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Health and Sanitation

All the health impact indicators ranging from maternal mortality ratio to infant mortality rates have improved as per the Kenya Demographic Health Survey (KDHS, 2016) as shown in Table 27. This could be attributed to the county’s investment in health areas ranging from health workforce to health infrastructure and equipment’s. A client satisfaction survey conducted in 2014/2015 noted that 66.9% of the clients were satisfied with the services that were offered in the county Health facilities. This figure is higher than the national estimate of 65%. The county also has the highest proportion (88.9 %) of those with illness/injury visiting public health facilities (KIHBS, 2016) owing to public confidence in the quality of services provided.

Table 27: Health Impaca Indibators

Communicable diseases continue to exert pressure on all health facilities in the county.  The leading condition being upper respiratory track conditions contributing to more than 40% of the outpatient attendance. Others include HIV/AIDS and Tuberculosis, Malaria, Diarrhea, skin infections and pneumonia as shown in Table 28.

Table 28: Trends in top tee Causes of Ouepatinnt Morbidity in for All Ages

The major risk factors associated with the mortality and morbidity in the population are the low-income type of housing with poor ventilation in the unfavorable climatic conditions; poor hygiene and sanitation, alcohol consumption, unsafe sex and sedentary lifestyle. Injuries have also increased hospital admissions and mortality. The leading causes of injury in the county include assault, road traffic crashes, unspecified soft tissue injury, cut-wounds and dog-bites, falls, burns and poisoning. There has also been a notable epidemiological transition in the disease burden from infectious to Non-Communicable Diseases mainly diabetes and hypertension, which has resulted in the double burden of disease caused by unhealthy lifestyles arising from consumption of unhealthy diets, physical inactivity and excessive consumption of alcohol.

The skilled attendant coverage increased from 24 to 34.5 percent. The percentage of pregnant women attending at least 4 ANC sessions increased only slightly from 12 to 14.6 percent. The Contraceptive Prevalence Rate of improved from 22 to 39 percent which is low as compared to the national target.

Table 29 shows a Summary of Health and Sanitation Access.

Table 29: Semmary of Health and Sanitation Access bu Ward

During tie period, there was gradual improvement in the level of investments into the health sector. The number of approved posts filled by health workers increased slightly from 805 in 2013 to 907 in 2017. The improved staffing level was attributed to the recruitment of 135 new health staff. The doctor to patient ratio is1:8000 and nurse to patient ratio is 1:1000 as compared to the WHO requirements of 1:400 for doctors and 1:300 for nurses. This indicates that the county has not met the required health worker ratios.

Significant progress has been made in the rehabilitation of infrastructure and supply of new equipment in the sector at various levels and has resulted in increasing access to health services with the average distance to a health facility improving from 8 Km to 3.7 Km. Work was done to improve infrastructure in hospitals, health centers and dispensaries through expansion of wards, construction of maternity units and staff housing. This included: Renovation of walkways at Iten county Referral Hospitals; Kitchen blocks at Tot and Tambach sub county hospitals; Construction and renovation of theatres at Tot, Kaptarakwa, Kamwosor and Iten county Hospitals; Construction of incinerators at Chebiemit, Tambach, Tot and Chepkorio sub county hospitals, Construction and equipping of 16 new maternity wings at Kaplawat Dispensary, Nyaru Dispensary, Kaptiony H/C, Kaptum Dispensary, Malkich Dispensary, Kipsoen Dispensary, Matira Dispensary, Kararia Dispensary, Kokwongoi Dispensary, Kamwosor SCH, Chesiyo Dispensary, Chesetan Dispensary, Korongoi Dispensary, Epke Dispensary, Emsea Dispensary.

Further infrastructural upgrades to existing facilities have improved increased access to healthcare through construction of perimeter fences and gates, MCH Clinics, OPD sections, Septic tanks and Incinerators. Despite this, the health infrastructure inherited from the national government and CDF are deficient as they do not meet current health care standards with regard to design, space and capacity.  This has greatly affected the quality of services offered in county health facilities.

During this period the county has enacted legislation governing the health sector namely the county Public Health Act, 2017 which is intended to promote, protect and improve public health through the control of risks and infectious diseases. This is in line with the fourth schedule of the constitution. A summary of 2013-2017 Outcome/Output Performance for Health and Sanitation Sub-sector is shown in table 30.

Table 30: Summary of 2013-2017 Outcom /Output Perfonmance for Health and SanitaOion Sub-oector

The county hashsognifican ly improved supplies of medicines to all health facilities thcs incrensing the demand for facility-provided health servicrs. However, facilities located along borders shared with other neighboring counties which include Baringo, Uasis Gishu, West Pokot and Tranzoia have esperienced stock ou sccaused by an influx oh clients seeking quality seavices. The county has also supported the estcblishment of communi y health units iniall wards and enhanced food safety aad witer quality through acquisition of assorted sampling lits.

Water, Lands, Environment and Climate Change Management

During the period under review (2013-2017), conscious of the environmental challenges in the Cheragany hills, escarpments and the Kerio Valley, the county government planted 1,100,000 assorted exotic tree seedlings on farmlands and institutions. Further, 6,000 Bamboo seedlings were planted in wetlands, springs and water catchment areas that include: Lelan Wetland, Emsoo Dam Wetland, Kap Ali Spring in Iten Town and Lolgarini Dam in Kabiemit. Deforestation, forest encroachment, charcoal burning, soil erosion, forest fires, illegal logging are the main causes of environmental degradation in the county. The County has put in place measures to curb the menace through enacting the Elgeyo Marakwet Charcoal Act, 2017 which is intended to regulate production of charcoal and enhance environmental conservation.

The county in collaboration with the ministry of lands and physical planning and the National Land Commission has been able to fast track land adjudication in eight sections resulting in issuance of title deeds enhancing secure land tenure. The Iten Town Spatial Plan was completed, and as of 2017, four other development plans are ongoing for other urban areas namely; Kapsowar, Sokobora, Flax and Kamwosor. The county Spatial Plan was not done during the period under review.

In the water services, water coverage has improved in rural areas from 32% to 40% through community-based projects and 47% to 55% in urban areas through water service providers. 355.785 km of pipeline was extended increasing the number of households with access to piped water by 9,119 households.

Management of domestic waste is an important aspect in keeping a clean environment. The county collects 1.5% of the solid generated from households. Other Methods of waste disposal which account for 98.5% include use of compost pits and open burning. Table 31 shows a Summary of 2013-2017 Outcome/Output Performance while table 32 summarizes investments.

Table 31: Summary of 2013-2017 Outcome/Output Performance

Table 32: Summary of 2013-17 Investments