The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS An Assessment of Health care Delivery Under Devolution: County Briefs Eldah Onsomu, Boaz Munga, Phares Mugo, Nancy Nafula, Rose Muraya, Mary Mwami, Mercy Matwere Quality health care is a basic right in Kenya as vaccination and cases of stunting, wasting and granted by the 2010 Constitution. It is also a underweight among children.priority government commitment under the “Big Four” agenda on Universal Health Care (UHC) and 5. Health financing: Share of total county budget Vision 2030. Devolution of the health sector granted allocated to health, aggregate and per capita health county governments the opportunity to design health spending and National Health Insurance Fund care delivery interventions to tackle county-specific (NHIF) coverage. health challenges. Counties are also charged with the 6. Health infrastructure: Health facilities by type, responsibility of coordinating and managing the delivery hospital beds and cots. of primary health care services, including promotion of primary health care, public health and sanitation, 7. Ownership of health facilities including public, disease surveillance and response among others. private, Non-Government Organizations (NGOs) The 2010 Constitution also requires the public to be and Faith Based Organizations (FBOs). involved in county planning and budgeting to enhance the relevance of the services delivered in respective 8. Proportion of population with access to improved counties. To this end, the County Health Briefs (2018) water and sanitation. provide data and information on the status of health across counties, and are instrumental in enabling 9. Availability, functionality and validity of medical each county develop county specific strategies and equipment and drugs. interventions to improve health outcomes. 10. Health service delivery indices: Medical drugs, The data and information used in preparation of the briefs infrastructure, amenities, medical equipment, and was obtained from the KIPPRA study on “An Assessment human resources for health; public participation of Health Delivery under Devolution (2017)” that aimed and citizen satisfaction; and overall health service at evaluating the changes brought about by key policy delivery index. reforms on delivery and uptake of health care services Data Sources in the country since the accession to devolution in 2013. The study survey captured information on availability of 1. KIPPRA Health Assessment Survey 2017 health inputs (human, capital, commodities) in primary health care facilities and estimated health service 2. Ministry of Health, Kenya Health Information System delivery indices. Additional data was obtained from (HIS) secondary data sources. 3. Kenya Demographic and Health Survey 2014 Each County brief provides a profile of respective county 4. Kenya National Bureau of Statistics Population health status indicators as follows: projections from the 2009 Kenya Population and 1. County indicators: Population estimates, poverty Housing Census level, life expectancy and fertility rate. 5. Office of Controller of Budget County Expenditure 2. Human resources for health: Medical workers Books; disaggregated by doctors, nurses, clinical officers 6. Ministry of Health, Health Sector Performance and public health workers. Report 2017/18 3. Health indicators: Malaria test positivity rate, HIV For all indices, 100% was the best possible score and prevalence, tuberculosis prevalence and number of 0% the worst. The indices were computed from data new non-communicable disease cases. collected during the KIPPRA Health Assessment Survey 4. Health status: Use of contraceptives, attendance 2017 and were based on: by a skilled health worker during child delivery, 1 (i) Availability and/or functionality/validity of medical inputs (this included the sub-indices on medical drugs, infrastructure, amenities, medical equipment, and health human resources); and (ii) Public participation and satisfaction (including the public participation and citizen satisfaction sub- indices). All sub-indices were combined into one overall health service delivery index. 2 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution in Kenya 1. County indicators a) Use of contraceptives (2017): 58 out of every 100 a) Location: East Africa women of child bearing age b) Total population estimate (2017): 46,621,575 people b) Attendance by a skilled health worker (2017): 61.8 out (23,130,548 male and 23,491,027 female) of every 100 children born c) 15 years old and below: 42.9 out of every 10 persons c) Vaccination (2017): 74.9 out of every 100 children d) Overall poverty index (2015/16): 36.1 e) Life expectancy (2014): 59.5 years 30.0 26.0 f) Fertility rate (2014): 3.9 children per woman 25.0 20.0 2. Human resources for health (2017) 15.0 a) Medical workers: 84 per 100,000 population1 11.0 b) Doctors: 2,596 10.0 4.0 c) Nurses: 20,981 5.0 d) Clinical officers: 3,274 0.0 e) Public health workers: 5,001 Stunted Wasted Underweight 3. Health indicators a) Malaria test positivity rate (2017): 36.4 d) Stunted children (2014): 26 children in every 100 children b) HIV prevalence (2016): 5.6% e) Wasted children (2014): 4 in every 100 children c) Tuberculosis prevalence (2017): 196.7 per 100,000 people f) Underweight children (2014): 11 in every 100 children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 people 5. Health financing (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 20.2% b) Health spending (2014/15): Ksh 68,896.3 million 2500 2356 2104 c) Health spending (2015/16): Ksh 87,374.1 million 2000 1888 1627 d) Per capita health spending (2014/15): Ksh 1,625.2 1500 1000 757 e) NHIF coverage (2015/16): 24.6 persons for every 504 554 645 500 100 citizens 223 234 224 238 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 28% New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2 0 1 5/16 71.9 28.0 4. Health status 2014/15 69.5 30.5 80.0 74.9 70.0 61.8 60.0 58.0 - 2013/14 66.2 33.8 50.0 40.0 0.02 0.04 0.06 0.08 0.0 100.0 30.0 - - II Recurrent II Development 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of married Proportion of births Children 12 -23 months a) Hospital beds: 15 per 10,000 population women using attended by a skilled fully vaccinated contraception health worker b) Health facilities: 2 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 3 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 11,268 various conditions (2017) d) Primary health facilities: 10,734 a) Essential drugs for mothers: 78% e) County and sub-county hospitals: 534 b) Essential drugs for children: 39% f) Total beds and cots: 68,030 c) HIV & AIDS: 83% d) Malaria: 50% 1. Ownership of health facilities e) Tuberculosis: 74% a) Government: 49.9 percent f) Diabetes: 71% b) Non governmental organizations (NGOs): 3.2% c) Faith-based organizations (FBOs): 9.7% 4. Health service delivery indices (2017)2 d) Private: 37.2% a) Overall health service delivery index: 59.5% b) Medical drugs index: 65.8% c) Infrastructure index: 65.5% d) Amenities (water, incinerator and electricity) index: 37% 81.8% 50% e) Medical equipment index: 75.7% 10% f) Public participation in health sector index: 33%3% g) Citizen satisfaction in health sector index: 55.9% h) Health human resources index: 38.8% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic 2. Water and sanitation (2017) drugs Proportion of the population with access to improved water and 100.080.0 sanitation: 59.1% Human resource Public60.0 40.0 3. Level of availability and functionality of medical equipment 20.0 in health facilities (2017): 0.0Infrustructure Citizen a) Obstetric care equipment: 86.1% satisfaction b) Delivery pack: 79.6% Medical (water,… Equipment 5. Recommendations To address the emerging challenges in the health sector, the country needs to: (i) Implement interventions in preventive and promotive health care to reduce communicable and non-communicable disease prevalence, stunting, wasting and underweight among children (ii) Develop strategies to improve public participation in health planning, budgeting, policy formulation and implementation (iii) Invest in programs geared towards improvement of clean water supply and sanitation across all counties (iv) Invest in public health programmes that would increase uptake of immunizations and child delivery in health facilities (v) Establish a framework for sharing medical personnel and/or improve deployment of human resource for health (vi) Improve supply of the medical drugs to health facilities especially for children, mothers, communicable and non-communicable diseases (vii) Allocate more resources for construction of public health facilities to increase access to quality and affordable health care 4 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Mombasa County 1. County indicators a) Use of contraceptives (2017): 55 out of every 100 a) Location: Coast region of Kenya women of child bearing age b) Total population estimate (2017): 1,226,131 people b) Attendance by a skilled health worker (2017): 83 out of every 100 children born (635,853 male and 590,278 female) c) Vaccination (2017): 79 out of every 100 children c) 15 years old and below: 3.3 out of every 10 persons d) Overall poverty index (2015/16): 27.1% e) Life expectancy (2014): 56.5 years 30.0 26.0 f) Fertility rate (2014): 3.2 children per woman 21.1 20.0 2. Human resources for health (2017) 9.6 11.0 a) Medical workers: 245 per 100,000 population1 10.0 4.1 4.0 b) Doctors: 95 0.0 c) Nurses: 620 Stunted Wasted Underweight d) Clinical officers: 97 e) Public health workers: 136 II Mombasa II National 3. Health indicators d) Stunted children (2014): 21 children in every 100 a) Malaria test positivity rate (2017): 54% children b) HIV prevalence (2016): 7.4% e) Wasted children (2014): 4 in every 100 children c) Tuberculosis prevalence (2017): 444 per 100,000 people f) Underweight children (2014): 10 in every 100 d) Number and type of new non-communicable disease children cases in outpatient departments (OPD) per 100,000 people 5. Health financing (2013/14 to 2016/17): a) Total budget allocation to health sector (2015/16): 20.2% 3000 2625 b) Health spending (2014/15): Ksh 1,535.97 million2500 2091 2159 2057 c) Health spending (2015/16): Ksh 2,285.28 million2000 d) Per capita health spending (2014/15): Ksh 1,386 1500 1252 1000 e) NHIF coverage (2015/16): 31.8 persons for every 100917 951 934 500 243 310 --------5-06 citizens191 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 15% New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people I 2015/16 85% 15% 4. Health status I 2014/15 84% 16% 90.0 82.8 78.6 I 80.0 74.9 2013/14 74% 26% 70.0 61.8 I 60.0 55.0 58.0 0% 20% 40% 60% 80% 100% 50.0 40.0 II Recurrent ■ Development 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of married Proportion of births Children 12 -23 months a) Hospital beds: 2.7 per 10,000 population women using attended by a skilled fully vaccinated contraception health worker b) Health facilities: 14.6 per 10,000 population II Mombasa I National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 5 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 376 various conditions (2017) d) Primary health facilities: 359 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 17 b) Essential drugs for children: 0% f) Total beds and cots: 1,790 c) HIV & AIDS: 100% d) Malaria: 33% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 15.5% f) Diabetes: 50% b) Non governmental organizations(NGOs): 4.1% c) Faith-based organizations (FBOs): 3.8% 4. Health service delivery indices (2017)2 d) Private:75.9% a) Overall health service delivery index: 72.9% b) Medical drugs index: 63.8% c) Infrastructure index: 57.4% d) Amenities (water, incinerator and electricity) index: 16% 83.3% 44%% e) Medical equipment index: 75% f) Public participation in health sector index: 54.9% 76% g) Citizen satisfaction in health sector index: 87.1% h) Health human resources index: 89% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 80.0 2. Water and sanitation (2017) Human resource 60.0 Proportion of the population with access to improved water and 40.0 sanitation: 86.3% 20.0 0.0 Infrustructure 3. Level of availability and functionality of medical equipment in health facilities (2017) a) Obstetric care equipment:66.7% b) Delivery pack: 25% incinerator, electricity) Medical Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Support innovative approaches for health public participation (ii) Ensure adequate provision of medical equipment and drugs especially for malaria and tuberculosis in health facilities. 6 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kwale County 1. County indicators a) Use of contraceptives (2017): 42 out of every 100 a) Location: Coast region of Kenya women of child bearing age b) Total population estimate (2017): 848,674 people b) Attendance by a skilled health worker (2017): 50 out of (411,459 male and 437,215 female) every 100 children born c) 15 years old and below: 4.7 out of every 10 persons c) Vaccination (2017): 85 out of every 100 children d) Overall poverty index (2015/16): 47.4% 40.0 e) Life expectancy (2014): 57 years 29.7 26.0 f) Fertility rate (2014): 4.7 children per woman 30.0 20.0 2. Human resources for health (2017) 11.8 11.0 a) Medical workers: 48 per 100,000 population1 10.0 4.4 4.0 b) Doctors: 14 c) Nurses: 259 0.0 Stunted Wasted Underweight d) Clinical officers: 61 e) Public health workers: 66 II Kwale 11 National d) Stunted children (2014): 30 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 39% e) Wasted children (2014): 2 in every 100 children b) HIV prevalence (2016): 5.7% f) Underweight children (2014): 12 in every 100 children c) Tuberculosis prevalence (2017): 1561 per 100,000 people d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people a) Total budget allocation to health sector (2015/16): (2013/14 to 2016/17) 20.3% 3000 b) Health spending (2014/15): Ksh 977.25 million 2500 2516 c) Health spending (2015/16): Ksh 1,459.09 million 2000 1939 -----2-358 d) Per capita health spending (2014/15): Ksh 1,561~ 17161500 e) NHIF coverage (2015/16): 28.5 persons for every 100 1000 citizens 500 486 f) Development allocation as percentage of total health 312 330 375196 174 0 120 182 spending (2015/16): 45% 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people I - New hypertention in OPD per 100,000 people 2015/16 55% 45% New diabetes in OPD per 100,000 people I 2014/15 58% 42% 4. Health status I 2013/14 68% 32% 90.0 84.5 I 80.0 74.9 0% 20%4 0% 60%8 0% 100% 70.0 61.8 58.0 60.0 50.1 II Recurrent Development 50.0 ■ 41.5 40.0 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 Pm portion of married Pm portion of births Children 12 -23 months a) Hospital beds: 1.5 per 10,000 population women using attended by a skilled fully vaccinated contraception health worker b) Health facilities: 5.7 per 10,000 population II Kwale ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 7 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 147 various conditions (2017) d) Primary health facilities: 143 a) Essential drugs for mothers: 60% e) County and sub-county hospitals: 4 b) Essential drugs for children: 40% f) Total beds and cots: 492 c) HIV & AIDS: 50% d) Malaria: 80% 1. Ownership of health facilities e) Tuberculosis: 50% a) Government: 73.5 percent f) Diabetes: 80% b) Non governmental organizations (NGOs): 1.4% c) Faith-based organizations (FBOs): 4.8% 4. Health service delivery indices (2017)2 d) Private: 21.8% a) Overall health service delivery index: 68.7% b) Medical drugs index: 60% c) Infrastructure index: 72% d) Amenities (water, incinerator and electricity) index: 21% 93.3% 5% e) Medical equipment index: 86.7% 1% f) Public participation in health sector index: 55.9% 73% g) Citizen satisfaction in health sector index: 86.5% h) Health human resources index: 26.3% ■ Public ■ NGOs ■ FBOs Private Access to basic ■ drugs100.0 90.0 80.0 2. Water and sanitation (2017) Human resource 70.0 Public60.0 50.0 Proportion of the population with access to improved water and 40.030.020.0 sanitation: 33.7% 10.00.0 Infrustructure Citizen satisfaction 3. Level of availability and functionality of medical equipment in health facilities (2017): (water, Medical incinerator, Equipment a) Obstetric care equipment:100% electricity) b) Delivery pack: 80% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Encourage civic education and promote citizen engagement and utilization of health services (ii) Ensure that each household has access to clean and safe water (iii) Use community health workers to promote immunization and nutrition training in remote areas to curb high cases of stunted and underweight children 8 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kilifi County 1. County indicators a) Use of contraceptives (2017): 34 out of every 100 a) Location: Coast region of Kenya women of child bearing age b) Total population estimate (2017): 1,448,584 people b) Attendance by a skilled health worker (2017): 52 out of c) (696,684 male and 751,900 female) every 100 children born d) 15 years old and below: 4.6 out of every 10 persons c) Vaccination (2017): 74 out of every 100 children e) Overall poverty index (2015/16): 46.4% f) Life expectancy (2014): 59.5 years 50.0 39.1 g) Fertility rate (2014): 5.1 children per woman 40.0 30.0 26.0 2. Human resources for health (2017) 20.0 16.9 a) Medical workers: 45 per 100,000 population1 11.0 10.0 4.1 4.0 b) Doctors: 64 ~ ~ II01 ---.-.- (1 lq -, b1IC 0.0 c) Nurses: 439 Stunted Wasted Underweight d) Clinical officers: 83 e) Public health workers: 109 II Kilifi 11 National 3. Health indicators a) Malaria test positivity rate (2017): 62% d) Stunted children (2014): 39 children in every 100 children b) HIV prevalence (2016): 4.4% e) Wasted children (2014): 4 in every 100 children c) Tuberculosis prevalence (2017): 175 per 100,000 people f) Underweight children (2014): 17 in every 100 children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 5. Health financing people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 22.7% 3500 b) Health spending (2014/15): Ksh 1,922.84 million 3000 3001 c) Health spending (2015/16): Ksh 2,262.66 million 2500 2334 2000 2046 d) Per capita health spending (2014/15): Ksh 1,433 1500 15=15-------=---- e) NHIF coverage (2015/16): 24 persons for every 100 1000 citizens 500 446 548 231074 231383 203 286 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 30% New mental disorders in OPD 100,000 people - Newhypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 4. Health status 2015/16 70% 30% 80.0 74.1 74.9 2014/15 72% 28% 70.0 61.8 58.0 60.0 52.3 2013/14 82% 18% 50.0 40.0 34.1 0% 20%4 0% 60%8 0% 100% 30.0 20.0 II Recurrent 11 Development 10.0 0.0 6. Health infrastructure (2017) Proportion of Proportion of births Children 12 -23 married women attended by a months fully using contraception skilled health vaccinated a) Hospital beds: 7 per 10,000 population worker b) Health facilities: 2 per 10,000 population 11 Kilifi ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 9 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 282 various conditions (2017) d) Primary health facilities: 272 c) Essential drugs for mothers: 60% e) County and sub-county hospitals: 10 d) Essential drugs for children: 40% f) Total beds and cots: 1,002 e) HIV & AIDS: 100% 2. Ownership of health facilities f) Malaria: 100% a) Government: 40.9% g) Tuberculosis: 75% b) Non-governmental organizations(NGOs): 5.3% h) Diabetes: 100% c) Faith-based organizations (FBOs): 4.9% 5. Health service delivery indices (2017)2 d) Private: 48.8% a) Overall health service delivery index: 71.4% b) Medical drugs index: 79.2% c) Infrastructure index: 72% d) Amenities (water, incinerator and electricity) index: 41% 100% 49% e) Medical equipment index: 86.7% 5%5% f) Public participation in health sector index: 52.4% g) Citizen satisfaction in health sector index: 78.2% h) Health human resources index:31.3% ■ Public ■ NGOs ■ FBOs ■ Private 3. Water and sanitation (2017) Access to basic drugs Proportion of the population with access to improved water and 100.0 sanitation: 70% 80.0Human resource Public60.0 40.0 4. Level of availability and functionality of medical equipment 20.0 in health facilities (2017) 0.0 a) Obstetric care equipment:50% Infrustructure Citizen satisfaction b) Delivery pack: 62.50% incinerator, Medical electricity) Equipment 6. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Enhance civic education to improve uptake of family planning and nutrition among children (ii) Allocate adequate funds for purchase of essential drugs for mothers and children in the county (iii) Construct and or expand the existing public health facilities to enable citizens benefit from public health care services 10 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Tana River County 1. County indicators a) Use of contraceptives (2017): 29 out of every 100 a) Location: Coast region of Kenya women of child bearing age b) Total population estimate (2017): 313,567 people (156,188 b) Attendance by a skilled health worker (2017): 32 out of every 100 children born male and 157,379 female) c) Vaccination (2017): 70 out of every 100 children c) 15 years old and below: 5.0 out of every 10 persons d) Overall poverty index (2015/16): 62.2% 30.0 28.1 26.0 e) Life expectancy (2014): 56.5 years f) Fertility rate (2014): 5.8 children per woman 18.620.0 2. Human resources for health (2017) 11.0 10.0 5.7 a) Medical workers: 50 per 100,000 population1 4.0 b) Doctors: 5 0.0 c) Nurses: 129 Stunted Wasted Underweight d) Clinical officers: 25 II Tana River II National e) Public health workers: 59 3. Health indicators d) Stunted children (2014): 28 children in every 100 a) Malaria test positivity rate (2017): 64% children b) HIV prevalence (2016): 1.0% e) Wasted children (2014): 6 in every 100 children c) Tuberculosis prevalence (2017): 147 per 100,000 people f) Underweight children (2014): 19 in every 100 children d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people a) Total budget allocation to health sector (2015/16):10.4% (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 351.37 million 3000 c) Health spending (2015/16): Ksh 781.15 million 2661 2500 2492 2467 d) Per capita health spending (2014/15): Ksh 1,301 2000 e) NHIF coverage (2015/16): 19.4 persons for every 100 1717 1500 citizens 1000 f) Development allocation as percentage of total health 500 343 385 441661214891 264 305 spending (2015/16): 68% 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 32% 68% 4. Health status 2014/15 32% 68% 80.0 74.9 2013/14 73% 27% 70.2 70.0 61.8 58.0 60.0 0% 20% 40% 60%8 0% 100% 50.0 40.0 II Recurrent ■ Development32.2 28.7 30.0 20.0 6. Health infrastructure (2017) 10.0 0.0 a) Hospital beds: 21 per 10,000 population Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated b) Health facilities: 4 per 10,000 population contraception health worker Tana river ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 11 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 152 various conditions (2017) d) Primary health facilities: 146 a) Essential drugs for mothers: 67% e) County and sub-county hospitals: 6 b) Essential drugs for children: 17% f) Total beds and cots: 842 c) HIV & AIDS: 83% d) Malaria: 50% 1. Ownership of health facilities e) Tuberculosis: 83% a) Government: 70.1% f) Diabetes: 100% b) Non governmental organizations (NGOs): 3.9% c) Faith-based organizations (FBOs): 14.3% 4. Health service delivery indices (2017) 2 d) Private: 15.6% a) Overall health service delivery index: 51% b) Medical drugs index: 66.7% c) Infrastructure index: 70% 16% d) Amenities (water, incinerator and electricity) index: 88.9% 14% e) Medical equipment index: 70% f) Public participation in health sector index: 24.6% 4% g) Citizen satisfaction in health sector index: 19.4% 70% h) Health human resources index: 17.3% Access to basic ■ Public ■ NGOs drugs■ FBOs ■ Private 100.0 2. Water and sanitation (2017) 80.0Human resource Public60.0 Proportion of the population with access to improved water and 40.0 sanitation: 60.3% 20.0 0.0 3. Level of availability and functionality of medical equipment in Infrustructure Citizen satisfaction health facilities (2017) a) Obstetric care equipment: 100% incinerator, Medical b) Delivery pack: 60% electricity) Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Increase the number of Community Health Workers (CHWs) to assist in sensitization of the community on maternal and child health and encourage uptake of NHIF scheme (ii) Establish more interventions in preventive and promotive health care to reduce disease prevalence, stunting, wasting and underweight among children (iii) Come up with droughts and floods management strategies to improve water and sanitation services in the county (iv) Increase health public participation and civic education 12 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Lamu County 1. County indicators a) Use of contraceptives (2017): 42 out of every 100 a) Location: Coast region of Kenya women of child bearing age b) Total population estimate (2017): 132,582 people b) Attendance by a skilled health worker (2017): 47 out of (69,074 male and 63,508 female) every 100 children born c) 15 years old and below: 4.1 out of every 10 persons c) Vaccination (2017): 67 out of every 100 children d) Overall poverty index (2015/16): 28.5% e) Life expectancy (2014): 57 years 40.0 f) Fertility rate (2014): 4.3 children per woman 29.2 30.0 26.0 2. Human resources for health (2017) 20.0 a) Medical workers: 146 per 100,000 population1 11.8 11.0 b) Doctors: 10 10.0 4.2 4.0 c) Nurses: 108 0.0 d) Clinical officers: 28 Stunted Wasted Underweight e) Public health workers: 38 II Lamu II National 3. Health indicators a) Malaria test positivity rate (2017): 29% d) Stunted children (2014): 30 children in every 100 b) HIV prevalence (2016): 2.3% children c) Tuberculosis prevalence (2017): 215 per 100,000 people e) Wasted children (2014): 4 in every 100 children d) Number and type of new non-communicable disease f) Underweight children (2014): 12 in every 100 children cases in outpatient departments (OPD) per 100,000 5. Health financing people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 22.4% 6000 5000 ---- b) Health spending (2014/15): Ksh 398.44 million496346754000 4038 c) Health spending (2015/16): Ksh 598.33 million3000 30=49---------= d) Per capita health spending (2014/15): Ksh 4,102 2000 1844 e) NHIF coverage (2015/16): 13 persons for every 100 1566 1167 14181000 932 681 682 632 citizens 0 2013/14 2014/152 015/162 016/17 f) Development allocation as percentage of total health New mental disorders in OPD 100,000 people spending (2015/16): 41% --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 59% 41% 4. Health status 80.0 74.9 2014/15 67% 33% 70.0 67.461.8 58.0 60.0 2013/14 72% 28% 50.0 47.342.2 40.0 0% 20%4 0% 60%8 0% 100% 30.0 20.0 II Recurrent ■ Development 10.0 0.0 Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated 6. Health infrastructure (2017) contraception health worker Lamu a) Hospital beds: 3.4 per 10,000 population11 ■ National b) Health facilities: 14 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 13 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 61 various conditions (2017) d) Primary health facilities: 58 a) Essential drugs for mothers: 67% e) County and sub-county hospitals: 3 b) Essential drugs for children: 65% f) Total beds and cots: 175 c) HIV & AIDS: 66% d) Malaria: 50% 2. Ownership of health facilities e) Tuberculosis: 83% a) Government: 75% f) Diabetes: 83% b) Non governmental organizations (NGOs): 1.6% c) Faith-based organizations (FBOs): 3.3% 5. Health service delivery indices (2017)2 d) Private: 21.3% a) Overall health service delivery index: 65.6% b) Medical drugs index: 69.5% c) Infrastructure index: 70% 21% d) Amenities (water, incinerator and electricity) index: 3% 88.9%1% e) Medical equipment index: 83.3% 75% f) Public participation in health sector index: 43.1% g) Citizen satisfaction in health sector index: 47.2% h) Health human resources index: 57% I Public ■ NGOs I FBOs ■ Private Access to basic 3. Water and sanitation (2017) drugs 100.0 Proportion of the population with access to improved water and 80.0 sanitation: 70% Human resource Public 60.0 40.0 20.0 4. Level of availability and functionality of medical equipment 0.0 in health facilities (2017): Infrustructure Citizen satisfaction a) Obstetric care equipment:100% b) Delivery pack: 100% incinerator, Medical electricity) Equipment 6. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Support community health workers who provide services such as immunization and civic education on preventive health interventions (ii) Encourage more citizens to take up NHIF cover to enable them access medical services 14 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Taita Taveta County 1. County indicators a) Use of contraceptives (2017): 68 out of every 100 a) Location: Coast region of Kenya women of child bearing age b) Total population estimate (2017): 371,713 people (188,943 b) Attendance by a skilled health worker (2017): 63 out male and 182,770 female) of every 100 children born c) 15 years old and below: 3.7 out of every 10 persons c) Vaccination (2017): 89 out of every 100 children d) Overall poverty index (2015/16): 32.3% 30.0 26.0 e) Life expectancy (2014): 52 years 23.825.0 f) Fertility rate (2014): 3.2 children per woman 20.0 2. Human resources for health (2017) 15.0 11.0 10.0 7.2 7.8 a) Medical workers: 98 per 100,000 population1 4.05.0 b) Doctors: 31 0.0 c) Nurses: 248 Stunted Wasted Underweight d) Clinical officers: 52 II Taita-Taveta II National e) Public health workers: 59 3. Health indicators d) Stunted children (2014): 24 children in every 100 a) Malaria test positivity rate (2017): 29% children b) HIV prevalence (2016): 6.1% e) Wasted children (2014): 7 in every 100 children c) Tuberculosis prevalence (2017): 201 per 100,000 people f) Underweight children (2014): 8 in every 100 children d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 15.5% 4500 4170 b) Health spending (2014/15): Ksh 548.07 million4000 3982 3725 3500 3474~ c) Health spending (2015/16): Ksh 992.26 million 3000 d) Per capita health spending (2014/15): Ksh 3,063 2500 2000 e) NHIF coverage (2015/16): 30.4 persons for every 100 1500 1000 citizens902 500 6 88228 672545 673475 818 f) Development allocation as percentage of total health 0 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 18% New mental disorders in OPD 100,000 people - Newhypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 82% 18% 4. Health status 2014/15 50% 50% 100.0 88.8 90.0 2013/14 80.0 74.9 3% 97% 68.0 70.0 62.5 58.0 61.8 60.0 0% 20%4 0% 60%8 0% 100% 50.0 40.0 II Recurrent ■ Development 30.0 20.0 10.0 0.0 Proportion of married Proportion of births Children 12 -23 months 6. Health infrastructure (2017) women using attended by a skilled fully vaccinated contraception health worker a) Hospital beds: 11 per 10,000 population 11 TaitaTaveta ■ National b) Health facilities: 2 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 15 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 77 various conditions (2017) d) Primary health facilities: 75 a) Essential drugs for mothers: 60% e) County and sub-county hospitals: 2 b) Essential drugs for children: 40% f) Total beds and cots: 342 c) HIV & AIDS: 50% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 50% a) Government: 61.9 percent f) Diabetes: 80% b) Non governmental organizations(NGOs): 1.0% c) Faith-based organizations (FBOs): 8.6% 4. Health service delivery indices (2017) 2 d) Private: 27.6% a) Overall health service delivery index: 56.2% b) Medical drugs index: 56.7% c) Infrastructure index: 56% d) Amenities (water, incinerator and electricity) index: 28% 73.3% e) Medical equipment index: 83.3% 9% 62% 1% f) Public participation in health sector index: 52.2% g) Citizen satisfaction in health sector index: 46.1% h) Health human resources index: 25.6% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 80.0 2. Water and sanitation (2017) Human resource 60.0 40.0 Proportion of the population with access to improved water and 20.0 sanitation: 98.8% 0.0 Infrustructure 3. Level of availability and functionality of medical equipment in health facilities (2017) a) Obstetric care equipment: 60% incinerator, electricity) Medical Equipment b) Delivery pack: 100% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Sensitize the community on NHIF uptake (ii) Expand citizen and community participation in health planning, budgeting, policy formulation and implementation (iii) Improve supply of medical drugs especially for tuberculosis, malaria and essential drugs for mothers and children (iv) Increase development budgetary allocation to enhance infrastructural development and maintenance 16 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Garissa County 1. County indicators a) Use of contraceptives (2017): 6 out of every 100 a) Location: North Eastern region of Kenya women of child bearing age b) Total population estimate (2017): 439,915 people b) Attendance by a skilled health worker (2017): 40 out (244,851 male and 215,064 female) of every 100 children born c) 15 years old and below: 4.8 out of every 10 persons c) Vaccination (2017): 58 out of every 100 children d) Overall poverty index (2015/16): 65.5% e) Life expectancy (2014): 59.5 years 30.0 26.0 f) Fertility rate (2014): 6.1 children per woman 20.0 15.6 11.4 13.1 11.0 2. Human resources for health (2017) 10.0 4.0 a) Medical workers: 86 per 100,000 population1 b) Doctors: 61 0.0 c) Nurses: 257 Stunted Wasted Underweight d) Clinical officers: 74 II Garissa II National e) Public health workers: 80 3. Health indicators d) Stunted children (2014): 16 children in every 100 a) Malaria test positivity rate (2017): 44% children e) Wasted children (2014): 11 in every 100 children b) HIV prevalence (2016): 2.1% f) Underweight children (2014): 13 in every 100 children c) Tuberculosis prevalence (2017): 172 per 100,000 people d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): people (2013/14 to 2016/17) 18.3% 1200 b) Health spending (2014/15): Ksh 1,245.6 million ---11-251000 ---- 1053969 c) Health spending (2015/16): Ksh 1,432.2 million887800 d) Per capita health spending (2014/15): Ksh 1,845 600 e) NHIF coverage (2015/16): 18 persons for every 100 400 413 281 331 293 200 citizens153 101 122 152 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 18% New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 82% 18% 4. Health status 2014/15 63% 37% 80.0 74.9 2013/14 77% 23% 70.0 61.8 58.0 57.9 60.0 0% 20% 40% 60% 80% 100% 50.0 39.8 II Recurrent ■ Development40.0 30.0 20.0 10.0 5.5 6. Health infrastructure (2017) 0.0 a) Hospital beds: 17 per 10,000 population Proportion of married Proportion of births Children 12 -23 women using attended by a skilled months fully health worker vaccinated b) Health facilities: 4 per 10,000 populationcontraception 11 Garissa ■ National 1 World Health Organization (WHO) target is 230 medical workers per 100,000 people. 17 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 165 various conditions (2017) d) Primary health facilities: 150 a) Essential drugs for mothers: 50% e) County and sub-county hospitals: 15 b) Essential drugs for children: 60% f) Total beds and cots: 739 c) HIV & AIDS: 40% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 40% a) Government: 55.2% f) Diabetes: 60% b) Non governmental organizations (NGOs): 2.4% 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 1.2% a) Overall health service delivery index: 51.7% d) Private: 41.2% b) Medical drugs index: 51.7% c) Infrastructure index: 68% d) Amenities (water, incinerator and electricity) index: 100% e) Medical equipment index: 60% 41% f) Public participation in health sector index: 33.4% 55% g) Citizen satisfaction in health sector index: 45% 3% h) Health human resources index: 30.1% 1% Access to basic drugs ■ Public ■ NGOs ■ FBOs ■ Private 80.070.0 60.0 Human resource Public50.0 40.0 30.0 2. Water and sanitation (2017) 20.010.0 0.0 Proportion of the population with access to improved water and Infrustructure Citizen satisfaction sanitation: 45.1% 3. Level of availability and functionality of medical equipment (water, Medicalincinerator, Equipment in health facilities, (2017): electricity) a) Obstetric care equipment: 20% b) Delivery pack: 100% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Improve health care financing at the county for purchase of equipment (ii) Deploy adequate health professionals in the county (iii) Improve on sanitation and access to clean and safe water 18 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Wajir County 1. County indicators a) Use of contraceptives (2017): 2 out of every 100 women a) Location: North eastern region of Kenya of child bearing age b) Total population estimate (2017): 467,365 people (243,165 b) Attendance by a skilled health worker (2017): 20 out of every 100 children born male and 224,200 female) c) Vaccination (2017): 50 out of every 100 children c) 15 years old and below: 4 out of every 10 persons d) Overall poverty index (2015/16): 62.6% e) Life expectancy (2014): 61.5 years f) Fertility rate (2014): 7.8 children per woman 30.0 26.426.0 21.1 2. Human resources for health (2017) 20.0 14.2 11.0 a) Medical workers: 60 per 100,000 population1 10.0 4.0 b) Doctors: 14 c) Nurses: 54 0.0 d) Clinical officers: 6 Stunted Wasted Underweight e) Public health workers: 58 II Wajir 11 National 3. Health indicators a) Malaria test positivity rate (2017): 72% d) Stunted children (2014): 26 children in every 100 children b) HIV prevalence (2016): 0.2% e) Wasted children (2014): 14 in every 100 children c) Tuberculosis prevalence (2017): 87 per 100,000 people f) Underweight children (2014): 21 in every 100 children d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people a) Total budget allocation to health sector (2015/16): 15.8% (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 1,168 million 2500 c) Health spending (2015/16): Ksh 1,287.6 million 2111 d) Per capita health spending (2014/15): Ksh 1,5592000 2009 1708 1680 e) NHIF coverage (2015/16): 10 persons for every 100 1500 citizens 1000 f) Development allocation as percentage of total health 500 573 527 505 361 spending (2015/16): 52% 180 248 168 167 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people - Newhypertention in OPD per 100,000 people 2015/16 48% 52% New diabetes in OPD per 100,000 people 4. Health status 2014/15 46% 54% 2013/14 67% 33% 90 77.5 80 74.9 70 63.458 61.8 0% 20%4 0% 60%8 0% 100% 60 50 40 I I II II Recurrent ■ Development30 2020100 6. Health infrastructure, 2017 Proportion of Proportion of Children 12 -23 women using a) Hospital beds: 8 per 10,000 populationbirths attended by months fully contraception a skilled health vaccinated worker b) Health facilities: 2 per 10,000 population II Wajir ■ National 1 World Health Organization (WHO) target is 230 medical workers per 100,000 people. 19 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 135 various conditions, 2017 d) Primary health facilities: 130 a) Essential drugs for mothers: 50% e) County and sub-county hospitals: 5 b) Essential drugs for children: 83% f) Total beds and cots: 506 c) HIV & AIDS: 83.3% d) Malaria: 63% 1. Ownership of health facilities e) Tuberculosis: 50% a) Government: 98.2% b) Non-governmental organizations (NGOs): 9 f) Diabetes: 63% c) Faith-based organizations (FBOs): 1.8% 4. Health service delivery indices, 20172 d) Private: Zero a) Overall health service delivery index: 57.4% b) Medical drugs index: 63.3% 2% c) Infrastructure index: 66.7% d) Amenities (water, incinerator and electricity) index: 66% e) Medical equipment index: 83.3% 98% f) Public participation in health sector index: 28.9% g) Citizen satisfaction in health sector index: 33% h) Health human resources index: 16.5% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic 2. Water and sanitation, 2017 drugs 90.0 Proportion of the population with access to improved water and 80.070.0 Public sanitation: 6.2% Human resource 60.050.0 participation 40.0 30.0 3. Level of availability and functionality of medical equipment in 20.010.0 health facilities, 2017 0.0 Infrustructure Citizen a) Obstetric care equipment: 50% satisfaction b) Delivery pack: 50% (water, Medical incinerator, Equipment electricity) 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Invest in mobile health facilities capable of reaching far to reach communities (ii) Expand interventions in preventive and promotive health care to reduce prevalence of NCDs, especially diabetes among adults; and wasting, underweight and stunting among children (iii) Utilize community health workers to improve immunization and child nutrition (iv) Establish a framework for sharing medical specialists with neighbouring counties and/or with the national government; (v) Improve public private partnerships to share knowledge in areas of financing, innovation (vi) Expand local stakeholder engagement to improve health care utilization and service delivery 20 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Mandera County 1. County indicators a) Use of contraceptives (2017): 2 out of every 100 a) Location: North Eastern region of Kenya women of child bearing age b) Total population estimate (2017): 724,238 people (373,469 b) Attendance by a skilled health worker (2017): 39 out male and 350,769 female) of every 100 children born c) 15 years old and below: 5.3 out of every 10 persons c) Vaccination (2017): 43 out of every 100 children d) Overall poverty index (2015/16): 77.6% e) Life expectancy (2014): 61 years 40.0 36.1 f) Fertility rate (2014): 5.2 children per woman 30.0 26.0 24.9 2. Human resources for health (2017) 20.0 14.8 11.0 a) Medical workers: 31 per 100,000 population1 10.0 4.0 b) Doctors: 4 0.0 c) Nurses: 90 Stunted Wasted Underweight d) Clinical officers: 29 e) Public health workers: 38 II Mandera II National 3. Health indicators d) Stunted children (2014): 36 children in every 100 a) Malaria test positivity rate (2017): 21% children b) HIV prevalence (2016): 1.7% e) Wasted children (2014):15 in every 100 children c) Tuberculosis prevalence (2017): 51 per 100,000 people f) Underweight children (2014): 25 in every 100 children d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): people (2013/14 to 2016/17) 11.7% b) Health spending (2014/15): Ksh 934.8 million 600 c) Health spending (2015/16): Ksh 1,439.33 million 568 534 500 -5-1-9---.............. d) Per capita health spending (2014/15): Ksh 1,300 400 428 e) NHIF coverage (2015/16): 9.8 persons for every 100 300 218 citizens200 202 162 ;;;--:--165 179 100 127 1 ----- 12 472 f) Development allocation as percentage of total health 0 spending (2015/16): 37% 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people - New hypertention in OP □ per 100,000 people New diabetes in OPD per 100,000 people 2015/16 63% 37% 4. Health status 2014/15 63% 37% 80.0 74.9 2013/14 77% 23% 70.0 61.8 58.0 60.0 0% 20%4 0% 60%8 0% 100% 50.0 42.7 38.7 II Recurrent II Development40.0 30.0 20.0 6. Health infrastructure (2017) 10.0 1.9 0.0 a) Hospital beds: 1.2 per 10,000 population Proportion of married Proportion of births Children 12 -23 women using attended by a skilled months fully health worker vaccinated b) Health facilities: 7.4 per 10,000 populationcontraception II Mandera ■ National 1 World Health Organization (WHO) target is 230 medical workers per 100,000 people. 21 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 133 various conditions (2017): d) Primary health facilities: 125 a) Essential drugs for mothers: 43% e) County and sub-county hospitals: 8 b) Essential drugs for children: 86% f) Total beds and cots: 860 c) HIV & AIDS: 71% d) Malaria: 86% 1. Ownership of health facilities e) Tuberculosis: 43% a) Government: 56.7% f) Diabetes: 100% b) Non governmental organizations(NGOs): 0.1% c) Faith-based organizations (FBOs): 0.7% 4. Health service delivery indices (2017)2 d) Private: 42.5% a) Overall health service delivery index: 50.9% b) Medical drugs index: 71.5% c) Infrastructure index: 74.6% d) Amenities (water, incinerator and electricity) index: 61.1% 42% e) Medical equipment index: 77.8% 57% f) Public participation in health sector index: 30.2% 0% g) Citizen satisfaction in health sector index: 36% 1% h) Health human resources index: 5.4% Public NGOs FBOs Private Access to basic■ ■ ■ ■ drugs 80.0 2. Water and sanitation (2017) 70.0 60.0 Proportion of the population with access to improved water Human resource 50.040.0 and sanitation: 40.9% 30.020.0 10.0 0.0 3. Level of availability and functionality of medical equipment Infrustructure Citizen satisfaction in health facilities (2017) a) Obstetric care equipment:60% incinerator, Medical b) Delivery pack: 83.3% electricity) Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Have mechanisms in place to address water and sanitation issues in the county (ii) Enhance supply of essential drugs for mothers and children (iii) Enhance public participation in the health sector as a way of promoting sustainable health care in the county (iv) Support community health workers to enhance immunization, sensitization on use of contraceptives (v) Provide nutrition training to mothers to reduce stunting, wasting and underweight among children 22 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Marsabit County 1. County indicators a) Use of contraceptives (2017): 12 out of every 100 a) Location: North Eastern region of Kenya women of child bearing age b) Total population estimate (2017): 319,128 people (167,867 b) Attendance by a skilled health worker (2017): 26 out male and 151,261 female) of every 100 children born c) 15 years old and below: 4.6 out of every 10 persons c) Vaccination (2017): 68 out of every 100 children d) Overall poverty index (2015/16): 63.7% e) Life expectancy (2014): 64.5 years 40.0 f) Fertility rate (2014): 5 children per woman 30.1 30.0 26.5 26.0 16.3 2. Human resources for health (2017) 20.0 11.0 a) Medical workers: 124 per 100,000 population1 10.0 4.0 b) Doctors: 27 0.0 Stunted Wasted Underweight c) Nurses: 199 d) Clinical officers: 33 II Marsabit 11 National e) Public health workers: 40 d) Stunted children (2014): 27 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 25% e) Wasted children (2014): 16 in every 100 children b) HIV prevalence (2016): 1.2% f) Underweight children (2014): 30 in every 100 children c) Tuberculosis prevalence (2017): 174 per 100,000 people d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people a) Total budget allocation to health sector (2015/16): (2013/14 to 2016/17) 14.5% b) Health spending (2014/15): Ksh 1,728.89 million 900 c) Health spending (2015/16): Ksh 955.19 million 800 --8-3-8700 --685~69 9 d) Per capita health spending (2014/15): Ksh 1,358668 600 e) NHIF coverage (2015/16): 9.8 persons for every 100 500 400 364 344 citizens 300 303 329 200 ::-------;..: 2452 02 168 - f) Development allocation as percentage of total health156 100 0 spending (2015/16): 31% 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 69% 31% 4. Health status 2014/15 73% 27% 2013/14 80.0 74.9 66% 34% 70.0 67.561.8 58.0 60.0 0% 20%4 0% 60%8 0% 100% 50.0 II Recurrent ■ Development 40.0 30.0 25.8 20.0 11.7 6. Health infrastructure (2017) 10.0 0.0 Children 12 -23 months a) Hospital beds: 3.4 per 10,000 populationProportion of married Proportion of births women using attended by a skilled fully vaccinated contraception health worker b) Health facilities: 19.3 per 10,000 population Marsabit ■ National 1 World Health Organization (WHO) target is 230 medical workers per 100,000 people. 23 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 105 various conditions (2017) d) Primary health facilities:100 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 5 b) Essential drugs for children: 40% f) Total beds and cots: 619 c) HIV & AIDS: 67% d) Malaria: 50% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 71.5 percent f) Diabetes: 50% b) Non governmental organizations (NGOs): 0.1% c) Faith-based organizations (FBOs): 15.2% 4. Health service delivery indices (2017)2 d) Private: 13.2% a) Overall health service delivery index: 55.3% b) Medical drugs index: 67.8% c) Infrastructure index: 66% d) Amenities (water, incinerator and electricity) index: 13% 73.3% 15% e) Medical equipment index: 76.7% 0% f) Public participation in health sector index: 32.9% 72% g) Citizen satisfaction in health sector index: 45% h) Health human resources index: 25.7% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 2. Water and sanitation (2017) 80.070.0 60.0 Proportion of the population with access to improved water and Human resource 50.0 40.0 sanitation: 26% 30.020.0 10.0 0.0 3. Level of availability and functionality of medical equipment Infrustructure Citizen satisfaction in health facilities (2017) a) Obstetric care equipment:40% incinerator, Medical Equipment b) Delivery pack: 80% electricity) 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Ensure that each household has access to clean and safe water and improved sanitation and waste disposal (ii) Put more emphasis on outreach services through community health workers (iii) Support public health awareness and education (iv) Provide adequate medical equipment, drugs (v) Deploy adequate number of health personnel in health facilities 24 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Isiolo County 1. County indicators a) Use of contraceptives (2017): 27 out of every 100 a) Location: North Eastern region of Kenya women of child bearing age a) Total population estimate (2017): 157,032 people b) Attendance by a skilled health worker (2017): 44 out (75,169 male and 81,863 female) of every 100 children born b) 15 years old and below: 4.4 out of every 10 persons c) Vaccination (2017): 82 out of every 100 children c) Overall poverty index (2015/16): 51.9% 30.0 d) Life expectancy (2014): 67.5 years 26.0 25.0 e) Fertility rate (2014): 4.9 children per woman 19.1 20.0 2. Human resources for health (2017) 15.0 12.9 11.0 a) Medical workers: 137 per 100,000 population1 9.110.0 b) Doctors: 26 4.05.0 c) Nurses: 195 0.0 d) Clinical officers: 30 Stunted Wasted Underweight e) Public health workers: 30 II Isiolo 11 National 3. Health indicators a) Malaria test positivity rate (2017): 39% d) Stunted children (2014): 19 children in every 100 b) HIV prevalence (2016): 4.2% children c) Tuberculosis prevalence (2017): 339 per 100,000 people e) Wasted children (2014): 9 in every 100 children f) Underweight children (2014): 13 in every 100 children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) 5. Health financing a) Total budget allocation to health sector (2015/16): 1000 17.9% 900 908 800 814 807 ~ --------=- b) Health spending (2014/15): Ksh 548.31 million700 706 600 c) Health spending (2015/16): Ksh 681.13 million 500 400 d) Per capita health spending (2014/15): Ksh 3,670 300 200 195 181 184 188 e) NHIF coverage (2015/16): 20.5 persons for every 100 98 127 105 102 0 100 citizens 2013/14 2014/15 2015/16 2016/17 f) Development allocation as percentage of total health New mental disorders in OPD 100,000 people spending (2015/16): 16% - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 84% 16% 4. Health status 2014/15 84% 16% 90.0 82.3 80.0 74.9 2013/14 80% 20% 70.0 61.8 58.0 60.0 0% 20%4 0% 60%8 0% 100% 50.0 43.8 40.0 I II Recurrent ■ Development30.0 27.020.010.00.0 6. Health infrastructure (2017) Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated health worker a) Hospital beds: 39 per 10,000 populationcontraception ■ Isiolo ■ National b) Health facilities: 4 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 25 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 57 various conditions (2017) d) Primary health facilities: 54 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 3 b) Essential drugs for children: 75% f) Total beds and cots: 615 c) HIV & AIDS: 75% d) Malaria: 75% 2. Ownership of health facilities e) Tuberculosis: 50% a) Government: 68.4 percent f) Diabetes: 75% b) Non governmental organizations (NGOs): 1.8% c) Faith-based organizations (FBOs): 17.5% 5. Health service delivery indices (2017)2 d) Private: 12.3% a) Overall health service delivery index: 61.1% b) Medical drugs index: 75% c) Infrastructure index: 75% d) Amenities (water, incinerator and electricity) index: 12% 91.7% e) Medical equipment index: 79.2% 18% f) Public participation in health sector index: 36.7% 2% g) Citizen satisfaction in health sector index: 50.8% 68% h) Health human resources index: 19.6% Access to basic ■ Public ■ NGOs ■ FBOs ■ Private drugs100.0 3. Water and sanitation (2017) 80.0Human resource Public60.0 Proportion of the population with access to improved water 40.0 20.0 and sanitation: 70.7% 0.0 Infrustructure Citizen 4. Level of availability and functionality of medical equipment satisfaction in health facilities (2017) Medical (water,… Equipment a) Obstetric care equipment:100% b) Delivery pack: 100% 6. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Have a special fund dedicated to infrastructure development and enhance security in the county (ii) Ensure that adequate budget is allocated in a bid to improve provision of essential medical drugs 26 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Meru County 1. County indicators a) Use of contraceptives (2017): 78 out of every 100 a) Location: Eastern region of Kenya women of child bearing age b) Total population estimate (2017): 1,485,526 people b) Attendance by a skilled health worker (2017): 83 out of (745,024 male and 740,502 female) every 100 children born c) 15 years old and below: 3.9 out of every 10 persons c) Vaccination (2017): 84 out of every 100 children d) Overall poverty index (2015/16): 19.4% e) Life expectancy (2014): 65.5 years 30.0 25.2 26.0 f) Fertility rate (2014): 3.1 children per woman 20.0 2. Human resources for health (2017) 11.08.1 a) Medical workers: 90 per 100,000 population1 10.0 2.9 4.0 b) Doctors: 69 0.0 c) Nurses: 754 Stunted Wasted Underweight d) Clinical officers: 93 e) Public health workers: 157 II Meru 11 National 3. Health indicators d) Stunted children (2014): 25 children in every 100 a) Malaria test positivity rate (2017): 54% children b) HIV prevalence (2016): 3% e) Wasted children (2014): 3 in every 100 children c) Tuberculosis prevalence (2017): 219 per 100,000 people f) Underweight children (2014): 8 in every 100 children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 5. Health financing a) Total budget allocation to health sector (2015/16): people (2013/14 to 2016/17) 12.4% 6000 b) Health spending (2014/15): Ksh 1,728.89 million 5000 4880 c) Health spending (2015/16): Ksh 1,769.94 million 4000 ~ 3370 d) Per capita health spending (2014/15): Ksh 806 3000 3231 2000 2001 e) NHIF coverage (2015/16): 32.6 persons for every 100 1681 1000 1165 743 citizens608 0 276 299 265 244 2013/14 2014/15 2015/16 2016/17 f) Development allocation as percentage of total health New mental disorders in OPD 100,000 people spending (2015/16): 16% --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 84% 16% 4. Health status 2014/15 80% 20% 90.0 82.8 83.9 78.2 80.0 74.9 70.0 2013/1461.8 41% 59% 58.0 60.0 50.0 0% 20%4 0% 60%8 0% 100% 40.0 30.0 II Recurrent II Development 20.0 10.0 0.0 6. Health infrastructure (2017) Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated contraception health worker a) Hospital beds: 1.5 per 10,000 population II Meru ■ National b) Health facilities: 12 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 27 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 307 various conditions (2017) d) Primary health facilities: 293 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 14 b) Essential drugs for children: 50% f) Total beds and cots: 2,312 c) HIV & AIDS: 100% d) Malaria: 70% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 30.5 percent f) Diabetes: 38% b) Non governmental organizations (NGOs): 1.1% c) Faith-based organizations (FBOs): 11.8% 4. Health service delivery indices (2017) 2 a) Overall health service delivery index: 68.3% d) Private: 56.6% b) Medical drugs index: 83.3% c) Infrastructure index: 70.6% d) Amenities (water, incinerator and electricity) index: 88.9% 30% e) Medical equipment index: 88.9% 57% f) Public participation in health sector index: 41.6%1% g) Citizen satisfaction in health sector index: 61.1% 12% h) Health human resources index: 43.4% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 2. Water and sanitation (2017) 80.0 Proportion of the population with access to improved water Human resource 60.0 40.0 and sanitation: 48.7% 20.0 0.0 3. Level of availability and functionality of medical equipment Infrustructure in health facilities, (2017) a) Obstetric care equipment: 80% b) Delivery pack: 83.33% incinerator, electricity) Medical Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Construct and or expand the existing facilities to ensure that the citizens access adequate medical services; and (ii) Allocate more funds towards purchase of essential health drugs and equipment. 28 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Tharaka Nithi County 1. County indicators a) Use of contraceptives (2017): 74 out of every 100 a) Location: Eastern region of Kenya women of child bearing age b) Total population estimate (2017): 400,069 people (198,233 b) Attendance by a skilled health worker (2017): 77 out male and 201,836 female) of every 100 children born c) 15 years old and below: 4.3 out of every 10 persons c) Vaccination (2017): 95 out of every 100 children d) Overall poverty index (2015/16): 23.6% 35.0 32.9 e) Life expectancy (2014): 67 years 30.0 26.0 f) Fertility rate (2014): 3.4 children per woman 25.0 20.0 2. Human resources for health (2017) 15.0 10.8 11.0 a) Medical workers: 139 per 100,000 population1 10.0 3.3 4.0 b) Doctors: 47 5.0 0.0 c) Nurses: 329 Stunted Wasted Underweight d) Clinical officers: 40 II Tharaka Nithi II National e) Public health workers: 50 3. Health indicators d) Stunted children (2014): 33 children in every 100 a) Malaria test positivity rate (2017): 36% children b) HIV prevalence (2016): 5.3% e) Wasted children (2014): 3 in every 100 children c) Tuberculosis prevalence (2017): 243 per 100,000 people f) Underweight children (2014): 11 in every 100 d) Number and type of new non-communicable disease cases children in outpatient departments (OPD) per 100,000 people 5. Health financing (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 6000 26.2 % 5000 :::;......----:--5-404 b) Health spending (2014/15): Ksh 736.67 million4597 4000 c) Health spending (2015/16): Ksh 855.79 million 3696 3000 d) Per capita health spending (2014/15): Ksh 2,244 2000 1932 e) NHIF coverage (2015/16): 12.4 persons for every 100 1000 445 56125 857 7 citizens 0 2 37230 430 2013/14 2014/15 2015/16 2016/17 f) Development allocation as percentage of total health New mental disorders in OPD 100,000 people spending (2015/16): 15% --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people I 2015/16 85% 15% 4. Health status 2014/15 79% -21% 120.0 100.0 95.3 2013/14 80% 20% 80.0 74.0 76.6 74.9 0% 20%4 0% 60%8 0% 100% 58.0 61.8 60.0 II Recurrent ■ Development 40.0 20.0 0.0 Proportion of married Proportion of births Children 12 -23 months 6. Health infrastructure (2017) women using attended by a skilled fully vaccinated contraception health worker a) Hospital beds: 8 per 10,000 population II Tharaka Nithi I National b) Health facilities: 2 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 29 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 183 various conditions (2017) d) Primary health facilities: 175 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 8 b) Essential drugs for children: 29% f) Total beds and cots: 852 c) HIV & AIDS: 71% d) Malaria: 43% 1. Ownership of health facilities e) Tuberculosis: 71% a) Government: 51.6% f) Diabetes: 71% b) Non governmental organizations(NGOs): 4.6% c) Faith-based organizations (FBOs): 20.9% 4. Health service delivery indices (2017)2 d) Private: 24.8% a) Overall health service delivery index: 58.2% b) Medical drugs index: 64.2% c) Infrastructure index: 48.4% 24% d) Amenities (water, incinerator and electricity) index: 88.9% 51% e) Medical equipment index: 72.2% 21% f) Public participation in health sector index: 41.5% 4% g) Citizen satisfaction in health sector index: 39.5% h) Health human resources index: 53% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 80.0 2. Water and sanitation (2017) Human resource 60.0 Proportion of the population with access to improved water and 40.0 20.0 sanitation: 96.3% 0.0 Infrustructure 3. Level of availability and functionality of medical equipment in health facilities (2017) a) Obstetric care equipment: 71.43% incinerator, electricity) Medical Equipment b) Delivery pack: 83.33% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Design and implement more interventions in preventive and promotive health care to reduce disease prevalence, stunting, wasting and underweight among children (ii) Increase supply of the essential drugs for mothers and children (iii) Increase public participation in health planning interventions (iv) Increase the number of health personnel, especially public health workers, to sensitize the community on health care services (v) Increase expenditure on development for improved health infrastructural capacity in the county 30 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Embu County 1. County indicators a) Use of contraceptives (2017): 70.6 out of every 100 a) Location: Eastern region of Kenya women of child bearing age b) Total population estimate (2017): 565,367 people b) Attendance by a skilled health worker (2017): 82 out of every 100 children born (282,501 male and 282,866 female) c) Vaccination (2017): 86 out of every 100 children c) 15 years old and below: 3.7 out of every 10 persons d) Overall poverty index (2015/16): 28.2% 26.826.0 e) Life expectancy (2014): 67 years 30.0 f) Fertility rate (2014): 3.1 children per woman 20.0 11.111.0 2. Human resources for health (2017) 10.0 3.0 4.0 a) Medical workers: 190 per 100,000 population1 b) Doctors: 66 0.0 Stunted Wasted Underweight c) Nurses: 645 d) Clinical officers: 72 II Embu 11 National e) Public health workers: 100 3. Health indicators d) Stunted children (2014): 27 children in every 100 a) Malaria test positivity rate (2017): 57% children e) Wasted children (2014): 3 in every 100 children b) HIV prevalence (2016): 3.7% f) Underweight children (2014): 11 in every 100 c) Tuberculosis prevalence (2017): 245 per 100,000 people children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 5. Health financing people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 15.1% 7000 b) Health spending (2014/15): Ksh 375.87 million 6000 6009 5000 c) Health spending (2015/16): Ksh 1,314.42 million 4000 3404 d) Per capita health spending (2014/15): Ksh 1,9893000 2000 23551733 2040 e) NHIF coverage (2015/16): 33.5 persons for every 100 1000 983 3118755 21249 225 277 citizens0 2013/14 2014/15 2015/16 2016/17 f) Development allocation as percentage of total health New mental disorders in OPD 100,000 people spending (2015/16): 16% --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 84% 16% 4. Health status 2014/15 76% 24% 90.0 85.581.5 80.0 74.970.6 70.0 2013/1461.8 75% 25% 58.0 60.0 50.0 0% 20%4 0% 60%8 0% 100% 40.0 30.0 II Recurrent II Development 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of married Proportion of births Children 12 -23 months a) Hospital beds: 26 per 10,000 population women using attended by a skilled fully vaccinated contraception health worker b) Health facilities: 4 per 10,000 population 11 Embu I National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 31 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 202 various conditions (2017) d) Primary health facilities: 194 a) Essential drugs for mothers: 50% e) County and sub-county hospitals: 8 b) Essential drugs for children: 50% f) Total beds and cots: 1,485 c) HIV & AIDS: 67% 1. Ownership of health facilities d) Malaria: 33% a) Government: 47.1% e) Tuberculosis: 67% b) Non governmental organizations (NGOs): 2.5% f) Diabetes: 67% c) Faith-based organizations (FBOs): 12.7% 4. Health service delivery indices (2017)2 d) Private: 37.7% a) Overall health service delivery index: 69.6% b) Medical drugs index: 55.7% c) Infrastructure index: 73.4% d) Amenities (water, incinerator and electricity) index: 88.9% 38% 47% e) Medical equipment index: 83.3% f) Public participation in health sector index: 45.4% 13%2% g) Citizen satisfaction in health sector index: 63.1% h) Health human resources index: 81.2% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 2. Water and sanitation (2017) 100.0 80.0 Proportion of the population with access to improved water Human resource 60.0 Public participation and sanitation: 98.4% 40.020.0 0.0 3. Level of availability and functionality of medical equipment Infrustructure Citizen satisfaction in health facilities (2017): a) Obstetric care equipment: 75% incinerator, Medical Equipment electricity) b) Delivery pack: 100% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Enhance citizen participation by establishing a civic education unit, increasing the frequency of public participation forums, and involve the public during budget formulation and implementation processes (ii) Enhance provision of obstetric care equipment and essential drugs in the health facilities 32 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kitui County 1. County indicators a) Use of contraceptives (2017): 57 out of every 100 a) Location: Eastern region of Kenya women of child bearing age b) Total population estimate (2017): 1,108,594 people b) Attendance by a skilled health worker (2017): 46 out (534,651 male and 573,943 female) of every 100 children born c) 15 years old and below: 4.6 out of every 10 persons c) Vaccination (2017): 57 out of every 100 children d) Overall poverty index (2015/16): 47.5% 45.8 e) Life expectancy (2014): 64 years 50.0 f) Fertility rate (2014): 3.9 children per woman 40.0 30.0 26.0 19.7 2. Human resources for health (2017) 20.0 11.0 a) Medical workers: 76 per 100,000 population1 10.0 3.4 4.0 b) Doctors: 45 0.0 c) Nurses: 553 Stunted Wasted Underweight d) Clinical officers: 64 Kitui e) Public health workers: 120 II 11 National 3. Health indicators d) Stunted children (2014): 46 children in every 100 children a) Malaria test positivity rate (2017): 31% e) Wasted children (2014): 3 in every 100 children b) HIV prevalence (2016): 4.3% f) Underweight children (2014): 20 in every 100 c) Tuberculosis prevalence (2017): 177 per 100,000 people children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 people 5. Health financing (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 22.7% 4000 3500 b) Health spending (2014/15): Ksh 1,575.81 million3431 3000 =-----2-9-8~-8 --- ----....... c) Health spending (2015/16): Ksh 1,545.89 million2500 2584 2000 2029 d) Per capita health spending (2014/15): Ksh 1,314 1500 e) NHIF coverage (2015/16): 26.9 persons for every 100 1000 639 citizens500 395 447 494 0 103 190 219 149 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 31% New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people I 2015/16 - 69% 31% 4. Health status 2014/15 73% 27% 80.0 74.9 70.0 2013/1461.8 89% 11% 60.0 57.3 58.0 56.8 I 50.0 46.2 0% 20%4 0% 60%8 0% 100% 40.0 II Recurrent ■ Development 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of Proportion of births Children 12 -23 married women attended by a skilled months fully a) Hospital beds: 3.5 per 10,000 population using contraception health worker vaccinated Kitui b) Health facilities: 13 per 10,000 populationII ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 33 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 445 various conditions (2017) d) Primary health facilities: 441 a) Essential drugs for mothers: 67% e) County and sub-county hospitals: 14 b) Essential drugs for children: 33% f) Total beds and cots: 1481 c) HIV & AIDS: 100% d) Malaria: 50% 1. Ownership of health facilities e) Tuberculosis: 67% a) Government: 74.1 percent f) Diabetes: 100% b) Non governmental organizations (NGOs): 0.2% c) Faith-based organizations (FBOs): 6.6% 4. Health service delivery indices (2017)2 d) Private: 18.2% a) Overall health service delivery index: 57.8% b) Medical drugs index: 69.5% c) Infrastructure index: 58.0% d) Amenities (water, incinerator and electricity) index: 19% 72.2% e) Medical equipment index: 61.1% 7% 0% f) Public participation in health sector index: 33.2% g) Citizen satisfaction in health sector index: 64.0% 74% h) Health human resources index: 46.8% Access to basic drugs ■ Public ■ NGOs ■ FBOs ■ Private 80.070.0 60.0 Human resource 50.0 40.0 30.0 2. Water and sanitation (2017) 20.0 10.0 Proportion of the population with access to improved water and 0.0 Infrustructure Citizen satisfaction sanitation: 56.8% 3. Level of availability and functionality of medical equipment incinerator, Medical Equipment in health facilities (2017): electricity) a) Obstetric care equipment:100% b) Delivery pack: 66.6% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Improve the level of immunization and nutritional status among children (ii) Improve community participation in health sector planning and identification of health programmes and services (iii) Roll out water and sanitation (WASH) programme in collaboration with existing health sector stakeholders 34 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Machakos County 1. County indicators a) Use of contraceptives (2017): 76 out of every 100 women a) Location: Eastern region of Kenya of child bearing age b) Total population estimate (2017): 1,203,250 people b) Attendance by a skilled health worker (2017): 63 out of (603,366 male and 599,884 female) every 100 children born c) 15 years old and below: 3.9 out of every 10 persons c) Vaccination (2017): 90 out of every 100 children d) Overall poverty index (2015/16): 23.3% 30.0 26.5 e) Life expectancy (2014): 62 years 26.0 25.0 f) Fertility rate (2014): 3.4 children per woman 20.0 2. Human resources for health (2017) 15.0 11.08.1 a) Medical workers: 102 per 100,000 population1 10.0 6.5 4.0 5.0 b) Doctors: 88 0.0 c) Nurses: 659 Stunted Wasted Underweight d) Clinical officers: 97 II Machakos I I National e) Public health workers: 113 3. Health indicators d) Stunted children (2014): 27 children in every 100 children a) Malaria test positivity rate (2017): 19% e) Wasted children (2014): 7 in every 100 children b) HIV prevalence (2016): 5% f) Underweight children (2014): 8 in every 100 children c) Tuberculosis prevalence (2017): 189 per 100,000 people d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 15.8% 4 500 b) Health spending (2014/15): Ksh 1,924.63 million 4000 L 40813500 z c) Health spending (2015/16): Ksh 2,525.73 million3000 2960 2500 z ~ 246z5 d) Per capita health spending (2014/15): Ksh 1,4622000 1500 148z8 e) NHIF coverage (2015/16): 28.4 persons for every 100 1000 815 915628 citizens500 403 123 189 154 2330 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 21% New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 4. Health status 2015/16 79% 21% 100.0 90.0 90.0 2014/15 74% 26% 80.0 75.9 74.9 70.0 63.4 58.0 61.8 60.0 2013/14 31% 69% 50.0 40.0 0% 20%4 0% 60%8 0% 100% 30.0 II Recurrent II Development 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of married Proportion of births Children 12 -23 a) Hospital beds: 2.8 per 10,000 population women using attended by a skilled months fully contraception health worker vaccinated b) Health facilities: 18.7 per 10,000 population 11 Machakos ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 35 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 409 various conditions (2017) d) Primary health facilities: 397 a) Essential drugs for mothers: 67% e) County and sub-county hospitals: 12 b) Essential drugs for children: 50% f) Total beds and cots: 2308 c) HIV & AIDS: 80% d) Malaria: 33% 1. Ownership of health facilities e) Tuberculosis: 83% a) Government: 43.6% f) Diabetes: 100% b) Non governmental organizations (NGOs): 1.5% c) Faith-based organizations (FBOs): 7.8% 4. Health service delivery indices (2017)2 d) Private: 47% a) Overall health service delivery index: 63.4% b) Medical drugs index: 68.8% c) Infrastructure index: 74.6% d) Amenities (water, incinerator and electricity) 47% 44% index: 83.3% e) Medical equipment index: 80.6% 1% 8% f) Public participation in health sector index: 38.6% g) Citizen satisfaction in health sector index: 49.7% h) Health human resources index: 47.9% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 2. Water and sanitation (2017) 80.0 Human resource 60.0 Proportion of the population with access to improved water 40.0 and sanitation: 83.5% 20.0 0.0 3. Level of availability and functionality of medical equipment Infrustructure in health facilities (2017): a) Obstetric care equipment: 100% incinerator, electricity) Medical Equipmentb) Delivery pack: 100% 11. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Ensure sufficient medical supplies in health facilities especially drugs for mothers, children and malaria (ii) Expand public health education among pregnant women and mothers as a measure towards addressing stunting and wasting among children (iii) Address non-communicable diseases, especially hypertension among adults through promotion of healthy living and nutritional support 36 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Makueni County 1. County indicators a) Use of contraceptives (2017): 80 out of every 100 a) Location: Lower eastern region of Kenya women of child bearing age b) Total population estimate (2017): 968,596 people b) Attendance by a skilled health worker (2017): 54.6 out of every 100 children born (478,469 male and 490,127 female) c) Vaccination (2017): 90 out of every 100 children c) 15 years old and below: 4 out of every 10 persons d) Overall poverty index (2015/16): 34.8% 30.0 26.0 e) 25.1Life expectancy (2014): 62 years f) Fertility rate (2014): 3.3 children per woman 20.0 10.211.0 2. Human resources for health (2017) 10.0 2.1 4.0 a) Medical workers: 62 per 100,000 population1 0.0 b) Doctors: 51 Stunted Wasted Underweight c) Nurses: 436 Makueni National d) Clinical officers: 73 II 11 e) Public health workers:152 d) Stunted Children (2014): 25 in every 100 children 3. Health indicators e) Wasted children (2014): 2 in every 100 children a) Malaria test positivity rate (2017): 11% f) Underweight children (2014): 10 in every 100 children b) HIV prevalence (2016): 5.6% c) Tuberculosis prevalence (2017): 194 per 100,000 people 5. Health financing d) Number and type of new non-communicable disease a) Total budget allocation to health sector (2015/16): cases in outpatient departments (OPD) per 100,000 people 30.4% (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 1,264.9 million c) Health spending (2015/16): Ksh 1,769.5 million 6000 5000 d) Per capita health spending (2014/15): Ksh 1,680::.;.........-4-957 4000 4015 e) NHIF coverage (2015/16): 27.4 persons for every 3000 3183 100 citizens 2366 2000 ----------------------- f) Development allocation as percentage of total health 1000 496 583 741 1004 spending (2015/16): 32% 0 273 235 315 243 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people I - New hypertention in □PD per 100,000 people 2015/16 - 68% 32% New diabetes in OPD per 100,000 people 2014/15 4. Health status 79% 21% 2013/14 85% 15% 100.00 89.70 I 90.00 80.30 80.00 74.9 70.00 61.8 0% 20%4 0% 60%8 0% 100%58 60.00 54.60 50.00 40.00 II Recurrent II Development 30.00 20.00 10.00 0.00 rl~~,~~Ll 6. Health infrastructure (2017) Proportion of Proportion of Children 12 -23 women using births attended months fully a) Hospital beds: 16 per 10,000 population contraception by a skilled health vaccinated worker b) Health facilities: 4 per 10,000 population II Makueni 11 National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 37 Number of health facilities Proportion of health facilities with validity medical drugs for a) Total health facilities: 345 various conditions b) Primary health facilities: 336 c) Essential drugs for mothers: 80% c) County and sub-county hospitals: 9 e) Essential drugs for children: 82% d) Total beds and cots: 1,558 f) HIV & AIDS: 60% g) Malaria : 63% 1. Ownership of health facilities h) Tuberculosis: 88% a) Government: 70.2% h) Diabetes : 80% b) Non governmental organizations (NGOs): 0.9% 10. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 9% d) Private: 19.9% a) Overall health service delivery index: 60% b) Medical drugs index: 58.3% c) Infrastructure index: 59% 20% d) Amenities (water, incinerator and electricity) index: 66.7% 9% 1% e) Medical equipment index: 80% 70% f) Public participation in health sector index: 38.5% g) Citizen satisfaction in health sector index: 80% h) Health human resources index: 37.6% ■ Public ■ NGOs ■ FBOs ■ Private 2. Water and sanitation Access to basic drugs Proportion of the population with access to improved water and 80.070.0 sanitation: 88.0% 60.0Human resource 50.0 40.0 9. Level of availability and functionality of medical equipment in 30.020.0 health facilities, 2017 10.00.0 a) Obstetric care equipment: 100% Infrustructure Citizen satisfaction b) Delivery pack: 100% incinerator, Medical Equipment electricity) 11. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Utilize community health workers to enhance access to immunization and child nutrition services for improved long-term child development (ii) Address rising cases of non-communicable diseases especially diabetes and hypertension in the county (iii) Establish a framework for sharing medical specialists with neighbouring counties and/or with the national government (iv) Equip health facilities with essential supplies and equipment while adhering to Kenya Essential Package for Health (KEPH) services (v) Build capacity of health staff in health planning and budgeting through partnerships with other stakeholders in public private sectors (vi) Expand resource flows for drugs and human resource inputs 38 Number of health facilities Proportion of health facilities with validity medical drugs for a) Total health facilities: 345 various conditions b) Primary health facilities: 336 c) Essential drugs for mothers: 80% The KENYA INSTITUTE for PUBLIC c) County and sub-county hospitals: 9 e) Essential drugs for children: 82% POLICY RESEARCH and ANALYSIS d) Total beds and cots: 1,558 f) HIV & AIDS: 60% g) Malaria : 63% 1. Ownership of health facilities h) Tuberculosis: 88% a) Government: 70.2% h) Diabetes : 80% b) Non governmental organizations (NGOs): 0.9% Health Care Delivery under Devolution: Nyandarua County 10. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 9% d) Private: 19.9% a) Overall health service delivery index: 60% b) Medical drugs index: 58.3% 1. County indicators a) Use of contraceptives (2017): 66 out of every 100 c) Infrastructure index: 59% a) Location: Central region of Kenya women of child bearing age d) Amenities (water, incinerator and electricity) index: b) Total population estimate (2017): 699,924 people b) Attendance by a skilled health worker (2017): 85 out of 66.7% every 100 children born 347,557 male and 352,367 female) e) Medical equipment index: 80% c) Vaccination (2017): 81 out of every 100 childrenc) 15 years old and below: 4.3 out of every 10 persons f) Public participation in health sector index: 38.5% d) Overall poverty index (2015/16): 34.8% g) 40.0Citizen satisfaction in health sector index: 80% e) Life expectancy (2014): 60 years 29.4 h) Health human resources index: 37.6% 26.0f) Fertility rate (2014): 3.5 children per woman 30.0 20.0 2. Human resources for health (2017) 11.0 2. Water and sanitation 6.8a) Medical workers: 83 per 100,000 population1 10.0 2.0 4.0 Proportion of the population with access to improved water and b) Doctors: 56 0.0 sanitation: 88.0% c) Nurses: 446 Stunted Wasted Underweight 9. Level of availability and functionality of medical equipment in d) Clinical officers: 51 II Nyandarua II National health facilities, 2017 e) Public health workers: 101 a) Obstetric care equipment: 100% 3. Health indicators d) Stunted children (2014): 30 children in every 100 b) Delivery pack: 100% childrena) Malaria test positivity rate (2017): 49% e) Wasted children (2014): 2 in every 100 children b) HIV prevalence (2016): 3.8% f) Underweight children (2014): 7 in every 100 children c) Tuberculosis prevalence (2017): 119 per 100,000 people d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): 25% people (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 970.04 million 6000 c) Health spending (2015/16): Ksh 1,137.62 million 5434 5000 4818 -----.........4..6 58 d) Per capita health spending (2014/15): Ksh 686 4000 e) NHIF coverage (2015/16): 22.5 persons for every 3715 3000 100 citizens 2000 f) Development allocation as percentage of total health 1318 1648 1665 1334 1000 spending (2015/16): 18%681 523 632 432 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people I New diabetes in OPD per 100,000 people 2015/16 82% 18% I 2014/15 65% 35% 4. Health status I 2013/14 77% 23% 90.0 85.3 81.4 I 80.0 74.9 65.6 0% 20%4 0% 60%8 0% 100%70.0 61.8 58.0 60.0 II Recurrent II Development 50.0 40.0 30.0 6. Health infrastructure (2017) 20.0 10.0 a) Hospital beds: 10 per 10,000 population 0.0 Children 12 -23 months b) Health facilities: 3 per 10,000 populationProportion of married Proportion of births women using attended by a skilled fully vaccinated contraception health worker 11 Nyandarua ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 39 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 175 various conditions (2017) d) Primary health facilities: 171 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 4 b) Essential drugs for children: 70% f) Total beds and cots: 693 c) HIV & AIDS: 70% d) Malaria: 80% 1. Ownership of health facilities e) Tuberculosis: 80% a) Government: 48.6% f) Diabetes: 80% b) Non governmental organizations(NGOs): 2.8% c) Faith-based organizations (FBOs): 10.5% 4. Health service delivery indices (2017) 2 d) Private: 40.3% a) Overall health service delivery index: 54.5% b) Medical drugs index: 80% c) Infrastructure index: 40% d) Amenities (water, incinerator and electricity) index: 39% 48% 33.3% e) Medical equipment index: 69.4% 10% f) Public participation in health sector index: 44.6% 3% g) Citizen satisfaction in health sector index: 48.3% h) Health human resources index: 66% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 80.0 70.0 2. Water and sanitation (2017) 60.0Human resource Public50.0 Proportion of the population with access to improved water and 40.030.0 sanitation: 81.1% 20.010.0 0.0 3. Level of availability and functionality of medical equipment Infrustructure Citizen satisfaction in health facilities (2017) a) Obstetric care equipment: 80% incinerator, Medical b) Delivery pack: 66.67% electricity) Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Increase the number of community health workers and NHIF coverage through enhanced community sensitization (ii) Increase public participation in health planning, budgeting and programme implementation (iii) Invest in preventive and promotive health care to reduce disease prevalence, stunting, wasting and underweight among children (iv) Establish socio-economic activities to improve citizens’ economic status and eliminate poverty 40 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Nyeri County 1. County indicators a) Use of contraceptives (2017): 73 out of every 100 women a) Location: Central region of Kenya of child bearing age b) Total population estimate (2017): 814,182 people (405,394 b) Attendance by a skilled health worker (2017): 88 out of every 100 children born male and 408,788 female) c) Vaccination (2017): 84 out of every 100 children c) 15 years old and below: 3.3 out of every 10 persons d) Overall poverty index (2015/16): 19.3% 30.0 26.0 e) Life expectancy (2014): 60 years f) Fertility rate (2014): 2.7 children per woman 20.0 15.1 11.0 2. Human resources for health (2017) 10.0 4.0 a) Medical workers: 121 per 100,000 population1 2.4 2.5 b) Doctors: 97 0.0 c) Nurses: 817 Stunted Wasted Underweight d) Clinical officers: 90 I Nyeri I National e) Public health workers: 140 3. Health indicators d) Stunted children (2014): 15 children in every 100 children a) Malaria test positivity rate (2017): 32% e) Wasted children (2014): 2 in every 100 children b) HIV prevalence (2016): 4.3% f) Underweight children (2014): 3 in every 100 children c) Tuberculosis prevalence (2017): 188 per 100,000 people 5. Health financing d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): 15.8% people (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 2,107.11 million 5000 c) Health spending (2015/16): Ksh 2,032.45 million 4500 4547 4000 s s d) Per capita health spending (2014/15): Ksh 2,5743500 3000 s 301s7 .. e) NHIF coverage (2015/16): 30.7 persons for every 1002500 2000 citizens 1500 1677 1528 f) Development allocation as percentage of total health 1000 1085 75 500 642 2 85 572011 636384 spending (2015/16): 12% 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people 2015/16 88% 12% - Newhypertention in OPDperl00,000 people New diabetes in OPD per 100,000 people 2014/15 84% 16% 4. Health status 2013/14 85% 15% 75%8 0% 85%9 0% 95% 100% Recurrent Development 100.0 88.190.0 84.3 80.0 73.1 74.9 70.0 58.0 61.8 60.0 6. Health infrastructure (2017) 50.0 40.0 a) Hospital beds: 5.2 per 10,000 population 30.0 20.0 b) Health facilities: 21.7 per 10,000 population 10.0 0.0 Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated contraception health worker 11 Nyeri ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 41 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 375 various conditions (2017) d) Primary health facilities: 365 a) Essential drugs for mothers: 60% e) County and subcounty hospitals: 10 b) Essential drugs for children: 60% f) Total beds and cots: 1822 c) HIV & AIDS: 80% d) Malaria: 80% 1. Ownership of health facilities e) Tuberculosis: 80% a) Government: 33.9% f) Diabetes: 100% b) Non governmental organizations (NGOs): 0.5 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 10% d) Private: 55.6% a) Overall health service delivery index: 59.6% b) Medical drugs index: 76.7% c) Infrastructure index: 64% 34% d) Amenities (water, incinerator and electricity) index: 86.7% 56% e) Medical equipment index: 16.7% 100%% f) Public participation in health sector index: 39.8% g) Citizen satisfaction in health sector index: 58.6% h) Health human resources index: 75% ■ Public ■ NGOs ■ FBOs ■ Private 2. Water and sanitation (2017) Access to basic drugs 100.0 Proportion of the population with access to improved water and 80.0 sanitation: 55.2 percent Human resource 60.0 3. Level of availability and functionality of medical equipment 40.0 in health facilities (2017) 20.0 0.0 a) Obstetric care equipment: 100% Infrustructure Citizen satisfaction b) Delivery pack: 50% incinerator, electricity) Medical Equipment 11. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Sustain efforts that have led to decline in number of new hypertension cases (ii) Ensure adequate supply of equipment and drugs in health facilities especially drugs for mothers and children (iii) Eliminate stunting, wasting and underweight in the county through expanding public health education programmes 42 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kirinyaga County 1. County indicators a) Use of contraceptives (2017): 81 out of every 100 a) Location: Central region of Kenya women of child bearing age b) Total population estimate (2017): 619,872 people b) Attendance by a skilled health worker (2017): 93 out of (311,694 male and 308,178 female) every 100 children born c) 15 years old and below: 3.3 out of every 10 persons c) Vaccination (2017): 92 out of every 100 children d) Overall poverty index (2015/16): 20% e) Life expectancy (2014): 62.5 years f) Fertility rate (2014): 2.3 children per woman 30.0 26.0 25.0 2. Human resources for health (2017) 20.0 17.2 a) Medical workers: 88 per 100,000 population1 15.0 b) Doctors: 31 11.0 10.0 7.7 c) Nurses: 422 3.9 4.05.0 d) Clinical officers: 50 0.0 e) Public health workers: 115 Stunted Wasted Underweight 3. Health indicators II Kirinyaga II National a) Malaria test positivity rate (2017): 7% d) Stunted children (2014): 17 children in every 100 b) HIV prevalence (2016): 3.3% children c) Tuberculosis prevalence (2017): 248 per 100,000 people e) Wasted children (2014): 4 in every 100 children d) Number and type of new non-communicable disease f) Underweight children (2014): 8 in every 100 children cases in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) 5. Health financing a) Total budget allocation to health sector (2015/16): 1800 5.8% 1600 1592 1400 ................ ...........___ b) Health spending (2014/15): Ksh 202.51 million 1200 1247 12651140 1000 c) Health spending (2015/16): Ksh 1,287.93 million 800 796 d) Per capita health spending (2014/15): Ksh 656 600 400 ........... ........ 360 e) NHIF coverage (2015/16): 28.3 persons for every 100 200 213 128418 245155 153 0 citizens 2013/14 2014/15 2015/16 2016/17 f) Development allocation as percentage of total health New mental disorders in OPD 100,000 people spending (2015/16): 20% --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 4. Health status 2015/16 80% 20% 100.0 92.3 92.3 2014/15 90.0 37% 63%81.0 80.0 74.9 70.0 58.0 61.8 2013/14 9% 91% 60.0 50.0 0% 20%4 0% 60%8 0% 100% 40.0 30.0 II Recurrent ■ Development 20.0 10.0 0.0 6. Health infrastructure (2017) Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated a) Hospital beds: 17 per 10,000 population contraception health worker b) Health facilities: 5 per 10,000 population 11 Kirinyaga I National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people 43 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 296 various conditions (2017) d) Primary health facilities: 288 a) Essential drugs for mothers: 80% e) County and sub-county hospitals: 8 b) Essential drugs for children: 100% f) Total beds and cots: 1,075 c) HIV & AIDS: 100% d) Malaria: 50% 1. Ownership of health facilities e) Tuberculosis: 40% a) Government: 29.2% f) Diabetes: 100% b) Non governmental organizations (NGOs): 2.9 c) Faith-based organizations (FBOs): 12.0% 4. Health service delivery indices (2017)2 d) Private: 55.8% a) Overall health service delivery index: 65.2% b) Medical drugs index: 78.3% c) Infrastructure index: 57% 29% d) Amenities (water, incinerator and electricity) index: 56% 93.3%3% 12% e) Medical equipment index: 86.7% f) Public participation in health sector index: 34.9% g) Citizen satisfaction in health sector index: 48% h) Health human resources index: 58.4% ■ Public ■ NGOs ■ FBOs ■ Private 2. Water and sanitation (2017) Access to basic drugs Proportion of the population with access to improved water and 100.090.0 80.0 sanitation: 85 percent Human resource 70.0 Public 60.0 50.0 40.0 30.0 3. Level of availability and functionality of medical equipment in 20.010.0 0.0 health facilities (2017): Infrustructure Citizen satisfaction a) Obstetric care equipment:100% b) Delivery pack: 100% incinerator, Medical electricity) Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Support the community health workers services such as nutrition, immunization and public health (ii) Come up with more and effective channels of health sector public participation (iii) Provide civic education to encourage up take of NHIF scheme D 44 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Murang’a County 1. County indicators a) Use of contraceptives (2017): 69 out of every 100 a) Location: Central region of Kenya women of child bearing age b) Total population estimate (2017): 1,106,275 people (545,456 b) Attendance by a skilled health worker (2017): 86 out male and 560,819 female) of every 100 children born c) 15 years old and below: 3.7 out of every 10 persons c) Vaccination (2017): 86 out of every 100 children d) Overall poverty index (2015/16): 25.3% 26.0 e) Life expectancy (2014): 62 years 30.0 19.3 f) Fertility rate (2014): 7.8 children per woman 20.0 11.0 2. Human resources for health (2017) 10.0 4.0 5.61.4 a) Medical workers: 54 per 100,000 population1 0.0 b) Doctors: 72 Stunted Wasted Underweight c) Nurses: 529 d) Clinical officers: 60 II Murang'a II National e) Public health workers: 202 3. Health indicators d) Stunted children (2014): 19 children in every 100 children a) Malaria test positivity rate (2017): 25% e) Wasted children (2014): 1 in every 100 children b) HIV prevalence (2016): 5.2% f) Underweight children (2014): 6 in every 100 children c) Tuberculosis prevalence (2017): 192 per 100,000 people d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people a) Total budget allocation to health sector (2015/16): (2013/14 to 2016/17) 15.8% b) Health spending (2014/15): Ksh 931.9 million 8000 7000 ____..6. 705 c) Health spending (2015/16): Ksh 2,215.63 million6401 6000 5494 5000 :.------: d) Per capita health spending (2014/15): Ksh 1,190 4502 4000 e) NHIF coverage (2015/16): 28.6 persons for every 3000 2000 100 citizens 1567 1754 1000 1085 1158 460 483 508 431 f) Development allocation as percentage of total health 0 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 34% New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 66% 34% 2014/15 64% 36% 4. Health status 2013/14 11% 89% 100.0 90.0 85.5 86.4 0% 20%4 0% 60%8 0% 100% 80.0 74.9 68.9 70.0 58.0 61.8 II Recurrent II Development 60.0 50.0 40.0 30.0 6. Health infrastructure (2017) 20.0 10.0 a) Hospital beds: 2.4 per 10,000 population 0.0 Proportion of married Proportion of births Children 12 -23 b) Health facilities: 7.7 per 10,000 population women using attended by a skilled months fully contraception health worker vaccinated Muranga ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 45 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 299 various conditions (2017) d) Primary health facilities: 288 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 11 b) Essential drugs for children: 25% f) Total beds and cots: 911 c) HIV & AIDS: 100% 1. Ownership of health facilities d) Malaria: 33% a) Government: 49.8% e) Tuberculosis: 100% b) Non-governmental organizations(NGOs): 37.3 f) Diabetes: 67% c) Faith-based organizations (FBOs): 13.5% d) Private: 42.6% 4. Health service delivery indices (2017) 2 a) Overall health service delivery index: 67.2% b) Medical drugs index: 70.8% c) Infrastructure index: 65% 43% d) Amenities (water, incinerator and electricity) index: 50% 91.7% e) Medical equipment index: 75% f) Public participation in health sector index: 37.9% 14% g) Citizen satisfaction in health sector index: 67.8% h) Health human resources index: 62.4% 37% Access to basic ■ Public ■ NGOs ■ FBOs ■ Private drugs100.0 80.0 Human resource Public2. Water and sanitation (2017) 60.0 40.0 Proportion of the population with access to improved water and 20.0 sanitation: 65.6% 0.0 Citizen 3. Level of availability and functionality of medical equipment in Infrustructure satisfaction health facilities, (2017) a) Obstetric care equipment: 100% incinerator, MedicalEquipment b) Delivery pack: 75% electricity) 11. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Balance budgetary allocations to health sector development projects and recurrent expenditure, while allocating more funds for facility improvement (ii) Ensure that medical supplies, especially drugs for children and malaria are available in the health facilities to reduce the burden of out of pocket expenditure by patients (iii) Address rising cases of hypertension in the county through public education and nutritional support 46 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kiambu County 1. County indicators a) Use of contraceptives (2017): 74 out of every 100 a) Location: Central region of Kenya women of child bearing age b) Total population estimate (2017): 1,905,084 people b) Attendance by a skilled health worker (2017): 93 out of every 100 children born (960,825 male and 944,259 female) c) Vaccination (2017): 97 out of every 100 children c) 15 years old and below: 3.5 out of every 10 persons d) Overall poverty index (2015/16): 23.3% e) Life expectancy (2014): 63.5 years 30.0 26.0 f) Fertility rate (2014): 2.7 children per woman 20.0 15.7 11.0 2. Human resources for health (2017) 10.0 4.0 a) Medical workers: 102 per 100,000 population1 i ~ 1 --121 -.3.. - 5.1r -I] --.-,I r r b) Doctors: 196 0.0 c) Nurses: 1205 Stunted Wasted Underweight d) Clinical officers: 165 II Kiambu 11 National e) Public health workers: 276 3. Health indicators d) Stunted children (2014): 16 children in every 100 a) Malaria test positivity rate (2017): 38% children b) HIV prevalence (2016): 3.8% e) Wasted children (2014): 2 in every 100 children c) Tuberculosis prevalence (2017): 218 per 100,000 people f) Underweight children (2014): 5 in every 100 children d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 people a) Total budget allocation to health sector (2015/16): (2013/14 to 2016/17) 15.8% b) Health spending (2014/15): Ksh 3,197.16 million 4500 c) Health spending (2015/16): Ksh 3,739.59 million 4000 3859 3500 3506 d) Per capita health spending (2014/15): Ksh 1,752 3000 2951 3098 ---------- e) NHIF coverage (2015/16): 31.6 persons for every 100 25002000 citizens 1500 1409 1457 1153 f) Development allocation as percentage of total health 1000 1062 500 spending (2015/16): 22% 0 180 210 189 228 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people 2015/16 78% 22% - Newhypertention in OP □ per 100,000 people New diabetes in OPD per 100,000 people 2014/15 83% 17% 4. Health status 2013/14 88% 12% 100.0 92.6 97.2 I I I 90.0 80.0 74.0 74.9 0% 20%4 0% 60%8 0% 100% 70.0 58.0 61.8 60.0 II Recurrent II Development 50.0 40.0 30.0 6. Health infrastructure (2017) 20.0 10.0 a) Hospital beds: 2.6 per 10,000 population 0.0 Proportion of Proportion of births Children 12 -23 b) Health facilities: 17.7 per 10,000 population married women attended by a skilled months fully using contraception health worker vaccinated 11 Kiambu ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 47 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 522 various conditions (2017) d) Primary health facilities: 491 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 31 b) Essential drugs for children: 60% f) Total beds and cots: 3,569 c) HIV & AIDS: 75% d) Malaria: 70% 1. Ownership of health facilities e) Tuberculosis: 75% a) Government: 22.5% f) Diabetes: 100% b) Non governmental organizations (NGOs): 2.1 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 13.0% d) Private: 62.8% a) Overall health service delivery index: 71.9% b) Medical drugs index: 80% c) Infrastructure index: 72% 22% d) Amenities (water, incinerator and electricity) index: 2% 100% 63% 13% e) Medical equipment index: 80% f) Public participation in health sector index: 43.1% g) Citizen satisfaction in health sector index: 62.8% h) Health human resources index: 65% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic 2. Water and sanitation (2017) drugs100.0 Proportion of the population with access to improved water and Human 80.0 Public resource 60.0 sanitation: 90.3% 40.0 20.0 3. Level of availability and functionality of medical equipment 0.0 Citizen in health facilities (2017) Infrustructure satisfaction a) Obstetric care equipment: 100% Medical b) Delivery pack: 80% (water,… Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Improve investment in promotive and preventive health care especially the emerging hypertension cases (ii) Balance between health recurrent and development spending (iii) Expand citizen and community participation in health planning, budgeting and programme implementation 48 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Turkana County 1. County indicators a) Use of contraceptives (2017): 10 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 1,122,599 people b) Attendance by a skilled health worker (2017): 23 out of (581,502 male and 541,097 female) every 100 children born c) 15 years old and below: 4.6 out of every 10 persons c) Vaccination (2017): 62 out of every 100 children d) Overall poverty index (2015/16): 79.4% e) Life expectancy (2014): 57 years 40.0 34.0 f) Fertility rate (2014): 6.9 children per woman 30.0 23.9 26.0 22.9 2. Human resources for health (2017) 20.0 11.0 a) Medical workers: 24 per 100,000 population1 10.0 4.0 b) Doctors: 15 c) Nurses: 154 0.0 d) Clinical officers: 36 Stunted Wasted Underweight e) Public health workers: 80 II Turkana II National 3. Health indicators a) Malaria test positivity rate (2017): 50% d) Stunted children (2014): 24 children in every 100 b) HIV prevalence (2016): 7.6% children c) Tuberculosis prevalence (2017): 183 per 100,000 people e) Wasted children (2014): 23 in every 100 children d) Number and type of new non-communicable disease cases f) Underweight children (2014): 34 in every 100 children in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) 5. Health financing a) Total budget allocation to health sector (2015/16): 400 374 350 18.4% 300 316 b) Health spending (2014/15): Ksh 1,028 million 250 237 200 c) Health spending (2015/16): Ksh 860.94 million 181 150 133 111393 d) Per capita health spending (2014/15): Ksh 2,217100 100 81 50 48 50 45 e) NHIF coverage (2015/16): 10.1 persons for every 100 0 citizens 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people f) Development allocation as percentage of total health - Newhypertention in OPD per 100,000 people spending (2015/16): 89% New diabetes in OPD per 100,000 people 4. Health status 2015/16 11% 89% 80.0 74.9 70.0 2014/15 40% 60%61.8 61.8 58.0 60.0 50.0 2013/14 52% 48% 40.0 30.0 0% 20%4 0% 60%8 0% 100%22.8 20.0 10.4 II Recurrent ■ Development 10.0 0.0 Proportion of married Proportion of births Children 12 -23 months 6. Health infrastructure (2017) women using attended by a skilled fully vaccinated contraception health worker a) Hospital beds: 14 per 10,000 population 11 Turkana ■ National b) Health facilities: 2 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 49 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 192 various conditions (2017) d) Primary health facilities: 179 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 13 b) Essential drugs for children: 30% f) Total beds and cots: 1,671 c) HIV & AIDS: 50% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 50% a) Government: 71% f) Diabetes: 60% b) Non governmental organizations(NGOs): 1.2% c) Faith-based organizations (FBOs): 15.9% 4. Health service delivery indices (2017)2 d) Private: 11% a) Overall health service delivery index: 44.3% b) Medical drugs index: 58.3% 11% c) Infrastructure index: 62% d) Amenities (water, incinerator and electricity) index: 16% 60% e) Medical equipment index: 73.3% 1% f) Public participation in health sector index: 11.5% 71% g) Citizen satisfaction in health sector index: 40% h) Health human resources index: 5.0% Access to basic drugs ■ Public ■ NGOs ■ FBOs ■ Private 80.0 70.0 60.0 Human resource Public50.0 2. Water and sanitation (2017) 40.030.0 Proportion of the population with access to improved water and 20.010.0 0.0 sanitation: 31.9% Infrustructure Citizen satisfaction 3. Level of availability and functionality of medical equipment in health facilities (2017) incinerator, Medical electricity) Equipment a) Obstetric care equipment: 50% b) Delivery pack: 83.33% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Enhance public awareness and civic education on the role of public participation in health sector planning, budgeting, policy formulation and implementation (ii) Improve supply of medical drugs especially for children, malaria, tuberculosis and diabetes (iii) Balance recurrent and development health expenditure to avoid compromising on quality service delivery (iv) Invest in public health programs that would increase uptake of immunizations, delivery in health facilities and reduce stunting, wasting and underweight in children (v) Invest in programmes geared towards improvement of water supply and sanitation (vi) Address rising cases of mental disorders through counselling (vii) Establish socio-economic activities to improve people’s welfare and reduce poverty 50 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: West Pokot County 1. County indicators a) Use of contraceptives (2017): 14 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 673,004 people b) Attendance by a skilled health worker (2017): 27 out of every 100 children born (333,240 male and 339,764 female) c) Vaccination (2017): 31 out of every 100 children c) 15 years old and below: 5.2 out of every 10 persons d) Overall poverty index (2015/16): 57.5% 60.0 45.9 e) Life expectancy (2014): 59 years 38.5 f) Fertility rate (2014): 7.2 children per woman 40.0 26.0 14.3 2. Human resources for health (2017) 20.0 11.04.0 a) Medical workers: 75 per 100,000 population1 0.0 b) Doctors: 11 Stunted Wasted Underweight c) Nurses: 242 d) Clinical officers: 50 II West Pokot II National e) Public health workers: 60 3. d) Stunted children (2014): 46 children in every 100Health indicators children a) Malaria test positivity rate (2017): 29% e) Wasted children (2014): 14 in every 100 children b) HIV prevalence (2016): 2.8% f) Underweight children (2014): 39 in every 100 children c) Tuberculosis prevalence (2017): 226 per 100,000 people d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): people (2013/14 to 2016/17) 15.7 b) Health spending (2014/15): Ksh 513.29 million 300 c) Health spending (2015/16): Ksh 1,058.43 million 250 264 d) Per capita health spending (2014/15): Ksh 1,605 215 200 e) NHIF coverage (2015/16): 10.3 persons for every 150 159 150 134 111268 100 citizens 100 106 87 67 72 f) Development allocation as percentage of total health 50 44 spending (2015/16): 22% 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people - Newhypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 77% 22% 4. Health status 2014/15 57% 43% 80.0 74.9 70.0 61.8 2013/14 46% 54% 58.0 60.0 50.0 0% 20%4 0% 60%8 0% 100% 40.0 31.2 30.0 27.0 II Recurrent II Development 20.0 14.2 10.0 0.0 6. Health infrastructure (2017) Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated a) Hospital beds: 22 per 10,000 population contraception health worker b) Health facilities: 3 per 10,000 population 11 West Pokot ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 51 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 102 various conditions (2017) d) Primary health facilities: 99 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 3 b) Essential drugs for children: 20% f) Total beds and cots: 639 c) HIV & AIDS: 75% d) Malaria: 25% 1. Ownership of health facilities e) Tuberculosis: 75% a) Government: 71.1% f) Diabetes: 25% b) Non governmental organizations (NGOs): 1.5 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 14.8% a) Overall health service delivery index: 52.8% d) Private: 12.6 b) Medical drugs index: 53.3% c) Infrastructure index: 50% d) Amenities (water, incinerator and electricity) index: 13% 75% 15% e) Medical equipment index: 75% 1% f) Public participation in health sector index: 16.7% 71% g) Citizen satisfaction in health sector index: 69.6% h) Health human resources index: 30.3% Access to basic drugs 100.0 ■ Public ■ NGOs ■ FBOs ■ Private 80.0Human resource Public60.0 2. Water and sanitation (2017) 40.020.0 Proportion of the population with access to improved water 0.0 and sanitation: 27.3% Infrustructure 3. Level of availability and functionality of medical equipment incinerator, Medical in health facilities (2017): electricity) Equipment a) Obstetric care equipment: 100% b) Delivery pack: 100% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Enhance public awareness and civic education on the role of public participation in health sector planning, budgeting, policy formulation and implementation (ii) Improve supply of essential medical drugs especially for children, malaria and diabetes (iii) Invest in public health programs that would enhance uptake of immunizations, delivery in health facilities and reduce stunting, wasting and underweight in children (iv) Balance between recurrent and development health expenditure to promote infrastructural development and maintenance (v) Invest in programs geared towards improvement of water supply and sanitation 52 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Samburu County 1. County indicators a) Use of contraceptives (2017): 23 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 293,972 people b) Attendance by a skilled health worker (2017): 29 out of every 100 children born (146,435 male and 147,537 female) c) Vaccination (2017): 64 out of every 100 children c) 15 years old and below: 5.0 out of every 10 persons d) Overall poverty index (2015/16): 75.8% 40.0 e) Life expectancy (2014): 60 years 30.1 28.930.0 26.0 f) Fertility rate (2014): 6.3 children per woman 20.0 13.6 2. Human resources for health (2017) 11.0 a) Medical workers: 97 per 100,000 population1 10.0 4.0 b) Doctors: 13 0.0 c) Nurses: 160 Stunted Wasted Underweight d) Clinical officers: 23 II Samburu II National e) Public health workers: 40 3. Health indicators d) Stunted children (2014): 30 children in every 100 a) Malaria test positivity rate (2017): 44% children e) Wasted children (2014): 14 in every 100 children b) HIV prevalence (2016): 5% f) Underweight children (2014): 29 in every 100 c) Tuberculosis prevalence (2017): 173 per 100,000 people children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 people 5. Health financing (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 600 14.1% 500 b) Health spending (2014/15): Ksh 548.54 million477 400 389 ----- c) Health spending (2015/16): Ksh 699.05 million300 28:2::::-----.._ z d) Per capita health spending (2014/15): Ksh 2,271200 ..........___ 195 e) NHIF coverage (2015/16): 10.2 persons for every 149 1 100 11 305 1 12449 79 46 100 citizens41 0 2013/14 2014/15 2015/16 2016/17 f) Development allocation as percentage of total health New mental disorders in OPD 100,000 people spending (2015/16): 18% --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 82% 18% 4. Health status 80.0 74.9 2014/15 64% 36% 70.0 61.8 64.1 58.0 60.0 2013/14 71% 29% 50.0 40.0 29.0 0% 20%4 0% 60%8 0% 100% 30.0 22.7 20.0 II Recurrent ■ Development 10.0 0.0 Proportion of married Proportion of births Children 12 -23 women using attended by a skilled months fully 6. Health infrastructure (2017) contraception health worker vaccinated a) Hospital beds: 11 per 10,000 population 11 Samburu ■ National b) Health facilities: 2 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 53 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 210 various conditions (2017) d) Primary health facilities: 197 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 13 b) Essential drugs for children: 60% f) Total beds and cots: 1,086 c) HIV & AIDS: 50% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 75% a) Government: 63.7% f) Diabetes: 75% b) Non governmental organizations (NGOs): 8.8% 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 10.8% a) Overall health service delivery index: 54.3% d) Private: 24.5% b) Medical drugs index: 70% c) Infrastructure index: 43% 25% d) Amenities (water, incinerator and electricity) index: 65% e) Medical equipment index: 73.3% 11% 64% f) Public participation in health sector index: 24.1% 9% g) Citizen satisfaction in health sector index: 37.0% h) Health human resources index: 67.7% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 80.0 2. Water and sanitation (2017) 70.0 60.0 Proportion of the population with access to improved water Human resource 50.040.0 and sanitation: 31.5% 30.020.0 10.0 0.0 3. Level of availability and functionality of medical equipment Infrustructure in health facilities (2017) a) Obstetric care equipment: 30% b) Delivery pack: 100% incinerator, electricity) Medical Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Invest in public health programs that would increase uptake of immunizations and delivery in health facilities (ii) Focus on preventive and promotive health care including disease surveillance to reduce disease prevalence, stunting, wasting and underweight among children (iii) Balance between the recurrent and development allocation for health to enhance infrastructural development (iv) Expand community health services and sensitize the community on essence of enrollment in NHIF (v) Invest in programs geared towards improvement of water supply and sanitation (vi) Expand citizen and community participation in health planning, budgeting, policy formulation and implementation 54 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Trans Nzoia County 1. County indicators a) Use of contraceptives (2017): 64 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 1,074,741 people b) Attendance by a skilled health worker (2017): 42 out of (533,158 male and 541,583 female) every 100 children born c) 15 years old and below: 4.7 out of every 10 persons c) Vaccination (2017): 64 out of every 100 children d) Overall poverty index (2015/16): 34% 40.0 e) Life expectancy (2014): 57 years 29.2 f) 30.0 26.0 Fertility rate (2014): 5.2 children per woman 20.0 15.3 2. Human resources for health (2017) 11.0 a) Medical workers: 139 per 100,000 population1 10.0 3.9 4.0 b) Doctors: 44 0.0 Stunted Wasted Underweight c) Nurses: 399 d) Clinical officers: 62 II Trans-Nzoia II National e) Public health workers: 115 d) Stunted children (2014): 29 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 43% e) Wasted children (2014): 4 in every 100 children b) HIV prevalence (2016): 5.1% f) Underweight children (2014): 15 in every 100 children c) Tuberculosis prevalence (2017): 138 per 100,000 people d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people a) Total budget allocation to health sector (2015/16): (2013/14 to 2016/17) 28.5% 1600 b) Health spending (2014/15): Ksh 1,232 million 1483 1400 1289 1200 1203 c) Health spending (2015/16): Ksh 1,613.73 million 1000 1060 d) Per capita health spending (2014/15): Ksh 1,194 800 600 61~9----........:.. e) NHIF coverage (2015/16): 19.7 persons for every 100 400 30- 407 4459 303.......___ 334 citizens200 177 --......1.1. 4 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people spending (2015/16): 28% - New hypertention in OP□ per 100,000 people New diabetes in OPD per 100,000 people 2015/16 72% 28% 4. Health status 2014/15 73% 27% 80.0 74.9 2013/14 73% 27% 70.0 63.9 61.8 63.9 58.0 60.0 0% 20%4 0% 60%8 0% 100% 50.0 41.8 II Recurrent 40.0 ■ Development 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of Proportion of births Children 12 -23 a) Hospital beds: 6 per 10,000 population married women attended by a skilled months fully using contraception health worker vaccinated b) Health facilities: 2 per 10,000 population II Trans-Nzoia ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 55 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 240 various conditions (2017) d) Primary health facilities: 231 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 9 b) Essential drugs for children: 60% f) Total beds and cots: 677 c) HIV & AIDS: 100% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 45.9% f) Diabetes: 60% b) Non governmental organizations (NGOs): 2.7% 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 7.6% a) Overall health service delivery index: 60.4% d) Private: 43.8% b) Medical drugs index: 80% c) Infrastructure index: 68% d) Amenities (water, incinerator and electricity) index: 86.7% 44% 46% e) Medical equipment index: 83.3% f) Public participation in health sector index: 48.4% 7% 3% g) Citizen satisfaction in health sector index: 46.7% h) Health human resources index: 9.6% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 2. Water and sanitation (2017) 80.0 Human resource Proportion of the population with access to improved water and 60.0 40.0 sanitation: 36.1% 20.0 0.0 3. Level of availability and functionality of medical equipment in Infrustructure health facilities (2017) a) Obstetric care equipment: 100% incinerator, Medical Equipment electricity) b) Delivery pack: 83.33% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Sustain efforts that had led to the decline of non-communicable diseases during the review period (ii) Invest in public health programs that would increase uptake of immunizations, delivery in health facilities as well as reduce stunting and underweight in children (iii) Enhance community health services and sensitize the communities on NHIF uptake (iv) Expand citizen and community participation in health planning, budgeting, policy formulation and programme implementation (v) Invest in programs geared towards improvement of water supply and sanitation across the county 56 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Uasin Gishu County 1. County indicators a) Use of contraceptives (2017): 10 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 1,173,303 people b) Attendance by a skilled health worker (2017): 23 out of (589,604 male and 583,699 female) every 100 children born c) 15 years old and below: 4.1 out of every 10 persons c) Vaccination (2017): 62 out of every 100 children d) Overall poverty index (2015/16): 41% e) Life expectancy (2014): 55.5 years 40.0 31.2 26.0 f) Fertility rate (2014): 3.6 children per woman 30.0 20.0 11.5 11.0 2. Human resources for health (2017) 10.0 3.0 4.0 a) Medical workers: 77 per 100,000 population1 0.0 7~ ~c----1-1'' • [ I ]------111 11r b) Doctors: 56 Stunted Wasted Underweight c) Nurses: 337 d) Clinical officers: 69 II Uasin Gishu II National e) Public health workers: 150 d) Stunted children (2014): 31 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 50% e) Wasted children (2014): 3 in every 100 children b) HIV prevalence (2016): 7.6% f) Underweight children (2014): 11 in every 100 children c) Tuberculosis prevalence (2017): 183 per 100,000 people d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): 17.3% people (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 938.73 million c) Health spending (2015/16): Ksh 1,290.86 million 2500 d) Per capita health spending (2014/15): Ksh 2,217 2000 1995 e) NHIF coverage (2015/16): 10.1 persons for every 100 1830 1500 1563 citizens 1287 1000 f) Development allocation as percentage of total health 712 spending (2015/16): 15% 500 492 476 546 332 306 312 262 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people 2015/16 85% 15% New diabetes in OPD per 100,000 people 4. Health status 2014/15 68% 32% 80.0 72.3 74.9 70.0 62.6 2013/14 74% 26% 59.0 61.858.0 60.0 50.0 0% 20%4 0% 60%8 0% 100% 40.0 II Recurrent ■ Development 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 a) Hospital beds: 14 per 10,000 population Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated b) Health facilities: 2 per 10,000 population contraception health worker 11 UasinGishu ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 57 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 106 various conditions, 2017 d) Primary health facilities: 99 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 7 b) Essential drugs for children: 0% f) Total beds and cots: 861 c) HIV & AIDS: 80% d) Malaria: 40% 1. Ownership of health facilities e) Tuberculosis: 80% a) Government: 60.6 percent f) Diabetes: 80% b) Non governmental organizations(NGOs): 3.6% 4. Health service delivery indices, 20172 c) Faith-based organizations (FBOs): 10.9% a) Overall health service delivery index: 57.9% d) Private: 26.9% b) Medical drugs index: 63.3% c) Infrastructure index: 52% d) Amenities (water, incinerator and electricity) index: 80% 27% e) Medical equipment index: 53.3% f) Public participation in health sector index: 41.2% g) Citizen satisfaction in health sector index: 69.6% 11% 61% h) Health human resources index: 46% 4% Access to basic drugs 80.0 ■ Public ■ NGOs ■ FBOs Private 70.0 ■ 60.0Human resource Public50.0 40.0 2. 30.0Water and sanitation (2017) 20.0 10.0 Proportion of the population with access to improved water 0.0 Citizen and sanitation: 83.4% Infrustructure satisfaction 3. Level of availability and functionality of medical equipment Medical in health facilities, (2017): incinerator,electricity) Equipment a) Obstetric care equipment: 80% b) Delivery pack: 80% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Utilize community health workers to increase NHIF uptake and improve immunization (ii) Establish more interventions in preventive and promotive health care to reduce disease prevalence; and eliminate stunting and underweight among children (iii) Focus on improving supply of the inadequate essential medical drugs especially foe malaria 58 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Trans Nzoia County 1. County indicators a) Use of contraceptives (2017): 64 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 1,074,741 people b) Attendance by a skilled health worker (2017): 42 out of (533,158 male and 541,583 female) every 100 children born c) 15 years old and below: 4.7 out of every 10 persons c) Vaccination (2017): 64 out of every 100 children d) Overall poverty index (2015/16): 34% 40.0 e) Life expectancy (2014): 57 years 29.2 f) 30.0 26.0 Fertility rate (2014): 5.2 children per woman 20.0 15.3 2. Human resources for health (2017) 11.0 a) Medical workers: 139 per 100,000 population1 10.0 3.9 4.0 b) Doctors: 44 0.0 Stunted Wasted Underweight c) Nurses: 399 d) Clinical officers: 62 II Trans-Nzoia II National e) Public health workers: 115 d) Stunted children (2014): 29 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 43% e) Wasted children (2014): 4 in every 100 children b) HIV prevalence (2016): 5.1% f) Underweight children (2014): 15 in every 100 children c) Tuberculosis prevalence (2017): 138 per 100,000 people d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people a) Total budget allocation to health sector (2015/16): (2013/14 to 2016/17) 28.5% 1600 b) Health spending (2014/15): Ksh 1,232 million 1483 1400 1289 1200 1203 c) Health spending (2015/16): Ksh 1,613.73 million 1000 1060 d) Per capita health spending (2014/15): Ksh 1,194 800 600 61~9----........:.. e) NHIF coverage (2015/16): 19.7 persons for every 100 400 30- 407 4459 303.......___ 334 citizens200 177 --......1.1. 4 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people spending (2015/16): 28% - New hypertention in OP□ per 100,000 people New diabetes in OPD per 100,000 people 2015/16 72% 28% 4. Health status 2014/15 73% 27% 80.0 74.9 2013/14 73% 27% 70.0 63.9 61.8 63.9 58.0 60.0 0% 20%4 0% 60%8 0% 100% 50.0 41.8 II Recurrent 40.0 ■ Development 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of Proportion of births Children 12 -23 a) Hospital beds: 6 per 10,000 population married women attended by a skilled months fully using contraception health worker vaccinated b) Health facilities: 2 per 10,000 population II Trans-Nzoia ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 59 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 240 various conditions (2017) d) Primary health facilities: 231 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 9 b) Essential drugs for children: 60% f) Total beds and cots: 677 c) HIV & AIDS: 100% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 45.9% f) Diabetes: 60% b) Non governmental organizations (NGOs): 2.7% 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 7.6% a) Overall health service delivery index: 60.4% d) Private: 43.8% b) Medical drugs index: 80% c) Infrastructure index: 68% d) Amenities (water, incinerator and electricity) index: 86.7% 44% 46% e) Medical equipment index: 83.3% f) Public participation in health sector index: 48.4% 7% 3% g) Citizen satisfaction in health sector index: 46.7% h) Health human resources index: 9.6% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 2. Water and sanitation (2017) 80.0 Human resource Proportion of the population with access to improved water and 60.0 40.0 sanitation: 36.1% 20.0 0.0 3. Level of availability and functionality of medical equipment in Infrustructure health facilities (2017) a) Obstetric care equipment: 100% incinerator, Medical Equipment electricity) b) Delivery pack: 83.33% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Sustain efforts that had led to the decline of non-communicable diseases during the review period (ii) Invest in public health programs that would increase uptake of immunizations, delivery in health facilities as well as reduce stunting and underweight in children (iii) Enhance community health services and sensitize the communities on NHIF uptake (iv) Expand citizen and community participation in health planning, budgeting, policy formulation and programme implementation (v) Invest in programs geared towards improvement of water supply and sanitation across the county 60 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Elgeyo-Marakwet County 1. County indicators a) Use of contraceptives (2017): 55 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 485,680 people (240,709 b) Attendance by a skilled health worker (2017): 65 out male and 244,971 female) of every 100 children born c) 15 years old and below: 4.6 out of every 10 persons c) Vaccination (2017): 85 out of every 100 children d) Overall poverty index (2015/16): 43.4% e) Life expectancy (2014): 59.5 years 35.0 29.9 f) Fertility rate (2014): 4.1 children per woman 30.0 26.0 25.0 - 2. Human resources for health (2017) 20.0 - a) Medical workers: 74 per 100,000 population1 15.0 - 12.611.0 b) Doctors: 26 10.0 - - c) Nurses: 344 4.3 4.05.0 - - d) Clinical officers: 62 0.0 [ lr l e) Public health workers: 189 Stunted Wasted Underweight 3. Health indicators II Elgeyo-Marakwet II National a) Malaria test positivity rate (2017): 10% b) HIV prevalence (2016): 2.5% d) Stunted children (2014): 30 children in every 100 c) Tuberculosis prevalence (2017): 109 per 100,000 people children d) Number and type of new non-communicable disease e) Wasted children (2014): 4 in every 100 children cases in outpatient departments (OPD) per 100,000 f) Underweight children (2014): 13 in every 100 people (2013/14 to 2016/17) children 5. Health financing 1000 838 a) Total budget allocation to health sector (2015/16): 800 600 24.5%572 477 400 b) Health spending (2014/15): Ksh 1,067.1 million 311 322 200 245 126174 171 154 c) Health spending (2015/16): Ksh 1,128.76 million12028 0 d) Per capita health spending (2014/15): Ksh 2,159 2013/14 2014/15 2015/16 2016/17 e) NHIF coverage (2015/16): 16.7 persons for every 100 New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people citizens New diabetes in OPD per 100,000 people f) Development allocation as percentage of total health spending (2015/16): 16% 4. Health status I I I 2015/16 ( 84% 16%90.0 85.2 80.0 74.9 70.0 65.0 61.8 2014/15 81% 19% 55.2 58.060.0 50.0 2013/14 83% 17% 40.0 30.0 I I I 0% 20%4 0% 60%8 0% 100% 20.0 10.0 II Recurrent II Development 0.0 Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated 6. Health infrastructure (2017) contraception health worker ElgeyoMarakwet ■ National a) Hospital beds: 2.7 per 10,000 population b) Health facilities: 16.5 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 61 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities:113 various conditions (2017) d) Primary health facilities: 105 a) Essential drugs for mothers: 67% e) County and sub-county hospitals: 8 b) Essential drugs for children: 67% f) Total beds and cots: 806 c) HIV & AIDS: 100% d) Malaria: 67% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 84.1 percent f) Diabetes: 100% b) Non governmental organizations (NGOs): 0.1% 2 c) Faith-based organizations (FBOs): 9.6% 4. Health service delivery indices (2017) a) Overall health service delivery index: 62.4% d) Private: 6.2% b) Medical drugs index: 83.5% c) Infrastructure index: 73.2% 6% d) Amenities (water, incinerator and electricity) 01%0% index: 88.9% e) Medical equipment index: 72.2% f) Public participation in health sector index: 29.5% 84% g) Citizen satisfaction in health sector index: 60.9% h) Health human resources index: 28.6% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 2. Water and sanitation (2017) 80.0Human resource Proportion of the population with access to improved water 60.0 40.0 and sanitation: 72.9% 20.0 0.0 3. Level of availability and functionality of medical Infrustructure equipment in health facilities (2017) a) Obstetric care equipment: 100% incinerator, Medical Equipment electricity) b) Delivery pack:100% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Allocate adequate budget to health development programmes in a bid to improve service delivery (ii) Promote community health outreach services (iii) Support public participation for enhanced citizen awareness of health care services in the county (iv) Improve clean water provision at facility and household levels 62 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Nandi County 1. County indicators a) Use of contraceptives (2017): 65 out of every 100 women a) Location: Rift Valley region of Kenya of child bearing age b) Total population estimate (2017): 988,247 people b) Attendance by a skilled health worker (2017): 47 out of every 100 children born (493,511 male and 494,736 female) c) Vaccination (2017): 96 out of every 100 children c) 15 years old and below: 4.5 out of every 10 persons d) Overall poverty index (2015/16): 36% e) 40.0Life expectancy (2014): 56.5 years 29.9 26.0 f) Fertility rate (2014): 4 children per woman 30.0 20.0 2. Human resources for health (2017) 11.111.0 3.9 4.0 a) Medical workers: 49 per 100,000 population1 10.0 b) Doctors: 14 0.0 c) Nurses: 361 Stunted Wasted Underweight d) Clinical officers: 59 II Nandi II National e) Public health workers: 130 3. Health indicators d) Stunted children (2014): 30 children in every 100 children a) Malaria test positivity rate (2017): 20% e) Wasted children (2014): 4 in every 100 children b) HIV prevalence (2016): 3.7% f) Underweight children (2014): 11 in every 100 children c) Tuberculosis prevalence (2017): 96 per 100,000 people 5. Health financing d) Number and type of new non-communicable disease a) Total budget allocation to health sector (2015/16): 22.5% cases in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 1,067.1 million c) Health spending (2015/16): Ksh 1,309.14 million 1400 d) Per capita health spending (2014/15): Ksh 1,254 1311 1200 e) NHIF coverage (2015/16): 25 persons for every 100 1000 875 800 789 citizens 600 480 f) Development allocation as percentage of total health 400 380 spending (2015/16): 36% 200 246 137 152 131 187100 110 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 64% 36% 4. Health status 2014/15 66% 34% 120.0 2013/14 65% 35% 100.0 96.3 80.0 74.9 0% 20%4 0% 60%8 0% 100% 64.5 58.0 61.8 60.0 46.8 Ill II Recurrent II Development40.0 1,1 nl 6. Health infrastructure (2017)20.0 a) Hospital beds: 7 per 10,000 population0.0 Proportion of married Proportion of births Children 12 -23 women using b) Health facilities: 2 per 10,000 population attended by a skilled months fully contraception health worker vaccinated 11 Nandi ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 63 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 213 various conditions (2017) d) Primary health facilities: 208 a) Essential drugs for mothers: 67% e) County and sub-county hospitals: 5 b) Essential drugs for children: 50% f) Total beds and cots: 740 c) HIV & AIDS: 83% 1. Ownership of health facilities d) Malaria: 33% a) Government: 68.1% e) Tuberculosis: 40% b) Non governmental organizations (NGOs): 2.8% f) Diabetes: 83% c) Faith-based organizations (FBOs): 8.0% 4. Health service delivery indices (2017)2 d) Private: 23.5% a) Overall health service delivery index: 56.1% b) Medical drugs index: 59.3% c) Infrastructure index: 59.8% 24% d) Amenities (water, incinerator and electricity) index: 88.9 percent e) Medical equipment index: 75% 8% f) Public participation in health sector index: 38.1% 3% 68% g) Citizen satisfaction in health sector index: 50.8% h) Health human resources index: 20.5% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 2. Water and sanitation (2017) 80.0 Human resource Public60.0 Proportion of the population with access to improved water 40.0 and sanitation: 71% 20.0 parnc:,:::: 0.0 3. InfrustructureLevel of availability and functionality of medical equipment satisfaction in health facilities (2017) Amernties{w a) Obstetric care equipment: 60% incinerator, Medical electricity) Equipment b) Delivery pack: 70% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Develop strategies to improve public participation in health planning and programme implementation (ii) Invest in preventive and promotive health care to eliminate disease prevalence, stunting, wasting and underweight among children (iii) Increase supply of essential medical drugs especially for children, malaria and tuberculosis (iv) Establish a framework for sharing medical personnel across the county (v) Increase the number of community health workers to offer community health services and sensitize the community on essence of enrollment in NHIF (vi) Increase development health budgetary allocation for infrastructural development 64 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Baringo County 1. County indicators a) Use of contraceptives (2017): 41 out of every 100 women a) Location: Rift Valley region of Kenya of child bearing age b) Total population estimate (2017): 729,290 people (365,045 b) Attendance by a skilled health worker (2017): 53.8 out male and 364,245 female) of every 100 children born c) 15 years old and below: 4.8 out of every 10 persons c) Vaccination (2017): 69 out of every 100 children d) Overall poverty index (2015/16): 34.6% 35.0 e) Life expectancy (2014): 56.5 years 29.530.0 26.0 f) Fertility rate (2014): 4.8 children per woman 25.0 20.2 20.0 2. Human resources for health (2017) 15.0 a) Medical workers: 80 per 100,000 population1 11.0 10.0 6.9 b) Doctors: 38 4.05.0 c) Nurses: 425 0.0 d) Clinical officers: 95 Stunted Wasted Underweight e) Public health workers: 105 II Baringo II National 3. Health indicators a) Malaria test positivity rate (2017): 20% d) Stunted children (2014): 29 children in every 100 children b) HIV prevalence (2016): 3% e) Wasted children (2014): 7 in every 100 children c) Tuberculosis prevalence (2017): 102 per 100,000 people f) Underweight children (2014): 20 in every 100 children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 people 5. Health financing (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 30.3% b) Health spending (2014/15): Ksh 1,236.5 million 800 c) Health spending (2015/16): Ksh 1,780.6 million 600 631 629563 d) Per capita health spending (2014/15): Ksh 1,963 400 415 370 e) NHIF coverage (2015/16): 17 persons for every 100 200 246 289 citizens 14 152925 108 103 f) Development allocation as percentage of total health 0 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 22% New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 78% 22% 2014/15 81% 19% 4. Health status 80.0 74.9 2013/14 85% 15% 69.4 70.0 61.8 58.0 60.0 53.8 0% 20%4 0% 60%8 0% 100% 50.0 41.4I I II Recurrent II Development40.030.020.0 6. Health infrastructure (2017)10.00.0 a) Hospital beds: 11 per 10,000 population Proportion of Proportion of births Children 12 -23 married women attended by a skilled months fully b) Health facilities: 3.1 per 10,000 population using contraception health worker vaccinated 11 Baringo ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 65 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 234 various conditions (2017) d) Primary health facilities: 230 a) Essential drugs for mothers: 60% e) County and sub-county hospitals: 4 b) Essential drugs for children: 60% f) Total beds and cots: 772 c) HIV & AIDS: 80% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 85.9 percent f) Diabetes: 100% b) Non governmental organizations (NGOs): 0.4% c) Faith-based organizations (FBOs): 5.1% 4. Health service delivery indices (2017)2 d) Private: 8.5 percent a) Overall health service delivery index: 63.5% b) Medical drugs index: 76.7% c) Infrastructure index: 72% 6% 0% 9% d) Amenities (water, incinerator and electricity) index: 100% e) Medical equipment index: 93.3% 85% f) Public participation in health sector index: 32% g) Citizen satisfaction in health sector index: 56.6% h) Health human resources index: 13.2% Access to basic ■ Pu blic ■ NG Os ■ FB Os ■ Pr ivate drugs100.0 Human 80.0 Public 2. Water and sanitation (2017) resource 60.0 Proportion of the population with access to improved water and 40.0 sanitation: 71.3% 20.00.0 Infrustructure Citizen 3. Level of availability and functionality of medical equipment in satisfaction health facilities (2017) a) Obstetric care equipment: 100% (water, Medicalincinerator, Equipment b) Delivery pack: 100% electricity) 11. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Consider deploying more health workers to health facilities that are understaffed (ii) Enhance public awareness and civic education on role of public participation in health sector planning, budgeting, policy formulation and implementation (iii) Invest in public health programs that would increase uptake of vaccinations, contraceptive use and delivery in health facilities (iv) Balance health recurrent and development expenditure (v) Purchase more medical supplies such as essential drugs for mothers, children and malaria 66 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Laikipia County 1. County indicators a) Use of contraceptives (2017): 59 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 523,874 people (259,755 b) Attendance by a skilled health worker (2017): 50 out male and 264,119 female) of every 100 children born c) 15 years old and below: 4.2 out of every 10 persons c) Vaccination (2017): 79 out of every 100 children d) Overall poverty index (2015/16): 45.9% e) Life expectancy (2014): 55 years 30.0 26.9 26.0 f) Fertility rate (2014): 3.7 children per woman 25.0 20.0 2. Human resources for health (2017) 13.915.0 a) Medical workers: 127 per 100,000 population1 11.0 10.0 b) Doctors: 33 4.4 4.0 c) Nurses: 276 5.0 d) Clinical officers: 30 0.0 Stunted Wasted Underweight e) Public health workers: 99 II Laikipia II National 3. Health indicators a) Malaria test positivity rate (2017): 27% d) Stunted children (2014): 27 children in every 100 b) HIV prevalence (2016): 3.7% children c) Tuberculosis prevalence (2017): 173 per 100,000 people e) Wasted children (2014): 4 in every 100 children d) Number and type of new non-communicable disease cases f) Underweight children (2014): 14 in every 100 in outpatient departments (OPD) per 100,000 people children (2013/14 to 2016/17) 5. Health financing 7000 a) Total budget allocation to health sector (2015/16): 6000 6068 7.6% 5000 b) Health spending (2014/15): Ksh 238.91 million 4000 3718 3639 3000 3200 c) Health spending (2015/16): Ksh 354.5 million 2000 d) Per capita health spending (2014/15): Ksh 1,414 1000 817 1081 1314 1166 564 468 520 543 e) NHIF coverage (2015/16): 32.5 persons for every 0 2013/14 2014/15 2015/16 2016/17 100 citizens New mental disorders in OPD 100,000 people f) Development allocation as percentage of total health --New hypertention in CPD per 100,000 people New diabetes in OPD per 100,000 people spending (2015/16): 65% 4. Health status 2015/16 35% 65% 90.0 I 79.3 2014/15 44% 56% 80.0 74.9 70.0 I 59.1 61.858.0 60.0 2013/14 69% - 31%49.550.0 I 40.0 0% 20%4 0% 60%8 0% 100% 30.0 II Recurrent ■ Development 20.0 10.0 0.0 Proportion of Proportion of births Children 12 -23 married women attended by a skilled months fully 6. Health infrastructure (2017) using contraception health worker vaccinated Laikipia a) Hospital beds: 2.4 per 10,000 population11 ■ National b) Health facilities: 15.2 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 67 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 135 various conditions (2017) d) Primary health facilities: 127 a) Essential drugs for mothers: 60% e) County and sub-county hospitals: 8 b) Essential drugs for children: 60% f) Total beds and cots: 802 c) HIV & AIDS: 40% d) Malaria: 80% 1. Ownership of health facilities e) Tuberculosis: 80% a) Government: 58.7% f) Diabetes: 80% b) Non governmental organizations (NGOs): 2.2% c) Faith-based organizations (FBOs): 8.0% 4. Health service delivery indices (2017)2 d) Private: 31% a) Overall health service delivery index: 62.8% b) Medical drugs index: 50% c) Infrastructure index: 74.6% d) Amenities (water, incinerator and electricity) index: 80% 31% e) Medical equipment index: 86.7% f) Public participation in health sector index: 26.1% 59% 8% g) Citizen satisfaction in health sector index: 62.9%2% h) Health human resources index: 59.5% Access to basic ■ Public ■ NGOs ■ FBOs ■ Private drugs100.0 2. Water and sanitation (2017) 80.0Human resource Public60.0 Proportion of the population with access to improved water and 40.0 sanitation: 42.3% 20.0 0.0 Infrustructure Citizen 3. Level of availability and functionality of medical equipment satisfaction in health facilities (2017) a) Obstetric care equipment: 80% incinerator, Medical b) Delivery pack: 100% electricity) Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Provide adequate medical supplies such as equipment and drugs in public health facilities (ii) Promote public awareness and civic education on public participation at all stages of health planning, budgeting and policy formulation (iii) Improve access to clean and safe drinking water at facility and household level (iv) Allocate more funds for the purchase of essential equipment and drugs 68 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Nakuru County 1. County indicators a) Use of contraceptives (2017): 57 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 2,104,254 people b) Attendance by a skilled health worker (2017): 70 out of (1,054,679 male and 1,049,575 female) every 100 children born c) 15 years old and below: 4.1 out of every 10 persons c) Vaccination (2017): 75 out of every 100 children d) Overall poverty index (2015/16): 29.1% e) 27.6Life expectancy (2014): 54.5 years 30.0 26.0 f) Fertility rate (2014): 3.7 children per woman 25.0 20.0 2. Human resources for health (2017) 15.0 10.2 11.0 a) Medical workers: 107 per 100,000 population1 10.0 4.5 4.0 5.0 b) Doctors: 135 0.0 c) Nurses: 1225 Stunted Wasted Underweight d) Clinical officers: 184 II Nakuru II National e) Public health workers: 225 3. Health indicators d) Stunted children (2014): 28 children in every 100 a) Malaria test positivity rate (2017): 33% children b) HIV prevalence (2016): 5.3 percent e) Wasted children (2014): 5 in every 100 children c) Tuberculosis prevalence (2017): 227 per 100,000 people f) Underweight children (2014): 10 in every 100 children d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 32.9% 2500 ---- b) Health spending (2014/15): Ksh 3,262.4 million2000 1952 2009 c) Health spending (2015/16): Ksh 4,119.16 million16711500 1494 d) Per capita health spending (2014/15): Ksh 1,7251227 1000 1079 e) NHIF coverage (2015/16): 34.5 persons for every 100916 914 citizens 500 158 145 130 115 f) Development allocation as percentage of total health 0 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 20% New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 80% 20% 4. Health status 2014/15 83% 17% 80.0 74.7 74.9 69.5 2013/14 84% 16% 70.0 61.8 58.0 60.0 56.8 0% 20%4 0% 60%8 0% 100% 50.0 40.0 II Recurrent ■ Development 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of married Proportion of births Children 12 -23 months a) Hospital beds: 16 per 10,000 population women using attended by a skilled fully vaccinated contraception health worker b) Health facilities: 2 per 10,000 population 11 Nakuru ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 69 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 486 various conditions (2017) d) Primary health facilities: 460 a) Essential drugs for mothers: 90% e) County and sub-county hospitals: 26 b) Essential drugs for children: 90% c) HIV & AIDS: 100% f) Total beds and cots: 3302 d) Malaria: 100% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 37.3% f) Diabetes: 100% b) Non-governmental organizations(NGOs): 0.4% 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 12.2% a) Overall health service delivery index: 68.6% d) Private: 46.3% b) Medical drugs index: 83.3% c) Infrastructure index: 95% d) Amenities (water, incinerator and electricity) index: 90% 37% 46% e) Medical equipment index: 80% f) Public participation in health sector index: 41.6% g) Citizen satisfaction in health sector index: 52% 0% h) Health human resources index: 38.2% 12% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 2. Water and sanitation (2017) 100.0 Proportion of the population with access to improved water 80.0Human resource 60.0 and sanitation: 62.1% 40.0 20.0 3. Level of availability and functionality of medical equipment in 0.0 Infrustructure health facilities (2017): a) Obstetric care equipment: 80% incinerator, Medical Equipment b) Delivery pack: 100% electricity) 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Focus on interventions in preventive and promotive health care to reduce non-communicable disease prevalence, stunting, wasting and underweight among children (ii) Increase public participation in health planning interventions (iii) Establish a framework for sharing medical personnel and/or improve deployment of human resource for health (iv) Allocate more resources for improvement in access to clean water and sanitation 70 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Narok County 1. County indicators a) Use of contraceptives (2017): 48 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 1,116,433 people b) Attendance by a skilled health worker (2017): 40 out of every 100 children born (561,788 male and 554,645 female) c) Vaccination (2017): 58.5 out of every 100 children c) 15 years old and below: 5.0 out of every 10 persons d) Overall poverty index (2015/16): 22.6% 40.0 32.9 e) Life expectancy (2014): 64 years 26.0 f) Fertility rate (2014): 6 children per woman 20.0 11.611.0 2. Human resources for health (2017) 2.4 4.0 a) Medical workers: 42 per 100,000 population1 0.0 b) Doctors: 36 Stunted Wasted Underweight c) Nurses: 299 d) Clinical officers: 50 II Narok II National e) Public health workers: 100 3. Health indicators d) Stunted children (2014): 33 children in every 100 children a) Malaria test positivity rate (2017): 17% e) Wasted children (2014): 2 in every 100 children b) HIV prevalence (2016): 5% f) Underweight children (2014): 12 in every 100 children c) Tuberculosis prevalence (2017): 126 per 100,000 people 5. Health financing d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): people (2013/14 to 2016/17) 11.0% b) Health spending (2014/15): Ksh 774.15 million 1200 c) Health spending (2015/16): Ksh 1,396.7 million 1087 1000 ,.....,.- d) Per capita health spending (2014/15): Ksh 1,253 800 823 e) NHIF coverage (2015/16): 29.5 persons for every 600 580 502 100 citizens477 400 375 --------- f) Development allocation as percentage of total health 200 202 20899 =----------94= 92 spending (2015/16): 11%81 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people --Newhypertention in OPD per 100,000 people 2015/16 89% 11% New diabetes in OPD per 100,000 people 2014/15 98% 2% 4. Health status 2013/14 88% 12% 80.0 74.9 70.0 0% 20%4 0% 60%8 0% 100%61.8 58.0 58.5 60.0 47.8 Recurrent Development 50.0 40.3 40.0 30.0 20.0 6. Health infrastructure (2017) 10.0 0.0 a) Hospital beds: 11 per 10,000 population Proportion of married Proportion of births Children 12 -23 women using attended by a skilled months fully b) Health facilities: 2 per 10,000 population contraception health worker vaccinated 11 Narok ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 71 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 179 various conditions (2017) d) Primary health facilities: 171 a) Essential drugs for mothers: 60% e) County and sub-county hospitals: 8 b) Essential drugs for children: 80% f) Total beds and cots: 1,253 c) HIV & AIDS: 80% d) Malaria: 85% 1. Ownership of health facilities e) Tuberculosis: 70% a) Government: 64.2 percent f) Diabetes: 70% b) Non-governmental organizations(NGOs): 0.1% c) Faith-based organizations (FBOs): 17.9% 4. Health service delivery indices (2017)2 d) Private: 14.0% a) Overall health service delivery index: 58.3% b) Medical drugs index: 66.7% 14% c) Infrastructure index: 60% d) Amenities (water, incinerator and electricity) index: 18% 100% e) Medical equipment index: 66.7% 0% 64% f) Public participation in health sector index: 32.5% g) Citizen satisfaction in health sector index: 55% h) Health human resources index: 27.6% ■ Public ■ NGOs ■ FBOs ■ Private 2. Water and sanitation (2017) Access to basicdrugs Proportion of the population with access to improved water 100.080.0 and sanitation: 42.1% Human resource 60.0 40.0 20.0 3. Level of availability and functionality of medical equipment 0.0 in health facilities (2017) Infrustructure a) Obstetric care equipment: 70% b) Delivery pack: 60% incinerator, Medical Equipment electricity) 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Improve deployment of human resource for health (ii) Focus and establish more interventions in preventive and promotive health care to reduce non-communicable diseases, stunting, wasting and underweight among children (iii) Increase the number of community health workers to offer community health services and sensitize the community on NHIF uptake (iv) Invest in public health programmes that would increase uptake of contraceptive use, immunizations and delivery in health facilities (v) Ensure supply of the medical drugs especially for mothers and HIV/AIDS (vi) Enhance public awareness and civic education on the role of public participation in health sector planning, budgeting, policy formulation and implementation (vii) Invest in programmes geared towards improvement of water supply and sanitation (viii) Balance between the recurrent and development allocation for health to enhance infrastructural development 72 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kajiado County 1. County indicators a) Use of contraceptives (2017): 50 out of every 100 a) Location: Southern region of Kenya. women of child bearing age b) Total population estimate (2017): 902,017 people b) Attendance by a skilled health worker (2017): 63 out of (453,297 male and 448,720 female). 100 children born c) 15 years old and below: 3.4 out of every 10 persons. c) Vaccination (2017): 56 out of every 100 children d) Overall poverty index (2015/16): 51.3% e) Live expectancy (2014): 62 years 30.0 26.0 f) Fertility rate (2014): 4.5 children per woman 18.2 20.0 2. Human resources for health (2017) 11.08.0 10.0 a) Medical workers: 39 per 100,000 population1 3.0 4.0 b) Doctors: 24 0.0 c) Nurses: 337 Stunted Wasted Underweight d) Clinical officers: 58 11 Kajiado II National e) Public health workers: 101 3. Health indicators d) Stunted children (2014): 18 in every 100 children a) Malaria test positivity rate (2017): 48% e) Wasted children (2014): 3 in every 100 children b) HIV prevalence (2016): 4.4% f) Underweight children (2014): 8 in every 100 children c) Tuberculosis prevalence (2017): 207 per 100,000 people 5. Health financing d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): 11% people (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 497 million 1000 c) Health spending (2015/16): Ksh 1,271.3 million 900 874 870 d) Per capita health spending (2014/15): Ksh 814 800 700 697 634 e) NHIF Coverage (2015/16): 23.5 persons for every 100 600 500 citizens 400 300 f) Development allocation as percentage of total health 200 167 209 190176 197 spending (2015/16): 18% 100 104 135 145 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people New hypertension in OPD per100,000 people 2015 /1 6 82 % 18 % New diabetes in OPD per100,000 people 4. Health status 2014 /1 5 58 % 42 % 80.00 74.9 70.00 63.20 54.50 58 61.8 2013 /1 4 88 % 12 % 60.00 56.40 50.00 40.00 0% 20 %4 0% 60 %8 0% 100 % 30.00 20.00 II Recu rren t II Deve lopm ent 10.00 0.00 6. Health infrastructure (2017) Proportion of Proportion of Children 12 -2 3 women using births attended months fully a) Hospital beds: 17 per 10,000 population contraception by a skille d vaccinated health worker b) Health facilities: 3 per 10,000 population I I Kajiado II National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 73 Number of health facilities Proportion of health facilities with valid medical drugs for a) Total health facilities: 312 various conditions b) Primary health facilities: 299 c) Essential drugs for mothers: 60% c) County and sub-county hospitals: 13 d) Essential drugs for children: 62% d) Total beds and cots: 1,511 e) HIV & AIDS: 100% 7. Ownership of health facilities f) Malaria : 80% a) Government: 34 percent g) Tuberculosis: 60% b) Non governmental organizations (NGOs): 7.2% h) Diabetes : 70% c) Faith-based organizations (FBOs): 3.8% 10. Health service delivery indices (2017)2 d) Private: 55% ii) Overall health service delivery index: 58.6% iii) Medical drugs index: 70% iv) Infrastructure index: 68% v) Amenities (water, incinerator and electricity) index: 69% 34 % vi) Medical equipment index: 73.3% 55 % vii) Public participation in health sector index: 31.1% 4% viii) Citizen satisfaction in health sector index: 54.7% 7% ix) Health human resources index: 12.9% Access to basic ■ Pu bl ic ■ NG Os ■ FB Os ■ Pr iv at e drugs 100.0 8. Water and sanitation 80.0 PublicHuman resource 60.0 participation Proportion of the population with access to improved water 40.0 and sanitation: 84.3% 20.0 0.0 9. Level of availability and functionality of medical CitizenInfrustruc ture satisfaction equipment in health facilities a) Obstetric care equipment: 60% Amenities(water, incinerator, Medical b) Delivery pack: 80% electricity) Equipment _J 11. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Utilize community health workers to address public health challenges such as immunization and child nutrition (ii)Establish a framework for sharing medical specialists with neighbouring counties and national government (iii)Increase citizen participation in health planning and budgeting interventions (iv)Upscale community health work in immunization against preventable diseases and mother and child health (vi))Invest in mobile health clinics that meet the demands of its pastoral community whenever droughts and floods occur (vii)Upscale rural and urban sanitation coverage and developing a functional sewerage system for all the major towns in the county 74 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kericho County 1. County indicators a) Use of contraceptives (2017): 63 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 970,266 people b) Attendance by a skilled health worker (2017): 64 out of (496,279 male and 473,987 female) every 100 children born c) 15 years old and below: 4.3 out of every 10 persons c) Vaccination (2017): 72 out of every 100 children d) Overall poverty index (2015/16): 30.3% 40.0 e) Life expectancy (2014): 56.5 years 28.7 26.0 f) Fertility rate (2014): 4 children per woman 20.0 12.45.6 11.04.0 2. Human resources for health (2017) 0.0 a) Medical workers: 54 per 100,000 population1 Stunted Wasted Underweight b) Doctors: 77 c) Nurses: 449 II Kericho II National d) Clinical officers: 74 e) Public health workers: 129 d) Stunted children (2014): 29 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 18% e) Wasted children (2014): 6 in every 100 children f) Underweight children (2014): 12 in every 100 children b) HIV prevalence (2016): 3.4% c) Tuberculosis prevalence (2017): 199 per 100,000 people 5. Health financing d) Number and type of new non-communicable disease a) Total budget allocation to health sector (2015/16): cases in outpatient departments (OPD) per 100,000 31% people (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 1,382.38 million c) Health spending (2015/16): Ksh 1,537.75 million 1200 d) Per capita health spending (2014/15): Ksh 1,838 1000 7 1005...............8 47 891 e) NHIF coverage (2015/16): 28.9 persons for every 800 600 61z6 100 citizens 400 f) Development allocation as percentage of total health 290 200 2611152=34=-= ------168 182 129025 spending (2015/16): 14%0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people I --New hypertention in OPD per 100,000 people 2015/16 86% 14% New diabetes in OPD per 100,000 people I 2014/15 86% 14% 4. Health status I 2013/14 53% 47% 80.0 71.8 74.9 70.0 0% 20%4 0% 60%8 0% 100%62.9 64.4 61.8 58.0 60.0 II Recurrent ■ Development 50.0 40.0 30.0 6. Health infrastructure (2017) 20.0 a) Hospital beds: 2.2 per 10,000 population 10.0 0.0 b) Health facilities: 13.5 per 10,000 population Proportion of Proportion of births Children 12 -23 married women attended by a skilled months fully using contraception health worker vaccinated 11 Kericho ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 75 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 220 various conditions (2017) d) Primary health facilities: 205 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 15 b) Essential drugs for children: 50% f) Total beds and cots: 1,925 c) HIV & AIDS: 50% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 68.3% f) Diabetes: 25% b) Non governmental organizations(NGOs): 1.8% c) Faith-based organizations (FBOs): 8.1% 4. Health service delivery indices (2017)2 d) Private: 22.2% a) Overall health service delivery index: 58.2% b) Medical drugs index: 64.2% c) Infrastructure index: 55.4% d) Amenities (water, incinerator and electricity) index: 22% 66.7% e) Medical equipment index: 66.7% 8% f) Public participation in health sector index: 32.4% 2% g) Citizen satisfaction in health sector index: 45.2%68% h) Health human resources index: 77.0% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 2. Water and sanitation (2017) 80.070.0 60.0 Proportion of the population with access to improved water Human resource 50.0 40.0 and sanitation: 79% 30.0 20.0 10.0 0.0 3. Level of availability and functionality of medical Infrustructure equipment in health facilities (2017) a) Obstetric care equipment: 70% b) Delivery pack: 75% incinerator, electricity) Medical Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Allocate adequate resources for purchase of medical equipment and drugs for HIV&AIDS and diabetes (ii) Put more emphasis on health sector public participation to enhance citizen involvement in health decision making processes (iii) Utilize community health workers to increase uptake of immunization; and train parents on nutrition 76 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Bomet County 1. County indicators a) Use of contraceptives (2017): 55 out of every 100 a) Location: Rift Valley region of Kenya women of child bearing age b) Total population estimate (2017): 941,386 people b) Attendance by a skilled health worker (2017): 52 out of every 100 children born (476,498 male and 464,888 female) c) Vaccination (2017): 81 out of every 100 children c) 15 years old and below: 4.6 out of every 10 persons d) Overall poverty index (2015/16): 48.8% 40.0 35.5 e) Life expectancy (2014): 58 years 26.0 f) Fertility rate (2014): 4.3 children per woman 30.0 20.0 2. Human resources for health (2017) 12.0 11.0 10.0 a) Medical workers: 35 per 100,000 population1 1.8 4.0 b) Doctors: 17 0.0 c) Nurses: 425 Stunted Wasted Underweight d) Clinical officers: 95 II Bomet II National e) Public health workers: 105 d) Stunted children (2014): 35.5 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 8% e) Wasted children (2014): 2 in every 100 children b) HIV prevalence (2016): 5.8% f) Underweight children (2014): 12 in every 100 children c) Tuberculosis prevalence (2017): 173 per 100,000 people d) Number and type of new non-communicable disease 5. Health financing cases in out-patient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): people (2013/14 to 2016/17) 10.5% b) Health spending (2014/15): Ksh 723.11 million 1000 c) Health spending (2015/16): Ksh 931.92 million 855 844 753 d) Per capita health spending (2014/15): Ksh 720 500 44,4 ------- e) NHIF coverage (2015/16): 21 persons for every 100 381 386287 citizens18190 117 169 1540 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 53% New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people I I I I 2015/16 47% 53% New diabetes in OPD per 100,000 people I 2014/15 66% 34% 4. Health status I 2013/14 59% 41% 90.0 81.3 I I I I 80.0 74.9 0% 20%4 0% 60%8 0% 100% 120% 70.0 61.8 60.0 54.8 58.0 52.2 II Recurrent ■ Development 50.0 40.0 30.0 6. Health infrastructure (2017) 20.0 10.0 a) Hospital beds: 10.6 per 10,000 population 0.0 Proportion of married Proportion of births Children 12 -23 b) Health facilities: 1.6 per 10,000 population women using attended by a skilled months fully contraception health worker vaccinated Bomet 11 National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 77 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 146 various conditions (2017) d) Primary health facilities: 140 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 6 b) Essential drugs for children: 60% f) Total beds and cots: 966 c) HIV & AIDS: 50% d) Malaria: 60% 1. Ownership of health facilities e) Tuberculosis: 60% a) Government: 82.3% f) Diabetes: 60% b) Non-governmental organizations(NGOs): 0.1% c) Faith-based organizations (FBOs): 6.1% 4. Health service delivery indices (2017) 2 d) Private: 11.6% a) Overall health service delivery index: 52.4% b) Medical drugs index: 65% c) Infrastructure index: 54.3% d) Amenities (water, incinerator and electricity) index: 12% 0%6% 85% e) Medical equipment index: 65% f) Public participation in health sector index: 39% 82% g) Citizen satisfaction in health sector index: 45% h) Health human resources index: 13.2% Access to basic Public NGOs FBOs Private drugs■ ■ ■ ■ 100.0 80.0 2. Water and sanitation (2017) Human resource Public60.0 Proportion of the population with access to improved water 40.0 and sanitation: 30.6% 20.0 0.0 Infrustructure Citizen 3. Level of availability and functionality of medical equipment satisfaction in health facilities (2017) a) Obstetric care equipment: 40% incinerator, Medical b) Delivery pack: 75% electricity) Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Strengthen management of human resource for health through deployment of adequate medical workers to all primary health care facilities (ii) Invest in preventive measures to reduce cases of infections and disease outbreaks, including appropriate solid waste management (iii) Encourage pregnant mothers to seek skilled health workers’ assistance during delivery (iv) Address levels of child wasting, stunting and underweight through nutritional support among pregnant mothers and children 78 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kakamega County 1. County indicators a) Use of contraceptives (2017): 62 out of every 100 a) Location: Western region of Kenya women of child bearing age b) Total population estimate (2017): 1,909,030 people b) Attendance by a skilled health worker (2017): 49 out of every 100 children born (930,684 male and 978,346 female) c) Vaccination (2017): 73 out of every 100 children c) 15 years old and below: 4.7 out of every 10 persons d) Overall poverty index (2015/16): 35.8% 30.0 28.4 e) Life expectancy (2014): 54 years 26.0 25.0 f) Fertility rate (2014): 4.4 children per woman 20.0 2. Human resources for health (2017) 15.0 10.1 11.0 a) Medical workers: 64 per 100,000 population1 10.0 4.0 b) Doctors: 71 5.0 1.8 c) Nurses: 868 0.0 Stunted Wasted Underweight d) Clinical officers: 140 e) Public health workers: 110 II Kakamega II National 3. Health indicators d) Stunted children (2014): 28 children in every 100 a) Malaria test positivity rate (2017): 49% children b) HIV prevalence (2016): 5.9% e) Wasted children (2014): 2 in every 100 children c) Tuberculosis prevalence (2017): 135 per 100,000 people f) Underweight children (2014): 10 in every 100 children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 5. Health financing people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 24.5% b) Health spending (2014/15): Ksh 1,744.46 million 1600 1400 c) Health spending (2015/16): Ksh 2,737.06 million1355 1200 -----------1244 d) Per capita health spending (2014/15): Ksh 1,27710941000 1062 e) NHIF coverage (2015/16): 30.2 persons for every 100 800 600 citizens 400 342 383 259 277 f) Development allocation as percentage of total health200 170 155 121 132 0 spending (2015/16): 35% 2013/14 2014/15 2015/162 016/17 New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 65% 35% 4. Health status 2014/15 73% 27% 80.0 73.1 74.9 2013/14 62% 38% 70.0 62.1 61.8 58.0 60.0 48.6 0% 20%4 0% 60%8 0% 100% 50.0 II Recurrent ■ Development40.0 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of married Proportion of births Children 12 -23 months a) Hospital beds: 1.5 per 10,000 population women using attended by a skilled fully vaccinated contraception health worker b) Health facilities: 12 per 10,000 population 11 Kakamega ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 79 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 307 various conditions (2017) d) Primary health facilities: 293 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 14 b) Essential drugs for children: 13% f) Total beds and cots: 2,312 c) HIV & AIDS: 100% d) Malaria: 25% 2. Ownership of health facilities e) Tuberculosis: 40% a) Government: 56.4% f) Diabetes: 38% b) Non governmental organizations(NGOs): 1.3% c) Faith-based organizations (FBOs): 9.4% 5. Health service delivery indices (2017) 2 d) Private: 32.2% a) Overall health service delivery index: 54.2% b) Medical drugs index: 58.5% c) Infrastructure index: 56.6% d) Amenities (water, incinerator and electricity) index: 70.8% 32% e) Medical equipment index: 77.1% f) Public participation in health sector index: 31.9% 57% g) Citizen satisfaction in health sector index: 61.6% 10%1% h) Health human resources index: 22.6% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 3. Water and sanitation (2017) 80.0 70.0 Proportion of the population with access to improved water 60.0Human resource Public50.0 and sanitation: 32.4% 40.0 30.0 20.0 4. Level of availability and functionality of medical equipment 10.00.0 in health facilities (2017): Infrustructure Citizen satisfaction a) Obstetric care equipment:50% b) Delivery pack: 62.50% incinerator, Medical electricity) Equipment 6. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Deploy adequate number of health personnel and ensure availability of essential drugs in health facilities (ii) Address water and sanitation challenges in the county (iii) Empower community health workers to provide services such as educating parents on nutrition to reduce cases of stunted growth and underweight among children 80 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Vihiga County 1. County indicators a) Use of contraceptives (2017): 60 out of every 100 a) Location: Western region of Kenya women of child bearing age b) Attendance by a skilled health worker (2017): 50 out of b) Total population estimate (2017): 637,678 people every 100 children born (304,583 male and 333,095 female) c) Vaccination (2017): 94 out of every 100 children c) 15 years old and below: 4.4 out of every 10 persons d) Overall poverty index (2015/16): 43.2% 30.0 26.023.5 e) Life expectancy (2014): 49 years f) Fertility rate (2014): 4.5 children per woman 20.0 11.0 2. 5.9Human resources for health (2017) 10.0 2.6 4.0 a) Medical workers: 57 per 100,000 population1 0.0 b) Doctors: 31 Stunted Wasted Underweight c) Nurses: 248 II Vihiga II National d) Clinical officers: 51 e) Public health workers: 89 d) Stunted children (2014): 24 children in every 100 children 3. Health indicators e) Wasted children (2014): 3 in every 100 children a) Malaria test positivity rate (2017): 52% f) Underweight children (2014): 6 in every 100 children b) HIV prevalence (2016): 3.8% c) Tuberculosis prevalence (2017): 155 per 100,000 people 5. Health financing d) Number and type of new non-communicable disease a) Total budget allocation to health sector (2015/16): cases in outpatient departments (OPD) per 100,000 22.7% people (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 732.93 million c) Health spending (2015/16): Ksh 611.26 million 3000 d) Per capita health spending (2014/15): Ksh 1,143 2709 2500 :;------:- -- e) NHIF coverage (2015/16): 24.2 persons for every 22552000 100 citizens 1500 1560 1650 f) Development allocation as percentage of total health 1000 spending (2015/16): 20% 500 401 220913 24606 360 218 261 0 2013/14 2014/15 2015/16 2016/17 2015/16 80% 20% New mental disorders in OPD 100,000 people - New hypertention in OP D per 100,000 people 2014/15 85% 15% New diabetes in OPD per 100,000 people 4. Health status 2013/14 87% 13% 94.4 0% 20%4 0% 60%8 0% 100%100.0 90.0 74.9 II Recurrent ■ Development80.0 70.0 59.5 58.0 61.8 60.0 50.3 50.0 40.0 6. Health infrastructure (2017) 30.0 20.0 a) Hospital beds: 13 per 10,000 population 10.0 0.0 b) Health facilities: 1.5 per 10,000 population Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated contraception health worker Vihiga ■ Nafunal 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 81 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 114 various conditions (2017) d) Primary health facilities: 104 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 10 b) Essential drugs for children: 17% f) Total beds and cots: 408 c) HIV & AIDS: 100% d) Malaria: 70% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 50.5 percent f) Diabetes: 33% b) Non governmental organizations (NGOs): 0.1 c) Faith-based organizations (FBOs): 8.4% 4. Health service delivery indices (2017)2 d) Private: 34.6% a) Overall health service delivery index: 57.5% b) Medical drugs index: 70% c) Infrastructure index: 63.2% 35% d) Amenities (water, incinerator and electricity) index: 94.4% 51% e) Medical equipment index: 77.8% f) Public participation in health sector index: 33.8% 8% 0% g) Citizen satisfaction in health sector index: 49.3% h) Health human resources index: 13.7% ■ Public ■ NGOs ■ FBOs ■ Private 2. Water and sanitation (2017) Access to basic drugs Proportion of the population with access to improved water 100.0 and sanitation: 43.2% 80.0Human resource Public60.0 40.0 3. Level of availability and functionality of medical 20.0 equipment in health facilities (2017) 0.0 Infrustructure a) Obstetric care equipment: 66.7% b) Delivery pack: 66.7% incinerator, Medical electricity) 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Upscale early screening services for non-communicable diseases and enhance wellness civic education among citizens (ii) Invest in promotive, preventive, curative and rehabilitative care for non-communicable disease cases (iii) Invest in community health services (iv) Increase investment in provision and management of medical equipment in facilities (v) Address human resource gaps in the county 82 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Bungoma County 1. County indicators a) Use of contraceptives (2017): 56 out of every 100 a) Location: Western region of Kenya women of child bearing age b) Total population estimate (2017): 1,581,193 people b) Attendance by a skilled health worker (2017): 41.1 out (780,920 male and 800,273 female) of every 100 children born c) 15 years old and below: 4.8 out of every 10 persons c) Vaccination (2017): 75.9 out of every 100 children d) Overall poverty index (2015/16): 35.7% e) Life expectancy (2014): 57.5 years 30.0 24.4 26.0 f) Fertility rate (2014): 5 children per woman 20.0 2. Human resources for health (2017) 9.0 11.0 a) Medical workers: 49 per 100,000 population1 10.0 1.8 4.0 b) Doctors: 67 ~ ~ ],____. ,"-. r □ ----l -I-r [ [ 0.0 c) Nurses: 673 Stunted Wasted Underweight d) Clinical officers: 100 e) Public health workers: 110 II Bungoma II National 3. Health indicators a) Malaria test positivity rate (2017): 60% d) Stunted children (2014): 24 children in every 100 b) HIV prevalence (2016): 3.2% children c) Tuberculosis prevalence (2017): 96 per 100,000 people e) Wasted children (2014): 2 in every 100 children d) Number and type of new non-communicable disease f) Underweight children (2014): 9 in every 100 children cases in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) 5. Health financing a) Total budget allocation to health sector (2015/16): 20.5% b) Health spending (2014/15): Ksh 1,619.15 million 2000 c) Health spending (2015/16): Ksh 1,533.93 million 1656 1500 d) Per capita health spending (2014/15): Ksh 1,353 1261 1115 e) NHIF coverage (2015/16): 16.8 persons for every 100 1000 1035 citizens 500 274 294 f) Development allocation as percentage of total health 211481 172 0 1 21128 133 spending (2015/16): 8% 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 92% 8% 4. Health status 2014/15 78% 22% 80.0 75.9 74.9 70.0 61.8 58.0 2013/14 67% 33% 60.0 55.5 50.0 41.4 0% 20%4 0% 60%8 0% 100% 40.0 30.0 II Recurrent II Development 20.0 6. Health infrastructure (2017) 10.0 a) Hospital beds: 12 per 10,000 population 0.0 Proportbnofmarried Proportion of births Children 12 -23 months b) Health facilities: 1 per 10,000 population women using attended by as killed fully vaccinated contraception health worker Bungoma ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 83 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 233 various conditions (2017) d) Primary health facilities: 221 a) Essential drugs for mothers: 88% e) County and sub-county hospitals: 12 b) Essential drugs for children: 25% f) Total beds and cots: 1,819 c) HIV & AIDS: 100% d) Malaria: 57% 1. Ownership of health facilities e) Tuberculosis: 75% a) Government: 58.4% f) Diabetes: 50% b) Non governmental organizations (NGOs): 1.7% c) Faith-based organizations (FBOs): 10.7% 4. Health service delivery indices (2017)2 d) Private: 29.2% a) Overall health service delivery index: 57.5% b) Medical drugs index: 65.8% c) Infrastructure index: 62.6% d) Amenities (water, incinerator and electricity) index: 29% 75% 58% e) Medical equipment index: 85.4% 11% 2% f) Public participation in health sector index: 31.4% g) Citizen satisfaction in health sector index: 51.1% h) Health human resources index: 30.8% ■ Public ■ NGOs Access to basic drugs■ FBOs ■ Private 100.0 80.0 2. Water and sanitation (2017) Human resource 60.0 40.0 Proportion of the population with access to improved water 20.0 and sanitation: 39.3% 0.0 Infrustructure Citizen satisfaction 3. Level of availability and functionality of medical equipment in health facilities (2017): a) Obstetric care equipment: 87.50% incinerator, Medical Equipmentelectricity) b) Delivery pack: 75% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Increase the supply of essential drugs for children, malaria and tuberculosis to health facilities (ii) Foster public participation in the decision-making process to enhance inclusiveness, accountability and transparency (iii) Deploy adequate number of health personnel to ensure quality service delivery (iv) Improve access to clean and safe drinking water at facility and household levels 84 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Busia County 1. County indicators a) Use of contraceptives (2017): 58 out of every 100 a) Location: Western region of Kenya women of child bearing age b) Total population estimate (2017): 855,242 people b) Attendance by a skilled health worker (2017): 59 out of (414,014 male and 441,138 female) every 100 children born c) 15 years old and below: 4.7 out of every 10 persons c) Vaccination (2017): 80 out of every 100 children d) Overall poverty index (2015/16): 69.3% 30.0 26.0 e) Life expectancy (2014): 52.5 years 25.0 22.0 f) Fertility rate (2014): 4.7 children per woman 20.0 2. 15.0Human resources for health (2017) 9.0 11.0 10.0 a) Medical workers: 49 per 100,000 population1 5.0 2.2 4.0 b) Doctors: 34 0.0 c) Nurses: 399 Stunted Wasted Underweight d) Clinical officers: 68 e) Public health workers: 58 II Busia 11 National 3. Health indicators d) Stunted children (2014): 22 children in every 100 a) Malaria test positivity rate (2017): 59% children e) Wasted children (2014): 2 in every 100 children b) HIV prevalence (2016): 6.8% f) Underweight children (2014): 9 in every 100 children c) Tuberculosis prevalence (2017): 266 per 100,000 people d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): people (2013/14 to 2016/17) 22.4% ---- b) Health spending (2014/15): Ksh 1,307.82 million3000 2609 c) Health spending (2015/16): Ksh 1,218.97 million2000 ------:.------2-020 d) Per capita health spending (2014/15): Ksh 1,4671185 14091000 e) NHIF coverage (2015/16): 31 persons for every 100690 0 12103 356 4191 98 94 127 citizens 2013/14 2014/15 2015/16 2016/17 f) Development allocation as percentage of total health New mental disorders in OPD 100,000 people spending (2015/16): 38% - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 62% 38% 4. Health status 2014/15 74% 26% 90.0 80.4 80.0 74.9 2013/14 71% 29% 70.0 61.8 60.0 57.5 58.0 58.5 50.0 0% 20%4 0% 60%8 0% 100% 40.0 II Recurrent II Development 30.0 20.0 10.0 0.0 6. Health infrastructure (2017) Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated a) Hospital beds: 1.4 per 10,000 population contraception health worker Busia b) Health facilities: 13.6 per 10,000 population11 ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 85 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 130 various conditions (2017) d) Primary health facilities: 123 a) Essential drugs for mothers: 100% e) County and sub-county hospitals: 7 b) Essential drugs for children: 80% f) Total beds and cots: 1,260 c) HIV & AIDS: 100% d) Malaria: 33% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 63.8% f) Diabetes: 50% b) Non governmental organizations(NGOs): 6.2% c) Faith-based organizations (FBOs): 10.0% 4. Health service delivery indices (2017)2 d) Private: 20.0% a) Overall health service delivery index: 59% b) Medical drugs index: 77.2% c) Infrastructure index: 56% d) Amenities (water, incinerator and electricity) index: 20% 72.2% e) Medical equipment index: 80.6% 10% f) Public participation in health sector index: 42.5% 6% 64% g) Citizen satisfaction in health sector index: 46.2% h) Health human resources index: 38.2% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 2. Water and sanitation (2017) 80.0 Human resource Public Proportion of the population with access to improved water 60.0 40.0 and sanitation: 61.6% 20.0 0.0 Citizen 3. Level of availability and functionality of medical equipment Infrustructure satisfaction in health facilities (2017) a) Obstetric care equipment: 66.7% incinerator, Medical electricity) Equipment b) Delivery pack: 50% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Provide adequate public health information to all citizens including child nutrition, protection of children from infections and on how to address cases of stunting and wasting among children (ii) Encourage health sector public participation at the county level 86 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Siaya County 1. County indicators a) Use of contraceptives (2017): 55 out of every 100 a) Location: Nyanza region of Kenya women of child bearing age b) Total population estimate (2017): 1,006,121 people b) Attendance by a skilled health worker (2017): 70 out (477,885 male and 528,236 female) of every 100 children born c) 15 years old and below: 4.4 out of every 10 persons c) Vaccination (2017): 78 out of every 100 children d) Overall poverty index (2015/16): 33.8% e) Life expectancy (2014): 42.5 years 30.0 24.7 26.0 f) Fertility rate (2014): 4.2 children per woman 25.0 20.0 2. Human resources for health (2017) 15.0 11.0 7.8 a) Medical workers: 52 per 100,000 population1 10.0 4.0 5.0 b) Doctors: 15 0.01·1- ----0.-2 -~ -~ ----I-t fr 'I E c) Nurses: 382 Stunted Wasted Underweight d) Clinical officers: 48 II Siaya II National e) Public health workers: 40 3. Health indicators d) Stunted children (2014): 25 children in every 100 a) Malaria test positivity rate (2017): 49% children b) HIV prevalence (2016): 23.7% e) Wasted children (2014): 0 in every 100 children c) Tuberculosis prevalence (2017): 223 per 100,000 people f) Underweight children (2014): 8 in every 100 children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 5. Health financing people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 1600 26.8% 1486 1400 b) Health spending (2014/15): Ksh 1,096.97 million 1200 1217 1081 1000 989 c) Health spending (2015/16): Ksh 1,333.41 million 800 d) Per capita health spending (2014/15): Ksh 1,495 600 e) NHIF coverage (2015/16): 28.2 persons for every 400 200 251 260 213 261 100 citizens156 130 95 136 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 31% New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 69% 31% 4. Health status 2014/15 78% 22% 90.0 78.0 80.0 74.970.4 2013/14 61% 39% 70.0 61.8 60.0 55.0 58.0 0% 20%4 0% 60%8 0% 100% 50.0 40.0 II Recurrent ■ Development 30.0 20.0 10.0 0.0 6. Health infrastructure (2017) Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated a) Hospital beds: 13 per 10,000 population contraception health worker b) Health facilities: 3 per 10,000 population 11 Siaya ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 87 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 104 various conditions (2017) d) Primary health facilities: 94 a) Essential drugs for mothers: 80% e) County and sub-county hospitals: 10 b) Essential drugs for children: 20% f) Total beds and cots: 466 c) HIV & AIDS: 100% d) Malaria: 40% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 67.9% f) Diabetes: 40% b) Non governmental organizations (NGOs): 0.5% 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 7.5% a) Overall health service delivery index: 57.9% d) Private: 20.3% b) Medical drugs index: 63.3% c) Infrastructure index: 64% d) Amenities (water, incinerator and electricity) index: 20% 73.3% e) Medical equipment index: 70.8% 8% f) Public participation in health sector index: 26.5% 1% g) Citizen satisfaction in health sector index: 70% 68% h) Health human resources index: 37.4% Access to basic Public NGOs FBOs Private drugs■ ■ ■ ■ 80.0 70.0 60.0 Public 2. Water and sanitation (2017) Human resource 50.040.0 Proportion of the population with access to improved water and 30.020.0 sanitation: 43.7% 10.00.0 Infrustructure Citizen satisfaction 3. Level of availability and functionality of medical equipment in health facilities (2017) a) Obstetric care equipment: 100% incinerator, Medical electricity) Equipment b) Delivery pack: 75% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Focus in preventive and promotive health care to reduce disease prevalence, non-communicable diseases, stunting, wasting and underweight among children (ii) Invest in public health programmes that would increase uptake of immunizations, delivery in health facilities and reduce stunting and underweight in children (iii) Ensure adequate supply of medical drugs especially for children, and for malaria and diabetes (iv) Increase the number of community health workers to offer community health services and sensitize the community on essence of enrollment to NHIF (v) Establish a framework for sharing medical personnel and/or improve deployment of human resource for health (vi) Invest in programmes geared towards improvement of water supply and sanitation (vii) Enhance public awareness and civic education on the role of public participation in health sector planning, budgeting, policy formulation and implementation 88 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kisumu County 1. County indicators a) Use of contraceptives (2017): 62 out of every 100 a) Location: Western region of Kenya women of child bearing age b) Total population estimate (2017): 1,157,351 people b) Attendance by a skilled health worker (2017): 69 out (571,398 male and 585,953 female) of every 100 children born c) 15 years old and below: 4.3 out of every 10 persons c) Vaccination (2017): 79 out of every 100 children d) Overall poverty index (2015/16): 33.9% e) Life expectancy (2014): 49.5 years 30.0 f) Fertility rate (2014): 3.6 children per woman 26.025.0 18.0 2. Human resources for health (2017) 20.0 15.0 a) Medical workers: 81 per 100,000 population1 11.0 10.0 6.6 b) Doctors: 108 4.05.0 ~ I 0.8-1 --- --.-- . --------j c) Nurses: 749 0.0 StuntedW astedU nderweight d) Clinical officers: 95 e) Public health workers: 115 II Kisumu ■ National 3. Health indicators d) Stunted children (2014): 18 children in every 100 a) Malaria test positivity rate (2017): 45% children b) HIV prevalence (2016): 19.3% e) Wasted children (2014): 1 in every 100 children c) Tuberculosis prevalence (2017): 306 per 100,000 people f) Underweight children (2014): 7 in every 100 children d) Number and type of new non-communicable disease cases 5. Health financing in outpatient departments (OPD) per 100,000 people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 12.3% 2000 b) Health spending (2014/15): Ksh 504.43 million c) Health spending (2015/16): Ksh 876.95 million 1500 1576 1246 1337 d) Per capita health spending (2014/15): Ksh 2,121 1000 1119 e) NHIF coverage (2015/16): 32 persons for every 100 500 435 425 495327 citizens 0 103 88 74 59 f) Development allocation as percentage of total health 2013/14 2014/15 2015/16 2016/17 spending (2015/16): 10% New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 90% 10% 4. Health status 2014/15 93% 7% 90.0 78.9 80.0 74.9 2013/14 90% 10% 69.2 70.0 62.4 61.8 58.0 60.0 85%9 0% 95% 100% 50.0 40.0 II Recurrent ■ Development 30.0 - - 20.0 10.0 - - 6. Health infrastructure (2017) 0.0 Proportion of married Proportion of births Children 12 -23 months a) Hospital beds: per 10,000 population women using attended by a skilled fully vaccinated contraception health worker b) Health facilities: 2 per 10,000 population 11 Kisumu 11 National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 89 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 225 various conditions (2017) d) Primary health facilities: 202 a) Essential drugs for mothers: 60% e) County and sub-county hospitals: 23 b) Essential drugs for children: 40% f) Total beds and cots: 2720 c) HIV & AIDS: 100% d) Malaria: 40% 1. Ownership of health facilities e) Tuberculosis: 80% a) Government: 56.3% f) Diabetes: 40% b) Non governmental organizations (NGOs): 7.4 c) Faith-based organizations (FBOs): 8.2% 4. Health service delivery indices (2017)2 d) Private: 27.7% a) Overall health service delivery index: 56.9% b) Medical drugs index: 60% c) Infrastructure index: 52.6% d) Amenities (water, incinerator and electricity) index: •28 % 40%e) Medical equipment index: 70% 8% 57%7% f) Public participation in health sector index: 37.8%g) Citizen satisfaction in health sector index: 70% h) Health human resources index: 68% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 70.0 60.0 2. Water and sanitation (2017) Human resource 50.0 Public Proportion of the population with access to improved 40.030.0 water and sanitation: 96.3% 20.0 10.0 0.0 3. Level of availability and functionality of medical Infrustructure Citizen satisfaction equipment in health facilities (2017) a) Obstetric care equipment: 40% incinerator, Medical b) Delivery pack: 20% electricity) Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Ensure adequate supply of basic medical equipment, essential drugs and deploy adequate health personnel to ensure quality service delivery (ii) Enhance public participation in the health sector as a way of promoting sustainable health care provision in the county 90 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Homa Bay County 1. County indicators a) Use of contraceptives (2017): 47 out of every 100 a) Location: Western region of Kenya women of child bearing age b) Total population estimate (2017): 1,151,235 people b) Attendance by a skilled health worker (2017): 60 out of (596,771 male and 554,464 female) every 100 children born c) 15 years old and below: 4.8 out of every 10 persons c) Vaccination (2017): 64 out of every 100 children d) Overall poverty index (2015/16): 33.5% e) Life expectancy (2014): 51 years 30.0 26.0 f) Fertility rate (2014): 5.2 children per woman 18.7 20.0 11.0 2. Human resources for health (2017) 10.0 2.3 4.0 5.4 a) Medical workers: 51 per 100,000 population1 ~ ~ ],_____._,,_ r_ -1 __r_ _I_I ,[ r 0.0 b) Doctors: 39 Stunted Wasted Underweight c) Nurses: 537 II Homa Bay II National d) Clinical officers: 70 e) Public health workers: 100 d) Stunted children (2014): 19 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 46% e) Wasted children (2014): 2 in every 100 children b) HIV prevalence (2016): 25.7% f) Underweight children (2014): 5 in every 100 children c) Tuberculosis prevalence (2017): 433 per 100,000 people d) Number and type of new non-communicable disease 5. Health financing cases in outpatient departments (OPD) per 100,000 a) Total budget allocation to health sector (2015/16): people (2013/14 to 2016/17) 24.3% b) Health spending (2014/15): Ksh 995.23 million 1200 c) Health spending (2015/16): Ksh 1,276.03 million 1000 982 d) Per capita health spending (2014/15): Ksh 1,074 800 745 e) NHIF coverage (2015/16): 27 persons for every 100 600 645 citizens 400 443 380 279 f) Development allocation as percentage of total health 200 250185 79 86 111 89 spending (2015/16): 18% 0 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people 2015/16 65% 35% New diabetes in OPD per 100,000 people 2014/15 63% 37% 4. Health status 80.0 74.9 2013/14 60% 40% 70.0 61.8 64.4 58.0 60.4 60.0 0% 20%4 0% 60%8 0% 100% 50.0 46.7 40.0 II Recurrent ■ Development 30.0 20.0 6. Health infrastructure (2017) 10.0 0.0 a) Hospital beds: 16 per 10,000 population Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated b) Health facilities: 2 per 10,000 population contraception health worker II Homa Bay ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 91 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 280 various conditions (2017) d) Primary health facilities: 265 a) Essential drugs for mothers: 80% e) County and sub-county hospitals: 15 b) Essential drugs for children: 20% f) Total beds and cots: 1,824 c) HIV & AIDS: 100% d) Malaria: 25% 2. Ownership of health facilities e) Tuberculosis: 50% a) Government: 59.3 percent f) Diabetes: 25% b) Non governmental organizations (NGOs): 12.1% c) Faith-based organizations (FBOs): 11.8% 5. Health service delivery indices (2017)2 d) Private: 16.8% a) Overall health service delivery index: 47.7% b) Medical drugs index: 50% c) Infrastructure index: 42.6% d) Amenities (water, incinerator and electricity) index: 17% 60% e) Medical equipment index: 46.7% 12% f) Public participation in health sector index: 34% 59% g) Citizen satisfaction in health sector index: 65% 12% h) Health human resources index: 35.9% Access to basic drugs 70.0 ■ Public ■ NGOs ■ FBOs ■ Private 60.0 Human resource 50.0 Public 40.0 3. Water and sanitation (2017) 30.0 20.0 Proportion of the population with access to improved water 10.0 0.0 and sanitation: 25.1% Infrustructure Citizen satisfaction 4. Level of availability and functionality of medical equipment in health facilities (2017) Medical a) Obstetric care equipment: 30% incinerator, electricity) Equipment b) Delivery pack: 40% 6. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Have mechanisms in place to address water and sanitation issues in the county (ii) Enhance supply of essential drugs for children and essential medical equipment 92 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Migori County 1. County indicators a) Use of contraceptives (2017): 45 out of every 100 a) Location: Western region of Kenya women of child bearing age b) Total population estimate (2017): 1,095,550 people b) Attendance by a skilled health worker (2017): 53 out of (532,995 male and 562,555 female) every 100 children born c) 15 years old and below: 4.9 out of every 10 persons c) Vaccination (2017): 57 out of every 100 children d) Overall poverty index (2015/16): 41.2% 30.0 26.4 26.0 e) Life expectancy (2014): 52 years 25.0 f) Fertility rate (2014): 5.3 children per woman 20.0 2. Human resources for health (2017) 15.0 11.0 8.6 a) Medical workers: 45 per 100,000 population1 10.0 4.0 4.0 b) Doctors: 28 5.0 c) Nurses: 370 0.0 d) Clinical officers: 72 Stunted Wasted Underweight e) Public health workers: 110 II Migori II National 3. Health indicators a) Malaria test positivity rate (2017): 49% d) Stunted children (2014): 26 children in every 100 b) HIV prevalence (2016): 14.7% children c) Tuberculosis prevalence (2017): 248 per 100,000 people e) Wasted children (2014): 4 in every 100 children d) Number and type of new non-communicable disease f) Underweight children (2014): 9 in every 100 children cases in outpatient departments (OPD) per 100,000 people 5. Health financing (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 9.2% 1200 b) Health spending (2014/15): Ksh 478 million 1000 978 c) Health spending (2015/16): Ksh 1,170.5 million 800 695 600 d) Per capita health spending (2014/15): Ksh 1,036 543 596 400 -437 e) NHIF coverage (2015/16): 19.3 persons for every 100211 227 264200 ---------- citizens 69 88 69 64 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/162 016/17 New mental disorders in OPD 100,000 people spending (2015/16): 21% --New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 79% 21% 4. Health status 2014/15 67% 33% 80.0 74.9 70.0 61.8 58.0 60.0 57.2 2013/1453.4 68% 32% 50.0 44.6 40.0 0% 20%4 0% 60%8 0% 100% 30.0 - - II Recurrent ■ Development 20.0 - - 10.0 0.0 6. Health infrastructure (2017) Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated a) Hospital beds: 2 per 10,000 population contraception health worker 11 Migori 11 National b) Health facilities:19.8 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 93 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 240 various conditions (2017) d) Primary health facilities: 227 a) Essential drugs for mothers: 83% e) County and sub-county hospitals: 13 b) Essential drugs for children: 33% f) Total beds and cots: 2,143 c) HIV & AIDS: 83% d) Malaria: 50% 1. Ownership of health facilities e) Tuberculosis: 67% a) Government: 63% f) Diabetes: 83% b) Non governmental organizations(NGOs): 6.7% c) Faith-based organizations (FBOs): 10.8% 4. Health service delivery indices (2017)2 d) Private: 20.8% a) Overall health service delivery index: 59.7% b) Medical drugs index: 66.5% c) Infrastructure index: 69% d) Amenities (water, incinerator and electricity) index: 20% 80% 11% e) Medical equipment index: 86.1% 6% 63% f) Public participation in health sector index: 33.5% g) Citizen satisfaction in health sector index: 50.6% h) Health human resources index: 32.5% Access to basic ■ Public ■ NGOs ■ FBOs ■ Private drugs100.0 80.0 Human resource 60.0 2. Water and sanitation (2017) 40.0 Proportion of the population with access to improved water and 20.00.0 sanitation: 37.9% Infrustructure 3. Level of availability and functionality of medical equipment in incinerator, Medical Equipment health facilities, (2017) electricity) a) Obstetric care equipment:100% b) Delivery pack: 100% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Improve access to water and sanitation for both the health facilities and households (ii) Allocate more resources to purchase of supplies and essential drugs (iii) Create innovative channels of health public participation since health is a devolved function (iv) Sensitize citizens on health issues such as uptake of NHIF scheme, immunization and vaccination among children 94 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Kisii County 1. County indicators a) Use of contraceptives (2017): 66 out of every 100 a) Location: Western region of Kenya women of child bearing age b) Total population estimate (2017): 1,376,387 people b) Attendance by a skilled health worker (2017): 73 out of (660,371 male and 716,016 female) every 100 children born c) 15 years old and below: 4.5 out of every 10 persons 30.0 26.0 d) Overall poverty index (2015/16): 41.7% 25.5 25.0 e) Life expectancy (2014): 58.5 years 20.0 f) Fertility rate (2014): 3.7 children per woman 15.0 11.0 8.4 2. Human resources for health (2017) 10.0 4.0 a) Medical workers: 52 per 100,000 population1 5.0 1.7 b) Doctors: 71 0.0 Stunted Wasted Underweight c) Nurses: 766 d) Clinical officers: 119 II Kisii 11 National e) Public health workers: 140 3. Health indicators c) Vaccination (2017): 82 out of every 100 children a) Malaria test positivity rate (2017): 15% d) Stunted children (2014): 26 children in every 100 children b) HIV prevalence (2016): 8% e) Wasted children (2014): 2 in every 100 children c) Tuberculosis prevalence (2017): 143 per 100,000 people f) Underweight children (2014): 8 in every 100 children d) Number and type of new non-communicable disease cases in outpatient departments (OPD) per 100,000 5. Health financing people (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 24.8 percent. 1600 1400 1418 1327 b) Health spending (2014/15): Ksh 1,647.44 million 1200 c) Health spending (2015/16): Ksh 2,533.88 million 1000 940 800 765 d) Per capita health spending (2014/15): Ksh 1,494 600 533 e) NHIF coverage (2015/16): 44.4 persons for every 100 400 370 376 440 200 citizens 126 127 124 121 0 f) Development allocation as percentage of total health 2013/14 2014/15 2015/162 016/17 spending (2015/16): 34% New mental disorders in OPD 100,000 people - New hypertention in OPD per 100,000 people New diabetes in OPD per 100,000 people 2015/16 66% 34% 4. Health status 2014/15 74% 26% 90.0 82.2 2013/14 30% 70% 80.0 72.8 74.9 70.0 66.1 61.8 58.0 60.0 0% 20% 40% 60% 80% 100% 50.0 II Recurrent ■ Development 40.0 30.0 20.0 10.0 6. Health infrastructure (2017) 0.0 Proportion of married Proportion of births Children 12 -23 women using attended by a skilled months fully a) Hospital beds: 18 per 10,000 population contraception health worker vaccinated b) Health facilities: 2 per 10,000 population 11 Kisii ■ National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 95 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 207 various conditions (2017) d) Primary health facilities: 184 a) Essential drugs for mothers: 83% e) County and sub-county hospitals: 23 b) Essential drugs for children: 33% f) Total beds and cots: 2,470 c) HIV & AIDS: 100% d) Malaria: 80% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 72.4 percent f) Diabetes: 40% b) Non governmental organizations (NGOs): 1.0% c) Faith-based organizations (FBOs): 8.6% 4. Health service delivery indices (2017)2 d) Private: 19.0 percent a) Overall health service delivery index: 52.8% b) Medical drugs index: 72.7% c) Infrastructure index: 63.4% d) Amenities (water, incinerator and electricity) index: 19% 76.7% 8% e) Medical equipment index: 55.6% 1% f) Public participation in health sector index: 35.6% 72% g) Citizen satisfaction in health sector index: 54.3% h) Health human resources index: 11.5% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 80.0 70.0 2. Water and sanitation (2017) 60.0Human resource Public50.0 Proportion of the population with access to improved water 40.030.0 and sanitation: 41.3% 20.010.0 0.0 Infrustructure Citizen 3. Level of availability and functionality of medical satisfaction equipment in health facilities (2017): a) Obstetric care equipment: 70% incinerator, Medical electricity) Equipmentb) Delivery pack: 66.67% 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Ensure there is adequate resource allocation to purchase equipment and ensure sufficient supply of essential medical drugs (ii) Improve on sanitation and ensure there is supply of clean and safe water for households (iii) Enhance public participation in health planning, budgeting and programme implementation (iv) Provide civic education on nutrition to eliminate the levels of stunted, wasted and underweight among children 96 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Nyamira County 1. County indicators a) Use of contraceptives (2017): 68 out of every 100 a) Location: Nyanza region of Kenya women of child bearing age b) Total population estimate (2017): 714, 603 people (344,053 b) Attendance by a skilled health worker (2017): 74 out of every 100 children born male and 370,550 female) c) Vaccination (2017): 92 out of every 100 children c) 15 years old and below: 4.3 out of every 10 persons d) Overall poverty index (2015/16): 32.7% 25.5 26.0 e) Life expectancy (2014): 59 years 30.0 f) Fertility rate (2014): 3.5 children per woman 20.0 9.6 11.0 2. Human resources for health (2017) 10.0 4.1 4.0 a) Medical workers: 51 per 100,000 population1 0.0 b) Doctors: 16 Stunted Wasted Underweight c) Nurses: 289 d) Clinical officers: 33 II Nyamira II National e) Public health workers: 76 d) Stunted children (2014): 26 children in every 100 3. Health indicators children a) Malaria test positivity rate (2017): 9% e) Wasted children (2014): 4 in every 100 children b) HIV prevalence (2016): 6.4% f) Underweight children (2014): 10 in every 100 children c) Tuberculosis prevalence (2017): 137 per 100,000 people 5. Health financing d) Number and type of new non-communicable disease cases a) Total budget allocation to health sector (2015/16): in outpatient departments (OPD) per 100,000 people 28.8% (2013/14 to 2016/17) b) Health spending (2014/15): Ksh 1,150.3 million c) Health spending (2015/16): Ksh 1,310.49 million 2500 d) Per capita health spending (2014/15): Ksh 1,803 2000 1966 e) NHIF coverage (2015/16): 35.6 persons for every 100 1621 1500 citizens 1175 1000 958 f) Development allocation as percentage of total health 570 500 290 315 447 spending (2015/16): 31% 121 0 109 11 91 2013/14 2014/15 2015/16 2016/17 New mental disorders in OPD 100,000 people I 2015/16 69% 31% --New hypertention in OPD per 100,000 people - New diabetes in OPD per 100,000 people 2014/15 75% 25% 4. Health status 2013/14 74% - 26% 100.0 92.1 I I 90.0 0% 20%4 0% 60%8 0% 100% 80.0 74.1 74.9 67.9 70.0 58.0 61.8 II Recurrent ■ Development60.0 50.0 40.0 30.0 6. Health infrastructure (2017) 20.0 10.0 a) Hospital beds: 14 per 10,000 population 0.0 Proportion of married Proportion of births Children 12 -23 b) Health facilities: 2 per 10,000 population women using attended by a skilled months fully contraception health worker vaccinated II Nyamira II National 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 97 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 142 various conditions (2017) d) Primary health facilities: 134 a) Essential drugs for mothers: 75% e) County and sub-county hospitals: 8 b) Essential drugs for children: 65% f) Total beds and cots: 1000 c) HIV & AIDS: 100% d) Malaria: 67% 1. Ownership of health facilities e) Tuberculosis: 100% a) Government: 65 percent f) Diabetes: 67% b) Non governmental organizations (NGOs): 0.7% c) Faith-based organizations (FBOs): 10.5% 4. Health service delivery indices (2017) 2 d) Private: 25.2% a) Overall health service delivery index: 61.4% b) Medical drugs index: 72.3% c) Infrastructure index: 73.4% d) Amenities (water, incinerator and electricity) index: 25% 88.9% e) Medical equipment index: 76.7% 10% f) Public participation in health sector index: 39.1% 1% 64% g) Citizen satisfaction in health sector index: 49.2% h) Health human resources index: 30.3% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 2. Water and sanitation (2017) 100.080.0 Proportion of the population with access to improved water Human resource 60.0 and sanitation: 40.4% 40.0 20.0 3. 0.0Level of availability and functionality of medical equipment Infrustructure in health facilities (2017): a) Obstetric care equipment: 60% b) Delivery pack: 72.2% incinerator, electricity) Medical Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Implement interventions in preventive and promotive health care to reduce disease prevalence, and eliminate stunting, wasting and underweight among children (ii) Focus on improving supply of the inadequate drugs (iii) Increase public participation in health planning interventions (iv) Allocate more resources for improvement of water supply and sanitation across the county (v) Utilize community health workers to increase NHIF uptake and in order to reduce Out-of- Pocket spending (vi) Improve deployment of human resource for health 98 The KENYA INSTITUTE for PUBLIC POLICY RESEARCH and ANALYSIS Health Care Delivery under Devolution: Nairobi County 1. County indicators a) Use of contraceptives (2017): 63 out of every 100 a) Location: Nairobi region of Kenya women of child bearing age b) Total population estimate (2017): 4,712,451 people b) Attendance by a skilled health worker (2017): 89 out of (2,316,005 male and 2,401,446 female) every 100 children born c) 15 years old and below: 3 out of every 10 persons c) Vaccination (2017): 74 out of every 100 children d) Overall poverty index (2015/16): 16.7% e) Life expectancy (2014): 62.5 years 30.0 24.0 26.0 f) Fertility rate (2014): 2.7 children per woman 25.0 2. Human resources for health (2017) 20.0 a) Medical workers: 252 per 100,000 population1 15.0 11.0 10.0 9.0 b) Doctors: 413 4.0 5.0 c) Nurses: 1,013 2.0 0.0 d) Clinical officers: 194 Stunted Wasted Underweight e) Public health workers: 225 II Nairobi II National 3. Health indicators a) Malaria test positivity rate (2017): 50% d) Stunted children (2014): 26 children in every 100 b) HIV prevalence (2016): 6.8% children c) Tuberculosis prevalence (2017): 405 per 100,000 people e) Wasted children (2014): 4 in every 100 children d) Number and type of new non-communicable disease cases f) Underweight children (2014): 11 in every 100 children in outpatient departments (OPD) per 100,000 people 5. Health financing (2013/14 to 2016/17) a) Total budget allocation to health sector (2015/16): 21 3500 ----v, percent ---------------------- 3260 b) Health spending (2014/15): Ksh 5246.65 million 3000 ---- 2701 c) Health spending (2015/16): Ksh 4904.88 million2500 2411 d) Per capita health spending (2014/15): Ksh 17452000 2001 e) NHIF coverage (2015/16): 35.2 persons for every 1001500 citizens 1000 1197 1157 1445 833 f) Development allocation as percentage of total health 500 ---6-21449398 368 spending (2015/16): 20% 0 2013/14 2014/15 2015/-1-6------ 2016/17 New mental disorders in OPD 100,000 people --New hypertention in OPD per 100,000 people 2015/16 80% 20% New diabetes in OPD per 100,000 people 4. Health status 2014/15 88% 12% 100.0 89.1 90.0 2013/14 89% 11% 80.0 74.4 74.9 70.0 62.6 58.0 61.8 60.0 0% 20%4 0% 60% 80% 100% 50.0 II Recurrent ■ Development40.0 30.0 20.0 10.0 0.0 6. Health infrastructure (2017) Proportion of married Proportion of births Children 12 -23 months women using attended by a skilled fully vaccinated contraception health worker a) Hospital beds: 18 per 10,000 population 11 Nairobi ■ National b) Health facilities: 2 per 10,000 population 1 The World Health Organization (WHO) target is 230 medical workers per 100,000 people. 99 Number of health facilities Proportion of health facilities with valid medical drugs for c) Total health facilities: 908 various conditions (2017) d) Primary health facilities: 864 a) Essential drugs for mothers: 63% e) County and sub-county hospitals: 44 b) Essential drugs for children: 75% c) HIV & AIDS: 88% f) Total beds and cots: 8551 d) Malaria: 88% 1. Ownership of health facilities e) Tuberculosis: 76% a) Government: 15.6 percent f) Diabetes: 75% b) Non governmental organizations (NGOs): 1.7% 4. Health service delivery indices (2017)2 c) Faith-based organizations (FBOs): 9.8% a) Overall health service delivery index: 73.5% d) Private: 60.6% b) Medical drugs index: 77.3% c) Infrastructure index: 92.8% 16% d) Amenities (water, incinerator and electricity) index: 95.8% 2% e) Medical equipment index: 83.3% 10% f) Public participation in health sector index: 49.9% g) Citizen satisfaction in health sector index: 43.9% 61% h) Health human resources index: 71.1% ■ Public ■ NGOs ■ FBOs ■ Private Access to basic drugs 100.0 2. Water and sanitation (2017) 80.0 Proportion of the population with access to improved water Human resource 60.0 and sanitation: 91.9% 40.0 20.0 3. Level of availability and functionality of medical equipment 0.0 in health facilities (2017): Infrustructure a) Obstetric care equipment: 100% b) Delivery pack: 100% incinerator, electricity) Medical Equipment 5. Recommendations To address the emerging challenges in the health sector, the county needs to: (i) Focus on innovative interventions in preventive and promotive health care to reduce disease prevalence, stunting and underweight among children (ii) Increase NHIF uptake and improve immunization (iii) Improve supply of the essential medical drugs (iv) Enhance public participation in health planning interventions About KIPPRA Policy Briefs For More Information Contact: KIPPRA Policy Briefs are aimed at a wide dissemination Kenya Institute for Public Policy Research and Analysis of the Institute’s policy research findings. The findings are Bishops Road, Bishops Garden Towers expected to stimulate discussion and also build capacity P.O. Box 56445-00200, Nairobi in the public policy making process in Kenya Tel: 2719933/4 KIPPRA acknowledges generous support from the Cell: 0736712724, 0724256078 Government of Kenya and the Think Tank Initiative of Email: admin@kippra.or.ke IDRC who have continued to support the Institute’s Website: http://www.kippra.org activities over the years Twitter: @kipprakenya 100 Kenya Institute for Public Policy Research and Analysis Bishops Garden Towers, Bishops Road P.O. Box 56445-00200, Nairobi, Kenya tel: +254 20 4936000; +254 20 2719933/4 fax: +254 20 2719951 email: admin@kippra.or.ke website: http://www.kippra.org