Nairobi county Group work feedback 1
Leadership, management & Governance Structure • CEC, Chief officer and County director of health services • Deputy Director ‐ Preventive & Promotive – • child health, RH, nutrition, immunization, HIV, TB, malaria, gender • Dep director – clinical services • nursing services, lab services, pharmacy, rehabilitative, clinical medicine • Dep director policy, planning and research • HSS, health financing, research, QI, M&E, administration • Dep director public health • Surveillance, community strategy, WASH, environmental health, development control, inoculation unit 2
Sub county • SC MOH leads • SCHMT with 5 core members ‐ SCPHN, SCHRIO, Public health, nursing dept. and lab services. Other co‐opted as needed; • Focal points: child health, community strategy, surveillance, SCASCOs, QI, nutrition Coordination between County and sub‐county teams • County director communicates to SCMOH who communicates to the SCHMT/focal points • All communication from county focal points must go through county director and not directly 3
Child health implementation • Child health, maternal health, neonatal and nutrition focal point reports to Dep P&P • WASH and community strategy report to Director public health • Multi‐sectoral approach with other line ministries – Agriculture, water, environment, administration (national govt), school health program, gender • How it works • TWGs and quarterly stakeholders meetings bring together relevant units and other sectors • Every dept. develops a quarterly work plan harmonized at directors level • Monthly CHMT meetings for planning and sharing • Annual work plans come from facility to sub county • Training selection of participants is done by SCMOH 4
Challenges County level • New organogram has not been implemented • Current organogram has gaps e.g. some cadres do not report to SC MOH because they report directly to county • Communication to sub‐county takes long due to long multiple channels. National to county communication • Formal ‐ National through COG to CEC to chief officer to director to CHMT members • Informal communication – focal points via county director, unwritten. • There is need to simplify and streamline the process 5
• Questions for today – • Interventions • Which interventions for child health need to be scaled up, adjusted or changed • HSS – what are the gaps or be adjusted? • Data ‐ What needs to be done with info systems, CHWs, supervision • Supply chain? • Budget advocacy – what is not being financed very well. Are you involved in the budgeting • Coordination – are TWG effective, are they helping 6
Interventions for child health that need to be scaled up 1. Kangaroo mother care – gaps are space, post discharge follow up, encourage KMC at home and in lower level facilities, documentation. 2. Adolescents behavior change practices to be incorporated in the different programs, Change the age we have been intervening; put effort in age 10‐14 years. Have programs for in and out of school, married. 3. Disability among children and adolescents – stigmatized children, sensitization of HCWs and CHWs, mapping households, recognize the different needs/disabilities. Partner with organizations/FBOs working with PWDs and Disabled people’s organizations (DPOs) 7
Interventions for child health that need to be scaled up ct. 5. ICCM and IMCI – treatment of pneumonia with antibiotics, gap is dispersible amoxicillin, align supply chain with reporting of cases 6. ICCM scale up – CHAs have been trained. Cascade to CHWs 7. Increase male engagement strategies ‘we men care’ to reach more facilities. Reaching the men through different strategies and locations where messaging on child health is done. Include men in design of interventions targeting women and children to increase their engagement 8. Adolescent mothers (15‐19 years) 30% of deliveries in Nairobi – consolidate the different interventions targeting young women with FP, ANC, delivery. Example: School health program where SC staff visit schools and link girls to youth CHVs and youth friendly services 9. Development of the AYSRH TWG to collate the issues. 10. Management and skills on resuscitation of the new born will offer great support 8
Interventions for child health that need to be scaled up ct. 11. The larger proportion of FSB showed the granulation of FSB and maternal data at the facility level to establish, if the deaths occur in the facility and at what time of the day the deaths occur. Especially during the unofficial working hours night shift and weekends due to staffing rations in this shifts. 12. security in informal settlements causes delay in seeking healthcare at night. Working with county administration to provide security. The health service provides are not able to access the facility early due to security. 14. EMOC assessments need to be strengthen 15. Data base for ToT and the trainees, then a post training follow up to ensure utilization of the information. Strengthening the data base on IRIS to ensure we can tie trainings to anticipated out comes. The county HSS team should. 16. Scale up of community based exclusive BF, including mother to mother support groups to assist mothers get peer development. 17. The use breastfeeding peer educators in Mx of acutely malnourished infants admitted in the wards. 9
HSS • Data and M&E • Regular DQA for data • Avail reporting tools • Scale up the use of MoH tools by private facilities • Supporting the facilities to do data entry at the source • Empowering the health facilities to draw the data from the DHIS and on the sources for • Supply chain – IMCI • Budget advocacy and allocation to go towards clearing the supply chain debts, enrolling health economist and pharmacists for qualification and allocation of funding through the county assembly • Improve the coordination with the public in the public participation • Budget advocacy for allocation of funds for child health through the advocacy of additional funding through the county assembly • Availability of funds after the budget has been passed due to delayed release of funds from national government. 10
Follow up action points 11
Recommendations – county team • Standardized organogram and communication policy for all counties from COG to be implemented • Streamline communication between national to county by ensuring county director is copied not just CECs • Redefine roles and responsibilities of national vs county with clearly scheduled activities e.g. data needs, supervision • COG should serve as an exchange not barrier – strengthen the health secretariat to facilitate easier exchange 12
Follow up points – partners & county • Prepare a fact sheet with data and key indicators to inform the CHMT feed back meeting. • Follow up meeting with CHMT to present the findings and make recommendations. • Come up with a joint work plan for the implementation of recommendations. • Support the CHMT to develop a joint Routine Data Quality Audit policy to ensure ownership of data at all levels. 13
Key actions to be followed up ‐ all • Kangaroo mother care • Adolescent focus • ICCM & Integrated Management Childhood Illnesses (IMCI) • Strengthen community strategy • Empower facilities and community teams to do DQA and data utilization • Ensure Technical Working Groups (TWG) are multi‐sectoral and data driven • Budget advocacy – data driven 14
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