Community Health 2 OYOO-1
Community Health 2 OYOO-1
Community Health 2 OYOO-1
OYOO
Course outline
• Healthcare delivery system: policies
• Vision 2030 flagship projects
• Kenyan Health policy: health strategic and investment plan (2012-
2017)
• Organization of health services in Kenya (4 tier system)
• Kenya Essential Package for health (KEPH)
• Organization of health services at the national level, county level,
intersectoral collaborations
• Integrated health services ; definitions, concept of rural health
services; homevisiting, family care, school health, mobile clinic
services
Healthcare delivery system
Policies Guiding Healthcare Delivery in Kenya and globally
Overview
• Kenya Vision 2030
• Alma Ata Declaration
• Paris Declaration
• Ouagadougou declaration
• Abuja declaration
Kenya vision 2030
• This is the country’s development blueprint covering the
period 2008-2030
• It aims to transform Kenya into a newly industrializing
“middle-income country providing a high quality life to all
citizens by the year 2030.
• The vision is based on three pillars:
• Economic
• Social
• Political
1. The economic pillar
• Aims at improving the prosperity of all Kenyans through
economic development programme, covering all the regions
of Kenya.
• Aims to achieve an average gross domestic product (GDP)
growth rate of 10% per annum beginning in 2012.
• Areas of interest are:
• Tourism
• Agriculture
• Trade
• Manufacturing
• Financial services
2. The social pillar
• Seeks to build a just and cohesive society with social equity in a
clean and secure environment
• Includes:
• Education and training to reduce illiteracy levels by increasing
access to education
• Improving healthcare delivery
• Improving quality of water and sanitation
• Ensuring a clean secure and sustainable environment
• Housing and urbanization
• Improving the livelihoods of all gender, youth and vulnerable
groups
• Equity and poverty elimination
3. The political pillar:
• Aims at realizing a democratic political system founded on
issue- based politics that respects the rule of law and
protects the rights and freedoms of every individual in
Kenyan society.
Guiding principles:
• In order to ensure that economic, social and political
governance gains more under the vision are neither reversed
nor lost as a result of change in ruling parties; the following
Eight Principles are adhered to:
Principles..cont.d
1. Constitutional supremacy-everything that is done should be
done according to the constitution.
2. Sovereignty of the people -
3. Equality of citizens
4. National values, goals and ideology
5. A viable political party system
6. Public participation in governance
7. Separation of powers (Legislature, executive and Judiciary)
8. Decentralization (devolution)
Vision 2030 for health
• To improve the overall livelihoods o f Kenyans, the
country aims to provide an efficient and high quality
healthcare system with best standards
• This is done through a two-pronged approach:
i. Devolution of funds and management of healthcare to
the communities and district medical personnel; leaving
the ministry to deal with policy and research issues
Vision 2030 for health cont.d
ii. Shifting the bias of the national health bill from curative
to preventive care.
• Special attention to be paid to lowering the incidence
of HIV/AIDS, Malaria, and TB, and lowering infant
mortality ratios.
COMMUNITY UNITS
National referral facilities
• Includes all provincial general hospitals and National
Referrals
• Are general, regional, or discipline specialists
Areas of focus:
•Highly specialized health care, for area / region of
specialization
•Training and research services on issues of national
importance
County referral facilities
• All district, sub-district hospitals, including NGO / private,
• Forms a network of County Referral Services in a county
Services offered:
Comprehensive in-patient diagnostic, medical, surgical and
rehabilitative care, including reproductive health services
Specialized outpatient services
Facilitate, and manage referrals from lower levels, and
other referrals
With other County Referral Facilities, form the County
Referral System
Primary care facilities
• All dispensaries, health centres, clinics, maternity homes
• Catchment area: 30,000 persons
Services offered:
•Disease prevention and health promotion services
•Basic outpatient diagnostic, medical surgical & rehabilitative
services
•Inpatient services for emergency clients awaiting referral, clients
for observation, and normal delivery services
•Facilitate referral of clients from communities, and to referral
facilities
Community Units
Services:
•Facilitate individuals, households and communities to
adopt appropriate healthy behaviours
•Provide agreed health services
•Recognize signs and symptoms of conditions requiring
referral,
•Facilitate community diagnosis, management &referral.
Health system structures
Health systems comprise of:
• Governance structures
• Management structures
• Coordination/ partnership structures
1. Governance structures
Definition of Governance:
• Governance entails processes, mechanisms and
institutions through which citizens and groups articulate
their interests, mediate their differences and exercise
their legal rights and obligations.
• It is the process through which elements in society wield
power and authority and influence and enact policies and
decisions concerning public life and economic and social
development .
Governance structures cont.d
• The governance structures of the health system are
created to provide an oversight role to the management
structures.
• They are supposed to provide voice to the citizens to
ensure that people’s rights of access to quality health care
are respected
Governance structures for the health system
in Kenya
• At the national level, the governance structure for the health
system is the Parliamentary Committee on Health.
• At the county level, a health (or social) committee is set up,
to provide overall governance for health in the county.
2.Management structures
• The sector stewardship and management framework relates
to how the government, through the Ministry of Health, shall
organize itself to coordinate and lead the delivery of the
defined health package.
• Management structures exist from national to community
levels.
• National level structures exist at all levels of the Ministry of
Health
Organisational Structure of National Health Services
CABINET
SECRETARY
FOR HEALTH
Directorate for
Directorate for Health Directorate for Sector
Health Promotion Directorate for
Curative and Planning and
and Disease Administration
Rehabilitation Governance
Prevention
National Hospitals Child Health Referral Services Health Planning Financial Mgt.
Sector
KEMSA Disease Control Pharmaceutical Supply Chain Mgt.
Coordination
NACC
NCD & Injury
Control
36
National level management functions
• National planning and policy formulation
• Enforcement of standards
• Ensuring commodity security
• Performance monitoring
• Capacity strengthening
• Resource mobilization
• Operational and research
• Monitor quality and standards of performance of the national and
county governments in the provision of health services
Management structures at county level
• The link person between the facilities and the community is the
Community Health Extension worker (CHEW).
1. Community:
• A community is a group of people (a large or small group) living
in a certain geographical area and working together for a
common goal.
• They share the same resources such as water, climatic and
geographic conditions, health services, administration and
leadership, as well as disadvantages such as shortages, risks and
dangers.
2. Family:
• The family is the smallest recognized group of individuals in a
community.
• It begins with a marriage union in which husbands and wives
have certain rights and obligations.
• It is one of the oldest institutions that mankind has known.
Characteristics of a healthy community
• Safe and healthy environment, relatively free from natural and man-
made Hazards
• Community members have high standards of personal hygiene
• Adequate supply of wholesome water
• Availability of adequate nutritious food
• Suitable housing
• Harmonious interpersonal relationships among members
• Availability and accessibility of health care facilities
Characteristics of healthy comm. Cont.d
Other services:
• Mental health visits
Functions of the community health nurse
in Mobile clinic services
• Setting up of clinic and arranging equipments and supplies
• Placing of a health worker and arranging at a particular
service area and assigning responsibilities accordingly
• Assessment of health status of patients
• Providing need based nursing care services
• Giving necessary instructions to patients and family
members
Functions cont.d
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