Community Health 2 OYOO-1

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COMMUNITY HEALTH 11

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.

All the above will reduce inequalities in access to


healthcare and improve key areas where Kenya is lagging
especially in lowering infant and maternal mortality.
Vision 2030 for health cont.d
• Specific strategies will involve; provision of a robust health
infrastructure network; and improving the quality of health
service delivery to the highest standards and promotion of
partnerships with the private sector
• In addition, the government is to provide access to those
excluded from healthcare due to financial reasons.
• Through encouragement to the private sector, Kenya intends
to become the rational provider of choice for highly
specialized healthcare, thus opening Kenya to “health
tourism” as an income generating activity
Health sectors flagship projects for 2012:
1. Revitalize community health centres to promote
preventive healthcare (as opposed to curative
intervention) and by promoting healthy individual
lifestyles
2. Delink the ministry of health from service delivery
in order to improve management of the country’s
health institutions primarily by devolution of health
management to communities and healthcare
experts at district, provincial and national hospitals
Flagship projects cont.d

3. Create a national health insurance scheme in order


to promote equity in Kenya’s healthcare financing:
4. Scale up the output-based approach system to
enable disadvantaged groups (e.g. the poor,
orphans) to access healthcare from preferred
institutions.
The Alma Ata Declaration
• An international conference on primary healthcare was held
in Alma Ata from 6th to 12th September 1978
• Marked a milestone in the history of public health
• Key to the attainment of the goal of Health For All
Objectives of Alma Ata Declaration
• To promote the concept of primary healthcare
• To evaluate the present healthcare situation
• To define the principles of primary healthcare
• To define the roles of governmental, national and
international organizations
• To formulate recommendations for the development
Declaration of Alma Ata
• Existing gross inequality in the health status of the people is
unacceptable
• People have a right and duty in participating individually and
collectively
• Primary healthcare is essential healthcare
• An acceptable level of health for all the people by the year
2000
Paris Declaration for Health
“ Partnerships for health and well being of our young and future
generatioins”

• A high level WHO conference was held in December 7 th -8th 2016 in


Paris France
Involves WHO Member states commiting to:
• Acting together for health and well being of the young and future
generations
• universal social protection floors for better health and well being
for all children and adolescents
• Schools and preschools promoting health and well being for all
children and adolescents
• Governance for health and well being of all children and
Abuja Declaration
• Made in 2001 by African Union Member Countries; a
conference Held in Abuja, Nigeria.
• In it, the member nations pledged to increase their health
budget to at least 15% of the state’s annual budget, and
requested western donor countries to increase their support.
Ouagadougou Declaration
• The International Conference on Primary Health Care and
Health Systems in Africa, meeting in Ouagadougou, Burkina
Faso, from 28th to 30th April 2008
• Reaffirmed the principles of the Declaration of Alma-Ata of
September 1978, particularly in regard to health as a
fundamental human right and the responsibility that
governments have for the health of their people
• The Conference expressed the need for accelerated action by
African governments, partners and communities to improve
health
Organization of health services in
Kenya
Overview
• Health systems organisation in Kenya.
• Governance, management and coordination structures:
national and county levels.
• Roles and functions of these structures at various levels of
the health care system.
• National health policy framework: process and evolution.
• Health sector reforms: components and characteristics.
Introduction
• The Kenya Health Sector Strategic and Investment Plan
(KHSSP III 2012 – 2017) defines the Kenya Essential
Package for Health (KEPH) as consisting of the following
cost-effective health services organised by:
1. Type:
• Promotive,
• Preventive,
• Curative &
• Rehabilitative
KEPH cont.d
2. Target group:
– Pregnancy and the new born (up to 28 days),
– Early childhood (29 days – 59 months),
– Late childhood and youth (5 – 19 years),
– Adulthood (20 – 59 years),
– Elderly (60 years and over),
– Cross cutting interventions (all cohorts/ groups).
The 4 Tier System
– Tier 1: Community level;
– Tier 2: Primary Care level
– Tier 3: County level
– Tier 4: National level
4 tier system
NATIONAL REFERRAL FACILITIES

COUNTY REFERRAL FACILITIES

PRIMARY CARE FACILITIES

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

TOP MANAGEMENT PRINCIPAL


SECRETARY
FOR HEALTH
Semi Autonomous Government
Agencies
DIRECTOR
GENERAL FOR
HEALTH

Resource Centre Disaster Management


SENIOR MANAGEMENT

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

KEMRI Animal Health Laboratory Health Information Logistics Mgt.

Reference Labs Nutrition Clinical Services Sector Governance Internal Audit

NHIF Health Promotion Nursing Services HR Management HR Administration


& Community Care

PPS Quality Assurance Infrastructure Mgt. Accounts


Environment and
Hygiene Control Reproductive
NBTS Procurement
Health

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 Constitution of Kenya 2010 has assigned the larger portion of


delivery of health services to the Counties with exception of National
Referral Services.
• Governance units at County level include:
₋ County department responsible for health;
₋ Hospital boards;
₋ Primary care management committees;
₋ Community health committees.
County level management functions
• Delivering county health services;
• Licensing and accrediting non state health service providers (HSPs);
• Financing of county level health services;
• Maintaining, enhancing and regulating asset development and HSPs
operations;
• Approving county special partnership agreements (SPAs) for county
HSPs;
• In collaboration with national government, gazette regulations for
community managed health supplies are implemented at county
level
County mngt functions cont.d
• Planning, investment and asset ownership function of public health
facilities;
• Developing an investment plan to enable fulfillment of the highest
attainable right to health and document, annually, progress on
fulfillment as required by the Constitution;
• Asset financing and ownership;
• Channeling public and other funds to develop health facilities.
Technical management of health at county
This comprises of:
• Office of the County Executive officer of Health
• Office of Head - Health department
• Other offices that shall be approved within the county by the
governor in consultation with the county assembly.
County technical management functions
• Strategic and operational planning, supportive supervision,
monitoring and review of health service delivery in the County
• Coordinate delivery of health services in the County
• Provide a linkage with County Executive officers, Heads of health
department and other actors to facilitate health sector dialogue at
the County
County technical mngt functions cont.d

• Provide leadership and stewardship for overall health management in


the County, through building linkages with, and putting in place
influencing strategies for health related sector’s in the County, such as
education, roads, gender, nutrition, etc.
• Mobilise resources for County health services
Facility management structures
Hospital Management Teams (HMTs) exist in all types of hospitals.
In general, the membership is made up of the heads of the following
departments:
• Nursing
• Medical
• Surgery
• Obstetrics and Gynaecology
• Pharmacy
• Laboratory and

Facility management functions
• Preparation of hospital work plans, e.g., annual operation plans;
• Ensuring equitable distribution of resources within the facility, e.g.,
supplies, staff within the departments;
• Ensure that quality services are offered to the clients in the hospital;
• Ensure that proper records and information are maintained;
Facility mngt functions cont.d
• Proper financial management, e.g., ensuring proper budgeting and
utilisation of funds such as the Facility Improvement Fund (FIF);
• Commodities and supplies management;
• Infrastructure and equipment management;
• Emergency preparedness and timely response;
• Human resource management and development.
Management structures at primary healthcare
facilities

• The management teams at the primary care facilities are composed of


an officer in-charge ,a clinical officer, nurse, public health officer.
• The link person between the level 2 and 3 facilities and the
community is the Community Health Extension Worker (CHEW).
Management structures at community level

• At community level, there are no formal management structures.


Management is provided by the County, while the health facilities
provide the supervisory function.

• The link person between the facilities and the community is the
Community Health Extension worker (CHEW).

• CHEWs are supported by CHWs/ CHVs


Exclusive Functions of The County and National
Department of Health
County functions
• County referral Health Services
• Sub-county Health Services
• Environmental Health Services
• Communicable Disease Control
• Nutrition
• Family Planning Maternal and Child Health
• Health Education
County functions cont.d
• Health Informative System
• Food Control Administrative Services
• Vector Borne Disease Control
• Communicable Disease Control and Management
• County Administration and Planning
• Primary Health Services
• Rural Health Training and Demonstration Centre
National government functions
• Kenyatta National Hospital (KNH)
• Moi Teaching and Referral Hospital (MT&RH)
• Kenya Medical Training College (KMTC)
• Kenya Medical Supplies Agency (KEMSA)
• National Hospital Insurance Fund (NHIF)
• National Quality Control Laboratory (NQCL)
• National Blood Transfusion Services
National functions cont.d
• Pharmacy and Poisons Board
• National Public Health Laboratory
• Government Chemist
• Radiation Protection Board
• Kenya Medical Research Institute (KEMRI)
• Mathari Mental Hospital
• Spinal injury Hospital
Coordination/ Partnership structures
in health system management
Introduction
• Partnership means voluntary joint action or decision-making
in a harmonious and supportive way, for a common goal and
outcome.
• It involves all stakeholders who, through their actions, will
influence health services delivery.
• In the health sector, partnership is guided by an overall
instrument, “the Code of Conduct,” which defines roles and
obligations of different sector actors towards attaining its
overall goal and objectives.
Coordination/ partnerships cont.d

• The health sector partnership in Kenya is guided by the


Kenya Health Sector-Wide Approach (KHSWAp) introduced in
2005.
• The SWAp principles is built around country ownership,
harmonisation, managing for results and mutual
accountability.
Coordination/ partnerships cont.d

• The SWAp principle is based on having the sector working around:


– One planning framework
– One budgeting framework
– One Monitoring framework
• Partnership structures are necessary as they provide opportunity for
stakeholders to share experiences, expertise and lessons learnt.
Partnership Structures in the Health Sector
• Partnerships are key in the successful achievement of the
objectives of the health sector.
• The health sector has put in place a multi-layered sector
coordination framework that consists of the following structures:
₋ Joint Interagency Coordinating Committee (JICC);
₋ Health Sector Coordinating Committee (HSCC);
₋ Health Sector Steering Committee (HSSC);
₋ Interagency Coordinating Committees (ICCs, for technical
issues);
₋ County Stakeholder Forums (CHSF).
Health Sector coordinating framework
Joint Inter Agency Coordinating Committee (JICC)

Health Sector Coordinating Committee (HSCC)

Health Sector Steering Committee Secretariat

County Health Stakeholders Forum


Functions of Joint interagency coordinating
committee
• Provides leadership for overall sector policy direction;

• Approves the Kenya Health Sector Policy and Strategic Plans;

• Undertakes advocacy for the health sector;

• Leads resource mobilisation efforts for the health sector.


Functions of ICC

• Support management of key action points as identified by the HSSC;

• Facilitate formation of working groups or task forces as required to


address key issues and tasks;

• Coordinate with and oversee work of appointed working groups and


task forces.
Membership of ICCs
• Government of Kenya, represented by head of department
responsible for the area of the ICC;
• Representative of HSCC steering committee secretariat;
• Heads of related divisions in the responsible department;
• Technical advisors nominated by government;
Membership of ICCs cont.d

• Development partners, represented by partners supporting the


areas of the ICC;
• Technical advisors nominated by development partners;
• Implementing partners, represented by partners supporting
the areas of the ICC;
• Technical advisors nominated by implementing partners.
County stakeholder forums
• Provide the oversight role in the provision of the health
services at the County level.
• The County Governor provides the chair for the Forum.
• The members of the Forum are drawn from relevant
government departments and implementing partners,
including faith-based and non-governmental organizations.
Functions of the county stakeholders forums
• Foster collaboration among the health sector stakeholders by
providing a platform for discussion and dialogue on health-
related issues;

• Review and approve the respective annual plans to ensure


that there is harmonization among health sector
stakeholders.
Non-governmental organizations
• Non-Governmental Organisations (NGOs) have been actively involved
in developing Community Based Health Care (CBHC) projects since
the mid 1970’s.
• Although collaboration between the Ministry of Health and NGO’s has
so far been good, it could be improved even more by creation of joint
coordinating committees.
• Indeed, it was through such joint efforts with assistance from WHO
and UNICEF that National Guidelines for the implementation of PHC in
Kenya were formulated
NGOs cont.d

• Many NGOs have on-going CBHC schemes.


• Some of the NGOs actively involved in CBHC programmes
include the following:
African Medical and ResearchFoundation (AMREF)
 Aga Khan Health services
Christian Health Association of Kenya (CHAK)
Kenya Red Cross society
Action Aid - Kenya
NGOs cont.d

• Catholic Relief Services - Kenya


• Family Planning Association of Kenya
• Institute of Cultural Affairs
• National Christian Churches of Kenya (NCCK)
• The Undugu Society
• World Vision
Integrated health services in
Kenya
Objectives
• By the end of the unit, students should be able to descuss:
• Concept of community health nursing
• Home visiting
• family care
• school health programmes in Kenya
• Mobile clinic services
Concept of community health nursing
Objectives:
• Define a community
• Define the concept of community health nursing
• List the aims of family health care
• Describe the process of home visiting
Definitions

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

• Availability and accessibility of suitable educational, social


and recreational facilities
• Gainful occupational activities (availability of stable or
reliable sources of income)
• Sound communication infrastructure
• Communal approach to and participation in tackling
community problems
Problems that affect the health of a
community
• Unsanitary environment
• Overcrowding
• Poverty
• Unclean and inadequate water supply
• Lack of nutritious food
• Unsafe environment
• Epidemic and endemic disease
• Unstable family life
Problems cont.d

• Illiteracy and ignorance


• Poor leadership and lack of participation
• Adverse weather conditions
• Poor infrastructure
• Political instability
Family Health Care
Definition of family health care
• Family health care is a holistic approach to the achievement
of wholesome health for the family

Aims of family health care


• Identifying and appraising health problems of the family
• Providing health education for the promotion of health and
prevention of diseases
• Sharing health information with the family to enable
members to understand and accept health problems
Aims cont.d
• Providing community health nursing services according to
the needs of the family
• Helping the family to develop competence at assessing their
health problems and at carrying out remedial health action
through health education, instructions and demonstrations
• Contributing needed materials for personal and social
development of family members
• Helping and encouraging the family members to utilize
available resources to maintain all aspects of the health of
the family
Principles of family health care
• Establish a good working relationship with the family
• Plan relevant health education and sharing of clear health
messages, which will guide them on how to take care of
themselves
• Gather relevant information about the family which will
enable them to identify health problems and set priorities
• Provide need-based support and services to the family
regardless of sex, age, income, and religion, in order to
improve their health status
• Work in collaboration with other health service agencies to
avoid duplicating family health care
Process of family health care
Step 1: Assessment:
• Assess the family so as to identify (diagnose) the family
health problems, needs and resources.
• This involves collecting data using interviews, observation,
communication, subjective appraisal, and reviewing available
records and reports
Step 2: Planning:
• Involves planning for health action by choosing effective and
affordable alternatives and setting priorities after considering
the available internal and external resources.
• One should work hand-in-hand with the family members at
all stages of planning.
Step 3: Implementation

• The nurse should implement the interventions or health


actions agreed with the family members.
• Implementing also includes increasing the family’s ability to
function effectively and removing barriers to health care
• Also involves assisting the family to do those things which
they cannot do by themselves.
Step 4: Evaluation
• This involves measuring whether the expected outcome has
been achieved.
• If no achievements have been made, find out the barriers to
implementation and change the approach accordingly.
Home Visiting
• Home visiting is an important part of the work of a
community health nurse
• It allows one to see the families and their needs in their own
homes
• It is one of the essential services provided by a community
health nurse
Purpose of home visiting
1. Allows the nurse to follow up individual families at home to
find out why some health problem persist in the
community despite efforts to prevent or control them for
example malnutrition, communicable diseases, or repeated
failure to attend clinics especially if the family is at risk.
2. It keeps the nurse aware of what is going on in his/her
catchment area
Types of home visit:
1. Illness home visits: In case of emergency, acute or chronic
illness
2. Dying patient home visits: terminal care, pronouncement
of death, grief support
3. Assessment home visits: Polypharmacy, Immobility, social
isolation, suspected abuse or neglect or recent catastrophic
diagnosis
4. Hospitalization follow-up home visits: acute illness, injury
or surgery or parents with newborn infants
Skills required for home visiting
• Good technical skills and knowledge of preventive and
therapeutic measures
• Good communication skills and teaching ability
• Good leadership skills and rational thinking to make sound
judgments
• Good counselling skills and an understanding of human
relations
Principles of home visiting
Home visits should be:
1. Planned and of benefit to the patient
2. Purposeful, clear and meet the patient‘s health needs
3. Should be regular and flexible according to the needs of
the patient
4. Educative to the patient; an excellent opportunity for
health education
Principles cont.d
5. Used to demonstrate principles of health
6. Convenient and acceptable to the patient
7. Respectful of the patient‘s right to refuse care
8. Recorded in the appropriate case file
Process of home visiting
Home visiting is carried out in 5 phases:
1. Entry/ Initiation phase:
• The community health nurse shares information with the
patient on the reason and purposes for home visits.
• This interaction may occur in a hospital ward or at a clinic
2. Pre-visit activities:
• Before the actual home visit, data is collected
regarding the patient and the family.
• Information is gathered regarding the location of the
house, distance from the health facility and the
physical address.
• The nurse should find out about the community
resources, assemble supplies and prepare for the first
contact with the patient at their doorstep.
3. Activities during home visiting
• This is the working phase during which you put into action
your planned health activities.
• During this phase you must establish trust and rapport with
the patient and the family so that there can be a positive
interpersonal relationship (a professional nurse-patient
relationship).
• This relationship will enhance the achievement of the
mutually determined health-oriented goals
4. Termination phase of visit
Termination of home visits can occur due to any of the
following reasons:
• The patients’ health has been restored and the patient can
function without the nurse
• The patient has changed their residence
• The community health nurse has transferred the patients’
care to another nurse or agency
5. Post visit activities
• Post-visit activities include recording and reporting important
events of the home visits
• The reports are shared with the appropriate authorities and
individuals about the patient and family
Advantages of home visiting
• Home visiting gives a more accurate assessment of the family
structure and behavior in their natural environment.
• Home visits provide an opportunity to observe the physical
environment of the home and identify barriers to, and
resources for achieving family health.
• At home, the nurse works with the patient first hand to
implement health action using realistic resources.
Advantaged cont.d

• By meeting the family on its home ground the nurse will be


enhancing the family’s sense of control and active
participation in meeting its health needs.
• It provides an excellent opportunity to implement planned
health care.
• It provides an opportunity to learn about the home and
family situation.
Advantages cont.d (2)
• It provides an opportunity to render health care services to
the family members in their own surroundings.
• It creates a good understanding between the nurse and the
patient and builds a good image of nurses.
• It provides an opportunity to clarify the doubts and
misconceptions raised by family members.
• It provides an opportunity to observe and appreciate family
practices and progress of care given by the nurse and others.
Disadvantages of Home Visiting
• Home visits consume a lot the nurse's time and energy as well as
transport fuel or bus fare.
• Unforeseen events may occur during home visits, which will
interfere with planned activities.
• The patient’s family may not accept the nurse due to various
factors such as cultural or religious differences, personal
characteristics of the nurse and the patient or to some extent,
socioeconomic status of the nurse and the patient.
• Confusion of the nurse’s role in a community where there may
be a lack of knowledge and understanding of the role of the
community health nurse.,
Outreach Services
• Outreach is an intervention or activity conducted by
community healthworkers, health educators, health
promoters out in the community, face to face with
individuals and leaders in the community
Objectives of outreach
• To develop liaison between the health facility and the
community
• To improve community awareness, trust and understanding
of the facility missions, programmes and successes
• To increase collaboration and communication with
community members, stakeholders, and key partners
• To share resources and exchange ideas with the community
• To increase program attendance
• To stimulate behavioral change and implementation of risk/
harm reduction modalities among targeted groups
Principles of outreach
• Clearly identify the target group
• One size does not fit all: tailor your strategy, message and
your materials according to the target audience
• Think from the client’s or community’s perspective and
include information about your services that may be helpful
to hear or read
• Enlist key community leaders to be your ambassadors
Principles cont.d
• Outreach= material + personal contact in multiple ways and
multiple times; build trust and become a familiar face
• Be a conversationist and not a preacher
• Create a system and schedule for providing outreach
• Consider where you have done outreach and think about
who is missing, track who is coming and adjust your strategy
as needed
Steps in outreach
• Planning
• Development
• Execution
• Evaluation
School Health Programme
Objectives
By the end of this lesson, students should be able to:
• Describe how to organize a school health programme
• State the objectives of a school health programme
• Explain how to plan and implement school health services
• State the activities undertaken during a school health service
• Evaluate school health programmes
Introduction
• School health focuses on ensuring health promotion,
conservation, protection and correction of abnormalities of
the school population.
• A school health programme is an integral part of community
health.
• A school health approach is advocated in the provision of
health services as school children are easy to reach, they also
disseminate health messages to the larger population.
• It is therefore important to consider school health
programmes as a priority need of the community.
Organization of school health programmes
• In Kenya, it is the responsibility of a community health nurse
to design school health programmes.
• In order to design a working school health programme, one
needs to involve the rest of the health team members, the
school administration and the community
Members of school health committees
• Teachers
• Pupils and students
• Parents
• Community formal and informal leaders
• Community health nurse
Process of the school health programme
1. Assess the problems of school children
2. Establish practical goals for the school population
3. Carry out the needed activities
4. Evaluate the process and results of the programs
Needs of a school child
• A stable home
• Proper nutrition
• Freedom from fatigue
• Clothing
• Good sight hearing and speech
• Freedom from infection
• Pure and safe water
• Clean buildings
Objectives of school health
• Promoting and maintaining the health of the school children.
• Promoting positive health behavior among staff and
students.
• Bringing up citizens who understand basic good health
habits.
• Ensuring general community health by using the child as a
channel for health messages to the family.
Objectives cont.d
• Improving the physical and social environment of the
school.
• Providing the aspects of prevention of disease;
Primary prevention, for example: eating diets rich in
vitamins A and C, iron and protein
Secondary prevention, that is, early diagnosis and
treatment
Tertiary prevention which includes rehabilitation.
Activities undertaken in School Health
programs
• Carrying out observation, screening, physical examination
and epidemiological investigations.
• Rendering emergency services and care of a continuing
illness.
• Counselling or arranging for counselling of pupils, teachers
and other persons in the school population.
• Involving parents, pupils and teachers in planning and
conducting health care activities.
Activities cont.d
• Contributing to the development of a curriculum in health
related matters, through clubs such as, biology, scout
association, Red Cross, social clubs and home science.
• Consultation with teachers and other personnel.
• Referral for specialized/ continued care.
Planning and implementation of school health
programmes
1. Assessing health needs;
Information is sourced from the following:
• Clinic records in the catchment area
• Previous reports on school health services: provided
monthly and quarterly
• Health team workers in the catchment area
• Teachers, students and parents
• Personal observations and experiences
• Formal and informal leaders
2. Implementation
Resources required for school health include:
• Manpower
• Materials
• Time
• Pupil awareness and participation
Inspection of the school environment
• Since the children spend a lot of the time in school, it is
important to ensure that their environment is safe and clean.
• The following areas are inspected:
Location of the school
Sanitation
Playground
Classroom
Furniture
Inspection cont.d

1. Location of the school


• Surroundings should be clean, free from noise
• Pollution, away from industrial and other waste or swampy
area.
2. Sanitation
• The school should have a good water supply, clean and
enough latrines, and solid waste disposal systems.
• There should be separate toilets for female and male
students.
• The environment should be clean and well maintained.
Inspection cont.d
3. Playground
• It should be dry with no potholes or stones to prevent accidents.
4. Classroom:
• This should be clean, well ventilated with adequate lighting.
• It should not be overcrowded and the students should be able to
hear the teacher and see the black board from where they sit.
5. Furniture:
• The seats should be simple and not attached to each other so
that the pupils can move them.
• The children’s feet should be able to touch the floor when they
are seated.
Promotion of proper nutrition in school health
programme
In case there is a feeding programme in the school, the nurse
should assess for:
• Methods of cooking and storage of food
• Personal hygiene of food handlers and children
• Cleanliness of the utensils
• Cleanliness of the kitchen
• Screening of the food handlers
Sharing health messages
• One should identify and plan to share the appropriate health
messages with the school population.
• The health messages shared should include, prevention of
common health problems, such as, sexually transmitted
infections, HIV/AIDS, skin conditions amongst others.
Record keeping in school health programs
The records should reflect:
• The number of schools covered.
• The number of pupils treated and types of ailments
• The number of pupils referred
• Activities carried out
• Health messages shared
• Information on the environmental health
• Effectiveness of the school health services
Evaluating school health services
Guiding questions include:
• Was the work plan followed ?
• Were the services geared towards meeting the priority
health needs?
• Were all the necessary activities carried out during the
school health services?
• How effective were the services provided?
Mobile clinic Services
Overview
• Introduction
• Mobile clinic team members
• Services offered during mobile clinics
• Roles of a community health nurse
• Operationalization of mobile clinics in Kenya
Introduction
• Mobile clinic services are a costly but effective way of
reaching the underserved
• Purpose is to provide accessible healthcare services to
vulnerable populations by reducing traditional barriers to
access (e.g., transportation, time constraints, distrust of
health care system)
• Taking healthcare to the doorsteps is the principle behind
mobile clinic services; especially in the underserved areas
Intro. Cont.d

• The World Health Organization (WHO) and its many partners


regularly deploy diverse mobile clinics and medical teams to
reach people cut off from access to health services.
• For many people these mobile clinics and teams may be their
only source of health care.
• Mobile clinics offer flexible and viable options for treating
isolated and vulnerable groups.
• The demand for mobile units keeps rising.
Mobile clinic team members
• Nurses
• Medical officers
• Radiologists
• Laboratory tehnicians
• Pharmacist
• Helper
• Drivers
• Specialists
Services offered
1. Maternal and child health services:
• Antenatal check ups and related services such as Tetanus
toxoid injection, iron and folic acid tablets, basic laboratory
tests
• Referral for complicated pregnancies
• Promotion of institutional delivery
• Post-natal check up
• Immunization clinics
• Treatment of common childhood illness such as diarrhea,
pneumonia, measles complications
• Treatment of Respiratory tract infections and Sexually
2. Family planning services
• Counselling for spacing and permanent methods
• Distribution of oral contraceptives, emergency
contraceptives
• Implant and IUD insertion
3. Diagnostic:
• Investigation facilities like hemoglobin, urine examination for
sugar and albumin
• Smear for malaria and vaginal smear for trichomonas
• Clinical detection of leprosy, tuberculosis and locally endemic
diseases
• Screening for breast cancer, cervical cancer etc
4. Specialized facilities
X-ray
ECG
Ultrasound
5. Emergency services and care in times of disaster/
epidemic/ public health emergency/ accidents

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

• Conducting education sessions as needed


• Assisting in curative services
• Supervision and guidance of health workers
• Monitoring of health records and registers
• Maintaining and preserving the health records, registers and
reports of the clinic services provided
• Helping in promoting good working environment
• Evaluating the service rendered
Operationalization of mobile
clinics in Kenya
Introduction
• Various initiatives have been put in place by the
government to mitigate challenges especially the high
maternal and child mortality rates as well as children
newly infected with HIV
• Among them are the free maternity services and mobile
clinic services that were introduced in all public health
facilities in 2013 and the implementation of the
Elimination of Mother to Child Transmission of HIV
(EMTCT) strategy.
Beyond Zero Campaign
• At the 2013 Organization of Africa First Ladies against
AIDS (OAFLA) meeting held in Addis Ababa Ethiopia,
African First Ladies committed to elimination of Mother
to Child Transmission of HIV (EMTCT)and keeping
Mothers Alive (KMA).
• The First Lady of Kenya, Margaret Kenyatta, made a
commitment to champion this worthy cause, especially
through provision of mobile clinic services .
Beyond zero cont.d
• The National Steering Committee (NSC) for EMTCT and the
Technical Advisory Team (TAT) in conjunction with the
Beyond Zero secretariat, has been set up to support the
Office of the First Lady (OFL) in implementation of her
strategy.
Overview of the mobile clinic
The clinic is partitioned into four:
1. The common area at the entrance
2. Maternal cum general consultation/ procedure room
3. Paediatric consultation / procedure room
4. Laboratory/ pharmacy area
NB: The clinic is equipped with all the essential drugs and
equipments that a primary health care facility might require
Responsibilities of the ministry of health

• The national government through the ministry of health is


responsible for the following:
1. Provision of the technical specification of the mobile
clinic and medical equipment.
2. Oversee the medical equipment’s installation
3. Verifying the functionality and authenticity of the
medical equipment during kitting of the mobile clinic.
MOH responsibilities cont.

4. Provide technical support in operationalization of the


mobile clinic, including orientation of the county health
management team(s)on the functioning of the mobile
clinics.
5. Support progress monitoring on the utility of the mobile
clinics through development of a tool for reporting, setting
baseline statistics and support counties to track progress.
Responsibilities of the county
• Upon receipt of the mobile clinics, the county governments
will be responsible for the following:
1. Verification of the medical equipment’s inventory and their
functionality at the time of receiving the mobile clinics and
regularly thereafter.
2. Allocation of health care workers, drivers and other
required personnel to operate the mobile clinic
3. Select, capacity-build and continually supervise a team to
operationalize the mobile clinic.
County responsibility cont.
4. Develop a calendar of mobile clinic operationalization,
based on need, equity and emergency situations among
other considerations.
5. Responsible to purchase and replenishment of the mobile
clinic’s supplies, i.e. pharmaceuticals, laboratory reagents,
non-pharmaceuticals and other consumables. This includes
fuel for both the mobile clinics and generators.
6. Provide regular feedback (including monitoring reports) on
the usage and performance of the mobile clinic.
7. Regular service and maintenance of the mobile clinic and
equipment to ensure continuity of service delivery.
County responsibility cont.
8. Provide security for the mobile clinic and its equipment.
This includes provision of comprehensive insurance cover
and installation of tracking devices on the mobile clinic to
enhance security on the truck.
9. Provide a county report on the utility of the mobile clinic
on a quarterly and annual basis.
10.Ensure that proper waste disposal and infection prevention
and control measures are adhered to in service delivery
within the mobile clinic.
11.Through the county Governor’s spouse (as the Beyond Zero
champion),carry out advocacy and create demand for HIV
control, maternal and child health services
Community responsibility
The mobile clinic is intended to increase access to health care by
members of the public, especially the hard-to-reach areas. The
community is expected to:
1. Own, use and advocate for mobile clinics and services that it
renders.
2. Participate in accountability mechanisms in consultation with
county teams and structures.
Monitoring and evaluation of Mobile clinics
• The contribution of the mobile clinic are assessed using
routine MOH monitoring tools and systems.
• A special monitoring and evaluation tool has been designed
to assist counties give feedback to the Beyond Zero
secretariat and the MOH on the utility and performance of
the mobile clinic.

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