2b.HEALTH CARE DELIVERY SYSTEM-D10 EDITED.pptx

Health care delivery system

1. Health care delivery system Also referred to as health care system  , is the organization of people , institutions , and resources that deliver health care services to meet the health needs of target populations.

2. Pillars of health care system Pillars of health are essential elements that enable health care system to function. There are four (4) pillars in the health system; Information (Communication) Management Human Resource Finance

3. KENYA HEALTH POLICY 2014-2030 POLICY GOAL Attaining the highest possible standards of health in a manner responsive to the needs of population The focus of the policy is on; -Realization of the right to health as outline in the constitution 2010 -Devolution of Health services

4. Kenya Health policy Objectives Eliminate communicable diseases Halt and reverse the rising burden of Non communicable diseases Reduce the burden of violence and injuries Provide essential health care Minimize exposure to health risks factors Strengthen collaboration with other sectors

5. ORGANIZATIOAL STRUCTURE OF HEALTH CARE SYSTEM

6. Ministry of health is one of the government ministries. It is the largest provider of health services in the country and has the legal obligation to supervise all the other health services in the country.

7. The legal obligation of the ministry of health is to supervise all the other service providers of health in the country.

8. Types and Arms of the Kenya Government

9. There are two types of governments currently in Kenya; ( i ) The Central government headed by the president (ii) The County government headed by the governor

10. There are three arms of government The legislature The Judiciary The Executive

11. legislature This deals with parliaments and is headed by the speaker There are currently two parliaments in Kenya The lower house- national assembly The upper house - senate Their functions include: Making laws and policies Representation of counties or constituencies in the different houses Articulation of individual citizen’s interests Custodian of all national resources including budgetary allocation

12. Judiciary This arm deals with the courts of justice and is headed by the chief justice Its functions include: Interpret and apply laws made by legislature Settles dispute and arbitration Presides over administration of justice Check and balance for the legislature and executive

13. Executive In charge of administration headed by the president Its functions include: Maintenance of public order Management of public resources and property Maintains foreign policy and treaties

14. Cont …… Military operations and safety of our boarders Collection and utilisation of taxes Planning and implementation of development programs Maintains checks and balances for legislature and judiciary

15. DIVISIONS IN THE MINISTRY OF HEALTH

16. There are ten (10) divisions in the ministry of health headquarters; Mental health Nursing services Pharmacy services National Public Health laboratory

17. 5. Curative health services 6. Preventive and p romotive health service 7. Planning and development 8. General administrative services 9. Finance 10.Medical supplies

18. Organization and Organizational structure Organization refers to the structure that is designed to support organizational processes. It is important to design organizational structures that will respond to changes taking place in the current health care environment.

19. The key factors influencing organizations are the: Vision The vision is future oriented, purposeful and designed to identify the desired future of the organization, for example, the hospital intends to be the best in terms of quality of services delivered. Mission The mission communicates the reason for the organization's existence or being. It identifies the organization's customers and types of services offered. It enacts the vision. Philosophy These are values and beliefs held about the nature of work required to accomplish the mission and the nature and rights of both the customers and employees.

20. Structures in Kenya’s Health System Coordination Government of Kenya, KHSSP, 2012 - 2017 JOINT INTER AGENCY COORDINATING COMMITTEE HEALTH SECTOR COORDINATING COMMITTEE COUNTY HEALTH STAKEHOLDERS FORUM SUB COUNTY HEALTH STAKEHOLDERS FORUM COMMUNITY HEALTH COMMITTEE Technical Working Groups & their ICCs COUNTY EXECUTIVE COMMITTEE COUNTY DEPARTMENT FOR HEALTH County Hospital Board Primary Care Facility Management Committee NATIONAL MINISTRY OF HEALTH COUNTY HEALTH MANAGEMENT TEAM County Hospital Management Team SUB COUNTY HEALTH MANAGEMENT TEAM Primary Care Facility Management Team COMMUNITY UNIT Governance Stewardship 22

21. Health Systems Structures Health systems comprise of: Governance structures; Management structures; Coordination/partnership structures.

22. Importance of Governance Structures 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.

23. Elements of governance Accountability: r equired or expected to justify actions or decisions Transparency: m ake available or more widely known Equity: t he quality of being fair and impartial Probity: t he quality of being honest and morally upright

24. ORGANISATIONAL STRUCTURE OF THE MINISTRY OF HEALTH (Organogram)

25. ORGANISATION CHART(ORGANOGRAM) Organizational structure refers to how work is organized and the levels of decision making, authority and responsibility of workers. Therefore, It is a diagrammatically representation of different department and position in the organisation It shows channels of communication and formal line of authority among departments It shows lines of accountability and vertical & Horizontal relationships

26. Organization structure in the ministry of health at national level

27. Abbreviations in the above organogram SAGAs- Semi Autonomous Government Agencies PRO- ICT- Information and Communication Technology HRD- Human Resources Development SCMD- HRM- human resources management

28. Five (5) departments in the ministry of health Standards and quality assurance and regulatory services Prevention and Promotion Health Curative and Rehabilitation services Health sector coordination and intergovernmental Policy, Planning and health financing

29. Importance of Organogram Is a tangible tool of management in an organisation Shows lines of accountability for what and who reports to whom Classify personnel and to have the right people taking right decision at the right time Helps in decision making i.e. right people taking right decision at the right time Helps in understanding own responsibilities and those of others i.e. depict interdepartmental relationships Helps in showing lines of communication i.e. facilitate easy flow of information.

30. Organizational Communication Communication refers to the need to create common understanding. Communication is an important factor in the organisational process. Therefore, organizational communication is the exchange of information within the organisation . The manager is charged with the responsibility of passing information through various channels.  

31. Cont ….Communication Effective communication can have several benefits. It can: Enlighten and help eliminate weaknesses, including gaps in responsibility, overlapping of functions, and duplication of effort. Provide employee with a well defined hierarchy and set of rules and procedures Enable clear understanding of management expectations

32. Channels of organizational communication. Vertical Flow The manager is responsible for passing information through vertical channels of communication, which includes both a downward and an upward flow of communication. A two way exchange of information is essential in organisations and managers must ensure that there is feedback at all levels.

33. Vertical Flow The manager is responsible for passing information through vertical channels of communication, which includes both a downward and an upward flow of communication. A two way exchange of information is essential in organizations and managers must ensure that there is feedback at all levels.

34. Barriers to downward communication may include: • The manager may withhold information • The employee may fail to understand the message • The employee may get information but this may not be relevant to their needs

35. Upward Communication This is the flow of information from the bottom up or from the subordinates to the supervisor. Ideally information should pass freely up the chain of command so that management gets the feedback needed to evaluate results and initiate improvements.

36. Barriers to upward communication may include: • If employees feel management is not interested in their ideas, they will not offer them. • At times, bad news gets blocked and is not communicated to the top management. • Delays in relaying messages.

37. Horizontal flow ; This is the flow of information where communication with each other at professional level or employee of equal rank exchange information including opinions and news.

38. Types of Communication The formal communication system is mainly used. It is based on a chain of command from the top of the organization to the bottom. This is used for all official messages including directives, procedures, policies, job instructions and so on.

39. An informal communication system can also be used. This is usually oral and not crucial to the functioning of the organization. It originates from informal groupings, for example, associations or welfare groups. In most cases, messages are transmitted through the ‘grapevine’ (also known as rumours ) and sometimes the communication is distorted or groundless. Such types of communication can cause fear and anxiety among staff and the manager should be aware of its existence and reinforce stability using more formal methods of communication.

40. Purpose of Communications Facilitates work Increase motivation Effects change Optimizes patient care Increase workers’ satisfaction Facilities coordination

41. Functions of the Cabinet Secretary for health Prepare health budgets which are handed over to the Principal secretary for finance Overall manager of health issues and presents policies affecting health in the cabinet Represent health issues in the world health assembly

42. Functions of the Principal secretary Accounting officer in the ministry Is the policy maker and formulates guidelines The decision maker in all administrative issues related to the ministry Has one or two under secretaries who deal with administrative duties

43. Director of medical services DMS is the technical adviser in the ministry of Health He/she Makes technical ministerial policies Has four deputy directors each heading a division

44. 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 shall be set up, to provide overall governance for health in the county.

45. Health under the Devolved System of Government In 2010, Constitution of Kenya introduced a devolved system of government, which is unique for Kenya and provides for one (1) national government and forty-seven (47) county governments. The governments at the national and county levels are “distinct and interdependent ,” and are expected to undertake their relations through “consultation and cooperation.” the Kenya Health Policy 2014−2030 takes into account the objectives of devolution.

46. Under the devolved system, t he decentralized system has consolidated service areas into 4 main categories for ease of governance and responsibility. These responsibilities are shared between the national government and county governments.

47. Devolution of healthcare Services in Kenya

48. National Level At national level, health leadership is provided by the Ministry of Health (MOH). The ministry of health has the following obligations to the county health facilities. This include;

49. Key mandates (Role) of the MOH are: ■ Development of national policy ■ Provision of technical support at all levels ■ Monitoring quality and standards in health services provision ■ Provision of guidelines on tariffs for health services ■ Conducting studies required for administrative or management purposes

50. National ministry responsibility for health ■ Health policy ■ Financing ■ National referral hospitals ■ Quality assurance and standards ■ Health information, communication and technology ■ National public health laboratories ■ Public-private partnerships ■ Monitoring and evaluation ■ Planning and budgeting for national health services ■ Services provided by Kenya Medical Supplies Agency (KEMSA), National Hospital Insurance Fund (NHIF), Kenya Medical Training College (KMTC) and Kenya Medical Research Institute (KEMRI) ■ Ports, borders and trans-boundary areas ■ Major disease control (malaria, TB, leprosy)

51. Therefore, the Ministry of Health (MOH) is responsible for providing stewardship and guidance to the county health service delivery.

52. County Government Level The Kenya Health Policy 2012 – 2030 proposed the formation of county health departments whose role was to create and provide an enabling institutional and management structure responsible for ‘coordinating and managing the delivery of healthcare mandates and services at the county level’. The policy also calls for the formation of county health management teams. These provide “professional and technical management structures” in each county to coordinate the delivery of health services through health facilities available in each county.

53. County department responsible for health ■ County health facilities and pharmacies ■ Ambulance services ■ Promotion of primary health care ■ Licensing and control of agencies that sell food to the public ■ Disease surveillance and response ■ Veterinary services (excluding regulation of veterinary professionals) ■ Cemeteries, funeral homes, crematoria, refuse dumps, solid waste disposal ■ Control of drugs of abuse and pornography ■ Disaster management ■ Public health and sanitation

54. Therefore, county departments of health are responsible for coordinating and managing the delivery of health service

55. ORGANISATION OF HEALTH SERVICE DELIVERY IN DEVOLVED GOVENMENT It’s a four (4) tier management under the following; ( i ) Community level (ii) -Health centres - Dispensary (iii) –County referral hospital - Sub county hospital (iv) National referral hospital

56. Organisation of Health Services Delivery Illustrated Highly specialised health care, for area / region of specialisation Training and research services on issues of national importance Comprehensive in-patient diagnostic, medical, surgical and rehabilitative care, including reproductive health services Specialised outpatient services Facilitate, and manage referrals from lower levels, and other referrals With other County Referral Facilities, form the County Referral System 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 Facilitate individuals, households and communities adopt appropriate healthy behaviours Provide agreed health services Recognise signs and symptoms of conditions requiring referral, Facilitate community diagnosis, management &referral. COUNTY REFERRAL FACILITIES NATIONAL REFERRAL FACILITIES Referral services Referral services Referral services PRIMARY CARE FACILITIES LEVELS DESCRIPTION FOCUS COMMUNITY UNITS All provincial, district, sub-district hospitals, including NGO / private, form network of County Referral Services in a county All National Referrals Are general, regional, or discipline specialists All dispensaries, health centres , clinics, maternity homes Catchment area: 30,000 persons No physical facilities 59

57. Kenya Essential Package of Health Service (KEPHs) Levels Source: KHSSP 2005-2010 As a result of the implementation of the constitution of Kenya 2010, health functions were devolved to the counties. KEPHs Represents the integration of all health programmes into a single package that focuses its interventions towards the improvement of health at different phases (cohorts) of the human development cycle.

58. Life-cycle cohorts Represent the phases or life-cycles human beings pass through during their development. They represent various age groups each of which has special needs that relate to the development phase they are passing through.

59. Cont …. Pregnancy and the New-Born (up to two weeks of age) Early Childhood (two weeks – 5 yrs ) Late Childhood (6-12 y ears) Youth and Adolescence (13-24 yrs ) Adult (25-59 yrs ) The elderly person (60 yrs +)

60. Objectives of KEPH (Kenya Essential Package for Health) Increase access to health services by targeting part of its interventions at the community level and at poor deprived areas and groups Integrate the different programmes towards the client Enhance the promotion of individual and community health Improve quality of service delivery by improving the responsiveness of health workers and changing their prevailing attitudes towards clients

61. The components of KEPH Eliminate communicable conditions Halt and reverse the rising burden of non-communicable conditions Reduce the burden of violence and injuries Provide essential healthcare Minimize exposure to health risk factors Strengthen collaboration with private and other health-related sectors

62. In the structure of county government, County Health Services are organized around three levels of care: Community Health care Primary care County Referral care.

63. Community level will focus on organizing appropriate demand for services, while Primary Care and primary referral services will focus on responding to this demand. The Community Health services comprise of all community based demand creation activities, organized around the Comprehensive Community Strategy defined by the Health Sector. The Primary care services will comprise of all dispensaries, health centers and nursing homes for public and non public providers. Their capacity to be upgraded, to ensure they can all provide appropriate demanded services.

64. Cont …. The Primary referral services will include all level four hospitals (district hospitals) and level five hospitals (provincial hospitals), which are now referred as Sub-County and county Referral health services. They provide specialized services, medical and their related infrastructure. The County health referral system comprise of ALL the referral health care services located in the County. N/B: Besides making policies, the Ministry of Health headquarters is responsible for four referral hospitals (Kenyatta National Hospital Moi Teaching and Referral Hospital, Mathari Hospital and National Spinal Injury Hospital).

65. County Referral Hospitals The hospitals include Kisumu’s Jaramogi Oginga Odinga Teaching and Referral Hospital, Kakamega Provincial Hospital, Nakuru Provincial General Hospital, Embu Provincial General Hospital, Nyeri Provincial General Hospital, Garissa Provincial General Hospital, Coast General Hospital in Mombasa and Mama Lucy Hospital in Nairobi ie all provincial hospitals were upgraded to County referral health services.

66. Health services delivery systems before and after devolution of MOH: levels of service delivery National Health sector strategic plan 2 National Health sector strategic plan 3 (2005-2010) (2012-2017) Level 1 - Community Tier 1 - Community level Level 2 - Dispensary/Clinics Level 3 - Health Centre/Nursing-maternity homes/Private clinics (Private providers) Tier 2 – Primary care level ( Level 2&3) Level 4 - District Hospital (47) Tier 3 - County level ( Level 4 & 5) Level 5 - Provincial Hospital (10) Level 6 - Tertiary/National Referral Hospital (2) Tier 4 - Tertiary/National level ( Level 6 )

67. Role of MOH in Health Services delivery at each level 1. Health Promotion and Prevention and minimal curative services; Tier 1: Level 1 Tier 2: Level 2 & 3 2. Curative and Rehabilitation services; Tier 3: Level 4 & 5 Tier 4: Level 6

68. National level The national government has responsibility for national referral services.

69. County level The counties are responsible for three levels of care: community health services, primary care services and county referral services. There is county health departments whose role is to create and provide an enabling institutional and management structure responsible for “ coordinating and managing the delivery of healthcare mandates and services at the county level .”

70. Cont …… There is county health management teams who provides “professional and technical management structures” in each county to coordinate the delivery of health services through health facilities available in each county.

71. COUNTY LEVEL STRUCTURE IN THE MINISTRY OF HEALTH

72. Organizational Structure of County Health Services Resource Centre Disaster Management Directorate for Health Promotion and Disease Prevention Directorate for Curative and Rehabilitation Directorate for Planning and Governance Directorate for Administration Child Health Referral Services Health Planning Financial Mgt. Disease Control Animal Health Nutrition Health Promotion & Community Care Environment and Hygiene Control NCD & Injury Control Pharmaceutical Laboratory Clinical Services Nursing Services Quality Assurance Reproductive Health Sector Coordination Health Information Sector Governance HR Management Infrastructure Mgt. Procurement Supply Chain Mgt. Logistics Mgt. Internal Audit HR Administration Accounts COUNTY DIRECTOR FOR HEALTH Sub County Health Management Teams 76

73. GOVERNOR County Health Management Team County Executive Committee County Director of Health

74. 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

75.   Technical Management of Health at County (CHMT) This comprises of: Office of the County Executive officer of Health through county director of health; Office of Heads -Health department; Other offices that shall be approved within the county by the governor in consultation with the county assembly.

76. County Technical Management Functions This also refereed to as County Health management team. It deals with 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 officer, Head of health department and other actors to facilitate health sector dialogue at the County; 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;

77. Ct…….functions of CHMT Deals with financial allocations to various projects Responsible for health status of the county Identification of major health problems in the district and taking action Providing technical and administrative support to the sub counties Implementing health policies and maintaining health standard within the county Resource mobilisation Holding stakeholders meeting with NGOs, FBOs and private sector Conducting Trainings for health workers Supportive supervision of all health facilities in the county Monitoring and evaluation Report writing formational government Personnel (Staffing) issues

78. Facility Management Functions (HMT) 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; 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.

79. Management Structures at Primary Care 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).

80. Management Structures at the 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

81. HEALTH SERVICES AT EACH LEVELS

82. Tier 1 (Level 1-community) ie community level: Promotion of health is emphasized This level comprises all community-based demand creation activities, that is, the identification of cases that need to be managed at higher levels of care, as defined by the health sector. Provide basic preventive and curative (basic) services for minor ailments with the support of the community health workers with the use of community package.

83. Tier 2: Level 2 & 3 (Dispensary & Health Centre) is primary care level Primary health care services are provided in this level 2 and 3. These include both preventive and curative services are provided. The facilities include dispensaries, health centers and nursing homes for both public and private providers. These are Rural health facilities. They are managed and supported by CHMT, HMB and Public Health unit of the county (Tier 3) hospitals.

84. Cont ….. The dispensary is the lowest level of the public health system and the first point of contact with patient. The facility is staffed with KRCHN assisted by enrolled Nurse and public health technician and support staff. Referring channel is to the next health Centre facility.

85. Community Health Nurse The community health nurse at the community level holds a vital role in implementing nursing related activities and coordinating other activities from different disciplines

86. Cont … The Health Care Centers' provide effective and integrated health care services to the community around and it is supported by the health Care facility team. The facility also provide minor surgical services such as incision & drainage including suturing of wounds.

87. Services and activities offered at the health Centre facility and dispensary (1,2,&3) The services and activities include; Promotive and preventive - Antenatal and postnatal services - Health education - Nutrition - Immunization 2. Curative 3. Family Planning 4. Home visit 5.School Health 6. Outreach and mobile clinics

88. The facility is staffed by: Medical officer – In charge of the facility Clinical officers -Assist the medical officer in the clinical running of the facility Community Health Nurses -Coordinate all activities related to nursing in the facility Enrolled nurses Pubic health Technicians Nutrition technicians Pharmacy technologist

89. Cont ….. Laboratory technician Physiotherapist Statistical clerk Driver Subordinate staff Watchman

90. Therefore she must have a good working relation with all the members from the different health committee. The community health nurse must be accepted and respected by all the team members. Must be well informed of the his/her roles

91. Management functions of a community Health nurse. Planning Supervisor Organizer Co- ordinator Educator Evaluation Controller Initiator

92. Therefore, for the community health nurse to succeed the above activities, she or he must; Be committed to the task Have good approach Have initiative and be ready to work Well informed of the sub county as the area of work, i.e., population, age ad groups Well informed of the other institutions or groups involved in similar services in the sub county’s.

93. Tier 3: Level 4 & 5 (County and sub county) health facility i.e. county level Provide supervision and management of health facilities in the county. The County Management Health team (CHMT) provide the above role within the county and sub county health facilities. All health services are provided by the level 4 and 5 health facilities unless highly specialized

94. Tier 4: Level 6 (National Referral Hospitals) i.e. National level The hospitals are the center's of excellence and provide complex health care requiring more complex technology and highly skilled personnel. The facility have a high concentration of resources and are relatively expensive to run

95. Teaching is one of the primary function of referral hospitals. They provide both basic and post graduate training for health professionals. Referrals from the county government are ultimately received and managed in this facilities. The teaching hospitals should provide leadership in setting high clinical standards and treatment protocols.

96. Effects of Devolved government on Health care delivery services in Kenya There are less referral cases to the National hospital since more health care facilities have been opened in the counties Reluctance from the national hospital to receive patients from the county hospitals There is more accountability by the county governments since they are closer to the people Improved referral system with the county government Increased job opportunities More recurrent health workers’ strikes as a result of unmet salary deals by both the national and county governments-this has led to delivery of poor health services amounting to patients’ negligence Health facilities in most counties have improved in delivery of health services as a result of closer supervision and appraisal by the county government. Services are cheap, affordable and accessible

97. QUESTIONS!!!!!!!! THANKYOU FOR TODAY

98. FACILITY IMPROVEMENT FUND (FIF) The FIF was introduced in 1989 as service charge in government health facility as a source of financial support to health services to cope with the demand in order to improve the quality of health services in the facilities and support County.

99. Supervision of facility improvement Fund Supervision of the above fund is done at four levels; Health care Financial Secretariat (MOH Head Quarters) County Director of Health Services County Health Management Team Hospital Management teams

100. Role of faith based organizations in Devolved Health Sector Health services delivery through the four (4) tiers following the set policies and guidelines Training of Health workers through FBO MTCs and Hospitals Community based health promotion and disease prevention Participate in the county and National health referral system Meds to offer an efficient, competitive and reliable supply chain for health commodities Partner and collaborate in planning , implementation and monitoring of health programs Support medical emergency response initiatives

101. National and international goals relevant to health care

102. Millennium Development Goals The Millennium Development Goals (MDGs ( 8 )-2000) were established as a response to many of the world’s foremost challenges to poverty Eradication globally. In 2001, a team of UN experts created the MDGs with indicators, without any inter-governmental process.

103. SDGs (2015) - The new Global Goals, and the broader sustainability agenda, go much further than the MDGs (2000), addressing the root causes of poverty and the universal need for development that works for all people. The goals were 17 sustainable goals which were to be achieved.

104. Kenya Vision 2030 -In 2015 world leaders adopted the 2030 Agenda for Sustainable Development, which includes a set of 17 Sustainable Development Goals (SDGs) to End poverty Fight inequality and injustice Tackle climate change by 2030 Its objective was to help transform Kenya into a "newly industrializing, middle-income “country providing a high quality of life to all its citizens by 2030 in a clean and secure environment." The Vision is based on three "pillars": Economic, Social, and Political

105. - The economic pillar aims to improve the prosperity of  all Kenyans through an economic development programme , covering all the regions of Kenya, and aiming to achieve an average Gross Domestic Product (GDP) growth rate of 10% per annum beginning in 2012. -The political pillar aims to realize 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

106. - The social pillar seeks to build a just and cohesive society with social equity in a clean and secure environment. The country aims to provide an efficient integrated and high quality affordable health care to all citizens. Priority will be given to preventive care at community and household levels, through a decentralised national health-care system. With devolution of funds and decision-making to counties, the Ministry headquarters will then concentrate on policy and research issues. Kenya also intends to become the regional provider of choice for highly- specialised health care, thus opening Kenya to “health tourism”

107. Implementation of Kenya’s Vision 2030 is faced by various challenges such as; Inadequate and limited resource allocation especially in carrying out development activities; Political interferences; Uncertain political environment; Constant inflation compounded with the weak currency; Global recession hence limited donor funding which is also greatly linked to donor dependency; Corruption especially in the misappropriation of funds as seen in the free Primary Education Programme ; Inadequate and ineffective involvement by the citizens of Kenya; Unsustainability of programmes ; Insufficient disaggregated data; Poor linkage of policy, planning and budgeting at the grass root levels; Natural and man-made disasters such as famine, drought, post election violence and economic crisis leading to reprioritization.

108. Agenda 2063 - It is a strategic framework for the socio-economic transformation of the continent over the next 50 years. Its builds on, and seeks to accelerate the implementation of past and existing continental initiatives for growth and sustainable development. -Some of the past and current initiatives it builds on include: the Lagos Plan of Action, The Abuja Treaty, The Minimum Integration Programme , the Programme for Infrastructural Development in Africa (PIDA), the Comprehensive Africa Agricultural Development Programme (CAADP), The New partnership for Africa’s Development (NEPAD), Regional Plans and Programmes and National Plans. It is also built on national, regional, continental best practices in its formulation.

109. Abuja Declaration (2006) This was declaration on Fertilizer for the African Green Revolution. declared that Africa's economic development vision must be based on raising and sustaining higher rates of economic growth (7 percent per year). To implement this vision, African heads of state and government adopted the Comprehensive Africa Agricultural Development Programme (CAADP) as a framework for the restoration of agricultural growth, food security and rural development in Africa

110. Assignment Read on the Models of nursing care delivery: 1. Functional nursing care 2. Case nursing 3. Primary nursing 4. Team nursing 5. Progressive nursing care .

111. Big four agenda for Kenya The Big Four priority areas announced by President Kenyatta in December 2017 are investments in Universal Health Coverage (UHC) to ensure; 1. Access to quality and affordable healthcare for all Kenyans; 2. Quality and affordable housing; 3. Food security; 3. Industrialization to promote value addition to products, whilst creating employment opportunities for the country's working-age population, by 2022.

112. The purpose of big four Agenda by 2020 To improve living conditions among Kenyans on these four pillars by; Achieving food and nutrition security, the government prioritizes investment in large-scale production (commercial farming), improving the productivity of smallholder farmers, and reducing the cost of food as a strategy to food insecurity.

113. For universal healthcare, the government to consider adopting pro-poor approaches to improving the status of health care in Kenya. The priorities for universal healthcare should include scaling up health insurance coverage (especially among vulnerable groups), constructing referral hospitals, increasing the availability of health personnel, and equipping hospitals with specialized equipment.

114. In the housing sector, the priorities of the government include; - Reducing the cost of construction, supporting development and - Provision of affordable home financing solutions, and - Upgrading informal settlements through the provision of basic infrastructure and services such as water and sanitation

115. The manufacturing sector's to be; - given incentives and a conducive environment to encourage manufacturing. - Local manufacturers to be shielded from the undue and external competition to encourage manufacturers to produce cheaper but quality goods. - County governments can also extend waivers of rates and certain licenses in respect of manufacturing ventures that operate and employ persons within their counties.

116. If the Big Four agenda turns out well, everyone stands to gain in an environment where there are jobs, critical healthcare services are available and accessible, there is adequate and nutritious food and every Kenyan has a roof over their head.

117. Nursing Care Delivery Systems/Modalities

118. There are four (4) main methods of assignment of patient care in a hospital. These are: Functional Nursing Case Assignment Team Nursing Primary Nursing

119. Others include: Total nursing care Progressive nursing care NOTE: The changes in these modalities or systems are a response to ever changing patient needs

120. Functional Nursing This method emphasises on the division of labour according to specific tasks. It is ‘task or thing oriented’ and is determined by the technical aspects of the job to be done. Each nurse has a clearly defined set of tasks determined by complexity, including skills, knowledge and experience in certain nursing techniques, for example, drug administration, wound dressing,etc .

121. In this approach, the nurse in charge must have experience and exceptional knowledge in nursing. The nurse must know the skill level of their workers in order to make accurate assignments. The nurse in charge establishes routines, structures and time.

122. ADVANTAGES OF FUNCTIONAL NURSING It emphasizes on efficient delivery of care There is little likelihood of confusion over who will do what. Minimal time is spent coordinating activities It is economical in that it allows for the use of less skilled personnel Each member can become highly skilled if they do the same tasks repetitively

123. Disadvantages. The nurse tends to lose close contact with patients. Fragmentation of care rather than total care. This means that the patient's needs may be overlooked because of failure to fit in compartments or task categories, for example, there may be a nurse skilled in administering medication but none skilled in dealing with anxiety.

124. Continuity of care is difficult if not impossible since no single staff member has a complete picture of the client's needs and responses to nursing or medical interventions. There is little avenue for development

125. Team Nursing Team nursing can be organised in the following manner: A group or team of nurses with different levels of skills are assigned to a group of patients. The size and composition of the team is dependent upon the setting. The team works together to accomplish a goal.

126. They focus on patient centered as opposed to task oriented assignments based on patient needs and the knowledge, skills and experiences of team members. A member of the work group is assigned as a leader. In the original concept, the team was led by a registered nurse.

127. The leadership role may be permanent or rotated. The team works together with each member performing the tasks for which they are best prepared. Team members report to the team leader who reports to the head nurse. Success is dependent upon effective communication

128. ADVANTAGES It allows individual members to make personal and useful suggestions. It combines the best thinking of all team members about patients' problems and improves the quality of decision making. It cultivates team spirit because work load is shared and balanced W hich affects the climate and continuity of care. There is fragmentation of care and better utilisation of personnel in the performance of quality care

129. There is also the potential for leadership development because of division of work and it encourages greater staff satisfaction.

130. DISADVANTAGES It may be difficult to find the time needed for team planning and conferences. This would mean that at times, care plans are not comprehensive enough. The time spent in coordinating delegated work and supervision can prove expensive/tasking. Logistics may hamper team nursing, for example, four or five nurses converging at a medicine cupboard designed to support one nurse. Continuity of patient care may suffer because of changing team leader

131. Primary Nursing This is a newer approach to the delivery of nursing services and is used by many institutions in the developed world. It is a patient-centered nursing system whereby One nurse (the primary nurse) assumes individual responsibility for a particular patient/patients. People are becoming more aware of it in this country and some institutions have begun to incorporate it. The following is the basis for assignment:

132. A professional nurse, usually a registered nurse, is assigned to a patient for their total hospital stay or to a small group of patients, not more than four or five or one patient who is very ill/serous sick. This nurse is known as a primary nurse. This nurse assumes full responsibility for twenty four hours a day for the duration of the patient’s stay in hospital.

133. The primary nurse assesses, plans and executes the plan or may delegate to a secondary or associate nurse to execute the plan during her absence.

134. Every nurse serves as the primary nurse for a few patients and as an associate nurse for other patients on other shifts. The primary nurse communicates with the physician and coordinates care with other health workers. The chief nurse/ nurse incharge functions as a coordinator of the unit and is a resource person for the primary nurses.

135. ADVANTAGES It encourages a one to one relationship and in so doing promotes total patient care by virtue of the quality of interaction. The nurse coordinates all aspects of care, including the physical, social and psychological, which ensures the continuity of care. This method promotes increased autonomy and responsibility leading to job satisfaction due to involvement.

136. Clients are satisfied as a result of their increased interaction with one nurse who is knowledgeable. Nurses more satisfied because they continue to learn as part of the in-depth care they are required to deliver to their patient

137. There is increased accountability, responsibility and independence Good and trusting relationship is developed between the nurse, patient and relatives

138. DISADVANTAGES It limits professional mobility. An associate nurse may find it difficult to follow plans made by another nurse. It requires high levels of expertise and commitment from all nurses, that is, patient care may suffer if the nurse is not competent enough to perform all the tasks assigned.

139. Primary nursing requires competent practitioners who can function independently when utilizing the nursing process. However, not all nurses are comfortable in accepting this responsibility. It may be less economical than the other methods since it may require a larger percentage of registered nurses

140. Can be intimidating for nurses who are less skilled and knowledgeable The nurse may be isolated from colleagues If the nurse is not competent, the patient will be disadvantaged

141. Case Nursing One professional nurse assumes total responsibility of providing complete care for one or more patients (1-6) while she is on duty. This method is used frequently in intensive care units and in teaching nursing students. It was the first type of nursing care delivery system.

142. Ct,,,,,,,,case nursing The patient/patients receive holistic and unfragmented care during the nurse’s shift The activities include treatment, medication administration and nursing care planning for the patient/patients There is follow-up care of patients upon discharge

143. Total Patient Care Is the oldest of the care delivery system. One nurse is assigned to one client and provides all care. The one-to-one pattern is common in critical care, with student nurses, and with private duty nurses. The advantage ; Client needs are met with only one nurse and that one nurse can focus on meeting all the biopsychosocial needs of the client and the family. Job and client satisfaction is achieved for that period/shift.

144. Disadvantage It is costly Nurse patient trusting relationship is not well established Continuity of care is not fully achieved. Etc……….

145. Progressive Client Care Nursing Also called step-down unit, intermediate care unit, transitional care unit, or telemetry unit) may be used in varying ways in different facilities. . But, often it is an intermediary step between ICU and a med/ surg floor. These patients still need a high level of skilled nursing care and surveillance (although less so than in an ICU) but are more stable. The nurse-to-patient ratio would be higher than in an ICU, but lower than a med/ surg unit — anywhere from 1-to-3 to 1-to-5. Some PCUs provide general care, while others are more focused, such as a cardiac care PCU. Patient care is provided in accordance to the unit e.g. ICU for critically ill, post intensive care unit, regular care unit

146. The client is evaluated and managed based on the intensity of care needed Advantages Efficient use of personnel and equipment The clients are in the best place to receive the care they require.

147. Clients move towards independence and is fostered where indicated Disadvantages There may be discomfort to patients who are moved too often Continuity of care is not adequate even though possible Long - term nurse client relationships are difficult to manage

148. END !!!!! THANKYOU!!!!!!