Topic; Planning

in health sector
(Kenya)
1. What is management in health care?
Management in healthcare involves coordinating resources and personnel to deliver
effective patient care. It includes planning, staffing, budgeting, policy implementation,
performance monitoring, and ensuring compliance with regulations.

2. What are main components of management? P. I & M/E

3. Planning in health sector;

5 year KHSSP (Kenya Health Sector Strategic Plan 2018–2023 (July 2018 – June 2023)
Why is planning in heath sector important?
 Resource allocation – human resources/ finances among others.

 Sharing of the responsibilities.

 Setting priorities among the prevailing problems.

 Effective decision making when faced with a particular issue.

Planning in health care; two important areas;

KEPH levels;
• Level 1 – Community Health Units
• Level 2 – Dispensary, Medical Clinic, Medical Centre.
• Level 3 – Health Centres, Nursing home, Maternity Home
• Level 4 – Sub-county hospital, Private hospitals, FBO
• Level 5 – County Referral Hospital
• Level 6 – National Referral Hospitals – GOK or FBO or Private
NB; All the above is supposed to be guided by SOPs – Staffing or
specialties, Infrastructures available and health care services offered in
those levels.
 Health Investment blocks or areas as recommended by WHO: targeted
1. Health Service Delivery; This block focuses on enhancing the accessibility, availability, and
quality of essential health services. It encompasses preventive, promotive, curative, and
rehabilitative services.
Interconnectedness: Effective service delivery relies on a well-trained health workforce,
robust information systems to track service utilization, and adequate financing to support
these services.

2. Health Workforce: This block highlights the importance of recruiting, training, deploying,
and retaining skilled health workers. Strengthening the health workforce ensures quality
healthcare services delivery, addressing workforce shortages and maldistribution, and
enhancing the capacity to respond to emerging health challenges.
Interconnectedness: The effectiveness of health service delivery is heavily dependent on the
availability and capability of the workforce. Furthermore, health information systems are
needed to assess workforce deployment and performance.
 Health Investment blocks or areas as recommended by WHO: targeted
3. Health Information Systems: This block aims to enhance the collection, analysis, and
utilization of health data.
Significance; Accurate data enables policymakers to make evidence-based decisions
regarding health interventions, continuous data collection helps track health trends and
outcomes, facilitating timely interventions and robust information systems are crucial for
evaluating the effectiveness of health programs and policies.
Interconnectedness: Health information systems support all other blocks by providing the
necessary data for workforce planning, service delivery improvements, and financial
management.

4. Access to Essential Medicines and Technologies; This block ensures that populations
have access to safe, effective, and affordable essential medicines, vaccines, and technologies.
Significance: Access to essential medicines is critical for effective treatment and prevention
of diseases, strong systems ensure that medicines are available when and where they are
needed and promoting appropriate use of medications helps combat issues like antibiotic
resistance.
Interconnectedness: Ensuring access to medicines relies on effective health financing and
supply chain systems.
5. Health Financing: This block mobilizes and manages financial resources to achieve
universal health coverage (UHC). Today, millions of people do not access services due to
the cost.
Significance: Reduces the economic burden on individuals and families, ensuring that
healthcare costs do not lead to financial hardship, and increased investment in health can
expand service coverage and improve quality.
Interconnectedness: Adequate financing is essential for all blocks. It enables the
recruitment and retention of health workers, the development of information systems,
and the procurement of medicines.

6. Leadership and Governance: This block focuses on strengthening leadership, governance,

and stewardship within health systems.
Significance: Accountability, multi-sectoral collaboration and community empowerment.
Interconnectedness: Effective leadership and governance are essential for coordinating
the efforts of all other blocks. They set the strategic direction and ensure that
investments are aligned with health system goals.
Components of Annual Work Plans (AWPs)
All levels of health care delivery ( Level 1 – 6) must develop its own AWP (FY)
1) Population and different sub population segments (Breakdown)
2) Situational analysis (required, available, gaps or surplus) in terms of human resources,
infrastructures, pharm or non-pharm products, other reagents.
3) Outlining and prioritizing the major health problems and then identifying the
appropriate interventions to address identified challenges.
4) Establishing the baselines - where the organizational unit stands as at now.
5) Establishing the annual targets for the health indicators – Upcoming financial year
6) Activities – Tasks to be carried out in order to achieve the set targets.
7) Finances – Budgets to help implement activities embedded in the annual work plans.
Annual Work Plans Consolidation;
AWP Consolidation happens at different levels;

a) CHU AWPs to Health Facility AWP

b) Health facility AWPs to Sub county level AWP

c) Sub county AWPs to County level AWP,

d) County AWPs to National level AWP

End
Topic; Indicators of health
Definition of Health Indicator
 A health indicator is a measurable characteristic of an
individual, population, or environment that reflects health
status.
 It helps assess progress, performance, or changes in health
over time.
 Health indicators can provide insights into various aspects of
health, such as quality and quantity, and are used to track the
effectiveness of health programs and policies.
Types of Indicators:
A. Demographic Indicators
1. Total Population: This refers to the entire number of individuals living in a
particular area, region, or country at a given point in time.

2. Population Growth Rate: This is a measure of how much a population

increases or decreases in size over the course of a year, expressed as a
percentage. It's typically calculated by comparing the population at the end of
the year to the population at the beginning of the year.

3. Life Expectancy at Birth: Life expectancy refers to the average number of

years a person can expect to live, based on current mortality patterns. It's
often calculated at birth and can vary depending on factors such as gender,
socioeconomic status, access to healthcare, and environmental conditions.
4. Crude Birth Rate: This is the number of live births occurring among a population during a
specified period, usually per 1,000 people in the population. It's called "crude" because it
doesn't take into account factors such as age distribution within the population. The
formula for calculating the crude birth rate is: 𝐶𝐵𝑅=No. of Births / Total Population × 1000.
Question; what is the CBR, if a population of 10,880 people experiences 218 births in a
year?

5. Crude Death Rate: This is the number of deaths occurring among a population during a
specified period, usually per 1,000 people in the population. Like the crude birth rate, it's
called "crude" because it doesn't consider the age distribution within the population. The
formula for calculating the crude death rate is: 𝐶𝐷𝑅 = No. of Deaths / Total Population ×
1000.
Question; what is the CDR, if a population of 10,880 people experiences 164 deaths in a
year?
B. Socioeconomic Indicators
6. Adult Literacy Rate: This is a measure that indicates the percentage of adults within a certain age range in a
population who are able to read and write with understanding. It's typically defined as the percentage of people
aged 15 and above who can both read and write a short, simple statement about their everyday life.

7. Gross Enrolment Rate for Primary education; Total enrolment in primary level of education, regardless of
age, expressed as a percentage of the official school-age population corresponding to primary level of education
in given school-year. GER can be over 100% due to the inclusion of over-aged and under-aged pupils/students
because of early or late entrants, and grade repetition. Gross Enrollment Rate for primary education =
Total Primary School Enrollment /Total Population of Official Primary School Age × 100

8. Percentage of Population with Access to safe water source: This indicator measures the proportion of the
population that has access to improved drinking water sources, such as piped water, boreholes, protected wells,
and rainwater collection systems.

9. Percentage of Population with Access to Sanitation Facilities: The indicator is calculated as the percentage of
the population with access to excreta disposal facilities out of the total population. This indicator provides
valuable information about the level of sanitation infrastructure in a community, which is critical for public
health, environmental sustainability, and overall well-being.
C. Family Planning Indicators
10. Total Fertility Rate: This is a measure used to estimate the average number of children that would be born
to a woman over her lifetime if she were to experience the exact current age-specific fertility rates (ASFRs)
throughout her childbearing years. It's commonly calculated for women of childbearing age, typically between
15 and 49 years old. The TFR is calculated by adding up all the age-specific fertility rates, and multiplying this
sum by five (the width of the age-group interval).
Age category Live births WRA ASFR
15-19 1000 5000 0.20
20-24 2000 10000 0.20 Total Fertility Rate = 1.13 x 5 = 5.65
25-29 3000 15000 0.20 TFR = 6 children per woman
30-34 2500 12000 0.21
35-39 1500 8000 0.19
40-44 500 4000 0.13
45-49 10 1000 0.01
Total 1.13

11. Contraceptive Prevalence Rate: This is a measure used to estimate the proportion of women of
reproductive age (usually defined as 15-49 years old) who are currently using or relying on contraception to
prevent pregnancy. It's typically expressed as a percentage.
The formula; 𝐶𝑃𝑅= No. of women currently using contraception / Total no. of women of reproductive age ×
100
D. Maternal Health Indicators
12. Maternal Mortality Ratio:
The Maternal Mortality Ratio (MMR) is a key indicator used to measure the number of
maternal deaths per 100,000 live births in a given population over a specified time period. It
provides important insights into the risks faced by women during pregnancy, childbirth, and
the postpartum period.
Formula; 𝑀𝑀𝑅= (No. of Maternal Deaths/ No. of Live Births) × 100,000

13. Assisted Delivery by a Health Professional: The percentage of births or deliveries that
occur with the assistance of any trained health professional including doctors, nurses and
midwives.
Assisted Delivery Rate=(Number of Assisted Deliveries​/ Total Number of Births )×100
Question; 800 births were attended by skilled health personnel of which 1,000 total births
(including those attended by both skilled and unskilled personnel).
What is the assisted delivery rate (%)?
E. Child Survival Indicators
14. Infant Mortality Rate: The estimated annual number of deaths of infants under 12 months
in a given year per 1,000 live births in that same year. IMR=(Number of Infant Deaths/
Total Number of Live Births )​ ×1,000

15. Under‐5 Mortality Rate: It measures the probability of a child dying before reaching the
age of five, per 1,000 live births, within a specified time period.
U5MR = (No. of Deaths of Children Under 5/ No. of Live Births​) × 1,000

16. Measles Vaccination Rate: This is a measure used to assess the proportion of individuals
within a population who have received the measles vaccine, typically expressed as a
percentage.
To calculate the Measles Vaccination Rate, you need data on: Number of Individuals
Vaccinated Against Measles: This includes the total number of individuals who have received
at least one dose of the measles vaccine within a specified time period.
Total Population: This refers to the total number of individuals in the population for whom
vaccination coverage is being assessed.
17. Stunted (height-for-age): Percentage of
children under age five whose height-for-age
is below minus‐two standard deviations from
the median of the reference population.
18. Underweight (weight-for-age): Percentage
of children under age five whose weight-for-
age is below minus - two standard deviations
from the median of the reference population.
19. Wasted (weight-for-height): Percentage of
children under age five whose weight-for-
height is below minus‐two standard
deviations from the median of the reference
population.
F. HIV/AIDS Prevention Indicators
20. HIV Prevalence rate: The HIV Prevalence Rate is a measure used to estimate the proportion of individuals
within a population who are living with HIV (Human Immunodeficiency Virus), typically expressed as a
percentage. HIV prevalence rates are important indicators for assessing the burden of HIV infection within a
population and monitoring trends over time. HIV Prevalence Rate= (Number of Individuals Living with HIV/
Total Population​) ×100

G. Infectious Diseases Control Indicators

21. TB Case Detection Rate: It represents the proportion of estimated TB cases that are detected and reported
to health authorities within a specified time period, typically expressed as a percentage.
No. of TB Cases Detected and Reported: All TB cases that have been diagnosed and reported to health
authorities within the specified time period. Estimated No. of TB Cases: All TB cases that are estimated to occur
within the population during the same time period based on epidemiological models and surveillance data.

22. TB (DOTS) Treatment Success Rate: it is the proportion of smear positive patients who were cured plus the
proportion who completed treatment. No. of TB Patients Successfully Treated: All TB patients who have
completed their treatment regimen and have been declared cured or have completed treatment without
evidence of treatment failure (such as relapse). Total No. of TB Patients Undergoing Treatment: All TB patients
who have initiated treatment within the specified time period.
End
 Data
Driven
Decision-
making
Tools -
DHIS2
What is DHIS2?
i. DHIS2 is a global free open-source software platform for health information

management - – University of Oslo.

ii. It is a tool for collection, validation, analysis, and presentation of aggregate statistical

data as well as patient based statistical data (event tracker data)

iii. A central repository—All data in one place. It Supports collection of many different data

sets (and can easily expand to new data requirements).

iv. Avoid duplicate systems for data collection and storage.

Recommended DHIS Browsers
• DHIS 2 is a web-based application and is available in an internet
browser when you have internet connection.
• The recommended browsers are
• Google Chrome
• Mozilla
• Internet Explorer 9 and above

27
 Requirements for DHIS2 Login
• A functional computer, mobile phone (smart phone or feature phone)
• Access to internet (means of internet connectivity) - Use Modem, LAN etc
• Web Browser (Google Chrome, Mozilla , Internet Explorer 9 and above)
• DHIS2 Website address
• Live site: www.hiskenya.org
• Training site: test.hiskenya.org
• Login credentials (user name and password)
Connect to DHIS2 Live Site or Training Site
Connecting to the DHIS2 Live Site Type URL

https://hiskenya.org

Type URL
Connecting to the Training Site

test.hiskenya.org
 Log in page

1. Enter your
username
2. Enter your
johnkamau password
*******
For users without log in 3. Click sign
credentials, request for in
access on this link
DHIS2 Home Page

Search Apps

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Different apps in KHIS;
Commonly used;
 Data entry - 3 dimensions are key in data entry;
What, where and when (Data set, Organizational unit and period)
Data synchronization happens in the middle of the night.

 Data visualizer;
a) MOH 705 A. Pneumonia cases, Qtrly 2022, Kiambu County. (Bar graph)
b) MOH 710 – OPV1 vs Penta 1 doses admin, May 2024, Kiambu County (all sub-counties)

 Reports;
a) Reporting rates by health facilities, sub-counties, and counties (MOH 705 A & B, 710)
b) Data set report – MOH 711, September 2022, Thika level 5 or Thika Town sub-county
c) Organization unit distribution by KEPH levels – Kiambu County

 GIS – Mapping – Measles dose 1 coverage by counties in Kenya

Log Out of DHIS

Log out
here.
Thank you!