Republic of Kenya

Level IV and V Annual Work Plan

County: Kakamega
Facility Matungu subcounty hospital.
Year: 2019/2020
Contents
Contents.......................................................................................................................................................................................................2
Table of Contents....................................................................................................................................................................................3
Executive Summary.................................................................................................................................................................................3
Acknowledgements.................................................................................................................................................................................3
Section 1: Overview of the Health Situation in the Facility Catchment Area............................................................................................4
1.1. Facility Catchment Population and Demographics.......................................................................................................................5
1.1.1. Population Breakdown and Description................................................................................................................................5
1.1.2. Facility Catchment Population...............................................................................................................................................5
1.2. Health Sector Investment Status in the Facility............................................................................................................................6
1.2.1. Availability of Tracer Health Infrastructure...........................................................................................................................6
1.2.2. Availability of Health Workforce............................................................................................................................................7
1.2.3. Health Commodities, Supplies and Products........................................................................................................................8
1.2.4. Health Management Information Systems/Monitoring and Evaluation...............................................................................8
1.2.5. Previous Financial Year Health Expenditure..........................................................................................................................9
1.2.6. Facility Management, Coordination, Leadership and Governance.......................................................................................9
Section 2: Situation Analysis and Priority Setting...................................................................................................................................10
2.1 Major Health Problems Observed in the Facility Catchment Area.................................................................................................11
2.2 Problem Analysis and Priority Interventions...................................................................................................................................14
Section 3: Annual Program Based Work Plan.........................................................................................................................................15
3.1 Annual Performance Targets...........................................................................................................................................................16
3.2 Annual Program Based Service Delivery Workplan.........................................................................................................................19
Program 1: Curative and Rehabilitative Health Services...................................................................................................................19
Program 2: Preventive and Promotive Health Services.....................................................................................................................22
Program 3: General Administration, Planning, Management Support and Coordination................................................................27
Section 4: Budget Distribution................................................................................................................................................................30
4.1 Budget Distribution by Program and Sub-Program Area............................................................................................................30
4.2 Budget Summary by Program Area and Source of Funds...........................................................................................................32

2
Table of Contents

Executive Summary

Acknowledgements

3
 Section 1:

Overview of the Health Situation in the Facility Catchment Area

4
1.1. Facility Catchment Population and Demographics
1.1.1. Population Breakdown and Description

Description Population Facility catchment area

segment estimates projected population
1 Total population in county
2 Total number of households
3 Children under one year (12 months) 3.71%
4 Children under five years (60 months) 16.9%
5 Under fifteen year population 42.3%
6 Women of child bearing age (15 – 49 Years)
7 Estimated number of pregnant women 3.84%
8 Estimated number of deliveries 3.84%
9 Estimated live births 3.79%
10 Total number of adolescent (15-24)
11 Adults (25-59)
12 Elderly (60+)
*Use county level population segment estimates.

1.1.2. Facility Catchment Population

Facility catchment area Population at Number of new Outpatient

beginning of FY outpatients utilization per
(past twelve months) person
(A) (B) (C) (D = C/B X 100)
1
2
Totals

5
 1.2. Health Sector Investment Status in the Facility
1.2.1. Availability of Tracer Health Infrastructure

Level of care Infrastructure Available Required Gap/Surplus

1 Level V- Total number of facilities
National/regional
referral facilities Total specialized units – ICU, Renal,
Cancer Treatment Centre, etc.
Total number of operating theatres
Number of specialized radiology
services/centers: providing MRI,
CT-scan
Number of specialized/tertiary
laboratories: histopathology,
microbiology, biochemistry
2 Level IV - County
referral facilities Total bed capacity
Total n umber of operating centre
Total of basic radiology
services/centers providing x-rays
and ultrasound
Number with secondary laboratory
services: hematology and
transfusion, microbiology,
biochemistry
Number of functional ambulances
linked to facility

6
 1.2.2. Availability of Health Workforce
Staff cadres Total number Total number Gap/Surplus
available required
1 Consultants
2 Medical officers
3 Dentists
4 Dental technologists
5 Public health officers
6 Pharmacists
7 Pharmacy technologists
8 Laboratory technologists
9 Orthopedic technologists
10 Nutritionists
11 Radiographers
12 Physiotherapists
13 Occupational therapists
14 Plaster technicians
15 Health records & information officers
16 Medical engineering technologists
17 Medical engineering technicians
18 Mortuary attendants
19 Drivers
20 Accountants
21 Administrators
22 Clinical officers (specialists)
23 Clinical officers (general)
24 Nursing staff (KRCHNs)
25 Nursing staff (KECHN)
26 Laboratory technicians
27 Community oral health officers
28 Secretarial staff/Clerks
29 Attendants/Nurse aides
30 Cooks
31 Cleaners
32 Security
7
 Staff cadres Total number Total number Gap/Surplus
available required
33 Community health extension workers
(PHT’s, social workers, etc.)
34 Community health workers
35 Casual workers/staff
36 Other (specify)

1.2.3. Health Commodities, Supplies and Products

Commodities Allocation (Ksh) in Actual Gap/Surplus
last FY requirements
(public)
Pharmaceuticals supplies
Non-pharmaceutical supplies
Medical equipment and technologies
Environmental/Public health supplies
Other medical supplies (oxygen, etc.)
Patient food
Fuel and lubricants
Other fuels: cooking gas, charcoal, firewood
Total

1.2.4. Health Management Information Systems/Monitoring and Evaluation

Reporting Level IV/V
1 Community units (linked to the facility) with updated
household registers
2 Community units providing monthly reports to facility
3 Facilities providing monthly reports
4 Quarterly performance reports prepared and discussed by
(level) management committee

8
 1.2.5. Previous Financial Year Health Expenditure
Item GoK/ GoK User fees Other Gov’t Local Total
County (Conditional sources donors/Partners
gov’t grants) (CDF/WDF,
(equitable etc.)
allocation)
Level IV Amount allocated
Amount received
Expenditure
Actual
requirements
Gap/Surplus

1.2.6. Facility Management, Coordination, Leadership and Governance

Intervention Level IV/V
Emergency contingency plans (including referral plan) available
Health service charter is available and is displayed
Outreaches carried out
Drugs and therapeutic committee meetings held in past twelve months
Mortality meetings held in past twelve months
Management Ccmmittee meetings held in past twelve months
Quarterly stakeholder meetings held in past twelve months
Annual work plan available for past year
Facility coards/committee meetings held in past twelve months

9
 Section 2:

Situation Analysis and Priority Setting

10
2.1 Major Health Problems Observed in the Facility Catchment Area

This section identifies the health problems and proposes that account for the most common morbidities and mortalities in the
catchment area.

Top ten most common health conditions/Issues/Challenges

Under five years Over five years

Category Condition/Issue Occurrence Condition/Issue Numbers/Prevalence
(In order of priority (quantitative or (In order of occurrence (quantitative
relevance to the sub- qualitative rating priority relevance to or qualitative rating)
county) the sub-county)
Linked to HIV/AIDS
communicable Malaria
conditions Tuberculosis
Pneumonia
Measles
Worm infestations
Diarrheal diseases
Others (specify)

Linked to the Heart diseases

increasing burden Cancers
of non- Hypertension
communicable Diabetes
conditions Mental disorders
Others (specify)

Linked to violence Road accidents

11
 Top ten most common health conditions/Issues/Challenges

Under five years Over five years

Category Condition/Issue Occurrence Condition/Issue Numbers/Prevalence
(In order of priority (quantitative or (In order of occurrence (quantitative
relevance to the sub- qualitative rating priority relevance to or qualitative rating)
county) the sub-county)
& injuries Domestic violence
Suicide
Wars/conflicts
Others (specify)

Linked to Pregnancy / childbirth

essential medical events
services Newborn events
Adult women health
events
Adolescent events
Others (specify)

Linked to Obesity
common health Smoking
risk factors Underweight children
Underweight mothers
Poor breastfeeding
practices
Lack of contraception
Alcohol and drug use
Unsafe sex

12
 Top ten most common health conditions/Issues/Challenges

Under five years Over five years

Category Condition/Issue Occurrence Condition/Issue Numbers/Prevalence
(In order of priority (quantitative or (In order of occurrence (quantitative
relevance to the sub- qualitative rating priority relevance to or qualitative rating)
county) the sub-county)
Others (Specify)

Linked to Unsafe water

collaboration Unemployment
with health- Insecurity
related sectors Low female education
Poor housing designs
Large population growth
Others (specify)

* These are conditions/issues/challenges affecting a significant proportion of the relevant population segment in the facility
catchment area. The ones in (italics) are examples.

13
 2.2 Problem Analysis and Priority Interventions
Area of health Key Issues/Challenges* Priority interventions to address identified challenges
Relate to access (demand side) to care and/or (Maximum of five per challenge – from list in Annex 1)
quality (supply side) of service delivery
Eliminate communicable
conditions

Halt and reverse

increasing burden of
non-communicable
conditions
Reduce the burden of
violence & injuries

Provide essential medical

services

Minimize exposure to
health risk factors

Strengthen collaboration
with health-related
sectors

* Challenges are those problems within control of the facility to manage. They form the basis for the planned activities and should
therefore have achievable solutions.

14
 Section 3:

Annual Program Based Work Plan

15
3.1 Annual Performance Targets

Baseline Eligible population Target

A Eliminate communicable conditions
(year X-1 performance) (year X + 1)

HIV+ pregnant mothers receiving preventive

ARV’s to reduce risk of mother to child
1 transmission (PMTCT)
Number of pregnant women receiving TT2 plus
2 immunization

3 Number of pregnant women receiving IPT2

Children under one year of age fully
4 immunized 
Children under one year of age distributed
with long lasting insecticide treated nets
5 (LLITNs) in endemic and epidemic districts

Number of pregnant women distributed with

6 LLITNs in endemic and epidemic districts
Number of people receiving MDA for
7 schistosomiasis

8 Number of TB patients completing treatment

9 Number of TB Patients tested for HIV
10 Number of newly diagnosed TB cases
11 Number of eligible HIV clients on ARVs
Number of children under the age of five
12 treated for diarrhea

13 Number of school age children de-wormed 

Eligible population Target

Halt and reverse increase in non- Baseline
(year X + 1)
B communicable conditions (year X-1 performance)
Number of adult OPD clients with BMI of
14 more than 25
Number of women of reproductive age
15 (WRA) screened for cervical cancer
16
 Number of new outpatients with mental
16 health conditions
Number of new outpatients found with
17 high blood pressure
Eligible population Target
Reduce the burden of violence and Baseline
(year X + 1)
C injuries (year X-1 performance)
Number of new outpatient cases
18 attributed to gender-based violence
Number of new outpatient cases
19 attributed to road traffic accidents
Number of new outpatient cases
20 attributed to other injuries
Number of patients with injury related
21 conditions dying in the facility
Eligible population Target
Baseline
(year X + 1)
D Provide essential health care (year X-1 performance)
Number of pregnant women attending at
22 least four ANC visits

Number of WRA receiving family planning

23 commodity
Number of pregnant women getting iron
24 supplements
Number of deliveries conducted by skilled
25 attendants in health facilities
Number of children under five dying in
26 health facility
27 Number of fresh still births in the facility
28 Number of facility maternal deaths
29 Number of surgical cold cases operated
Number of persons with ill health referred
30 to community units 
Number of newborns with low birth
31 weight (LBW – less than 2,500 grams)
Number of children under five years of
age attending child welfare clinics for
32 growth monitoring (new cases)
Number of households provided with
33 health promotion messages
34 Number of clients tested for HIV
17
 Eligible population Target
Strengthen collaboration with health Baseline
(year X + 1)
E related sectors (year X-1 performance)
Number of children under five years of
age attending child welfare clinics who
35 are under weight
Number of children under five years of
age attending child welfare clinics who
36 are stunted
Number of households with functional
37 toilets
Number of households with hand washing
38 facilities
Eligible population Target
Baseline
(year X + 1)
F Access (year X-1 performance)
39 Number of new outpatients (male)
40 Number of new outpatients (female)
Number of inpatients (admissions) under
41 five years of age
Number of inpatient (admissions) over
42 five years of age

18
3.2 Annual Program Based Service Delivery Workplan
3.1.1. Program Based Implementation Plan

This section of the plan outlines the programs and sub-programs as well as a summary of all the priority activities planned for the
year. It details the activities and expected outputs, implementation timelines and the estimated budget for each of the activities
within a sub-program and program.

Program 1: Curative and Rehabilitative Health Services

Program Outcome: Effective and efficient curative and rehabilitative health care services to the county citizens
Program Objective: To provide effective and efficient curative and rehabilitative at all health service delivery units

Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Sub-Program 1: Primary Health Facility Services
Output:
Primary care
treatment
services

Primary care
diagnostic
services

Primary facility
in-patient
services

Sub-Program 1: Total
19
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds
Sub-Program 2: Hospital Level Services
Output:
General
outpatient
services

Specialized
outpatient
services
Rehabilitative
services

Theatre
services

In-patient
services

Laboratory
services

Radiology
services
20
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Referral
services

Mortuary
services

Sub-Program 2: Total
Program Total:

Program 2: Preventive and Promotive Health Services

21
Program Outcome: Effective and efficient preventive and promotive health interventions within the county
Program Objective: To provide effective and efficient preventive and promotive health interventions across the county

Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Sub-Program 1: Reproductive Maternal Neonatal Child Health (RMNCH) Services
Staffing

Commodities
and supplies

Other
expenses

Sub-Program 1: Total          
Sub-Program 2: Immunization Services
Staffing

Commodities
and supplies

Other
expenses

22
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Sub-Program 2: Total
Sub-Program 3: Nutrition Services
Staffing

Commodities
and supplies

Other
expenses

Sub-Program 3: Total        
Sub-Program 4: Disease Surveillance and Control
Staffing

Commodities
and supplies

Other
expenses

Sub-Program 4: Total        
23
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds
Sub-Program 5: HIV Control Interventions
Staffing

Commodities
and sullies

Other
Expenses

Sub-Program 5: Total
Sub-Program 6: TB Control Interventions
Staffing

Commodities
and supplies

Other
expenses

Sub-Program 6: Total
Sub-Program 7: Malaria Control Interventions
Staffing

24
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Commodities
and supplies

Other
expenses

Sub-Program 7: Total
Sub-Program 8: Neglected Tropical Diseases Control
Staffing

Commodities
and supplies

Other
expenses

Sub-Program 8: Total
Sub-Program 9: Non-Communicable Disease Control
Staffing Lobby for employment of more staff 1.5M County /partners
1.nutritionist
2. nurses
Updates on NCDs 400000 County/partners
Intensify outreaches NCDS 150000 County/partners
Commodities Procurement of drugs and non pharms 2.4M County/partners
and supplies for NCDs
Purchase refrigerator 100000 County/partners

Other Form support groups and facilitate 500000 County/partners

expenses monthly meetings
NCDs open day 400000 County/Partners

25
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Sub-Program 9: Total
Sub-Program 10: Environmental Health, Water and Sanitation Interventions
Staffing

Commodities
and supplies

Other
expenses

Sub Program 10: Total

Sub-Program 11: School Health Interventions
Staffing

Commodities
and supplies

Other
expenses

Sub-Program 11: Total

Sub-Program 12: Community Health – Level 1 Interventions
Staffing

Commodities
and supplies

Other
expenses

26
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds
Sub-Program 12: Total
Program Totals:

Program 3: General Administration, Planning, Management Support and Coordination

Program Outcome: Effective and efficient preventive and promotive health interventions within the county
Program Objective: To provide effective and efficient preventive and promotive health interventions across the county

Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Sub-Program 1: Health workers and human resource management
Recruitment Lobby for more staff 5million County/partners
and 1. Clinical officers
deployment 2. Nurses
3. Medical officers
4. Lab techs
5. Records officers
Meeting for staff deployment 100000 County

Training (CPD) Facilitate training of staff(conferences, 1000 1000 1000 100 400000 County
AGM, seminars) 00 00 00 000

External CMEs 200000

Appraisal and Organize for monthly support 1500 1500 1500 150 600000 County/partners
supervision suppervision 00 00 000 000
0

Retirement Induction of successors 200000 county

and succession Retirement training 200000 county
planning

27
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds
Sub-Program 1: Total          
Sub-Program 2: Construction and Maintenance of Buildings

Sub Program 2: Total

Sub Program 3: Procurement of Medicines, Medical and Other Supplies

Sub-Program 3: Total
Sub Program 4: Procurement and Maintenance of Medical and Other Equipment

28
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Sub-Program 4: Total
Sub-Program 5: Management and Coordination of Health Services
Staffing Lobby for more staff 8million County/partner
1.clinical officers
2. medical officers
3.nurses
4.records
5. Pharm tech.
6.Lab-tech.
Sensitization of staff through CMEs, 1million county
Monthly HMT meetings 600000 county
Quarterly HMC 300000 county

Commodities Lobby for increase of finance to 48million County/partner

and supplies purchase hospital equipment, items

Other supervision 400000 County/partner

expenses Stakeholders meeting 400000 County/Partner

Sub-Program 5: Total
Sub-Program 6: Health Sector Planning, Budgeting and Monitoring and Evaluation

29
Key output Activities Q1 Q2 Q3 Q4 Total amount Source of funds

Sub-Program 6: Total
Program Totals:

Section 4:

Budget Distribution

30
4.1 Budget Distribution by Program and Sub-Program Area

Program Sub-program Total budget

1 Curative and Primary facility services
rehabilitative health Hospital services
services
2 Preventive and Reproductive Maternal Neonatal Child Health (RMNCH)
promotive health Services
services Immunization services
Nutrition services
Disease surveillance and control
HIV control interventions
TB control interventions
Malaria control interventions
Neglected tropical diseases control
Non-communicable disease control
31
 Environmental health, water and sanitation interventions
School health interventions
Community health – Level I interventions

3 General Health workers and human resource management

administration, Construction and maintenance of buildings
planning, management Procurement of medicines, medical and other supplies
support and Procurement and maintenance of medical and other
coordination equipment
Management and coordination of health services
Health sector planning, budgeting and monitoring and
evaluation

32
4.2 Budget Summary by Program Area and Source of Funds

Source of funds Budget distribution

Curative and Preventive and General Total
rehabilitative promotive health administration,
health services services planning,
management
support and
coordination
Public sources County government
Central government
(conditional grants)
User fees
Constituency development
fund
Other (specify)

Development Africa Development Bank

Partners Clinton Foundation
Danish Government
(DANIDA)
UK Government (DfID)
European Commission
German Government (GIZ)
Italian Government
Japanese Government
(JICA)
Netherlands Government
UN agency (UNAIDS)
UN agency (UNFPA)
UN agency (UNICEF)
UN agency (World Bank –
WB)
UN agency (WHO)

33
 Source of funds Budget distribution
Curative and Preventive and General Total
rehabilitative promotive health administration,
health services services planning,
management
support and
coordination
US Government
(USAID/APHIA)
Other (specify)

Community/ NGO/CSO (specify)

NGO Kenya Episcopal
Conference (KEC)
Christian Health
Association of Kenya
(CHAK)
Supreme Council of Kenya
Muslims (SUPKEM)
Other (specify)
Total

34