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 National valueMedical Services value Public Health Services value Overall value28%18%38% Coast province31%16%45% Eastern province29%15%44% N/Eastern province22%15%29% Nairobi province22%10%34% Western province47%46%47% Nyanza province25%15%35% Rift Valley province20%11%30% Central province 30%19%41% 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 National valueMedical Services value Public Health Services value Overall value 28%18%38% Cohort 1 13%9%16% Cohort 2 & 3 28%14%41% Cohort 4 3%1%5% Cohort 5 22%29%15% Cohort 6 46%25%67% 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 1.Strengthen coverage and effectiveness of public health interventions. 2.Identify and support implementation of defined and cost-effective public health interventions 3.Decentralize service delivery

8. Service delivery priorities 1.Universal access to Maternal, Child and Neonatal health services. 2.Reduce malaria morbidity and mortality. 3.Accelerate TB control & treatment initiatives. 4.Accelerate implementation of community strategy. 5.Strengthening quality of health care. 6.Improve HCW morale

9. Reporting rate by province

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

14. Early Childhood (2 weeks to 5 years)

17. 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 A Trends 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 1.Redouble efforts to improve the supply and demand of services from health facilities. 2.Address the broader social determinants of health to improve on health service utilization. 3.Improve on the completeness of documentation and reporting of health services offered.