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Technical Report Week 3 REPUBLIC OF KENYA MINISTRY OF HEALTH TECHNICAL REPORT WEEK 3 MOH TECHNICAL ASSISTANCE TO THE COUNTY GOVERNMENTS FOR MITIGATION OF COVID-19 PANDEMIC AND STRENGTHENING OF HEALTH SYSTEMS FOR UHC IN THE COUNTIES AUGUST 6, 2020 Version 1.2 1 | P a g e | P a g e 2 Contents 1. BACKGROUND...................................................................................................................................... 5 1.1 Team Mandate .......................................................................................................................................... 5 1.2 Technical Reporting ................................................................................................................................. 5 1.3 Methodology ............................................................................................................................................ 5 2. EXECUTIVE SUMMARY ...................................................................................................................... 6 2.1 Team Execution ....................................................................................................................................... 6 2.2 Summary of key findings ......................................................................................................................... 6 2.3 Summary of Recommendations ............................................................................................................... 8 3. KEY TECHNICAL FINDINGS .............................................................................................................. 9 3.1 County Bed Infrastructure ........................................................................................................................ 9 3.1.1 Total Bed Capacity......................................................................................................................... 9 3.1.2 Isolation Bed Capacity ................................................................................................................. 11 3.1.3 ICU Bed Capacity ........................................................................................................................ 12 3.2 Facility Infrastructure, Capacity & Preparedness................................................................................... 14 3.3 SOP’s, Job Aids and Protocols ............................................................................................................... 17 3.4 County Capacity in Human Resources for Health ................................................................................. 17 4. Quality of Services ................................................................................................................................. 20 5. County Administrative Support ............................................................................................................. 21 6. RECOMMENDATIONS ....................................................................................................................... 26 7. CONCLUSION ...................................................................................................................................... 28 8. APPENDICES........................................................................................................................................ 28 A. Technical Team Key Findings (Raw Data for all assessed facilities) .............................................. 28 B. Technical Team Recommendations (Raw data for all assessed facilities) ....................................... 28 C. Minimum Bed Counts per Cluster/County ...................................................................................... 28 D. Facility Scores per county ................................................................................................................ 28 E. Technical Assistance Team Organization ........................................................................................ 28 FIGURES Figure 1: ICU Bed Gap in Hot Spots ............................................................................................................... 13 Figure 2; Assessed Facility levels .................................................................................................................... 14 | P a g e 3 Figure 3; Assessed Facility Scores................................................................................................................... 14 Figure 4: Facility preparedness (Scores) Across 10 areas ............................................................................... 15 Figure 5: Assessed SOP, Job Aids, Protocols .................................................................................................. 17 Figure 6: Assessed HRH Staffing .................................................................................................................... 18 Figure 7; HRH Assessments for Doctors & Laboratory Personnel ................................................................. 18 Figure 8; HRH Assessment for Anesthesiologists ........................................................................................... 19 Figure 9; HRH Assessment for Critical Care Officers..................................................................................... 19 Figure 10; HRH Assessment for Capacity Building ........................................................................................ 20 Figure 11; Assessed Laboratory Services ........................................................................................................ 21 Figure 12; Summary of Scores for County Administrative ............................................................................. 22 Figure 13: County Administrative scores by County ....................................................................................... 22 TABLES Table 1: Assessed Bed Infrastructure by County ............................................................................................... 9 Table 2: Total Bed Infrastructure from Health & Non-Health Facilities ......................................................... 10 Table 3: Highest Bed Infrastructure by County ............................................................................................... 10 Table 4: County Health Facilities with +200 Bed Capacity ............................................................................ 11 Table 5: Isolation Beds in Hot spots ................................................................................................................ 12 Table 6: Number of ICU Beds in Hot spots ..................................................................................................... 13 Table 7: Facility Equipment & supplies readiness ........................................................................................... 16 Table 8: County Administrative Support Findings .......................................................................................... 23 Table 9: County Partners ................................................................................................................................. 25 | P a g e 4 1. BACKGROUND 1.1 Team Mandate To assist the Counties to meet set irreducible minimum standards, and to enhance attainment of the overriding National Universal Health Coverage Agenda, a team of 154 officers were commissioned to the exercise by the Cabinet Secretary for Health on 7th July 2020 , and commenced ground work on Phase I of the Technical Assistance exercise from 14th July 2020, for a period of 30 days. This would be followed by Phase II UHC Technical Assistance thereafter. The irreducible minimums were organized into terms of reference across nine thematic areas as follows. 1.1.1 County Capacity i). County infrastructure including bed count to support pandemic and essential services delivery. ii). Human Resources for Health capacity in the County iii). Availability of essential equipment and health commodities. 1.1.2 Quality of service, i). Laboratory testing, contact tracing, case management, quarantine and isolation. ii). Functionality of the supply chain in the County. 1.1.3 County Administration, Operations and Safety i). Communication/information sharing - national, inter county, public channels. ii). County Emergency Rapid Response team (RRT’s) and Multiagency teams (MAT’s). iii). County financing mechanisms and cost management for pandemic cases iv). County Risk Management Systems, risk identification and mitigation strategies. 1.2 Technical Reporting This report is a high level summary to highlight the key findings and conclusions of the Technical assistance teams efforts from July 14 th to August 6 th 2020. The findings will be discussed with the team leaders from the Technical Experts and the County Executive. A detailed report will thereafter, be prepared for onward transmission to the Ministry. 1.3 Methodology The Technical teams in collaboration with the CHMT’s, and Health Systems Inspectors utilized a combined check list to objectively score the following health facility areas: Section 1: Facility Preparedness Marks 1. Infrastructure 20 2. Equipment 20 3. IPC & Wash 10 4. Human Resources 15 5. Case Management 10 6. Capacity Building 10 7. Patient Information Management 5 8. Support Structures & Services 5 9. Support Structures & Services For Health Workers 5 10. Disinfection 5 | P a g e 5 2. EXECUTIVE SUMMARY This report documents the findings as collaboratively assessed by the Technical
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