Leadership and Governance
CHS is actively involved in policy development at national level through participation in the national ART taskforce and in various national technical working groups among them PMTCT, HTC, training, reproductive tract cancers, NASCOP M&E and EMR, EBI, PwP, TB/HIV, paediatric TB, MDR TB, commodity security, infection preventio9n and health care waste management, among others.
CHS supports leadership and governance efforts at counties. In 2013, CHS hosted a workshop where a specialist helped clarify various policy issues including devolution matters. CHS has also undertaken studies to understand challenges related to devolution in order to advise counties on ways to address them.
CHS also linked Muranga District Hospital to a e-course on Leadership and Management offered by the University of Washington. Nine health care workers were supported to undergo this training.
Health Care Financing
CHS in close collaboration with the Ministry of Health has ensured that grants are provided to strengthen and ensure continued health service delivery. In the 2012/2013 financial year, CHS issued a cumulative disbursement of US$1.81 million to 28 sub-grantees consisting of hospitals, District Health Management Teams, the Central Provincial Medical Office and two Community Based Organisations (CBOs).
Human Resources for Health
To promote the quality of health in Central Kenya, CHS provides facilities with human resource support to meet the increasing demand for health care services. CHS currently supports 282 health workers of various cadres at county level, 57 volunteer HTC providers and 148 peer educators and mentor mothers.
Training and mentoring of health workers as a capacity building strategy has ensured continuous advancement in the quality of health across CHS supported facilities. This is aimed at promoting knowledge and capacity of health workers and has been achieved through:
On-site clinical and systems mentorship: CHS officers spend time with service providers conducting one-on one and one-to group mentorship on various aspects of health care.
Continuous Medical Education (CMEs): These are conducted at the facility and sub-county level. Their main role is to enhance continuous learning among health workers competent through providing education on new and developing areas in the field. Examples include new models of care, new treatment guidelines and other relevant aspects related to service delivery.
58 CMEs conducted at facility level and 19 at the district level in 2012/2013
Formal training: this includes didactic off-site training as well as support for on-site learning including self based learning. Formal learning is based on national and other curricula.
Residential Mentorship: This is an innovative peer led learning whereby a team of very competent MOH mentors at Muranga District Hospital mentor health care workers from various facilities in various aspects of HIV service delivery and supportive systems. Learning occurs in a real-world clinical setting to maximize transfer of practical knowledge and skills. This is a sustainable model of learning that optimizes use of available MOH resources and ensures capacity is retained even beyond the life of the project. This program has helped ensure quality of services in facilities newly providing HIV services as the teams are twinned with mentors at Muranga and learn best practices. CHS developed this program in in collaboration with Muranga and continues to offer technical and financial support for it. Further, CHS further supports this program by providing training material and equipment such as laptops, projectors, printers, internet connection, and mentors and mentee allowances. Further, CHS provides curriculum development and technical support.
150 health workers were mentored on HIV-related aspects in 2012/2013
E-learning: Aimed at improving skills and knowledge among health workers, e-learning is a new and innovative approach that promises to promote service delivery at minimal cost. CHS has provided equipment and internet connection to link health care workers from five hospitals to advanced HIV courses, and one hospital to an online leadership and management course. CHS intends to continue offering cutting edge learning solutions.
Infrastructure Support
CHS provides infrastructural support to facilities to ensure quality services though provision of furniture – tables, cabinets, chairs, examination couches among others; clinical equipment such as digital weighing machines, digital blood pressure machines, ECG machines, pulse oximetres, resuscitaires; computers, printers; laboratory equipment, and renovation of buildings to enhance service delivery. To support the implementation of the community health strategy through community health workers, CHS supported the distribution of 100 bicycles to facilitate movement in communities.
In order to enhance service delivery, client privacy and infection control across CHS supported health facilities, repairs of five health facilities have been carried namely: Kirwara sub-District hospital, and Gachege Health Centres, Gatundu, Murang’a and Engineer District Hospitals and Nyeri Provincial General Hospital. A 3-room pre-fabricated structure has also been put up at Nyahururu District Hospital.
Health Management Information Systems (HMIS)
HMIS is one of the pillars of health systems that ensures availability of strategic information for management through monitoring and evaluation. CHS supports facilities to develop data collection mechanisms, reconstruct distorted data sets, analyse and interpret data for improved planning and decision making as well as adoption of quality intervention programs. Through mentoring and regular reviews, CHS ensures that the quality and accurate data is collected and that it is reliable to inform decision-making. CHS also supports electronic medical records at supported facilities to optimize both data and patient management.
Through Tegemeza, CHS has greatly improved the quality of data and information management at the county and facility level through the introduction of innovative and novel decision support systems. Introduction of the Integrated Patient Management System (IPMS) is a great milestone for CHS as this system presents great capabilities in data management for enhanced decision making. IPMS brings together data from HIV, PMTCT and TB clinics.
Laboratory Solutions
CHS works to strengthen the laboratory component of HIV management, including diagnostic services and logistics. This has been achieved through the supply of lab equipment as well as provision of buffer reagents and supplies.. The use of high level technology and laboratory systems to support lab services at facility level has ensured better access to diagnosis and treatment as well as increased efficiency in care and treatment.
Equipment provided by CHS includes haematology and biochemistry analysers, microscopes and fridges, among others. In a bid to strengthen LMIS, CHS has supplied labs in select facilities with computers.
With an aim of optimizing available resources for patient monitoring, CHS has established laboratory sample transport networks linking all 190 health facilities to CD4, haematology and biochemistry testing services available at larger facilities within the counties, further, all 190 facilities have been linked to HIV viral load testing services available at the National HIV Reference Laboratory. This networks ensues rapid transportation of samples and equally rapid transmission of results to the health facility with minimal inconvenience to the patient.
Pharmacy Solutions
CHS supports pharmacy systems to ensure that drugs are accessible to the patients as needed, and are used in a rational and safe manner. CHS supports commodity management at health facilities through support for forecasting, quantification and reporting. Further, a system that CHS supports for stock rotation between facilities ensures that there are less stock outs, expiries and wastages. CHS also provides buffer stocks for essential pharmaceutical commodities to ensure patient treatment is uninterrupted. Additionally, CHS builds the capacity of health care workers to identify and report adverse reactions to medicines as required by the Pharmacy and Poisons Board.
CHS continues to strengthen new areas of care including Kaposi’s sarcoma treatment through supply of chemotherapy commodities and capacity building of health care workers on chemotherapy procedures