AWP Handbook For Level 2&3 Health Facilities < sensitization tool>

1. AWP Handbook For Level 2&3 Health Facilities<sensitization tool> Supported by JICAOCCADEP

2. Thispresentation guides HFs to understand • What is AWP • AWP process and timeline • How to develop AWP and How to fill in data on the AWP template from Section 1 to Section 3.1* This presentation is for • Health Facility in Charge and Its Management CommitteeTeamfor level 2 & 3 • CHMT and SCHMT members who guide HFs *Section 3.2 & 4 are covered in the “MTEF Management Tool” downloadable from MOH website. (http://www.health.go.ke/health-best-practice/)

3. Contents 1 IntroductionofAWP 2 How to develop AWP 3 Assessment of the quality of AWP

4. 1 Introduction Annual Work Plan (AWP) is a document to operationalize the aspirations set in the County Health Sector Strategic Plan (CHSSP) and Universal Health Coverage (UHC). It sets out health sector priorities, targets, programmes and activities and annual resource allocation for the coming year and annual resource allocation. As an operational document, AWP guides County Health Management Team (CHMT), Sub-county Health Management Team (SCHMT), and Health Facilities (HFs) on what they are planning to achieve within a year.

5. 1 Introduction

6. 1 Introduction PlanAWPformulation process AWP template sensitization workshop by CHMT Develop Management AWP Develop AWP and submit to HF DevelopAWP and Submit to SCHMT Develop AWP, integrating HF AWP, hospital AWP (level4&5),andManagementAWP Develop AWP, integrating Sub-county AWP and Management AWP AWP Stakeholder Forum Finalize AWP and submit to CEC

7. ２ How todevelopAWP ? Analysis Target population? What you have and you do NOT have? - Infrastructure, Workforce, Commodities Common health challenges? Priority interventions? Section1: Overview of the Health Situation in the Facility Catchment Area Section2: Situation Analysis and Priority Setting Plan Whataretargetsand activities totacklehealthchallengesidentifiedinSection2? Budget amount and its source? Section3: Annual Program Based Workplan Section4: Program Based Budget Distribution Budget by Source of Funds

8. ２ How todevelopAWP ? MOH Reports (see next slides) County Data and Information and National Guidelines from CHMT and SCHMT (see next slides) Budget ceiling (see next slides) APR Report of FY(X-1) (If HF developed) CU AWP of FY(X+1) linked to the HF

9. ２ How todevelopAWP ? Use monthly Summary tool

10. ２ How todevelopAWP ? Use monthly Summary tool

11. ２ How todevelopAWP ?

12. ２ How todevelopAWP ?

13. ２ How todevelopAWP ? • Health Facility staff develops AWP as a team. • Health Facility in Charge should trigger the development process and be responsible for finalization. • HF needs to get consensus/inputs from HF committee.

14. ２ How todevelopAWP ? Good • If you do not need to fill in data,write “N/A(Not Applicable) ” , and if you could not get data, write “data is not available”. “0(zero)” is not accepted in those cases. “0 (zero)” and “N/A” are different. • If there is negative gap, use minus mark “ - ”and if there is surplus gap, use plus mark “+”. Good

15. ２ How todevelopAWP ? • Alignnumbersto the right.Thishelpsiteasy to read and grasp the number quickly and avoid possible mistakes when calculation. • Use commas for every three digits Good Bad There is commas every three digits, but numbers are not aligned to the right. Comparing with the example on the left, it is difficult to grasp the number and compare the number immediately.

16. ２ How todevelopAWP ?

17. Foranyquery on the population and its percentage, communicate with CHRIO or SCHRIO. Get data from 1) SCHRIO 2) Kenya National Bureau of Statistics office at the sub-county level 3) Estimate population based on reports from CUs or Village A B A (Total population)×B Obtain county or sub-county level population segment estimates from CHRIO or SCHRIO. CHMT decides which percentage HFs use before starting the AWP formulation process. *Figures in the original template is national data. Calculate the number of population by yourselves. A (Total population)×B

18. You need to follow the percentage shared by your county or sub-county government. To be precise, percentage and number of indicators 7 to 9 is not to be the same, considering stillbirth & miscarriage & multi birth cases. However, the number of live births serves as a proxy for the number of pregnant women in many cases.

19. *Delete “new” from the original template. “Total number of outpatients” is required to calculate “Outpatient utilization per person”. This12monthsisfor July to June of the previous financial year, FY(X-1) This total number of population is thenumberofpopulation of FY (X-1) . Write the total number ofoutpatientservices, which is available inMOH717“Monthly Workload Report for Hospitals” and you just add up the numbers for12months. It is more important to see the total percentage of outpatient utilization per person, rather than calculating the percentage of outpatient utilization per person by village or CUs.

20. Outpatient utilization per person per year is NOT a coverage indicator because the population in need is not well defined. However, LOW RATES are indicative of poor availability and quality of services.

21. 1 Health Centre for 30,000 people • 1 Dispensary for 10,000 people • 1 Health Centre or Dispensary locates within 5km of every household • 1 CU for 5,000 people This is about government HF in your HF catchment area. Thus, this “total number of facilities” do not include either private health facilities or faith-based facilities. B A * Delete “operational” from the template, since there is no operational delivery room at the level 2. Write the number of delivery rooms. Required number from “Health Infrastructure Norms and Standards” (MOH,2017) Indicate(-)fornegativegap ; (+) for surplus. Updateavailable numbersof Annual Performance Review Report (APR). If APR is not available, please count actual number of infrastructures.

22. For Level 3 Assumed total number of population : 18,611 people N/A

23. For Level 2 Assumed total number of population : 5,350 people N/A

24. Count the actual number of health workforce available at your HF. B A-B A Data from “Human Resources For Health Norms and Standards Guidelines For The Health Sector” (MOH, 2014)

25. Level 3 HF uses data in the highlighted area as they are. This number can be updated if there is any update on the national guideline above. For Level 3

26. Level 2 HF uses data in the highlighted area as they are. This number can be updated if there is any update on the national guideline. For Level 2

27. County or Sub-county Pharmacist County Commodity Nurse or Sub-county Nursing Officer A-B A B County Commodity Nurse or Sub-county Nursing Officer County Commodity Nurse or Sub-county Nursing Officer or County/ Sub-county Public Officer County Commodity Nurse or Sub-county Nursing Officer County Administratoror County Nutritionist ← For ambulance County Administrator or Transportation Officer County Administrator ↑　For both patients and staff Getdatafromtheoneswritteninredcolor.The information source might be different according to county or sub-county. Indicate(-)fornegativegap ; (+) for surplus. GetinformationfromHF’s AWP for FY(X-1). If you do not have, you just write “NA”.

29. “0” ~”4” is applicable. If you prepared quarterly performance report and discussed it three times per year, pleas write “3”. If your facility submit monthly report to sub-county at the monthly basis, please write “1”, if not, “0”. Household Register (MOH513) is to be filled by CHVs every six months and reported to CHEWs. This is about Community Extension Workers Summary (MOH515). Ifyourhealthfacilityisdispensary and health centre, please fill in the column of “Level Ⅱ”, “Level Ⅲ” respectively. This is about Facility Management Team at level 2-3 HF.

30. For Level 3 N/A N/A For Level 2 N/A N/A

31. DANIDA,Linda Mama and HealthSectorSupportFund are to be recorded here under the “GoK (conditional grants)”. This is the amount which county approved to allocate. Get this data from the County budgets. This is the amount which HF requested in AWP for the previous year. If you do not have AWP for previous year, please write “data is not available”. Amount received - Actual requirements Main budget source for HFs is DANIDA (GOK(conditionalgrants). Get the allocated amount of DANIDA fund from CHMT CHMT

33. Plans should include contingency plans for the continuity of essential building systems, such as electricity, water, ventilation, fire, and communication systems at the time of emergency. This plan is about disaster management and response plan. This is to be facilitated by CHMT to develop, together with Facility Management Team. ← Yes or No ← Yes or No ←Number (0,1,2,3・・） ←HFsdonothavethiscommittee.Write“N/A”. ← Number (0,1,2,3・・） ← Number (0,1,2,3・・） ← Number (0,1,2,3・・） ← Yes or No ← Number (0,1,2,3・・） This committee is applicable for level 4&5 hospital. At the HF level, write “Yes or No” for FacilityManagement team meeting(Staff meeting), and the number of the meeting held in the past twelve months

35. ２ How todevelopAWP ?

36. For quantitative data, sum up the total number on MOH705A, 705B and MOH711 of FY(X-1) respectively. In some category, such as “common health risk factors” and “collaboration with health-related sectors”, write the qualitative data “High”, “Moderate” and “Low”, based on your experience as a health professional. If you get the number, write both qualitative and quantitative data. In the original template, there are some examples of disease in italics. You can change disease names based on the reality of your catchment areas.

39. “common health risk factors” and “collaboration with health related sectors” are mainly for sub-county and county level to analyze. At the level 2-3 health facility level, you may skip these areas, since you do not have data on “unsafe water”, “smoking”, “Low contraceptive utilization”, “unemployment” of your catchment area. Otherwise, write “High”, “Moderate” and “Low” of prevalence as qualitative rating, based on your experience. If you get the number, write both qualitative and quantitative data.

40. Consider your interventions which can minimize or eliminate the identified challenges. • WHAT can you (HF) do to WHOM at your facility level, considering your budget ceiling, number of workforce and number of available investment? • Fill this part based on the major health problems identified in 2.1. • What were your major health problems identified in 2.1? • What are the key challenges of those health problems at the health facility level and community level?

41. Clarify “demand side” problem or “supply side” problem. This will help you get an idea of intervention. Annex1isnotavailable. Start to write disease name which was identifiedin 2.1. Clarify the linkage “disease”, “key challenges (causes)” and “interventions” in this table. Write one intervention in one row. This will help to prioritize the interventions in the next step.

43. Bad Example

44. ２ How todevelopAWP ?

45. Data source: Monthly report of HF for 12months (1st July-30th June) of the last financial year, FY(X-1). Q How to set targets? Consider your budget ceiling, workforce and infrastructure identified in Section 1, before you start to plan the targets. Set target to a better level Target • When the data is not well collected and the reality is worse, increase the target. • When the trend of indicators is improving or not changing, set target to a better level to continue the improving trend or to see improving trend Baseline Now Maintain current level* or adjust the level slightly downward • When the situation is getting worse, maintain the current value, or adjust it slightly downward to stop the worsening trend. * “Maintain the current level” does NOT mean that you do not need to do anything.

46. . This AWP Handbook shows how to calculate eligible population based on the indicator manual. Calculation of eligible population is difficult for HFs, because the population in need is not well defined at the HF level. HF can seek guidance from respective SCHRIOs. If you cannot fill in the eligible data, fill in the actual data from July to December of FY(X) to see the current achievement. This will help to set the target. For some indicators (#16,19-21, 37-42), you do not need to fill in eligible population number

47. This table shows how to get the eligible population. For some indicators such as #2, 3, 5, 6, 22, 35 and 36, there are possibly two eligible population; Uptake denominator and Coverage denominator. Indicator with uptake denominator shows the achievement out of the population received health service, while indicator with coverage denominator shows the achievement out of the population category. Please follow the instruction of CHMT, on which denominator (eligible population) is good for your county. .

48. Consider your target based on baseline and eligible population/ achievement of FY(X).

49. Consider your target based on baseline and eligible population/achievement of FY(X).

50. Consider your target based on baseline and eligible population/ achievement of FY(X).