WHO)
US Government (USAID /
CDC/Other)
Other (specify)
Households User fees / charges
Public
Benefit
Organization
s
NGO / CSO (specify)
Kenya Episcopal Conference
(KEC)
Christian Health Association of
Kenya (CHAK)
Supreme Council of Kenya
Muslims (SUPKEM)
Other (specify)
TOTAL

SECTION 7: KEY TARGETS FOR THE COMING YEAR
7.1 Health Service improvement targets
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Trends in KEPH service targets
POLICY
OBJECTIVE
Number of hospitals
providing service
Baseline Target Baseline Target
of the burden of
Communicable
Conditions
Immunization 54 69 3 3
Child Health 69 69 3 3
Screening for communicable conditions 69 69 3 3
Antenatal Care 69 69 3 3
Prevention of Mother to Child HIV Transmission 37 69 3 3
Good hygiene practices 69 69 3 3
HIV and STI prevention 69 69 3 3
Port health n/a
Control & prevention neglected tropical diseases 69 69 1 3
rising burden of non
communicable
conditions
Community screening for NCDs 18 24
Institutional Screening for NCD’s 69 69 3 3
Workplace Health & Safety 69 69 3 3
Food quality & Safety 69 69 3 3
Reduce the burden
of violence and
injuries
Pre hospital Care 69 69 3 3
Community awareness on violence and injuries 69 69 3 3
Disaster management and response 0 69 0 3
Provide essential
health services
Outpatients 69 69 3 3
Emergency 69 69 3 3
Maternity 69 69 3 3
In patient 14 20 3 4
Clinical laboratory 11 20 3 4
Specialized laboratory 0 0 0 1
Radiology 0 0 2 3
Operative services 0 0 2 3
Specialized therapy 0 0 0 1
Specialized services 0 0 0 1
Rehabilitation 0 3 0 3

POLICY
OBJECTIVE
Number of hospitals
providing service
Baseline Target Baseline Target
health risk factors
Health Promotion including health Education 69 69 3 3
Sexual education 69 69 3 3
Substance abuse 69 69 3 3
Micronutrient deficiency control 69 69 3 3
Physical activity 69 69 3 3
Strengthen
collaboration with
health related
sectors
Safe water 69 69 3 3
Sanitation and hygiene 69 69 3 3
Nutrition services 69 69 3 3
Pollution control 69 69 3 3
Housing 69 69 3 3
School health 69 69 3 3
Water and Sanitation Hygiene 69 69 3 3
Food fortification 69 69 3 3
Population management 69 69 3 3
Road infrastructure and Transport

Health outcome targets
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Trends with Health Outcomes
Policy Objective Indicator Baseline Annual Target 5 year target
Accelerate
reduction of the
burden of
Communicable
Conditions
# Fully immunized children 6657 7358 36792
# of target population receiving MDA for schistosomiasis
# of TB patients completing treatment 243 255 1275
# of Newly diagnosed TB cases 445 600 3000
# HIV + pregnant mothers receiving preventive ARV’s 51 102 510
# of eligible HIV clients on ARV’s 7331 8624 43124
# of targeted under 1’s provided with LLITN’s ***
# of targeted pregnant women provided with LLITN’s 85 0 0
# of under 5’s treated for diarrhea 16681 21763 108816
# School age children dewormed 36215 56897 284488
Halt, and reverse
non communicable
conditions
# of adult population with BMI over 25 *****
# women of reproductive age screened for cervical cancers *****
# of new outpatients with mental health conditions *****
# of new outpatients cases with high blood pressure ****
# of pregnant women receiving iron folate supplements 11762 17451 87255
# of children under five attending CWC for growth monitoring(new cases)
# of patients admitted with cancer
Reduce the burden
of violence and
injuries
# new outpatient cases attributed to gender based violence *****
# new outpatient cases attributed to road traffic accidents 5330** 53 265
# new outpatient cases attributed to other injuries 53 265
# of facility deaths due to injuries 0 0
Provide essential
health services
# deliveries conducted by skilled attendant 2700 7105 35526
# of women of Reproductive age receiving family planning 12441 30344 151719
# of facility based maternal deaths (per 100,000 live births) 6 0 0
# of facility based under five deaths (per 1,000 under 5 outpatients) 0 0
# of newborns with low birth weight 188 0 0
# of facility based fresh still births (per 1,000 live births) 89 0 0
Surgical rate for cold cases 267
# of pregnant women attending 4 ANC visits 3242 4987 24938
Minimize exposure
to health risk
factors
# population who smoke
# population consuming alcohol regularly
# infants under 6 months on exclusive breastfeeding
# of Population aware of risk factors to health
# of salt brands adequately iodised
# adult new attendances with Adult Mid Upper Arm Circumference above
normal
Couple year protection due to condom use
# of children between 6 – 11 months supplemented with Vit A 4903 5161 25805
# of children between 12 – 59 months supplemented with Vit A 12529 20881 104408
# of lactating mothers supplemented with Vit A 4671 5838 29194
Strengthen
collaboration with
health related
sectors
# of persons infected with jiggers
# under 5’s stunted 68 265 1328
# under 5 underweight
School enrollment rate
# women with secondary education
# of households with latrines 11262 45048 225240
# of houses with adequate ventilation
# of classified road network in good condition

Policy Objective Indicator Baseline Annual Target 5 year target
# Schools providing complete school health package
Trends in Community Unit outcomes
Targeted improvement Baseline Target
Number of Households reached with health promotion messages, 57621
Number of persons with ill health being followed up 690
Number of Households without functional toilets 57915
Number of Community action days 175
Number of Households without hand washing facilities 56619
Number of Persons referred to facility from Community Units 7695
Number of Community dialogue days held 336
Number of births occurring in the home environment 1948
Number of deaths occurring in the home environment 63
Number of deaths with verbal autopsies completed in Community

7.2 Health output targets
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
County Health Output targets
Policy
Objective
Indicator
Baseline Annual target 5 year target
Improving
access to
services
Per capita Outpatient utilization rate
% of population living within 5km of a facility
% of facilities providing BEOC
% of facilities providing CEOC
Bed Occupancy Rate
% of facilities providing Immunization
Improving
quality of care
TB Cure rate
% of fevers tested positive for malaria
% maternal audits/deaths audits
Malaria inpatient case fatality
Average length of stay (ALOS)
Improving
demand for
services
% facilities with publicly displayed service charters
Per capita OPD utilization rate

7.3 Health investment targets
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Policy
Objective
Indicator
Baseline Annual Target 5 year target
Service delivery
systems
% of functional community units
% outbreaks investigated within 48 hours
% of hospitals offering emergency trauma services
% hospitals offering Caesarean services
% of referred clients reaching referral unit
Health
Workforce
# of Medical health workers per 10,000 population
% staff who have undergone CPD
Staff attrition rate
% Public Health Expenditures (Govt and donor) spent on Human Resources
Health
Infrastructure
# of facilities per 10,000 population
% of facilities equipped as per norms
# of hospital beds per 10,000 population
% Public Health Expenditures (Govt and donor) spent on Infrastructure
Health Products % of time out of stock for Essential Medicines and Medical Supplies (EMMS) – days
per month
% Public Health Expenditures (Govt and donor) spent on Health Products
Health
Financing
General Government expenditure on health as % of the total government
Expenditure
Total Health expenditure as a percentage of GDP
Off budget resources for health as % of total public sector resources
% of health expenditure reaching the end users
% of Total Health Expenditure from out of pocket
Health
Leadership
% of health facilities inspected annually
% of health facilities with functional committees
% of Counties with functional County Health Management Teams
% of Health sector Steering Committee meetings held at National level
% of Health sector steering committees meeting held at county level
% of facilities supervised
Number of counties with functional anti-corruption committees
% of facilities with functional anti-corruption committees
% of policies/document using evidence as per guidelines
% of planning units submitting complete plans
# of Health research publications shared with decision makers
% of planning units with Performance Contracts
% of County planning units with Performance Contracts
Health
Information
# of sector quarterly reports produced and disseminated.
% of planning units submitting timely, complete and accurate information
% of facilities with submitting timely, complete and accurate information
% Public Health Expenditures (Govt and donor) spent on Health Information

Community Unit investment targets
Investment area Type of investment Baseline Target
Health
Workforce
Community Health Extension Worker
Trained Community Health Workers (Male)
Trained Community Health Workers (Female)
Other (specify)
Health
Infrastructure
Bicycles
Motor cycle
Mobile phone
Community boards
Other (specify)
Health Products Number of kits supplied in the past year
Health
leadership
Number of Committee meetings held in past 12 months
Number of committee meetings attended by all CHC members
Number of quarterly Community dialogue days
Number of committee meetings attended by other health partners in the
Community Unit in the past 12 months
Health
Information
Updated Household register for community
Number of Monthly reports sent to health facility in past year
Number of births included in Household register in past year
Number of deaths included in Household register in past year
Service
provision
First Aid skills – CHEWs
First Aid skills – CHWs
Emergency contingency plans (including referral plans)

SECTION 8: KEY INTERVENTIONS FOR THE COMING YEAR
8.1 Health Outcome priorities
The key interventions are geared towards addressing the six key health policy objectives with
particular emphasis on areas of preventive, promotive health and advocacy.
Priority interventions
POLICY
OBJECTIVE
KEPH SERVICES Key priorities for the coming year (3)
of the burden of
Communicable
Conditions
Immunization • Increase the number of immunizing facilities from 55
to 60
• Improve cold chain equipment.
• Train managers of mid level EPI management
• Provide affordable power sources to the immunizing
facilities.
• Enhance immunization surveillance and supervision.
• Avail adequate vaccines and immunization logistics
• Establish more integrated mobile outreach
programmes
• Set a County immunization day once a year
Child Health • Train health workers on IMCI/ zinc ORS
supplementation
• Provide guidelines on child health care
• Provide essential medicines and equipments for child
health
• Scale up management of High Impact Nutrition
Intervention (HINI) in the County
Screening for communicable conditions • Establish clinical laboratories in 10 more health
centres
• Train health workers on screening of emerging
communicable diseases like Ebola and malburg
• Increase the number of health workers to aid in
comprehensive screening
• Provide essential equipments and guidelines for
screening.
• Provide basic screening skills at community level
• Upscale surveillance of communicable diseases in the
community
Antenatal Care • Train more health workers on Focussed Antenatal
care.
• Provide essential guidelines for ANC
• Provide essential medicines and supplements for ANC
• Strengthen mobile outreach programmes to include
FANC
• Sensitization on importance of ANC at the community
level
Prevention of Mother to Child HIV Transmission • Sensitize community on PMTCT
• Train Health workers on PMTCT
• Upscale testing services at the community level
• Increase referral to CCC
• Increase the number of CCC units in the county
• Scale up uptake of ARVs in PMTCT sites
Integrated Vector Management • Identification of mosquito breeding areas
• Provision of enough Rapid diagnostic Test kits to all
facilities.

POLICY
OBJECTIVE
• Procure enough insecticides and spray equipments
• Adopt selective distribution of LLINs to malralia
identified hotspots
• Enhance surveillance for jigger manifestation.
•
Good hygiene practices • Upscale of Community Led total sanitation (CLTS)
• Upscale health education at the community level and
schools
• Creation of Health clubs in schools.
• Provision of leaky tins for hand washing at
homesteads.
• Ensure all food handlers are clean and medically
examined.
HIV and STI prevention • Health education to the community.
• Accelerate HIV Testing and Counselling through
establishment of Moonlight testing services mainly
targeting the commercial sex workers.
• Encourage Voluntary Medical Male Circumcision
(VMMC).
• Avail enough stocks of condoms.
• Identifiy special target groups like morans for
advocacy on retrogressive cultural practices
• Early identification and treatment of Sexually
transmitted diseases (STIs)
Port health
Control & prevention neglected tropical diseases • Enhance surveillance
• Prompt reporting of suspected neglected tropical
diseases like: trachoma, kalhazar, Guinea worm
• Educate the community about the diseases
• Carrying out mass drug administration (MDA)
rising burden of non
communicable
conditions
Community screening for NCDs • Train health workers on screening of NCDs
• Community sensitization on NCDs
• Conduct monthly screening of NCDs through
integrated mobile outreaches
• Budget and Procure equipment’s for screening NCDs
Institutional Screening for NCD’s • Create awareness in the institutions
• Conduct screening once in every semester
• Advocate for establishment of institutional clinics
Workplace Health & Safety • Create awareness on occupational hazards at
workplace.
• Establishment of health and safety committees in the
workplaces
• Establishment of Standard Operating Procedures
(SOPs) at work places.
• Put proper signs for direction and exit during
emergencies
• Designate exit points and fire assembly points
• Construct user friendly facilities which can
accommodate the needs of the disabled.
• Budget and procure equipment for personal safety
• Train workers on first aid
Food quality & Safety • Medical examination and screening of food handlers.
• Ensure food premises meet the basic minimum
requirements.
• Put in place rodents control measures.
• Provide waste bins for refuse disposal.
• Community sensitization on food safety.
• Train food handlers on proper food preparation.
• Consistent inspection of food and food premises
• Train food producers on proper handling from the

POLICY
OBJECTIVE
source to the consumer.
• Taking regular food samples to government
laboratoies
Reduce the burden
of violence and
injuries
Pre hospital Care • Train community health volunteers on first aid.
• Budget, procure and Provide first aid kits to
community health volunteers.
• Strengthening of community referral system.
Community awareness on violence and injuries • Create community awareness on importance of
peace.
• Sensitize community against retrogressive practices
like gender violence.
• Create awareness on the importance of following the
rule of law.
• Liaise with other stakeholders on creation of
alternative mean of livelihood
Disaster management and response • Establishment of disaster management and response
teams.
• Training of disaster management and response teams
• Set aside resources for disaster mitigation.
• Activate early warning systems to forecast and
mitigate disaster effects.
• Hold quarterly meetings on disaster preparedness.
• Map out areas which are prone to disaster.
Provide essential
health services
Outpatients • Setting up of customer care desks in all facilities.
• Operationalize 24 hours outpatient services in the
High volume hospitals
• Digitalize outpatient services in high volume hospitals
• Provide enough well trained staff to man the out
patients
• Budget, procure and provide essential equipment and
logistics
Emergency • Increase the number of ambulances.
• Improve communication through provision of VHF
radios and mobile phones.
• Establish emergency units in hospitals and health
centres.
• Train health workers on emergency preparedness.
• Provide equipment and resources in emergency units
Maternity • Increase the number of maternity units
• Provide adequate equipment in the maternity units
• Provide adequate well trained staff
• Provide standard operating procedures.
In patient • Maintain high standards of cleanliness
• Expand the capacity to offer inpatient services
• Adequately equip inpatient departments.
• Provide adequate essential commodities.
• Increase staff across all cadres
• Form inpatient therapeutic committees
Clinical laboratory • Establish clinical laboratories in all health centres.
• Budget, procure and provide laboratory equipment
and reagents.
• Recruit more laboratory staffs
Specialized laboratory • Strengthen the linkage between the county
laboratories and specialized laboratories
Radiology • Establish a radiology department in each sub county.
• Recruit more radiologists.
• Capacity building on the existing staffs
• Budget, procure and provide more radiological
equipments
Operative services • Construct a modern theatre in the County referral
Hospital and Baragoi Sub county Hospital

POLICY
OBJECTIVE
• Recruit theatre staffs for Baragoi sub county hospital.
• Conduct refresher training for theatre staff.
• Budget, procure and provide theatre equipment.
• Construct and equip minor theatres in all health
centres
Specialized therapy • Procure essential drugs and commodities
Specialized services • Set up specialized treatment departments at the
county referral hospital.
• Improve referral system
Rehabilitation • Establish 6 youth friendly centres in the county and
equip them
• Staff and equip the psychiatric unit in the County
referral hospital
• Equip physiotherapy and occupational therapy
department at the county referral hospital
• Expand and adequately equip the eye unit at the
County referral hospital.
• Set aside specials unit for nutritional rehabilitation
health risk factors
Health Promotion including health Education • Recruit and deploy a Health Education officer in each
sub county.
• Create awareness on existing health risk factors
through monthly community dialogue days, chiefs
barazas, local radio
• Conduct daily health education sessions in high
volume facilities.
Sexual education • Identify the specific groups that require sex education.
• Carry out sex education to the identified groups
• Acquire IEC materials for sex education.
Substance abuse • Create awareness on effects of substance abuse
• Identify the target groups.
• Acquire IEC materials on substance abuse.
• Put up a rehabilitation Centre
• Liaise with other stakeholders who undertake
rehabilitation.
• Liaise with government departments to enforce the
law.
Micronutrient deficiency control • Create awareness on the importance of good nutrition.
• Sensitization of fortified food in the market
• Procure enough micronutrient supplies in the county
• Sensitize pregnant mothers on the use and
importance of IFAS.
• Up scaling supplementation of micronutrient activities.
• Streamline micronutrient supply
Physical activity • Formation of health clubs in schools, workplaces and
in the community
• Create awareness on importance of physical activities
• Procurement and provision of sports equipment
Strengthen
collaboration with
health related
sectors
Safe water • Hold quarterly water stakeholders meeting.
• Strengthen water users association committees.
• Carry out regular water surveillance taking samples to
government laboratories
Sanitation and hygiene • Budget and procure refuse trucks
• Identify damping sites
• Procure dustbins
• Provide refuse transfer stations
• Provide protective personal garments
• Promote health education on sanitation and hygiene
Nutrition services • Increase the staffs in the county
• Integrate nutrition into health services
• Mapping out particular areas of nutrition need where
partners can supplement government efforts

POLICY
OBJECTIVE
• Strengthen monthly nutrition technical forum
• Formation of nutrition fields days committee
•
Pollution control • Procure equipment to measure air pollution level
• Collaboration with Neema to enforce law pollution
control
• Create aware on the importance of pollution control
•
Housing • Collaborate with other sectors to ensure that new
houses built meet minimum required standards
• Proper sitting of buildings
• Collaborate with other partners in constructing new
houses of health workers in the health facilities
School health • Forming of school health clubs
• Health education to schools
• Ensure schools meets minimum standard sanitary
requirements
Water and Sanitation Hygiene • Construct a sewage treatment works
• Budget and procure exhauster
• Construct storm water drains/channels
Food fortification • Securing of fortified supplements for the county
• Conducting monitoring and evaluation of foods in the
market
• Check regularly the standards of fortified foods in the
market
Population management • Sensitizing the population on the importance of family
planning
• Strengthen formal birth and death registration
• Identify the special population for support
Road infrastructure and Transport • To improve road infrastures network in the county
linking to health facilities
• Constructing bridges across seasonal rivers that
prevent population to access health services
• Construct storm water road drainage

8.2 Health Output priorities
Health output priorities are intended to facilitate easy access, utilization and good quality of health care services in
the county. These priorities are supposed to be addressed first and foremost in order to strengthen important health
care systems and foundation.
Priority interventions
Output area Intervention area Priority interventions for the year
Improving
Access to
services
Availability of critical inputs (Human
Resources, Infrastructure, Commodities)
• Employ more health workers
• Expand existing health facilities as well as
putting up new facilities. One per ward.
• Budget, procure and provide adequate
commodities to include drugs, food, vaccines
and equipment
Functionality of critical inputs
(maintenance, replacement plans, etc)
• Regular maintenance of machines and
equipments.
• Take inventory of available machines and
equipments
• Put in place a procurement and disposal
committee
• Allocate resources for procurement of new
machinery and equipments
Readiness of facilities to offer services
(appropriate HR skills, existing water /
sanitation services, electricity, effective
medications, etc)
• Recruit and deploy staffs to new facilities.
• Upgrading of skills for existing staff
• Regular maintenance of existing water and
sanitation services
• Put up water and sanitation services (Tanks and
toilets)
• Install renewable energy in health facilities.
• Ensure professionalism in order to facilitate
effective medication
• Provide equipment and commodities to aid in
effective medication

Output area Intervention area Priority interventions for the year
Improving
Quality of care
Improving patient/client experience • Provide a client friendly environment
• Conducting client exit interviews.
Assuring patient/client safety (do no
harm)
• Adhere to raid down SOPs
• Proper control of commodities.
• Put danger signs where appropriate
Assuring effectiveness of care • Conduct periodic quality control
• Set up a quality control committee
• Set up a feedback mechanism e.g. a suggestion
box

8.3 Health budget distribution and priorities for coming year
_____________________________________________________________________________________________
The health budget set forth a clear financial requirement for the implementation of various activities meant to
enhance health care services in the county. This budget
Budget distribution and milestones
Orientation
area
Intervention area Budget distribution Quarterly milestones Target quarter for
delivery ( )
Amount (KES) Source 1 2 3 4
Service
delivery
Strengthening emergency and referral services 48,000,000.00 • Quarterly review of emergency
and referral systems
• Purchase of ambulances
√ √ √ √
Strengthening outreach services 10,920,000.00 • Conduct monthly outreach
services.
• Quarterly review of outreach
nactivities
√ √ √ √
Scaling up community services 6,000,000.00 • Establishment of community
units
• Quarterly supervision to
community units
• Monthly reporting from
community units
√ √ √ √
Improving Supervision and mentorship 2,700,000.00 • Quarterly support
supervision to all health
facilities.
√ √ √ √
Organization of facility services (clinical audits,
OJT, therapeutic committee’s)
250,000.00 • Conduct quarterly clinical
audits in health facilities
• Formation of OJT and
therapeutic committees
√ √ √ √
Health
Infrastructure
(physical
infrastructure,
equipment,
transport, ICT)
Improving availability, functionality and
readiness of physical infrastructure (construction,
expansion, maintenance)
87,500,000.00 • Expansion of existing
facilities
facilities and departments
• Maintenance of existing
facilities
√ √ √ √
readiness of medical and hospital equipment
(purchase, maintenance)
32,740,000.00 • Procure medical equipments
for new facilities
• Procure equipments for
developing departments in
existing facilities
√ √ √ √
readiness of transport (purchase, maintenance)
33,000,000.00 • Procure utility vehicles for
health facilities
• Procure motorbikes for hard
to reach facilities
• Repair and maintain motor
vehicles and motorbikes
√ √ √ √
readiness of ICT (purchase, maintenance)
500,000.00 • Installation of electronic
record and computers in
facilities
√ √ √
Health
Workforce
Production of Health Workers (pre-service
training)
60,000,000.00 • Sponsor successful
candidates for preservice
training
√ √ √ √
Attraction, retention and motivation of health
workers
433,000,000.00 • Ensure availability of
salaries and renumeration
for health workers
√ √ √ √
Recruitment of required health workers 98,372,000.00 • Bi annual recruitment of
new health workforce
√ √
Training, and development of health workforce 30,000,000.00 • Career development and
progression of existing
health workforce
√ √ √ √
Improving institution capacity for health
workforce management
14,500,000.00 √ √

Orientation
area
delivery ( )
Health
information
Collection of routine data from facilities 877,800,000.00 • Monthl facilities collection
of reports
• Monthly health facility
incharges meeting
√ √ √ √
Collection of data on health vital events (births,
deaths)
220,000.00 • Monthly data collection on
births and deaths
notification
√ √ √ √
Collection of data from surveillance 1,200,000.00 • Monthly data collection for
surveillance
√ √ √ √
Collection of data from research 1,600,000.00 • Quaterly research √ √ √ √
Collection of data from health related sectors 870,000.00 • Monthly collection of data
from health related sectors
and partners
√ √ √ √
Data validation and analysis 3,200,000.00 • Qurterly meeting for data
analysis
√ √ √ √
Information dissemination and use 998,000.00 • Quarterly meetings for data
dissemination
√ √ √ √
Health
Products
Procurement of required health products 210,124,207.00 • Qurterly meeting of
procurement committee
• Quraterly quantification and
procurement of
commodities
√ √ √ √
Warehousing / storage of health products 5,000,000.00 • Quarterly estimation of
health products
• Quaerterly ordering and
storage of health products
√ √ √ √
Distribution of health products 18,900,100.00 • Quarterly quantification and
allocation of health products
• Quarterly delivery of health
products to all health
facilities
√ √ √ √
Monitoring rational use of health products 11,000,999.00 • Quarterly monitoring of
drug reports and registers
√ √ √ √
Health
Financing
Costing of health service provision 8,000,000.00 • Quarterly implementation
plans on health care services
√ √ √ √
Mobilizing resources to improve resource
adequacy
355,000.00 • Quarterly review of county
budgetary needs
• Quarterly proposal writing
for resources
√ √ √ √
Risk pooling and improving equity 120,000.00 • Quartery sensitization of
community to enter into
health insurance
√ √ √ √
Strategic purchasing and improving efficiency in
resource use
246,000,000 • Quaerterly review of
procurement and purchasing
procedures
• Quarterly total cost analysis
of commodities
√ √ √ √
Leadership and
Governance
Health stewardship and county management 4,060,000.00 • Annual APRP planning
• Quarterly Implementation
plans
• Quarterly CHMT meetings
√ √ √ √
Health partnership and coordination 500,000.00 • Conduct quarterly health
stakeholders forums
• Conduct quarterly
performance review with
stake holders
√ √ √ √
Public Private Partnerships 1,400,000.00 • Conduct quarterly support
supervision to private health
institutions
• Provision of commodities to
Private institutions
√ √ √ √

Orientation
area
delivery ( )
Health governance and linkage with County
system
500,000.00 • Quarterly evaluation
management leadership of
health gaps
• Qurterly meeting with
county administration to
facilitate understanding
√ √ √ √

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