County Health Strategic and Investment Plan 2013 - 2018

Department of Health Services
COUNTY GOVERNMENT OF
UASIN GISHU
Department of Health Services
2013 - 2018
COUNTY HEALTH STRATEGIC

AND INVESTMENT PLAN
MINISTRY OF HEALTH
Uasin Gishu County Health Strategic Plan 2013-2018

Any part of this document may be freely quoted, reproduced or translated in full or in part, provided the source is
acknowledged. It should not be sold or used in conjunction with commercial purposes.
Published by:
County Government of Uasin Gishu
P.O. Box 40 30100
Eldoret,
KENYA
UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018
II
TABLE OF CONTENTS
Acronyms
Preface
viii
Foreword
ix
Executive Summary
Process of Development and Adoption of the County Health Strategic

and Investment Plan
xii
UGC Health Department
xiv
Core Values of the County Health Department
xv
Section 1: Introduction and Background
1.1 Purpose of the Strategic Plan
1.2 County Geographical Location and Size
1.3 Physiographic and Natural Conditions
1.4 Administrative Units
1.5 Demographic Features
1.6 Emerging and Re-emerging Issues
18
1.7 Health Service Outputs
23
1.8 Issues and Challenges in Providing Health Services (SWOT)
25
1.9 Health System Investment
26
Section 2: Problem Analysis, Objectives and Priorities
35
2.1 Problem Analysis
36
2.2 Strategic Focus and Objectives
38
2.3 Sector Input and Process Targets for Achievement of County Objectives
40
Section 3: Resource Requirements and Financing
47
52
3.1 Resource Mobilization Strategy
Section 4: Implementation Arrangements
54
4.1 County Health Services Coordination Framework
55
4.2 Monitoring and Evaluation Plan
59
4.3 Comprehensive Monitoring and Evaluation Plan
60
Section 5: References
66
Section 6: Annexes
68
6.1 Annex 1: Risk Factors
68
6.2 Annex 2: The Monitoring and Evaluation Framework
68
6.3 Annex 3: Participant List
70
6.4 Annex 4: Functions, Roles and Responsibilities
70
III
Table of Tables
Table 1:
Uasin-Gishu County Administrative and Political Units and Size
Table 2:
Uasin Gishu Population Distribution and Projection, 2013 to 2017
Table 3:
Uasin Gishu Population Distribution by Age Group 2013
Table 4: Population Projection 2013 2017/2017
10
Table 5:
Uasin Gishu Population Distribution per Sub-county and Health Care Coverage
10
Table 6:
Distribution of Health Facilities per Manning Agency across Sub-counties
11
Table 7: Top Ten Causes of OPD Morbidity among Under-5s in Uasin Gishu
12
Table 8: Over-5 Top Ten Causes of OPD Morbidity in Uasin Gishu
12
Table 9:
13
Uasin Gishu OPD Service Utilization
Table 10: Reported Causes of Inpatient Mortality in MTRH 2011 to 2013
15
Table 11: Inpatient Utilization
17
Table 12: Health Impact
17
Table 13: Key Health Indicators
17
Table 14: Emerging and Re-emerging Health Issues and Interventions
20
Table 15: Health Service Outputs
23
Table 16: Issues and Challenges in Providing Health Services
25
Table 17: Available Human Workforce against Required Numbers and Gaps
28
Table 18: Problem Analysis
36
Table 19: Investment Area Details
43
Table 20: Budget Summary
48
Table 21: Investment Area Budget Summary
52
Table 22: Partnership and Coordination Structure
57
Table 23: Service Outcome and Output Targets for Achievement of County Objectives
62
Table 24: County Monitoring Indicators
63
IV
Table of Figures
Figure 1: Results Framework
Figure 2: Map Location of Uasin Gishu County in Kenya
Figure 3:
Health Facility Distribution Map by type -2013
Figure 4:
SARAM Kenya 2013: Health Facility Distribution by Type across Constituencies
Figure 5:
Uasin Gishu County Population Pyramid 2013
Figure 6:
Uasin Gishu Outpatient Morbidity 2011 to 2013
11
Figure 7: Outpatient Services Utilization 2011-2013
13
Figure 8:
13
Uasin Gishu County Immunization Coverage
Figure 9: Comparative Uptake of Reproductive Health Services
14
Figure 10: Top Ten Causes of Mortality, 2011-2013
16
Figure 11: Leading Causes of Death, 2011-2013
16
Figure 12: Health Information System
37
Figure 13: UASIN GISHU County Health Department Organogram
56
Figure 14: Detailed Clinical Services Structure
56
Figure 15: Comprehensive Planning Cycle
60
Figure 16: Uasin Gishu County Planning Cycle
61
ACRONYMS
AIDS Acquired Immunodeficiency Syndrome
ALOS Average Length of Stay
ANC Antenatal Care
ART Antiretroviral Treatment
ARVs Antiretrovirals
AWP Annual Work Plan
BEOC
Basic Emergency Obstetric Care
BoR
Bill of Right
BMI
Body Mass Index
CBR Crude Birth Rate

CDH County Director for Health
CDR Crude Death Rate
CEC County Executive Committee
CEOC Comprehensive Emergency Obstetric Care
CHMT County Health Management Team
CHW Community Health Worker
CIDP County Integrated Development Plan
CME Continuing Medical Education
COH Chief Officer for Health
CoK Constitution of Kenya
CSO Civil Society Organization
CU Community Unit
DHIS
District Health Information Software
DMOH
District Medical Officer of Health
HER Electronic Health Records

EMMS Essential Medicines and Medical Supplies
EMR Electronic Medical Records
DQA
Data Quality Assessment
ESP Economic stimulus package

FBO Faith-based Organization
GBV
Gender-based Violence
GF
Global Fund
HDU
High Dependency Unit
HIS
Health Information System
VI
HMIS
Health Management Information System
HIV
Human Immunodeficiency Virus
HRH
Human Resources for Health
HSSF
Health Sector Service Fund
ICD-10 International Classification of Diseases version 10.

ICDP Integrated County Development Plan
ICT Information and Communication Technology
ICU Intensive Care Unit
IDSR Integrated Disease Surveillance and Response
IMR Infant Mortality Rate
KEMSA
Kenya Medical Supplies Agency
KHP
Kenya Health Policy
KHPF
Kenya Health Policy Framework
KHSSP
Kenya Health Sector Strategic Plan
KNBS
Kenya National Bureau of Statistics
LLITNs Long-Lasting Insecticide Treated Nets

M&E Monitoring and Evaluation
MDG Millennium Development Goal
MDR-TB Multi Drug Resistant Tuberculosis
MTRH Moi Teaching and Referral Hospital
MOH Ministry of Health
MSF Mdicens Sans Frontires
NASCOP National Aids and STI Control Program
NCDs Non-Communicable Diseases
NGO Non-governmental Organization
NHSSP National Health Sector Strategic Plan
PHC Primary Health Care
PPE Personal Protective Equipment
RTA Road Traffic Accidents
RTK Rapid Test Kit
SARAM
Service Availability Readiness Assessment Mapping
SCHMT
Sub-County Health Management Team
SD
Standard Deviation
SWOT
Strengths, Weaknesses, Opportunities and Threats
SMART
Specific, Measurable, Reliable and Timely
VII
SOPs
Standard Operating Procedures
STI
Sexually Transmitted Infection
TB Tuberculosis
TBA Traditional Birth Attendant
TWG Technical Working Group
UGCHSSP
Uasin Gishu County Health Sector Strategic Plan
UNAIDS
Joint United Nations Program on HIV/AIDS
UNICEF
United Nations Children Fund
USAID
United States Agency for International Development
WFP
World Food Programme
WHO
World Health Organization
VIII
PREFACE
The County Government of Uasin Gishu has committed itself to providing equitable, affordable and quality
health care of the highest standard to all Kenyans, as per the Bill of Rights in the Constitution of Kenya
2010. This will be achieved through appropriate and available policies, guidelines and programmes that
the countys Health Department will implement.
This strategic plan conveys the Health Departments vision, mission, goal and core functions, policy
priorities, strategic objectives, investment areas, implementation framework and the resource requirements
between 2013 and 2018. The plans implementation will also be closely monitored through the Health
Departments monitoring and implementation framework at county and sub- county levels. The plan
recognizes the strengths, challenges and some of the underlying weaknesses within the current social,
economic and political environment under which this plan will be implemented. Being the first strategic
plan within the new devolved system of governance, it is expected that all players will rally around the
strategic directions outlined in the plan to realize the countys health goals.
The structure and framework of this plan is informed by the Kenya Health Sector Strategic Plan (KHSSP)
2014-2018. The KHSSP ensures the linkage between the outputs, outcomes and impact on one hand
and investment that are needed to achieve the same on the hand. The ultimate objective is evidence-based
and client-oriented focus that deviates away from the old disease-based approach.
The preparation of this plan would not have been possible without the valuable contribution of the
Directorate of Preventive and Promotive Services, Directorate of Curative and Rehabilitative Services led
by the County Health Management Team (CHMT) and Sub-County Health Management Teams (SCHMTs).
Finally, we would like to take this opportunity to thank the technical working group (TWG) and all those
who in one way or another participated and contributed in the process of preparing and developing this
document.
Dr. Evans Kiprotich

County Director of Health, Preventive and Promotive Services
UASIN GISHU COUNTY
IX
FOREWORD
The Constitution of Kenya 2010 established national and county governments, which are distinct but
interdependent, and which are expected to carry out their respective functions on the basis of consultation
and cooperation. The Fourth Schedule of the constitution assigns health policy and health service delivery
to the national and county governments respectively. To realize the right to health as stipulated in the Bill of
Rights and Financial Management Acts 2012. This outlines the priorities envisioned in the Kenya Health
Policy Framework (KHPF) 20122030, which are aligned to the National Health Sector Strategic Plan
(NHSSP) 20122017 and to the United Nations Millennium Development Goals (MDGs).
The Uasin Gishu County Health Sector Strategic Plan (UGCHSSP) 2013- 2018 is a key milestone in
the countys department of health services. It outlines the countys priorities towards the attainment of
quality health care for the people of Uasin Gishu. The development of this strategic plan is a result of
an evaluation of the sector through an elaborate and participatory process that is intended to ensure
leadership & governance, ownership & sustainability, stewardship & commitment by the key stakeholders.
To guide the implementation of the strategic plan, comprehensive essential service packages have been
defined and will be provided across the six key strategic objectives and seven health investment areas,
which will contribute to achieving the national targets and attaining KHPF 2012-2030 and Kenya Vision
2030.
The strategic plan articulates the vision, mission and core values of Uasin Gishu Countys health sector. It
also sets out strategic objectives, strategies, activities, time frame and resource requirements.
It is expected that the realization of the activities as outlined in the strategic plan will cost a total of KES
6,653,240,000.
The successful implementation of this strategic plan is expected to provide a basis for quality health care
and improved productivity in the County of Uasin Gishu.
Mr. Wilson Kemei

Chief Officer of Health Services
UASIN GISHU COUNTY
EXECUTIVE SUMMARY
The County Government of Uasin Gishu was established after the enactment of the Constitution of Kenya
2010. The countys Department of Health is mandated to carry out devolved health functions. These
include; county health facilities and pharmacies, ambulance services, promotion of primary health care;
licensing and control of undertakings that sell food to the public, cemeteries, funeral parlors and crematoria.
The strategic plan is composed of five key chapters that cover specific priorities and thematic areas.
Section One outlines the purpose of this strategic and investment plan as stipulated in the County Government
Act 2012. It provides background information of Uasin Gishu County, including the 30 administrative
units (wards), the demographic features and a map indicating the current distribution of health facilities.
It also provides the projected population for the different sub-counties, totalling 1,023,656 in 2013 to
1,178,391 in the year 2018 (the duration of the strategic plan) with an annual growth rate of 3.6%
(KNBS). It also outlines the countys vision, mission, and core values.
Section Two focuses on the county situational analysis. It highlights the general health status and morbidity
and mortality patterns. It includes the following trends: immunization coverage at 63.5% (DHIS 2013),
fully immunized, 76% in 2011 (DHIS). I also includes the burden of emerging, re-emerging and noncommunicable conditions i.e. cancers, hypertension and diabetes mellitus among the top 10 causes of
morbidity and mortality; communicable diseases posing a big challenge with increase in the prevalence
of HIV from 4.5% to 4.9% (UNAIDS/NASCOP Report 2013). There is also an emergence of multi-drug
resistant TB (MDR-TB) that has seen cases the rise from the first diagnosed in 2008 to the current total of 31
reported in County, which calls for specialized techniques and expensive equipment to diagnose MDR-TB.
The county has a latrine coverage of 86.7% with notable low coverage in the urban slum dwellings where
indiscriminate open defecation is witnessed, which increases the risk of waterborne diseases.
Section Three states the problem analysis, objectives, and the key priorities of the county strategic plan.
It elaborates the strategic focus, sector goal and objectives. In each of the specific objectives, various
strategies have been proposed. The section also provides for the sector inputs and processes with targets
for achievement and contains the key milestones that need to be reached.
Section Four outlines the resources and the financing required to implement the strategic plan. The total
cost of implementation is this strategic plan is estimated to be KES 6,653,240 000 (approximately USD
69 million). The resource mobilization strategies are also highlighted in this section. It is expected that
the government will finance most of the budget with implementing and support partners expected to fill
the gaps.
Section Five illustrates the implementation framework and the organogram for governance, coordination,
and managerial structures, with the different functions, roles and responsibilities of each stakeholder
outlined. This section also provides the monitoring and evaluation framework that has been proposed to
monitor and evaluate the achievement of the objectives and realization of goals as stated in the strategic
plan during plan period.
The development of this strategic plan was made possible through the support of the national Ministry
of Health, which provided technical guidance, the Government of Uasin Gishu County, especially H.E.
the Governor, the County Executive Committee Member for health and the County Assemblys Health
Committee who provided resources and leadership.
XI
We also recognize and commend the role played by health partners and stakeholders during the whole
process. We would like to particularly appreciate MEASURE Evaluation-PIMA, Kenya Red Cross and
AMPATH Plus for their technical and financial support throughout the process of developing this document
and the subsequent printing of the initial copies.
With the support of both the county government and the national government and all stakeholders, this
pragmatic strategic plan can be implemented successfully for the benefit of the people of Uasin Gishu.
For:
Dr. Eunice J. Siria

County Executive Committee Member for Health
UASIN GISHU County
XII
PROCESS OF DEVELOPMENT AND ADOPTION

OF THE COUNTY HEALTH STRATEGIC AND
INVESTMENT PLAN
The Uasin Gishu County Health Strategic and Investment Plan was developed through a consultative and
participatory process at various levels. The process involved the establishment of a technical working
group (TWG) that included a wide variety of stakeholders to oversee the following key technical areas:
service delivery; human resources for health; health infrastructure; medical products; health information
system; finance; and leadership and governance. The stakeholders that constituted the working groups
were drawn from county Department of Health, Non-governmental organizations (NGOs), FBOs and the
private sector. These included, but were not limited to, MEASURE Evaluation-PIMA, Kenya Red Cross,
AMPATH PLUS and Population Services Kenya, among others. Each working group, assisted by a task
force that assessed the needs in specific technical areas, identified the key challenges, drafted priority
strategic actions, and helped set the specific objectives, indicators, targets and planned outcomes.
The process involved the county government represented by the County Executive Committee (CEC) for
Health, the Chief Officer for Health (COH), the County Health Management Team (CHMT), the Subcounty Health Management Teams (SCHMTs), partners and stakeholders who provided guidance and
oversight.
The planning process involved a workshop where sections of the strategic plan were discussed and a draft
of the plan was produced. Subsequently, the document was revised by the Department of Health staff and
stakeholders, appraised by the CEC, and finally adopted by the County Assembly.
XIII
Vision Statement
Excellence in health care for all people in Uasin Gishu County.
Mission
To promote health and prevent disease and injury through the provision of the highest attainable quality,
acceptable, accessible, affordable and equitable health care services that are innovative, sustainable
and responsive to the people of Uasin Gishu County and beyond.
XIV
UGC HEALTH DEPARTMENT
XV
CORE VALUES OF THE COUNTY HEALTH DEPARTMENT

Service Excellence
Understanding and responding to public health needs and the people we serve
Pursuing our commitment to innovation and evidence-based best practices
Fostering a culture of continuous quality improvement
Integrity
Working honestly and ethically in our obligation to fulfil our public health mission.
Ensuring responsible stewardship of public health resources
Partnership
Working with stakeholders and communities to protect and promote the health of all Uasin Gishu
Countys population
Seeking, listening to and respecting internal and external ideas and opinions
Optimizing resources and leadership
Achieving public health goals in collaboration with our partners and other counties
Exploring and defining the roles and responsibilities of health care providers and partners
Health Equity
Eliminating health disparities and working to attain the highest level of health for all people
Ensuring the quality, affordability and accessibility of health services for all residents of Uasin
Gishu county
Integrating social justice, social determinants of health, vulnerable populations, diversity and community
Protecting all individuals and communities in Uasin Gishu County against the spread of disease,
injuries and environmental hazards
Leadership
Building organization-wide and community-wide opportunities for collaboration
Fulfilling an innovative vision of public health service
Championing public health expertise and best practices
Creating opportunities for individual development and leadership
Adhering to public health principles and standards
XVI
Legislative and other Mandates

The Health Department is directly responsible for implementing, managing and overseeing the issues
emanating from the following health and constitutional articles.
The power of the people, devolution and health:
Article 1(4) of Constitution of Kenya (CoK) 2010 that states that the sovereign power of the people is
exercised at the national and county levels.
Article 6(2) of CoK stipulates that the national and county governments are distinct and interdependent
and shall conduct their mutual relations on the basis of consultation and cooperation.
The Bill of Rights (BoR):
The CoK guarantees the right to the highest attainable standard of health, including:
The right to life, reproductive health and other attributes of good health.
The right to emergency treatment.
Clarity on responsibility of the state (duty bearers) and citizens (right holders) in ensuring that the above
aspects are met.
The CoK guarantees health for all Kenyans:
Art. 26; Every person has the right to life.
Art.42; Every person has the right to a clean and healthy environment.
Art. 43. (1) Every person has the right (a) to the highest attainable standard of health, which includes
the right to health care services, including reproductive health care.
53. (1) Every child has the right(c) to basic nutrition, shelter and health care.
56. The State shall put in place affirmative action programmes designed to ensure that minorities and
marginalized groups(e) have reasonable access to water, health services and infrastructure.
County Governments
Service delivery: planning is guided by Articles 102-121 under county planning in the County Government
Act, 2012 and Article 121(1) of Public Financial Management Act, 2012. County Government Act,
2012 (109) County sectorial plan.
A County department shall develop county sectorial plan as component parts of the county integrated
development plan.
The County sectorial plans shall be:
- Programme based;
- The basis for budgeting and performance management; and
- Reviewed every five years by the county executive and approved by the county assembly, but updated
annually.
XVII
SECTION 1:
Introduction and Background
1.1 Purpose Of The Strategic Plan

Over the years, the country has taken several steps
to provide a firm foundation that ensures that health
is achieved for all its citizens. The promulgation of
the Constitution of Kenya on August 27, 2010,
was a major milestone towards the improvement of
health standards.
For this to be realized, there is need for a road map

to guide implementation of the same. Therefore, the
purpose of this strategic and investment plan is to
guide the county in:
The new constitution, which states that (Article 43)

all citizens are entitled to the highest attainable
standard of health including emergency
treatment... gave hope to many citizens as it
sought to ensure that a rights-based approach to
health is adopted and applied in delivery of health
services in the country. It provides a conducive
legal framework to ensure a comprehensive and
people-driven health service delivery.
Providing a framework and a road map on how

the medium-term county health objectives will
be achieved;
In the devolved system of governance, the transition

authority also devolved the health service delivery
mandate to the counties. The national government
maintains the responsibility for policy development
through the state department for health while the
counties are entrusted with the task of implementing
the national policy, with a focus on their local
priorities; thus the development of this strategic and
investment plan.
Strengthening participation, involvement and

partnerships with both public and private
sectors;
Uasin Gishu County is committed to implementing

the National Health Policy 2013-2017 through
a consultative and all inclusive approach. The
county has developed its Integrated Development
Plan 2013-2017 on which this strategic plan is
anchored.
The health strategic plan incorporates information
on the health situation and outcomes as envisioned
by the county. It also highlights the priority health
investment areas needed to attain the health
outcomes of the county, the resources needed, the
strategy to mobilize the required resources and
how the sector will be organized and managed
to ensure that the strategic objectives of the county
are achieved in an efficient and effective manner.
Prioritization of key investment areas in health;
Monitoring targeted county health performance

indicators;
Resource mobilization and allocation in the
prioritized health investment areas;
Contributing towards the achievement of the

Millennium Development Goals (MDGs), the
Kenya Health Policy 2012-2030(KHP) and
Vision 2030;
Accelerating health service delivery to the
highest attainable standards as envisioned in
he 2010 constitution; and
Provide an informed input into the Integrated
County Development Plan (ICDP) and County
Fiscal Strategy Paper defined under the County
Government Act 2012 and the Public Finance
Management Act 2012.
Uasin Gishu Countys health priorities have
informed the development of this plan in line with
a results framework, which has been developed
by the Ministry of Health to guide the process of
the realization of long-term health goals defined in
Vision 2030 and the Kenya Health Policy 20132017, as illustrated in the diagram below.
HEALTH SECTOR SPECIFIC
GOVERNMENT - WIDE
Kenya Health Policy (2012\2030)

(Long term health intent for Kenya)
Vision 2030
(Long - Term development intent for Kenya)
Kenya Health Sector Strategic

& Investment Plan
(2012/2017)
Second Medium - Term Plan (2013/2018)
Integrated County Development Plan

(5 year County Development targets)
County
Specific
Priorities
County Health Strategic & Investment Plan

(5 years County targets and investment
priorities
Budget
Distribution of known or potential resources
Operational Plan
Annual targets and activities for
implementation with available funds
Performance Contract
Annual performance targets
County
Specific
Priorities
1.2 County Geographical Location And Size

Uasin Gishu County lies in the mid-west of the Rift Valley and borders six counties, namely Elgeyo Marakwet
County to the east, Trans Nzoia to the north, Kericho to the south, Baringo to the south- east, Nandi to
the south-west and Kakamega to the west. The county covers a total geographical area of 3,345.2 km2.
Figure 3: Health Facility Distribution Map by type -2013
Figure 4: SARAM Kenya 2013: Health Facility

Distribution by Type across Constituencies
1.3 Physiographic and Natural

Conditions
Uasin Gishu County is a highland plateau with
altitudes falling gently from 2,700 meters above
sea level to about 1,500 meters above sea level.
The average amount of rainfall in the county ranges
from 900 1200mm per annum. The county has
two rainfall seasons: long rains (March to August
with the peak being May to August); and short rains
(between September to November). Temperature
ranges from between 25 C32C.
The topography is higher to the east and declines
gently towards the western border. The county
is physiographically divided into three zones:

the upper highlands, upper midlands and lower
highlands. These zones greatly influence land use
patterns as they determine the climatic conditions.
The geology is dominated by tertiary volcanic rock
with no known commercially exploitable minerals.
1.4 Administrative Units

Uasin Gishu County is divided into six sub-counties:
Turbo; Soy; Ainabkoi; Moiben; Kessess; and
Kapseret. The sub-counties are further sub-divided
into 30 wards, as indicated in Table 1. Eldoret
town is the countys administrative and commercial
capital.
Table 1: Uasin Gishu county administrative and political units and size
Sub-County
No. of Admin. Units (Wards)
Est. Pop. 2013
Area KM2
Pop. Density
117,962
479.9
246
Per KM2
Ainabkoi
Kapseret
184,347
415.8
443
Kesses
114,529
581.6
197
Moiben
158,451
777.1
204
Soy
268,925
768
350
Turbo
179,442
322.7
556
Uasin Gishu County
30
1,023,656
3,345.1
306
Sub-County No. of Admin. Units (Wards) Est. Pop. 2013 Area KM2 Pop. Density Per KM2
1.5 Demographic Features

Population Size and Composition
Uasin Gishu County has a total population of 1,023,656 consisting of 513,649 males and 510,007
females, according to 2013 population estimates. The population is projected to increase to 1,178,391
in 2017. In 2013, there were 231,421 households, which are expected to rise to 266,589 in 2017.
The table below shows the population distribution per the various age groups and projection for the
strategic plans 5-year period.
Table 2: Uasin Gishu Population Distribution and Projection, 2013 to 2017

Description
Propor tion
Estimates
(KBS)
2009 (KBS)
2013
2014
2015
2016
2017
Total
population
894,179
1,023,656
1,059,767
1,097,918
1,137,443
1,178,391
Total
number of
households
202,291
231,421
239,752
248,383
257,325
266,589
Children
under 1
year (12
months)
3.90%
34,873
39,895
41,331
42,819
44,360
45,957
Children
under 5
years
16.9%
151,116
172,877
179,101
185,548
192,228
199,148
Under -15
population
42.3%
378,238
432,704
448,281
464,419
481,139
498,460
W o m e n
of
child
bearing age
(15 - 49 yrs)
24%
214,603
245,506
254,344
263,500
272,986
282,814
Estimated
number of
deliveries
3.84%
34,336
39,281
40,695
42,160
43,678
45,250
Estimated
live births
3.79%
33,889
38,769
40,165
41,611
43,109
44,661
Total
number of
adolescents
(1524 yrs)
21%
187,778
214,818
222,551
230,563
238,863
247,462
Adults (2559 yrs)
26.1%
233,381
266,988
276,599
286,557
296,873
307,560
Elderly (60+
yrs)
4.80%
42,921
49,101
50,869
52,700
54,597
56,563
Source: KNBS 2009 2013, Growth rate 3.6%
Table 3: Uasin Gishu Population Distribution by Age Group 2013

Age Group
Male
Female
Total
0 to 4
78,574
77,254
155,829
5 to 9
72,289
71,024
143,313
10 to 14
62,394
62,528
124,921
15 to 19
53,426
55,372
108,798
20 to 24
58,228
62,983
121,211
25 to 29
47,004
48,201
95,205
30 to 34
36,754
34,242
70,997
35 to 39
29,488
33,889
38,769
26,995
21%
187,778
214,818
55,768
26.1%
233,381
266,988
40 to 44
19,867
17,507
37,373
45 to 49
16,650
14,905
31,555
50 to 54
11,255
9,955
21,210
55 to 59
8,180
7,570
15,749
60 to 64
5,993
5,633
11,626
65 +
13,847
15,538
29,385
Total Pop.
513,949
509,707
1,023,656
Sex ratio Male : Female 50.2:49.8
Figure 5: Uasin Gishu County Population Pyramid 2013
Male
Female
Sex ratio 50.2:49.8
10
The above population pyramid illustrates that Uasin
Gishu County comprises a predominantly youthful
population aged between 10-29 years, which
comprises 45% of the population (2013 estimates).
Children under 5 years of age comprise 14.6% of
the population. This demands the initiation of youthfriendly health services. The pyramid also indicates
that Uasin Gishu County has more males than
females (Sex ratio 50.2:49.8). Other factors that
may require urgent attention include unemployment
that may pose challenges to the health of the
youthful population, who may engage in drugs and

substance abuse, irresponsible sexual behaviour,
crime, etc.
The table below presents the countys projected
population over the 5- year period of the strategic
plan (20132017). The county had a total
population of 1,023,656 as per 2013 projections.
This is projected to rise to 1,179,215 by 2017,
assuming that the growth rate remains constant at
3.62%. Soy sub-county has the highest population
as per the projection and Kesses has the lowest.
Table 4: Population Projection 2013 2017/2017

Sub-County
No. of
Administrative
Units (Wards)
Est. SubCounty Pop.

2013
2014
2015
2016
2017
Ainabkoi
117,962
122,209
126,608
131,166
135,888
Kapseret
184,347
190,983
197,859
204,982
212,361
Kesses
114,529
118,652
122,924
127,349
131,933
Moiben
158,451
164,155
170,065
176,187
182,530
Soy
268,925
278,606
288,636
299,027
309,792
Turbo
179,442
185,902
192,594
199,528
206,711
County Total
30
1,023,656
1,060,508
1,098,686
1,138,239
1,179,215
12
Kapseret
184,347
415.8
443
10
18,435
37
Kesses
114,529
581.6
197
13
6,737
23
16
Moiben
158,451
777.1
204
17
8,803
32
12
Soy
268,925
768
350
19
11,692
54
16
Turbo
179,442
322.7
556
17
11,963
36
16
UG
County
30
1,023,656
3,345.1
306
90
10,237
205
80
23
optimally CUs
Functional but sub-
24
Existing
6,939
Units
Ideal Community
14
Public Facilities
246
Pop. Density
479.9
Area
117,962
Est. Pop. 2013
No. of Admin.
Units (Wards)
Ainabkoi
Sub-County
Pop. Per Facility
Community Units
Table 5: Uasin Gishu Population Distribution per Sub-county

and Health Care Coverage
11
One of the strategies towards attaining health care
for the residents of Uasin Gishu County is to take
services closer to the population i.e. through the use
of community-based strategies. The ideal number of
functional Community Units (CUs) to ensure effective
health interventions at the community level is 1 unit
per 5,000 people. Using these criteria, Uasin
Gishu County required 205 CUs (ideal) by 2013;
however, only 80 CUs existed, 23 of which were
reported to be semi-functional, as indicated in the
table above. This calls for investment in this level of
service provision i.e. to operationalize (make fully
functional) all the 80 CUs by the end of the plan

period. Some sub-counties (KapseretLangas and
TurboHuruma) will, however, require more units
based on an expected sharp rise in population due
to the presence of informal settlements (slums). The
number then will need to be raised to 100 CUs as
proposed in section 4 of this document (investment
area).
The table below shows health service coverage
per sub-county with number of health facilities and
also showing contribution per sector.
Table 6: Distribution of Health Facilities per Manning Agency across SubDistribution of Public Health facilities
counties
Contribution per health care giver
Tier 2
Tier 3
Tier 4
Public
FBO
NGO
Private
Total
DISP
HC
HOSP
National
CMOH
Ainabkoi
14
12
31
10
14
Kapseret
10
11
27
10
Kesses
13
23
11
13
Moiben
17
24
13
17
Soy
19
30
13
19
Turbo
17
11
12
41
13
17
Uasin Gishu Cnty
90
28
55
176
79
16
90
MOH MFL 2013/

Ehealth Kenya
Figure 6: Uasin Gishu Outpatient Morbidity 2011 to 2013

UASIN GISHU OPD MORBIDITY 2011 TO 2013
2013
2012
2011
12
The leading cause of morbidity in the county, as illustrated by the chart above and the tables below, is
other diseases of the respiratory system. However, confirmed malaria is on the rise with declining cases
managed as clinical malaria. This may be attributed to increased use of Rapid Test Kits (RTKs) to diagnose
and manage malaria.
Table 7: Top Ten Causes of OPD Morbidity among Under -5s in Uasin Gishu
Cases reported
Condition
2011
2012
2013
Clinical malaria
67,420
64,073
46,303
Diarrhea
19,264
21,125
23,300
Diseases of the skin (incl. wounds)
16,913
16,466
20,925
Confirmed malaria
13,908
16,342
18,583
Pneumonia
8,158
9,963
12,312
Eye infections
4,150
4,985
5,438
Intestinal worms
3,540
3,754
3,649
Ear infections
3,466
4,832
4,494
Accidents - fractures, injuries etc.
2,998
3,170
5,293
Chickenpox
2,577
2,384
1,525
All other cases
136,209
162,141
217,884
Total Cases
278,603
309,235
359,706
OPD Attendance (Curative)
230,448
263,732
287,703
Referrals In
4256
5778
2982
Referrals Out
1134
7631
1591
Table 8: Over -5 Top Ten Causes of OPD Morbidity in Uasin Gishu

Cases reported
Disease
2011
2012
2013
Other Diseases of the respiratory system
136,151
148,379
218,337
Clinical malaria
124,383
114,122
88,064
Diseases of the skin (incl. wounds)
46,348
52,102
65,330
Confirmed malaria
25,248
36,688
42,434
Typhoid fever
18,325
23,991
36,120
Accidents - fractures, injuries etc.
21,338
21,528
25,786
Pneumonia
18,757
23,064
28,428
Diarrhea
15,459
18,640
20,937
Dental disorders
17,527
15,737
18,977
10
Urinary tract infection
13,565
15,220
20,820
All other cases
297,772
312,764
424,396
Total cases
734,873
782,235
989,629
Total OPD Attendances (Curative)
544,684
627,675
762,586
Referrals In
10,986
1,911
3,515
Referrals Out
10,826
6,449
5,795
13
Figure 7: Outpatient Services Utilization 2011-2013

Uasin Gishu County
Facilities, 2,013,,
1,442,008
Uasin Gishu County
Facilities, 2,012,
1,184,401
Uasin Gishu County
Facilities, 2,011,
962,214
MTRH, 2,011,
22,768
MTRH, 2,012,
207,344
MTRH, 2,013,
200,209
In terms of service utilization, there is a general increase in the number of clients seeking services from the
primary facilities and a decline in those going for services at the referral facility (MTRH).
Table 9: Uasin Gishu OPD Service Utilization

2011
2012
2013
General OPD
1,183,982
1,391,745
1,642,217
Immunization coverage (FIC)
74.2%
66.8%
63.5%
Measles coverage
77%
74%
65.3%
Deliveries by skilled workers
12002
15803
18578
1st ANC visit
24004
28093
26913
4th ANC visit
7181
10207
9712
Figure 8: Uasin Gishu County Immunization Coverage

Uasin Gishu County Immunization Coverage
65%
2013
Measles coverage
64%
Immunization
coverage (FIC)
74%
2012
67%
Poly.
(Measles coverage)
77%
2011
74%
)%
10%
20%
30%
40%
50%
60%
70%
80%
90%
The previous chart indicates a decline in general immunization and measles vaccine coverage over the
three- year period. This is a trend that needs to be reversed, especially bearing in mind that Uasin Gishu
14
has a youthful population, as portrayed by the population pyramid in Figure 9. This implies that the
children under 5 years of age will be at risk of acquiring vaccine preventable diseases as the threshold for
herd immunity is far below. Considering that 45% of the population falls in the reproductive age groups,
this compounds the situation even further. This, in turn, will pose challenges and strain the countys health
system and resources.
Figure 9: Comparative Uptake of Reproductive Health Services
CHART SHOWING COMPARATIVE UPTAKE OF

REPRODUCTIVE HEALTH SERVICES
45,000
40,000
39,281
38 393
38,393
36,974
Expected Pregnant Women
35,000
28 093
28,093
30,000
25,000
24,004
4th ANC Visit
18,578
20,000
Skilled Deliveries
15,803
15,000
10,000
1st ANC Visit
26,913
12,002
10,207
9,712
7,181
5,000
2011
2012
2013
The countys antenatal care (ANC) coverage is still low. The picture indicated in the chart above shows
low uptake of ANC services; this could be due to client attitudes or service limitation (accessibility).
Workable solutions include introduction of mobile reproductive health services, construction of health care
facilities, upgrading existing facilities, investing in the health workforce and enhancing health promotion
services, among others.
Other key areas that need to be addressed include the low number of skilled deliveries and fourth ANC
visits.
15
Table 10: Reported Causes of Inpatient Mortality in MTRH 2011 to 2013

2011
Top Ten Inpatient Mortality 2012

Conditions

Conditions
HIV
222
HIV
Diseases of the circulatory 293

system
Diseases of the circulatory system
151

system
HIV
Diseases of the respiratory system
110
Diseases of the respiratory 137

system

system
Neoplasm
108
Neoplasms
Neoplasm
Diseases of the digestive system
108
Diseases of the digestive 84

system

system
Accidents
95
Acute renal failure
67
Accidents
131
Anaemias
55
Accidents
59
Anaemias
79
Renal failure
43
Tuberculosis
54
Tuberculosis
69
Tuberculosis
40
Anaemia
51
Renal failure
59
Diarrhoea
36
Diarrheal diseases
33
Meningitis
54
2011

Conditions

Conditions
HIV
222
HIV

system
Diseases of the circulatory system
151

system
HIV
Diseases of the respiratory system
110

system

system
Neoplasm
108
Neoplasm
Neoplasm
Diseases of the digestive system
108

system

system
Accidents
95
Acute renal failure
67
Accidents
131
Anaemias
55
Accidents
59
Anaemias
79
Renal failure
43
Tuberculosis
54
Tuberculosis
69
Tuberculosis
40
Anaemia
51
Renal failure
59
Diarrhoea
36
Diarrheal diseases
33
Meningitis
54
Total Other Causes of Death
1,895
Total Other Causes of Death 1,017
Total Other Causes of Death 1,382
Total Deaths
2,863
2,247
2,816
364
105
364
105
254
166
254
166
16
Figure 10: Top Ten Causes of Mortality, 2011-2013
TOP TEN CAUSES OF MORTALITY, 2011 TO 2013

TOTAL OTHER CAUSES OF DEATH
DIARRHOEA
TUBERCULOSIS
RENAL FAILURE
2013
ANAEMIAS
2012
ACCIDENTS
DISEASES OF THE DIGESTIVE SYSTEM
2011
NEOPLASM
DISEASES OF THE RESPIRATORY SYSTEM
DISEASES OF THE CIRCULATORY SYSTEM
HIV DISEASES
200
400
600
800
1000 1200
1400
1600
1800
2000
Figure 11: Leading Causes of Death, 2011-2013
LEADING CAUSES OF DEATH, 2011 - 2013

TOTAL OTHER CAUSES OF DEATH
DIARRHOEA
TUBERCULOSIS
RENAL FAILURE
2011
ANAEMIAS
2012
ACCIDENTS
2013
DISEASES OF THE DIGESTIVE SYSTEM

NEOPLASM
DISEASES OF THE RESPIRATORY SYSTEM
DISEASES OF THE CIRCULATORY SYSTEM
HIV DISEASES
1000
2000
3000
4000
5000
HIV is the leading cause of death in the county (MTRH data), as indicated in the chart above, followed
by diseases of the circulatory system, respiratory diseases and non-communicable diseases, such as
neoplasm, anaemia and renal failure.
17
Table 11: Inpatient Utilization

County Hospitals & Health Centres
MTRH
2011
2011
2012
2013
720
779
734
105%
87%
103%
Admissions
8,155
8,343
10,265
No of beds
112
112
112
No of deliveries
7,315
7,894
10,125
Maternal deaths
44
36
41
Available beds
2012
2013
105
% Occupancy
ALOS
Maternity
Table 12: Health Impact

Impact level Indicators
National Estimates
County Estimates
Life expectancy at birth (years)
63
60 (male 56, female 65)
Annual deaths (per 1,000 persons) crude mortality
Female 5.8
Male 6.0
7.8
Neonatal mortality rate (per 1,000 births)
31/1000
33/1000
Infant mortality rate (per 1,000 births)
52/1000
57/1000
Under-5 mortality rate (per 1,000 births)
74/1000
80/1000
Maternal mortality rate (per 100,000 births)
488/100,000
147/100,000
Table 13: Key Health Indicators

Total population projection (2012)
1,023,656
Total health personnel (2012)
3,798
Staff: patient ratio
1:270
Crude birth rate (CBR)
49.4/1,000
Crude death rate (CDR) -
7/1,000
Life expectancy
65.9 years
Women of childbearing age (15 49 years)
24%
Total fertility rate
3.4 %
Neonatal mortality rate
52/1,000
Infant mortality rate (IMR)
48/1,000
Children under 1 year
3.71%
Children fully immunized at 1 year of age
35 %
Children under 5 years
16.9 %
18
Under - 5 mortality rate
38/1,000
Children under 5 years attending growth monitoring clinic (new visits)
38%
Children de-wormed at least once a year
25%
Pregnant women attending at least four ANC visits
22%
Deliveries conducted by skilled health staff in facility
30%
Women receiving family planning commodities
34%
Malaria prevalence
43.4%
Respiratory Infections
20.7%
Malnutrition rate among under-5s
61%
HIV prevalence rate
4.3 %
HIV+ women receiving PMTCT
20%
Targeted adult HIV+ patients receiving ART
4.8%
TB in every 100,000 people
170/100,000
Doctor:Patient ratio
1:10,034
Source: Uasin Gishu County Health Strategic Plan 2013-2018
1.6 Emerging and Re-emerging Issues

Introduction
Globally, the number of deaths arising from noncommunicable causes, such as heart disease
and injuries, is growing. Outbreaks of infectious
diseases, food borne diseases or contaminated
pharmaceuticals and other products can spread
from other countries across the globe, counties and
communities. The Health Department must continue
to prevent and control infectious diseases while
addressing health threats from non-communicable
diseases and environmental health risks.
As Uasin Gishu countys socio-economic status
continues to change, the health system surveillance
must improve with a focus on addressing these
emerging and re-emerging health concerns. The
county should take a leadership role in promoting
a comprehensive real-time infectious disease
surveillance and emergency response system given
the presence of the following features in the county
which can contribute to health risk factors and
hazards:
The county is situated along an international
northern corridor highway from South Africa to
Cairo.
The international airport in Eldoret exposes the

county to risks associated with international
travel in terms of infections and epidemics listed
as WHO notifiable diseases.
The national referral hospital (MTRH) attracts a
high volume of referral cases of communicable
diseases.
Institutions of higher learning with high student
populations from across the globe pose disease
surveillance challenges.
Emerging health issues

Diabetes and obesity
Hypertension
Cancer
TB & MDR-TB
Drugs and substance abuse
Public health emergencies

The response to any emergency or disaster must be
a coordinated community effort. There is a need to
develop and disseminate the Uasin Gishu County
Public Health Emergency Guidelines that will assist
the county and public health professionals during
19
the first 24 hours of a disaster. These should be used
in conjunction with existing emergency operational
plans, procedures, guidelines resources, assets
and incident management systems.
The dominant public health issues in Uasin Gishu
County include:
Occupational health hazards
WHO notifiable diseases e.g. Ebola, influenza,
measles, polio, guinea worm, etc.
Neighbouring counties/countries with endemic

vector-borne diseases, such as yellow fever,
and viral haemorrhagic fevers and bacterial
meningitis
Road traffic accidents
Risk of HIV among key populations, such as
men having sex with men, long distance truck
drivers, commercial sex workers, and injecting
drug users
Zoonotic diseases i.e. Anthrax, rabies, Rift

Valley fever
20
Table 14: Emerging and Re-emerging Health Issues and Interventions

Output Area
Situation
Emerging Health
Issues
Increased cases of:
Intervention Area
Lung diseases e.g., pneumonia, TB & MDR-TB

WHO notifiable diseases e.g. rabies and measles
Diabetes and obesity
Hypertension
Cancer
Drug and substance abuse
HIV& AIDS
Child malnutrition and stunted growth
Increase case detection, early diagnosis,

treatment and management
Strengthen
initiatives
surveillance
and
response
Provide PPE
Promote healthy lifestyle
Regular medical check-ups and screening
Establish regular specialist clinics and offer
subsidized services.
Drug and substance abuse sensitization and
law enforcement.
Carry out a survey on d rugs and substance
abuse
Strengthen
surveillance,
screening and vaccination
international
Behaviour change communication (among

key populations, youth etc).
Early diagnosis and treatment of HIV and STIs
Structured interventions (alternative incomegenerating activities)
Ensure consistent availability of HIV diagnostics
& ART/Prophylaxis
Strengthen prevention and diagnosis of new
infections of HIV e.g. eliminate mother- tochild transmission (eMTCT), early Infant
diagnosis (EID)
Improve nutrition education
21
Output Area
Re-emerging
Health Issues
Situation
Intervention Area
Malaria epidemics
Give micronutrients and supplementation

Carry out research and baseline survey
Terror attacks / threats
Notifiable diseases e.g. measles, rabies, anthrax etc.
Capacity building and implementation of malaria

case management policy
Human conflict
Road traffic accidents
Workplace acquired infections
Unplanned settlements (slum dwellings)
Inter-sectoral emergency preparedness
Network with national and research centers
Promote community cohesion
Establish and equip modern referral laboratory for prompt
diagnosis
Road safety awareness and response by stakeholders
Strengthen infection prevention measures
Vaccinate staff using WHO approved antigens
Collaborate with relevant departments for education on
implementation of the Occupational Health and Safety Act
(OHSA) and protocols
Rural and urban planning, zoning, and waste management through
inter-sectoral collaboration.
Public Health Preparedness and Response:

Core Competencies in disaster management
and emerging health concerns
The Public Health Preparedness and Response Core
Competencies are to be used with the understanding
that they are practised within foundational public
health competencies, generic emergency core
competencies, and position-specific or professional
competencies.
The four core competencies span preparedness,
response and recovery roles.
Performance Goal: Proficiently perform assigned
prevention, preparedness, response, and recovery
role(s) in accordance with established national,
state, and local health security and public health
policies, laws, and systems.
1. Model Leadership:
Solve problems under emergency conditions.
Manage behaviour associated with emotional
responses in self and others.
Facilitate collaboration with internal and external

emergency response partners.
Maintain situational awareness.
Demonstrate respect for all persons and cultures.
Act within the scope of ones legal authority.
2. Communicate and Manage Information:

Manage information related to an emergency.
Use principles of crisis and risk communication.
Report information potentially relevant to the
identification and control of an emergency
through the chain of command.
Collect data according to protocol.
Manage the recording and/or transmission of
data according to approved protocol.
3. Plan for and Improve Practice:

Contribute expertise to a community hazard
vulnerability analysis (HVA).
22
Contribute expertise to the development of
emergency plans.
Participate in improving the organizations
capacities (including, but not limited to,
programs, plans, policies, laws, and workforce
training).
Refer matters outside of ones scope of legal
authority through the chain of command.
Response
Recovery/Rehabilitation.
The competency domains for the workforce include:
Risk reduction, disease prevention and health
promotion
Policy development and planning
Ethical practice, legal practice and accountability
4. Protect Worker Health and Safety
Communication and information sharing
Maintain personal/family emergency preparedness

plans.
Education and preparedness
Employ protective behaviour according to changing

conditions, personal limitations, and threats.
The disaster competencies for health staff span four
broad areas :
Mitigation and prevention
Preparedness
Care of the community

Care of individuals and family
Psychological care
Care of vulnerable populations
Long-term recovery of individuals, families and
communities.
23
1.7 Health Service Outputs

Table 15: Health Service Outputs
Output Area
Situation
Access /
Utilization
Human resources:
Shortage of human resources for health in terms of numbers
and skill mix:
Intervention area
Recruit more staff as per norms and standards
Staff promotion, review of remuneration,
Leading to the intermittent closure of health facilities
Availability of critical inputs (commodities, equipment

&innovative interventions, etc.)
Leading to facilities being manned by one member

of staff
Career development through both short- and long-term

to develop specialized skills.
High staff attrition rate
Develop a human resource development plan
Absence of attractive and retention package f or human

resources
Poor working environment and conditions
Shortage of specialized skills in health facilities
Infrastructure:
Renovation and construction of modern infrastructure
Inadequate physical infrastructure
Adhere to recommended construction and maintenance

structural plans
Poorly maintained infrastructure

Frequent power interruption
Inadequate supply of safe water
Provide backup power generators

Provide alternative sources of portable water
Lack of adequate storage capacity
Construct staff houses
Weak referral systems:
Procure and effectively manage ambulances
Lack of a county referral hospital
Build and equip county referral hospital and sub-county

hospitals
Lack of enough ambulances

Ill-equipped health facilities
Lack of fully functional community units in place
Lack of referral protocols
Construct stores and warehouses
Develop a referral policy

Sensitize CHWs and health care workers on referral
systems
Encourage two-way referral system
Strengthen the community strategy
Develop and implement referral protocols
Geographical inaccessibility due to:

Rough terrain and poor road network
Advocacy and multi-sectoral collaboration to improve

road networks
Poor road conditions
Transport/communication:
Increase the number of facilities having ICT automation
Low coverage and utilization of ICT and networking

in client management
Capacity building in ICT
Low ICT capacity of the technical human resource
Use innovative mobile (sms) alerts to clients and

management information systems
Develop an elaborate data information system
Commodities and equipment:
Procure basic equipment
Insufficient basic equipment
Procure and provide specialized diagnostic equipment
Lack of specialized diagnostic laboratory equipment
Ensure timely, regular and consistent supply of essential

medicines and medical supplies
Erratic and insufficient supply of essential medicines and

medical supplies (EMMS)
Poorly maintained equipment
Build capacity of staff in commodity management

Improve inventory management,
Strengthen supply chain management,
Implement preventive maintenance policy
24
Advocacy and health promotion
Religious/social cultural barriers:

Underutilization of health care
services
preference for TBAs and herbalists
Retrogressive religious/cultural beliefs
conform to modern health practices
due
that
to
dont
Sensitization and male involvement in health

Behavior change communication
Reorient TBAs on their role in referral
Enforcement of public
Low male involvement in health issues
health
laws
Poor health-seeking behaviour

Poor emergency preparedness and response capability:
Lack of the coordinating team/mechanism
Form an integrated county/ sub- county disaster

management committee
Lack of human resource capacity
Capacity building of staff on disaster management
Lack of emergency equipment and supplies
Output Area
Access /
Utilization
Adapt and implement legislation to guide disaster

preparedness and response
Procurement and supply of emergency equipment and

supplies
Situation
Intervention area
Low client/provider satisfaction:
Conduct patient satisfaction surveys
Lack of client satisfaction surveys
Create customer care desks
Sub-optimal community engagement

programming and implementation
in
health
Non-compliance of service charter by health care

providers
Unfriendly services for minority groups e.g. physically
challenged clients and key populations at risk of HIV
Poorly motivated health care providers
Inadequate sanitary facilities
Lack of a conducive and clean working environment
Inadequate community awareness on health rights
Install a suggestion box

Ensure all health facilities have a customer service
charter, and ensure its dissemination and compliance
Youth-friendly services
Training of staff on customer care
Ensure facilities are accessible to the disabled
Motivate staff (general) e.g. timely promotions, salary
emoluments (commensurate to skills and qualifications)
Ensure a conducive working environment.
Motivate staff through performance- based incentives.
Give Recognition Awards to the best performing staff.
Poor adherence to clinical
Produce, avail and disseminate clinical guidelines to

all staff
guide lines and standard operating procedures at

service delivery level
Strengthen support supervision
Ineffective support supervision and follow-up
Adapt and disseminate HIS policy
No client feedback
Conduct routine DQAs and reviews
Improper documentation
Capacity build staff on data management
Low data demand and use for decision-making
Procure and distribute sufficient data capture and

reporting tools
Weak data management structures
Strengthen documentation and reporting system

Advocate for active data and
decision-making
information
use
for
Implement Kenya quality improvement of care
25
Output Area
Situation
Intervention area
Non-functional therapeutic committee in health facilities
Establish clinical audit committees
Poor and inadequate waste disposal systems (especially

medical waste)
Establish and support infection prevention and biosafety committees
Partial adherence to infection prevention protocols
Establish and support a medical board at the county

level
Weak enforcement by regulatory bodies

Lack of and non-adherence standard operating
procedures in all health facilities
Formulate and disseminate SOPs and ensure adherence

Put in place an effective waste disposal system at all
levels
1.8 Issues and Challenges in Providing Health Services (SWOT)

Table 16: Issues and Challenges in Providing Health Services
Strengths
Weaknesses
Existence of basic health infrastructure
Human resource shortage (skill mix and numbers)
Existing health sector partners (donor

goodwill)
Poor attraction and retention of health care workers
Availability of human resources for health
Sub-optimal sensitization of communities to create demand leading to underutilization of health services
Existing innovative healthcare approaches

like integrated outreaches, etc.
Existing policies, plans and documents to
build on
Existence of a community strategy
Existence of public-private partnerships in
health
Inadequate infrastructure capacity to offer quality care
Poor health-seeking behaviour and low customer satisfaction

Lack of stakeholder/partnership coordinating framework
Inadequate and erratic supply of drugs/non-pharmaceuticals and equipment
Inadequate infrastructure and poor maintenance of the existing physical
infrastructure
and equipment
Lack of knowledge on the roles of facility health committee and hospital
management boards
Inadequate funding for health
Weak referral system
Mushrooming of unlicensed private facilities (weak enforcement of regulation of
private health sector services)
Lack of emergency preparedness and response mechanism
Lack of a legal framework for alternative medicines (traditional healers, herbalists)
Poor quality data and low data utilization in decision making
26
Opportunities(External)
Threats
Devolved health services is an opportunity to address local

health priorities and increase local participation
Political goodwill and visionary leadership
Presence of a national referral and teaching hospital within
the county with highly skilled personnel
Growing ICT sector
Existing health training colleges, universities
Existence of other competitive suppliers of essential
The county being an international transit centre (northern corridor

and the international airport) that predisposes it to accidents,
injuries and imported communicable and airborne conditions
Harmful social-cultural practices e.g. key populations
Unhealthy lifestyles e.g. alcohol , drug abuse, diabetes, and heart
disease
Urbanization challenges, including
settlements, refuse management
overcrowding/
informal
Community goodwill and high literacy levels

Existence of a motorable road network
Sports for health advocacy
1.9 Health System Investment
Health information
Introduction
Health financing
This section of the strategic plan highlights the

current situation of health service delivery in UasinGishu County by looking into the seven investment
areas (building blocks) of the health system. It is
well known that resources are never enough and,
therefore, the right move is to make effective and
efficient use of the scarce resources available until
the situation improves (World Health Organization,
2008). Therefore, in order to provide quality,
equitable, affordable, acceptable, and accessible
health care for the citizens of this county and the
country at large as envisaged in both the KHSSP
III and UGCHSP visions, efforts are needed to
have these building blocks in the right quantity
and quality mix. Any skewed distribution of these
resources along political, economic, or social
lines will definitely create inequity and negatively
affect the end users, thereby denying them of their
fundamental human rights.
Service provision
The details of each health investments are captured

in a sub-set of this section and relate to:
Human resources for health
Health infrastructure
Health leadership and governance
Health product and commodities
The human resources for health (HRH) situation

in the county is not optimal at all levels of health
delivery. Staff shortages cut across all clinical and
non-clinical cadres. The county has a total of 187
health facilities comprising both public, faith-based
organizations, and other private groups. There
are also 80 community units (CUs) that currently
exist. The public health facilities consist of 4 Tier
3 government facilities, 96 Tier 2 facilities and
80 CUs at Tier 1. While the number of hospitals
is adequate, the hospitals lack basic equipment,
physical infrastructure and adequate personnel and
hence need to be upgraded and operationalized
in all service delivery areas, such as surgical
theatres. The overall health system in the county
requires strengthening so as to improve health
service delivery.
Health Workforce
Human resources for health is the backbone and
the strongest pillar of the health system and, hence,
without it the health system will not function. The HRH
situation in the county is characterized by shortages
of health staff at all levels of health delivery.
As of June 2014, the county had a total of 916
health workers working in the county Health
Department. Out of these 100 were on contractual
27
terms. The recent employment of staff on contractual
terms under the economic stimulus program went
a long way to mitigate the biting staff shortages.
Without these contracted staff, many health facilities
in the county, especially lower level heath facilities,
would have closed. Therefore, there is a need for
a permanent solution that includes absorption of
contracted staff and employment of more staff. Staff
shortages cut across all clinical and non-clinical
cadres.
There is a need for the harmonization of salaries
and review of terms and conditions of service
(transfer, promotion, training opportunities, etc.)
between contracted and government staff to reduce
inequities and improve staff morale. Inequities are
compounded by the fact that the terms of service
for some contract staff are not clear, leaving health
professionals and their managers in a state of
uncertainty about their future.
The health workforce forms an integral part of
the health care system and it is a key input in the
provision of quality health care services. Without
proper management of human resources for health,
provision of quality, accessible, and affordable
health care will be a noteworthy challenge in the
county.
The county leadership has prioritized health work
force issues in its county agendas.
The key areas of investments are as follows:

1. Recruitment, deployment of health workers and
outsourcing of non-technical staff. This should
be based on needs with the aim of ensuring
equitable distribution of health workers.
2. Attraction and retention of the health work
force to include timely promotions, review
of remuneration, career development plan
and training policy (training and professional
development). Public recognition of service,
through awards and titles such as the Professional
of the Year award, as well as developing and
supporting a career development system.
3. Improvement of the working environment.
Conducive and safe working environments
for the countys entire health workforce can
be achieved through provision of appropriate
equipment and supplies, training, mentoring,
and continuous supportive supervision, as
well as improving the living conditions of
health workers and their families and investing
in infrastructure and services (staff houses,
sanitation, electricity, telecommunications, etc.)
as these factors have a significant influence

on the health workers decisions to relocate
and work in rural facilities.
4. Institutionalize staff performance reviews through
performance contracts and appraisals to track
staff productivity.
Dental technologists
Public health officers
Plaster technicians
Health records & information 12

officers
Medical
technologists
Medical
technicians
Mortuary attendants
Drivers
Accountants
13
14
15
16
17
18
19
16
engineering 3
engineering 2
Physiotherapists
Occupational therapists
12
12
12
Radiographers
11
Orthopedic technologists
Nutritionists
10
51
Medical labtechnologists
13
Pharm. technologists
Pharmacists
70
76
Public health technicians
Medical officers
Dentists
Consultants
Staff Cadres
No. Available
No.
/
Persons
National
2
10
10
10
10
18
11
17
90
44
29
14
25
21
86
40
Hospitals
1
10
27
24
67
67
Primary Care
County
10,000 Available by Tier
Community
0
Required
16
18
12
12
16
12
96
16
21
Hospitals
Staff availability / need in Uasin Gishu County
Primary
21
17
60
252
34
108
78
Community
0
Total Gaps
11
12
69
18
Hospitals
Table 17: Available Human Workforce against Required Numbers and Gaps
Primary Care
0
21
12
54
208
29
38
Community
0
28
Care
Clinical officers (general)
Nursing
staff
(Kenya 276
Registered Community Health
Nurse)
Nursing staff (Kenya Enrolled 130

Community Health Nurse)
Medical
technicians
Community oral ealth officers 1
23
24
25
26
Other (specify)
35
1180
Source: Uasin Gishu County Health Strategic Plan 2013-2018
Community health workers
Supplies officers
33
34
Security
29
Community health extension 61

workers (social workers, etc)
Cleaners/support staff
30
31
Cooks
29
11
32
Secretarial staff
Clerks
27
28
laboratory 11
66
24
22
Administrators
Clinical officers (specialists)
20
21
Staff Cadres
No. Available
No.
/
Persons
County
0.011
National
0
60
38
10
30
10
40
100
300
90
30
Hospitals
5
10
32
99
38
22
Primary Care
0
56
19
11
98
170
26
Community
1180
Required
12
20
13
87
424
90
86
Hospitals
10,000 Available by Tier
Primary
61
34
50
213
159
86
Community
2000
Total Gaps
10
12
55
124
52
64
Hospitals
Staff availability / need in Uasin Gishu County
Primary Care
5
34
50
115
60
60
Community
820
29
Care
30
Health Infrastructure
Key Area of Investment
The total number of health facilities in the county

is 176. Of these, there are about 90 government
facilities, which consist of 4 Tier 3 facilities, 86
Tier 2 facilities and a number of private and FBO
facilities. Even with the available health services,
there lacks an effective and functional referral
system, inadequate ambulance coverage, coupled
with non-functional community units which had
been established to enable communities access
to information about services and to provide
a link to the formal health structure. To actualize
functionality of the community strategy, there is a
need to provide CUs with the necessary tools and
resources. The facilities also lack adequate health
service provision resources i.e. basic essential
equipment, such as OPD and inpatient diagnostic
equipment, clinical rooms and offices and basic
amenities at all facilities. The county health facilities
also lack adequate staff houses; hence the need to
establish these, especially in rural health facilities.
Physical infrastructure
The absence of a county referral hospital has led to

heavy dependence on the national hospital located
in the county (MTRH) for primary health care, rather
than for highly specialized cases as evidenced by
data on cases which should have been handled
at the county level that show nonconformity with
an effective and efficient referral system. However,
there is a proposal to come up with a county referral
hospital and to enable fully functional sub-county
hospitals.
There is also an urgent need to secure reliable
funding from the county budget and increase the
number of community units to improve access to
Tier 1 services.
The county lacks a general drugs and supplies
store, hence the need to construct one. There is also
a need to make provisions for water supplies to all
facilities. A number of facilities have no electricity
and water connections; thus there is a need to
connect them to the national grid.
Construction of a county referral hospital

Expansion of existing facilities to provide basic
and comprehensive health care
Construction of staff houses
Invest in health information and communication
technology (ICT) infrastructure
Procure ambulances to strengthen referral system
Collaborate with other sectors to improve other
social amenities, such as road networks, water
and sewerage, electricity and communications.
Service Delivery
Service delivery is the key component that
incorporates all other building blocks of a health
system and through which health service delivery
is measured. Optimal health service delivery that
effectively responds to the health needs of the citizens
can be achieved through better organization and
management of an integral health system. The main
service providers of health care in the county are
government facilities in various tiers systems.
Health services utilization is sub-optimal and this
can be attributed to the following:
Sub-optimal community engagement in health
programming and inadequate community
awareness on health rights
Non-compliance with the service charter
Lack of adequate disability friendly services
Poor adherence to clinical guidelines and
standard operating procedures at service
delivery level
Ineffective support supervision and follow-up
No client feedback
Non-functional therapeutic committee in health
facilities
31
Partial adherence
protocols
to
infection
prevention
Weak enforcement by regulatory bodies

Low adherence to standard operating procedures
in all health facilities
Weak referral system
Inadequate quality assurance checks through
internal or external monitoring systems
Key Areas of Investment:

Conduct patient satisfaction surveys
Create customer care desks
Provide suggestion boxes
Ensure that all health facilities have a customer
service charter and ensure its dissemination and
compliance
Healthcare Financing
The countys health care system has been
characterized by under-funding from the central
government, which means that most of the funding
has gone towards servicing recurrent expenditure
and utilities, which has limited the countys capital
and developmental activities. In addition, there are
few active non-state actors in health care services
that can complement the government in providing
health care services. This under-funding has led to
an over-reliance on donors and user fee collections,
which is insufficient and unreliable.
Recently, the government abolished user fees at
the primary health care level (dispensaries and
health centers) and substituted this with a direct
government allocation through a project called the
Health Sector Service Fund (HSSF); hence, the fate
of the funding is not clear in this new dispensation.
Key areas of investment and strategies

include the following:
Set up youth-friendly services

Train staff on customer care
Ensure facilities are accessible to the disabled
Ensure a conducive
environment
and
safe
Produce, avail and

guidelines to all staff
disseminate
working
clinical
Strengthen support supervision

Establish clinical audit committees
Establish infection prevention and bio-safety
committees
Establish a medical board at county level
Formulate and disseminate SOPs and ensure
adherence
Provide a high capacity modern waste disposal
system at the county level
Strengthen the community strategy
Strengthen referral systems through procurement
of ambulances
Lobbying and advocating for a larger allocation

of health sector funding to the county government.
Developing new and strengthening existing
partnerships to enhance integrated health care
financing in the county (e.g. a funding pot or
single resource envelope).
Strengthening resource mobilization, both
internally and externally, through developing
joint proposals.
Improving social health insurance by advocacy
for increased registration of the community to
the existing health insurance scheme, a publicprivate partnership in health insurance.
Improving fee collection and financial controls
in Tier 3 facilities through scale-up of financial
management/information networking (cash
registers) to enhance transparency and
monitoring.
Implementing demand-side performance-based
financing to increase service utilization, results
and quality services.
32
Conducting comprehensive costing of health
care services and ensuring hospital resources
are appropriately allocated and utilized.
Essential medicines and medical supplies
Seeking innovative pro-poor health care

financing options to break the financial barriers
to accessing health care services.
Purchase of modern medical equipment
Strengthening financial accountability, integrity,

management, and capacity building.
Environmental, water, hygiene and sanitation

commodities
Seeking a timely disbursement of allocated

funds.
Cost cutting measures e.g. equipment placement

for high volume facilities
The health information system (HIS) is a

comprehensive and integrated structure that
collects, collates, analyses, monitors, evaluates,
stores, disseminates, health and health-related data
for use by all; data is increasingly driving the health
care industrys decision making, as evidenced by
the many initiatives to capture outcome data.
Health Products and Commodities

Health products and commodities are a vital
component of public health care. To maintain
a regular supply of these inputs, effective public
commodity supply management is required.
Currently, supply of health products and technologies
is inadequate due to insufficient funds and/or an
inefficient supply chain. This results in under-stocked
or out-of-stock supplies at health facilities. Clients
are then forced to make private purchases, resulting
in poor treatment outcomes and inappropriate
medicine use (e.g. under- dosage, drug resistance,
missed diagnosis, etc.).
The current levels of investments in health products
and commodities represent a major underinvestment area in the countys health sector. The
required investment to deliver the essential package
in health is enormous and is driven by the cost of
essential medicines and medical supplies.
The county also lacks modern equipment in health
facilities. This not only makes service delivery
inefficient but also compromises patient safety.
There is a need to purchase modern equipment
and ensure its maintenance.
Key investment areas are:

Vaccines and other related logistics
X-ray and laboratory commodities
Nutrition commodities
The role of HIS in the health sector is not just

routine collection of health sector data and dutiful
conveyance of the same to higher levels, but also
facilitation of evidence-based decision- making
at all levels, including at the point of collection.
Information collection, analysis and presentation
should be organized in such a way that the most
needy groups and individuals are identified and
that health planning should be based on such
information and strategies designed to address any
identified inequalities. HIS forms an integral part
in better health planning and monitoring of health
service delivery with a view to quality health care. It
is, therefore, a powerful monitoring and evaluation
(M&E) tool for making health care delivery more
effective and efficient.
The County Health Records and Information
Management Department is charged with the
responsibility of managing and coordinating HIS
activities, of which the various public health, clinical
services departments and other health providers
/ players (both public and private) functions and
activities form the primary source of data.
Reproductive health commodities

33
Figure 12: Health Information System
Quarterly/Annual Health Forums planned, to

disseminate/share sector information
Monitoring, Evaluation, and Management
- Aimed at improving data demand, use, storage

and security at all levels.
Community
Facility
Sub-county/County
National
Data Collection
Data Collection and Indicators
Data Aggregation and Analysis
Enhance data quality assurance and audits at

all levels by all players (public and private) and
ensure continuous appraisal of District Health
Information Software (DHIS) reports (data
verification).
Enhance human resource capacity building on
HIS and deployment of HIS essential resources
To provide guidance on how to access health
data from the producers and how to share the
health data produced
Adapt and customise SOPs on data capture
and management
International
The county faces challenges in the existing HIS.

These include: data collection and management;
poor clinical records management; low reporting
levels from lower levels; poor data utilization and
sharing; low deployment and utilization of ICT
infrastructure; overload of reporting units; limited
human resource capacity in terms of numbers and
skills; and partner reporting systems / requirements.
All these have affected the efficiency of data
management in various sub systems.
The county seeks to re-engineer its HIS functionality
and role by:
Ensuring a fully functional
framework for HMIS
coordinating
- HMIS technical working structure formed,

bringing together different sources of information
for health in one forum.
- Develop updated HIS structure /legal framework
aligned to the health policy and general health
law.
The above issues will addressed by fully adopting

the Kenya Health Policy, the Kenya HIS Policy and
Kenya EMR policy guidelines, but customized to
the county. In addition, the county should deploy
more HIS and ICT resources, and develop and roll
out an integrated health management information
system, which has all inclusive data management
approach across all functional clinical and public
health care structures.
The policy seeks to address issues such as
partnership in data collection and information
sharing, guidelines on data processing, and data
warehousing, as well as instituting standardized
mandatory reporting by all care providers (public
and private) and quality in data management in the
health sector.
Deployment of Information Communication

Technology in Health Care
In order to establish a functional HIS, it is essential to
put in place a system of procurement, deployment
and use of information and communication
technology (ICT) that will ensure that a careful
balance is established between the need for the
34
technology and the human and resource availability.
The aim is to ensure maximum use of modern
technology to enhance the overall performance of
the health sector.
The framework will involve:
Providing guidelines for the specification and
selection of products and services to develop,
enhance and maintain equipment and systems
for data collection and analysis; information
generation and dissemination; information
transmission and communication.
Providing standards for the development of
human resources for information management.
Providing guidelines for the development
and enhancement of a culture of information
utilization in the health sector.
Identify priority areas and systems to be
developed to meet the challenges of the sector.
In the deployment and use of ICT in the
health sector, the HIS Unit shall focus for the
development of:
- Health management information and support
systems;
- Internal communication systems; and
- External communication systems.
The HIS Units to be considered are:

Primary health care
County referral hospitals
County Health Management Team
Leadership and Governance

The County Department of Health is mandated
to coordinate and provide overall leadership
and management to the entire department. It
will be responsible for the overall coordination
and management of county health services.
The scope includes coordination of health care
delivery, leadership and stewardship of county
governance systems and functions. The county
Health Department plays a key role in planning
and monitoring of health systems and services and
the health regulatory framework.
Better governance and leadership initiatives
aim to increase the participation of citizens in
decisions that affect their lives and promote ethical
and effective leadership in the county. Increased
stakeholder involvement enhances transparency
and accountability in health service delivery and
ensures quality of services.
A key challenge in the county is how to foster good
governance and create an enabling environment
for health services improvement. Therefore, there
is a need to build the capacity of the Health
Department to ensure effective stewardship in health
across all levels with a view to improving structured
and effective coordination of the department.
Key investment areas

Adopt and implement the Kenya Health Policy.
Develop county and sub-county health sector
strategic plans and annual work plans.
Recognition, harmonization, and re-alignment
of health priorities around the governments
agenda.
Capacity building of health managers across
all levels of health management, leadership
and governance.
35
SECTION 2:
Problem Analysis, Objectives and Priorities
36
2.1 Problem Analysis

Table 18 below provides a listing of policy objectives and priorities.
Table 18: Problem Analysis

Policy objective
Challenges
Priority Investment areas
Uncoordinated and un-sustained outreach services

Breakdown of cold chains systems and periodic
stock-outs of essential supplies
Low reporting levels, hence poor data management
Inadequate data sharing and utilization
Risk of disease importation through the northern
corridor highway
Inadequate funding for innovative approaches
Weak cross-border screening systems for human
and zoonotic diseases
Weak public health and veterinary department
linkages
Inadequate basic and specialized diagnostic
facilities in the county
Sub-optimal Tier 1 service delivery
Inadequate public-private partnership in provision
of preventive and promotive health services
Weak surveillance systems
Eliminate communicable
conditions
Weak school health programs

Inadequate human resources for health (numbers
skills and retention challenges)
Non-adherence to medication
Weak implementation of Public Health Act (Cap.
242),Food Drugs and Chemicals Act (Cap.254)
and Meat Control Act (Cap. 34), Alcoholic Act
(Cap. 256).
Weak policy implementation to improve hygiene
standards
(waste disposal/water and sanitation)
Poor knowledge of good hygiene practices
among communities in the county
Low demand for health services due to poor healthseeking behaviour and inadequate investment
in health education to impact health- seeking
behaviour
Poor housing and overcrowding in urban areas
due to lack of enforcement of urban housing
Substance abuse, unprotected sex
Strengthen outreach services and active case

detection and management
Strengthen routine data collection and DQA
Avail the necessary data capture and reporting
tools
Put in place a functioning organizational structure
Adopt the National HIS standard operating
procedures (SOPs)
Reorient all staff on the new HIS management,
skills, policies, techniques and technologies
Deploy ICT in health data management (both
hardware and software)
Routine maintenance of cold chain systems
Strengthen cross-border surveillance and establish
screening program at all ports of entry
Strengthen public health and veterinary department
linkages and collaborate on surveillance and
response
Strengthen
programme
Integrated
Quality
Assurance
Establish and strengthen diagnostic capacity

Establish and equip a modern county referral
diagnostic facility.
Full implementation of community health strategy
Strengthen school health programs and health
education
Strengthen surveillance systems and establish a
response team
Strengthen law enforcement
Strengthen private public partnership
Advocate for additional funding for critical county
health priorities
Implement strategies to attract and retain staff
Advocate for appropriate county level legislation
and policies to promote, good housing, health
education and hygiene
Strengthen monitoring and evaluation frame work
Establish effective supply chain management
37
Policy objective
Challenges
Inadequate investment in addressing predisposing

factors in non-communicable diseases (NCDs)
Inadequate facilities for early screening and
diagnosis
Inadequate investment in management
rehabilitation services for NCDs
and
Investments in community awareness creation on

NCDs and observe national/international health
days.
Build capacity of health care providers on
detection and management of NCDs
Provision of diagnostic equipment and commodities
Inadequate community awareness on NCDs

Limited access to data and information due to
weak inter- and intra-sectoral collaboration
Lack of operational research
Invest in routine screening, early diagnosis and

management of non-communicable diseases
Strengthen nutrition education and outreaches
Implement national regulations and policies on
public nutrition
Multi-sectoral collaboration on food diversification
Strengthen routine data collection and DQA
Avail the necessary data capture and reporting
tools
Strengthen referral strategy
Scale up investment in rehabilitation services in
Tier 3 and Tier 4 facilities
Halt, and reverse

the rising burden of
non- communicable
conditions
Capacity building of health workers (palliative

care, oncology and other NCDs care).
Allocate resources to ensure operational research
on diverse NCDs
Advocate for community/workplace behaviour
change communication
Advocate for stringent measures on quality control
for food and drug safety
Advocate for by-laws that promote healthy lifestyles
and reverse trend of risk factors
Encourage and support staff to conduct operational
research and surveys
Develop/revise guidelines for supervising routine
data collection at relevant levels
Establish health research regulatory structures
Review and appraisal of operational research and
survey protocols
Develop research standard operating procedures
(SOPs)
and
Set up emergency preparedness and response

teams at all tiers
Limited capacity of health workers to provide

specialized care
Establish specialized units to cater for injuries and

gender-based violence e.g. rescue centers
Non-compliance of existing laws
Capacity building of health workers on life-saving

skills and specialized care
Inadequate
response
Reduce the burden of

violence and injuries
emergency
preparedness
Inadequate rehabilitation and psycho-social care

centres
Domestic violence, gender-based violence
Advocate and enforce public health laws,/the

penal code
Establish more rehabilitation and psycho-social
centers
Improve county referral hospital to provide
specialized services
38
Policy objective
Minimize exposure to
health risk factors
Challenges
Poor health promotion/education to reduce

lifestyle risk
Sensitize the community and other authorities on

safe waste management
Poor sanitation and waste management
Improve sanitation
Weak implementation of infection, prevention and

control policies
Enforcement and implementation of occupational

health and safety measures in the working
environments
Weak enforcement of regulations and guidelines

on minimization of exposure to health risk factors
Rampant drug abuse among the youth
Lack of occupational health and safety measures
Lack of risk reduction plan
Strengthen health promotion mechanism to reduce

lifestyle risk
Establish and implement risk reduction plan
Encourage food diversity
Food insecurity
Promote condom use
Inadequate infrastructure
Equip and operationalize the existing health

facilities to increase the scope of health service
delivery
Shortage of human resources and skills mix for

health
Inadequate health service delivery resources
Weak referral systems
Weak health facility-community linkage
Inadequate financing to the Health Department
Low reporting and poor utilization of health care
services data
Provide essential health
services
Bottom-up pull system procurement process of

essential medicines and medical supplies and
equipment
Increase financial resource allocation to health
department
Implement
recommended
staffing
norms
Recruitment of staff adequate in number, skills mix
with an attraction and retention package
Ensure fully functional coordinating framework for
HMIS (that collects, collates, analyses, stores and
disseminates, health and health-related data and
work closely with the M&E department)
Adopt and customise the National HIS SOPs
Use religious, political and community opinion
leaders to increase utilization of services
Procure ambulances for patient evacuation
Source for ambulances and establish fleet
management unit
Strengthen implementation of community health
strategy
Strengthen collaboration
with health related
sectors
Weak inter-sectoral collaboration and linkage
Initiate joint planning, monitoring and evaluation
Weak central coordination mechanism
Strengthen coordination among health-related

sectors
Weak public-private partnership
Initiate and strengthen MOU with all relevant

partners
Different sector planning cycles

Lack of joint planning
Map the partners

Strengthens stakeholder forums
2.2
Strategic Focus and Objectives
Overall Goal
The overall goal of this plan is to reduce illnesses, disabilities and exposure to risk factors through evidencebased interventions and best practices.
Specific Objectives
1. Eliminate and control communicable conditions
Strengthening the community strategy by making the 23 semi-functional units to be fully functional and
increasing the number to 100 by the end of the plan period.
39
Increase immunization coverage from 65.3% to
90%.
Increase proportion of households with access
to safe water and sanitation services from
85% to 92% (include indicator on number of
households using treated water and latrines)
Revive number of schools providing complete
school heath programme from 45 to 250 in 5
years
Scale up facilities reporting Integrated Disease
Surveillance and Response
(IDSR) from 85 to 130 health facilities
Establish isolation centers in all Tier 3 facilities
Engage and strengthen private health providers
through support supervision visits at least 4
times per year in all private facilities; continuous
medical education once a month for all private
practitioners; have infection prevention control
committee/ in all health facilities
2. Halt and reverse increasing burden of

NCDs
Increase
public
awareness
on
both
communicable and non-communicable diseases
through behavior change communication
(BCCs) in barazas, schools, churches, groups,
radio shows, etc., through monthly barazas in
every facility
Promote early detection, screening and
diagnosis of common NCDs in all the health
facilities and patient education sessions, and
through integrated outreach programs
- promoting healthy life style/ practices i.e

discourage sedentary lifestyles and encourage
good feeding habits for the whole community
- train and build the capacity of health care
providers on management of chronic illnesses/
diseases
3. Reduce the burden of violence and

injuries
Establish emergency preparedness and
response teams in Tier 2 and Tier 3 facilities
Establish emergency, diagnostic and specialized
facilities at the county referral hospital (e.g. Burn
treatment centers, intensive care units, etc.)
Create public awareness among the citizens
on violence and injuries and promote safety
measures
Establish psycho-social care at all health facilities
i.e. counselling services,
4. Provide essential health services to Uasin

Gishu County citizens
Strengthen, equip and improve access for
diagnostic services from 44 to 60 in Tier 2 and
3 facilities
Improve client linkage and referral systems
through provision of ambulances
Encourage dissemination and adherence to
standard operating procedures
Provide comprehensive and integrated service
packages
Improve customer care at all levels by sharing
information with the citizens (adherence to
patient service charter)
Set up a well-equipped and accessible

diagnostic and treatment center for NCDs in all
sub- county hospitals, including include Tier 2
facilities
Strengthen patient triage (capacity building,

space, equipment)
Set up a palliative and rehabilitation center at

the county referral hospital
Improve supply chain management of essential

Advocate for policies that promote healthy

lifestyles and reverse the trend of risk factors:
Enhance infection and prevention control

measures in all health facilities
-
supplements
diseases
Conduct operational research on client

satisfaction (exit interviews, focus group
discussions)
for
micronutrient
deficiency
40
Improve the capacity of the human resources in
numbers and skills mix
Availability of essential services, medicine and

medical supplies
Upgrade existing health facilities and

construct new ones and strengthen basic and
comprehensive emergency obstetric care
The key outputs will be:
5. Minimize exposure to health risk factors

Establish youth-friendly centers and encourage
peer group discussions
Increase health promotion and provision
of information to citizens on health-seeking
behaviour and risks associated with unhealthy
lifestyles
Improve occupational health safety through
infection prevention PEP, PPE and workplace
policies among the health workers and citizens,
improve sanitation and waste management and
strengthen food safety and quality control
6.
Strengthen
sectors
collaboration
with
other
Strengthen collaboration with other sectors for

provision of safe water, improvement of road
networks, communication equipment, education
and food security and diversification.
Promote public-private partnerships at all levels
Establish forums for engagement and
information sharing (coordination meetings with
stakeholders)
2.3 Sector Input and Process Targets

for Achievement of County Objectives
Support the 200 community units.

Conduct one outreach per facility per month
Carry out 4 support supervisions per facility per
year
Procuring and maintaining 8 ambulances
Construct a county referral hospital and upgrade
the 6 sub-county hospitals
Conduct monthly CMEs and continuous on job
trainings
Health Infrastructure (physical infrastructure,

equipment, transport, ICT)
Construction and renovation of facilities and
staff houses
Construction of specialized units
Provision of medical equipment to facilities
Put in place a proper inventory
Purchase of vehicles and ICT equipment

Construct a county referral hospital and upgrade
6 facilities to sub-county hospitals and renovate
100 health facilities (to include service blocks)
Construct 100 staff houses at the end of 5 years
Specialized units constructed and equipped in
the county referral hospital (theatre, ICU, X-ray,
etc.)
Below are the key milestones to achieve the

overall goal, objectives, and key outcomes of the
investment areas.
Purchase 10 utility vehicles
Service Delivery:
Health Products
Enhancing community services and outreaches

Mentorship and capacity building of health
care workers
Ensure proper linkage and referral systems and
emergency preparedness
Providing comprehensive
service package to citizens
essential
Equip 50 health facilities with ICT by the end of

5 years
Purchase, storage, and distribution of required
health products
Procure and install logistics management
information system in 50 facilities
health
41

Essential medicines, medical supplies and
commodities procured/ supplied in a timely
manner through online ordering
Logistics management information
procured, installed and in use.
system
- Adopt but customize and distribute the national

health records management policy and SOPs
and
- Avail all the necessary standard data collection

and reporting tools
Health Financing
Automation of revenue collection
Enhance public-private
stakeholder collaboration
To ensure quality and standard data

documentation using the standard data capture
tools (both hard and electronic).
partnerships
Advocate for more resource allocation
- Reorient staff on the new emerging HIS

management, skills, policies, techniques and
technology
- Deploy ICT in health data management (both

hardware and software)
Collaborate with health insurance agencies
To clarify the roles and functions of different

stakeholders in data management in order to
minimize duplication and maximize optimal
utilization of resources.
- Enhance organizational structures at all levels
Establish income generating activities in health

facilities
Increased transparency and accountability

Increased stakeholder financial support
Increased county government funding for the
Health Department
Better access to health care

The following are the HIS strategic objectives
geared towards actualizing data for decision
making:
To collect and analyze health information about
diseases, services, health workforce, medicines
and medical products, infrastructure and
equipment from all stakeholders of the health
sector.
- Strengthen human resource coordinating
structure with adequate resources
- Adopt the Kenya national health indicators
- Avail data collection and reporting tools (to
facilitate collection data)
- Develop a data analysis plan
- Develop/upgrade existing databases
- Adopt but customize the National HIS standard
operating procedures (SOPs)
- Put in place clear data collection, transfer, and

reporting mechanisms at all levels
- Define/develop standard reporting requirements
for different stakeholders
- Develop written mandates for planning,
coordinating and managing the health
information system for all levels
- Put in place mechanisms for health information
planning,
management,
stakeholder
coordination and consensus building for all
levels
- Develop clear and well defined health
information roles and responsibilities for relevant
individuals and organizations at all levels
- Develop human capacity in terms of skills and
numbers in relevant areas
- Develop local leadership in health information
and capacity for stakeholder coordination
To ensure timely, wide and needs-based
dissemination of data to all stakeholders.
- Strengthen data use, dissemination, and quality
improvement
- Develop health information communication and
advocacy plan
42
- Enhance commitment to health information at all
levels
Health Workforce
To develop and implement a research agenda in

collaboration with relevant partners to support
county policy development.
In-service and pre-service training
- Develop evaluation and research agenda

based on the identified health gaps and needs
Recruitment and retention of staff

Staff motivation through recognition awards ,
timely promotions and provision of conducive
working environment
Put in place a revised scheme of service
- Strengthen coordination of surveys/evaluations

and research studies
- Strengthen surveys and surveillance systems
Health workers recruited and retained
To develop and implement regulations regarding

mandatory reporting of defined information
requirements.
Staff skills upgraded
- Develop/revise guidelines for supervising

routine data collection at relevant levels
- Strengthen supervision, data assessments and
feedback component
Staff motivated well
Health Information
Collect data for routine health information, vital
events, research and surveillance
Disseminate health information
- Strengthen data quality component
Train staff on revised data collection tools
To develop, implement and enforce regulatory

mechanism for health research.
Automate 50 health facilities in the county
- Establish health research regulatory structures
Develop a data use plan
- Review and appraisal of operational research

and survey protocols
- Adopt but customize the National Health
Research SOPs
Leadership and Governance

Conduct quarterly health stakeholders meetings
Encourage regular facility committee meetings
Conduct health facility committee elections
every three years
Conduct monthly CHMT /SCHMT management
meetings and quarterly performance review
Encourage public participation in county health
budget preparation
Print and distribute data management tools

Printed health information registers and reporting
tools
Electronic health records established in hospitals
and sub-county facilities and e-mobile reporting
Data properly stored and secured
Data use plan in place
Appropriate sharing and use of information at
all levels
Internet connectively available at county and
sub-county levels
Continuous capacity on HIS areas done yearly

Annual work plan and budgets prepared
Increased partner /stakeholders participation
in health
Increased public confidence in the health system
43
Table 19: Investment Area Details

Orientation
area Service
Delivery
Milestones for achievement

Intervention area
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
Community services Established 118 fully functional community units
84
34
41
41
58 community unit strengthened and fully

functional.
23
35
71
71
Outreach services
Enhanced capacity to conduct targeted facility

integrated health outreaches in ALL facilities
(4800 for plan period)
1200
1200
1200
1200
Supportive
supervision to
lower units (CHMT
& SCHMT)
Regular managerial and programmatic support

supervision - CHMT (quarterly, half yearly &
annually)

supervision SCHMT (monthly)
72
72
72
72
11 utility vehicles for supervision availed and

11
maintained.
11
11
11
11
Improved skills for the staff at all tiers (seminars,

250
workshops, OJT, mentorship visit)
250
250
250
250
Capacity building of target populations on

emergency preparedness & response (health 500
care providers, schools & community)
500
500
500
500
Developed IEC materials; put up in all facilities

100
to improve work safety
100
100
100
100
Enhanced advocacy, communication, and

social mobilization (social mobilization,
12
observing national health days, including
medical check ups & screening), CMEs, IEC)
12
12
12
12
Disability
services)
10
12
Strengthened commodity management system

(drugs and other medical supplies/equipment)
On-the-job training
Emergency
preparedness
planning
Patient safety
initiatives
Established skilled emergency preparedness

6
and response committees.
Therapeutic
Therapeutic committees set up in all sub-counties
committee meetings
30
and at all hospitals
and follow up
Health promotion
mainstreaming
(disability
friendly
Clinical audits
(including maternal
death audits)
Formed and strengthened maternal/neonatal

100
audit committee across all tiers (1, 2, 3, 4).
Referral health
services
Procurement of 8 ambulances(1 ambulance per

sub-county referral hospital, 2 for county, 1 for
8
community referral services and 1 for referral
hospital)
Recurrent expenses
Utility services availed (As per the annual

costing)
Information centre
Establishment of Huduma Centre
Disaster
preparedness
Establish rapid response teams for emergencies

12
and disease outbreaks
12
12
12
12
Research
Carry out county specificoperational research
37
44
Orientation
area Service
Delivery

Intervention area
Milestone
Annual targets
Year 2
Year 3
Year 4
Year 5
Renovation/completion of existing health

20
facilities 100 (to include service blocks)
20
20
20
20
Install water storage tanks for portable water

(capacity minimum of 40,000 litres) in 120 20
facilities
20
30
30
20
Upgrading 6 health centers to sub-county

3
hospitals
7 operating theatres constructed and equipped

4
(6 sub- county & 1 county referral hospital)
Construct 100 staff houses at the end of 5 years 5
15
15
30
35
Equipping 50 health facilities with ICT set up at

10
the end of 5 years
10
10
10
10
Preventive maintenance for all health facilities

buildings & equipment regularly serviced
100
and maintained. Including service contracts
development.
100
100
100
100
Health facilities provided with proper equipment

10
inventory
40
50
50
50
Procure power generators/solar installations for

10
electricity back up in health facilities.
40
Procure basic facility equipment (Triage kit)
80
87
Procure specialized diagnostic equipment in

the county referral facility (CT Scan, MRI, CD4
0
Machine, LED Microscope) safety hoods, viral
load machines)
Equipment:
Maintenance and
repair
All health facilities equipment regularly serviced

100
and maintained
100
100
100
Transport: Purchase
and maintenance
10 utility vehicles procured
Utility vehicles and ambulances repaired
10
15
20
20
20
ICT equipment:
Purchase
Set up and maintained ICT equipment in

10
selected health facilities
30
50
50
50
Procurement of
required health
products
Procurement and purchase of medicine and

non-pharmaceutical , vaccines, PPEs and
emergency kits with distribution to facilities. 187
(Procurement and distribution of medicines, nonpharmaceuticals and vaccines.)
200
200
200
200
Construction of drug stores (I major at county

7
and Sub stores at each sub county level)
Cold chain maintenance and upgrading
40
50
50
50
Established a county referral hospital
Year 1
1
Establish a county rehabilitation center for drugs

1
& substance abuse.
Physical
Infrastructure:
Expansion of
existing facilities
Specialized units constructed and equipped

in the county referral hospital.( ICU, X-ray burn 2
unit, psychiatric unit, trauma/orthopedic etc.)
Health
Infrastructure
(physical
infrastructure,
equipment,
transport,
ICT)
Purchasing 11 utility vehicles
Physical
infrastructure:
Maintenance
Equipment:
Purchase
Health
Products
Ware housing and

Storage
Monitoring and
evaluation
20
Establish an integrated logistics management

information system procured, installed and in 10
use to manage stocks and ordering
45
Orientation
area Service
Delivery

Intervention area
Year 1
Year 2
Year 3
Year 4
Year 5
Purchase of software for financial management
10
40
50
50
50
Budget preparation and planning
Coordination of health stakeholders (NGO,

private clinic) to avoid duplication and maximize 4
funding (including mapping)
Lobby for corporate social responsibilities (no of

4
meetings held)
Conduct periodical internal & external financial

2
audits
Annual work plan and budgets prepared
County health summit and performance review

1
meeting conducted

24
meetings
24
24
24
24
County
health
management
performance review conducted
12
12
12
12
Facility health performance review meeting

2244
conducted -monthly
2244
2244
2244
2244
Conduct quarterly Health Facility Committee

748
Meetings
748
748
748
748
Conduct CHMT
supervision
187
187
187
187
Quarterly
conducted
Establishment of technical working groups

1
(TWGs)
Recruitment of new
staff
Recruitment and retention of human resources

50
for health
50
50
50
50
Recruitment of new
staff

50
for health
50
50
50
50
10
10
10
10
Costing of health
service provision
Health
Financing
Annual targets
Milestone
Resource
mobilization
Planning and
health stakeholders
meeting
Leadership
and
Governance
Quarterly
coordination
meeting
and
SCHMT
stakeholders
quarterly
Facilities
meetings/forums
12
Salary remunerations and emoluments (revise &

implement schemes of service)
Personnel
emoluments for staff Incentives for hard to reach HCFs
Health
Workforce
10
Staff motivation and recognition
In-service training
and development
In-service training /
Seminars & workshops
specialized
1
training 25
10
25
25
25
25
10
10
10
10
Management training (mid and senior level)
25
25
50
50
50
Orientation & induction of new staff
50
50
50
50
50
Career growth & development
50
50
50
50
50
46
Orientation
area Service
Delivery

Intervention area
Health
Information
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
Introduction of Integrated Hospital Information

10
Management System in 50 health facilities
40
50
50
50
Deployment of ICT Infrastructure (hardware,

software, Internet connectivity and LAN) in the 10
50 Health Facilities.
40
50
50
50
Staff capacity building on data management at

10
all levels
30
50
50
50
Printed and distributed integrated data collection

187
and reporting tools.
187
187
187
187
Strengthened data demand, use, dissemination,

and quality improvement through quarterly data 4
review meetings.
Carry out data quality audits (DQAs)
M&E plans developed
Conduct health data management trainings for

4
middle and senior level managers
Provision of smart phones, laptops and tablets

25
at both middle and senior level management
100
Provision of PCs and internet connectivity to the

187 facilities for data management and client 10
messaging services.
30
50
50
50
Introduce mobile phone reporting system for

80
births and deaths (CHEWs & CHWs)
206
206
206
206
Produce periodical county reports on health

service utilization, disease burden and MDG
28
performance (monthly, quarterly, half yearly and
annually)
28
28
28
28
Monitoring of vital system (GIS)) events by use of

information technology (E-health, geographical 7
information systems)
Targeted health information monitoring
187
187
187
187
Evidence-based surveys (nutrition, drug &

substance abuse, health service customer 7
satisfaction, Occupational Safety)
Sub-county-based
review meeting
30
30
30
30
30
Quarterly, clinical audits, data quality audits

30
and verification
30
30
30
30
Analytical data packages (SPSS, EPI INFO,

7
etc.)
Community dialogue meetings held
824
824
824
824
30
30
30
30
Electronic and hard copy data storage, data

1
bank and back-up established
Enhanced health
information
management
system and
innovations (both
routine and vital
events)
Monitoring and
surveillance
Data analysis
Information
dissemination
HIS, HIMS and M&E policy guidelines

developed and distributed in health facilities in
1
conformity with WHO health data management
(and fully integrate the systems with DHIS)
meetings
and
187
quarterly
240
Facilitated feedback (including mortality and

30
morbidity meetings) to all levels by county team
47
SECTION 3:
Resource Requirements and Financing
48
Table 20: Budget Summary

Orientation
area Service
Delivery

Intervention area
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
2m
1m
1m
0.5m
Strengthened commodity management system

(drugs and other medical supplies/equipment)
Established 77 fully functional community units
Community services 23 community unit strengthened and fully
functional.
Outreach services
Supportive
supervision to
lower units (CHMT
& SCHMT)
On-the-job training
Emergency
preparedness
planning
Service
Delivery
Patient safety
initiatives
2m
Enhanced capacity to conduct targeted facility

integrated health outreaches in ALL facilities
(4800 for plan period)
10m
10m
5m
5m

supervision - CHMT (quarterly, half yearly &
annually)
0.5m
0.3m
0.5m
0.3m

supervision SCHMT (Monthly)
0.5m
0.5m
0.5m
0.5m
11 utility vehicles for supervision availed and

4m
maintained
4m
4m
4m
4m
Improved skills for the staff at all tiers (seminars,

10m
workshops, OJT, mentorship visit)
5m
5m
5m
5m
Capacity building of target populations on

emergency preparedness & response (health 5m
care providers, schools & community).
4m
3m
3m
2m
Developed IEC materials; put up in all facilities

10m
to improve work safety
10m
5m
3m
2m
Enhanced advocacy, communication, and social

mobilization (social mobilization, observing
3m
national health days Including medical check
ups & screening), CMEs, IEC
3m
3m
3m
3m
Disability
services)
4m
6m
8m
10m
Established skilled emergency preparedness

5m
and response committees.
Therapeutic
Therapeutic committees set up in all sub-counties
committee meetings
1m
and at all hospitals
and follow-up
Health promotion
mainstreaming
(disability
friendly
2m
Clinical audits
(including maternal
death audits)
Formed and strengthened maternal/neonatal

5m
audit committee across all tiers (1, 2, 3, 4).
Referral health
services
Procurement of 8 ambulances (1 ambulance

per S/C referral hospital and 2 at county; I
80m
for community referral services and I for referral
hospital)
Recurrent expenses
Utility services availed (As per the annual

costing)
Information centre
Establishment of Huduma Centre
Disaster
preparedness
Establish rapid response teams for emergencies

2m
and disease outbreaks
2m
2m
2m
1m
Research
Carry out county specific operational research
4m
3m
2m
2m
10m
5m
49
Orientation
area Service
Delivery

Intervention area
Milestone
Annual targets
Year 2
Year 3
Year 4
Year 5
Renovation/completion of existing health

30m
facilities 100 (to include service blocks)
20m
20m
10m
5m
Install water storage tanks for portable water

(capacity minimum of 40,000 litres) in 120 5m
facilities
5m
5m
5m
5m
Upgrading 6 health centers to sub county

90m
hospitals
190m
7 operating theatres constructed and equipped

30m
(6 sub county & 1 county RH)
30m
Construct 100 staff houses at the end of 5years 50m
50m
50m
50m
50m
4.5m
4.5m
Equipping 50 health facilities with ICT set up at

10m
the end of 5 years
10m
10m
10m
10m
Preventive maintenance for all health facilities

buildings & equipment regularly serviced
10m
and maintained, including service contracts
development.
10m
10m
5m
5m
Health facilities provided with proper equipment

10m
inventory
5m
5m
3m
1m
Procure power generators/solar installations for

15m
electricity back up in health facilities
10m
5m
5m
5m
Procure basic facility equipment (Triage kit)
4m
3m
2m
2m
80m
80m
Established a county referral hospital
Year 1
200m
Establish a county rehabilitation center for drugs

50m
& substance abuse.
Physical
infrastructure:
Expansion of
existing facilities
Specialized units constructed and equipped

in the county referral hospital.( ICU, X-ray burn 100m
unit, psychiatric unit, trauma/orthopedic etc.)
Health
Infrastructure
(physical
infrastructure,
equipment,
transport,
ICT)
Purchasing 11 utility vehicles
Physical
infrastructure:
Maintenance
Equipment:
Purchase
Health
Products
4.5m
4m
Procure specialized diagnostic equipment in

the county referral facility (CT Scan, MRI, CD4
Machines, LED microscopes, safety hoods, viral
load machines)
Equipment:
Maintenance and
repair
All health facilities equipment regularly serviced

10m
and maintained
10m
5m
5m
5m
Transport: Purchase
and maintenance
10 utility vehicles procured
10m
10m
10m
10m
10m
Utility vehicles and ambulances repaired
5m
5m
5m
5m
5m
ICT equipment:
Purchase
Set up and maintained ICT equipment in

20m
selected health facilities
20m
10m
10m
10m
Procurement of
required health
products
Procurement and purchase of medicine and

non-pharmaceutical , vaccines, PPEs and
emergency kits with distribution to facilities. 40m
(Procurement and distribution of medicines, nonpharmaceuticals and vaccines.)
40m
40m
40m
40m
Construction of drug stores (I major store at

100m
county and stores at each sub--county level)
50m
50m
50m
50m
Cold chain maintenance and upgrading
30m
20m
20m
20m
50m
50m
20m
10m
Warehousing and
storage
Monitoring and
evaluation
30m
Establish an integrated logistics management

information system that is procured, installed 100m
and in use to manage stocks and ordering
50
Orientation
area Service
Delivery

Intervention area
Costing of health
service provision
Health
Financing
Leadership
and
Governance
Resource
mobilization
Planning and
health stakeholders
meeting
Quarterly
coordination
meeting
Recruitment of new
staff
Health
Workforce
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
Purchase of software for financial management
20m
20m
10m
10m
5m
Budget preparation and planning
1m
1m
1m
1m
1m
Coordination of health stakeholders (NGO,

private clinic) to avoid duplication and to 10m
maximize funding (including mapping)
10m
5m
5m
5m
Lobby for corporate social responsibilities

10m
(number of meetings held)
10m
10m
10m
10m
Conduct periodical internal & external financial

0.5m
audits
0.5m
0.5m
0.5m
0.5m
Annual work plan and budgets prepared at

2m
all levels
2m
2m
2m
2m
County health summit and performance review

5m
meeting conducted
5m
5m
5m
5m

0.8m
meetings
0.8m
0.8m
0.8m
0.8m
County
health
management
performance review conducted
0.5m
0.5m
0.5m
0.5m
0.5m
Facility health performance review meeting

0.5m
conducted -monthly
0.5m
0.5m
0.5m
0.5m
Conduct quarterly Health Facility Committee

0.5m
Meetings
0.5m
0.5m
0.5m
0.5m
Conduct CHMT
supervision
0.5m
0.5m
0.5m
0.5m
0.5m
0.6m
0.6m
0.6m
0.6m
0.6m
Quarterly
conducted
0.6m
0.6m
0.6m
0.6m
0.6m
Establishment of technical working groups

1m
(TWGs)
1m
1m
1m
1m

200m
for health
200m
100m
100m
100m
Salary remunerations and emoluments (revise &

250m
implement schemes of service)
270m
280m
300m
320m
20m
30m
35m
40m
40m
and
SCHMT
stakeholders
quarterly
Facilities
meetings/forums
Personnel
emoluments for staff Incentives for hard to reach HCFs
Staff motivation and Recognition
In-service training
and development
10m
10m
10m
10m
10m
In-service training / seminars & workshops ,

15m
Specialized training
15m
10m
10m
10m
Management training (mid and senior level)
10m
10m
10m
10m
10m
Orientation & induction of new staff
5m
5m
5m
5m
5m
Career growth & development
15m
20m
15m
10m
10m
51
Orientation
area Service
Delivery

Intervention area
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
Introduction of Integrated Hospital Information

50m
Management System in 50 health facilities
50m
30m
20m
10m
Deployment of ICT infrastructure (hardware,

software, Internet connectivity and LAN) in the 50m
50 Health Facilities.
40m
20m
10m
5m
Staff capacity building on data management at

20m
all levels
10m
5m
3m
1m
Printed and distributed integrated data collection

3m
and reporting tools.
2m
2m
1m
1m
Strengthened data demand, use, dissemination,

and quality improvement through quarterly data 5m
review meetings.
4m
4m
3m
20
Carry out data quality audits (DQAs)
0.5m
0.5m
0.5m
0.5m
0.5m
M&E Plans developed
5m
Conduct health data management trainings for

10m
middle and senior level managers
10m
10m
10m
10m
Provision of smart phones, laptops and tablets

1m
at both middle and senior level management
0.8m
0.5m
0.5m
0.5.m
Provision of PCs and internet connectivity to the

187 facilities for data management and client 30m
messaging services.
30m
20m
20m
5m
Introduce mobile phone reporting system for

10m
births and deaths (CHEWs & CHWs)
5m
5m
3m
1m
Produce periodical county reports on health

service utilization, disease burden and MDG
0.5m
performance (monthly, quarterly, half yearly and
annually)
0.5m
0.5m
0.5m
0.5m
Monitoring of vital system(GIS))events by use of

information technology (E-health, geographical 0.5m
information Systems)
0.5m
0.5m
0.5m
0.5m
Targeted health information monitoring
1m
1m
1m
1m
1m
Evidence-based surveys(Nutrition, Drug &

Substance Abuse, Health service Customer 4m
satisfaction, Occupational Safety)
4m
3m
2m
1m
Sub-County-based
review meeting
2m
2m
2m
2m
Quarterly, Clinical Audits, data quality audits

0.3m
and verification
0.3m
0.3m
0.3m
0.3m
Analytical data packages (SPSS, EPI INFO,

0.3m
etc.)
0.3m
0.3m
0.3m
0.3m
Community dialogues meetings held
0.5m
0.5m
0.5m
0.5m
1m
1m
1m
1m
Electronic and Hard copy Data storage, data

10m
bank and backup established
Enhanced health
information
management
system and
innovations (both
routine and vital
events)
Health
Information
Monitoring and
surveillance
Data analysis
Information
dissemination
HIS, HIMS and M&E policy guidelines

developed and distributed in health facilities in
5m
conformity with WHO health data management
(and fully integrate the systems with DHIS)
meetings
and
quarterly
2m
0.5m
Facilitated feedback (including mortality and

1m
morbidity meetings) to all levels by county team
52
Table 21: Investment Area Budget Summary

Budget Summary:
Annual targets(KES '000 000)
Orientation area
Year1
Service delivery
140
Year2
Year3
Year4
Year5
Total
Item budget
proportion
47
36.8
29
25.3
278.1
4.18
Health infrastructure (physical infrastructure, 425.5

equipment, transport, ICT)
497.5
256.5
200
193
1572.5
23.64
Health products
170
160
130
120
850
12.78
270
Health financing
41.5
41.5
26.5
26.5
21.5
157.5
2.37
Leadership and governance
10
10
10
10
10
50
0.75
Health workforce
525
560
465
485
505
2540
38.18
Health information
209.6
162.4
106.1
79.1
43.1
600.3
9.02
Sub Total
1621.6
1488.4
1060.9
959.6
917.9
6048.4
Contingency of 10% of Sub-Total
162.16
148.84
106.09
95.96
91.79
604.84
9.09
Grand Total
1783.76
1637.24
1166.99
1055.56
1009.69
6653.24
100.00
The table on the previous page summarizes the

overall budget estimates in each of the investment
areas as follows:
Proper mapping and coordination of the existing

partners to avoid duplication of the available
resources
Service delivery - 4.18%;

Health infrastructure - 23.64%;
Ensure timely and continued flow of resources

from the county government through planning
and avoid over-reliance on donor support
Health products - 12.78%;
Optimal collection and utilization of user fees

Ensure transparency and accountability of all
resources
Health financing - 2.37%;

Leadership and governance - 0.75%;
Timely repairs and maintenance of existing

machinery, equipment and infrastructure
Health workforce - 38.18%;

Health information - 9.02%.
The details of each of these investment areas are
stated in table 15.
3.1 Resource Mobilization Strategy

Strategies to ensure
available resources
sustainability
of
Partners disclosure their resource envelope

Introduction of attractive and retention packages
for health workers
Identify and prioritize needs
Optimal use of the available resources
Strategies to Mobilize Resources from New

Sources
Introduction of income-generating activities in
all health facilities (i.e. pharmacies, restaurants,
and shops, kitchen gardens, M-pesa, etc.)
Creation of Friends of Uasin Gishu County for
support in health financing e.g. elite athletes
Solicit external support in terms of grants and
loans through proposal writing and establishing
new collaborations and partnerships
Involving partners in ongoing county health
plans and activities
Community involvement through social health
insurance
53
Exchange programs with partners from outside
of the county
Regular meeting with county health committees

on resources utilization
Specialized diagnostic services in high volume

facilities e.g. CT scan, MRI, DNA, etc.
Health tourism
Strengthening governance and leadership

structures at all levels; good corporate
governance
Taking advantage of corporate social

responsibility (Public Private Partnerships)
Establishment of interdepartmental networking

system
Strategies to Ensure Efficiency in Resources

Utilization
Introduction and strengthening of performance
contracting
Capacity building for all health workers to
ensure optimum output
Strengthen internal and external control
mechanisms to minimize corruption and
embezzlement of resources
Introduction of CCTV in health facilities

Capacity building on financial management for
managers
Embrace IT in finance management and
Enterprise Resource Planning (ERP)
54
SECTION 4:
Implementation Arrangements
55
4.1 County Health Services Coordination Framework

Devolved health services in Kenya are headed by
the County Executive Committee (CEC) member for
health at the county level of government. The CEC
represents the executive arm that directly reports to
the Governor. The functions of the CEC include:
supervising the administration and delivery of
services in the county and all decentralized units
and agencies in the county; performing any other
functions conferred on it by the Constitution of
Kenya or national legislation; and carry out any
function incidental to any of the assigned functions.
The holder of the office is responsible for providing
leadership towards implementation of health
interventions as per the National health policies
and guidelines besides overall coordination and
management of county health services.
The Chief Officer of Health, who is directly under the
CEC for health, is the accounting officer in respect
of the exercise of delegated power and shall be
responsible to the County Health Services Executive
Member for the administration of a County Health
Services Department, including implementation
of policies and development plans, development
and implementation of strategic plans, formulation
and implementation of effective programmes to
attain Vision 2030 and sector goals, promotion
of national values and principles, adherence to
governance values and principles of public service
and any other duties as assigned by the respective
County Executive member.
The holder of the office will work directly with the
County Directors of Health, who in turn, will oversee
the departments of Promotive and Preventive Care
Services and Clinical Services;
They will coordinate health services at the county
and sub-county level i.e. to oversee service
provision at all levels in the sub-counties. Hospitals
will have hospital management teams to supervise
health service provision and ensure that services
offered are of the highest attainable standards.

Primary Health Care (PHC) Facilities / Services
will be headed by Hospital Managers and assisted
by health facility committees.
The functions of the PHC will be coordinated by the
Director, Preventive & Promotive Services, through
the technical departments. Service provision at the
community level will be overseen by community
health extension officers who will supervise the
community health workers. Nontechnical health
services will be provided under the Health
Administration department, and headed by the
County Health Administrator. This will be a support
arm to the technical services.
To improve governance and social accountability
at the community level, hospitals will have health
management boards and primary health facilities
will have facility management committees. Service
provision at the community level will be overseen
by community health committees. Their main
responsibility will be to represent the community
at the various tiers of service provision, ensuring
the rights-based approach in health care delivery
is realized. They will oversee implementation of
activities, approve budgets and assist in resource
mobilization for health services.
To facilitate operational provision of health
services, this strategic plan proposes the following
organizational structure, based on the county
functions for health outlined in the Fourth Schedule
of the Constitution, health policy objectives and
orientations, and the need for clearly demarcated
areas of responsibilities. The proposal also takes
into account the need to have a lean structure
based on functionality and integration of services
at the county level.
The rationalized organogram for the countys health
management is shown below.
56
Figure 13: UASIN GISHU County Health Department Organogram
County Chief Executive Member of Health (CEC)
Partner and Stakeholder

Ordinating Secretariat
Chief Officer
of health
Administrator
Director Clinical
Services
County Hospital
Manager- (Officer)
Refer to Detailed
Structure Below
County
Pharnacist
Environmental
Health Officer
Director - Preventive and

Promotive Health Services
Reproductive
Health
Programme
Officers
Public Health
Officer Ward Level
Public Health
Technicians/Chew
Figure 14: Detailed Clinical Services Structure

Director - Clinical
Serces
County Hospital manager

(Officer I/C)
Chief nurse
(In Charge of
Nursing in
the Facilties)
Clinical Officer
In Charge
Lab In Charge
Pharmacist
In Charge
Health
Administrator
(Administration)
Records
Officer
Rehabilitation
Nutritionist
Physiotherapy
and Occupational
The respective staff in the specialization areas will report to the respective in-charges who, in turn, will
report to the facility in-charge
The optimum staffing will be determined as per facility levels
The county head office will have the policy team and the pharmacist, the rest of the team will operate
from the respective facilities and the devolved offices
57
Table 22: Partnership and Coordination Structure

Partners
Ministry of Health
Intervention Areas
Outputs
Policy, guidelines, standards and

norms development
Uniformity of health services
Client satisfaction
Training and capacity building
Skilled health workforce
Quality health care
Safe health care
Achievement
sector goal
Regulatory role
Investment plan document
Strategic plan development

Monitoring and evaluation
Support
Development
External Partners:
Development Partners
(WHO, USAID, GF,
UNICEF, GTZ, WFP
Outcomes
strategic
plan
of
Progress review
Timely intervention
Investment plan document
Achievement
sector goals
Progress review
of
Timely interventions
Capacity building
Improved access to quality

health services
Quality health care
Infrastructure development
Available resources
health
health
Client satisfaction
Motivated staff
Program funding
HMIS Support
Water and sanitation
Internal Implementing
Partners:
World Vision, AMREF,
AMPATH, MEASURE
evaluation, AFYAInfo,
Kenya Red Cross, PSK,
Hope World Wide, Kenya
pharma, ITEC, FUNZO
Kenya, FHOK, CSOs
School health
Supporting community strategy
implementation
Empowered community
Reduced
cases
of
communicable diseases
Capacity building
HIS strengthening
Health products management
Automation of health services
Community-based intervention in
HIV, malaria, TB, Kenya Mentor
Mothers Program
Other government
sectors and departments:
(Agriculture, Water,
Environment, Roads, etc.)
Provision of safe water
Availability of safe water
Technical support (e.g. plan

approvals, inspections, health
education, transportation e.g
accessibility
Safe environment
County political
leadership: (Governor,
CEC ,County Reps, MPs,
Senators, elected leaders)
Political goodwill
Political support
Projects and commitments
Resource availability
Approval of budgets
Provision of security
County administrative
leadership
Resource mobilization
Resource allocation
Security
Education
Food security
Reduction of morbidity
and mortality due to
waterborne diseases
Reduction in malnutrition
Healthy population
Achievement
sector goals
of
health
-CDF
-County Assembly
Public-Private Partnership:
(individual and private
stakeholders, nursing
homes, hotels, banks,
industries, etc.)
Financial and material aid
Availability of resources
Projects support
Corporate responsibility
Service provision
Improved quality of care
58
4.2 Monitoring and Evaluation Plan

A sound system of monitoring and evaluation
(M&E) of health interventions at the county level is
critical in showing and measuring the performance
of health indicators that translate into progress
towards achieving outcomes and desired impact
of all health efforts.
Since achievement of desired health outcomes
relies on efforts by all actors, both public and
private, the information generated by such an M&E
system should respond to the information needs of
key stakeholders.
There is a need for consensus among the
development partners, technical government
agencies and implementing partners on the basic
core M&E framework. Such a consensus will
reduce the burden of requests for data from different
stakeholders.
This document identifies the key functions and actions
of the Uasin Gishu county M&E system within the
context of general health and disease M&E systems
in Kenya; it reviews current issues and opportunities
that exist at the national, county, sub-county and
community levels. It provides a summary of M&E
planning and reviews the necessary capacity
to be built in order to fulfil these functions. This
document also lays the foundation for measuring
progress through the identification of the goals and
objectives across health intervention strategies.
Further, it provides guidance on specific indicators
against which progress will be measured. Finally,
this document reviews the available and desired
data sources and identifies the roles of key health
M&E stakeholders.
The monitoring and review process is at both the
operational and the strategic level. At the strategic
level, the monitoring process will be in line with
monitoring support towards the strategic objectives
of the overall health sector. On the other hand, the
operational monitoring will focus on monitoring
progress towards the strategic priorities using one
monitoring framework and indicators to measure

progress.
Strategic monitoring will be done at the mid-term
and end-term of this plan period. The mid-term
review will coincide with the formal articulation of
the strategic policy objectives of the health sector.
Hence, it will focus on:
reviewing progress made and identifying
challenges and strategies for acceleration; and
incorporating any realignment of the strategic
priorities with the policy framework.
All levels of the Health Department, including
partners, will be involved in the process of strategic
monitoring. Each level of service delivery will carry
out its own monitoring and evaluation. Operational
monitoring will be carried out monthly, quarterly,
and annually. It will focus on monitoring progress
against interventions and activities set out in the
annual work plans.
Indicators will be utilized to measure progress
against set targets. The indicators will be used in
the following ways:
Sector-wide indicators: This is a set of indicators
the sector will use to inform on progress at the
strategic level. Collection and monitoring of
progress will be the responsibility of the entire
health sector.
Program indicators: These involve indicators
that the respective program areas will use
to inform on progress towards programme
objectives. The number will depend on the
particular program area. Monitoring of progress
will be the responsibility of the respective
program area.
County-specific indicators: These are indicators
that will be unique to the county for monitoring
progress.
The overall purpose of the M&E framework is to
improve the accountability of the health sector. This
shall be achieved through a focus on strengthening
the countys capacity for information generation,
59
validation, analysis, dissemination, and use
through addressing the priorities, as outlined in the
health information system investment section of this
document. This M&E chapter focuses on how the
sector will attain the stewardship goals needed
to facilitate achievement of the HIS investment
priorities. These stewardship goals are:
Supporting the establishment of a common data
architecture for the health sector;
Enhancing sharing of data and promoting
information use at all levels; and
Improving the performance monitoring and
review processes at county, sub-county and
facility levels.
4.3 Comprehensive Monitoring and

Evaluation Plan
A comprehensive M&E plan will be developed to
clearly define the extent of investment and support
that the county will put in place in order to ensure
the realization of this strategy. The M&E plan to
be developed shortly after the completion and
adoption of this strategy will:
Provide a brief description of the county health
vision and strategy and its results framework;
Describe the components of the health
management system, including the process and
implementation strategy to collect, analyze and
use health data, as well as the countys M&E
needs by program area/strategic objectives;
Describe the range of activities that will be
undertaken to satisfy those health sector data
needs in the county and the timeline and
the human resources that will be devoted to
implementing the M&E strategies;
Outline activities that will support the health
information systems at all levels; and
escribe an evaluation plan that addresses how
and when the baseline assessments will be
conducted and when the mid-project and endline evaluations will be conducted.
Detailed M&E operational plans will be developed
at departmental, section and health facility level;
the set will be used as internal documents to provide

additional guidance to health leaders and staff on
M&E activities and responsibilities.
Common Data Architecture

A common data architecture is needed to ensure
coordinated information generation so that data and
information sharing and efficiencies are maximized
in data and information management. The county
M&E unit will carry the mandate of establishing
and overseeing the common data architecture by
use of the DHIS platform for aggregate data and
electronic health records system. The health sector
has identified sector indicators for monitoring and
evaluating the implementation of the county health
sector strategic and investment plan. The common
data architecture will provide the data sources for
these indicators as defined in the health sector
indicator manual.
Enhancement of Sharing Data and Promoting

Information Use
The sector recognizes the fact that different data are
used by different actors for their decision-making
processes and investment decisions. To enhance
these processes and decisions,, data need to
be translated into information that is relevant for
decision-making and use by county citizens. Data
will be packaged and disseminated in formats that
are determined by the needs of the stakeholders.
Sharing Service Delivery Expectations

In line with the 2010 Kenya Constitution,
the County Government Act 2012, and the
Financial Management Act 2012 need for
sector transparency, accountability information
on expected services will be publicly displayed
outside each facility unit, based on the package to
be delivered there.
Uasin Gishu County and Sub-county Annual

State of Health Report
The health sector shall publish annually a state
of health report which will be a compilation of
statistical information from different sources that
60
will present a snapshot of performance covering
the different strategic objectives articulated in this
strategic plan. It will be informed by the county
and sub-county annual health state report and will
be produced by the planning and M&E units at
the county levels. The sub-county and county state
report will be presented at a county annual health
review summit and published on the County MOH
Website. This forum will draw attendance from
MOH county level, the county health management
teams, SAGAs and CSOs, implementing partners,
county implementers and other health- related
sectors / stakeholders.
Quarterly Performance Review Reports

At all levels, performance review reports will be
produced outlining the performance against the
strategic objectives outlined in this plan. The reports
will be discussed by the health management teams,
including all the stakeholders at the quarterly
performance review meetings. The discussion will
focus on a review of the findings and the agreed

action points. The final report will be submitted to
the next level of reporting.
Annual Work Plan

This strategic plan will be implemented over a fiveyear period; activities will be implemented through
an annual work planning process at different levels.
The planning and M&E unit at the sub-county and
county levels will translate data and information
according to the targets set and performance
reviews through various communication channels
e.g. county MOH websites, bulletins, newsletters,
booklets, etc. to disseminate the information to all
the stakeholders. The plan shall be shared through
the county assembly and national government.
Figure 15: Comprehensive Planning Cycle

County Health Sector AWP
County Management AWP
Moi Referral Hospital

Sub - County Annual Work Plan
Sub - County Hospital AWP
Primary Care AWP
Sub County Management
Community Unit Annual Work Plan (AWP)
61
Figure 16: Uasin Gishu County Planning Cycle

Annual Work Plan
Start: November
End: Mid February
Annual County Health

Report Start: December
End: January
Health SP
Performance Monitoring and Evaluation

Performance
processes
monitoring
and
review
All performance reviews and evaluations will

contain specific, targeted and actionable
recommendations; the process will be outlined
in the County Health M&E framework.
Annual
Performance Review
Start: June
End: July
All the planning units and institutions will be

required to maintain an implementation tracking
plan.
The implementation of the agreed actions will
be monitored by the planning and M&E unit at
all levels, with coordination and oversight from
County Health Management.
All institutions will provide a response to

the recommendation(s) within a stipulated
timeframe.
62
Table 23: Service Outcome and Output Targets for Achievement of County
Objectives
Objective
Eliminate communicable
conditions
Halt, and reverse the

rising burden of noncommunicable conditions
Reduce the burden of

violence and injuries
Provide essential health

services
Minimize exposure to
health risk factors
Strengthen collaboration
with health-related sectors
Targets
Indicator
Yr. 1
Yr. 2
Yr. 3
Yr. 4
Yr. 5
% Fully immunized children
63.5
70
78
85
90
% of TB patients completing treatment
89.5
90
91
92
93
% HIV + pregnant mothers receiving (PMTCT)preventive ARVs
40.2
48
56
65
75
% of eligible HIV clients on ARVs
78
80
82
84
85
% of (targeted) under-1ss provided with LLITNs
% of pregnant women attending at least 1 ANC visit provided 44

with LLITNs
52
60
68
75
% of under-s treated for diarrhoea
16.9
14
12
11
10
% of school age children dewormed
65.9
70
75
80
85
% of children 12-59 months dewormed
50
60
70
80
% of adult population with BMI over 25
% Women of reproductive age screened for cervical cancers
25
35
43
50
% of new outpatients with mental health conditions
0.27
% of new outpatients cases with high blood pressure
0.96
10
15
20
% of patients admitted with cancer
% new outpatient cases attributed to gender-based violence
% new outpatient cases attributed to road traffic injuries
% new outpatient cases attributed to other injuries
% of deaths due to injuries
% deliveries conducted by skilled attendant
36.9
44
52
60
70
% of women of reproductive age receiving family planning
37.3
44
52
60
70
% of facility-based maternal deaths
% of facility-based under-5 deaths
% of newborns with low birth weight
7.7
% of facility-based fresh still births
9.8
8.8
7.8
6.8
Surgical rate for cold cases
% of pregnant women attending 4 ANC visits
19.3
30
40
50
60
% 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 iodized
Couple year protection due to condom use
% of population with access to safe water
65
68
70
72
75
% of under5s stunted
% of under-5 underweight
School enrolment rate
% of households with latrines
86.7
88
89
90
92
% of houses with adequate ventilation
% of classified road network in good condition
% of schools providing complete school health package
45
52
59
65
70
63
Objective
Targets
Indicator
Yr. 1
Yr. 2
Yr. 3
Yr. 4
Yr. 5
INVESTMENT OUTPUTS
Improving access to
services
Improving quality of care
Per capita outpatient utilization rate (M/F)
% of population living within 5km of a facility
% of facilities providing BEOC
% of facilities providing CEOC
Bed occupancy rate
% of facilities providing immunization
76
79
82
85
88
TB cure rate
80
82
83
84
85
% maternal audits/deaths audits
87.8
89
91
92
95
Malaria inpatient case fatality
Average length of stay (ALOS)
% of fevers tested positive for malaria
Table 24: County Monitoring Indicators

County Objectives
Indicators
Scale up the number of functional community units
Number of community units established and reporting to DHIS
Increase immunization coverage
% of immunization coverage
Improve access to safe water and sanitation services
% of households with latrines
Enhance provision of complete heath package in school
Number of schools providing complete heath package
Increase IDSR reporting in health facilities
Number of facilities reporting IDSR
Establish isolation centers in all tier 3 and 4 facilities
Number of facilities with functional Isolation centers established
Promote early detection and diagnosis of common NCDs
% of NCDs detected
Increase public awareness on non-communicable diseases
Number of public awareness campaigns conducted on NCDs
Increase access to diagnostic and treatment services
Number of centers providing diagnostic and treatment services
Set up palliative and rehabilitation centers
Number of palliative and rehabilitation centers
Advocate for by-laws that promote healthy lifestyles and reverse Number of acts /bylaws that promote healthy lifestyles
trend of risk factors
Establish functional emergency preparedness and response teams Number of sub-counties that have an emergency and response team
in sub-counties
Establish emergency, diagnostic and specialized facilities (e.g. burn Number of emergency, diagnostic and specialized facilities
units, ICUs/HDUs).
established
Create public awareness on violence and injuries
Number of public awareness campaigns on violence conducted

injuries
Establish psycho-social care units at sub-counties.
Number of sub-counties with psycho-social care units
Improve client referral system
% of referrals initiation
% of referrals received
% referrals completion
% referrals counter referred
Adherence to standard operating procedures
Number of health care workers adhering to the SOPs disseminated
Provision of integrated services (one-stop shop) at health facilities
Number of health facilities providing integrated services
Reduce stock-out of essential medicine and medical supplies
Number of health facilities reporting stock-outs of essential medicines
Improved quality of care at the health facilities
% of health facilities reporting improved quality of care
services (QoC survey)

Adherence to citizen service charter
Number of health facilities with citizen service charter
64
County Objectives
Indicators
Strengthen linkages and referral systems between various tiers of % of intra facility referrals initiation
health care service delivery
% of intra facility referrals completion
% of inter facility referrals initiation
% of inter facility referrals completion
& of inter facility counter referrals
Foster partnerships with health stakeholders to improve health and Number of stakeholders actively participating in the stakeholder
deliver services
forums
Improve financing of the health sector
% of resources allocated to the health sector
65
SECTION 5:
References
66
References
Constitution of Kenya 2010
Uasin Gishu County CIDP.
Kenya Demographic and Health Survey 2008/09
Kenya DHIS 2012- www.hiskenya.org
Government of Kenya, County Government Act No 17, 2012
Government of Kenya, Transition to Devolved Government Act, 2012
UN Millennium Development Goals
Kenya Vision 2030
Ministry of Health, Norms and Standards, 2007
Ministry of Health. Annual Work Plan July 2012- June 2013, Uasin-Gishu County
Ministry of Health. Kenya SARAM County Fact Sheet 2013
Ministry of Medical Services and Ministry of Public Health and Sanitation. Kenya Health Sector
Strategic Plan (KHSSP) III, 2012-2017 Nairobi.
Ministry of Medical Services and Ministry of Public Health and Sanitation. Kenya Health Policy
2012-2030. Nairobi: Government of Kenya; 2012
67
SECTION 6:
Annexes
68
6.1 Annex 1: Risk Factors

Risk Factors Causing Mortality
Risk Factors Causing Morbidity
National
County-specific
National
County-specific
Condition
Condition
Condition
Condition
Unsafe sex
Unhealthy lifestyle
Unsafe sex
Unsafe water, sanitation

and hygiene

& hygiene

and hygiene

& hygiene
Unhealthy lifestyle
Suboptimal breastfeeding
Childhood and maternal

underweight
Unsafe sex
Childhood & maternal

underweight
Drug and substance

abuse
Suboptimal breastfeeding
Road traffic accident
Indoor air population
Harmful socio- cultural

practices
High blood pressure
Harmful socio- cultural

practices
Alcohol use
Road traffic accident
Alcohol use
Drug and substance

abuse
Vitamin A deficiency
Insecurity
Vitamin A deficiency
Insecurity
High blood glucose
Ignorance and illiteracy

of community
Zinc deficiency
Ignorance and illiteracy

of community
High blood pressure
Food insecurity/
deficiencies
Iron deficiency
Foodinsecurity/
deficiencies
10
Zinc deficiency
10
Poor housing/ shelter
10
Lack of contraception
10
Poor housing/ shelter
Unsafe sex
6.2 Annex 2: The Monitoring and Evaluation Framework

Frequency
Targets
Focus
Level of Monitoring
and review
Monthly
Monthly activity reports
Identify activities whose implementation is Activity level

delaying delivery of outputs, and plan to
address challenges
Quarterly
Quarterly progress
reports
Identify outputs whose achievement during the year is Output level

threatened, and plan to address challenges affecting
them
Annually
Annual progress
reports
Identify
progress,
issues
and
challenges Output level
affecting implementation of outputs, and make
recommendations of priorities for coming year
Mid term
Mid-term review
Identify progress, issues and challenges Outcome level

affecting implementation of outcomes towards
supporting the achievement of the overall goal,
and make recommendations for the remaining
half of the strategic plan
End term
End-term review
Identify progress, issues and challenges that Goal level

affected achievement of the overall goal, and
make recommendations for the next strategic
plan focus to enable it to support achievement
of overall sector policy
69
Narrative Summary
Objectively Verifiable Indicators
Means of Verification
OVERALL GOAL
The staff appointment letters
People in Uasin Gishu County

Provision of excellent health care
access the highest possible
for all people in Uasin Gishu
attainable quality of health care
County and beyond
within the county
Mid-term and end-term

review report
Health service assessment
report.
PURPOSE
To promote health and prevent
disease and injury through
provision of highest attainable
quality, acceptable, accessible,
affordable and equitable health
care services that is innovative,
responsive and sustainable
to the people of Uasin Gishu
County and beyond
People of Uasin Gishu access

health care services that
are affordable, equitable,
innovative, responsive and
sustainable
The staff appointment letters

Mid-term and end-term
review report
Health service assessment
report
Key Assumptions
That the strategic plan will
be adopted by the county
and that the devolved system
of government will continue
getting support from the central
government
County government will
continue to adequately and
sustainably fund health care
in the county
The people of Uasin Gishu
will continually seek health
care services from within
the county department of
health
OBJECTIVE 1: Eliminate and control communicable conditions

% of fully immunized
children
OUTPUT 1.0
Reduce burden of
communicable diseases
in Uasin Gishu County by
20% by 2018
ACTIVITIES FOR OUTPUT 1.0
Outreaches and
Immunization campaigns
Decentralization of HIV
care centers
Procurement of LLITNs
OUTPUT 1.2 To increase
awareness on communicable
diseases and their risk factors
% TB treatment success rate

and TB smear +ve cure rate
% HIV+ve pregnant
mothers receiving (PMTCT)
preventive ARVs
The commodities will be

continuously available in
the right quantities
% of eligible HIV clients on

ARVs
% of (targeted) under- 1s
provided with LLITNs
Annual performance reports.
% of pregnant women
attending at least 1 ANC
visit provided with LLITNs
Clients will continue

seeking health care services
from within the county
Services will be accessible
and available to all clients
of Uasin Gishu County
% of under-5s treated for

diarrhoea
% School age children dewormed
% of children 12-59months
de-wormed
OBJECTIVE 2: Halt and reverse increasing burden of NCDs

OUTPUT 2.1
Reduce burden of noncommunicable diseases
in Uasin Gishu County by
2018\
OUTPUT 2.2
To increase awareness on
non-communicable diseases
and its risk factors
% of adult population with

BMI over 25
County government will

continue to adequately and
sustainably fund health care
in the county.
% of women of reproductive
age screened for cervical
cancers
% of new outpatients with
mental health conditions
Annual performance reports
% of new outpatients cases

with high blood pressure
% of patients admitted with
cancer
The people of Uasin Gishu

will continually seek health
care services from within
the county department of
health
70
6.3 Annex 3: Participant List

1
Dr. Eunice Siria
CEC- Health
Mr.Wilson Kemei
Chief Officer Health
Dr.Evans Kiprotich
Director Health-Preventive and Promotive

Services
Dr. Billy Lubanga
Director Health-Clinal Services
Esther Serem
CCN
Alexander Korir
CDSC
Susan Muchemi
CNUTO
Salome Tomno
CCSC
Peninah Chesire
CPHO
10
Silas Kosgei
CHRIO
11
Amos Kutto
CMLT
12
Hillary Ndiema
CTBLC
13
Richard Cheserek
CCO
14
Joyce Sambu
HRIO
15
Daniel Cheruiyot
SHRIO
16
David Kirui
HRIO
17
Hellen Cheruto
Coordinator
GF-KRC
18
Sylivester Kimaiyo
COP
AMPATH
19
Pauline Siror & Jonathan

Chelanga
M&EO
MEASURE Evaluation
21
Samson Mely
CRHO
6.4 Annex 4: Functions, Roles and Responsibilities

County Executive Committee Member
(CECM), Health
Responsibilities/functions
Provide leadership and stewardship for overall
health management in the county
Provide strategic and operational planning,
monitoring and evaluation of health services in
the county
Provide a linkage with the national ministry
responsible for health
Collaborate on health services with state
and non-state stakeholders in the county and
between counties
Mobilize resources for county health services
Establish mechanisms for the referral function

within and between the counties, and between
the different levels of the health system in line
with the sector referral strategy
Coordinating and collaborating through County
Health Stakeholder Forums (CHMB, FBOs,
NGOs, CSOs, development partners)
Coordinate delivery of health services in the
county
Provide linkage with County Executive and
other actors to facilitate health sector dialogue
at the County
Coordinating capacity building of the health
workforce within the County
71
sub-county
Chief Officer of Health (COH)

The office holder is an authorized officer in
respect of exercise of delegated power and shall
be responsible to the respective county executive
member for:
The administration of a county department of
health services
Implementation of policies and development
plans
Development and implementation of strategic
plans
Formulate and implement effective programs to
attain Vision 2030 and sector goals
Promote national values and principles of
governance and values and principles of public
service
County Director of Health (CHD)

Provide leadership and stewardship for overall
health management in the sub-counties
Provide a linkage between primary health care
services and county health services
Collaborate with stakeholders in the sub-county
health services and between sub counties
Coordinate strategic and operational planning,
supportive supervision, monitoring and review
of health service delivery including hospitals in
the county
Provide linkage with County Director for Health

and other actors to facilitate health sector
dialogue in the sub-county
Coordinate the development and implementation
of facility health plans
Coordinate capacity building for health workers
within the sub-county.
Coordinate community strategy in the subcounty, including receiving the monthly reports
from the community health extension workers
Supervise the work improvement teams in
primary health care facilities to ensure quality
control and adherence to guidelines
Provide strategic and operational planning and
monitoring and evaluation of health services in
the sub-county
Heads of Programs
The Head of Programs will be responsible for
program planning and reporting, M & E, fundraising
and financial reporting tasks, including, but not
limited to:
Program work
Contribute to overall strategic discussions
and decisions on program coordination, new
initiatives and new partnerships
Contribute to management development and
implementation, strategy, policies and values, as
agreed in the Senior Health Management Team
Mobilize resources for sub-county health services

with
Be responsible for designing, coordinating and

implementing county initiatives, such as capacity
development, campaigns, learning activities
etc. in coordination with county managers
Establish mechanisms for the referral function

within and between the sub-counties, and
between the different levels of the health system
in line with the sector referral strategy
Manage communication with counterparts in

county initiatives
Support other county managers in designing
and implementing their respective programs
Coordinating and collaborating through SubCounty Health Stakeholder Forums (SCHMB,

FBOs, NGOs, CBOs, development partners)
Develop fundraising proposals in close

cooperation with county health managers
Planning, monitoring and reporting
Coordinate delivery of health services in the
Be partaker responsible for ensuring that
72
the monitoring and evaluation framework
is implemented, including strengthening the
framework and developing the capacities with
partners and staff to implement the framework
Develop and prepare monitoring plans; regularly
monitor and review the activities to ensure the
activities are in line with achieving expected
outputs and suggest revisions if needed.
Assist in documenting work done and
continuously assess work while collecting
success stories and drawing lessons learned
from the field
Compile monthly, quarterly yearly activity reports
based on county activity running/performance.
Ensure that relevant partner requirements are
communicated to and understood by staff and
all stakeholders
Hospital Management Teams
at the facility
Capacity building and support to community
health extension workers and community health
workers
Management of resources
Emergency response
Provide secretarial services to the governance
structure at that level i.e. health facility management
committee
Resource mobilization
Human resource management

Provide inspiring and supportive leadership
to health staff and partners in the implementation
of the program and build a collaborative, open
and trusting environment among the partners
Assist health care staff in program activity
implementation and problem solving.
Functions and responsibilities

Preparation of hospital work plans e.g. business
and annual operational plans
Ensure equitable distribution of resources within
the facility e.g. supplies, staff within departments
Ensure that quality services are offered to the
clients in the hospital
Ensure that proper records and information are
maintained
Proper financial management e.g. ensuring
proper budgeting and utilization of funds e.g.
FIF
Other duties
The Head of Programs is responsible for fulfilling
any other program-related requirements
Roles of In-Charges
1. Facility Officer in Charge
Roles and responsibilities

Responsible for the day-to-day running of
facility
the
Coordinating the planning for the facility e.g.

annual operation plan
Commodities and supplies management
Financial management
Infrastructure and equipment management

Emergency preparedness and timely response
Ensuring provision of curative, rehabilitative

preventive and promotion services
Human resources management and development
Proper record keeping
Primary Health Care Facility Teams
Monthly, quarterly and annual reporting on

health care services
2. Medical Superintendents
Overall coordination and management of

services at health facility
Operational planning for public health services
Setting and enforcing standards of health care
73
Heads of Hospital Departments
services in all hospital departments

Setting and maintaining high levels of discipline
among the hospital staff by chairing all the
reward and sanction committee meetings and
promptly solving disciplinary cases
Serving as the authority to incur expenditure
holder for the hospital
Chairing the hospitals finance and procurement
committees
Overseeing the delivery of all the services in the
hospital
Supervising department heads and wards incharges
Encouraging all inclusive participatory
management
Striving to motivate and inspire staff, and

encouraging and building a team spirit within
the departments
Setting performance standards ( monthly, yearly,
etc.) and giving the departments quarterly
reports
Chairing regular (monthly) departments meetings
(administrative or clinical) and give reports
With the departmental staff, develop a mission
and vision for the departments (basically the
hospitals)
Ensure continuous medical developments for
departmental staff
Encouraging team work

Identifying the key result areas with the heads
of departments in he hospital for continuous
monitoring and evaluation
Taking the lead in doing annual operation plans
for the hospital
Providingoverall supervision of
activities, facilities and conditions
Setting and enforcing standards
hospital
Ensuring appropriate and efficient deployment

and commitment of available staff
Striving to motivate and inspire staff
Ensuring adequate supply of commodities and
drugs
Participate in capacity building of staff in the

department and other staff
Encourage and participate in research
Ensure proper management of patients/ clients
and record keeping
Ensure proper referring of patients, when
required
Ensure all staff in the department uphold a high
level of discipline
Take an active role in ensuring that supplies and
equipment are available in the department
74
75
76
Department of Health Services,

Uasin Gishu County
This Strategic and investment plan was
developed with support from U.S. Agency
for International Development through the
MEASURE Evaluation PIMA project

County Health Strategic and Investment Plan 2013 - 2018

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County Health Strategic and Investment Plan 2013 - 2018

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Department of Health Services

COUNTY HEALTH STRATEGIC

Uasin Gishu County Health Strategic Plan 2013-2018

UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018

Process of Development and Adoption of the County Health Strategic

UGC Health Department

Core Values of the County Health Department

Section 1: Introduction and Background

1.1 Purpose of the Strategic Plan

1.2 County Geographical Location and Size

1.3 Physiographic and Natural Conditions

1.4 Administrative Units

1.5 Demographic Features

1.6 Emerging and Re-emerging Issues

1.7 Health Service Outputs

1.8 Issues and Challenges in Providing Health Services (SWOT)

1.9 Health System Investment

Section 2: Problem Analysis, Objectives and Priorities

2.1 Problem Analysis

2.2 Strategic Focus and Objectives

Section 3: Resource Requirements and Financing

3.1 Resource Mobilization Strategy

Section 4: Implementation Arrangements

4.1 County Health Services Coordination Framework

4.2 Monitoring and Evaluation Plan

4.3 Comprehensive Monitoring and Evaluation Plan

6.1 Annex 1: Risk Factors

6.2 Annex 2: The Monitoring and Evaluation Framework

6.3 Annex 3: Participant List

6.4 Annex 4: Functions, Roles and Responsibilities

UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018

Uasin-Gishu County Administrative and Political Units and Size

Uasin Gishu Population Distribution and Projection, 2013 to 2017

Uasin Gishu Population Distribution by Age Group 2013

Table 4: Population Projection 2013 2017/2017

Distribution of Health Facilities per Manning Agency across Sub-counties

Table 8: Over-5 Top Ten Causes of OPD Morbidity in Uasin Gishu

Uasin Gishu OPD Service Utilization

Table 10: Reported Causes of Inpatient Mortality in MTRH 2011 to 2013

Table 11: Inpatient Utilization

Table 12: Health Impact

Table 13: Key Health Indicators

Table 14: Emerging and Re-emerging Health Issues and Interventions

Table 15: Health Service Outputs

Table 16: Issues and Challenges in Providing Health Services

Table 18: Problem Analysis

Table 19: Investment Area Details

Table 20: Budget Summary

Table 21: Investment Area Budget Summary

Table 22: Partnership and Coordination Structure

Table 24: County Monitoring Indicators

UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018

Figure 2: Map Location of Uasin Gishu County in Kenya

Health Facility Distribution Map by type -2013

SARAM Kenya 2013: Health Facility Distribution by Type across Constituencies

Uasin Gishu County Population Pyramid 2013

Uasin Gishu Outpatient Morbidity 2011 to 2013

Figure 7: Outpatient Services Utilization 2011-2013

Uasin Gishu County Immunization Coverage

Figure 9: Comparative Uptake of Reproductive Health Services

Figure 10: Top Ten Causes of Mortality, 2011-2013

Figure 11: Leading Causes of Death, 2011-2013

Figure 12: Health Information System