Annual Operational Plan 5 Mid-term (July – December 2009) Progress report

1. Annual Operational Plan 5 Mid-term (July – December 2009)Progress report Dr S K Sharif Director Public Health & Sanitation

2. Health Services Index

3. Introduction • Health Services Coverage trends critical input into analysis of health trends and distribution • Are numerous indicators in Kenya that follow up on coverage of different Health Services, all serving different purposes • Follow up of implementation of interventions • Follow up of program progress • Follow up of system, or sector implementation • System assessment requires a representative set of indicators for follow – up of overall progress. • Health Services Index provides a means to summarize trends in a selected set of indicators, to provide for an overall picture of trends for Service Coverage in the sector • Has been developed by HMIS unit in Technical Planning Department, for overall monitoring of sector wide progress • Program monitoring to continue, based on program specific indicators

4. Key principles • Cohort based index, in line with country’s service package • Total number of indicators fixed at 30. • Ensure a single indicator on its own doesn’t have a significant impact on the overall Health Index • But, have a manageable number of indicators for which information can be made available • Each result area to have at least 1 indicator. More indicators for priority result areas (cohorts 1 & 2) • Number of indicators by cohort fixed, informed by priorities of sector • Cohort 2&3 = 33% of Indicators, Cohort 1=30%, cohort 5=17%, cohorts 5 & 6 = 10% each • Actual indicators making up index may be changed, to limit the vertical focus on improving a single indicator target during implementation. • Each indicator in the index carries the same weight. • If no data, value of indicator shall be zero. • Ensures future focus is on improving both access (services to un-served cohorts), and coverage (improve coverage’s) • Sub index analysis factored in • Indicators for both Medical Services, and Public Health in each cohort • Each cohort to have its own index value, based on its indicators

5. Health Services Index • Overall the sector performance was 28% with a contribution of 18% from MOMS and 38% from MOPHs. • Performance was higher by level 2 and 3 than level 4,5 and 6. • Western province had equal performance in both medical and public health services and had higher index

6. Health Services Index • Overall the sector performance was 28% with a contribution of 18% from MOMS and 38% from MOPHs. • High performance in Cohort six and cohort 2 and 3.

7. AOP 4 Priorities • Strengthen coverage and effectiveness of public health interventions. • Identify and support implementation of defined and cost-effective public health interventions • Decentralize service delivery

8. Service delivery priorities • Universal access to Maternal, Child and Neonatal health services. • Reduce malaria morbidity and mortality. • Accelerate TB control & treatment initiatives. • Accelerate implementation of community strategy. • Strengthening quality of health care. • Improve HCW morale

9. Reporting rate by province

10. Pregnancy, Delivery and the Newborn (up to 2 weeks)

11. Pregnancy, Delivery and the Newborn (up to 2 weeks)

12. Pregnancy, Delivery and the Newborn (up to 2 weeks)

13. Pregnancy, Delivery and the Newborn (up to 2 weeks)

14. Early Childhood (2 weeks to 5 years)

15. Early Childhood (2 weeks to 5 years)

16. Early Childhood (2 weeks to 5 years)

17. Early Childhood (2 weeks to 5 years) • 200 U5 per 1000 new cases attending CWC are underweight. • Coast, N-Eastern and R-Valley have highest rates of underweight.

18. Proportion of children 6-59 months receiving Vitamin ATrends AOP1 – AOP4

19. Equity Analysis • Five parameters used in analysis: • Literacy index (Secondary school enrolment rate) • Poverty index • Level of urbanisation • Aridity • Gender development index

20. Effect of literacy on service delivery • The most literate population enjoy better service coverage than the least literate

21. Effect of poverty on service delivery • The least poor (rich) enjoy better access to services.

22. Effect of urbanization on service delivery • The most urbanized districts experience better health service coverage than the least urbanized (rural) districts

23. Effect of aridity on service delivery • Aridity seem to have no effect on the coverage of maternal services. • Arid districts seem to have better immunization coverage than non arid districts

24. Effect of gender development on service delivery • Districts with populations that males and females have equal powers in decision making enjoy better coverage than those with gross imbalances in power.

25. AOP 4 performance • In general the trends of coverage for most of the indicators has declined over the years. • Proportion of pregnant women delivering under skilled attendance stagnated at about 30% nationally. • Facility reporting rates to the district remains poor.

26. Recommendation • Redouble efforts to improve the supply and demand of services from health facilities. • Address the broader social determinants of health to improve on health service utilization. • Improve on the completeness of documentation and reporting of health services offered.