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MOMBASA COUNTY FAMILY PLANNING COSTED IMPLEMENTATION PLAN

2018-2022

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CONTENTS FOREWORD v CHAPTER ONE: INTRODUCTION

1

1.1 COUNTY BACKGROUND1

1.2 POPULATION DEMOGRAPHICS

1

MOMBASA POPULATION PYRAMID

2

1.3 RATIONALE FOR THE FAMILY PLANNING COSTED

IMPLEMENTATION PLAN

2

1.4 THE DEVELOPMENT PROCESS

4

1.5 KEY PRINCIPLES OF THE FP-CIP

4

CHAPTER 2: SITUATIONAL ANALYSIS

5

2.1 THE GLOBAL CONTEXT

5

FP 2020

5

SUSTAINABLE DEVELOPMENT GOALS (SDGS)

6

2.3 FAMILY PLANNING TRENDS IN KENYA

8

2.4 UNMET NEED FOR FAMILY PLANNING

9

2.5 GENERAL HEALTHCARE SITUATION IN MOMBASA COUNTY

9

FAMILY PLANNING UPTAKE BY METHODS

9

2.6 FACTORS AFFECTING FAMILY PLANNING IN MOMBASA COUNTY

10

2.7 POPULATION WITH SPECIAL NEED FOR FAMILY PLANNING

11

2.8 STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS

12

(SWOT) ANALYSIS

12

PESTEL ANALYSIS

13

CHAPTER THREE: IMPLEMENTATION PLANS

15

3.0 STRENGTHENING HEALTH SYSTEMS

15

CHAPTER FOUR: IMPLEMENTATION PLAN

17

CHAPTER 5: RESEARCH, MONITORING & EVALUATION

34

5.3 DATA FLOW

38

CHAPTER 6: PARTNERSHIP AND FINANCING

39

6.0 INTRODUCTION

39

6.1 STAKEHOLDERS ANALYSIS

39

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REFFERENCES 43

ANNEX 2: Rates of adolescent pregnancy and motherhood in Kenya per region 48

ANNEX 3: Commodity Prices

49

ANNEX 4: Family Planning Method Mix Dynamics

49

ANNEX 5: Sustainable Development Goals

50

ANNEX 6: WHY INVEST IN FAMILY PLANNING

50

ANNEX 7: Population Pyramid by Age and Gender

51

ANNEX 8: Demographic Dividend Investment Wheels

51

ANNEXE 9: LIST OF FP-CIP DEVELOPMENT TEAM

52

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FOREWORD The Department of Health Services is mandated by the Constitution of Kenya (2010) to carry out various health functions as outlined in the Health Sector Functions Assignments and Transfer Policy Paper of 2013. Article 43 (1) (a) provides every person with the right to the highest attainable standards of health, which includes the right to healthcare services, in which reproductive health care is a key component. Family planning has proven to be the most cost-effective intervention in preventing maternal deaths. It also contributes to economic growth, reduced child mortality and unplanned pregnancies and unsafe abortions. Family Planning interventions contribute to the attainment of several of the Sustainable Development Goals (SDGs). According to the Kenya Demographic Health Survey (KDHS) 2014, the Contraceptive Prevalence Rate for Mombasa County is 55% compared to the national rate of 58%. However, there still exists an unmet need for family planning which stands at 20.8% for coastal region where Mombasa lies compared to 18% nationally. The Mombasa County Family Planning Costed Implementation Plan 2018-2022 aims at improving the socio-economic well-being of the people of Mombasa County by expanding access to family planning services to attain a modern contraceptive prevalence rate of 63.6% by the year 2022.

Hon. Hazel Koitaba County Executive Committee Member for Health Services, County Government of Mombasa.

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PREFACE The County department of health Mombasa is committed to improving access to family planning, as it is a low cost, high dividend investment for addressing Mombasa’s high maternal mortality ratio and improving the health and welfare of women, men, and ultimately, the nation. Family planning is an essential component in our county development agenda to become a middle-income country in the next 30 years. However, we must make substantial investments to improve health outcomes and meet the needs for family planning, while also educating and training workers, promoting new job opportunities for young people, and strengthening economic stability and governance. Therefore, let us work together to ensure the health and wealth of our county. By committing ourselves to the full and implementation of the Mombasa County Family Planning Costed Implementation Plan, 2018–2022 (FP-CIP), we can realize our goals of reducing unmet need for family planning to 15 percent and increasing the modern contraceptive prevalence rate amongst married and women in union to 63.6 percent by 2022. Full and successful implementation of the FP-CIP requires the concerted and coordinated efforts of the county government, the private sector, and civil society and development partners. We must all work together to ensure an enabling environment for policy, financing, service delivery, advocacy programmes, and the effective mobilization of communities and individuals to overcome sociocultural barriers to accessing family planning services. The County Government of Mombasa department of health services is committed to providing the required leadership to coordinate and implement the FP-CIP, so as to ensure that every Mombasa citizen has the right to health, education, autonomy, and personal decision making about the number and timing of their childbearing.

Dr. Khadija Shikey Chief Officer Health, County Government of Mombasa.

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ACKNOWLEDGEMENT This Family planning costed implementation plan benefited from wide consultations with individuals, institutions and organizations with special interest on family planning and reproductive health. Their participation, assistance, comments, suggestions and cooperation in providing information to the process proved instrumental. The technical working group of Mombasa County, wishes to acknowledge the dedicated efforts and leadership of the Mombasa County led by H.E Governor Hassan Joho, through the Health department led by the CEC for Health.Hazel Koitaba, County Chief Officer of Medical Services Dr..Khadija Shikely , County Health Director Dr. Shem Patta and the whole team of Mombasa. The County Health Department is indebted to the individuals and organizations especially DSW Kenya who gave finance support by hiring a consultant and backing the several meetings during this CIP development process. Special appreciation to Cosmas Mutua the lead facilitator for technical guidance throughout this process. Special recognition goes to the key stakeholders that contributed to the development of this plan to include; DSW Kenya, Marie Stopes Kenya, KMYDO, FHOK and Religious leaders.. We acknowledge all the individuals who represented the different institutions/ departments, listed in annex 9. It is our sincere hope and desire that the family planning costed implementation plan will be of great help in improving access and utilization of FP services to the people of Mombasa County

Aisha Abubakar County Chief Officer Public Health County Government of Mombasa

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ABBREVIATIONS AIDS AWP AYSRH

Acquired Immunodeficiency Syndrome Annual Work Plan Adolescent and Youth Sexual and

M&E MMR MOH

Monitoring & Evaluation Maternal Mortality Ratio Ministry of Health

CHEWs

Reproductive Health Community Health Extension Workers

MOU

CHMT

County Health Management Team

NASCOP

CHVs

Community Health Volunteers County Integrated Development Plan Costed Implementation Plan Continuous Medical Education

NCPD

Memorandum of Understanding National AIDS and STI Control Programme National Council for Population and dev.

NGO OJT PAC

Non-Governmental Organizations On Job Training Post Abortion Care Kit

PHC PHOs PSK PWD PWUD QI

Population and Housing Census Public Health Officers Population Service Kenya People with Disability People Who Use Drugs Quality Improvement

SDG SDPs SOPs STI SW WRA TB TFR

Sustainable Development Goals Service Delivery Point Standard Operating Procedures Sexually Transmitted Infection Sex Workers Women of Reproductive Age Tuberculosis Total Fertility Rate

CIDP CIP CME CPR CYP DHIS DMPAs DQA DRH DSW eMTCT FBO FP GDP HIS HIV HRH HSS ICT IEC KDHS

LAPMs mCPR

Contraceptive Prevalence Rate Couple Year Protection District Heath Information System Depot Medroxyprogesterone Acetate Data Quality Assurance Division of Reproductive Health Deutsche Stiftung Weltbevölkerung Elimination of Mother to Child Transmission Faith Based Organization Family Planning Good Dispensing Practice Health Information Systems Human Immunodeficiency Virus Personnel for Health Health Systems Strengthening Information Communication Technology Information Education & Communication

TNA

Training Needs Assessment

TOT

Trainer of Trainer’s

Kenya Demographic Health Survey

TWG UN

Technical Working Group United Nations

UNFPA

United Nations Population Fund

URC

University Research Council

WHO

World Health Organization

Long Acting and Permanent Methods Modern Contraceptive Prevalence Rate

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OPERATIONAL DEFINITIONS OF TERMS Adolescent: An adolescent is any person between the age of 10 and 19 years. Adolescence is a period marked by significant growth, remarkable development and changes in the life course for boys and girls, filled with vulnerabilities and risks, as well as incredible opportunities and potential. (WHO) Adolescent-Friendly Services: These are sexual and reproductive health services delivered in ways that are responsive to specific needs, vulnerabilities and desires of adolescents. These services should be offered in a non-judgmental and confidential way that fully respects human dignity. Age Appropriate: This is suitability of information and services for people of a particular age, and in the case of the document, particularly in relation to adolescent development. Advocacy: is the process of informing and/or influencing decision makers in order to change policies and/or financial allocations, and to ensure effective policy implementation. Advocacy plays a critical role in ensuring that national commitments translate into concrete action. Beyond zero: is an initiative spearheaded by The First Lady of the Republic of Kenya, Her Excellency Margaret Kenyatta. It is part of the initiatives outlined in a strategic framework towards HIV control, promotion of maternal, newborn and child health in Kenya. Through this initiative Her Excellency has fundraised to ensure all the 47 counties have a mobile clinic (equivalent of a Level Four hospital). Mombasa County already has the mobile clinic. Contraceptive Prevalence Rate (CPR): the percentage of currently married women and sexually active unmarried women who are currently using a method of contraception or whose sexual partners are practicing any form of contraception. Community strategy: recognition and introduction of Level One services, which are aimed at empowering Kenyan households and communities to take charge of improving their own health. Elimination of Mother-To-Child Transmission (eMTCT): refers to the elimination of transmission of HIV from a HIV-positive woman to her child during pregnancy, labour, delivery and/or breastfeeding. Family planning: refers to a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods. Health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO definition) Health care professional: includes any person who has obtained health professional qualifications and licensed by the relevant regulatory bodies. Integration: refers to delivering multiple services or interventions to the same patient by an individual health care worker or by a team of health care workers and, possibly, workers from other fields. Life Skills Education: This is a structured program of needs and outcomes-based participatory learning that aims to increase positive and adaptive behavior by assisting individuals to develop and practice psycho-social skills that minimize risk factors and maximize protective factors. Life skills education programs are theory and evidence based, learner-focused, delivered by competent facilitators and are appropriately evaluated to ensure continuous improvement of documented results. x


Linkage: refers to a relationship between different parties such as, between community to health facility, Sub-county and County hospitals or between two departments within a facility. Methods of Contraception: (family planning) are classified as modern or traditional methods. Modern Contraceptive Methods: include female sterilization, male sterilization, oral hormonal pills, the intrauterine device (IUD), injectables, implants, male condoms, female condoms, Lactational Amenorrhea Method (LAM. Traditional Methods: include rhythm and withdrawal. Missed Opportunity: for family planning is defined as an opportunity for family planning counseling, education or service that was missed at the health center or outreach. Policy: Refers to those actions, customs, laws or regulations by governments or other social/civic groups that directly or indirectly, explicitly or implicitly affect people, communities, programs, or institutions. It can also be defined as a framework which guides decision making. Reproductive Rights: include the right of all individuals to attain the highest standard of sexual and reproductive health and to make informed decisions regarding their reproductive lives free from discrimination, coercion or violence. Special target populations: refers to populations that require special attention due to vulnerability. These groups vary according to the topic in discussion and the geographic area in discussion. For the purpose of this strategy, the following are the special target groups referred to: adolescents and youth, people living with disability, women living with HIV, drug users and female sex workers. The Sustainable Development Goals (SDGs), officially known as Transforming our world: The 2030 Agenda for Sustainable Development is a set of seventeen aspirational “Global Goals� with 169 targets between them, spearheaded by the United Nations. See annex 6 for all the SDGs. SDG Goal 3: Ensure healthy lives and promote well-being for all at all ages. 3.1: By 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births 3.7: By 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.

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CHAPTER ONE: INTRODUCTION 1.1 COUNTY BACKGROUND Mombasa County is one of the 47 Counties of Kenya. Its capital and the only city in the county is Mombasa. Initially it was one of the former Districts of Kenya but in 2013 it was reconstituted as a county, on the same boundaries. It is the smallest county in Kenya, covering an area of 229.7 km2 excluding 65 km2 of water mass. The county is situated in the South Eastern part of the former Coast Province. It borders Kilifi County to the North, Kwale County to the South West and the Indian Ocean to the East. Administratively, the county is divided into six sub-counties, and thirty wards. The county lies between latitudes 3°56’ and 4°10’ south of the equator and longitudes 39°34’ and 39°46’ east.

1.2 POPULATION DEMOGRAPHICS According to the 2009 census, Mombasa County had a population of 939,370 persons of which 486,391 and 452,109 were male and female respectively. Using County population growth rate of 3.5% per annum, the population of Mombasa County is projected to be 1,225,363 persons by 2017 and 1,266,358 persons by 2018. This is irrespective of local and international tourist and unexpected influx. Kisauni constituency has the highest population representing 20.7% of the county population. The productive population (25-59 years) for Mombasa County in 2017 is estimated to be More than one third of the population is under 15 years old.

302,665.

Catchment Population by Sub-County 2013- 2018 2009

Population projections

Sub County Units

Pop Census

% of Total

2013

2014

2015

2016

2017

2018

1.

Mvita

143,128

15.2%

166,624

173,077

179,781

186,744

193,977

201,490

2.

Nyali

185,990

19.8%

216,522

224,908

233,619

242,668

252,066

261,829

3.

Kisauni

194,065

20.7%

225,923

234,673

243,762

253,203

263,010

273,197

4.

Changamwe

147,613

15.7%

171,845

178,501

185,415

192,596

200,055

207,804

5.

Jomvu

102,566

10.9%

119,403

124,028

128,832

133,821

139,005

144,388

6.

Likoni

166,008

17.7%

193,260

200,745

208,520

216,596

224,986

233,699

939,370

100%

1,093,577

1,135,933

1,179,929

1,225,629

1,273,099

1,322,408

TOTAL

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MOMBASA POPULATION PYRAMID

1.3 RATIONALE FOR THE FAMILY PLANNING COSTED IMPLEMENTATION PLAN The Mombasa County FP-CIP is the guide for all FP programming for the county government across all sectors, development partners, and implementing partners. Mombasa’s FP-CIP details the necessary programme activities and costs associated with achieving county goals, providing clear programmelevel information on the resources the county must raise domestically and from partners. The plan gives critical direction to Mombasa’s FP programme, ensuring that all components of a successful programme are addressed and budgeted for in county government and partner programming.

More specifically, the FP-CIP will be used to; • Ensure one; unified county strategy for family planning is followed: The FP-CIP articulates Mombasa consensus-driven priorities for family planning derived through a consultative process and thus becomes a social contract for donors and implementing partners. The plan will help ensure that all FP activities are aligned with the county’s needs, prevent fragmentation of efforts, and guide current and new partners in their family planning investments and programmes. All stakeholders must align their FP programming to the strategy detailed in this document. In addition, the Department of Health (DOH) must hold development and implementing partners to account for their planned activities and to realign funding to the county’s needs identified as priorities. At the same time, the FP-CIP details commitments, targets, actions, and indicators to make the DOH ultimately accountable for their achievement. All other sectoral departments should work in tandem with the DOH to implement the FP-CIP and coordinate efforts.

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• Define key activities and an implementation roadmap: The FP-CIP includes all necessary activities, with defined targets appropriately sequenced to deliver the outcomes needed to reach the county’s committed FP goals by 2020. • Determine impact: The FP-CIP includes estimates of the demographic, health, and economic impacts of the FP programme, providing clear evidence for advocates to use to mobilize resources. • Define a county budget: The FP-CIP determines detailed commodity costs and programme activity costs associated with the entire FP programme. It provides concrete activity and budget information to inform the DOH budget requests for FP programmes. It also provides guidance to the DOH and partners to prioritise the funding and implementation of strategic priorities. • Mobilize resources: The FP-CIP should also be used by the County Government Of Mombasa (CGM) and its partners to mobilize needed resources. The plan details the activities and budget required to implement a comprehensive FP programme, and as such, the DOH and partners can systematically track the currently available resources against those required as stipulated in the FPCIP and conduct advocacy to mobilize funds from development partners to support any remaining funding gaps. • Monitor progress: The FP-CIP’s performance management mechanisms measure the extent of activity implementation and help ensure that the county’s FP programme is meeting its objectives, ensuring coordination, and guiding any necessary course corrections. • Provide a framework for inclusive participation: The FP-CIP and its monitoring system provide a clear framework for broad-based participation of stakeholders within and outside of the CGM and are inclusive of relevant groups and representatives from key populations in the implementation and monitoring of the plan. Partners to mobilize needed resources. The plan details the activities and budget required to implement a comprehensive FP programme, and as such, the DOH and partners can systematically track the currently available resources against those required as stipulated in the FP-CIP and conduct advocacy to mobilize funds from development partners to support any remaining funding gaps. • Monitor progress: The FP-CIP’s performance management mechanisms measure the extent of activity implementation and help ensure that the county’s FP programme is meeting its objectives, ensuring coordination, and guiding any necessary course corrections. • Provide a framework for inclusive participation: The FP-CIP and its monitoring system provide a clear framework for broad-based participation of stakeholders within and outside of the CGM and are inclusive of relevant groups and representatives from key populations in the implementation and monitoring of the plan.

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1.4 THE DEVELOPMENT PROCESS Mombasa County began developing its Family Planning Costed Implementation Plan, 2017–2021/22 (FP-CIP) in the second quarter of 2017, with support initiated by Deutsche Stiftung WeltbevÜlkerung (DSW) supported by a facilitator. A group of high-level team from the Department of Health and civil society were also involved through a technical working group. The plan and activity matrix was presented in various forms to expert groups throughout the process including various partners and DOH experts across technical areas. The costing was developed based on international best practices and customized to the Kenyan and county context. Finally, the DOH circulated draft version of the FP-CIP to its partners and stakeholders before the plan was finalized. Finally the FP-CIP was validated then launched

1.5 KEY PRINCIPLES OF THE FP-CIP I.

A rights-based approach- Recognizing and respecting human and reproductive health rights as envisioned in article 43 of Kenya constitution, this FP-CIP will seek to ensure inclusion of all residents of the county, including populations with special needs such as the adolescents and the people living with disability.

II.

Devolution- Embracing a devolved system of government, the plan recognizes the power of the County to make decisions that are focused and targeted for the benefit of the residents of Mombasa County.

III. A multi-sectoral approach- Recognizing that health is not just a health issue, but a larger development issue, a response coordinated by the county department of health will engage the different stakeholders including the different departments of the county Government, private sector, religious leaders, youth leadership, civil society and the community at large, in initiatives to support FP services in the county. IV. Integration- Described in this strategy, will ensure that FP information and services are provided within the same health facilities where all other health services are provided, and will make use of the community units, with effective referrals made for services that need more specialized skills from other health facilities in the county. V.

Evidence-based interventions- This FP-CIP will seek to address the real issues identified by the stakeholders, and brought out by the data from different sources in the county.

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CHAPTER 2: SITUATIONAL ANALYSIS 2.1 THE GLOBAL CONTEXT Scaling up FP services is one of the most cost-effective interventions to prevent maternal, infant, and child deaths globally. Family planning interventions aid in lowering maternal, infant and child mortality, contributing to Sustainable Development Goals (SDGs). Through a reduction in the number of unintended pregnancies in the country, it is estimated that a quarter to a third of all maternal deaths could be prevented. Family planning is linked indirectly as a contributor to positive health outcomes. For example, FP interventions contribute to reducing poverty, increasing gender equity, preventing the spread of HIV, reducing unintended teenage pregnancies; improve nutritional status of mother and child and lowering infant and child deaths. In addition, each dollar spent on FP initiatives on average results in a six dollar savings on health, housing, water and other public services. Lack of access by adolescent girls to family planning, including contraceptive information, education, and services, is a major factor contributing to unwanted teenage pregnancy and maternal death. In low and middle income countries, complications of pregnancy and childbirth are the leading causes of death amongst adolescent girls age’s 15–19.Currently, more than 200 million women in developing countries desire to space or limit pregnancies; however, they lack access to FP options. Amongst women of reproductive age in developing countries, 57 per cent (867 million women) need access to contraceptive methods because they are sexually active but do not want a child in the next two years. Of these women, 645 million (74%) are using modern methods of contraception; the remaining 222 million are not, resulting in significant unmet need for modern FP methods.

2001 ABUJA DECLARATION In April 2001, the African Union countries met and pledged to set a target of allocating at least 15% of their annual budget to improve the health sector and urged donor countries to scale up support

FP 2020 TThe government of the United Kingdom, through the Department for International Development (DFID), and the Bill & Melinda Gates Foundation partnered with the United Nations Population Fund (UNFPA) to host a gathering of leaders from national governments, donors, civil society, the private sector, the research and development community, and other interest groups. The purpose was to renew and revitalize global commitment to ensuring the world’s women and girls, particularly those living in low-resource settings, have access to contraceptive information, services and supplies. The resulting event was the London Summit on Family Planning, held on 11 July 2012. At the summit, implementers, governments and FP stakeholders united to determine priorities and set forth commitments. The summit aimed to “mobilize global policy, financing, commodity and service delivery commitments to support the rights of an additional 120 million women and girls in the world’s poorest countries 5


to use contraceptive information, services and supplies, without coercion or discrimination, by 2020.” Achieving this ambitious target would prevent a staggering 100 million unintended pregnancies, 50 million abortions, 200,000 child birth-related and maternal deaths, and 3 million infant deaths. The London Summit on Family Planning called on all stakeholders to work together on various areas, including;

• Increasing the demand and support for family planning

• Improving supply chains, systems, and service delivery models

• Procuring the additional commodities.

• Fostering innovative approaches to family planning challenges

• Promoting accountability through improved monitoring and evaluation

SUSTAINABLE DEVELOPMENT GOALS (SDGS) Building on the commitments of global SDGs by the United Nations to address domestic and global inequalities by 2030. Goals 3 and 5 give direct and indirect outcomes related to family planning. Goal 3 specifies to “ensure healthy lives and promote well-being for all at all ages.” Further, the subactivity states; • 3.1- By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births • 3.7- By 2030 ensure universal access to sexual and reproductive health care services, including family Planning, information and education and the integration of reproductive health into national strategies and programmes. Further, Goal 5, “achieve gender equality and empower all women and girls,” includes sub-activity 5.6: To ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development (ICPD) and the Beijing Platform for Action and the outcome documents of their review conferences. Given the focus areas in family planning and equitable access, if the necessary resources, political will, advocacy, and in country priorities are provided, the SDGs are set to achieve substantial impact outcomes.

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2.2 NATIONAL CONTEXT The constitution of Kenya mandates state and non-state organs to observe, respect, protect, promote and fulfill health rights and take legislative policy and other measures to achieve the said rights. Table 1 below summarizes some of the main constitutional provisions that impact on human health.

ARTICLE 43

CONTENT (1) Every person has the right a) To the highest attainable standard of health, which includes the right to health care services including reproductive health care; b) To accessible and adequate housing, and to reasonable standards of sanitation; c) To be free from hunger and have adequate food of acceptable quality; d) To clean and safe water in adequate quantities. (2) A person shall not be denied emergency medical treatment.

53-57

Rights of special groups: - Children have the right to basic nutrition and health care. - People with disability have the right to reasonable access to health facilities, access to materials and devices. - Youth have the right to relevant education and protection from harmful cultural practices and exploitation. - Minority and marginalized groups have the right to affirmative action programs of the state that ensure they have reasonable health services.

174,235 and the Fourth Schedule

Objectives of devolution versus the fourth schedule on roles: National: Health policy, National referral facilities; and capacity building and technical assistance to counties; County Health services: County health facilities and pharmacies; Ambulance services; Promotion of primary health care; licensing and control of undertakings that sell food to the public; veterinary services; cemeteries; funeral parlours and crematoria; Refuse removal, refuse dumps and solid waste disposal. Staffing of county Governments: Within a framework of uniform norms and standards prescribed by an Act of Parliament for establishing and abolishing offices, appointment and confirmation of appointments and disciplining staff except for teachers.

176

Every County Government shall decentralize its functions and the provision of its services to the extent that it is efficient and practicable to do so.

187

Transfer of functions and powers between levels of Government

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County departments of health services are mandated by law to carry out various health functions as outlined in the health sector functions, assignments and transfer policy paper of 2013. These functions include: 1.

Provide leadership and management of the county health teams, planning, development and monitoring of County health services in compliance with the national standards.

2.

County level prioritization of health investments, setting and reporting on relevant targets and coordination of all actors in the county health systems.

3.

Provide guidance on health facilities within the county in implementing health service tariffs and benefits.

4.

Development and management of referral services within the county health systems and other referral health facilities.

5.

Conduct County studies including operational research to inform decision making in health service delivery at all levels.

6.

Provision of emergency medical and ambulance services in the County.

7.

Provision of County pharmacy services and county health facility services.

8.

Provision of preventive, promotive and rehabilitative services to the County.

9.

Strengthen inter County and national health services collaboration.

10. Facilitate and coordinate the role of non-state actors in the county health system focusing on county priorities and ensure their compliance with the national policy and regulatory requirements; and 11. To facilitate capacity building for health care workers and the community in the county.

2.3 FAMILY PLANNING TRENDS IN KENYA AAccording to the Kenya Demographic and Health Survey (KDHS) 2014, 58 per cent of currently married women are using a contraceptive method. The most popular modern contraceptive methods used by married women are: injectable (26%), implants (10%), and the pills (8%). The use of modern methods has increased over the last decade from 32 per cent to 53 per cent. However 18 per cent of currently married women have an unmet need for family planning services, with 9 per cent in need of spacing and 8 per cent in need of limiting. Women are more familiar with modern methods of contraception (98%) than with traditional methods (84%). The public sector is the major source of contraceptive methods in Kenya, providing contraception to 60 per cent of current users. Within the public sector, 24 per cent of users obtain their methods from government dispensaries, 20 per cent from government hospitals, and 16 per cent from government health centers. 34per cent of modern contraceptive users obtain their methods from the private medical sectors, mainly from private hospitals/clinics (21%) and pharmacies (10%). Except for the pill and male condoms, the public sector is the primary provider of most types of contraception used in Kenya. The majority of women who use the pill obtain it from the private sector (57%), and nearly half of women who use male condoms obtain them from other sources, largely from shops (39%). These findings point to the continued reliance on government facilities as a major source of contraceptives. However, 31 per cent of family planning users discontinue the use of a method within 12 months of starting its use. Side effects and health concerns (11%) are the main reasons for discontinuation.

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2.4 UNMET NEED FOR FAMILY PLANNING Eighteen per cent of currently married women have an unmet need for family planning, with 9 per cent having an unmet need for spacing and 8 per cent having an unmet need for limiting. Only 15 per cent of women have a met need for family planning. If all currently married women who say they want to space or limit births were to use a family planning method, the contraceptive prevalence rate would rise to 76 per cent. Currently, 75 per cent of the family planning needs of married women are being met. Unmet need is higher in rural areas (20%) than in urban areas (13%). Unmet need decreases with increasing education. Married women with no education have a higher unmet need for family planning (28%) than their educated counterparts (23% or less). Unmet need declines steadily as households’ wealth increases from 29 per cent in the lowest wealth quintile to 11 per cent in the highest quintile. Total demand for family planning is higher among women aged 35-39 (89%), However, it is lower among younger women (15-19) and those older (45-49) (each 61%). Demand for family planning does not vary much by urban-rural residence; however, there are wide variations by region. North Eastern has the lowest demand (33%) and Eastern the highest (83%). Women with no education (47%) and women in the lowest wealth quintile (60%) have a lower demand than their more educated or wealthier counterparts. ( KDHS 2014 )

2.5 GENERAL HEALTHCARE SITUATION IN MOMBASA COUNTY FAMILY PLANNING COVERAGE IN MOMBASA COUNTY 2016 DHIS SUB COUNTY

FP

PUBLIC

FBO

PRIVATE

TOTAL

NO. OF CUs

NYALI

6

1

38

5

50

45%

MVITA

10

1

24

9

44

47%

LIKONI

6

0

16

8

30

53%

KISAUNI

8

0

42

8

58

37%

JOMVU

5

0

9

5

19

43%

CHANGAMWE

4

0

10

6

20

48%

39

2

139

41

221

47.9%

COUNTY TOTAL

COVERAGE %

FAMILY PLANNING UPTAKE BY METHODS

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2.6 FACTORS AFFECTING FAMILY PLANNING IN MOMBASA COUNTY Several factors were identified as reasons for low uptake of family planning services in Mombasa county hence poor FP indicators. They are as listed below with proposed mitigation measures.

Factors

Mitigation measures • Awareness creation on FP

Mwenye syndrome (husband/in-laws)

• Targeted messaging to mwenye • Male champions • Women empowerment • Sensitization to religious leaders through facts

Religion (Catholics are more of the challenge)

• Targeted community based awareness (congregation) • Religious champions (experience sharing from satisfied clients) • Male champions

Low of male involvement

• Community dialogue sessions • Male prioritization strategy • FGDs

• Social cultural barriers (fear of ‘chemicals/ hormonal’), myths and misconceptions

• Community dialogue sessions with targeted messages • Awareness creation on FP

• Social Cultural value of girls (dowry/bride price etc.)

Socio-economic – affordability/ accessibility/timings of the methods

10

• Focus group discussions FP • Parents awareness • Conducting outreaches • Advocacy for free services for removal


• Conduct outreaches • Proximity of women to GOK facilities is limited (16%) • Lack of FP services in some of the private facilities

• CHVs distribution of barrier methods, POPs and COCs. • Private sector engagement • Standardize service charges for FP service by private facilities • Updated reporting by private facilities

Inadequate commodities within facilities Capacity gap by service providers (Health care workers and CHVs)

• Commodity security strengthening • Building capacity • Refresher trainings • On job trainings • Age appropriate school outreaches

Limited youth friendly service centers (2 only in the county)

• Extended working hours for youth and working women • Expand youth friendly services in facilities (centers) • Use of different social media to sensitize the public on FP

Technology (media biasness)

• Involve politicians in issues to do with FP

Lack of political good will

• Train politicians on FP and its importance

Inadequate integration of health services

• Ensure integration of services in all departments at the facilities

Low education level

Educate community on Fp

2.7 POPULATION WITH SPECIAL NEED FOR FAMILY PLANNING Special need group

Reason  Access to the facilities

Persons with disability

 Access to different methods  Communication barrier  Stigma leading to poor access to FP services

11


 Inadequate information on Family planning  Fear and stigma Adolescent and young people

 Access to the facilities  Inadequate youth friendly services  24.7% of the population is aged 15-24  Stigma leading to them not accessing FP services

People living with HIV/AIDs

Staunch Catholics, Muslims, Kavonokia

 Inadequate service integration in the facilities  They command numbers  Inadequate information on family planning

Men

They hold a key role in family decision making.

Key population

Due to their frequent sexual activities hence exposure to unplanned pregnancies

2.8 STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS (SWOT) ANALYSIS

STRENGTH

WEAKNESS

Adequate health facilities offering family Erratic commodity supply planning services in the county Family planning champions (Youth,,,,,)

Frequent Industrial unrest

Health care workers trained on Family planning Inadequate youth friendly services Supportive county health management teams

Unsupportive infrastructure to special groups

Family planning TWG

Inadequate health care workers trained on how to handle special groups

Available trained CHV on community family Inadequate health care workers trained on LARC planning Active commodity security TWG

12

Service providers not trained on F&Q


Family planning budgetary allocation

Inadequate resource allocation on Family planning

Established CHMT,SCHMT,HMT

Demotivated health workers and CHV

Weekly radio shows

Late reporting from some facilities

GOK level 2&3 offering free FP services

Long waiting time

Available beyond zero van OPPORTUNITY

THREAT

Supportive family planning partners

Frequent Industrial unrest

Political good will

Some private facilities not reporting

Available FP policy and guidelines

Politics

Public private partnership

Annual population growth rate of 3.5% Social-cultural economic factors

Available media airtime-radio salaam

Over the counter prescription

Journalists trained on FP coverage

PESTEL ANALYSIS The PESTEL highlights the importance of identifying trends and anticipating changes in a variety of environments. A clear understanding of the environment could influence an organization’s vision as well as whether and how to alter their strategy. It can help an organization to (re)position itself in a dynamic context. ENVIRONMENT

Political

POSITIVE ISSUES

NEGATIVE ISSUES

Political goodwill with financial investment to FP

Political negativity around FP

Beyond zero truck

Majority leaders in the county are Muslim who aren’t highly supportive of FP (thou its changing)

Good representation of women in the county assembly

Elections/change of government every five years

Devolution and thus more facilities in the sub counties

13


Economic

30% procurement given to W/Y/PWDs mixed poverty levels leading to citizen empowerment Religious based/related Cooperation by local leaders/village elders Urbanism/Urban poor (leading to increased/uncontrolled CSOs present in county sexual activities)

Social

Urbanism leading to higher uptake of FP Inadequate public facilities (no more cultural restriction) (16%) Cultural – mwenye Social media App e.g. (Livia App.) Good network coverage Technological

Negative social media influence (distortion of facts)

Commodity tracking and service delivery reporting through SMS/online Rumors Social media influence More adverts/info on FP

Environmental

Good communication network (roads)

Coastal environment leads to sexual tourism

Constitution of Kenya 2010 FP guidelines and policy Mombasa county health bill (awaiting assent)

Legal

Mombasa county reproductive health (draft bill) Mombasa county health and investment plan

14

Slow process of enacting laws The education Act in conflict with the Kenyan constitution


CHAPTER THREE: IMPLEMENTATION PLANS 3.0 STRENGTHENING HEALTH SYSTEMS The provision of family planning services can only be effectively achieved when the health systems are strengthened. The World Health Organization (WHO) defines a health system as ʺthe sum total of all the organizations, people and actions whose primary intent is to promote, restore or maintain health”. Health‐system strengthening is also defined as improving the six building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes. Due to the importance of FP advocacy, this CIP will handle it as a seventh block that needs strengthening. Fig. 3: Health Systems Strengthening Blocks, Desired Attributes and Outcomes

Pillar 1: Service delivery: Service delivery requires infrastructure and logistics, including physical space, equipment, utilities, waste management, transport, and communications. It also considers the need for privacy and confidentiality, safe water, sanitation and hygiene, and infection control. Pillar 2: Health workforce: Health workforce includes having trained service providers working with the right attitude, knowledge and skills. The staff should have the necessary commodities (such as medicines, disposables, and reagents), equipment, and adequate financing, to perform their jobs. Recognition and support for the vital roles played by community champions, community organizations and lay workers, thus strengthening the community systems is critical to avoiding demoralized staff that could lead to a high turnover. 15


Pillar 3: Information systems: A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status. Research, monitoring and evaluation are activities that support this function. Pillar 4: Supply of medical and health products: A well�functioning health system should ensure equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost�effectiveness. Systems should be put in place to avoid stock out of the essential medical and health products. Pillar 5: Financing Health financing includes resource mobilization for funds to enable the smooth running of the health services. The systems should raise and secure adequate funds for health in order to ensure people can use services they need. Pillar 6: Leadership and governance: This entails providing strategic direction to the family planning response. The County Health Department is responsible for providing leadership to the various actors in health in the County. The team should take up the ownership and commitment, and offer leadership and guidance to other interested partners in the provision of FP within the County. Pillar 7: Advocacy: This pillar is important for informing and/or influencing decision makers in order to change policies and/or financial allocations, and to ensure their effective implementation. Although it has not been discussed as a separate pillar in the WHO HSS pillars, advocacy plays a critical role in ensuring there is ownership and buy-in from the relevant stakeholders. Family planning in the County can only be effective if there is commitment by the County leadership, in order for the strategy on FP to translate into concrete action.

16


CHAPTER FOUR: IMPLEMENTATION PLAN The vision, mission and strategy goal specifically bring out the expectations of this strategy in regards to FP. The strategies and key activities are suggestions that have been refined from the consultative meetings held with the different stakeholders, and aligned to the existing County guidelines, policy and operational documents. These strategies and key activities have been divided into the agreed health systems pillars. Vision: A healthy and productive population Mission: To promote sustainable development in Mombasa County through advocacy and provision of comprehensive and integrated quality FP services that are accessible, acceptable, affordable and responsive. Strategy Goal: To reduce unmet family planning needs to 15% and increase the modern contraceptive prevalence rate (mCPR) to 63.6% among women of reproductive age in Mombasa County by 2022.

Strategic Objectives: 1.

To increase utilization of FP services by 80% by 2022 in Mombasa County.

2.

To increase the capacity of the Health care work force in FP by 20% by 2022.

3.

To improve availability, quality and use of data for decision making by 2022.

4.

To have a specific budget line for FP by 2019.

5.

To eliminate stock out of FP commodities in all health facilities in Mombasa County by 2019.

17


18

Service integration

Male involvement.

STRATEGIES

KEY ACTIVITIES

INDICATORS

Increased access to FP services at Integrate FP services in all service proall CCC sites vision points

Recognition of male partners

Conduct 120 dialogue meetings in the sub-counties

No of CCC sites integrating FP

No. of male partners rewarded

No of dialogue meetings held.

No of male FP chamIncreased male Identify, engage and train pions identified and participation in 150 male FP champions trained. RH/FP intervenNo of active male tions. champions reporting. Conduct refresher trainNo. of FP champions ing for 150 trained male participating champions

OUTCOMES

Aim: 1. To increase access and utilization of quality family planning services.

PILLAR 1: Service delivery

IMPLEMENTATION PLAN

FREQUENCY

Quarterly

Annually

Branded items(LesAnnually sos,Pens,Notebooks FP commodities/supplies Funds Quarterly Reporting tools FP IEC materials

Personnel Funds

Funds Training materials

Funds Sensitization Materials Annually Reporting tools

INPUTS

MOH 731

Activity Reports

MOH 515

Activity Reports

Training Reports Minutes Monitoring Reports

DATA SOURCE


19

STRATEGIES

OUTCOMES

Conduct mentorship session in the sub counties on LARC Conduct quarterly in reaches in the Health facilities in the 6 sub counties Conduct integrated outreaches in 6 sub counties especially hard to reach areas (2 integrated outreaches per sub-county per quarter) Conduct 1 sensitization session per sub county to Key populations Train 150 HCW on how to offer FP services to Key population

Train 60 HCW on LARC

Strengthen Integrated FP services in Beyond Zero clinic

KEY ACTIVITIES

INPUTS

FREQUENCY

No of HCWs trained

No. of sensitization sessions conducted

No of outreaches conducted

No. of clients attended

No. of mentorship sessions conducted

Funds Training materials

Funds IEC materials

Annually

Quarterly

Quarterly

Quarterly

Funds Personnel commodities Funds Personnel commodities

Quarterly

Personnel Funds

Funds No of integrated FP Personnel outreaches Beyond Zero FP commodiContinous Clinic ties/Supplies Reporting tools Funds No of HCWs trained on Training mateAnnually LARC rials

INDICATORS

Training report

Activity Reports

Registers

Registers

Participant list/Log Books

Training report

MOH 711

DATA SOURCE


20

Community mobilization, education and empowerment

Enhancing service delivery systems and structures

STRATEGIES

KEY ACTIVITIES

INDICATORS

No. of community dialogue forums on AYSRH in the county.

No. of parents and guardians trained on Adolescent youth sexual reproductive health

Train 60 parents and guardians on Adolescent youth sexual reproductive health

Increased com- Conduct community diamunity awarelogue forums on AYSRH ness on AYSRH in the county

No of teachers trained

No of operational YFC

Train 120 teachers (primary and secondary) and School HCP on Adolescent youth sexual reproductive health

Strengthen 3 existing youth-friendly centers that offer age appropriate reproductive health care

Conduct daily health talks No. of health talks conin all the facilities. ducted Establish 6 Functional youth-friendly centers Increased access that offer age appropriate to age approprireproductive health care No of YFS established ate reproductive health care

OUTCOMES

Quarterly

Quarterly

Personnel Training materials Funds FP IEC Materials

Funds FP IEC Personnel

Annually

Bi-annually

Daily

FREQUENCY

Funds Personnel Commodities

Funds Personnel Commodities and supplies

IEC materials

INPUTS

Reports

Training Reports

Reports

Reports

Activity Reports

DATA SOURCE


21

OUTCOMES

INDICATORS Funds Personnel

INPUTS

Conduct OJT and mentor- No of HCW mentored ship to 60 service provid- on FP ers on FP

No. of health care providers trained

Funds Personnel

Funds Training materials

Tools No of assessments done Personnel funds

Sensitize 100 religious leaders on Adolescent No of religious leaders youth sexual reproductive sensitized health

KEY ACTIVITIES

Increased/ade1. Personnel manConduct annual FP staff quate number of agement capacity gaps and needs skilled service assessment at the County. providers. Train 60 health care providers on FP.(as per the assessment report)

Aim: To improve the capacity of healthcare workforce to provide family planning services and information at all levels.

PILLAR: 2. Health workforce

STRATEGIES

Annually

Quarterly

Annually

Quarterly

FREQUENCY

Mentorship report

Training report

Assessment report

Reports

DATA SOURCE


22

STRATEGIES

Train 180 CHVs on FP bi-annually

Train 30 service providers on sign language annually  Train 60 health promotion officers, PHOs & CHAs on FP advocacy

OUTCOMES No of facilities motivated

INDICATORS

Annually

funds Personnel Training materials

Train 180 CHVs on FP advocacy

Annually

No of CHVs trained

No of CHAs identified

Funds Tools personnel

Annually

Annually

Identify and Recruit 60 CHAs

Funds Personnel Appraisal tools

Annually

Annually

Annually

FREQUENCY

Funds

No. of staff appraised.

No. of facilities reached Personnel with RH/FP policies, Funds guidelines, registers, Tools manuals regularly.

Funds Tools Personnel

Funds Tools Personnel

INPUTS

Train 30 service providers on sign language. No of service providers trained

Conduct annual staff appraisal.

Disseminate updates on RH/FP policies, guidelines, registers, manuals regularly.

Reward and recognition of best performing HCWs on No of HCWs rewarded RH/FP

Motivation of best facilities regarding RH/FP service per year Per Sub County

KEY ACTIVITIES

Training report

report

Training report

Reports

Reports

Reports

Reports

DATA SOURCE


23

2. Supportive supervision

1. Dissemination of tools

Aim: Enhance availability of quality FP data and use at all levels of healthcare for decision making

PILLAR: 3. Information (Research, Monitoring, Evaluation & Reporting)

STRATEGIES

Improved data quality

Increased availability of all reporting tools

OUTCOMES

Annually

Distribute data reporting tools to all levels of care

Conduct DQAs to 72 heath facilities

Annually

Quarterly

Funds Personnel Funds No. of DQAs conducted Personnel Tools

Train 170 managers and No of health managers service providers on Sup- and service providers port supervision trained

No of facilities with all funds data reporting tools

Annually

FREQUENCY

Procure FP reporting tools No of FP tools procured funds

INPUTS

Annually

No. of facilities with reporting tools

INDICATORS

Funds Tools

Quantify data reporting tools required

KEY ACTIVITIES

Report

Training report

Report

Delivery note

Check list

DATA SOURCE


24

3. Data review meetings

STRATEGIES

Funds Personnel

Conduct RH/FP data analNo. of data analysis ysis meetings in each Sub meetings conducted County

Funds Personnel

No. of service providers Personnel trained on DDU Funds

Conduct 948 FP data No. of data review review meetings of CUs at meetings conducted HF level

Funds Personnel Tools

Funds

Develop quarterly FP score cards/ fact sheets

No of bulleting published

Funds Personnel

Conduct 6 data supNo of support superviport supervision at the sion visits conducted Sub-county level annually

No of support supervision conducted

Conduct 24 data support supervision at the County level annually

Funds Personnel tools Funds Personnel

No. of visits done

Conduct data support supervision by the county at the sub County level

INPUTS

Deploy electronic medical No. of facilities using record system in the major electronic medical hospitals and dispensaries records in the County.

INDICATORS

KEY ACTIVITIES

Increased use of Train 100 Service providdata for decision ers and health managers making on Data demand and use

OUTCOMES

Quarterly

Annually

Quarterly

Annually

Quarterly

Quarterly

Quarterly

Quarterly

FREQUENCY

Reports

Training reports

Reports

Reports Score cards

Reports

Reports

Reports

Reports

DATA SOURCE


25

OUTCOMES

Increased num4. Capacity build- ber of skilled ing personnel on data management Increases uptake of opera5. Operational tional research research to support the decision-making process

STRATEGIES

INPUTS

Availability of RH/FP budget document

Budget for operational researches on the areas of RH/FP

Conduct 170 RH/FP service evaluations at the sampled health facilities

Conduct AYSRH health research partner’s forum.

No of health workers trained on research

No of AYSRH research Funds partners forum conductpersonnel ed Funds No of RH/FP evaluaPersonnel tions conducted tools

Annually

Annually

Annually

Annually

Funds Personnel Training materials

Train 100 health care workers on basic research methods.

Funds personnel

Annually

Funds personnel

No of RH/FP research needs identified

Identify areas of research (research needs) within RH/FP component.

Annually

Monthly

FREQUENCY

Personnel Funds

No. of CMEs conducted Funds Personnel

INDICATORS

Set up research committee Research committee in in the County. place

Conduct 84 Continuous Medical Education in the seven sub-counties.

KEY ACTIVITIES

Reports

Reports List of stakeholders

List of participants Availability of RH/ FP budget document

Reports

Report

Reports

Reports

DATA SOURCE


26

1. Supply chain management

Aim: Increase availability of quality FP commodities

PILLAR: 4. Medical products, vaccines and technologies

6. Information and technology

STRATEGIES

Conduct 8 system reviews (EMR and m-health) quarterly

Develop and utilize digital platforms for sharing SRH information Set up m-health platform for FP services at the community level.

Develop a website for the department of health

KEY ACTIVITIES

No of EMR /m-health system reviews conducted

Funds

Funds Personnel

Funds Mobile phone

m- health platform for FP services at the community developed

Biannually

Quarterly

Annually

Annually

Annually

Funds Website developers computers Internet connectivity Funds- airtime computer

FREQUENCY

INPUTS

No of SRH platforms developed

Health website developed

INDICATORS

Participate in the national Increased availForecasting & Quantifica- No. of quantifications ability of contration exercise. done ceptives

Increased use of IT systems and structures for information sharing

OUTCOMES

Report

Reports

Functional m-health platform

Reports

Reports

DATA SOURCE


27

OUTCOMES

INDICATORS

Conduct quarterly distribution/ redistribution of RH/FP

Conduct quarterly ordering of RH/FP

Funds -Funds -Procurement plan

No. of stores renovated and equipped No. of facilities with FP commodities and equipments

Quarterly

Annual

Annually

Funds Tools

No. of facilities sensitized

Annually

Quarterly

Quarterly

Annually

FREQUENCY

Quarterly

-Funds

-Funds -S11

-SDP CCDRR form -Funds -Funds - SDP CCDRR form

INPUTS

No. of facilities and sub Funds counties visited

No. of health Care workers trained

No. of health facilities with FP commodities

No. of facilities ordering

Conduct one F&Q activity in the County No. of F and Q done

KEY ACTIVITIES

Improved knowledge and Train 120 Health Workers skills in Comon Commodity managemodity Manage- ment ment Conduct quarterly support Improved persupervision at sub-county formance and facility level Improved detec- Conduct one day sensitition and report- zation meeting on pharing of ADRs macovigilance for 122 and poor quality health facilities providing medicines FP services Renovate and equip commodities stores-one per sub-county Resource mobili- Increased rePurchase of FP commodization sources for FP ties, FP equipments initiatives

STRATEGIES

LPOs Delivery notes

BQs Handing over reports

Reports

Supervision report

Training reports

S11

Order form Report

CCDRR

DATA SOURCE


28

Advocate for itemized budget on FP

PILLAR: 5 Health financing &Partnership Aim: Increase allocation & timely disbursement of FP funds

3. Quality control

STRATEGIES

KEY ACTIVITIES

Inclusion of FP budget line in the county health budget.

Conduct one joint AWP meeting of CHMT members, Health Executive & The County Treasury Conduct 4 joint AWP meetings of SCHMT members

Conduct one program based budget training and development for 40 managers

Increased avail- Conduct quarterly drug, ability of quality medicine and therapeutic FP products committee meeting Renovate and equip commodity storage areas.

OUTCOMES Funds

INPUTS

Funds

Funds

No. of meetings held

No. of Sub Counties with AWP

No. of managers trained Funds

No. of storage areas Funds renovated and equipped

No. of medicine and therapeutic committee meetings conducted

INDICATORS

Annually

Quarterly

Annually

Once

Quarterly

FREQUENCY

Reports

Report

Training report

Report

Meeting report

DATA SOURCE


29

KEY ACTIVITIES

Conduct annual Stakeholder meetings (County Assembly Health committee, DOH, 5CSOs). Conduct a baseline survey on Adolescent Youth Sexual Reproductive Health (AYSRH)

OUTCOMES

Increased partnerships for FP funding.

Conduct 1 workshop to Increased policy domesticate relevant RH/ formulation and FP and ASRH policies, adaptation guidelines and strategies. Launch RH/FP and ASRH policies, guidelines and strategies

PILLAR 6: Leadership and governance Aim: Increase number of County & Sub County level FP Champions Leadership and governance for FP

STRATEGIES Funds

INPUTS

Funds

Funds

No. of workshops conducted No. of policies domesticated No. of launches done

No. of surveys conductFunds ed

No. of stakeholder meetings conducted

INDICATORS

Annually

Annually

once

Annually

FREQUENCY

Reports

Reports

Survey report

Reports

DATA SOURCE


30

1. Build capacity of FP stakeholders

PILLAR: 7. Advocacy Aim: Strengthen stakeholder involvement, political commitment and investment in advocacy for FP

STRATEGIES

Strengthened multi-sectoral coordination and networking, partnership and community partnerships

INDICATORS

Establish &Train FP TWG No. of TWG members members established and trained

No. of support supervision conducted

Conduct 4 meetings to disseminate RH/FP and No. of meetings conASRH policies, guidelines ducted and strategies

KEY ACTIVITIES

Increased Conduct quarterly RH/ leadership and FP and AYSRH support coordination for supervision in the county FP strategies in the County

OUTCOMES

funds

Funds Checklist

Funds

INPUTS

once

Quarterly

Quarterly

FREQUENCY

Training report

Supervision report

Dissemination report

DATA SOURCE


31

STRATEGIES

OUTCOMES

No. of IEC materials pretested

No. of workshops conducted

No. of stakeholder meetings conducted

INDICATORS

No. of meetings conConduct 1 meeting to disducted seminate & distribute the No. of IEC materials IEC materials. distributed Erect billboards in 3 major No. of billboards erectsub county towns ed Conduct 4 road shows to No. of road shows concreate awareness on FP ducted No. of people sensitized No. of clients accessing Commemoration of RH/FP services World Contraceptive Day No. of IEC materials distributed

Conduct quarterly Stakeholder meetings (FBOs, CORPs, Media, Admin, MOE, Youth & Gender, CHMT Conduct 2 workshops to design & develop FP/RH and ASRH related IEC materials and documentary. Pretest the developed IEC materials. Production of 10 IEC materials.

KEY ACTIVITIES

once

once Annually

Annually

funds funds

funds

once

Annually

Quarterly

FREQUENCY

funds

funds

funds

funds

INPUTS

Activity reports

Reports

Reports

Meeting report

Pretest report

Workshop report

Stakeholders meeting report

DATA SOURCE


32

STRATEGIES

INDICATORS

Funds

Annually

Funds

No. of FP e-platforms developed

Annually

funds

Annually

Quarterly

Annually

funds

Funds

Annually

FREQUENCY

funds

INPUTS

No. of dialogue sessions done and focused group discussions conducted

No. of people sensitized No. of clients accessing Commemoration of World RH/FP services Condom Day No. of IEC materials distributed No. of people sensitized No. of clients accessing Commemoration of Intl RH/FP services Youth Day No. of IEC materials distributed No. of people sensitized No. of clients accessing Commemoration of World RH/FP services Population Day No. of IEC materials distributed Recognition of FP cham- No. of FP champions pions identified

KEY ACTIVITIES

Advocate for elimination of barriers that Conduct dialogue seshinder young sions and focused group people’s access discussions to RH information and services Develop/customize FP e-platform for the youth

OUTCOMES

FP e-platforms developed report

Dialogue report

Reports

Activity reports

Activity reports

Activity reports

DATA SOURCE


33

Media advocacy

Annually

Weekly

Funds

Quarterly

Annually

Biannually

FREQUENCY

Funds

Funds

No. of sensitization meetings

No. of Pre-recorded Conduct 5 meetings to demedia programs, talk velop Pre-recorded media shows and radio spots programs, talk shows and No. of media houses radio spots participating Airing of recorded mes- No. of recorded messages sages aired

Funds

Funds

INPUTS

No. of popular media houses identified

FP advocacy for hard to reach population

Conduct media assessIncreased media ment to identify popular coverage media houses Conduct sensitization meetings with popular media stations on FP/RH and ASRH programmes

Conduct 4 dialogue No. of dialogue sessessions with religious sions done and focused leaders (catholic, Muslim, group discussions conmiracle church) ducted

Increased FP awareness and uptake among hard to reach population

INDICATORS

KEY ACTIVITIES

OUTCOMES

STRATEGIES

Reports

Activity reports

Meeting Reports

Assessment report

Dialogue report

DATA SOURCE


CHAPTER 5: RESEARCH, MONITORING & EVALUATION 5.0 INTRODUCTION Research, monitoring and evaluation are critical elements for gathering evidence and measuring of the achievement of this five-year CIP. Every year, annual plans will be developed to ensure the CIP is operational. The annual work plans will outline indicators that will be used to track the progress at the end of every year. Data management tools will be enhanced to ensure that all the necessary data is collected, analyzed and used for programming and decision making. Routine data will be collected using the tools on the ground and operational research carried out as need arises. The County will partner with academic and research institutions, implementing partners, as well as the National government. A mid-term evaluation of this CIP will be carried out in 2019, and an end-term evaluation in 2022. This will be soon after the release of the results of the National Population and Housing Census and the Kenya Demographic and Health Survey, that are both expected in 2019. The results will be compared with the baseline data used in this strategy that has primarily been drawn from the KDHS, 2014 and the estimates from the PHC. The targets for both the mid-term and end-term evaluations are provided in the table below.

5.1 EXPECTED RESULTS Table 4: Key Performance Indicators and Targets for the Strategy PILLAR

1. Service Delivery

Key Performance Indicators (KPIs)

Baseline 2017

Midterm 2019

Endterm 2022

% of women of reproductive age receiving any family planning methods

45

50

55

Total Fertility rate (TFR)

3.2

3.1

2.9

% of women with unmet need of FP (Costal region)

20.6

17

15

# of facilities offering LARCs

131

160

200

# of facilities offering Youth FP services

4

6

12

No. of adolescent accessing FP services (10-14 yrs.)

1554

3108

6200

No. of adolescent accessing FP services (15-19 yrs.)

1600

3378

6800

% of teenage pregnancies

17

14

10

% of contraceptive Prevalence Rate, Modern Methods (mCPR)

43.6

55

63.6

55

65

75

4

6

12

% of contraceptive Prevalence Rate any Methods (CPR) # of health facilities offering Adolescent friendly services

34


# of comprehensive integrated outreaches conducted by facilities # of health workers trained on FP LMIS % of facilities offering integrated RH/HIV services # of health care providers with sign language skills

102

344

860

120 51 50

170 60 100

50

100

# of doctors recruited #. of clinical officer recruited # of Health records and information officers recruited #. of Pharmacist recruited #. of Pharm.Tech recruited #. Of Nutritionist recruited #. of CHEWs officer recruited No. of clinical staff trained on LARC

55 43 6 95(60 CPGH) 0 6 0 1 4 0 0 0

5 25 4 5 7 20 15 75

20 40 40 10 20 40 30 150

# of CHVs, CHEWs trained on FP

330

1500

2150

# mentorship and follow up visits on FP by CHMT

1

10

20

# of mentorship and follow up visits on FP by SCHMT # of health promotion officers, PHOs & CHEWs capacity built # of dialogue meetings held at the CHU level

2

10

20

30

30

86

160

200

344

No. of health care workers trained on data for decision making

30

60

150

# of surveys conducted among special groups on FP.

0

3

5

# of facilities using revised FP M&E tools.

167

180

200

% of facilities submitting timely FP reports.

71

85

100

No of facilities submitting FP reports monthly

167

180

200

No. of facilities with active QI teams.

1

5

10

% of facilities visited by the CHMT during support supervision

70

85

100

41

49

55

1 4

6 12

12 20

4

12

20

0

2

5

# of nurses recruited

2. Health workforce

# of CUs with CHVs trained in community based information system management # of CUs established # of county Data review meetings with the sub counties No. of data review meetings with the facilities at 6 sub counties # of operational researches carried out

35


% of facilities reporting no stock out of FP commodities 4. Medical Products, vaccines and technologies

10

5

0

55

90

150

100

100

100

100

100

100

100

100

100

0

1

1

% financial allocation for implementation of the costed 0 FP plan

50

75

% of FP budget utilization on FP (Burn rate)

0

50

100

# of FP specific stakeholder committee forums held #. of MOUs done with FP current implementing partners # of TWGs trained on FP # of stakeholders mapped on FP # of FP TWG meetings held #. of champions advocating for FP

2

5

10

0

3

10

0 0 1 70

1 1 8 120

1 1 20 150

#. of policy formulated or /and adapted

0

1

1

#. of FP advocacy messages developed and disseminated to media

0

10

25

No. of health workers trained on commodity management. % of facilities with LMIS tools % of primary SDPs that have at least 3 modern methods of contraception available on day of assessment % of secondary/tertiary SDPs with at least 3 modern methods of contraception available on day of assessment Availability of a costed FP plan

5. Health Financing

6. Leadership and governance

7. Advocacy

5.2 DATA COLLECTION The methods of data collection will be a combination of quantitative and qualitative methods. Standardized data collection tools and techniques will be used. Most data in respect of some indicators will be collected monthly, quarterly or annually. The survey-based indicators will be collected at baseline, mid-term and end-term where possible. The data collected from National processes such as the DHIS and the Population Census both expected in 2019, will also be used in the end line evaluation. The main data collection tools and techniques will include in the DHIS2. Listed in the table below are standard data capture and reporting tools that are currently in use and of importance to FP.

36


TOOL Facility, Community, Hospital and management planning tool

PURPOSE AWP indicators

MOH 406

Post-natal care register

MOH 512

Family planning register

MOH513

House Hold Register

MOH 514

Service Delivery Log Book

MOH 515

Community Health Extension worker summary Family planning visit cards

MOH 711 (

MOH 711 Integrated Reproductive Health, Maternal child Health , Social Work & Rehabilitation Summary

MOH 717

Workload Summary

MOH 731

Comprehensive HIV/AIDS Facility Reporting Form

DHIS 2

District Health Information System version 2

FP Dashboard National Family Planning Dashboard for monitoring FP commodity data on monthly basis

FO 58

Facility Contraceptives Consumption Report and Request Form Report on damaged products and products of poor quality

The data quality to be observed includes: Reliability: The data generated by a program’s information system, based on set protocols and procedures and does not change according to who is collecting or using it, and when or how often they are used. The data is measured and collected consistently. Accuracy (validity): Accuracy refers to how correctly information is derived from the database or registry and it reflects the reality it was designated to measure. The data should be concise. Timeliness: Timeliness refers primarily to how current or up-to-date the data is, at the time of release, by measuring the gap between the end of the reference period to which the data is obtained and the 37


date on which the data becomes available to users. The data should come in consistently from the health facilities. Completeness: Completeness means that an information system from which the results are derived is appropriately inclusive. Integrity: Integrity is when data generated by a program’s information system are protected from deliberate bias or manipulation for political or personal reasons.

5.3 DATA FLOW Routine data will be generated from the community units and taken up to the facility level. The facilities will submit their data to the SCHRIOs through the SCMOH offices in the Sub-County. This will be consolidated and entered in the DHIS2 platform which is a system used nationally. There exists a feedback mechanism in form of Reports, supervision and such forums from the national, CHMT-SCHMTs downwards to the facilities and community units, and these is used to inform decision making. All relevant information received from the National level will be channeled down to the County mainly through the CHMT. The flow of data will include data for services as well as for commodities, and will be utilized for decision making.

38


CHAPTER 6: PARTNERSHIP AND FINANCING 6.0 INTRODUCTION The delivery of this CIP is the responsibility of the County Health Team. This however does not mean that the other partners do not have a role. This chapter seeks to identify some of the key players in FP in the county, and their current contribution. These include partners in various sectors in Government, the private sector, faith sector, NGOs and CBOs. This chapter further seeks to cost the CIP, with the hope that it will be included as a stand-alone budget line within the county health budget in 2018/19FY. The costing helps to guide the allocation of these funds. With a clear budget, the partners can also identify areas that they can offer support, aligned to their core business. The successful implementation of this strategy will therefore be dependent upon the collaborative efforts and synergies of all the stakeholders and actors, led by the County Health Team.

6.1 STAKEHOLDERS ANALYSIS The stakeholders in the FP response broadly include National and County Government Ministries, Development Partners, Private Sector, NGOs and the Faith Sector among others. Each of the groups mentioned in one way or another, engage with the Mombasa County Health Department in providing financial and technical capacity support for successful FP services and programme interventions. The County Health Department engages the various groups, in consultative processes through thematic interest groups. The table below gives a stakeholder analysis of Mombasa County. Table 6: Stakeholders in Mombasa County O R G A N I Z AT I O N SECTOR/ DEPARTMENT TYPE ORGANIZATION NAME

Department of Health

/

ROLE IN FP Technical guidance/support, service delivery: Policy and guidelines, infrastructure, procurement, staffing, financing, Advocacy , Partner coordination

Government

National Government[ (i.e. DRH,NASCOP)

Policy formulation,

Ministry of Devolution and Planning

Resource allocation.

County Government.

Educate, sensitize and advocacy with a focus on youth and adolescent

Ministry of Education. Ministry of Public Service, Youth and Gender Affairs. Ministry of Culture, Sports and Talent Development

FP/HIV integration Capacity Building

Office of First Lady 39


DSW Kenya Marie Stopes Kenya NGOs

FHOK

FP Budget analysis and advocacy Service provision Advocacy Service provision Advocacy

KMYDO

FP advocacy

KANCO

Health Advocacy

Private sector

Private health facilities

Partnerships delivery

FBOs

Faith Based health facilities

Service delivery

Community FP champions

Others

Community

40

and

service

Awareness creation and community mobilization Mobilization, Consumers.


41

Total Year 2

Total Year 1

Pillar 1: Service Delivery Male Involvement Service integration Awareness creation 11,777,300 12,601,711 Community mobilization Pillar 2: Health Workforce Personnel Management Capacity Building 7,107,750 7,605,292 Pillar 3: Information M&E Strengthening Operational research 22,143,600 23,693,652 Pillar 4: Medical Products, Commodities and Supplies Supply chain management Resource mobilization Commodities 35,258,900 37,727,023 Quality Control Pillar 5: Health Financing Resource Mobilization partnership 3,819,800 2,042,200 Pillar 6: Leadership and Governance Profiling of FP partners Capacity Building of FP Partners 4,327,800 4,630,746 Pillar 7: Advocacy Advocacy for FP funding Awareness creation Media advocacy 15,724,000 16,824,680 GRAND TOTAL 100,159,150 105,125,304

INTERVENTION AREA

SUMMARY BUDGET

27,038,659

43,193,668

2,338,114

5,301,741

25,352,207

40,367,914

2,185,154

4,954,898

19,262,576 120,269,755

8,707,299

8,137,662

18,002,407 112,484,072

14,427,698

Year 4

Total

13,483,830

Year 3

Total

20,610,956 128,688,637

5,672,862

2,501,782

46,217,225

28,931,365

9,316,810

15,437,637

Year 5

Total

90,424,620 550,074,512

24,888,048

2,676,907

202,764,731

120,717,213

40,874,815

67,728,178

Total Cost


42


REFFERENCES LEGISLATIVE FRAMEWORKS •

Republic of Kenya (2010). The Constitution of Kenya. 2010

County Governments Act No. 17 of 2012

B.MOMBASA COUNTY DOCUMENTS •

Mombasa County Integrated Development Plan (CIDP) 2013-2017.

Mombasa County Health Sector Strategic and Investment Plan (2013 – 2017).

Mombasa County Monitoring and Evaluation Framework (2014-2018).

C. NATIONAL DOCUMENTS •

Republic of Kenya. (2014). Personnels For Health Norms and Standards Guidelines For The Health Sector: Towards Universal Health Coverage: The Kenya Health Strategic and Investment Plan, 2014 – 2018

Republic of Kenya (2008). Kenya Vision 2030: Sector Plan for Health 2008-2012.

Republic of Kenya (2012). Kenya Health Policy 2012 – 2030.

Republic of Kenya (2012). Kenya Health Sector Strategic and Investment Plan 2012-2018.

Republic of Kenya. (2014). Personnels For Health Norms and Standards Guidelines For The Health Sector: Towards Universal Health Coverage: The Kenya Health Strategic and Investment Plan

Republic of Kenya (2013-2017). Second Medium Term Plan: Transforming Kenya: Pathway to Devolution Socio-economic Development, Equity and National Unity.

Republic of Kenya (2009). National Family Planning Guidelines for Service Providers.

Republic of Kenya (2009). National Reproductive Health Strategy 2009-2015.

Republic of Kenya (2011). Implementation Guidelines for the Kenya Quality Model for Health.

Republic of Kenya (2012) The Independent Electoral and Boundaries Commission: Preliminary report on the Delimitation of Boundaries of Constituencies and Wards

Kenya National Bureau of Statistics (KNBS) et al. (2014). Kenya Demographic Health Survey 2014

Kenya National Bureau of Statistics (2009). Population and Housing Census.

Kenya National Bureau of Statistics, ICF International. 2015. 2014 KDHS Key Findings. Rockville, Maryland, USA: KNBS and ICF International

Kenya National Bureau of Statistics & Society for International Development. (2013) 43


Exploring Kenya’s Inequality: Pulling Apart or pooling Together •

National Council for Population and Development (2013) Kenya Population Situation Analysis.

Ministry of Devolution and Planning, Kenya. (2013). Millennium Development Goals: Status Report for Kenya

Ministry of Health, Kenya. Family Planning Commodities Quantification and Supply Plan, Technical Report July 2016

Ministry of Devolution and Planning. (2013). Millennium Development Goals: Status Report for Kenya – 2013.

D. OTHER DOCUMENTS •

African Population and Health Research Center (APHRC), Ministry of Health (MOH), Ipas, Guttmacher Institute, Incidence and Complications of Unsafe Abortions in Kenya: Key Findings of a National Study. Nairobi (2013)

Cates W. Use of contraception by HIV-infected women. IPPF Med Bull 2001; 35: 1-2. Quoted in http://www.who.int/bulletin/volumes/87/11/08-059360/en/

FP2020. Accelerating Progress: Strategy for 2016-2020.

FP2020. Commitment to Action: Measurement Annex. November 2015

Muganda-Onyando Rosemarie and Omondi M, Down the Drain: Counting the Cost of Teenage Pregnancy and School Dropout in Kenya. Center for the Study of Adolescents (2008)

Population Council, The Adolescent Experience In-depth: Using Data to Identify and Reach the Most Vulnerable Young People (2010)

Senate Economic Planning Office. (2009) Promoting Reproductive Health: A Unified Strategy to Achieve the MDGs. Policy Brief. Jul, 2009.

United Nations Population Fund (UNFPA), Needs Assessment of Obstetric Fistula in Kenya (2004).

World Health Organization (2007). Everybody’s business: Strengthening health systems to improve health outcomes. WHO’s framework for action. Geneva, Switzerland

World Health Organization (2009). Priority Interventions: HIV/AIDS prevention, treatment and care in the health sector. Geneva, Switzerland.

World Health Organization, Risk and Protection Factors Affecting Adolescent Reproductive Health in Development Countries. Summary (2004)

E. WEBSITES •

Beyond Zero – http://www.beyondzero.or.ke/commons/security/login. action;jsessionid=4688B1AECB92D56A144890E92024FE53. Accessed on September 26,

County Statistics from KNBS: http://www.knbs.or.ke/index.php?option=com_ content view= article&id= 176&Itemid=645 Accessed 17th Aug 2016.

44


The Daily Nation. Leader pursues investors in a bid to end poverty. Tuesday July 15 2014. http://www.nation.co.ke/counties/Kwale-Governor-Salim-Mvurya-Poverty-InvestmentForum/1107872-2385352-dx7r7e/index.html

Health work force – http://www.who.int/hrh/workforce_mdgs/en/ accessed September 26, 2016.

Kenya Population (2016) – Worldometers. www.worldometers.info/world-population/kenyapopulation/. Accessed on 18th August 2016

Kenya Health Information System. https://hiskenya.org/dhis-web-commons/security/ login. action;jsessionid= 98D323654E5821F3E4FC05FD32C15CAA

Kenya National Bureau of Standards (2010). The 2009 Kenya Population Census http://cob. go.ke/counties/kwale-county/

Population Reference Bureau: Family Planning: Pathway to Poverty Reduction. Accessed on October 13, 2016. http://www.prb.org/Multimedia/Video/2012/family-planning-povertyreduction.aspx

Promoting Reproductive Health: A Unified Strategy to Achieve the MDGs. Policy Brief: Senate Economic Planning Office. Jul, 2009. https://www.senate.gov.ph/…/PB%20200903%20-%20Promoting%20Reproductive%. Accessed on 25th August 2016

Sustainable Development Goals. http://www.un.org/sustainabledevelopment/sustainabledevelopment-goals/ Accessed September 26, 2016.

UNFPA. Family Planning. http://www.unfpa.org/family-planning. Accessed on October 13, 2016.

UNFPA, 2014. http://kenya.unfpa.org/news/counties-highest-burden-maternal-mortality. Accessed October 9, 2016.

WHO, achieving the health-related MDGs, http://www.who.int/hrh/workforce_mdgs/en/ accessed September 26, 2016.

45


ANNEXES Annex 1: National Health Work Force Staffing Needs STAFF CATEGORY

Dental staff

Sub categories Community Oral Health Officers Dental assistant Dental general practitioner

needs 1,604 1,924 962

Dental specialist

359

Laboratory assistant

11,137

Laboratory staff Laboratory technician / scientists

Medical practitioners Midwives Non-surgical specialists

Surgical specialists

Nurses

Pharmacy staff

46

Total staff

5,569

Norms/ 10,000 persons By staff category

1.1

By sub categories 0.4 0.4 0.2 0.1 2.5

4.1

1.3

Laboratory technologist

1,471

0.3

Nutritionist

2,335

Clinical Officer Medical Officer

16,278 13,141

Enrolled Midwife

0

Registered Midwife

13,308

Emergency / trauma specialist

572

Physician / internal medicine

1,544

Psychiatrists ENT General surgeon

461 452 947

Obstetrics / Gynaecology

585

0.1

Ophthalmologist

552

0.1

Orthopedician Pediatrician Orthopedic technician

495 506 831

0.1 0.1 0.2

Orthopedic technologist

416

Plaster technician

0

-

Nurse assistant

0

-

Enrolled nurse Registered nurse BSN nurse specialized nurse Dispenser

23,574 11,335 467 2,939 0

5.4 2.6 0.1 0.7 -

Pharmacy technologist Pharmacist

3,106 724

0.5 7.2

3.7 3.0 -

3.0

3.0 0.1

0.6

1.1

8.7

0.9

0.4 0.1 0.1 0.2

0.1

0.7 0.2


Radiology assistant X-ray technician Radiology staff Radiographer Radiologist Environmental Public Health Officers health staff Public Health Technicians Community staff

Rehabilitation specialists

Trained Community Health Worker Social Health Worker

Occupational Therapists

Administrative staff

2,662

0.6 1.6

120,886 3,528

0.3 0.2 0.1 1.0 0.6 27.5

28.3

0.8 0.2

704 0.6

Physiotherapists

Management staff

1,505 0 753 576 4,229

Health Records and Information Officer Health Records and Information Technician

1,768

0.4

4,071

0.9

0

1.2

Medical engineering technologist

413

Medical engineering technician Drivers

825 7,252

0.2 1.6

Clerks

8,661

2.0

Cleaners

11,890

2.7

Security

9,718

2.2

Accountants

3,846

0.9

Administrators

4,330

1.0

Cooks

6,503

Secretaries

3,362

0.8

2,593

0.6

Casuals General support Mortuary attendants staff Patient attendants

749 7,858

12.6

2.5

0.1

1.5

0.2 1.8

47


ANNEX 2: Rates of adolescent pregnancy and motherhood in Kenya per region

48


ANNEX 3: Commodity Prices Product DMPA POPs COCs Male Condoms Implants – Jadelle Implants – Implanon IUCDs Female Condoms Cycle Beads Emergency Pills Dollar exchange rate Ksh.100/dollar

Unit Size Vials Cycles Cycles Pieces Sets Sets Sets Pieces Sets Doses

Unit Price (USD) 0.955 0.34 0.21 0.029 8.885 10.542 0.54 0.72 2.256 0.25

ANNEX 4: Family Planning Method Mix Dynamics Method mix is not expected to change significantly between 2011 and 2017. However, female condoms are expected to contribute 0.5% of methods used in 2017 up from 0% in 2011. Pills are expected to decline by 0.1% from 16.6% in 2011 to 16.5% in 2017 and Vasectomy by 0.3% to 0% in 2017. Method Mix 2011 Data element

Method Mix 2017

% of Total

% of Total

CPR

FP Injections IUCD insertion Implants insertion Sterilization BTL Sterilization Vasectomy Client receiving condoms Female Condoms Natural Family Planning

16.6 53.2 5.0 10.0 1.8 0.3 7.0 0.0 1.0

16.5 53.2 5.0 10.0 1.8 0.0 7.0 0.5

10.92 35.21 3.31 6.62 1.19 0.0 4.63 0.33

All others FP

5.0

Totals

100

6.0 100

3.97 66.19

Pills POPs Pills COCs

49


ANNEX 5: Sustainable Development Goals The Sustainable Development Goals (SDGs), officially known as transforming our world: the 2030 Agenda for Sustainable Development is a set of seventeen apparitional “Global Goals� with 169 targets between them. Spearheaded by the United Nations, through a deliberative process involving its 193 Member States, as well as global civil society. The goals are contained in paragraph 54 United Nations Resolution A/RES/70/1 of 25 September 2015.

ANNEX 6: WHY INVEST IN FAMILY PLANNING

50


ANNEX 7: Population Pyramid by Age and Gender

ANNEX 8: Demographic Dividend Investment Wheels

51


ANNEXE 9: LIST OF FP-CIP DEVELOPMENT TEAM NAME

ORGANIZATION/DEPARTMENT

Emily Mwaringa

DOH

Dr. Mohammed Hanif Hussein

DOH

Seif Salim

DOH

Faith Chiguba

DOH

Mamu Athuman

DOH

Victor Mwaghoti

DOH

Victoria Kapune Josephine Waronja

DOH DOH

Pauline Odinga

DOH

Margaret Mwaila

NCPD

George Ouma

DSW

Halima Ali

DSW

Sheikh Mohmoud Abdillah

CIPK

Mustafa Asman

KMYDO

Feddis Mumba

CBO

Rita Wanjiru

KANCO

Martina Adega

KANCO

Danson Maloti

FHOK

Esther Ajwang

MSK

Cosmas Mutua

Lead Facilitator

52

MOMBASA COUNTY FAMILY PLANNING COSTED IMPLEMENTATION PLAN  
MOMBASA COUNTY FAMILY PLANNING COSTED IMPLEMENTATION PLAN