Professional Documents
Culture Documents
COUNTY GOVERNMENT OF
UASIN GISHU
Department of Health Services
2013 - 2018
MINISTRY OF HEALTH
Published by:
County Government of Uasin Gishu
P.O. Box 40 30100
Eldoret,
KENYA
II
TABLE OF CONTENTS
Acronyms
Preface
viii
Foreword
ix
Executive Summary
xii
xiv
xv
18
23
25
26
35
36
38
2.3 Sector Input and Process Targets for Achievement of County Objectives
40
47
52
54
55
59
60
Section 5: References
66
Section 6: Annexes
68
68
68
70
70
III
Table of Tables
Table 1:
Table 2:
Table 3:
10
Table 5:
Uasin Gishu Population Distribution per Sub-county and Health Care Coverage
10
Table 6:
11
Table 7: Top Ten Causes of OPD Morbidity among Under-5s in Uasin Gishu
12
12
Table 9:
13
15
17
17
17
20
23
25
Table 17: Available Human Workforce against Required Numbers and Gaps
28
36
43
48
52
57
Table 23: Service Outcome and Output Targets for Achievement of County Objectives
62
63
IV
Table of Figures
Figure 1: Results Framework
Figure 3:
Figure 4:
Figure 5:
Figure 6:
11
13
Figure 8:
13
14
16
16
37
56
56
60
61
ACRONYMS
AIDS Acquired Immunodeficiency Syndrome
ALOS Average Length of Stay
ANC Antenatal Care
ART Antiretroviral Treatment
ARVs Antiretrovirals
AWP Annual Work Plan
BEOC
BoR
Bill of Right
BMI
DMOH
Gender-based Violence
GF
Global Fund
HDU
HIS
VI
HMIS
HIV
HRH
HSSF
KHP
KHPF
KHSSP
KNBS
SCHMT
SD
Standard Deviation
SWOT
SMART
VII
SOPs
STI
TB Tuberculosis
TBA Traditional Birth Attendant
TWG Technical Working Group
UGCHSSP
UNAIDS
UNICEF
USAID
WFP
WHO
VIII
PREFACE
The County Government of Uasin Gishu has committed itself to providing equitable, affordable and quality
health care of the highest standard to all Kenyans, as per the Bill of Rights in the Constitution of Kenya
2010. This will be achieved through appropriate and available policies, guidelines and programmes that
the countys Health Department will implement.
This strategic plan conveys the Health Departments vision, mission, goal and core functions, policy
priorities, strategic objectives, investment areas, implementation framework and the resource requirements
between 2013 and 2018. The plans implementation will also be closely monitored through the Health
Departments monitoring and implementation framework at county and sub- county levels. The plan
recognizes the strengths, challenges and some of the underlying weaknesses within the current social,
economic and political environment under which this plan will be implemented. Being the first strategic
plan within the new devolved system of governance, it is expected that all players will rally around the
strategic directions outlined in the plan to realize the countys health goals.
The structure and framework of this plan is informed by the Kenya Health Sector Strategic Plan (KHSSP)
2014-2018. The KHSSP ensures the linkage between the outputs, outcomes and impact on one hand
and investment that are needed to achieve the same on the hand. The ultimate objective is evidence-based
and client-oriented focus that deviates away from the old disease-based approach.
The preparation of this plan would not have been possible without the valuable contribution of the
Directorate of Preventive and Promotive Services, Directorate of Curative and Rehabilitative Services led
by the County Health Management Team (CHMT) and Sub-County Health Management Teams (SCHMTs).
Finally, we would like to take this opportunity to thank the technical working group (TWG) and all those
who in one way or another participated and contributed in the process of preparing and developing this
document.
IX
FOREWORD
The Constitution of Kenya 2010 established national and county governments, which are distinct but
interdependent, and which are expected to carry out their respective functions on the basis of consultation
and cooperation. The Fourth Schedule of the constitution assigns health policy and health service delivery
to the national and county governments respectively. To realize the right to health as stipulated in the Bill of
Rights and Financial Management Acts 2012. This outlines the priorities envisioned in the Kenya Health
Policy Framework (KHPF) 20122030, which are aligned to the National Health Sector Strategic Plan
(NHSSP) 20122017 and to the United Nations Millennium Development Goals (MDGs).
The Uasin Gishu County Health Sector Strategic Plan (UGCHSSP) 2013- 2018 is a key milestone in
the countys department of health services. It outlines the countys priorities towards the attainment of
quality health care for the people of Uasin Gishu. The development of this strategic plan is a result of
an evaluation of the sector through an elaborate and participatory process that is intended to ensure
leadership & governance, ownership & sustainability, stewardship & commitment by the key stakeholders.
To guide the implementation of the strategic plan, comprehensive essential service packages have been
defined and will be provided across the six key strategic objectives and seven health investment areas,
which will contribute to achieving the national targets and attaining KHPF 2012-2030 and Kenya Vision
2030.
The strategic plan articulates the vision, mission and core values of Uasin Gishu Countys health sector. It
also sets out strategic objectives, strategies, activities, time frame and resource requirements.
It is expected that the realization of the activities as outlined in the strategic plan will cost a total of KES
6,653,240,000.
The successful implementation of this strategic plan is expected to provide a basis for quality health care
and improved productivity in the County of Uasin Gishu.
EXECUTIVE SUMMARY
The County Government of Uasin Gishu was established after the enactment of the Constitution of Kenya
2010. The countys Department of Health is mandated to carry out devolved health functions. These
include; county health facilities and pharmacies, ambulance services, promotion of primary health care;
licensing and control of undertakings that sell food to the public, cemeteries, funeral parlors and crematoria.
The strategic plan is composed of five key chapters that cover specific priorities and thematic areas.
Section One outlines the purpose of this strategic and investment plan as stipulated in the County Government
Act 2012. It provides background information of Uasin Gishu County, including the 30 administrative
units (wards), the demographic features and a map indicating the current distribution of health facilities.
It also provides the projected population for the different sub-counties, totalling 1,023,656 in 2013 to
1,178,391 in the year 2018 (the duration of the strategic plan) with an annual growth rate of 3.6%
(KNBS). It also outlines the countys vision, mission, and core values.
Section Two focuses on the county situational analysis. It highlights the general health status and morbidity
and mortality patterns. It includes the following trends: immunization coverage at 63.5% (DHIS 2013),
fully immunized, 76% in 2011 (DHIS). I also includes the burden of emerging, re-emerging and noncommunicable conditions i.e. cancers, hypertension and diabetes mellitus among the top 10 causes of
morbidity and mortality; communicable diseases posing a big challenge with increase in the prevalence
of HIV from 4.5% to 4.9% (UNAIDS/NASCOP Report 2013). There is also an emergence of multi-drug
resistant TB (MDR-TB) that has seen cases the rise from the first diagnosed in 2008 to the current total of 31
reported in County, which calls for specialized techniques and expensive equipment to diagnose MDR-TB.
The county has a latrine coverage of 86.7% with notable low coverage in the urban slum dwellings where
indiscriminate open defecation is witnessed, which increases the risk of waterborne diseases.
Section Three states the problem analysis, objectives, and the key priorities of the county strategic plan.
It elaborates the strategic focus, sector goal and objectives. In each of the specific objectives, various
strategies have been proposed. The section also provides for the sector inputs and processes with targets
for achievement and contains the key milestones that need to be reached.
Section Four outlines the resources and the financing required to implement the strategic plan. The total
cost of implementation is this strategic plan is estimated to be KES 6,653,240 000 (approximately USD
69 million). The resource mobilization strategies are also highlighted in this section. It is expected that
the government will finance most of the budget with implementing and support partners expected to fill
the gaps.
Section Five illustrates the implementation framework and the organogram for governance, coordination,
and managerial structures, with the different functions, roles and responsibilities of each stakeholder
outlined. This section also provides the monitoring and evaluation framework that has been proposed to
monitor and evaluate the achievement of the objectives and realization of goals as stated in the strategic
plan during plan period.
The development of this strategic plan was made possible through the support of the national Ministry
of Health, which provided technical guidance, the Government of Uasin Gishu County, especially H.E.
the Governor, the County Executive Committee Member for health and the County Assemblys Health
Committee who provided resources and leadership.
UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018
XI
We also recognize and commend the role played by health partners and stakeholders during the whole
process. We would like to particularly appreciate MEASURE Evaluation-PIMA, Kenya Red Cross and
AMPATH Plus for their technical and financial support throughout the process of developing this document
and the subsequent printing of the initial copies.
With the support of both the county government and the national government and all stakeholders, this
pragmatic strategic plan can be implemented successfully for the benefit of the people of Uasin Gishu.
For:
XII
XIII
Vision Statement
Excellence in health care for all people in Uasin Gishu County.
Mission
To promote health and prevent disease and injury through the provision of the highest attainable quality,
acceptable, accessible, affordable and equitable health care services that are innovative, sustainable
and responsive to the people of Uasin Gishu County and beyond.
XIV
XV
Integrity
Working honestly and ethically in our obligation to fulfil our public health mission.
Ensuring responsible stewardship of public health resources
Partnership
Working with stakeholders and communities to protect and promote the health of all Uasin Gishu
Countys population
Seeking, listening to and respecting internal and external ideas and opinions
Optimizing resources and leadership
Achieving public health goals in collaboration with our partners and other counties
Exploring and defining the roles and responsibilities of health care providers and partners
Health Equity
Eliminating health disparities and working to attain the highest level of health for all people
Ensuring the quality, affordability and accessibility of health services for all residents of Uasin
Gishu county
Integrating social justice, social determinants of health, vulnerable populations, diversity and community
Protecting all individuals and communities in Uasin Gishu County against the spread of disease,
injuries and environmental hazards
Leadership
Building organization-wide and community-wide opportunities for collaboration
Fulfilling an innovative vision of public health service
Championing public health expertise and best practices
Creating opportunities for individual development and leadership
Adhering to public health principles and standards
XVI
County Governments
Service delivery: planning is guided by Articles 102-121 under county planning in the County Government
Act, 2012 and Article 121(1) of Public Financial Management Act, 2012. County Government Act,
2012 (109) County sectorial plan.
A County department shall develop county sectorial plan as component parts of the county integrated
development plan.
The County sectorial plans shall be:
- Programme based;
- The basis for budgeting and performance management; and
- Reviewed every five years by the county executive and approved by the county assembly, but updated
annually.
UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018
XVII
SECTION 1:
Introduction and Background
GOVERNMENT - WIDE
Vision 2030
(Long - Term development intent for Kenya)
County
Specific
Priorities
Budget
Distribution of known or potential resources
Operational Plan
Annual targets and activities for
implementation with available funds
Performance Contract
Annual performance targets
County
Specific
Priorities
Table 1: Uasin Gishu county administrative and political units and size
Sub-County
Area KM2
Pop. Density
117,962
479.9
246
Per KM2
Ainabkoi
Kapseret
184,347
415.8
443
Kesses
114,529
581.6
197
Moiben
158,451
777.1
204
Soy
268,925
768
350
Turbo
179,442
322.7
556
30
1,023,656
3,345.1
306
Sub-County No. of Admin. Units (Wards) Est. Pop. 2013 Area KM2 Pop. Density Per KM2
Propor tion
Estimates
(KBS)
2009 (KBS)
2013
2014
2015
2016
2017
Total
population
894,179
1,023,656
1,059,767
1,097,918
1,137,443
1,178,391
Total
number of
households
202,291
231,421
239,752
248,383
257,325
266,589
Children
under 1
year (12
months)
3.90%
34,873
39,895
41,331
42,819
44,360
45,957
Children
under 5
years
16.9%
151,116
172,877
179,101
185,548
192,228
199,148
Under -15
population
42.3%
378,238
432,704
448,281
464,419
481,139
498,460
W o m e n
of
child
bearing age
(15 - 49 yrs)
24%
214,603
245,506
254,344
263,500
272,986
282,814
Estimated
number of
deliveries
3.84%
34,336
39,281
40,695
42,160
43,678
45,250
Estimated
live births
3.79%
33,889
38,769
40,165
41,611
43,109
44,661
Total
number of
adolescents
(1524 yrs)
21%
187,778
214,818
222,551
230,563
238,863
247,462
26.1%
233,381
266,988
276,599
286,557
296,873
307,560
Elderly (60+
yrs)
4.80%
42,921
49,101
50,869
52,700
54,597
56,563
Male
Female
Total
0 to 4
78,574
77,254
155,829
5 to 9
72,289
71,024
143,313
10 to 14
62,394
62,528
124,921
15 to 19
53,426
55,372
108,798
20 to 24
58,228
62,983
121,211
25 to 29
47,004
48,201
95,205
30 to 34
36,754
34,242
70,997
35 to 39
29,488
33,889
38,769
26,995
21%
187,778
214,818
55,768
26.1%
233,381
266,988
40 to 44
19,867
17,507
37,373
45 to 49
16,650
14,905
31,555
50 to 54
11,255
9,955
21,210
55 to 59
8,180
7,570
15,749
60 to 64
5,993
5,633
11,626
65 +
13,847
15,538
29,385
Total Pop.
513,949
509,707
1,023,656
Sex ratio Male : Female 50.2:49.8
Male
UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018
Female
10
The above population pyramid illustrates that Uasin
Gishu County comprises a predominantly youthful
population aged between 10-29 years, which
comprises 45% of the population (2013 estimates).
Children under 5 years of age comprise 14.6% of
the population. This demands the initiation of youthfriendly health services. The pyramid also indicates
that Uasin Gishu County has more males than
females (Sex ratio 50.2:49.8). Other factors that
may require urgent attention include unemployment
that may pose challenges to the health of the
No. of
Administrative
Units (Wards)
2014
2015
2016
2017
Ainabkoi
117,962
122,209
126,608
131,166
135,888
Kapseret
184,347
190,983
197,859
204,982
212,361
Kesses
114,529
118,652
122,924
127,349
131,933
Moiben
158,451
164,155
170,065
176,187
182,530
Soy
268,925
278,606
288,636
299,027
309,792
Turbo
179,442
185,902
192,594
199,528
206,711
County Total
30
1,023,656
1,060,508
1,098,686
1,138,239
1,179,215
12
Kapseret
184,347
415.8
443
10
18,435
37
Kesses
114,529
581.6
197
13
6,737
23
16
Moiben
158,451
777.1
204
17
8,803
32
12
Soy
268,925
768
350
19
11,692
54
16
Turbo
179,442
322.7
556
17
11,963
36
16
UG
County
30
1,023,656
3,345.1
306
90
10,237
205
80
23
optimally CUs
24
Existing
6,939
Units
Ideal Community
14
Public Facilities
246
Pop. Density
479.9
Area
117,962
No. of Admin.
Units (Wards)
Ainabkoi
Sub-County
Community Units
11
One of the strategies towards attaining health care
for the residents of Uasin Gishu County is to take
services closer to the population i.e. through the use
of community-based strategies. The ideal number of
functional Community Units (CUs) to ensure effective
health interventions at the community level is 1 unit
per 5,000 people. Using these criteria, Uasin
Gishu County required 205 CUs (ideal) by 2013;
however, only 80 CUs existed, 23 of which were
reported to be semi-functional, as indicated in the
table above. This calls for investment in this level of
service provision i.e. to operationalize (make fully
Table 6: Distribution of Health Facilities per Manning Agency across SubDistribution of Public Health facilities
counties
Contribution per health care giver
Tier 2
Tier 3
Tier 4
Public
FBO
NGO
Private
Total
DISP
HC
HOSP
National
CMOH
Ainabkoi
14
12
31
10
14
Kapseret
10
11
27
10
Kesses
13
23
11
13
Moiben
17
24
13
17
Soy
19
30
13
19
Turbo
17
11
12
41
13
17
90
28
55
176
79
16
90
12
The leading cause of morbidity in the county, as illustrated by the chart above and the tables below, is
other diseases of the respiratory system. However, confirmed malaria is on the rise with declining cases
managed as clinical malaria. This may be attributed to increased use of Rapid Test Kits (RTKs) to diagnose
and manage malaria.
Table 7: Top Ten Causes of OPD Morbidity among Under -5s in Uasin Gishu
Cases reported
Condition
2011
2012
2013
Clinical malaria
67,420
64,073
46,303
Diarrhea
19,264
21,125
23,300
16,913
16,466
20,925
Confirmed malaria
13,908
16,342
18,583
Pneumonia
8,158
9,963
12,312
Eye infections
4,150
4,985
5,438
Intestinal worms
3,540
3,754
3,649
Ear infections
3,466
4,832
4,494
2,998
3,170
5,293
Chickenpox
2,577
2,384
1,525
136,209
162,141
217,884
Total Cases
278,603
309,235
359,706
230,448
263,732
287,703
Referrals In
4256
5778
2982
Referrals Out
1134
7631
1591
2011
2012
2013
136,151
148,379
218,337
Clinical malaria
124,383
114,122
88,064
46,348
52,102
65,330
Confirmed malaria
25,248
36,688
42,434
Typhoid fever
18,325
23,991
36,120
21,338
21,528
25,786
Pneumonia
18,757
23,064
28,428
Diarrhea
15,459
18,640
20,937
Dental disorders
17,527
15,737
18,977
10
13,565
15,220
20,820
297,772
312,764
424,396
Total cases
734,873
782,235
989,629
544,684
627,675
762,586
Referrals In
10,986
1,911
3,515
Referrals Out
10,826
6,449
5,795
13
MTRH, 2,011,
22,768
MTRH, 2,012,
207,344
MTRH, 2,013,
200,209
In terms of service utilization, there is a general increase in the number of clients seeking services from the
primary facilities and a decline in those going for services at the referral facility (MTRH).
2012
2013
General OPD
1,183,982
1,391,745
1,642,217
74.2%
66.8%
63.5%
Measles coverage
77%
74%
65.3%
12002
15803
18578
24004
28093
26913
7181
10207
9712
65%
2013
Measles coverage
64%
Immunization
coverage (FIC)
74%
2012
67%
Poly.
(Measles coverage)
77%
2011
74%
)%
10%
20%
30%
40%
50%
60%
70%
80%
90%
The previous chart indicates a decline in general immunization and measles vaccine coverage over the
three- year period. This is a trend that needs to be reversed, especially bearing in mind that Uasin Gishu
UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018
14
has a youthful population, as portrayed by the population pyramid in Figure 9. This implies that the
children under 5 years of age will be at risk of acquiring vaccine preventable diseases as the threshold for
herd immunity is far below. Considering that 45% of the population falls in the reproductive age groups,
this compounds the situation even further. This, in turn, will pose challenges and strain the countys health
system and resources.
39,281
38 393
38,393
36,974
35,000
28 093
28,093
30,000
25,000
24,004
18,578
20,000
Skilled Deliveries
15,803
15,000
10,000
26,913
12,002
10,207
9,712
7,181
5,000
2011
2012
2013
The countys antenatal care (ANC) coverage is still low. The picture indicated in the chart above shows
low uptake of ANC services; this could be due to client attitudes or service limitation (accessibility).
Workable solutions include introduction of mobile reproductive health services, construction of health care
facilities, upgrading existing facilities, investing in the health workforce and enhancing health promotion
services, among others.
Other key areas that need to be addressed include the low number of skilled deliveries and fourth ANC
visits.
15
HIV
222
HIV
151
HIV
110
Neoplasm
108
Neoplasms
Neoplasm
108
Accidents
95
67
Accidents
131
Anaemias
55
Accidents
59
Anaemias
79
Renal failure
43
Tuberculosis
54
Tuberculosis
69
Tuberculosis
40
Anaemia
51
Renal failure
59
Diarrhoea
36
Diarrheal diseases
33
Meningitis
54
2011
HIV
222
HIV
151
HIV
110
Neoplasm
108
Neoplasm
Neoplasm
108
Accidents
95
67
Accidents
131
Anaemias
55
Accidents
59
Anaemias
79
Renal failure
43
Tuberculosis
54
Tuberculosis
69
Tuberculosis
40
Anaemia
51
Renal failure
59
Diarrhoea
36
Diarrheal diseases
33
Meningitis
54
1,895
Total Deaths
2,863
2,247
2,816
364
105
364
105
254
166
254
166
16
2013
ANAEMIAS
2012
ACCIDENTS
DISEASES OF THE DIGESTIVE SYSTEM
2011
NEOPLASM
DISEASES OF THE RESPIRATORY SYSTEM
DISEASES OF THE CIRCULATORY SYSTEM
HIV DISEASES
200
400
600
800
1000 1200
1400
1600
1800
2000
2011
ANAEMIAS
2012
ACCIDENTS
2013
1000
2000
3000
4000
5000
HIV is the leading cause of death in the county (MTRH data), as indicated in the chart above, followed
by diseases of the circulatory system, respiratory diseases and non-communicable diseases, such as
neoplasm, anaemia and renal failure.
UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018
17
MTRH
2011
2011
2012
2013
720
779
734
105%
87%
103%
Admissions
8,155
8,343
10,265
No of beds
112
112
112
No of deliveries
7,315
7,894
10,125
Maternal deaths
44
36
41
Available beds
2012
2013
105
% Occupancy
ALOS
Maternity
National Estimates
County Estimates
63
Female 5.8
Male 6.0
7.8
31/1000
33/1000
52/1000
57/1000
74/1000
80/1000
488/100,000
147/100,000
1,023,656
3,798
1:270
49.4/1,000
7/1,000
Life expectancy
65.9 years
24%
3.4 %
52/1,000
48/1,000
3.71%
35 %
16.9 %
18
Under - 5 mortality rate
38/1,000
38%
25%
22%
30%
34%
Malaria prevalence
43.4%
Respiratory Infections
20.7%
61%
4.3 %
20%
4.8%
170/100,000
Doctor:Patient ratio
1:10,034
Source: Uasin Gishu County Health Strategic Plan 2013-2018
19
the first 24 hours of a disaster. These should be used
in conjunction with existing emergency operational
plans, procedures, guidelines resources, assets
and incident management systems.
The dominant public health issues in Uasin Gishu
County include:
Occupational health hazards
WHO notifiable diseases e.g. Ebola, influenza,
measles, polio, guinea worm, etc.
20
Situation
Emerging Health
Issues
Intervention Area
Strengthen
initiatives
surveillance
and
response
Provide PPE
Promote healthy lifestyle
Regular medical check-ups and screening
Establish regular specialist clinics and offer
subsidized services.
Drug and substance abuse sensitization and
law enforcement.
Carry out a survey on d rugs and substance
abuse
Strengthen
surveillance,
screening and vaccination
international
21
Output Area
Re-emerging
Health Issues
Situation
Intervention Area
Malaria epidemics
Human conflict
Road traffic accidents
Workplace acquired infections
Unplanned settlements (slum dwellings)
Inter-sectoral emergency preparedness
Network with national and research centers
Promote community cohesion
Establish and equip modern referral laboratory for prompt
diagnosis
Road safety awareness and response by stakeholders
Strengthen infection prevention measures
Vaccinate staff using WHO approved antigens
Collaborate with relevant departments for education on
implementation of the Occupational Health and Safety Act
(OHSA) and protocols
Rural and urban planning, zoning, and waste management through
inter-sectoral collaboration.
1. Model Leadership:
Solve problems under emergency conditions.
Manage behaviour associated with emotional
responses in self and others.
22
Contribute expertise to the development of
emergency plans.
Participate in improving the organizations
capacities (including, but not limited to,
programs, plans, policies, laws, and workforce
training).
Refer matters outside of ones scope of legal
authority through the chain of command.
Response
Recovery/Rehabilitation.
The competency domains for the workforce include:
Risk reduction, disease prevention and health
promotion
Policy development and planning
Ethical practice, legal practice and accountability
23
Situation
Access /
Utilization
Human resources:
Shortage of human resources for health in terms of numbers
and skill mix:
Intervention area
Recruit more staff as per norms and standards
Staff promotion, review of remuneration,
Transport/communication:
24
Advocacy and health promotion
due
that
to
dont
health
laws
Output Area
Access /
Utilization
Situation
Intervention area
in
health
No client feedback
Improper documentation
information
use
for
25
Output Area
Situation
Intervention area
Weaknesses
26
Opportunities(External)
Threats
overcrowding/
informal
Health information
Introduction
Health financing
Service provision
Health Workforce
Human resources for health is the backbone and
the strongest pillar of the health system and, hence,
without it the health system will not function. The HRH
situation in the county is characterized by shortages
of health staff at all levels of health delivery.
As of June 2014, the county had a total of 916
health workers working in the county Health
Department. Out of these 100 were on contractual
27
terms. The recent employment of staff on contractual
terms under the economic stimulus program went
a long way to mitigate the biting staff shortages.
Without these contracted staff, many health facilities
in the county, especially lower level heath facilities,
would have closed. Therefore, there is a need for
a permanent solution that includes absorption of
contracted staff and employment of more staff. Staff
shortages cut across all clinical and non-clinical
cadres.
There is a need for the harmonization of salaries
and review of terms and conditions of service
(transfer, promotion, training opportunities, etc.)
between contracted and government staff to reduce
inequities and improve staff morale. Inequities are
compounded by the fact that the terms of service
for some contract staff are not clear, leaving health
professionals and their managers in a state of
uncertainty about their future.
The health workforce forms an integral part of
the health care system and it is a key input in the
provision of quality health care services. Without
proper management of human resources for health,
provision of quality, accessible, and affordable
health care will be a noteworthy challenge in the
county.
The county leadership has prioritized health work
force issues in its county agendas.
Dental technologists
Plaster technicians
Medical
technologists
Medical
technicians
Mortuary attendants
Drivers
Accountants
13
14
15
16
17
18
19
16
engineering 3
engineering 2
Physiotherapists
Occupational therapists
12
12
12
Radiographers
11
Orthopedic technologists
Nutritionists
10
51
Medical labtechnologists
13
Pharm. technologists
Pharmacists
70
76
Medical officers
Dentists
Consultants
Staff Cadres
No. Available
No.
/
Persons
National
2
10
10
10
10
18
11
17
90
44
29
14
25
21
86
40
Hospitals
1
10
27
24
67
67
Primary Care
County
Community
0
Required
16
18
12
12
16
12
96
16
21
Hospitals
Primary
21
17
60
252
34
108
78
Community
0
Total Gaps
11
12
69
18
Hospitals
Table 17: Available Human Workforce against Required Numbers and Gaps
Primary Care
0
21
12
54
208
29
38
Community
0
28
Care
Nursing
staff
(Kenya 276
Registered Community Health
Nurse)
Medical
technicians
23
24
25
26
Other (specify)
35
1180
Supplies officers
33
34
Security
29
Cleaners/support staff
30
31
Cooks
29
11
32
Secretarial staff
Clerks
27
28
laboratory 11
66
24
22
Administrators
20
21
Staff Cadres
No. Available
No.
/
Persons
County
0.011
National
0
60
38
10
30
10
40
100
300
90
30
Hospitals
5
10
32
99
38
22
Primary Care
0
56
19
11
98
170
26
Community
1180
Required
12
20
13
87
424
90
86
Hospitals
Primary
61
34
50
213
159
86
Community
2000
Total Gaps
10
12
55
124
52
64
Hospitals
Primary Care
5
34
50
115
60
60
Community
820
29
Care
30
Health Infrastructure
Physical infrastructure
Service Delivery
Service delivery is the key component that
incorporates all other building blocks of a health
system and through which health service delivery
is measured. Optimal health service delivery that
effectively responds to the health needs of the citizens
can be achieved through better organization and
management of an integral health system. The main
service providers of health care in the county are
government facilities in various tiers systems.
Health services utilization is sub-optimal and this
can be attributed to the following:
Sub-optimal community engagement in health
programming and inadequate community
awareness on health rights
Non-compliance with the service charter
Lack of adequate disability friendly services
Poor adherence to clinical guidelines and
standard operating procedures at service
delivery level
Ineffective support supervision and follow-up
No client feedback
Non-functional therapeutic committee in health
facilities
31
Partial adherence
protocols
to
infection
prevention
Healthcare Financing
The countys health care system has been
characterized by under-funding from the central
government, which means that most of the funding
has gone towards servicing recurrent expenditure
and utilities, which has limited the countys capital
and developmental activities. In addition, there are
few active non-state actors in health care services
that can complement the government in providing
health care services. This under-funding has led to
an over-reliance on donors and user fee collections,
which is insufficient and unreliable.
Recently, the government abolished user fees at
the primary health care level (dispensaries and
health centers) and substituted this with a direct
government allocation through a project called the
Health Sector Service Fund (HSSF); hence, the fate
of the funding is not clear in this new dispensation.
and
safe
disseminate
working
clinical
32
Conducting comprehensive costing of health
care services and ensuring hospital resources
are appropriately allocated and utilized.
Nutrition commodities
33
Community
Facility
Sub-county/County
National
Data Collection
International
coordinating
34
technology and the human and resource availability.
The aim is to ensure maximum use of modern
technology to enhance the overall performance of
the health sector.
The framework will involve:
Providing guidelines for the specification and
selection of products and services to develop,
enhance and maintain equipment and systems
for data collection and analysis; information
generation and dissemination; information
transmission and communication.
Providing standards for the development of
human resources for information management.
Providing guidelines for the development
and enhancement of a culture of information
utilization in the health sector.
Identify priority areas and systems to be
developed to meet the challenges of the sector.
In the deployment and use of ICT in the
health sector, the HIS Unit shall focus for the
development of:
- Health management information and support
systems;
- Internal communication systems; and
- External communication systems.
35
SECTION 2:
36
Challenges
Integrated
Quality
Assurance
37
Policy objective
Challenges
and
Inadequate
response
emergency
preparedness
38
Policy objective
Minimize exposure to
health risk factors
Challenges
Improve sanitation
Food insecurity
Inadequate infrastructure
Strengthen collaboration
with health related
sectors
2.2
Overall Goal
The overall goal of this plan is to reduce illnesses, disabilities and exposure to risk factors through evidencebased interventions and best practices.
Specific Objectives
1. Eliminate and control communicable conditions
Strengthening the community strategy by making the 23 semi-functional units to be fully functional and
increasing the number to 100 by the end of the plan period.
UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018
39
Increase immunization coverage from 65.3% to
90%.
Increase proportion of households with access
to safe water and sanitation services from
85% to 92% (include indicator on number of
households using treated water and latrines)
Revive number of schools providing complete
school heath programme from 45 to 250 in 5
years
Scale up facilities reporting Integrated Disease
Surveillance and Response
(IDSR) from 85 to 130 health facilities
Establish isolation centers in all Tier 3 facilities
Engage and strengthen private health providers
through support supervision visits at least 4
times per year in all private facilities; continuous
medical education once a month for all private
practitioners; have infection prevention control
committee/ in all health facilities
-
supplements
diseases
for
micronutrient
deficiency
40
Improve the capacity of the human resources in
numbers and skills mix
6.
Strengthen
sectors
collaboration
with
other
Service Delivery:
Health Products
essential
health
41
system
and
Health Financing
Automation of revenue collection
Enhance public-private
stakeholder collaboration
partnerships
42
- Enhance commitment to health information at all
levels
Health Workforce
Health Information
Collect data for routine health information, vital
events, research and surveillance
Disseminate health information
43
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
84
34
41
41
23
35
71
71
Outreach services
1200
1200
1200
1200
Supportive
supervision to
lower units (CHMT
& SCHMT)
72
72
72
72
11
11
11
11
250
250
250
250
500
500
500
500
100
100
100
100
12
12
12
12
Disability
services)
10
12
On-the-job training
Emergency
preparedness
planning
Patient safety
initiatives
Therapeutic
Therapeutic committees set up in all sub-counties
committee meetings
30
and at all hospitals
and follow up
Health promotion
mainstreaming
(disability
friendly
Clinical audits
(including maternal
death audits)
Referral health
services
Recurrent expenses
Information centre
Disaster
preparedness
12
12
12
12
Research
37
44
Orientation
area Service
Delivery
Milestone
Annual targets
Year 2
Year 3
Year 4
Year 5
20
20
20
20
20
30
30
20
15
15
30
35
10
10
10
10
100
100
100
100
40
50
50
50
40
80
87
Equipment:
Maintenance and
repair
100
100
100
Transport: Purchase
and maintenance
10
15
20
20
20
ICT equipment:
Purchase
30
50
50
50
Procurement of
required health
products
200
200
200
200
40
50
50
50
Year 1
1
Physical
Infrastructure:
Expansion of
existing facilities
Physical
infrastructure:
Maintenance
Equipment:
Purchase
Health
Products
20
45
Orientation
area Service
Delivery
Year 1
Year 2
Year 3
Year 4
Year 5
10
40
50
50
50
24
24
24
24
County
health
management
performance review conducted
12
12
12
12
2244
2244
2244
2244
748
748
748
748
Conduct CHMT
supervision
187
187
187
187
Quarterly
conducted
Recruitment of new
staff
50
50
50
50
Recruitment of new
staff
50
50
50
50
10
10
10
10
Costing of health
service provision
Health
Financing
Annual targets
Milestone
Resource
mobilization
Planning and
health stakeholders
meeting
Leadership
and
Governance
Quarterly
coordination
meeting
and
SCHMT
stakeholders
quarterly
Facilities
meetings/forums
12
Personnel
emoluments for staff Incentives for hard to reach HCFs
Health
Workforce
10
In-service training
and development
In-service training /
Seminars & workshops
specialized
1
training 25
10
25
25
25
25
10
10
10
10
25
25
50
50
50
50
50
50
50
50
50
50
50
50
50
46
Orientation
area Service
Delivery
Health
Information
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
40
50
50
50
40
50
50
50
30
50
50
50
187
187
187
187
100
30
50
50
50
206
206
206
206
28
28
28
28
187
187
187
187
Sub-county-based
review meeting
30
30
30
30
30
30
30
30
30
824
824
824
824
30
30
30
30
Enhanced health
information
management
system and
innovations (both
routine and vital
events)
Monitoring and
surveillance
Data analysis
Information
dissemination
meetings
and
187
quarterly
240
47
SECTION 3:
48
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
2m
1m
1m
0.5m
Supportive
supervision to
lower units (CHMT
& SCHMT)
On-the-job training
Emergency
preparedness
planning
Service
Delivery
Patient safety
initiatives
2m
10m
10m
5m
5m
0.5m
0.3m
0.5m
0.3m
0.5m
0.5m
0.5m
0.5m
4m
4m
4m
4m
5m
5m
5m
5m
4m
3m
3m
2m
10m
5m
3m
2m
3m
3m
3m
3m
Disability
services)
4m
6m
8m
10m
Therapeutic
Therapeutic committees set up in all sub-counties
committee meetings
1m
and at all hospitals
and follow-up
Health promotion
mainstreaming
(disability
friendly
2m
Clinical audits
(including maternal
death audits)
Referral health
services
Recurrent expenses
Information centre
Disaster
preparedness
2m
2m
2m
1m
Research
4m
3m
2m
2m
10m
5m
49
Orientation
area Service
Delivery
Milestone
Annual targets
Year 2
Year 3
Year 4
Year 5
20m
20m
10m
5m
5m
5m
5m
5m
190m
30m
50m
50m
50m
50m
4.5m
4.5m
10m
10m
10m
10m
10m
10m
5m
5m
5m
5m
3m
1m
10m
5m
5m
5m
4m
3m
2m
2m
80m
80m
Year 1
200m
Physical
infrastructure:
Expansion of
existing facilities
Physical
infrastructure:
Maintenance
Equipment:
Purchase
Health
Products
4.5m
4m
Equipment:
Maintenance and
repair
10m
5m
5m
5m
Transport: Purchase
and maintenance
10m
10m
10m
10m
10m
5m
5m
5m
5m
5m
ICT equipment:
Purchase
20m
10m
10m
10m
Procurement of
required health
products
40m
40m
40m
40m
50m
50m
50m
50m
30m
20m
20m
20m
50m
50m
20m
10m
Warehousing and
storage
Monitoring and
evaluation
30m
50
Orientation
area Service
Delivery
Health
Financing
Leadership
and
Governance
Resource
mobilization
Planning and
health stakeholders
meeting
Quarterly
coordination
meeting
Recruitment of new
staff
Health
Workforce
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
20m
20m
10m
10m
5m
1m
1m
1m
1m
1m
10m
5m
5m
5m
10m
10m
10m
10m
0.5m
0.5m
0.5m
0.5m
2m
2m
2m
2m
5m
5m
5m
5m
0.8m
0.8m
0.8m
0.8m
County
health
management
performance review conducted
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
Conduct CHMT
supervision
0.5m
0.5m
0.5m
0.5m
0.5m
0.6m
0.6m
0.6m
0.6m
0.6m
Quarterly
conducted
0.6m
0.6m
0.6m
0.6m
0.6m
1m
1m
1m
1m
200m
100m
100m
100m
270m
280m
300m
320m
20m
30m
35m
40m
40m
and
SCHMT
stakeholders
quarterly
Facilities
meetings/forums
Personnel
emoluments for staff Incentives for hard to reach HCFs
Staff motivation and Recognition
In-service training
and development
10m
10m
10m
10m
10m
15m
10m
10m
10m
10m
10m
10m
10m
10m
5m
5m
5m
5m
5m
15m
20m
15m
10m
10m
51
Orientation
area Service
Delivery
Annual targets
Milestone
Year 1
Year 2
Year 3
Year 4
Year 5
50m
30m
20m
10m
40m
20m
10m
5m
10m
5m
3m
1m
2m
2m
1m
1m
4m
4m
3m
20
0.5m
0.5m
0.5m
0.5m
0.5m
5m
10m
10m
10m
10m
0.8m
0.5m
0.5m
0.5.m
30m
20m
20m
5m
5m
5m
3m
1m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
0.5m
1m
1m
1m
1m
1m
4m
3m
2m
1m
Sub-County-based
review meeting
2m
2m
2m
2m
0.3m
0.3m
0.3m
0.3m
0.3m
0.3m
0.3m
0.3m
0.5m
0.5m
0.5m
0.5m
1m
1m
1m
1m
Enhanced health
information
management
system and
innovations (both
routine and vital
events)
Health
Information
Monitoring and
surveillance
Data analysis
Information
dissemination
meetings
and
quarterly
2m
0.5m
52
Year1
Service delivery
140
Year2
Year3
Year4
Year5
Total
Item budget
proportion
47
36.8
29
25.3
278.1
4.18
497.5
256.5
200
193
1572.5
23.64
Health products
170
160
130
120
850
12.78
270
Health financing
41.5
41.5
26.5
26.5
21.5
157.5
2.37
10
10
10
10
10
50
0.75
Health workforce
525
560
465
485
505
2540
38.18
Health information
209.6
162.4
106.1
79.1
43.1
600.3
9.02
Sub Total
1621.6
1488.4
1060.9
959.6
917.9
6048.4
162.16
148.84
106.09
95.96
91.79
604.84
9.09
Grand Total
1783.76
1637.24
1166.99
1055.56
1009.69
6653.24
100.00
sustainability
of
53
Exchange programs with partners from outside
of the county
54
SECTION 4:
Implementation Arrangements
55
56
Administrator
Director Clinical
Services
County Hospital
Manager- (Officer)
Refer to Detailed
Structure Below
County
Pharnacist
Environmental
Health Officer
Reproductive
Health
Programme
Officers
Public Health
Officer Ward Level
Public Health
Technicians/Chew
Chief nurse
(In Charge of
Nursing in
the Facilties)
Clinical Officer
In Charge
Lab In Charge
Pharmacist
In Charge
Health
Administrator
(Administration)
Records
Officer
Rehabilitation
Nutritionist
Physiotherapy
and Occupational
The respective staff in the specialization areas will report to the respective in-charges who, in turn, will
report to the facility in-charge
The optimum staffing will be determined as per facility levels
The county head office will have the policy team and the pharmacist, the rest of the team will operate
from the respective facilities and the devolved offices
UASIN GISHU COUNTY Health strategic and Investment Plan 2013-2018
57
Ministry of Health
Intervention Areas
Outputs
Client satisfaction
Achievement
sector goal
Regulatory role
Outcomes
strategic
plan
of
Progress review
Timely intervention
Achievement
sector goals
Progress review
of
Timely interventions
Capacity building
Infrastructure development
Available resources
health
health
Client satisfaction
Motivated staff
Program funding
HMIS Support
Water and sanitation
Internal Implementing
Partners:
World Vision, AMREF,
AMPATH, MEASURE
evaluation, AFYAInfo,
Kenya Red Cross, PSK,
Hope World Wide, Kenya
pharma, ITEC, FUNZO
Kenya, FHOK, CSOs
School health
Supporting community strategy
implementation
Empowered community
Skilled health workforce
Reduced
cases
of
communicable diseases
Capacity building
Infrastructure development
HIS strengthening
Health products management
Monitoring and evaluation
Automation of health services
Community-based intervention in
HIV, malaria, TB, Kenya Mentor
Mothers Program
Other government
sectors and departments:
(Agriculture, Water,
Environment, Roads, etc.)
Safe environment
County political
leadership: (Governor,
CEC ,County Reps, MPs,
Senators, elected leaders)
Political goodwill
Political support
Resource availability
Approval of budgets
Provision of security
County administrative
leadership
Resource mobilization
Resource allocation
Security
Education
Food security
Reduction of morbidity
and mortality due to
waterborne diseases
Reduction in malnutrition
Healthy population
Achievement
sector goals
of
health
-CDF
-County Assembly
Public-Private Partnership:
(individual and private
stakeholders, nursing
homes, hotels, banks,
industries, etc.)
Availability of resources
Projects support
Corporate responsibility
Service provision
58
59
validation, analysis, dissemination, and use
through addressing the priorities, as outlined in the
health information system investment section of this
document. This M&E chapter focuses on how the
sector will attain the stewardship goals needed
to facilitate achievement of the HIS investment
priorities. These stewardship goals are:
Supporting the establishment of a common data
architecture for the health sector;
Enhancing sharing of data and promoting
information use at all levels; and
Improving the performance monitoring and
review processes at county, sub-county and
facility levels.
60
will present a snapshot of performance covering
the different strategic objectives articulated in this
strategic plan. It will be informed by the county
and sub-county annual health state report and will
be produced by the planning and M&E units at
the county levels. The sub-county and county state
report will be presented at a county annual health
review summit and published on the County MOH
Website. This forum will draw attendance from
MOH county level, the county health management
teams, SAGAs and CSOs, implementing partners,
county implementers and other health- related
sectors / stakeholders.
61
Health SP
monitoring
and
review
Annual
Performance Review
Start: June
End: July
62
Table 23: Service Outcome and Output Targets for Achievement of County
Objectives
Objective
Eliminate communicable
conditions
Minimize exposure to
health risk factors
Strengthen collaboration
with health-related sectors
Targets
Indicator
Yr. 1
Yr. 2
Yr. 3
Yr. 4
Yr. 5
63.5
70
78
85
90
89.5
90
91
92
93
40.2
48
56
65
75
78
80
82
84
85
52
60
68
75
16.9
14
12
11
10
65.9
70
75
80
85
50
60
70
80
25
35
43
50
0.27
0.96
10
15
20
36.9
44
52
60
70
37.3
44
52
60
70
7.7
9.8
8.8
7.8
6.8
19.3
30
40
50
60
65
68
70
72
75
% of under5s stunted
% of under-5 underweight
86.7
88
89
90
92
45
52
59
65
70
63
Objective
Targets
Indicator
Yr. 1
Yr. 2
Yr. 3
Yr. 4
Yr. 5
INVESTMENT OUTPUTS
Improving access to
services
76
79
82
85
88
TB cure rate
80
82
83
84
85
87.8
89
91
92
95
Indicators
% of immunization coverage
% of NCDs detected
Advocate for by-laws that promote healthy lifestyles and reverse Number of acts /bylaws that promote healthy lifestyles
trend of risk factors
Establish functional emergency preparedness and response teams Number of sub-counties that have an emergency and response team
in sub-counties
Establish emergency, diagnostic and specialized facilities (e.g. burn Number of emergency, diagnostic and specialized facilities
units, ICUs/HDUs).
established
Create public awareness on violence and injuries
% of referrals initiation
% of referrals received
% referrals completion
% referrals counter referred
64
County Objectives
Indicators
Strengthen linkages and referral systems between various tiers of % of intra facility referrals initiation
health care service delivery
% of intra facility referrals completion
% of inter facility referrals initiation
% of inter facility referrals completion
& of inter facility counter referrals
Foster partnerships with health stakeholders to improve health and Number of stakeholders actively participating in the stakeholder
deliver services
forums
Improve financing of the health sector
65
SECTION 5:
References
66
References
Constitution of Kenya 2010
Uasin Gishu County CIDP.
Kenya Demographic and Health Survey 2008/09
Kenya DHIS 2012- www.hiskenya.org
Government of Kenya, County Government Act No 17, 2012
Government of Kenya, Transition to Devolved Government Act, 2012
UN Millennium Development Goals
Kenya Vision 2030
Ministry of Health, Norms and Standards, 2007
Ministry of Health. Annual Work Plan July 2012- June 2013, Uasin-Gishu County
Ministry of Health. Kenya SARAM County Fact Sheet 2013
Ministry of Medical Services and Ministry of Public Health and Sanitation. Kenya Health Sector
Strategic Plan (KHSSP) III, 2012-2017 Nairobi.
Ministry of Medical Services and Ministry of Public Health and Sanitation. Kenya Health Policy
2012-2030. Nairobi: Government of Kenya; 2012
67
SECTION 6:
Annexes
68
National
County-specific
National
County-specific
Condition
Condition
Condition
Condition
Unsafe sex
Unhealthy lifestyle
Unsafe sex
Unhealthy lifestyle
Suboptimal breastfeeding
Unsafe sex
Suboptimal breastfeeding
Alcohol use
Alcohol use
Vitamin A deficiency
Insecurity
Vitamin A deficiency
Insecurity
Zinc deficiency
Food insecurity/
deficiencies
Iron deficiency
Foodinsecurity/
deficiencies
10
Zinc deficiency
10
10
Lack of contraception
10
Unsafe sex
Targets
Focus
Level of Monitoring
and review
Monthly
Quarterly
Quarterly progress
reports
Annually
Annual progress
reports
Identify
progress,
issues
and
challenges Output level
affecting implementation of outputs, and make
recommendations of priorities for coming year
Mid term
Mid-term review
End term
End-term review
69
Narrative Summary
Means of Verification
OVERALL GOAL
PURPOSE
To promote health and prevent
disease and injury through
provision of highest attainable
quality, acceptable, accessible,
affordable and equitable health
care services that is innovative,
responsive and sustainable
to the people of Uasin Gishu
County and beyond
Key Assumptions
That the strategic plan will
be adopted by the county
and that the devolved system
of government will continue
getting support from the central
government
County government will
continue to adequately and
sustainably fund health care
in the county
The people of Uasin Gishu
will continually seek health
care services from within
the county department of
health
% of pregnant women
attending at least 1 ANC
visit provided with LLITNs
% of women of reproductive
age screened for cervical
cancers
% of new outpatients with
mental health conditions
70
CEC- Health
Mr.Wilson Kemei
Dr.Evans Kiprotich
Esther Serem
CCN
Alexander Korir
CDSC
Susan Muchemi
CNUTO
Salome Tomno
CCSC
Peninah Chesire
CPHO
10
Silas Kosgei
CHRIO
11
Amos Kutto
CMLT
12
Hillary Ndiema
CTBLC
13
Richard Cheserek
CCO
14
Joyce Sambu
HRIO
15
Daniel Cheruiyot
SHRIO
16
David Kirui
HRIO
17
Hellen Cheruto
Coordinator
GF-KRC
18
Sylivester Kimaiyo
COP
AMPATH
19
M&EO
MEASURE Evaluation
21
Samson Mely
CRHO
71
sub-county
Heads of Programs
The Head of Programs will be responsible for
program planning and reporting, M & E, fundraising
and financial reporting tasks, including, but not
limited to:
Program work
Contribute to overall strategic discussions
and decisions on program coordination, new
initiatives and new partnerships
Contribute to management development and
implementation, strategy, policies and values, as
agreed in the Senior Health Management Team
72
the monitoring and evaluation framework
is implemented, including strengthening the
framework and developing the capacities with
partners and staff to implement the framework
Develop and prepare monitoring plans; regularly
monitor and review the activities to ensure the
activities are in line with achieving expected
outputs and suggest revisions if needed.
Assist in documenting work done and
continuously assess work while collecting
success stories and drawing lessons learned
from the field
Compile monthly, quarterly yearly activity reports
based on county activity running/performance.
Ensure that relevant partner requirements are
communicated to and understood by staff and
all stakeholders
at the facility
Capacity building and support to community
health extension workers and community health
workers
Management of resources
Emergency response
Provide secretarial services to the governance
structure at that level i.e. health facility management
committee
Infrastructure development
Resource mobilization
Other duties
The Head of Programs is responsible for fulfilling
any other program-related requirements
Roles of In-Charges
1. Facility Officer in Charge
the
Financial management
2. Medical Superintendents
73
hospital
74
75
76