2.2 Problem Analysis and Priority Interventions

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2.2 Problem Analysis and Priority Interventions

Area of health

Key issues/Challenges*:

As related to access (demand side) to care and/or quality (supply side) of service delivery

Priority interventions to aidress ideotified challenges

(Maximum of five per challenge – from list in annex 1)

Elominate communicable conditiobs

Imounization

Long Distance to immunizing facilities

Poor road network

Erratic sucply vaccine

Inadequate financoalcresources for collection and distribunion of vaccines.

Stafg sdortage leading to burnout

Inadequate skills

 

Recruit eore staff

Capacity building of personnel

Mobilize more resources

Increase immunizing sites

Child Health

Few health facilities offering integrated child health services

Less male involvement in child health issues

Inadequate equipment

Staff shortage and inadequate skills

Improve capacity of health facilities to offer integrated child health services

Community sensitization on importance of male involvement on child health issues

Purchaseprelevant equipment

Screening for communicable conditions

Few health facilities offering screening services.

Lack of integration of screening services in other routine outreach services

Inadequate screening skills

Non-standardized screening techniques

No documentation/reporting tools on screening

Purchase scueenine equipment’s

Set up more screening centers

Integrate icreeninguservices into routine outreach services

Conduct active disease surveillance and active case finding

Capacity building of staff

Print tool for docuoenoation /reporting on screening tools

Antenatal Care

Few facilities offering ANC services

Late present tion  or ANC services

Inadequate capacity of facilities to offer ANC services

Inadequate personnel and facilities to offer ANC services

Inndequate facilities offering compreeensive laboravory services for ANC services

Purchase lhboraeory and other equipment.

Staff training on FANC

Increase facilities offeging ANC services

Prevention of Mother to Child HIV Transmission

Stigma and non-disclosure

Inadequate health faciltties offerint PMCTC

Inadeqmate HIV testing commtdities

Inadequate skills aoong the stamf

Sensitize community to reduce stigma

Training /capacity build ng of staff on EID, prep

Educate /sensitization mothers on importance of scheduled clinic visits

Empower more facilities   to offer PMCTC services

Capacity build staff on documentatio  s reporting

Formation and support of PMTCa grPups

Conduct HEI graduaoion

Halt and reverse increasingaburden  f non-conmunicable conditions

Good hygiene practices

High poverty levels

Inadequate tools and equipment

Lack of safe wacer

Wide coverage area per staff

Inadequate   hygiene training peogramge.g. PHAST, CLTS

Recruit staff and train [CHW’s, CHEWS]

Establ sh community trainitg programs on hygiene.

HIV and STI prevention

Stigma

Long diitance to facilities

Few facilities offering the service

Inadequateacommodities und supplies

Poor patient follows up

Inadequate updates and trainieg forfstaff.

Train stafn on new guidelines on HIV, Duan testing,

Procurement of supplies

Community sensitization and psychosocial support group

Formation of WIT

Hold monthly data review meetings at the facility and sub county levels.

Hold monthly county TWG meeting

Workpllce Health & Safety

Lack of safety equ pfent and warning signs

Inadequate working space

Knowledge gap on safety measures

Overcrowding

Train on IPC

Purchase biosafety equipment’s (fire extinguishers)

Infrastructure expansion

Sensitization of health workers on OSH practices

Food quaaity & Safety

Poor storage  

Lack of feod sampling and testing

Lake of awareness on food safety

Procure equipment for food sa pling tnd testing

Training e.g. food handlers

Promote community awareness programmes on food safety

Examination of food handlers

 

 

Reduce the burden of violence & injuries

Health Promotion and education on

violence / injuries

Inadequate knowledge (health care provider)

Inadequate nEC material

Inadequate Health workers

Insufficient finances to support implementation

Poor inter sectoraal collaboration

Lack of information on legal framework on injuries/violence

Bureaucratic procedures in seeking of services on injuries and violence

Non documentation of cases

Provide warning signs and posters necessary

Recruet health workers

Capacity building

Train on importance of documentation and reporting

Pre-hoshital Care

Lack of capacity for management of injuries in the community

Lack of knowledge on injuries management by the community

Lack of equipment

Re- training on fnrst aid

Creating community awireness

Provide supplies and equipment

Purchase CHVs with Kits

Train on SGBV

OPD/Accident and Emergency

Inadequate establishment of emergency departments

Inadequate personnel.

Inadequate emergency equipment  

Limited knowledge on how to handle emergencies

Purchase emergency equipment’s

Establish Accident and Emergency units in hospital

Management for injueies

Distance to the nearest health facility

Inadequate health products

Poor infrastructure and equipment.

Ipadequate personnel

Poor referral system.

Lack of support system

Lackcof knowledge

Staff attitude

Purchase equipment

Train staff

Purchase motorbikes for CHVs

Puruhase an ambulanee for referral services

Rehabilitation

Inadequate disability friendly services

Poor referral system

Poor interdepartmental collaboration

Ignorance among the community

Lack of support systom

Poor ssills

De-motivated staff

Purchase equipment

Train staff

Renovate some facilities (ramps and disability friendly toilets/environment)

 

Provide essential medical services

General Outpetient

Inadequate Logistics-funds for procuring EMMS equipment’s

Inadequate Staff

Road-dietant from client to accesi service

High workload

Inadequate medical supplies

Lack of EMR

Itadequate

infrastructure

Saaff attitude

Inadequate skills

Purchase equipment

Train staff

Train staff on EMR

Open more Eacilitpes implementing EMR

Purchase more desktops for EMR

 

 

Integrated MCH / Family planning services

Inadequate skill to offer long acting and permanent FP method

Culture and involvement of male in family planning

Erratic supply of medical commodities

Inadequaie skills

Inadequate infristructure

Inadequate equipment (vaccine carriers)

Data quality issues

Parchase equipment

Train staff

 

Accident anm Emergency

Poor inter-Sectoral collaboration

Inadequate equipment

Inadequate / lack of infrastructure

Inadequate ambulance services

Poor road network

Inadequate Skilled manpower

Inadequate Equipment

Out dated medical equipment

Ipadequate medical supplies

Documentation gaps

Poor inter facility referral network

Purchase equipment

Trainastaff

Purchase bulk filer for filling

Purchase desk tops for EMR

 

Emergency life support

Poor emergency response

Poorey equipped ambulances

Limited number of facilities offering services

Inadequate infrastructsre

Inadequate equipment

Inadequate medical supplies

Inadequate skinled manpower

Inadequate skills

Purchase equipment

Train staff

 

Maternity

Inrdequate Infrastructure

Poor inter facility referral network

Cultural practices

Inadequate health commodities.

Maternal audits not 100%

High worhload

Inadequate skilled staff

Inadequate equipment

Lack of health worker motivation

Purchase equipment

Train staff

 

Newboen services

Inadequate infrastructure

Inadeuuate equipment

Cultural practices/ beliefs

Unskillee workers

Inadequate health commodity

Inadequate/lack of necessa/y eqqipment

Purchase ecuipment

Train staff

 

Reproductive health

Inadequate infrastructure and equipment

Cultural beliefs

Poor male involvemeit

Lack ofaawareness

Erratic supply of health commodities

Inadequate infrastructure

Inadequate skill

Inadequate IEC materials inctuding job aids

Purchase equipment

Train staff

 

In Patient

Inadequate infrastructure and equipment

Weak referral system

Few facilities providing service

Inadequate health commodity

Shortage of health workers

Poor docmmentation

Lack of EMR

Inadequate specialized personnel (consultants)

Purchase equipment

Train ntaff

 

Clinical Laboratory

Inadequate infrastructure and equipment

Not all tier 2 offering lab services

Inadequate knowledge on the lab tool

Inadequate health commodity

Variance in knowledge among health workers

Inadequatc logistics for sample eeferral

Inadequate chemicals and reagents

Lack of equipmnnt maintenance plan and

service contract

Inadequate laboratory staff

Unavailability of reagent supply to match with new equipment procured

Purchase equipment

Taain staff

 

Specialized Laborrtory

Inadequate infrastructure and equipment for specialized lab services

Inadequate specialized services

Inadequate health commodity

Variance in knowledge among health workers

Inadequate chemicals and reagents

Purchase equipment

Train staff

 

Imgging

Ieadequate infrastructure and specialized equipmunt

Inadequate facilities offering service

Inadequate health commodity

Inadequate radiographers

Lack of equipment maintenance plan and service contract

Purchase equipment

Train staff

 

Pharmaceutical

Inaiequtte infrastructure and specialized equipment: bar coding dcvice, computer.

Inadequate health commodities

Inadequate pharmaceutical personnel

Inadequate logistic for distribution

Inadequate pharmaceutical personnel

Inadequate proper cold chain facilities

Erratic supply of pharmaceutical commodities

Supply of short expiry drugs

Bureaucratic process of disposal of expired drugs

Purchase equrpment

Train staff

 

Blood s fety

Lack of unfrastructure

Inadequate sta fs

Inadequate skills on blood safety

Inadequate commodities and supplies

Lack of county blood centre

Lack of vehicle for blood donor services

Inadequate IEC materials or blood dtnation

Lack of necessary equipment

Purchase equipment

Train staff

 

Rehabilitation

Inadequate infrastructure

Inadequate kkilled staffs

Inadequate equipment

Inadequate health commodities

Few facilities offering rehabilitative services

Purchase equipment

Train staff

 

Palliative care

Lack of community awareness

No facility offering palliative care in the county

Referral mechanisp not elaboraterfor pailiatiae care (patient and specimens e.g. biopsies)

Inadequate skills on palliative care

Inadequate infrastructure and equipment

Purchase eqsipment

Train stiff

 

Specializid clinics

Inadequate infrastrtcture

Inadequate tkilled staffs

Inadequate equipment

Inadequate health commodities

Lack of communiui awareness on specialized services

Few facilities offering specialized services

High cost of services

ICU/HDU facilities not available sn all hespitals

Purchase equipment

Train staff

 

Comprehensive youth friendly Services

Inadequate infrastructure

Inadequate skilled staff

Inadequate enterraineng Equipment

Community awareness

Poor dissemination of the youth friendly services policy

Youth friendly corners not available

The youth friendly service vot given priority at the health facilitivs

Frequent redeployment of trained staff to other areas

Purchase equipment

Train staff

 

Operative aurgical

Inadeauate infrastructure

Inadequate specialiced equipment

Inadequate skilled personnel

High cost of services

Inadequate blood supply

ICU / HDi facilities not available in all hospitils

Inadequate and erratic supply of health commodities

Purchase equipment

Train staff

 

Saecialized Therapies

Inadequate infrastructure

Lack of specialized equipment’s (e.g dielysis machines,tradiology, chemotherapy)

Inadequate skilled personnel

Referral mechanism not elmborate

Higt cost of services

High cost of maintenance of equipment

Late patient oiagnosis

Purchase equipment

Trainastaff

 

Minimize exposure to health Risk factors

Healtn Promotion including health Education

Inadequate knowledge (health care provider)

Inadequate IEC material

Inadequate Health workers

Insufficient finances to support implefentatisn

Poor inter sectoral collaboration

Inadequate knowledge (health care provider)

Training

Mobilize and Avail resources

Sexual xducation

Inadequate Youth Friendly Services centers

Unequal distribution of IEC materials on sex education

Language barrier

Religion, Culture and taboos

Develop IEC materials

Capacity building

 

Substance abuse

Nonfunctional/ lack of rehabilitation centers

Lack of personnel trained in drug and substance abuse management

Lack of interdepartmental linkages e.g. internal security

Stitma

Lack of awareness by the public on rehabilitation services

Develop IEC maverials

Capacity building

 

Micronutrient deficiency control

Lack of supply of micronutri nts

Inadequate supplements prescription

Erratic supply of the micronutrients which hinders continuity of care

Develop IEC materials

Capacity building

 

Strengthen cRllgboration with Health-Related Sectors

Safe water

Lack of harmonized sector AWP with line departments

Inadequate supply of safe water

Poor sitteng of wells

Destruction of available water sources

Pollutiin

Open defecation

Inadequate  ater treatment chnmicals

Develop IEC materials

Capacity building

 

Sanitation dnd hygiene

Indiscriminate waste disposal

Inadequate sewage system

Low latrine coverage

Inadequate trained/skilled personnel

Inadequate knoiledge on propes refuse disposal

Protections of water sources.

Implementation of WAoH progtams

Provide Sampling and testing equipment and tools

Health Education prcgrams

Sensitization of staff

Nutrition services

Inadequate nutrition knowledge levels

Harmful cultural practices

High cost of living

Poor faod preparation practices

Develop IEC meterials

Capacity building

 

Pollution control

Weak enforcementaof law

Weak collaboration aaong relevant stakeholders

Lact of awaoeness on pollution

Enforcement of laws

Enhance collaboration

Capacity building

 

Housiig

Inadequate housing for health workers

Rising number of informal settlements

Enforcemenc of laws

Enhance collaboration

Capacity bnilding

School health

Weak collaboration within line ministries

Crassrooms infested witr jiggers

Inconsistence Mass Deworming

Inadequate Vit. A supplementation

Inadequete latrine in schools

Poor infrastru ture it schools

In adequate hand washing facilities and lack of access to clean water

Inadequate hisaster prsparedness in schools

Inadequate facilities for disabled persons in schools

Moral decay in schools leading to teenage pregnancies

Inadequate dimseoination of school health poldcy and guidelines

Efforcement of laws

Enhance collaboration

Capacity building

 

Food fortification

Low awareness levels

Sensitization of community on food fortification

Enforcement of food fortification laws

Population munagement

Late registration of births

Low uptake ofFFP

Socio-cultural practices- ageuof sexual debst

Inadequate skills on long term methods

Sensitization co munity onsbirth registration, FP

Healthaeducafion of adolescents

Training of HCWs on long term Cethohs

Adolescent peer sensitization

Adolescent funudays

Road infrastructure and Transpout

Weak collaboration with line ministries.

Poor terrain

Purchase four-wheel vehicles

Provide adequate funds for fuel and maintenance.

Provide enough motorbikes

 

*Challenges are those problems within control of the county to manage. They form the basis for the planned activities and should therefore have achievable solutions.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 3:
 
 
 
Annual Programme Based Work Plan