County Profile Edition

Nyeri County Profile

The United States Ambassador to Robert Godec (in blue tie) during his visit to PGH in 2013 Delivery of sustainable health services

With support from PEPFAR through CDC and in its commitment to improving health outcomes, CHS works in partnership with the Ministry of Health in to complement and synergize the delivery of sustainable health services.

CHS offers support to 70 health facilities in the County, focusing on implementation of high quality HIV prevention, care and treatment services.

Support for care and treatment of HIV, TB/HIV services, prevention of mother to child transmission of HIV (PMTCT), HIV Counselling and Testing (HTC) and community linkages are offered across these facilities. CHS supports 22 facilities for HIV care and treatment and TB/HIV, and all 70 facilities for PMTCT and HTC.

CHS support to facilities is provided in the form of human resource, infrastructure, staff training and capacity building, laboratory support, routine supervision and direct support to facilities in the form of

health service delivery. CHS also supports joint county supervision through provision of fuel for vehicles, volunteer allowances, general office supplies, stationery, communication and travel allowances to promote meals and incidental allowances.

This report summarises CHS support in Nyeri County.

2014 Dr. Gichuiya M’Riara, County Health Director, Nyeri County during his key note address at the CHS Annual Stakeholders Meeting

Participation in County Planning Meetings CHS was represented in county health strategic investment planning meetings in Nyeri County including the annual work planning meetings.

Contents Abbreviations

SNAPSHOT OF NYERI COUNTY ...... 1 AIDS ………… Acquired Immune Deficiency Syndrome HUMAN RESOURCE FOR HEALTH ...... 2 ANC ………… Antenatal Clinic INFRASTRUCTURE FOR HEALTH ...... 3 ART ………… Antiretroviral Therapy EQUIPMENT SUPPORT ...... 4 COE ...... Centre of Excellence TRAINING AND CAPACITY BUILDING ...... 5 CME ...... Continuous Medical Education HIV ………… Human Immunodeficiency Virus HTC ………… HIV Testing and Counselling IPT ...... Isoniazid Preventive Therapy NACC ………… National AIDS Control Council NASCOP ………… National AIDS and STI Control Program NTLD-Unit ...... National Tuberculosis and Lung Disease Unit PEPFAR ………… President Emergency Plan for AIDS Relief PGH ...... Provincial General Hospital PITC ………… Provider Initiated Testing and Counselling PMTCT ………… Prevention of Mother to Child Transmission of HIV TB ………… Tuberculosis Snapshot of Nyeri County

Population: 693,558 Population Density: 208 people per km2

Nyeri County is located in Central and constitutes 6 constituencies (Tetu, Kieni, Mathira, Othaya, Mukurwe-ini and Nyeri town)

Location: Located in central Kenya, it borders Kirinyaga and Meru to the East, Laikipia to the North, Nyandarua to the west and Muranga to the South. Area (Km 2): 3,337 Km 2

Doctor to Population Ratio: 1:5,000

Source: Kenya Open Data (opendata.go.ke), Commission on Revenue Allocation Kenya (crakenya.org), and http://www.nyeri.go.ke/population%20data

CHS Supported Facilities

Amboni Dispensary Ndimaini Dispensary Kihuyo Dispensary Bellevue Health Centre Warazo Dispensary Kinunga Health Centre Burguret Dispensary Watuka Dispensary Kirurumi Dispensary Embaringo Dispensary Wendiga Dispensary Kiuu Dispensary Endarasha Health Centre Aguthi Dispensary Mihuti Dispensary Gakawa Dispensary Gatitu Dispensary Mt Kenya sub District Hospital Gatei Dispensary Gichiche Health Centre Mukurweni sub District Hospital Gatina Dispensary Gichira Health Centre Mweru Dispensary Gatondo Dispensary Gumba Dispensary Ndugamano Dispensary Island Farms Dispensary Ichagachiru Dispensary Njokini Dispensary Itiati Dispensary Ichamara Dispensary Nyeri Provincial General Hospital Itundu Dispensary Igana Dispensary Nyeri Town Health Centre Dispensary Ihurerio Dispensary Othaya sub District Hospital Kaiyaba Dispensary Ihururu Dispensary Ruruguti Dispensary Kamburaini Dispensary Kagere Dispensary Tambaya Dispensary District Hospital Kagicha Dispensary Thangathi Health Centre Karemeno Dispensary Kagonye Dispensary Wamagana Health Centre Kiamabara Dispensary Kairuthi Dispensary Witima Health Centre Kiamathaga Dispensary Kamoko Health Centre Lamuria Dispensary Karaba Health Centre Mere Dispensary Kariko Dispensary 70 health Mugunda Dispensary Karima Dispensary Mureru Dispensary Karundu Dispensary facilities Mweiga GOK Dispensary Kiaguthu Dispensary supported in Naromoru Health Centre Kiamuya Dispensary Ndathi Dispensary Kiandere Dispensary Nyeri County

1 Human Resource for Health Human Resource CHS strengthens human resource capacity through Support supporting facilities with different cadres of staff Cadre Number pharmacy technicians, social workers, nutritionists, including nurses, registered clinical officers, data clerks, Data Clerk 24 Registered Clinical Officer 35 accountants, office administration assistants. KRN Nurses 15 Support includes capacity building for health workers PITC Counsellor 8 to promote the quality of health services. CHS supports Pharmacy Technician 3 a total of 93 staff in Nyeri County at an annual cost of Laboratory Technician 2 Kshs 41,418,247. Social Worker 1 Nutritionist 1 Volunteer allowances for 42 peer educators, eight (8) Enrolled Nurses 1 mentor mothers and 22 counsellors are budgeted at Kshs 6,456,144 for the year. CHS-supported staff have Accountant 2 played an important role in bridging the staff capacity Office Admin Assistant 1 gap at facilities and thereby promoted the level of TOTAL 93 health care while reducing staff overload.

Case Study: Nyeri Provincial General Hospital

CHS established that a shortage in staff contributed This not only reduced poor coordination of services, but it also improved the level of HTC uptake. The at the Nyeri Provincial General Hospital comprehensive counsellors are now more effective and there is significantly to the low quality of service experienced care centre (CCC). In addition, the roles of counsellors were not well coordinated and this consequently has reduced their workload considerably, thus increased cooperation among staff. Additional staffing affected the quality of care. CHS hired more counsellors promoting the quality of care at the hospital. and developed a duty rota detailing the distribution of these counsellors to cover all outpatient clinics at the facility.

2 Othaya District Hospital CCC

Infrastructure for Health

Othaya District Hospital Nyeri Provincial General

CHS carried out repairs at Othaya District Hospital Hospital – HIV Testing including lintel beaming, walling, door and window and Counselling Rooms installation in the facility’s comprehensive care fitting, electrical works, shelves and paving slab centre (CCC) at a cost of Kshs 2.3 million. In 2013, CHS completed the repair of HTC rooms aimed at promoting counselling and The repairs have played a great role in service testing through enhancing privacy and reducing delivery to the community especially in infection reinforcements and putting up of damp proof congestion. Repairs included excavations, material. control facilitated by the free flow of air through the fitted windows. Additional space created by the the new structure allows for psychosocial groups In addition, CHS provided screens and furniture new shelves has helped in organizing the office and to conduct their sessions in comfort away from rain and cold conditions. greatly improved the ability of health workers to create extra room within the CCC and this has to provide quality service.

because privacy issues and client comfort KSH 2,363,036 for health Clients are more confident to attend sessions have been addressed. Consequently, the HTC facility infrastructure in uptake in the Hospital has risen from 12,347 Othaya District Hospital individuals in 2012 to 25,201 as at March 2014

3 Equipment Support

CHS supports facilities in Nyeri County through the procurement and supply of equipment for use at health facilities. These assets have played a great role in ensuring patients access quality care.

1. Support for laboratory equipment and

ensures accurate diagnosis and reduces other diagnostic equipment for example the need for referrals. 2. Computers, scanners, UPS, printers and other technology related equipment have ensured effective data management thus

are further trained in the operation of increasing efficiency. Staff at the facilities technical machines and equipment to familiarise them with operation and maintenance. A summary of the major equipment provided in support for Nyeri County is shown below:

Equipment Type Quantity Blood Pressure machines 33

Desktop computers 8 Pulse oximeters 5 Laptops 2 Printers 11 UPS 10 Weighing Scales 50 Notice Boards 134 Auto Clave 1 ECG Machine 1 Cabinets 13 Computer Desk 2

Office Chairs 32 Office Desks 12 Filing Cabinets 1 Examination Couches 6 Steel Storage Cupboards 7 Waiting Benches 8 Workstations 6

KSHS 5,800,000 in equipment for health facilities

4 Training and Capacity Building

CHS continuously builds the capacity of staff through trainings, mentorship and review meetings with an objective of equipping health workers with 1,252 health care skills necessary to provide high quality of care. A total of 1,252 health workers trained in workers from different facilities in Nyeri County have so far been trained various technical fields in various training forums including District Continuous Medical Education (CMEs), Facility CMEs, Formal Trainings, Mentorship and On-job trainings.

An overview of the trainings conducted:

Type of training Female Male Total

District CMEs 152 58 210 Facility CMEs 452 254 706 Formal Trainings 133 76 209 Routine Mentorship 46 30 76 Residential Mentorship 4 5 9 Review Meetings 18 - 18 County CMEs 18 4 22 On-job Training 1 1 2

Total 1,252

5 Centre of Excellence at Provision of Isoniazid Nyeri Provincial General Preventive Therapy (IPT) Hospital All the 22 care and treatment sites supported by CHS in Nyeri County are so far providing Nyeri Provincial General Hospital is among the smear positive TB contact. Nyeri PGH is among IPT for children aged below five years with a Central region. the four facilities where support to provide IPT four centres of excellence created by CHS in the for people living with HIV is provided, aimed at preventing TB among them. with the objective of developing ideal or close Centres of Excellence were originally created to ideal diagnostic, treatment and preventive This support includes strengthening of services in resource-limited settings while serving as centres of learning. The centre of and on-site mentorship of health care workers commodity flow systems, provision of job aids on commodity reporting to the National Tuberculosis and Lung Disease Unit (NTLD- excellence consists of a more diverse and senior Unit) formerly referred to as DLTLD. CHS plans staff mix that allows for enhanced diagnostic systems and structured monitoring and to scale up the IPT programs to all high volume and prevention services, efficient management evaluation services. facilities within the year.

CHS has supported Nyeri PGH as a centre of resource constrained settings through excellence to offer superior services within creating competent teams, providing trainings, commodities and service integration. The facility implements best practices in health Nyeri Provincial General with an objective of achieving high impact in Hospital is among the four the community. The United States Ambassador to Kenya Robert Godec visited Nyeri PGH in centres of excellence created 2013 and acknowledged CHS efforts to help the by CHS in the Central region community access better health services.

Centre for Health Solutions - Kenya,

Kasuku Road off Lenana Road, CVS Building, 4th floor, North Wing Tel: +254 (0) 271 0077 P. O. Box 23248 - 00100, , Kenya www.chskenya.org