Purpose To support the Government of Kenya and the Ministries of - - PowerPoint PPT Presentation

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Purpose To support the Government of Kenya and the Ministries of - - PowerPoint PPT Presentation

Dec 09, 2023 147 likes •346 views

Purpose To support the Government of Kenya and the Ministries of Public Health and Sanitation and of Medical Services (MOPHS and MOMS), under the auspices of the Second National Health Sector Strategic Plan (NHSSPII), to provide integrated

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SLIDE 1

Purpose

  • To support the Government of Kenya and the Ministries of Public Health

and Sanitation and of Medical Services (MOPHS and MOMS), under the auspices of the Second National Health Sector Strategic Plan (NHSSPII), to provide integrated effective health services in Kenya, particularly for poor women and infants

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SLIDE 2

Purpose Level Indicator #2:

N of EHS targeted districts meeting minimal Emergency Obstetric Care (EmOC) coverage

  • Signature contribution of the EHS programme: health care

infrastructure

– Construction and physical upgrading of health facilities – Major contributions of equipment

  • WHO EmOC coverage indicators used/adapted for programme

evaluation

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SLIDE 3

EmOC Signal Functions: Provision of these services within last 3 months

Basic EmOC Comprehensive EmOC

  • Parenteral antibiotics
  • Parenteral anti-convulsants

(magnesium sulphate)

  • Parenteral oxytocics
  • Manual removal of placenta
  • Manual vacuum aspiration
  • Vacuum extraction
  • Neonatal resuscitation
  • Blood transfusion
  • Caesarean delivery

EHS Adaptation of Indicators: “Readiness for Use” vs Documentation of Provision of Services

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SLIDE 4

District

BEOC

WHO Minimum number of facilities RECOMMENDED

BEOC

EHS number of facilities TARGETED for upgrades

CEOC WHO Minimum number of

facilities RECOMMENDED

CEOC

EHS number of facilities TARGETED for upgrades

Homa Bay

2 3 1 1

Kisumu West

1 2

Kuria

2 2 1

Migori

5 5 1 1

Siaya

4 5 1 1

Suba

2 3 1

Total

13 20 4 5

EHS Goals

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SLIDE 5

District

BEOC

EHS number of facilities TARGETED for upgrades Number of facilities ACHIEVING BEOC status, BEOC-1, BEOC-2

CEOC

EHS number of facilities TARGETED for upgrades Number of facilities ACHIEVING CEOC status, CEOC-1, CEOC-2

Homa Bay

3 1 BEOC 2 BEOC-1 1 1 CEOC-1

Kisumu West

2 1 BEOC-2 1 CEOC-2

Kuria

2 1 BEOC 1 BEOC-2 1 1 CEOC

Migori

5 4 BEOC 1 BEOC-1 1 1 CEOC

Siaya

5 5 BEOC-2 1 1 CEOC

Suba

3 2 BEOC-1 1 2 CEOC

Total

20 7* BEOC 5 5 CEOC

EHS Achievements

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SLIDE 6

BASELINE SIGNAL FUNCTIONS FOR ESSENTIAL OBSTETRIC CARE BEOC FUNCTIONS CEOC FUNCTIONS Anti-biotics Oxytocics Anti-convuls Man vac aspiration Man removal placenta Vacuum extraction Resusci- tation Blood trans- fusion C- section Homa Bay District Hospital Maguna Health Center NA NA Ndiru Health Center NA NA Pala Health Center NA NA Kombewa District Hospital Manyuanda Health Center NA NA Kehancha District Hospital Kekonga District Hospital NA NA Isebania sub-District Hospital NA NA Migori District Hospital Karungu sub-District Hospital NA NA Macalder sub-District Hosp NA NA Muhuru Health Center NA NA Awendo sub-District Hospital NA NA Siaya District Hospital Dienya Health Center NA NA Kadenge Ratuoro HC NA NA Ligega Health Center NA NA Nyang'u Dispensary NA NA Rwambwa Health Center NA NA Suba District Hospital Mbita sub-District Hospital Magunga Health Center NA NA Sena Health Center NA NA

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SLIDE 7

ENDLINE: SIGNAL FUNCTIONS FOR ESSENTIAL OBSTETRIC CARE BEOC FUNCTIONS CEOC FUNCTIONS District Anti-biotics Oxytocics Anti- convuls Man vac aspira-tion Man removal placenta Vacuum extrac-tion Resusci- tation Blood trans- fusion C-section Homa Bay District Hospital Maguna Health Center NA NA Ndiru Health Center NA NA Pala Health Center NA NA Kombewa District Hospital Manyuanda Health Center NA NA Kehancha District Hospital Kekonga District Hospital NA NA Isebania sub-District Hospital NA NA Migori District Hospital Karungu sub-District Hospital NA NA Macalder sub-District Hosp NA NA Muhuru Health Center NA NA Rongo District Hospital

  • Awendo sub-District Hospital

NA NA Siaya District Hospital Dienya Health Center NA NA Kadenge Ratuoro HC

?

NA NA Ligega Health Center NA NA Nyang'u Dispensary NA NA Rwambwa Health Center NA NA Suba District Hospital Mbita sub-District Hospital Magunga Health Center NA NA Sena Health Center NA NA

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SLIDE 8

Termite-infested Ndiru Health Center prior to EHS investment

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SLIDE 9

Purpose Level Indicator #2

Recommendation: EmOC coverage

  • Share lessons learnt in the planning and construction of new

structures with the Ministries and other donor partners

  • Continue to focus efforts on increasing use of these facilities to

maximize effectiveness of this investment

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SLIDE 10

Purpose Level Indicator #3:

Percent of births w/ a Skilled Attendant

  • Kenya DHS 2006: Skilled attendance in Nyanza Province

approximately 45%.

– Trend data suggest skilled attendance stagnant ~ 38% from 1992-2002, then rose to 45% – In 2006, 9% of births in a private health facility in Nyanza Province

  • EHS Target: 32% of births with a Skilled Attendant in target

Districts (35% by 2011 End of Project)

  • 2 data sources for Evaluation

– HMIS data from 2005 and 2010 – Baseline and Endline Surveys on number of births by targeted health facility

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SLIDE 11

Percent of births with a skilled attendant; 6 EHS Districts

10 20 30 40 50 % of births with a Skilled Attendant 2005 2006 2007 2008 2009 2010 Year Kuria Migori Suba Kisumu W Siaya Homa Bay

5 of 6 Districts met the target of 32% by end of 2010 3 Districts met the 2011 target of 35% by end of 2010

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SLIDE 12

Mean number of Deliveries per Month in Targeted Hospitals

50 100 150 Suba District Hosp Siaya District Hosp Rongo District Hosp Migori District Hosp Mbia SD Hosp Macalder SD Hosp Kuria District Hosp Kombewa District Hosp Kegonga District Hosp Karungu SD Hosp Isebania SD Hosp Homa Bay District Hosp Awendo SD Hosp Baseline: mean n of deliveries Endline: mean n of deliveries

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SLIDE 13

Mean number of Deliveries per Month in Health Centers

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Purpose Level Indicator #3

Recommendation: Skilled Attendance at Birth

  • Continue programming to support Supply and Demand side for

skilled attendance at birth

– Conclusions from the Value For Money assessment are required to determine if there are some supply or demand side activities that are less efficient than others.

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SLIDE 15

Purpose Level Indicator #4:

Percent of births w/ 4+ Antenatal Care visits

  • EHS Goal: 32% of births with 4+ ANC visits
  • Data Source: HMIS 2008 and 2010

– HMIS only available starting in 2008

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SLIDE 16

Percent of births with 4+ Antenatal Care visits; 6 EHS Districts

10 20 30 40 50 % of births with 4+ANC visits 2005 2006 2007 2008 2009 2010 Year Kuria Migori Suba Kisumu West Siaya Homa Bay

3 of 6 Districts met the target

  • f 32% by end of

2010 2 of 6 Districts met the 2011 target of 35% by end of 2010

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SLIDE 17

Percent of births with 1st ANC visit

  • 100
  • 50

50 100 Percent change from 2005 to 2010 in ANC first visits Total Suba District Hosp Siaya District Hosp Sena HC Rwamba HC Rongo District Hosp Pala HC Nyangu Disp Ndiru HC Muhuru HC Migori District Hosp Mbita Sub District Hosp Manyuanda HC Magunga HC Magina HC Macalder Sub District Hosp Ligega HC Kuria District Hosp Kombewa District Hosp Kegonga District Hosp Karungu Sub District Hosp Kadenge Ratuoro HC Isebania Sub District Hosp Homa Bay District Hosp Dienya HC Awendo Sub District Hosp

Overall: 14% decrease in % of births with a 1st ANC visit Great variation across Districts in 1st ANC visits

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SLIDE 18

Purpose Level Indicator #4

Recommendation: ANC4+ visits

  • Closely monitor health facilities showing decreases in first ANC visits in

the months following the end of EHS-supported activities

  • Continue programming to support Supply and Demand side for skilled

attendance at birth