Annual Operational Plan 5 Quarter 1 (July – September 2009) Performance progress

Annual Operational Plan 5 Mid-term (July – December 2009)Progress report

Dr S K Sharif

Director Public Health & Sanitation

Health Services Index

Introduction

•Health Services Coverage trends critical input into analysis of health trends anddistribution

•Are numerous indicators in Kenya that follow up on coverage of different HealthServices, all serving different purposes

–Follow up of implementation of interventions

–Follow up of program progress

–Follow up of system, or sector implementation

•System assessment requires a representative set of indicators for follow – up ofoverall progress.

•Health Services Index provides a means to summarize trends in a selected set ofindicators, to provide for an overall picture of trends for Service Coverage in thesector

•Has been developed by HMIS unit in Technical Planning Department, for overallmonitoring of sector wide progress

–Program monitoring to continue, based on program specific indicators

Key principles

•Cohort based index, in line with country’s service package

•Total number of indicators fixed at 30.

–Ensure a single indicator on its own doesn’t have a significant impact on the overall Health Index

–But, have a manageable number of indicators for which information can be made available

–Each result area to have at least 1 indicator. More indicators for priority result areas (cohorts 1 & 2)

•Number of indicators by cohort fixed, informed by priorities of sector

–Cohort 2&3 = 33% of Indicators, Cohort 1=30%, cohort 5=17%, cohorts 5 & 6 = 10% each

•Actual indicators making up index may be changed, to limit the vertical focus on improvinga single indicator target during implementation.

•Each indicator in the index carries the same weight.

•If no data, value of indicator shall be zero.

–Ensures future focus is on improving both access (services to un-served cohorts), and coverage(improve coverage’s)

•Sub index analysis factored in

–Indicators for both Medical Services, and Public Health in each cohort

–Each cohort to have its own index value, based on its indicators

Health Services Index

National value

Medical Servicesvalue

Public HealthServices value

Overall value

28%

18%

38%

Coast province

31%

16%

45%

Eastern province

29%

15%

44%

N/Eastern province

22%

15%

29%

Nairobi province

22%

10%

34%

Western province

47%

46%

47%

Nyanza province

25%

15%

35%

Rift Valley province

20%

11%

30%

Central province

30%

19%

41%

•Overall the sector performance was 28% with a contribution of 18% from MOMS and 38%from MOPHs.

•Performance was higher by level 2 and 3 than level 4,5 and 6.

•Western province had equal performance in both medical and public health services andhad higher index

Health Services Index

National value

Medical Servicesvalue

Public HealthServices value

Overall value

28%

18%

38%

Cohort 1

13%

16%

Cohort 2 & 3

28%

14%

41%

Cohort 4

Cohort 5

22%

29%

15%

Cohort 6

46%

25%

67%

•Overall the sector performance was 28% with a contribution of 18% fromMOMS and 38% from MOPHs.

•High performance in Cohort six and cohort 2 and 3.

AOP 4 Priorities

1.Strengthen coverage and effectiveness ofpublic health interventions.

2.Identify and support implementation ofdefined and cost-effective public healthinterventions

3.Decentralize service delivery

Service delivery priorities

1.Universal access to Maternal, Child andNeonatal health services.

2.Reduce malaria morbidity and mortality.

3.Accelerate TB control & treatment initiatives.

4.Accelerate implementation of communitystrategy.

5.Strengthening quality of health care.

6.Improve HCW morale

Reporting rate by province

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

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

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

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

Early Childhood (2 weeks to 5 years)

Early Childhood (2 weeks to 5 years)

Early Childhood (2 weeks to 5 years)

Early Childhood (2 weeks to 5 years)

•200 U5 per 1000new casesattending CWC areunderweight.

•Coast, N-Easternand R-Valley havehighest rates ofunderweight.

Proportion of children 6-59 months receiving Vitamin ATrends AOP1 – AOP4

Equity Analysis

•Five parameters used in analysis:

–Literacy index (Secondary school enrolment rate)

–Poverty index

–Level of urbanisation

–Aridity

–Gender development index

Effect of literacy on service delivery

•The most literate population enjoy better service coveragethan the least literate

Effect of poverty on service delivery

•The least poor (rich) enjoy better access to services.

Effect of urbanization on service delivery

•The most urbanized districts experience better health servicecoverage than the least urbanized (rural) districts

Effect of aridity on service delivery

•Aridity seem to have no effect on the coverage of maternalservices.

•Arid districts seem to have better immunization coverage thannon arid districts

Effect of gender development on servicedelivery

•Districts with populations that males and females have equalpowers in decision making enjoy better coverage than those withgross imbalances in power.

AOP 4 performance

•In general the trends of coverage for most ofthe indicators has declined over the years.

•Proportion of pregnant women deliveringunder skilled attendance stagnated at about30% nationally.

•Facility reporting rates to the district remainspoor.

Recommendation

1.Redouble efforts to improve the supply anddemand of services from health facilities.

2.Address the broader social determinants ofhealth to improve on health serviceutilization.

3.Improve on the completeness ofdocumentation and reporting of healthservices offered.