CHAPTER 9HEALTH SERVICESPharmacy DepartmentThe Pharmacy department is a key pillar in the provision of health services. Well stocked hospital pharmacies ensure that the common morbidities can be handled by the public health care facilities at all the levels and promotes confidence of the citizenry in our health care system. The department has several key responsibilities including, but not limited to, Ensuring availability of adequate pharmaceuticals based largely on local morbidity Promoting rational use of medications in facility set ups Ensuring that available medicines are kept in ideal conditions and records are kept. Advising the CHMT and HMTs on medicines and medical supplies related matters Quantifying the amount of medicines required for the county for purposes of planning for procurement.Within the financial year, much has been accomplished as far as the mandate of the department is concerned.Procurement of essential medicines and medical supplies was done in March 2014 from KEMSA at a total cost of Kshs. 24 million. This was later followed by a Kshs. 7.743 million purchase from Mission for Essential Medical Supplies (MEDS) in July. Purchase from local suppliers for the same period was at Kshs. 3.607 million.In the above purchases the department ensured that all facilities received EMMS supplies based on work load of the given facilities. That was and remains the sole consideration when drugs are supplied.KEMSA and MEDS delivered the EMMS direct to the facilities and that minimized the overall cost of procurement to the county.Variety of medicines procured was also vast as compared to the previous year. For example, health facilities up to the dispensary level received second line antibiotics.

In partnership with AMPATH Chronic Disease Management Programme (CDM), various Revolving Fund Pharmacy (RFP) units have been set up in Burnt Forest Hospital, Huruma Sub-district Hospital, Ziwa Sub-district Hospital and plans are underway to set up one at the Uasin Gishu District Hospital. The Revolving Fund Pharmacy in Turbo SDH is a success story and so far, part of revenue generated has enabled the hospital to be connected to a clean water source and also piping of the facility.The RFP as set up is not a direct competitor of the main pharmacies in the said facilities, but rather act as alternative source of medication for patients seen at the facilities but cannot get the prescribed medicine(s). As a result, drug availability was boosted by that noble partnershipThe above achievements notwithstanding, a myriad of challenges were experienced though the same period. Some of the challenges are attributable to the common ones observed in all sector due to implementation of devolutionA training on pharmacovilance was carried in the month of June where 30 participants drawn from facilities that offer ART services, this will assist in monitoring of adverse following the administration of ART drugs among the clients. The supply of EMMS was to some extent erratic and insufficient. This was partly due to the lengthy procurement procedure and an extended lead time by the major suppliers-KEMSA and MEDS.Insufficient pharmacy staff was also a major challenge. This impacted a lot on estimation of EMMS quantities and also in generation of reports where EMMS is concerned.Reporting tools for antibiotics were not available to most facilities and as thus, the health care providers could not accurately do the recording as required.

NURSING DEPARTMENTIMMUNIZATIONUasin Gishu County was part of the counties that had high risk districts with the prevalence of tetanus. In this regard the national government rolled out a supplementary immunization programme that targeted Eldoret East and Wareng districts. During this period the districts performed well recording coverage of 96%. At the same time the county also did a national immunization programme on polio with three (3) rounds consecutively. Also the county scored above the target projections of 100 % and recorded 116%. The strategy employed was house to house which assisted the immunization teams to identify and report cases of flaccid paralysis which were thoroughly investigated.In order to strengthen routine immunization, the county formed six (6) sub county depots for storage and distribution of reproductive and immunization commodities. In this regard, vaccine specific refrigerators as well two domestic fridges were issued to be used for storage of antigens at the sub county levels. Further, cold chain inventory for functional and non functional epi equipment was done to inform on gaps that exist and future replacement plans to cater for additional antigens in the immunization schedule. The revival of the outreaches has positively increased the coverage of immunization from the previous 70% to 76%.A preventive mechanism on future cold chain breeches has been put in place to ensure that children under one year receive potent and viable vaccines.REPRODUCTIVE HEALTHReproductive health as well as maternal and neonatal health was further strengthened by capacity building through the support of stakeholders namely Ampath, PSI, SOS, IPAS and FHOK. This assisted the health care workers improve their skills and competences especially on post abortal care, cervical, breast and prostate cancer screening, long term methods of family planning. The exercise was run through all the six sub counties and in all hospitals. This also included integrated outreaches at the facility level. To this end service delivery has improved and utilization of health care services increased due to advocacy, sensitization, communication and awareness creation. During screening of the reproductive tract cancers, treatment has been instituted including cryotherapy, colposcopy.With the advent of free maternity, skilled deliveries has improved coupled with additional maternity facilities.STAFFINGDue to staffing challenges that the county was encountering an elaborate staff ratio nationalization programme was instituted and redistribution done in order to foster service delivery.CAPACITY BUILDINGIn order to keep abreast with current trends in health care management, teams were trained on monitoring and evaluation, epidemiology and quality data review. To keep to ever changing reproductive field a total of 30 health care workers were trained on comprehensive reproductive health at the Decentralized Training Centre (DTC) stationed at the National blood transfusion centre in Eldoret. A further training on Emergence obstetric care was also carried out on 14 health care providers. This has equipped the nurse/midwives with the requisite skills to attend to the increased hospital deliveries as well as unsafe, incomplete abortions. YOUTH FRIENDLY SERVICESOur county boosts of a majority of its population to be aged between 15 and 35 years of age. The department of nursing together with its partners FHOK facilitated the integrated its services to suit the needs of this cohort pioneered at Chepkanga health centre. This not only improved accessibility to family planning services but also utilization of HIV testing and counseling services. Secondly, the YFS has positively impacted the youth to better communicate with their peers, parents and care givers. It has also charted career paths for some as well as reduced teen pregnancies.

HEALTH RECORDS AND INFORMATION

The HIS provides information and interpretation related to a wide range of indicators computed on the basis of routine data generated from facility based Health Information System (HIS) during the period 2013/2014. Routine data collection, compilation, analysis and use constitute an important management function of an effective health care delivery system. Sound and effective manage-ment decisions are based on evidence derived from use of good statistics which provide guidance to the decision making process at all levels in the health system. This presents highlights the progress made in a wide range of indices at County Level in performance of delivery of health care services by the health facilities at all levels.

Digitization of Health Facilities

This is meant to provide a common digital platform to standardize data capture,Referral systems and provide uniformity in Health Management Information Systems.This as be implemented through Public Private Partnership arrangement.

PUBLIC HEALTHThis the department which mainly deals with disease prevention and promotion of health, through various interventions which including:- Food quality control, water quality control, inoculation/ vaccination, sanitation and hygiene, liquid and solid waste management, disease surveillance/ disease control, prosecution in relation to health, occupational health and safety, behavior change and communication, health education and promotion, disaster preparedness and response, defaulter tracing, institutional health, pollution control and revenue generation.Food quality controlThe department came up with the Alcoholic drinks control Act 2013 for Uasin Gishu County which regulates the processing, storage, distribution and sale of alcoholic drinks. Through the Act we managed to receive over 500 applicants for alcoholic drinks outlets and licensed leading to the generation of over Kshs. 20 million.Mapping and licensing of food premises were carried out and all food premises that met minimum public health requirements were licensed and revenue collected through licensing was Ksh. 1,249,820. In order to ensure that there were good hygiene practices in handling of food during preparation, transportation, and sale food handlers were medically examined where Ksh 754,150 was collected as revenue.

ProsecutionThe department issued statutory notices to various authors of nuisance who contravene Public Health Act cap 242 where 750 statutory notices were served, 489 complied, while 261 did not comply. There were 250 cases taken to court, 11 are due for mention and hearing and so far Ksh. 735,000 has been paid inform of fines and this forms part of revenue generated by the department of public health. Disease surveillance and controlDetection and reporting of diseases targeted for eradication, elimination and control is ongoing. So far we have investigated 12 cases of Acute Flaccid Paralysis (AFP) and specimen taken to KEMRI Nairobi for analysis out of 18 expected cases.In disease surveillance where 42 diseases are monitored on weekly basis, reporting rate has improved from 49% to 74%. This has enabled the county to maintain high degree of alertness level on disease outbreaks monitoring and notification. As part of response activities the county has conducted 2 campaigns against tetanus targeting woman of child bearing age where 65% and 64 % were attained respectively and 2 rounds of polio campaigns where carried out where 109% and 98% were achieved. There was a slight upsurge of malaria cases in the month of June 2014 and the situation subsided immediately. On disease outbreaks there were two reported case of food poisoning where a total 25 people were affected and were treated and discharged in June 2014 at Kesses Sub-county and Kapseret. There were also 2 suspected cases of anthrax in Turbo and Kiapseret Sub-county but the lab reports ruled out that it was not anthrax. And on alcoholic drinks there were 14 reported deaths and 64 admissions as a result of consumption of adulterated alcohol. Samples from the suspected drinks were taken Government Chemist and the results showed that they were safe for consumption.Environmental Sanitation Waste management was well coordinate in liaison with department of environment and where collection was carried out on weekly basis from trading centres from sub-counties. In urban public toilets were also hire out for easy management where a total of Ksh.240, 000 was collected. The Public health office charged with Cemetery management ensures that the best practices were observed during the calendar year and disposal of bodies were accorded due respect. The office managed to collect Ksh 219,000.as part of revenue paid for the services. As part of ensuring that the population was provided with good housing and safe occupation for businesses operation, building plans were approved for construction where Ksh 314,000 was collected. Slaughter House Management The public health office charge with cleanliness at slaughter house was also coordinating ensured good hygiene practices was observed. The office also is charged with revenue collection and Ksh 742,150 was collected.Inoculation/ vaccination Inoculation department deals with vaccination of international travellers e.g. yellow fever vaccine, polio vaccine and also other vaccines used for disease prevention e.g. for typhoid for food handlers, anti rabies for dog bites and Hepatitis B the department managed to raise Ksh 1,199,850.Institutional healthSchools were routinely inspected and health education given to children and new schools were inspected for registration, the office manages to raise the standard of learning in schools and also collected revenue Ksh 434,000. Sanitation and hygieneThe department held a sensitization meeting on Community Led Total Sanitation (CLTS) which is yet to be rolled out to the entire county so as to improve sanitation and hygiene. The department works with communities to improve latrine coverage which increased from 79% in July 2013 to 85% in June 2014.In general the department of public department in the last financial year managed to collect a total of Ksh 25,153,270.

NUTRITION The nutrition section of the health department is one of the sections that offer preventive, promotive and curative services. The section was able to carry out several activities in different health facilities. SAM cases reported were 1,626 while MAM cases reported were 1,921.Schools and House Hold Screening programmeAs a section of health the nutrition department was able to take anthropometrics for children in ECD centres in our county especially in our urban areas during the last quater. Z- Scores, MUAC weight and height were among those that were computed. a total of 8 schools were screened in the urban region and their nutritional status analyzed. 541 children were weighed. 218 households in kamukunji and 32 in kambi turkana were screened for nutritional disorders. The identified cases were managed at both huruma and UGDH.School de-worming1,385 primary school children were de-wormed in 8 urban schools and 2 schools in burnt forest with 120 children during the last quater.SupplementationSupplementation was done at various levels. Children less than five years were supplemented with both vitamins A. 16,655 children under one year were given 200,000 Iu of vitamin A. Children above one year supplemented with vitamin A were 11,362. Children between 2 and 5 years supplemented with vitamin A were 1671. 12 primary schools and ECD centers were supplemented with mix me. 3 children homes were also de-wormed and, supplemented with vitamin A and mix me mineral and nutrition powders.Pregnant and Lactating mothers pregnant Supplemented with vitamin angles were 6,819ANC mothers receiving iron and folate were 2,039Nutrition EducationNutrition education is routine in all our health facilities which have a nutrition officer attached to it. The topics given weight are those that promote good nutrition and hence good health. These topics include breast feeding messages, complementary feeding, diet therapy in the management of non communicable diseases especially diet in diabetes, diet in hypertension and cancers.Malezi Bora annual activityMalezi Bora is an annual activity that takes place in the months of May and November respectively. The events during tha past year were successesful and were marked by a launch for each month, one in meibeki health centre and a second one at Uasin Gishu District Hospital.Word Breastfeeding dayThe nutrition section in collaboration with the nutrition section of AMPATH and MTRH was able to mark this important week, celebrated in the world during the first week of august every year, by participating in a walk around town sending the messages on the importance of breast feeding and how breastfeeding is linked to the achievement of all the millennium development goals. Sub county activities followed thereafter with the year's theme and health messages being communicated effectively. Non Communicable DiseasesConditions handled by the nutrition department included diabetes and hypertension among the non communicable diseases. 4,020 cases of diabetes and 11,963 cases of hypertension were reported and diet therapy given to all of the above clients in different health facilities.Special ClinicsThe nutritionists in the county also handle all the special clinics including the TB and the diabetic clinic, here diet therapy is administered for all the clients and counseling and nutrition education given routinely at every visit. Medical CampThe nutrition section of the health department was also able to participate in a free medical camp where all the nutritional needs of all the clients present were met. A total of 319 clients were seen at the nutrition clinic. Their anthropometrics were taken and a total of 285 were educated on nutrition because they presented with disorders that were linked to nutrition especially diabetes and hypertension. 60 children were seen at the clinic and vitamin A was administered 45 children who were below 5 years and over 200 children were supplemented with mix me nutrition powder. 180 pregnant and lactating mothers were also supplemented with vitamin angels.With our rising number of in patients, the nutrition department was also able to review all the menus used in our facilities for in patients and maternity patients. The nutrition section is dedicated to giving quality nutrition and health services in the county and is looking forward to improving the services even more. The department appreciates the support given by the health department but we can do much better if our main challenges are addressed which include staffing, currently the department has only 13 nutrition officers.LABORATORY DEPARTMENTThe medical laboratory department is a key pillar in the provision of health services. The mandate is achieved through application of modern scientific knowledge and skills to guide in promoting health in diagnosis of both communicable and non communicable conditions. Well established consistent medical laboratory diagnostic services are essential for health promotion, disease prevention, diagnosis, monitoring and client management. There forty four (44) functional GOK facilities in the county. Quality diagnostic services will ensure early disease detection, guide in treatment and management of clients, improved quality of care for communicable and non communicable conditions in the county therefore promoting healthy living for all residents in the county. The department has several key responsibilities including: Ensuring consistent availability of adequate diagnostic commodities and supplies in Promoting utilization of laboratory diagnostic services through provision of quality services. Advising the CHMT and HMTs on laboratory diagnostic services matters related to technical human resource issues, quality commodities and equipments for planning.Within the financial year, much has been accomplished as far as the mandate of the department is concerned.

Departments mandate achievementsThe laboratory diagnostic service provision was achieved at all active sites. The diagnosis falls in two groups of essential tests (routine test) available at all diagnostic sites and specialized tests which are available at specific higher level laboratory facilities at tier 3. The total 209,452 tests were performed, of these 157,024 wee routine and 52,427 were specialized tests. On malaria diagnosis, confirmed diagnosis by Malaria microscopy or malaria RDT test is currently used in the county. There were 66,586 confirmed malaria cases within the period of this report. On ANC profile 23,421 cases were served at the county diagnostic ANC profile tests include Rapid HIV test, malaria parasite test, haemoglobin estimation,VDRL for syphilis, urinalysis, ABO & Rhesus blood grouping and pregnancy test.Equipments AcquiredSpecialized Equipments were acquired through National TB & Leprosy program are three (3) Fluorescent Microscopes and One (1) Gene XPERT machine for MDR TB & XDR TB Diagnosis. Two binocular electric microscopes were donated by EXACT DIAGNOSIS Malaria study to Railways and Mois bridge facilities.On staff capacity building on the New HIV Algorithm training Sponsored by AMPATHPLUS, 384 Health Workers providing HTC services in the county were trained. Quality malaria diagnosis has been promoted whereby sixteen (16) MLTs officers were trained on malaria microscopy by centre of excellence at KEMRI Kisumu by DOMC, two (2) officers trained as malaria quality control officers by KEMRI. 8 officers trained on Biosafety/Biosecurity by MSH/NPHLS.1 officer trained on Good clinical laboratory practice (GCLP) by AMREF.The challenges faced by department includes;- Inadequate staffing, part of these being attributed to end of contract for ESP staff. The county to consider employing more medical laboratory technologists. Erratic supply of reagents due to inadequate funding for the department. The request is to the county to help to enhance consistent diagnostic service delivery through continuous and consistent supply of commodities. Lack of specialized equipment in county and sub county hospitals. The county to consider procurement of specialized equipment to promote quality health care to guide in management of communicable, non communicable and lifestyle diseases. Laboratory infrastructure and equipment in some facilities are in a state of disrepair. The county is requested to consider building a modern laboratory meeting the required standards for construction and renovation of facilities and replacement of equipment.

HIV/AIDSART sites were scaled up from 19 to 20 sites and the number of patients currently on ARVs were 22321 in July 2014 up from 201543 in July 2013. the current county HIV prevalence was 4.3 % down from 5.1 % last year.