Republic of Kenya - DOC by 9XK627

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									          Republic of Kenya




        MINISTRY OF HEALTH




KENYA NATIONAL EXPANDED PROGRAMME
          ON IMMUNIZATION
          MULTI YEAR PLAN
             2006-2010
                                                      TABLE OF CONTENTS
LIST OF TABLES ................................................................................................................... 5
LIST OF FIGURES ................................................................................................................. 5
LIST OF ACRONYMS ........................................................................................................... 6
EXECUTIVE SUMMARY ..................................................................................................... 8
1.0       BACKGROUND INFORMATION ......................................................................... 10
   1.1         GEOGRAPHY AND DEMOGRAPHIC CHARACTERISTICS ............................................... 10
   1.2         HEALTH SECTOR PRIORITIES..................................................................................... 10
2.0 HEALTH CARE DELIVERY SYSTEMS .................................................................... 12
   2.1         POLICY OF THE MINISTRY OF HEALTH ...................................................................... 12
   2.2         THE NATIONAL HEALTH SECTOR STRATEGIC PLAN II (NHSSPII) ........................... 13
       2.2.1      The Kenya Essential Package for Health ............................................................................... 13
       2.2.2      Service Delivery......................................................................................................................... 14
       2.2.3      Improving Financial Access ..................................................................................................... 14
       2.2.4      Improving Health Worker Performance ................................................................................. 14
       2.2.5      Health Planning .......................................................................................................................... 14
       2.2.6      Monitoring and Evaluation ....................................................................................................... 14
       2.2.7      Human Resource Management and Development ................................................................ 15
       2.2.8      Quality Assurance and Standards ............................................................................................ 15
       2.2.9      Investment and Maintenance .................................................................................................... 15
       2.2.10      Performance Monitoring .......................................................................................................... 15
   2.3         SECTOR WIDE APPROACH (SWAP) ........................................................................... 15
3.0       SITUATION ANALYSIS .......................................................................................... 17
   3.1         THE EXPANDED PROGRAMME ON IMMUNISATION .................................................... 17
   3.2         PROGRAMME STRUCTURE ......................................................................................... 17
   3.3         ROUTINE IMMUNIZATION .......................................................................................... 17
       3.3.1      Immunization Schedule for Kenya .......................................................................................... 18
   3.4         ROUTINE IMMUNIZATION COVERAGE ....................................................................... 18
   3.5         REACHING EVERY DISTRICT (RED) APPROACH ........................................................ 22
   3.6         POPULATIONS AT RISK OF MISSING IMMUNISATION SERVICES................................... 22
   3.7         DISEASE SURVEILLANCE ........................................................................................... 22
       3.7.1      AFP Surveillance ....................................................................................................................... 22
       3.7.2      Measles Surveillance ................................................................................................................. 24
       3.7.3      Haemophilus Influenza Type b (Hib) Surveillance .............................................................. 24
   3.8         EPIDEMIC PREPAREDNESS AND DISEASE OUTBREAK RESPONSE ............................... 25
       3.8.1      Measles Outbreaks ..................................................................................................................... 26
       3.8.2      Polio Outbreaks .......................................................................................................................... 26
       3.8.3      Neonatal Tetanus ....................................................................................................................... 26
   3.9         DATA MANAGEMENT AND EPI REPORTING SYSTEM ................................................ 26
   3.10        VACCINE QUALITY, SUPPLY AND UTILIZATION ........................................................ 26
       3.10.1      Vaccine Procurement and Distribution .................................................................................. 26
       3.10.2      Utilization of Vaccines ............................................................................................................ 28
   3.11        COLD CHAIN ............................................................................................................. 28
       3.11.1      The National Vaccine Stores ................................................................................................... 28
       3.11.2      Cold Chain Equipment ............................................................................................................. 28
   3.12        TRANSPORT............................................................................................................... 29
   3.13        INJECTION SAFETY AND HEALTH CARE WASTE MANAGEMENT ............................... 30
       3.13.1      Injection Safety ......................................................................................................................... 30


                             Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                               2
       3.13.2      Waste Management .................................................................................................................. 30
   3.14       EPI COMMUNICATION............................................................................................... 30
       3.14.1      Advocacy ................................................................................................................................... 31
       3.14.2      Social Mobilization ............................................................... Error! Bookmark not defined.29
       3.14.3      Programme Communication ................................................ Error! Bookmark not defined.29
       3.14.4      Other Partners Working in EPI Communication ............... Error! Bookmark not defined.29
4.0       IMPLEMENTATION OF THE EPI COMPREHENSIVE MYP 2006-2010 ...... 32
   4.1   THE NATIONAL HEALTH STRATEGIC PLAN AND THE CMYP ....... ERROR! BOOKMARK
   NOT DEFINED.30
   4.2   THE EPI PROGRAMME IN THE MINISTRY OF HEALTH.......... ERROR! BOOKMARK NOT
   DEFINED.30
   4.3   EPI PROGRAMME GOAL .................................. ERROR! BOOKMARK NOT DEFINED.30
   4.4   PROGRAMME OBJECTIVES ............................... ERROR! BOOKMARK NOT DEFINED.31
   4.5   STRATEGIC AREAS .......................................... ERROR! BOOKMARK NOT DEFINED.32
   4.6   TARGETS ......................................................... ERROR! BOOKMARK NOT DEFINED.32
   4.7   GOVERNANCE AND PARTNERSHIPS ................. ERROR! BOOKMARK NOT DEFINED.32
   4.8   MONITORING AND EVALUATION ..................... ERROR! BOOKMARK NOT DEFINED.33
5.0  THE IMMUNIZATION SYSTEM COMPONENTS .ERROR! BOOKMARK NOT
DEFINED.34
   5.1   SERVICE DELIVERY ......................................... ERROR! BOOKMARK NOT DEFINED.34
   5.2   VACCINE SUPPLY, QUALITY AND LOGISTICS .. ERROR! BOOKMARK NOT DEFINED.34
   5.3   DISEASE SURVEILLANCE ................................. ERROR! BOOKMARK NOT DEFINED.34
   5.4   ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION....... ERROR! BOOKMARK
   NOT DEFINED.35
   5.5   PROGRAMME MANAGEMENT .......................... ERROR! BOOKMARK NOT DEFINED.35
6.0       NATIONAL PRIORITIES BASED ON THE SITUATIONAL ANALYSIS
          ERROR! BOOKMARK NOT DEFINED.36
7.0: NATIONAL PRIORITIES, NIP OBJECTIVES AND MILESTONES,
STRATEGIES, STRATEGIC ACTIVITIES, NATIONAL, AND ORDER OF
PRIORITY.............................................................................................................................. 42
8.0       MYP ACTIVITY TIMELINE ...................................................................................... 54
9.0       USING THE GIVS FRAMEWORK AS A CHECKLIST ..................................... 67
STRATEGIC AREA ONE: PROTECTING MORE PEOPLE IN A CHANGING WORLD .... 67
10.0      KEPI ANNUAL WORK PLAN (2006) ......................................................................... 69
11.0      KEPI ANNUAL WORK PLAN (2006) - BUDGET SUMMARY 2006/7 ............. 79
12.0 COST, BUDGET AND FINANCING FOR THE CMYP ... ERROR! BOOKMARK
NOT DEFINED.77
   12.1  METHODOLOGY FOR COSTING THE CMYP ...... ERROR! BOOKMARK NOT DEFINED.77
   12.2  MACROECONOMIC INFORMATION ................... ERROR! BOOKMARK NOT DEFINED.78
   12.3  VACCINES AND INJECTION EQUIPMENT........... ERROR! BOOKMARK NOT DEFINED.78
   12.4  PERSONNEL COSTS (EPI SPECIFIC AND SHARED) ................. ERROR! BOOKMARK NOT
   DEFINED.78
   12.5 VEHICLES, AND TRANSPORT COSTS ................ ERROR! BOOKMARK NOT DEFINED.78
   12.6 COLD CHAIN EQUIPMENT, MAINTENANCE AND OVERHEADS ..... ERROR! BOOKMARK
   NOT DEFINED.78



                             Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                 3
  12.7 OPERATIONAL COSTS FOR CAMPAIGNS ........... ERROR! BOOKMARK NOT DEFINED.79
  12.8 PROGRAMME ACTIVITIES, OTHER RECURRENT COSTS AND SURVEILLANCE ....ERROR!
  BOOKMARK NOT DEFINED.79
  12.9 OTHER EQUIPMENT NEEDS AND CAPITAL COSTS ................ ERROR! BOOKMARK NOT
  DEFINED.79
  12.10   COSTS FOR IMMUNIZATION ACTIVITIES DURING THE PERIOD FOR THE CMYP
          ERROR! BOOKMARK NOT DEFINED.79
  12.11   FINANCING FOR THE PROGRAMME .............. ERROR! BOOKMARK NOT DEFINED.79
  12.12   INTERVENTIONS TO IMPROVE THE FINANCIAL VIABILITY OF THE PROGRAMME
          ERROR! BOOKMARK NOT DEFINED.80
       12.12.1 Securing Probable Resources ............................................... Error! Bookmark not defined.80
       12.12.2 Securing Additional Resources............................................ Error! Bookmark not defined.80
13.0      CMYP COSTING AND FINANCING GRAPHS FOR KENYA ERROR! BOOKMARK
NOT DEFINED.83
ANNEX 1:            SWOT ANALYSIS ........................................................................................... 81
  1.1        MANAGEMENT ..................................................................................................... 81
  1.2        VACCINES SUPPLY AND QUALITY .................................................................. 83
  1.3        LOGISITCS ............................................................................................................. 85
  1.4        SERVICE DELIVERY ............................................................................................ 87
  1.5        SURVEILLANCE ................................................................................................... 91
  1.6        ADVOCACY AND COMMUNICATION .............................................................. 94
  1.7        EPI CAPACITY BUILDING ................................................................................... 97




                          Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                          4
List of Tables

Table 1: Vital Statistics for Kenya ............................................................................................ 10

Table 2: A summary of Routine Immunization Achievements ................................................ 20

Table 3: Yellow Fever Immunization Coverage 2001-2005 .................................................... 21

Table 4: Results of Acute Flaccid Paralysis (AFP) indicators for 2002 - 2005 ....................... 23

Table 5: Number of Confirmed Measles Cases from January 2002 to March 2006 .............. 24

Table 6: Vaccine Procuring Process and responsibility by year. ............................................ 27

Table 7: Time Frames for NHSSP II/POW, cMYP and AOPs/annual implementation plans
       ...................................................................................... Error! Bookmark not defined.30

Table 8.1: Service Delivery ...................................................................................................... 42

Table 8.2: Vaccine Supply, Quality and Logistics ................................................................... 44

Table 8.3: Surveillance ............................................................................................................ 46

Table 8.4: Advocacy and Communication ............................................................................... 47

Table 8.5: Management ........................................................................................................... 50

Table 9: Inputs to different EPI systems components......... Error! Bookmark not defined.77

Table 10: Macro Economic Trends in Kenya, 2006 - 2010. Error! Bookmark not defined.78

Table 11: Multi-Year Costing for Kenya (in US$) – Summary Table ..... Error! Bookmark not
       defined.81

List of Figures

Figure 1: Annual comparison on Hib isolates ..................... Error! Bookmark not defined.24

Figure 2: Confirmed Measles Cases in Kenya 2001-2005 .. Error! Bookmark not defined.24




                           Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                         5
LIST OF ACRONYMS

AD       -     Auto Destruct (syringes)
AEFI     -     Adverse Events Following immunization
AFP      -     Acute Flaccid Paralysis
AIDS     -     Acquired Immune Deficiency Syndrome
AIE      -     Authority to Incur Expenditure
AOP      -     Annual Operation Plan
BCC      -     Behaviour Change and Communication
BCG      -     Bacilli Calmette-Guerin (Vaccine)
CAG      -     Cash Assistance to Government
CBAW     -     Child Bearing Age Women
CBHC     -     Community Based Health Care
CBO      -     Community Based Organisation
CBS      -     Central Bureau of Statistics
CDC      -     Communicable Disease Control
CFC      -     Cloro Fluoro Carbon
CORPS    -     Community Own Resource Persons
DANIDA   -     Danish Aid National Development Agency
DARE     -     Decentralized Aids and Reproductive
DDSC     -     District Disease Surveillance Coordinator
DIFD     -     Department for International Development
DHE      -     Division of Health Education
DHEO     -     District Health Education Officer
DHMT     -     District Health Management Team
DHP      -     District Health Programme
DMOH     -     District Medical Officer of Health
DMS      -     Director of Medical Services
DPT      -     Deptheria Partusus and Tetnus
DQA      -     Data Quality Audit
DRCO     -     District Registered Clinical Officer
EPI      -     Expanded Programme on Immunization
FBO      -     Faith Based Organization
FIC      -     Fully Immunized Children
GAVI     -     Global Alliance for Vaccines and Immunization
GDP      -     Gross Domestic Product
GOK      -     Government of Kenya
HepB     -     Hepatitis B
Hib      -     Haemophylus influenza type b
HIS      -     Health Information Systems
HIV      -     Human Immunodeficiency Virus
NHSSP    -     National Health Sector Support Programme
ICC      -     Inter Agency Coordination Committee
IDS      -     Integrated Disease Surveillance
IDSR     -     Integrated Disease Surveillance & Response
IEC      -     Information Education and Communication
IMCI     -     Integrated Management of Childhood Illnesses
JICA     -     Japan International Agency
JPWF     -     Joint Program of Work and Funding
KAfI     -     Kenya Alliance for Immunization


             Kenya EPI Comprehensive Multi-Year Plan 2006-2010   6
KBC      -     Kenya Broadcasting Corporation
KDHS     -     Kenya Demographic and Health Survey
KEMRI    -     Kenya Medical Research Institute
KEMSA    -     Kenya Management and Supplies Agency
KEPH     -     Kenya Essential Packages for Health
KEPI     -     Kenya Expanded Programme on Immunization
KMTC     -     Kenya Medical Training College
MCH      -     Maternal Child Health
MDVP     -     Multi Dose Vial Policy
MLM      -     Mid Level Management
MNT      -     Maternal Neonatal Tetanus
MOH      -     Ministry of Health
MTEF     -     Mid Term Expenditure Framework
MTRH     -     Moi Teaching and Referral Hospital
MYP      -     Multi Year Plan
NARC     -     National Rainbow Coalition
NCPD     -     National Council Population Development
NGO      -     Government of Kenya
NID      -     National Immunization Days
NPCC     -     National Polio Certification Committee
NPEV     -     Non-Polio Enteroviruses
NPHL     -     National Public Health Laboratories
NPEC     -     National Polio Expert Committee
NNT      -     Neonatal Tetanus
OJT      -     On the Job Training
OPV      -     Oral Polio Vaccine
PDSC     -     Provincial Disease Surveillance Committee
PHEO     -     Provincial Health Education Officer
PHI&RO   -     Provincial Health Information and Records Officer
PHMT     -     Provincial Health Management Team
PHO      -     Public Health Officer
PHT      -     Public Health Technician
PRSP     -     Poverty Reduction Strategy Paper
RED      -     Reaching Every District
SIA      -     Supplemental Immunization Activities
SDP      -     Service Delivery Point
SNID     -     Supplemental National Immunization Days




             Kenya EPI Comprehensive Multi-Year Plan 2006-2010     7
Executive Summary

The Kenya Expanded Programme on Immunization’s (KEPI) overall goal is to increase
access to immunization services, provide effective and potent vaccines and increase
demand for the services in order to reduce infant morbidity and mortality rates due to
vaccine preventable diseases. The EPI services are provided under the Kenya Essential
Package for Health (KEPH), which integrates all health programmes into a single package
focused on improving health at different stages of the human life cycle.

The country’s routine immunization trends have shown steady but slow increase. Nationally,
measles routine immunization is on an increase, but the levels have not increased as fast as
they would have been expected. Measles immunization coverage is currently only at 65
percent coverage, a level that is not sufficient for controlling outbreaks. Mass vaccination
campaigns have been conducted in Kenya since 1996.

The NHSSP II (2005 – 2010) goal is to contribute to the reduction of health inequalities and
to reverse the downward trend in health related impact and outcome indicators. The Joint
Programme of Work (POW) for the Health Sector Wide Approach developed in June 2006
outlines the operationalization of the NHSSP II, the different programme areas including
immunization, and financial support requirements. The priorities of the NHSSP II are
centered on the provision of Kenya Essential Package for Health as part of Kenyan
Economic Recovery Strategy for Wealth and Employment Creation (ERSWEC, known as
ERS). The foreseen risks during the implementation of NHSSP II includes: unpredictable
macro-economic status of the country; increasing levels of poverty, shortage of drugs and
essential supplies, critical shortage of human resources and the devastating impact of
HIV/AIDS.

This Comprehensive Multi Year Plan 2006 - 2010 will guide the immunization activities in
Kenya. It highlights the national goals, objectives, and strategies derived from the EPI
situational analysis. The analysis has been done through comprehensive review of KEPI’s
Annual operational reports, immunization coverage reports, programme sector’s assessment
reports, programme evaluation reports, findings of surveys carried out during the plan
period, and the KEPI joint review of April 2006. In addition to this, interviews were done with
key staff at all levels to fill in gaps in information and to enrich the review information. The
review focused on the strengths and weaknesses and suggested recommendations for
future improvements.

This strategic planning is carried out by immunization system components rather than by
targeted disease or initiative.
Key Areas: The Key areas identified below are not reflective of the contents of this
document. Further issues need to be raised, and key data to strengthen the points.
Major areas of focus include:
Provision of services to hard-to-reach populations;
Introduction of new vaccines;
Integrated interventions aimed at reducing child morbidity and mortality.
The cMYP 2006-2010 is the programme’s main strategy in its contribution towards
achievement of the fourth Millennium Development Goal.

The success of the programme largely depends on adequate financing for all proposed
activities to be undertaken during the planning period. It will be the responsibility of the EPI
through the Interagency Coordinating Committee to ensure that the programme gets
adequate financial and material support both locally and internationally.




                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                              8
Kenya is now moving towards establishing a health Sector Wide Approach (SWAp) during
the NHSSP II plan period.

The programme will be monitoring the trends in financing to ensure it is moving towards
financial sustainability by reducing financing gaps, and converting more probable financing
to secure financing.




                  Kenya EPI Comprehensive Multi-Year Plan 2006-2010                      9
1.0    Background Information

1.1     Geography and Demographic Characteristics
Kenya is situated in East Africa; it borders Tanzania to the south, Uganda to the West,
Ethiopia and Sudan to the North, Somalia to the Northeast, and the Indian Ocean to the
Southeast. Administratively, it is divided into 8 provinces, which are further subdivided into
78 districts covering an area of 582, 646 square kilometers, of which approximately 80 % of
the land is arid or semi-arid and only 20% is arable.

The population of Kenya was 28.7 million in the last census of 1999, of which 4% are
children aged under one year; 16% under five years and 44% under 15 years. Women of
childbearing age 15 – 49 years make 24% of the population. Annual population growth rate
was 3.2 per cent (1989 – 1999 inter-census growth rate). Average life expectancy is at 54
years with the HIV/AIDS impact factored. Infant mortality rate (IMR) was at 77 per 1,000 live
births in the most recent five (5) year period preceding the survey in 2003 (KDHS 2003). It is
however imperative to note that most of the vital statistics have deteriorated between 1998
and 2003.

       Table 1: Vital Statistics for Kenya

                      Statistic                                  Indicators
                                              1998                      2003
       Annual Growth Rate                     3.0                       2.9 % 2
       Crude Birth Rate                       34.6 per 1000             37.5 per 10001
       Crude Death Rate                                                 12 per 10002
       Total Fertility Rate                   4.7     children     per 4.9      children    per
                                              woman                     woman1
       Infant Mortality Rate                  74 per 1000 live births   77      per 1000    live
                                                                        births1
       Under-five Mortality Rate              111.5 per 1000 live 115 per 1000              live
                                              births                    births1
       Maternal Mortality Rate                590 per 100,000 live 414 per 100,000          live
                                              births                    births1
       Male Life Expectancy at birth                                    52.8 years2
       Female Life Expectancy at birth                                  60.4 years2
       1                                              2
        Source: KDHS 1998/2003               Source: 1999 Population Census

The proportion of the population residing in the rural areas is still higher than the proportion
in the urban areas. The urban population has increased from 10 percent in 1969 to 19
percent in 1999.

1.2    Health Sector Priorities

The Government of Kenya (GOK) is determined to improve the access and equity of
essential health care services and to ensure that the health sector plays its essential role in
the realization of the Kenyan Economic Recovery Strategy for Wealth and Employment
Creation (ERSWEC, known as ERS). As a signatory of the Millennium Declaration with its
internationally defined Millennium Development Goals (MDGs), Kenya has expressed its
commitment to reach these targets in the remaining ten years.

Kenya has incorporated these and other international goals into its national targets. These
are further being translated into regional and district level targets as part of the MOH’s
annual operational plan to inform and guide local priority setting and resource allocation.


                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                         10
Specific outcomes to be achieved in the ERS programme period represents the
achievements of the targets by MOH, through the implementation of the annual operational
plans.

At national level, the ERS3 and National Development Plan 2004 – 2009 presents Kenya’s
road map for economic recovery, whose four pillars are: achieving rapid economic growth in
a stable macroeconomic environment; strengthening the institutions of governance;
rehabilitating and expanding physical infrastructure; and investing in the poor.

A key component of the ERSWEC policy as relates to the health sector is the introduction of
the National Social Health Insurance Fund (NSHIF) in a phased approach to eventually
achieve universal coverage of free health care to the Kenya Population.




                  Kenya EPI Comprehensive Multi-Year Plan 2006-2010                     11
2.0 Health Care delivery systems

Kenya’s Ministry of Health offers health services through its public sector health facilities that
account for 69% of the 4,634 health facilities in Kenya, while the FBO/NGO and the private
for-profit sector ‘own’ the remaining 31%. However, all EPI services in 3200
Public/FBO/NGO/Private facilities are supported by the Kenya Expanded Programme on
Immunization. The major private health care providers include: AMREF, CHAK/NCCK
(Christian Health Association of Kenya), KCS (Kenya Catholic Secretariat), and the Kenyan
Aga Khan Foundation.

The above listed providers for health services in Kenya are the key actors contributing to the
achievement of the current National Health Sector Strategic Plan (NHSSP II). The NHSSP II
recognizes that ‘reversing the trends’ cannot be achieved by the government health sector
alone. Active involvement and partnership with other stakeholders will be key to achieving
the NHSSP II outputs.

External Policy Environment
The Kenya national health system is operating within the context of international health
initiatives. The achievement of the MDGs is of primary importance

Internal Policy Environment
The policy frameworks within which the Annual Operational Plans and programmes are
implemented include: The Kenya Health Policy Framework of 1994; the NHSSP II 2005-
2010; and the new 10/20 policy on cost sharing. Another potential policy of importance will
be the implementation of the proposed National Social Health Insurance Fund (NSHIF) Act
of 2004 once it is implemented; These form the internal policy environment for programmes’
and AOP’s implementation.

The 1994 Kenya Health Policy Framework and the NHSSP I 1999-2004 fashioned the
implementation of health sector reforms in Kenya.

Kenya’s NHSSP II 2005-2010 aims to reverse the downward trends of most health indicators
by: addressing the poor access to health care and the limited utilization of promotive and
preventive health services; the poor quality of service delivery; limited efficiency and
effectiveness of the support services; insufficient collaboration and coordination with the
other stakeholders that contribute to health provision; and finally the insufficient funding to
health sector.

The overall health sector performance indicators and targets provide the monitoring
framework for NHSSP II and also MOH’s programmes. Targets have been defined on the
basis of the ERS and the MDGs, together with preliminary assessments of what can be
achieved over the five years.

2.1    Policy of the Ministry of Health

The Kenya Health Policy Framework of 1994 provides the health policy and strategic
direction in improving the health status of the population by ensuring provision of equitable
quality health services through a decentralized health system.

The health sector’s vision is to create an efficient and high quality health care system that is
accessible, equitable and affordable for every Kenyan household.

The mission is to promote and participate in the provision of integrated and high quality
curative, preventive, promotive and rehabilitative health care services to all Kenyans.



                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                          12
(The specific issues in the policy that address immunization directly need to be clarified)
refer to the 1994 policy framework

2.2          The National Health Sector Strategic Plan II (NHSSPII)

The goal of the NHSSP II is to contribute to the reduction of health inequalities and to
reverse the downward trend in health related impact and outcome indicators. This will be
achieved through:
   i)      Shifting service delivery from a curative and disease burden modality to a human
           capital development approach, which is named the Kenya Essential Package for
           Health (KEPH). Its approach aims at shifting interventions towards the promotion
           of healthy lifestyles, integration of vertical services and ensuring continuum of
           care, through strengthening the various levels of care across cohorts (from
           community to national referral hospital). Additionally the NHSSP II has introduced
           a Human Rights Approach in all its interventions, in particular when strengthening
           community based health care through the village health committees and
           Community Owned Resource Persons (CORPs)


                Under the new community strategy that aims to bridge the gap between the
                community and the first level of health service provision – the dispensary, each
                dispensary will have a Community Health Extension Worker (CHEW) who will be
                responsible for the training and supervision of the Community own Resource
                Persons (CORPS) under their jurisdiction. In turn each CORP will be responsible
                for the health of 20 households

      ii)       Articulated priorities and outputs that each annual plan should achieve if the
                downward trend of health indicators is to be reversed. NHSSP II acknowledges
                that its effective implementation requires further strengthening of its various
                support systems, such as planning, human resource management, quality
                assurance and health standards, procurement services, infrastructure/equipment
                and communication.
      iii)      The higher level provides overall management support which is needed in areas
                like policy development, joint planning, sector coordination, the institution of
                common resource envelop to which all stakeholders contribute, and a joint
                monitoring/review of performance.

2.2.1        The Kenya Essential Package for Health

The Kenya Essential Package for Health (KEPH) integrates all health programmes into a
single package focused on improving health at different stages of the human life cycle. It
requires a shift in the prevailing paradigm, which is focused on service delivery. NHSSP II
therefore adopts a broader approach that entails moving from the emphasis on disease
burden to the promotion of healthy life styles of individuals, with attention to the various
stages in the human life cycle. In this approach health programmes centre around the
different phases of human development and in this way complement each other, so that
synergy and mutual reinforcement among the programmes can be achieved. Once all
programmes jointly focus on a particular phase in human development, their combined
outputs are expected to be better than each one could have achieved individually. KEPH
distinguishes six distinct life cycle stages:

            Pregnancy, delivery and the newborn child (up to 2 weeks of age)
            Early childhood (3 weeks to 5 years)
            Late childhood (6 to 12 years)



                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                    13
    Adolescence (13 to 24 years)
    Adulthood (25 to 59 years)
    Elderly (60 years and over)
These phases represent various age group or cohorts, each of which has special needs.

2.2.2 Service Delivery
The KEPH approach has defined six service delivery levels:
     Level 1: the community level, is the foundation of the service delivery priorities,
      because it allows the community to define its own priorities so as to develop
      ownership and commitment to health services. Communities will be empowered with
      information and skills. Only in this way can real change towards healthy life styles be
      achieved. (Ref: MoH Community strategy 2006)
     Levels 2 and 3: are respectively, the dispensaries and the health centres and
      maternity/nursing homes, which will primarily handle Promotive and preventive care,
      but also some curative services.
     Levels 4-6: are the primary, secondary and tertiary hospitals, which will focus mainly
      on the curative and rehabilitative aspects of the service delivery package.

2.2.3 Improving Financial Access
The MOH’s plan during the NHSSP II period is to use criteria for strengthening resource
allocation to regions and districts that is pro-poor and gender focussed. More resources will
be targeted to hard-to-reach areas of the country.. In addition, resources will be targeted to
services for women and children, such as Immunization, reproductive health, and services
for women at community level (treated bed nets and deliveries conducted by skilled birth
attendants).
(The above, adopted from the NHSSP II, forms a good introductory section. More
information that is specific to immunization is necessary.)

2.2.4 Improving Health Worker Performance
MOH is taking a number of important steps during the NHSSP II plan period to improve the
performance of health workers at all levels, including developing incentive schemes to
motivate better performance. The competence of service providers will be addressed
through a series of training and performance management initiatives.
(More information that is specific to immunization is necessary.)

2.2.5 Health Planning (Take note of the GoK finance/planning cycle)
NHSSP II sets a specific objective of strengthening district health planning in a way that
focuses on the mutual responsibility of providing necessary resources on the one hand and
achieving the stated targets and outputs on the other. District targets will be fully integrated
into the national health system beginning with the third operational plan for the period –
AOP3. During planning, the districts will be expected to prioritize based on access/utilization
and cost-effective interventions with the aid of a planning guideline.

2.2.6 Monitoring and Evaluation
The objective of the M&E support system is to assist health managers to make informed
decisions and contribute to better quality planning and management. The overall thrust is to
introduce performance based monitoring throughout the system that is linked to performance
indicators, outputs and targets set for NHSSP II. In the meantime, all districts will be
expected to adopt and use the same sector performance indicators for their daily work.
Districts and programmes are expected to add other more specific indicators where needed
to supervise the performance in their respective fields.

With respect to immunization specific indicators, these will be set nationally in line with
global goals (e.g. GIVS) and monitored by the Child-Health ICCs.



                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                         14
2.2.7 Human Resource Management and Development
NSSP II intends to improve the use and performance of the already available personnel,
even as it increases the numbers, quality and mix of the workforce in order to address
shortages. The objectives set in the human resources component involve instituting sound
management principals at the central levels, decentralizing certain functions where
appropriate, building additional human capacity in line with the health needs of the
population, aligning human resource development activities with KEPH priorities, and
making the development of the health sector workforce more demand driven (rather than
supply driven).

It is expected that in the NHSSP II period emphasis will be placed on optimizing staffing
norms of Levels 1,2 & 3 service provision as this is where the bulk of preventive health
activities occur. This should impact positively on immunization service provision.

2.2.8 Quality Assurance and Standards
The major objectives of the quality assurance support system are to ensure the development
and use by all health professionals of clinical standards, protocols and guidelines; to
strengthen patients’ rights; and to revitalize and strengthen the relationships between MOH
and the various professional bodies. Although monitoring of vaccines has been weak, the
establishment of a National Regulatory Authority (NRA) and more involvement of Kenya
Burea of Standards, will strengthen vaccine and biologicals quality.

2.2.9 Investment and Maintenance (Review S.M deal with this)
The objectives for investment and maintenance are to ensure the continuous availability of
care related equipment, reliable energy supply, adequate provision of water and waste
disposal tools (in consultation with the National Environmental Management Authority), and
the ongoing maintenance of equipment and facilities. Moreover, the transport system will be
upgraded to ensure that an adequate number and type of vehicles are available and well
maintained.

All districts will be facilitated with vehicles to conduct supervisory and outreach activities
however all district health activities are to be conducted in a sectarian approach
(More information that is specific for immunization is necessary.)


2.2.10 Performance Monitoring (This section may not be relevant if 2.2.6 is
comprehensively done)
The main shift of NHSSP II is the introduction of performance-based monitoring grounded in
specified and time-bound outputs for both service delivery and support systems. NHSSP II
sets performance indicators that will be monitored during joint annual reviews and the annual
summits. The indicators, and targets have been aligned with the Economic Recovery
Strategy and the Millennium Development Goals.



2.3    Sector Joint Program of Work and Funding (JPWF)

A key shift in NHSSP II is the emphasis on improvement in coordination of activities across
the sector, to enable efficient and effective delivery of services. To this end, the sector is
moving towards initiation of a Sector Wide Approach (SWAp) to guide the implementation of
the NHSSP II.
This move towards better coordination has led to elaboration of a Joint Program of Work and
Funding (JPWF). This is the sector’s multi year operational document that details the key
interventions the sector is focusing on to guide attainment of the NHSSP II objectives, with


                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                       15
their costs, and available financing. As such, it is the sector’s fundable document, guiding
investments in the sector by both Government, and partners.

Identification of areas for investment focus would then require a detailed look at the actual
activities and interventions planned, to ensure added investments are focused in areas
where they would make the highest impact (underfunded areas, and priority areas). This
cMYP is aimed at providing this level of detail for investments in immunization in Kenya,
during the period of the NHSSP II. It is therefore the document that details out, for the period
of the NHSSP II, the operational interventions that are to be focused on to enable
achievement of the immunization related objectives of the sector. It is hoped it will act as a
guide to future investments in immunization in the country..




                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                         16
3.0    SITUATION ANALYSIS

3.1    The Expanded Programme on Immunisation

The Kenya Expanded Programme on Immunization (EPI) was established in 1980 and is
integrated within the Department of Preventive and Promotive Health Services of the
Ministry of Health as part of the Essential Health Package (EHP).

3.2    Programme Structure

The Kenya Expanded Programme on Immunization (KEPI) falls under the Department of
Preventive and Promotive Health services. At the central level the KEPI Management Unit
has the following sub-units: Administration, Logistics, Supplies, Social Mobilization, Disease
Surveillance, HMIS, and Training. The KEPI Manager is assisted by two deputy managers i)
Quality Control and Logistics and ii) the Routine Immunization respectively. EPI programme
management at other levels is carried out by: i) Provincial EPI Logistician who coordinates
EPI programme for all districts in the province; ii) District EPI Logistician coordinates EPI
programme at district level; iii) and at the Facility Level health workers are assigned with the
responsibility for EPI activities. Immunization is carried out alongside Maternal and Child
Health activities such as growth monitoring, nutrition and antenatal care. Decentralized KEPI
functions include programme planning, service delivery at facility level, monitoring and
evaluation. The provincial level has functions of technical assistance to the districts in
planning and training activities, Monitoring and Evaluation, and supervision of districts.
Operationization of EPI activities is at districts level whose functions include preparation and
implementation of work plans, management of health services and district data training and
supervision at the health facility level. At the health facility level, the management
committees have the responsibility of ensuring efficient and smooth running of the health
services through support and guidance to the healthcare staff attached to the facilities; and
health staff provides EPI services. The implementation of EPI activities always aims to
enhance community participation. (Ref: Appendix ?? KEPI Organogram)
(A narrative is inappropriate for structure. Replace above with an Organogram)

3.3    Routine Immunization

The goal set out for the Kenya Expanded Program on Immunization (KEPI) was to reduce
morbidity, mortality and disability due to life threatening infections of childhood. (This goal
excludes children under 15yrs given vaccination in 2002, and presupposes that antenatal
vaccination is only for the benefit of children)

The Government of Kenya provides vaccines for the vaccine preventable diseases free of
charge through the Kenya Expanded Programme on Immunization (KEPI). The targeted
diseases during the plan period were: Tuberculosis, poliomyelitis, diphtheria, pertusis,
tetanus, and measles. Additional new-targeted diseases hepatitis B and Haemophilus
Influenza type b (Hib) and yellow fever were included into the routine immunization in 1st July
2001 in a pentavalent formulation (DPT-HepB+Hib) with support from the Global Alliance of
Vaccines and Immunizations (GAVI) for a period of five (5) years.
(A section that qualifies for the activities below should be inserted here.)

KEPI’s key activities focus on the following areas during the plan period:
       i)     Routine Immunization
       ii)    Supplemental Immunization
       iii)   Integrated Disease Surveillance
       iv)    Integrated Social Mobilization
       v)     Training.



                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                         17
3.3.1 Immunization Schedule for Kenya
The Kenya programme currently offers measles, DPT-HepB+Hib, Polio, BCG and TT
vaccines. Vitamin A supplementation is also administered alongside immunization services.
Traditionally, the programme has been heavily dependent on collaborating partners and
donors for procurement of vaccines, cold chain supplies and other logistics. These partners
include UNICEF, WHO, GAVI, JICA among others.

Measles, DPT-HepB+Hib, OPV and BCG vaccines are given to children under one year of
age and tetanus toxoid vaccine to pregnant women and women of child bearing age.
In order to significantly reduce childhood vaccine preventable diseases, vaccines
administration have been scheduled as follows:

Current Routine Vaccination Schedule for Children under 1 year

Name of the disease       Name of the          Number of     Time of              Route of
                          Vaccine              doses         vaccination          administration
Tuberculosis              BCG                  1             Birth                Intradermal
Poliomyelitis             OPV                  4             Birth, 6,10,14 wks   Per oral
Diptheria                 “Pentavalent”        3             6,10,14 wks          Intramuscular
Pertusis
Tetanus
Hepatitis B
HiB
Measles                   Measles              1             9 months             Subcutaneous
Yellow fever (Selected    Yellow fever         1             9 months             Intramuscular
districts)
Vitamin A deficiency      Vitamin A            1             9 months             Per oral

Current Routine TT Vaccination Schedule for women

Place              Doses        Starting time                       Route
Coast Province     5            15 yrs                              Intramuscular
Other Provinces    5            1st contact during pregnancy        Intramuscular

For the successful intervention against other childhood infections, the programme has
incorporated vitamin A in all Service delivery points for routine administration to children from
6 months up to 59 months at 6 month intervals as well as postnatal mothers within two
weeks of delivery.

3.4     Routine Immunization Performance, Gaps and Challenges


3.4.1   Strategies Used

During the plan period, investments and strategies will be put in place to improve the
performance of EPI. This includes Sustainable out reach services (SOS) through the
Community Strategy and the Reaching Every District (RED) approach,
(More data on SOS, section 3.5 RED will fit here, other strategies thro GAVI support and
integrated out reach if any)




                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                          18
3.4.2 Performance and Gaps
Based on information from KEPI’s Annual operational reports, immunization coverage
reports, programme sector’s assessment reports, programme evaluation reports, findings of
surveys carried out during the plan period, and the KEPI review of April 2006. The EPI
performance during the plan period under review (2001 – 2005) was documented as follows:
     Routine immunization trends from 1994 to 2005, which included the plan period
        under review (2001 t0 2005) increased steadily but slowly. Generally, the overall
        immunization coverage in the country for all antigens has been steadily increasing
        from the year 2000, but to date the rate of increase is unacceptably slow.

       By the end of the year 2005, DPT3 [Penta 3] coverage in Kenya was second only to
        BCG at 75 percent. Central and Eastern Provinces were leading with a DPT/Penta3
        of 88 and 81 percent respectively.

       Nationally, measles routine immunization is on an increase, but the levels of increase
        although started very low at 37 percent coverage in 1993, have not increased as fast
        as desired. Measles immunization coverage is currently only at 65 percent coverage,
        a level that is not sufficient for controlling outbreaks.

Table showing proportion of districts having various coverage performances

NB: Total districts =78

         Coverage %          2003       2004         2005         2006           Remarks
                                                  (Jan-Dec)    (Jan-June)
       >80% fully            24/78     25/78        16/78         15/78
       immunized                                                             Between 80% -
                           (30.7%) (32.0%)        (12.5%)        (11.7%)     100% of districts
                                                                             should have this
                                                                             type of coverage
       50-79% fully          40/78     36/78        46/78         43/78
       immunized                                                             Less than 20% of
                           (51,2%) (46.1%)        (35.9%)        (33.5%)     districts should
                                                                             have this type of
                                                                             coverage
       <50% fully            14/78     17/78        16/78         20/78      No district
       immunized                                                             should have this
                           (17.9%) (21.7%)        (12.5%)        (15.6%)     low level of
                                                                             children fully
                                                                             immunized


Table 2 showing level of attrition from the immunization schedule at one year of age (Pent 1
to Measles Drop out 2005 and Jan - June 2006)

DROP-OUT RATE               2003         2004           2005              2006                        Remark
(DPT-1 to Measles)        Jan-Dec      Jan-Dec        (Jan-Dec)        (Jan-June)

<10% drop-outs              14/78         11/78     20/78 districts   39/78 districts Between 80% - 100% o
                           (18%)         (14%)                                        have this level of drop-o
                                                       (15.6%)           (30.4%)


                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                       19
11-20% drop-outs                44/78           23/78      19/78 districts     20/78 districts Less than 20% of distric
                               (56%)           (72%)                                           this level of drop-outs
                                                              (14.8%)             (15.6%)
> 20% drop-outs                 20/78           44/78      39/78 districts     19/78 districts No district should have
                               (26%)           (33%)                                           children dropping out o
                                                                (30.4%)           (14.8%)      immunization schedule

Source: KEPI


A summary of detailed situational analysis is presented in Table 2.

Table 2: A summary of Routine Immunization Achievements

Component         Achieved                                         National
                  Indicators
                                          2001          2002         2003         2004       2005
Service           Antigen
Delivery
                  BCG                     79%           80%        89% (87.3      92%         94%
                                                                     KDHS

                  Polio 3                 56%           62%           71%         73%         68%
                                                                   (72.2)KDH
                                                                       S)*
                  NIDS/SNIDS             SNIDS          SNID         SNID         SNID       SNID
                  conducted for Polio

                  DPT/PENTA 3             65%           66%       73% (72.5)      76%         77%
                                                                    KDHS*
                  MNT
                  TT2+                    34%           29%        66%(51.9)      69%         71%
                                                                     KDHS
                  SIAs conducted for                    SNIDs
                  MNT

                  Measles                 56%           69%          65%          67%         69%
                                                                    (72.5)*
                                                                    KDHS
                  NIDS/SNIDS                            NIDs        SNIDs        SNIDs       SNIDs
                  conducted for
                  Measles

                  Yellow Fever**           -              -          58%          53%         39%
                  NID/SNIDs for                         SNIDs                                SNIDs
                  Yellow Fever

                  Fully Immunised         46%           46%        55% (--)*      59%         61%

Vaccine           National stock out       _        BCG Sept          _             _      BCG- Sept
Supply, quality   of vaccines                        & Oct                                   & Oct
and Logistics     reported during the                                                      TT- Feb
                  year.                                                                    Measles –
                                                                                           April
                                                                                           OPV - July
                  Number of districts     ALL           ALL          ALL          ALL         ALL
                  using AD syringes
                  for vaccine safety.   GAVI/GOK    GAVI/GOK      GAVI/GOK      GAVI/GOK   GAVI/GOK

Advocacy and      Availability of a        -             Yes         Yes          Yes         Yes
Communication     communication



                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                  20
                          plan (At national
                          level and district
                          level during
                          NIDs/SNIDs)
Surveillance              Completeness for         84%             85%         82%             100%      100%
                          routine EPI of
                          district reporting to
                          national level
                          Timeliness for           56%             65%         80%             72%       92%
                          routine EPI of
                          district reporting to
                          national level



Programme                 Number of ICC              4              4              4            4         4
Management                meetings held
                          (Child Health
                          included in ICC
                          since 2005)


Source: KDHS 2003

                                 Trends of selected Routine immunization Antigens 2001 -2005

                100

                                                                                                    94
                                                                               92
                90                                            89


                80        79                 80
                                                                               76                   77
                                                              73               73
                70                                            71                                    71
                                             69                                69                   69
                                                                                                    68
                                             66               66               67
                          65                                  65                                              BCG
                                             62                                                     61
                60                                                             59                             OPV3
                                                              58
  % Coverages




                          56                                  55                                              Penta3
                                                                               53                             TT +
                50
                                                                                                              Measles
                          46                 45                                                               YF
                40                                                                                  39        FUC
                          34
                30                           29


                20


                10


                 0
                       2001               2002             2003             2004                2005
                                                           Years




Table 3: Yellow Fever Immunization Coverage 2001-2005 consider comparing with
measles coverage

Rift                  Coverage Coverage Coverage Coverage Measles Coverage                               Measles
Valley
Province                2001     2002     2003     2004    2004     2005                                  2005
Baringo                No data       No data         49%            48%             54%          39%          55%
Marakwet               No data       No data         31%            41%             74%          23%          81%
Keiyo                  No data       No data         62%            47%             89%          22%          88%
Koibatek               No data       No data         92%            76%             84%          73%          78%



                               Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                    21
Source; Ministry of Health KEPI-Routine Immunization Data


3.4.3   Accelerated Disease Control Activities

Starting 1996, there have been mass vaccination campaigns conducted in Kenya. Those
planned for this year (2006) are for polio, measles and maternal & neonatal tetanus control
and prevention. Also, there will be more SIAs for the coming years. For districts especially at
high risk of importation of wild poliovirus, the SIAs will continue from time to time until
certification of polio eradication is achieved in the African Region.
(More elaboration on the campaigns done so far, and its impact eg elimination of the threat of
importation of wild polio virus from neighbouring countries, the dramatic morbidity and
mortality drop of measles after the 2002 campaign etc.)

3.5      Reaching Every District (RED) Approach
Innovations to improve routine EPI activities for achievement of the fourth Millennium
Development Goal (MDG4) have been supported by the Ministry of Health and its partners.
One of these is the RED Approach strategy that has been implemented since 2003 in all 78
districts. An evaluation of the strategy carried out in 2005 in four districts (Busia, Garrisa,
Isiolo, and Siaya) showed a steady increase in vaccination coverage between 2002 and
2005 which was attributed to the additional resources from partners for the strategy.
(Reference)

3.6    Populations at risk of missing Immunisation Services
Some regions of Kenya are hard to reach such as the arid and semi-arid areas inhabited by
pastoralists groups. These areas have been identified and special intervention strategies
have been designed. Also in the same category are the non-immunised refugees and
migrants who come into the country through the country’s porous borders in the Northern
and North Eastern Region.

3.7     Disease Surveillance
In 2002 Kenya adopted the strategy on Integrated Disease Surveillance and Response
(IDSR) and adapted the WHO/AFRO generic guidelines and training. KEPI is implementing
integrated surveillance activities for measles, NNT and AFP with linkages to other IDSR
diseases.

The health facility trained EPI focal person is responsible for case definition, information
recording of suspected cases, use of local laboratory to help diagnose suspected cases,
through collection and transportation of clinical specimens for investigations in district
hospitals. The District Disease Surveillance Coordinators (DDSC) ensures quality of
surveillance activities is undertaken at the district level. The Provincial Medical Officer is
charged with coordination of surveillance activities with the assistance of the Provincial
Disease Surveillance Coordinator (PDSC). The specimens are collected and transported
from the provincial level to EPI Unit at central level which in turn sends to the National
Reference Laboratory, Kenya Medical Research Institute (KEMRI) for investigations.

The Kenya Medical Research Institute (KEMRI) is also involved in the planning and
implementation of surveillance activities, particularly for AFP and measles.

3.7.1   AFP Surveillance

The AFP surveillance in Kenya has improved significantly since 1997. Since the year 2003
Kenya has consistency done well in meeting the major indicators for AFP surveillance as
depicted below. As such, the country is on course for certification in 2007.


                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                        22
Table 4: Results of Acute Flaccid Paralysis (AFP) indicators for 2002 – 2005

  INDICATORS                                                2001         2002      2003        2004                                2005
  No. AFP detected                                          267          252       309         137                                 268
  No of AFP detected Rate                                   1.83         1.71      2.19        2.0                                 1.94
  Stool Adequacy (80%)                                      64.4         75.8      82          92                                  87
  Non Polio Entero virus isolation (10%)                    8.2          7.4       10.5        9.8                                 8.6
  60 day follow up (80%)                                    65           82.4      84          80                                  90
  Report timeliness (80%)                                   56           65        73          76                                  92
  Report completeness (80%)                                 84           85        82          100                                 100
Source: KEPI


                      100%                                                                     3
                      90%




                                                                                                     Non-Polio AFP Rate /100,000
                                                                                               2.5
                      80%
   % Stool Adequacy




                      70%
                                                                                               2
                      60%
                      50%                                                                      1.5
                      40%
                                                                                               1
                      30%
                      20%
                                                                                               0.5
                      10%
                       0%                                                                      0
                             1997    1998   1999   2000   2001   2002   2003    2004    2005

                                         % StoolAdequacy         Non-polio AFP rate**

The introduction of a “late stool questionnaire” tool to collect information from all late cases
(cases investigated after 14 days following paralysis onset) has greatly improved
performance of AFP surveillance.
The challenges were Non-Polio Entero virus isolation of less than the 10% target and the
regional disparities in performance. However, it is gratifying to note that all the high-risk
areas of wild polio virus importation, North Eastern and Nairobi Provinces, have consistently
met all the key targets.




                                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                     23
                                                 AFP Surveillance Major Indicators 2005

                                                                                                                                                                4.8
                           98




                                                                                                                                                                           Non-Polio AFP Rate
                                                                                                                                                                3.6
        Stool Adequacy




                           92


                                                                                                                                                                2.4
                           86


                           80                                                                                                                                   1.2

                                                                                                                                                                                     Target
                           74                                                                                                                                   0                    80% Stool adequacy
                                    Central Coast EasternNairobi
                                                               N/Eastern yanza Rift Western
                                                                       N                  National                                                                                   1/100,000 Non AFP
                                                                              Valley

                                    % AFP cases with adequate stools                                            Non-Polio AFP Deection Rate

(Juliet to provide the 2005 data for bar graph production on stool adequacy and case
detection, then in the annexes we will have two maps showing districts for red, yellow and
green again on the stool adequacy and detection rate)

3.7.2 Measles Surveillance
Measles case based surveillance was introduced in the EPI programme during the June
2002 National measles catch-up campaign to monitor disease burden on morbidity and
mortality in the country. The data below shows the confirmed measles cases in Kenya 2001
– 2005.

Table 5: Number of Confirmed Measles Cases from January 2002 to March 2006

                                           Measles
                         120                    Number of Laboratory-Confirmed Measles Cases by Month of
                                                       Onset, January 2002 – March 2006, Kenya


                         100                                                   Introduction of case-
  Number of Cases




                                                                               based
                          80

                          60

                          40

                          20

                           0
                                           ay




                                                                                ay




                                                                                                                     ay




                                                                                                                                                         ay
                                                                    ov




                                                                                                         ov




                                                                                                                                             ov




                                                                                                                                                                                   ov
                                     ar




                                                                          ar




                                                                                                               ar




                                                                                                                                                   ar




                                                                                                                                                                                                 ar
                                                                                                                                   p




                                                                                                                                                                       p
                                                  l




                                                                                       l




                                                                                                                            l




                                                                                                                                                                l
                                                         pt




                                                                                              pt
                               02




                                                                   03




                                                                                                        04




                                                                                                                                            05




                                                                                                                                                                                  06
                                                Ju




                                                                                     Ju




                                                                                                                          Ju




                                                                                                                                                              Ju
                                                                                                                                Se




                                                                                                                                                                    Se
                                                                 N




                                                                                                      N




                                                                                                                                          N




                                                                                                                                                                                N
                                    M


                                          M




                                                                         M


                                                                               M




                                                                                                              M


                                                                                                                    M




                                                                                                                                                  M


                                                                                                                                                        M




                                                                                                                                                                                                M
                                                      Se




                                                                                           Se
                            n-




                                                                n-




                                                                                                     n-




                                                                                                                                         n-




                                                                                                                                                                               n-
                          Ja




                                                              Ja




                                                                                                   Ja




                                                                                                                                       Ja




                                                                                                                                                                             Ja




                                                                                                          Time

Source: KEPI

3.7.3                     Haemophilus Influenza Type b (Hib) Surveillance and PBM

In 2001 a paediatric Bacteria Meningitis – Haemophilus Influenzae (PBM-Hib) surveillance
site was established at Kenyatta National Hospital to monitor trends in Hib meningitis among



                                                  Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                   24
under five children under five years presenting with meningitis in order to assess the impact
of the newly introduced Hib pentavalent vaccine. Kilifi district hospital started Hhib
surveillance started in 1994 before theHib vaccine was introduced in Kenya. The chart
below shows confirmed Hib cases from the Kilifi site and demonstratingted the reduction of
of hib cases towards the end of 2003.


                     Laboratory-Confirmed Hib in Children under 5 Years, Kilifi District Hospital, 1994-2004
                                                                                Vaccine
                                                                              Introductio
                30
                                                                                   n


                25



                20
   Frequency




                                                                                                               Pulm Asp
                15                                                                                             BC
                                                                                                               CSF

                10



                5



                0
                 n- 94


                 n- 95


                 n- 96


                 n- 97


                 n- 98


                 n- 99


                 n- 00


                 n- 01


                 n- 02


                 n- 03
                  l-D 94


                  l-D 95


                  l-D 96


                  l-D 97


                  l-D 98


                  l-D 99


                  l-D 00


                  l-D 01


                  l-D 02


                  l-D 03


                        04
               Ja e c


               Ja e c


               Ja e c


               Ja e c


               Ja e c


               Ja e c


               Ja e c


               Ja e c


               Ja e c


               Ja e c
               Ju un


               Ju un


               Ju un


               Ju un


               Ju un


               Ju un


               Ju un


               Ju un


               Ju un


               Ju un


                      n
                    Ju
                    J


                    J


                    J


                    J


                    J


                    J


                    J


                    J


                    J


                    J
                 n-
               Ja




Source: KEMRI, Welcome trust, Kilifi
In addition, pediatric bacterial meningitis with special focus on pneumoccocal surveillance is
being conducted in five other hospitals across the country to document the burden of
disease due to pediatric bacterial pneumoccocus. The burden of disease so established is
expected to support the introduction of an appropriate pneumoccocal vaccine in future.



ROTAVIRUS
Diarrhoea caused by Rotavirus is thought to be a major cause of mortality in Kenya as in the
other African countries. Surveillance has therefore been initiated in order to establish the
burden of disease among children presenting with severe diarrhea. Although the surveillance
activities are currently limited to Kenyatta National Hospital, more sites will be introduced in
different parts of Kenya over the next 2 years so as to take care of regional variation.


3.7.4          Maternal Neonatal Tetanus Surveillance
Maternal and neonatal elimination efforts started in 1987. The main objective was to eliminate neonatal
tetanus by 1995. However, this goal was not realized and had to be reviewed along with new strategies
for other EPI diseases.


                              Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                           25
Aggressive efforts started in 2000 with emphasis on case based surveillance and introduction of the
5TT schedule. Health workers have been trained in MNT case detection, investigation and reporting
using the standard case investigation form. In 2003 the tetanus toxoid coverage for pregnant women
who received at least one dose of TT was 87%-90% but only 52 % of the pregnant women received the
recommended minimum two doses of TT. The coverage has since improved to 73% for TT2+.


3.8     EPI Diseases Outbreak and Response

3.8.1   Measles Outbreaks

Since 2003 Kenya has experienced sporadic measles outbreaks with the most recent in
2005/6. Following each outbreak, Mop-up campaigns including the administration of Vitamin
A, were conducted.

3.8.2   Polio Outbreaks

Kenya has had no reported case of wild poliomyelitis since 1984. However there is a threat
of Polio importation from Somalia, Ethiopia and South Sudan.

In order to accelerate the country’s Polio-free certification process, three committees have
been launched. These are: Polio Certification Committee (NPCC); National Polio Eradication
Expert Committee (NPEC) and the National Task force for the laboratory containment of the
wild polio virus (NTFLCPV)

3.8.3   Neonatal Tetanus

Maternal and neonatal tetanus elimination efforts started in 2000 through case based
surveillance and vaccination campaigns in 10 high risk districts. Health workers have been
trained in detection, investigation and reporting of any single case of NNT using a standard
case investigation form.

3.9     Data Management and EPI Reporting System

Routine Immunization and disease surveillance data are reported on a monthly basis except
for AFP data, which are reported on a weekly basis. Reports are sent from health facilities to
districts where information is consolidated and forward to the respective provincial levels.
Provinces processes the data and forwards the same electronically (using an
epidemiological programme) to the National level. Monitoring for completeness and
timeliness immunization coverages, vaccine wastage rates and disease surveillance data is
done at all levels.
Currently the software is in use at the National, Provincial, and only 3 out of 78 districts.

3.10    Vaccine Quality, Supply and Utilization

3.10.1 Vaccine Funding, Forcasting, Procurement and Distribution (S.M fix this)

(Table showing sources of funds for vaccines and proportion to the overall budget for each
contributor. Gaps can also be reflected on the same table, if any)
The EPI Unit does forecasting and ordering of vaccines and supplies. Forecasting is done
annually every September based on vaccine needs, which are normally estimated with
support from UNICEF and WHO. All vaccines for the programme are procured from
UNICEF/WHO pre-qualified manufacturers.


                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                           26
Procurement is done by GOK (MOH/KEPI) through UNICEF with the support of development
partners –WHO, UNICEF, GAVI, JICA, DFID. GAVI vaccine fund has also supported in the
procurement of the new pentavalent antigens. The normal Government of Kenya (GOK)
procurement procedures are followed.

In 2001 JICA supported sub NIDs with the procurement of vaccines through UNICEF. During
the FY 2002/3 GoK established a financial vote for vaccines in KEPI. This subscription,
though not much, was an indication of the GOK‘s commitment to sustain the immunization
services being provided by KEPI in the country.

Table 6: Vaccine Procuring Process and responsibility by year.

ANTIGEN                              PROCURING AGENT        YEAR
BCG                                  GOK                    2001 –2006
OPV                                  GOK                    2001 –2006
TT                                   GOK, UNICEF            2001- 2006
MEASLES                              GOK, DFID              2001- 2006
PENTA/YELLOW FEVER                   GAVI                   2001 – 2006
Source: KEPI

All vaccines procured are those recommended in the Ministry of Health KEPI Immunization
schedule.

These vaccines are registered by the Pharmacy and Poisons Board of Kenya under Cap 244
of the Laws of Kenya for the registration of drugs. However, the registration process is not
yet fully developed in the country, as Kenya has no laboratory that could be used to test
biological products and vaccines. Thus, the registration of vaccines is accomplished on the
basis of information from the manufacturers and laboratory from the country of origin. There
is no testing of the viability and potency of vaccines on arrival in the country.

Vaccines are supplied as per the schedule below; these periods for different levels have
been determined using the guidelines in the vaccine manual.

        National level          -     6 months
        Regional level          -     6 months
        District level          -     3 months
        Health facility level   -     1 month

Vaccines are ordered using the tools developed from the standardized vaccine management
guidelines plus other tools recommended in the GOK procurement procedures e.g. S12, S11
etc.

There has been a number of nationwide Stockouts of vaccines and these have been
associated with suppliers’ noncompliance with target delivery dates. Also there has been
localized Stockouts linked to lack of transport for the collection and delivery of vaccines to
depots or user points.

The following vaccine stock outs were experienced periodically between 2002-2006: BCG,
TT, Measles, “Pentavalent” and OPV.
There have been no stock-outs experienced for the Yellow Fever vaccine.




                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010                     27
3.10.2 Utilization of Vaccines

Multi-Dose Vial Policy (MDVP) has been adopted in the EPI programme at all levels and
since its introduction vaccine wastages have been reduced.

In February 2002 the EPI Unit with the support from development partners developed the
vaccine management guidelines, these have been distributed to all Districts and immunizing
centers.

The introduction of the vaccine vial monitors (VVM) by UNICEF in 1997 has helped in
reducing vaccine wastage. The BCG, DPT, HIB/HEB, TT and measles vials are being
supplied with the VVM markers.

However, vaccine wastage is still a challenge for the EPI programme with most SDPs still
having gaps in wastage management.



3.11   Cold Chain

3.11.1 The National and Regional Vaccine Stores

The Central Vaccine Store is located in Nairobi; it has adequate storage capacity for Penta 3
vaccines. In addition to vaccines, the central store stocks syringes and safety boxes supplied
under the GAVI bundling policy, also those procured by other donors, and also stocks cold
chain spare parts. There are five regional vaccine stores located in Nakuru, Mombasa,
Kisumu, Nyeri and Garissa. The central and regional stores have a 50 KWA standby
generator with automatic changeover.

Currently all the 275 District Hospitals and all the 875 Health Centers are fully cold chain
equipped. However, only fifty percent (50%) of the 4,049 Dispensaries are cold chain
equipped. This gives a total of 75% - 80% of the GOK health facilities well equipped with
cold chain equipment.

Most cold rooms are now getting old, with the Mombasa and Kisumu cold rooms being the
most problematic.
Most of the regional cold rooms are now old, with the Mombasa and Kisumu cold rooms
being unserviceable. The cold rooms are managed jointly by KEPI and KEMSA.
Currently the stock management is manual with quarterly reports collected during the
quarterly vaccine distribution. At Central level there are four cold rooms with a total capacity
of 100.5m3 . This capacity is adequate although unreliable due to frequent equipment failure
and irregular supply of fuel. The regional cold rooms have capacities of 17m 3 . The capacity
has been inadequate since the introduction of Pentavalent vaccine.

3.11.2 Cold Chain Equipment

The Cold Chain Equipment was supported by DANIDA, WHO, UNICEF, and JICA among
others. However, these now require replacement with CFC compliant equipment.

The cold chain equipment status as at 2006 at all levels is as below:

      National level has three (3) cold rooms and one (1) freezer room for Polio and
       Measles vaccines;
      Regional (provincial) level – four (4) freezers and one cold room;


                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                         28
      District level – all district hospitals have two freezers, one (1) Sibir refrigerator for
       Pentavalent vaccines, and Eight (8) cold boxes;
      Health Center and Dispensary level – Health Centers and Dispensaries have one (1)
       RCW 42 EG RCW5O EG refrigerator for storing all vaccines. The RCW 42 EG is
       gradually being phased out and being replaced with the RCW 50EG
      North Eastern province health facilities have been supplied with solar refrigerators,
       best suited for this environment and sunlight is quite adequate. The province has no
       electricity supply, and delivery of gas to the far flung health facilities proofed difficult.

There is a regular annual cold chain inventory being conducted, but is often incomplete due
to poor response from the districts. This assists KEPI in equipment forecasting and
preparing the replacement plans. At the central level there is an annual preventive
maintenance plan, but the challenge has been funding, transport, staff capacity in some
districts and the irregular supply of spare parts.


The refrigerators at the health facility level use both electricity and gas. KEPI allocates funds
annually for the gas supply even where the cold chain depends on electricity to avoid any
immunization disruption.

Commodity distribution
This has been handed over to KEMSA since 2003 while vaccines distribution is still being
done by KEPI. Districts have complained of poor distribution of these commodities and the
overall coordination. It is an integrated distribution system where all commodities are
delivered together for all the health programmes. This has not been very smooth and
discussions are on-going between KEPI and KEMSA on how to improve this system

3.12   Transport

The EPI Unit’s Administration and Support Services is responsible for the transport
management. The following is the current transport fleet for EPI programme:
 Every district should have at least one double cabin pickup available for both vaccine
    supplies distribution and for supportive supervision.
 Motorcycles were introduced in every district in 1995 for the integrated disease
    surveillance.
 At central level there are currently four trucks in operation. These trucks have been
    procured for vaccine delivery to provincial and district levels through the support of the
    following donors:
         o      In 1985 DANIDA, procured the first lorry, which is currently out of the road.
         o      In 1989, UNICEF bought one lorry with Italian Government support
         o      Then JICA bought one Toyota lorry
         o      In 2000 JICA bought two trucks
Currently, only two trucks are in a serviceable condition while another two need
rehabilitations and total overhaul
The island districts of Lamu, Siaya, Kwale and Suba each received a motorboat through the
DANIDA support. However, these motorboats are no longer operational due to high
maintenance costs. The last transport study was carried out by DANIDA in 1994 which calls
for a new study soon. Currently most of the districts KEPI vehicles are no longer serviceable.
Motorcycles have been supplied to all districts to strengthen surveillance activities and data
collection. KEPI vehicles are supposed to be replaced after every 5 years, but never adhered
due to lack of resources.



                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                             29
3.13   Injection Safety and Health Care Waste Management

3.13.1 Injection Safety

The KEPI’s Injection Safety and Immunization Waste Management sub unit, which is under
the Logistics and Cold Chain Maintenance unit, has developed strategies and annual
operational plans guided by both the Public Health Act Caps 242 of the Laws of Kenya and
the Environmental Management and Coordination Act of 1999.

The Kenya Injection Safety and Immunization Waste Management Plan of Action 2001-
2005, has laid out strategies and actions to be under taken in KEPI’s implementation of the
national policy document on injection safety and health care waste management of 2001.
The Auto Disabling syringes (ADs) were introduced into immunization services in July 2001,
currently all health facilities are receiving AD syringes for immunization services. All ADs and
reconstitution syringes are supplied with adequate safety boxes for safe disposal of sharps.

3.13.2 Waste Management
In the past waste management at the health facility level has been through open burning, pit
latrine, dumping, and incineration. Since the introduction of pentavalent vaccine there has
been a lot of waste generation from the use of AD syringes, safety boxes etc.

The EPI programme is currently implementing waste management and injection safety in
collaboration with JSI. In addition, construction of incinerators is on going, already fifty (50) -
Den Mont incinerators have been constructed with UNICEF support. The eventual target is
for all districts to have an incinerator. Health facilities with no incinerators are using the “burn
and bury” (BnB) method.
The challenges in this area include inadequate number of trained waste management
personnel, lack of assessment and routine supervision, inadequate number of incinerators,.
The waste management plan is still in draft form and there is low community awareness on
health care waste management. Others Challenges include:
 Low priority in Ministry of Health on HCWM among other competing priorities.
 Inadequate funding towards HCWM.
 Regulatory instruments on HCWM still in draft form.
 Lack of a Legal framework
Incineration is the preferred method of disposal due to the following reasons:
       o Various incineration technologies available is already a great investment.
       o Incinerators are capable of significantly reducing the waste.
       o Affordability of technology compared to other technologies like; autoclaving and
           shredding.

3.13.3 AEFI Surveillance
AEFI surveillance began in 2002 during the measles catch-up campaign. However,
guidelines were not developed, although generic WHO tools were adopted. Training of staff
on AEFI investigation, management and reporting has not been covered adequately. As a
result AEFI surveillance data is unavailable.

3.14   EPI Communication, Social Mobilisation and Advocacy,

The EPI programme has always felt the need to establish intensive communication and
social mobilization interventions in its programme planning with the intention to increase the
public’s awareness and participation in routine immunization, NIDs, and integrated disease
surveillance through behaviour change. At the EPI Unit, the National Social Mobilization and



                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                            30
Communication Officer works in collaboration with technical staff and focal persons at
provincial and district levels.

Currently there is no policy nor other document that outlines communication strategies for
EPI routine and supplemental activities. For routine immunization, there is no permanent
committee, unlike in the supplemental immunization activities (SIAs) where committees
oversee issues such as material production and conduct preparatory activities.

A National Social Mobilization and Communication Committee formed in 2002, but focuses
only on supplemental immunization activities (SIAs). During the SNIDs social mobilization
campaigns, sub-committees have been formed at national, provincial, district and divisional
levels. These committees are responsible for planning, organizing and guiding
implementation of social interventions at their respective levels.
Communication materials for routine immunization, surveillance and supplemental activities
are available in health facilities in form of posters, leaflet, fact sheets, manuals, training
guides and immunization schedule charts. In addition, radio, newspapers, television,
megaphones and health talks are used to disseminate EPI messages.

On advocacy, the Interagency Coordinating Committee (ICC) on EPI is the major organ
responsible for EPI resource mobilization.




                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                       31
4.0    Implementation of the EPI Comprehensive MYP 2006-2010

4.1    The National Health Strategic Plan II, GIVS and the cMYP

The NHSSP II (2005 – 2010) and the Joint Programme of Work and funding (JPWF) for the
Health Sector Wide Approach was developed through a consultative process and
consolidation of work programmes from the various programmes and central Ministry of
Health departments in 2005 and 2006 respectively.

The JPWF outlines the operationisation of the NHSSP II and the different programmatic
areas including immunization. The prevention and treatment of Vaccine Preventable
diseases is outlined as key intervention for the health sector to implement during the time
period.

This Comprehensive Multi Year Plan takes account of the immunisation component as
outlined in the NHSSP II while taking cognizance of GIVS, which will determine activities,
government and immunization partners investment decisions in immunization activities over
the NHSSP II time period. It acts as an advocacy document for sector-funding. The actual
implementation will be elaborated in the annual implementation plans in line with MYP
activity timeline below (section 8). The detailed activities to be carried out for the respective
immunization operation systems are outlined in section 7, tables 8.1 – 8.5 of this cMYP,
whereas the timeline and costing are in sections 8 and 9 respectively. This relationship is
outlined in the table below.

Table 7: Time Frames for NHSSP II/POW, cMYP and AOPs/annual implementation
plans

                             2004/5      2005/6     2006/7      2007/8     2008/9      2009/10
NHSSP II & POW
Immunization cMYP
Annual Implementation        AIP 1       AIP 2      AIP 3       AIP 4      AIP 5       AIP 6
Plan (AIP)
 (I find the above table confusing. It shows 3 different plans covering different periods without
showing a deliberate inter-linkage)




                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                          32
                        NHSSP II 2005 - 2010


                          AOP 6             AOP 1
                                                                              MDGs
                                                                                  GIVS
                                   cMYP
                   AOP 5                         AOP 2



                          AOP 4             AOP 3




4.2       The Kenya Expanded Programme on Immunization (KEPI)

KEPI falls within the Department of Prevention and Promotive Health services of MOH. This
cMYP has been developed by KEPI based on the priorities referred to in the NHSSP II. In
addition, the plan is further guided by evidence gathered through a desk review of the
programme for the period 2001 – 2005 carried out in March 2006. This process has been
enriched by a financial analysis and costing of the cMYP to apportion available funds and
highlight funding gaps. Covering the period 2006-2010, the cMYP focuses on the main
components of the immunization operational and support systems with key strategies and
activities aimed at addressing national priorities identified by MOH and supplemented by a
thorough programme-based situational analysis. In each of the next five years beginning
with 2006, annual EPI plans will be derived from this cMYP.

4.3       KEPI Goal

The overall focus of the immunization activities is to actualise the intervention to prevent
Vaccine Preventable Diseases, as outlined in the NHSSP II and GIVS. (This is elaborated in
the programme goal, which is to increase access to immunization services, provide effective
and potent vaccines and increase demand for the services in order to reduce infant morbidity
and mortality rates due to vaccine preventable diseases. – This goal, as in 3.3, needs to be
revised as it is not in-line specifically with GIVS Strategy 4 “Expand vaccination beyond
traditional target group)
Suggested goal should be:
Increase access to traditional and new immunization services, provide effective and potent
vaccines and increase demand for the services in order to reduce morbidity, mortality and
disability due to vaccine preventable diseases.

4.4       Programme Objectives
         To fully immunize at least 80% of infants in all districts against childhood
          immunisable diseases before attaining the age of 12 months by 2010;




                      Kenya EPI Comprehensive Multi-Year Plan 2006-2010                  33
              To reduce child mortality by increasing the National coverage of one-year old
               children immunized against measles to 85% by 2009 in-line with MDG 4;
              To eliminate maternal neonatal tetanus by 2008 through vaccination of all pregnant
               women and women of childbearing with at least two doses of tetanus toxoid vaccine;
              To sustain high community awareness on the importance of completing the
               immunization schedule.
              To achieve polio free status and certification by 2008
              Contribute to the strengthening of the National Health System

The defined coverage, and wastage objectives the sector is focusing on are detailed in the
table below.
                                             Coverage targets                 Wastage targets

  Type of Vaccine                     2006    2007     2008     2009   2006   2007     2008     2009
  Routine Immunization                 (%)     (%)     (%)      (%)    (%)     (%)      (%)     (%)
  Traditional Vaccines
       BCG                            90%     90%      95%      95%    75%     70%     60%      60%
       TT - Pregnant women            75%     80%      85%      90%    35%     30%     25%      20%
       TT - Child bearing age women   20%     25%      30%      35%    35%     30%     25%      20%
       Measles                        70%     75%      80%      85%    50%     45%     40%      35%
   OPV(1)                             85%     90%      90%      90%    20%     15%     10%      10%
  Underused and New Vaccines
       Yellow Fever                   50%     60%      70%      80%    50%     45%     40%      35%
    DTP-Hep B-Hib(1)                  85%     90%      90%      90%    12%     10%     10%      10%
  Campaigns                           (%)     (%)      (%)      (%)    (%)     (%)     (%)      (%)
       Polio                          90%     90%      90%             15%     15%     15%
       Measles                        95%                       95%    15%                      15%
       MNT campaigns                  80%              80%             15%             15%
       Outbreaks                      95%



4.5            Strategic Areas

The 2006-2010 Comprehensive EPI Plan shall be implemented within the framework of
Global Immunization Vision and Strategies (GIVS) in the four main strategic areas namely:
   i. Protecting more people
  ii. Introducing new vaccines and technologies
 iii. Integrating immunization, other linked health interventions, and surveillance in the
      health systems context
 iv. Immunizing in a context of global interdependence.

Activities for the above areas have been outlined within the immunization system
components summarized as:

  i.         Service Delivery
 ii.         Vaccine Supply, quality and Logistics
iii.         Disease Surveillance
iv.          Advocacy, social Mobilization and Communication
 v.          Programme Management

4.6      Priority Targets
Priority targets highlighted




                             Kenya EPI Comprehensive Multi-Year Plan 2006-2010                         34
Each component of the system has a set of planned activities with different targets for each
year up to 2010. These targets have been outlined in section 7, tables 8.1 to 8.5 that are to
be accomplished in order to achieve the objectives.

4.7    Governance and Partnerships

The implementation of the NHSSP II will be guided through Annual Work Plans, which are
based on activities outlined in the District Integrated annual work plans and Annual Work
Programmes for Central MOH departments. The cMYP will be used to develop Annual Work
Programmes for EPI.

Coordination of partners is done through the Child Health Inter-agency Coordinating
Committee (ICC). The ICC was fully involved in the development process of the cMYP. It is
therefore expected that the Child Health ICC will advocate and support the implementation
of the plan.

4.8    Monitoring and Evaluation

The monitoring and evaluation framework for cMYP will be based on annual joint reviews
involving all stakeholders of the plan. A monitoring framework will be developed based on
usage of routine data, and feedback (bulletins, newsletters, review meetings) and
implemented, accompanied by a set of indicators to monitor the performance of the cMYP.

Annual evaluations on the implementation of the cMYP will be conducted every January for
the subsequent implementation year under review. The final review will be done in January
2011 before the next planning process.
To enable the implementation for the above activities, significant additional resources will be
required.




                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                        35
5.0    The Immunization System Components

5.1    Service Delivery

In the next five years, the programme will endeavour to sustain and improve on the gains
made over the years by providing quality immunization services. In Kenya, a significant
proportion of immunizations take place in outreach clinics and the programme will ensure
that the outreach strategy is not only sustained, but re-energized within the RED strategy
framework. In hard to reach areas, catch up campaigns will be implemented locally. The
current population at risk that is scattered in refugee camps, major towns and other places
will deserve special attention and immunization campaigns will be conducted if justifiable.
Table 8.1 contains details of the activities to be covered.


5.2    Vaccine Supply, Quality and Logistics

The EPI programme will ensure that adequate vaccines bundled with injection materials are
procured through WHO/UNICEF approved mechanisms. Through ICC, procurement of
vaccines and other logistics will be prioritised to avoid disruption of the services. The current
storage capacities for both vaccines and dry store materials at central and regional vaccine
stores will be expanded to be line with the growing population. It is also planned to introduce
computerised stock management system in the regional vaccine store rooms to improve
management of vaccines and injection materials and this will require procurement of
computers and accessories. The programme will procure land and construct vaccine stores
and offices at central level.

At district and health centre levels, trainings will be conducted to improve on record keeping.
The adherence to vaccine wastage guidelines will be monitored during the period.

Transport availability will be improved at all levels through procurement of appropriate types
of transport its maintenance during the 2006/2007plan period. Replacement of refrigerators
will be another focus in the 2006-2010 plan. The programme will therefore advocate for more
adequate resources in order to achieve this obligation.

Injection safety and waste management will be strengthened through the continued use of
AD syringes in both routine and supplemental immunization services and proper disposal of
injection materials. In addition, AEFI surveillance will be improved through production of
guidelines, adequate tools and specific AEFI training thus requiring extra resources from the
current. Health workers will from time to time receive training on safe injection and waste
management. Since health care waste management has to be tackled in a broader
perspective, the EPI will compliment efforts made by the MOH and other stakeholders by
providing incinerators to cover the remaining District Hospitals to achieve 100% coverage
during plan period. Details for activities are contained in Table 8.2

5.3    Disease Surveillance

Trainings for health workers will continue to be conducted to improve their knowledge and
skills in disease surveillance. Laboratory capacity will be further built through adequate
supplies of laboratory reagents and establishment of laboratory networks locally and within
neighbouring countries. Disease outbreak responses will also be conducted in affected
areas to disrupt the transmission of the disease.
In this multiyear plan, we hope to maintain or improve the tempo of detection and notification
of AFP, measles, and NNT at current levels, but being more efficient through utilizing the




                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                          36
same current resources. However, additional resources will be required for Hepatitis B, PBM
5.0    The Immunization System Components

5.1    Service Delivery

In the next five years, the programme will endeavour to sustain and improve on the gains
made over the years by providing quality immunization services. In some parts of Kenya, a
significant proportion of immunizations take place in outreach clinics and the programme will
ensure that the outreach strategy is sustained. In hard to reach areas, follow-up campaigns
will be organised and conducted.

Immunization coverage will be increased from current administrative coverage of 68% to
90% for the fully immunized child. However, special attention will be given to improving the
routine immunization coverage of populations at increased risk of low access or utilization of
immunization services. These include those in the urban slums, the internally displaced,
refugees, and those residing in geographically remote areas. A mixture of strategies will be
used, all with reference to community preferences.

Human resource and infrastructural capacity building will have to be strengthened at all
levels. Health workers trainings on MLM and RED will be conducted to improve their
managerial skills that will in turn impact on issues such as reduction on drop-out rate, safe
injection and waste management practices, reduction of missed opportunities and defaulter
tracing among others. Cold-chain capacity will also be expanded so as to increase access
to immunization services in both place and time. Currently many immunizing facilities can
only provide services periodically due to lack of refrigeration equipment.

5.2    Vaccine Supply, Quality and Logistics

The EPI programme will ensure that adequate quantities of quality vaccines and related
supplies are procured through approved mechanisms. Through the Child Health ICC,
procurement of vaccines and other logistics will be prioritised to avoid disruption of the
services. The current storage capacities for both vaccines and dry store materials at central
and regional vaccine stores will be expanded to be line with the growing population.

The National Regulatory Authority will be strengthened through the support of the Pharmacy
and Poisons board and by external technical assistance, so as to ensure that vaccine quality
is guaranteed. KEPI internal quality assurance mechanisms will in-turn ascertain vaccine
quality is maintained to the point of utilization thus minimizing AEFIs’. In addition, AEFI
surveillance will be improved through production of guidelines, adequate tools and specific
AEFI training which will require extra resources from the current.

Introduction of a computerised stock management system is planned for the regional
vaccine store rooms so as to improve management of vaccines and injection materials. This
will require procurement of computers and accessories. The programme through the Ministry
of Health will identify land for the construction of a larger Central Store and administration
offices.

At district and health centre levels, trainings will be conducted to improve stock keeping.
Adherence to vaccine management guidelines and target settings will be monitored during
the period.

Transport availability for distribution of the programmes critical logistics will be improved at
all levels through procurement of appropriate types of transport during the plan period. This
will be accompanied with resources for maintenance and other operational costs of the
vehicles.


                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                         37
In addition to increasing the total numbers of cold-chain equipment, there will also be
replacement of unserviceable and CFC refrigerators in the 2006-2010 plan. The programme
will therefore advocate for adequate resources to achieve this obligation.

Injection safety and waste management will be strengthened through ensuring continued
use of AD syringes in both routine and supplemental immunization services and proper
disposal of injection materials. Immunization waste management guidelines will be
developed in line with the National Health Care Waste Management Policy. Health workers
will from time to time receive training on safe injection and waste management practices.
Since health care waste management has to be tackled in a broader perspective, the EPI
will compliment efforts made by the MOH and other stakeholders by providing support for
the construction of incinerators to cover the remaining District Hospitals to achieve 100%
coverage during plan period.

5.3    Disease Surveillance

Trainings for health workers will continue to be conducted to improve their knowledge and
skills in EPI disease surveillance in line with the Integrated Disease Surveillance and
Response approach. The National Reference Laboratory capacity will be further improve
through procurement of adequate supplies of laboratory reagents and specialized training of
its staff.

Laboratory networks locally will be supported for the monitoring of trends of occurrence and
actual burden of vaccine preventable diseases. In addition, collaboration with laboratories in
neighbouring countries will be enhanced.
Vaccine preventable disease surveillance data (Polio, measles, PBM, Rota virus) will be
monitored so as to address gaps in immunization coverage in a timely manner as
appropriate..

5.4    Advocacy, social Mobilization and Communication

Advocacy, social mobilization and communication are very crucial in EPI services. Through
the Child Health ICC and the health SWAp, the programme will lobby for more resources for
effective implementation of the planned activities. Of priority, will be the development and
dissemination of the EPI Advocacy Guidelines, in conjunction with the Division of Child
Health, which will be aligned to the National Health Promotion Policy. As part of the
dissemination, health workers will be trained on the new guidelines.

Advocacy meetings will be conducted with District Health Management Teams and District
Health Stakeholders for more EPI specific resource mobilization.

Key EPI messages will be developed and disseminated through print media and electronic
media both nationally and at local levels where this capacity is available. Other channels
such as drama and community meetings will be encouraged and strengthened, spearheaded
by the CORPs in conjunction with their respective CHEWs.

The quarterly EPI newsletter will continue being published and distributed to all health
facilities and pre-service health institutions. In addition, posters, leaflets and fact sheets will
also be developed.

5.5    Programme Management

5.5.1 Planning



                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                           38
Management of the Kenya Expanded Programme on Immunization will be aligned to the
new principles of management of health services as outlined in the Kenya Essential
Package for Health. Annual planning guidelines will be developed and disseminated to the
districts and provinces in order to provide programme direction in terms of objectives and
targets. The development of the annual objectives, targets and indicators will refer to this
cMYP which takes into account NHSSP II, the respective AOP, global immunization
guidelines and the deliberations of the Child Health ICC.
Beginning with the AOP III, all health planning process will be decentralized to the district
and provincial levels, from which the national plan will be derived.

5.5.2 Financing
KEPI will endeavour to mobilize adequate resources for implementation of all its activities. It
will ensure that all gaps and challenges noted in the past years are addressed. Since KEPI
activities are supported through multiple funding sources, both programme planning and
resource mobilization will take into consideration the comparative interests of the different
funding sources.
The main sources of support for this MYP are
      The Government of Kenya – personnel emoluments, commodity support and main
         operational costs
      World Health Organization – Technical assistance for routine and supplemental
         immunization activities, operational costs of disease surveillance activities
      United Nation’s Childrens Fund – Technical Assistance for routine and supplemental
         immunization activities especially regarding advocacy and social mobilization,
         procurement agent services, emergency response
      Global Alliance for Vaccines & Immunization – national commodity support
         (Pentavalent and yellow fever) and health systems strengthening.
      African Development Bank –III Project – this is a three-year loan facility limited to 7
         districts and primarily for health facility infrastructure improvement, but also
         addressing human resource skills improvement
      British Department for International Development – a new five-year project for health
         systems strengthening, with special emphasis on (but not limited to) improving M&E
However, even with the above support, gaps are anticipated in the funding of this cMYP as
identified in the costing tool. The Child Health ICC will therefore play a critical role in
advocating for the needed resources.

5.5.3 Coordination and Integration
The Coordination framework will be adopted from NHSSP II, where coordination levels fall
under Child Health ICC, and the district health sector stakeholders forum for the National
and District levels respectively.
The various cross-cutting challenges in the Health Sector are best addressed through an
integrated approach. In addition integration will ensure sustainability of services. This plan
will adopt the framework outlined in the NHSSP II were planning, human and overall
financial resources, and logistics at all levels are integrated. In addition, the Child Health
Strategic Plan will be developed which articulate other issues beyond immunization in an
integrated manner. Broad programmatic concerns such as surveillance, monitoring and
evaluation, and social mobilization will continually be integrated.

5.5.4 Human Resource Management
Three thousand additional health workers are required within the planned period. However,
the funding for only 1500 has been secured, leaving a gap of another 1500.
In service training of both the current and in-coming health workers will be conducted
throughout this planned period. In addition, CORPs training will be incorporated as part of
the implementation of the community strategy under NHSSP II.




                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                        39
5.5.5
Supportive Supervision

The programme will ensure that supportive supervision is conducted regularly and that
district micro-plans are followed up. It will also ensure that EPI policies are reviewed to
incorporate any new developments in the EPI.


5.5.6
Monitoring and Evaluation
Monitoring and Evaluation will be strengthened at all levels of programme implementation
through the development of tools and facilitating skills improvement at all levels. District and
Rural Health Facilities will continue to analyze the immunization and disease surveillance
data on monthly basis and take action on identified gaps.

Monitoring activities will be aligned to both the GoK financial year cycle and calendar year.
Activities to be monitored are those related to performance of immunization coverage and
cost-effectiveness of the different immunization strategies..

Routine immunization and IDSR monitoring tools will continue to be standardised nationally
to ensure that data from peripheral levels can be easily merged with the national database.
Annual review meetings will be conducted with districts and provincial EPI staff to assess the
immunization data and status of implementation of activities. Periodic surveys and
operational research will be conducted in collaboration with partners.
Evaluation of this cMYP will be conducted in January 2011.


5.5.7
Innovations
The planning/resource mobilization for major innovations and any new vaccines introduction
during the plan period will be considered through a wide consultatory forum, with initial
inputs from the Child Health ICC.




                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                         40
6.0    National Priorities based on the Situational Analysis

1. Attain and sustaining high routine immunisation coverage in respect to the fully
    immunized child.
2. Availability of adequate vaccines , supplies and appropriate cold chain logistics
3. Procurement and rehabilitation of existing National and Regional cold rooms and the
    replacement of cold chain equipment at the district level;
4. Procurement of appropriate types of transport, replacement and maintenance of
    transport equipment
5. Improved documentation and data management
6. Integrated implementation of child health interventions
7. Sustaining high quality surveillance on AFP, Measles, Yellow fever, Hib and NNT
8. Strengthening advocacy and social mobilization activities; strengthening of partnerships
    in health and improved community participation; improving Radio/TV messages and print
    media coverage
9. Continued training of staff at all levels
10. Improved monitoring, supervision and feedback on performance to lower health facilities
11. Strengthening safe injection practices and waste management
12. Establish burden of disease for other vaccine preventable diseases of public health
    importance (e.g Rotavirus, Streptococcus pneumonia) through sentinel surveillance, and
    prepare for introduction for vaccine.
13. Construction of a new KEPI headquarters with adequate furniture and equipment




                  Kenya EPI Comprehensive Multi-Year Plan 2006-2010                     41
7.0:     NATIONAL PRIORITIES, NIP OBJECTIVES AND MILESTONES, STRATEGIES, STRATEGIC ACTIVITIES, NATIONAL, AND ORDER
                                                      OF PRIORITY
Table 8.1: Service Delivery
  National goals             National                      Targets                               Strategies                                         Key Activities                               Order of
   (until 2010)              objective                                                                                                                                                           priority
 By 2010 or sooner all   100% of districts     Baseline:                             - Strengthen implementation of RED       - Conduct program review and micro-planning workshops at           1
 districts will have     achieving >=80%                                             strategy in all districts                all levels
 routine immunization    Penta 3 coverage by   2006: 45% districts achieve Penta 3   - Support use of provincial level data   - Strengthen/establish sustainable outreach services
 coverage of >= 80%      2010.                 coverage of >=80%                     management system for analysis and       - Strengthen/establish defaulter-tracing systems in the district
 and a national                                2007: 60% districts achieve Penta 3   feedback                                 - Develop facilitative supervision schedules at all levels
 average of at least     National coverage     coverage achieve >=80%                - Use a combination of approaches to     - Integrate EPI supportive supervision into existing district
 90%.                    >=90%                 2008: 75% districts achieve Penta 3   reach everybody targeted for             health programs
                                               coverage achieve >=80%                immunization                             - Open more SDPs in far to reach population
                                               2009: 90% districts achieve Penta 3   - Strengthen continuous professional     - Train HWs in MLM and other relevant trainings e.g. RED
                                               coverage achieve >=80%                development                              and GIVS strategy

 Reduce child            100% districts        Baseline: 68% national coverage       - Strengthen implementation of RED       - Open more SDPs in far to reach population                        2
 mortality by measles    achieving >=90%       2006: 75% districts achieving         strategy in all districts                - Select appropriate number of districts each year for
 by 95% by 2008          measles coverage      >=80% coverage                        - Use a combination of approaches to     breakthrough improvement in order to reach annual targets
                         by 2010.              2007: 80% districts achieving         reach everybody targeted for             - Implement Rapid Results Initiatives (RRIs) in districts
                                               >=90% coverage                        immunization                             targeted for breakthrough improvement
                         National coverage     2008: 85% districts achieving         - Integrate vitamin A administration     - Integrate/strengthen data collection, reporting, analysis and
                         >=95%                 >=90% coverage                        with routine immunization                feedback of vitamin A
                                               2009: 90% districts achieving
                                               >=90% coverage

 By 2010 or sooner all   100% districts        Baseline: ??% districts …             - Strengthen implementation of RED       - Train health workers from districts with low utilization on      3
 districts will have     achieving <10%        2006: 80% districts achieve penta1-   strategy in all districts                interpersonal communication and how to motivate clients to
 achieved a drop out     penta1-penta3 drop-   penta3 drop-out <=10%                 - Increase community demand for          return for immunization
 rate of less than 3%    out rate by 2010      2007: 90% districts achieve penta1-   immunization services                    - Provide quality EPI services (SOPs)
                                               penta3 drop-out <=5%                  - Improve HW interpersonal
 By 2010 or sooner all                         2008 Penta. 3 drop out rate <3%       communication skills
 districts will have     100% districts
 achieved measles        achieving <10%        baseline: ??% districts …
 drop out rate of less   penta1-measles        2006: 60% districts achieve penta1-
 than 10%                drop-out rate by      measles drop-out <10%
                         2010                  2007: 70% districts achieve
                                               measles drop-out rate of <10%
                                               2008: 80% districts achieve
                                               measles drop-out rate of <10%
                                               2009: 90% districts achieve
                                               measles drop-out rate <10%




                                                               Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                            42
By 2010 all district   80% of districts        2007: 40% districts TT5 coverage    - Expand immunization beyond the           - Initiate TT programs for school going children in high risk    5
will have a TT 5 for   achieving >=80%         >= 80%                              traditional target age group               districts
pregnant women of      TT5 coverage by         2008: 60% districts TT5 coverage    - Assess and develop appropriate           - Integrate anti-helminths with TT immunization for school
80% and a national     2010.                   >= 80%                              interventions for integration              children
average of 75 %                                2009: 70% districts TT5 coverage    - Strengthen/establish outreach/mobile     - Conduct TTSIAs for child bearing women in high risk
                       National coverage       >= 80%                              - Enhance routine immunization for TT      districts (14 districts)
                       >=90%                                                       - Use a combination of approaches to       - Train HWs and scale up the 5 TT schedule program for
                                                                                   reach everybody targeted for TT            pregnant women in all health facilities
                                                                                   - Strengthen system for TT5 reporting      - Screen mothers (CBAW) to reduce missed opportunities
                                                                                                                              - Revise tools for capturing TT5
Protect Districts      Border districts                                            - Cross border collaboration               - Synchronize polio immunization campaigns with                  7
bordering Somalia,     conduct campaigns                                           - Partner collaboration                    neighboring countries
Sudan and Ethiopia     synchronized with                                                                                      - Strengthen cross-border surveillance and communication
from polio and         neighboring
measles outbreaks      countries
By 2010 all district   FIC coverage in the     2006: <=5 districts with <50% FIC   - Use a combination of approaches to       - Open more SDPs in far to reach population                      4
have 90% FIC           hard-to-reach areas     2007: No district with <50%         reach everybody targeted for               - Collaborate with other sectors in providing immunization
                       improved                2008: No district with <60%         immunization                               services
                                               2009: No district with <80%         - Provide additional resources as          - Initiate and sustain Integrated immunization activities into
                                               2010: No district with <90%         needed to support RED plans in             other community outreach services
                                                                                   districts with hard to reach populations   - Integrate outreach/mobile clinics in hard to reach
                                                                                                                              communities
                                                                                                                              - Provide & sustain transport for outreach activities
Maximize benefits to   Child health services   To be developed – see activities    - Use a combination of approaches to       - Integrate vit A and anti-helminth administration and other     6
mothers and children   integrated into                                             reach hard to reach populations            child health services with EPI outreach services
attending health       Immunization                                                - Assess and develop appropriate           -Integrate follow-up of HIV exposed children into routine
facilities             services                                                    interventions for integration              immunization
                                                                                                                              - Screen all sick children for immunization and ensure
                                                                                                                              provision of missed antigens
                                                                                                                              - Establish baseline measures and annual targets of
                                                                                                                              integrated services and
                                                                                                                              - Strengthen data collection, reporting, analysis and feedback
                                                                                                                              of integrated services
Prevent against                                                                    Provide access to immunization             - Provide immunization services to refuge camps bordering
importation of                                                                     services in humanitarian emergencies       Ethiopia and Sudan (Turkana district, Kakuma Camp) and
vaccine preventable                                                                                                           Somalia (Garissa district, Dadaab Camp, etc.)
disease from
neighboring
countries




                                                               Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                   43
 Table 8.2: Vaccine Supply, Quality and Logistics
  National               National                     Targets                                    Strategies                                          Key Activities                           Order of
 goals (until            objective                                                                                                                                                            priority
   2010)
                      100% districts        2006-2007: 80% of districts      - Improve and strengthen vaccine management            -Train on forecasting, requisitioning and prompt          1
                      reporting no stock    reporting no stock outs of all   systems at all levels.                                 reporting by facilities
                      outs of any           antigens and supplies            - Improve health care worker skills in vaccine         - Integrate procurements by the agents
                      antigen or                                             management                                             - Forecast vaccines and supplies at facility, district,
                      injection materials   2008-2010: 100% districts        - Ensure reliable supply of vaccines at all levels     province and national levels
                      and                   reporting no stock outs of all   - Ensure availability of Injection equipment (AD &     - Distribute vaccine management guidelines
                      documentation         antigens and other supplies      reconstitution syringes), safety boxes at all levels   -Train and update staff on vaccine management
                      tools and                                              - Improve supply of documentation tools and            guidelines
                      consumables by                                         consumables.                                           - Distribute vaccines and other supplies to SDPs on
                      2010                                                                                                          monthly basis.
                                                                                                                                    - Involve facilities in the EPI planning processes
                                                                                                                                    - Computerize vaccine management system
                                                                                                                                    - Mobilize locally available resources to avail
                                                                                                                                    materials and consumables
Adopt the multi       90% districts         2006- 80% districts achieve      Institute vaccine wastage monitoring system            - Develop vaccine wastage data entry and analysis         4
dose vial policy by   achieving required    required standards                                                                      functions into existing EPI INFO immunization
2007                  wastage                                                                                                       module- national and provincial levels
                      standards per         2007- 2010: 90% districts                                                               - Regularly update HWs on vaccine management
                      national policy by    achieve required standards                                                              and administration
                      2007                                                                                                          - Regularly monitor vaccine wastage at all levels

                      Ensure reliable       2006- set up task force on       Strengthen capacity of Pharmacy and Poisons            - Train and sensitize Pharmacy and Poisons Board          5
                      national supply of    vaccine quality                  Board to monitor the quality of vaccines and other     - Institute vaccine quality task force
                      vaccines of                                            related biologicals                                    - Develop guidelines
                      assured quality       2007- develop and                                                                       - Regularly monitor adherence to guidelines
                                            disseminate guidelines

                                            2008- functional national
                                            regulatory authority in place




                                                            Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                            44
                      All eligible health    Baseline: 50% health            - Develop and implement a system to replace cold        - Carry out an inventory of all cold chain equipment   2
                      facilities having      facilities with SDP# are        chain equipment in current and new SDPs                 in the country
                      basic functional       equipped with functional cold   - Institute a system to annually assess functionality   - Replace non CFC free and unserviceable cold
                      cold chain             chain equipment                 of cold chain system                                    chain equipment
                      equipment by                                                                                                   - Procure and distribute cold chain equipment to
                      2010                   2007: >70% of health                                                                    new SDPs
                                             facilities with SDP No. are                                                             - Support KEMSA to stock cold chain equipment
                      Obsolete               equipped with functional cold                                                           and spare parts at regional KEMSA stores
                      equipment (non-        chain equipment                                                                         - Decentralize cold chain maintenance workshop to
                      CFC free)                                                                                                      regional level
                      replaced in all        2008: > 80%                                                                             - Update staff on cold chain management and
                      health facilities by   2009: > 90%                                                                             maintenance
                      2010                   2010: = 100%                                                                            - Provide cold chain technicians with appropriate
                                                                                                                                     cold chain tool kits
                                                                                                                                     - Provide appropriate source of energy to support
                                                                                                                                     cold chain
All levels adopt      Provide functional     Baseline:                       - Ensure local availability of safety boxes and low-    - Carry out a baseline inventory survey on             3
and implement         waste                  2006-2010 100% availability     cost incinerators                                       incinerators
technologies for      management             of safety boxes                 - Ensure proper waste management at all levels in       - Develop an incinerator construction and
safe disposal and     system in all of                                       accordance with national policy                         maintenance plan
destruction of        immunizing             Baseline: 64% hospitals with                                                            - Avail AD syringes & safety boxes to all
injection materials   facilities             functional incinerators 2007:                                                           immunization service points
and other sharps                             75% hospitals with functional                                                           - Design cost effective incinerators at district and
by 2010.              100% of district       incinerators                                                                            sub district levels
                      and provincial         2008-2010: 100% hospitals                                                               - Support districts to construct incinerators at
                      hospitals have         with functional incinerators                                                            district and sub district levels
                      functional                                                                                                     - Support immunizing facilities to burn and bury
                      incinerator                                                                                                    waste for those with no incinerators
                                                                                                                                     - Adopt checklist for supportive supervision from
                                                                                                                                     CDC/KEPI/WHO Pilot project
                      Establish KEPI         Baseline:                       Improve infrastructure space and layout                 - Review office and storage capacity of EPI at all     6
                      offices and                                                                                                    levels (technical report)
                      storage capacity       -2006_65%                                                                               - Procure land for KEPI HQ for construction of
                      up to 80% at all       -2007_70%                                                                               offices and cold rooms
                      levels by 2010         -2008_75%                                                                               - Construct new and rehabilitate existing cold
                                             -2009_80%                                                                               rooms and stores in the regions and districts
                                             -2010_>80%




                                                            Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                   45
   Table 8.3: Surveillance
National goals          National                     Targets                                      Strategies                                              Key Activities                            Order of
 (until 2010)           objective                                                                                                                                                                   priority
Ensure capacity for 100% districts      Baseline: 0% Districts           - Strengthen disease surveillance at all levels including - Conduct quarterly progress meetings between KEPI,                   1
surveillance in every implementing IDSR implementing IDSR                the community                                               PHMTs, DHMTs and Partners.
district              by 2010           2006 - 25%                                                                                   - Revise surveillance guidelines for health workers.
                                        2007 - 50%                       - Improve district capacity on disease surveillance and - Train health workers on IDSR (VPDs) and redefine
                                        2008 - 75%                       response to outbreaks                                       their role on disease surveillance.
                                        2009 - 90%                                                                                   - Develop guidelines for introduction of community
                                        2010 – 100%                      - Strengthen / sustain laboratory network capacity to       surveillance.
                                                                         manage and analyze specimens                                - Train existing CORPs and facility health committees
                                                                                                                                     on disease surveillance.
                                                                         - Strengthen data collection, analysis, interpretation, use - Establish links for surveillance reports at district level
                                                                         and exchange of data at all levels                          - Provide financial support to district level regularly for
                                                                                                                                     AFP/measles/MNT, HIB, and Rotavirus surveillance
                                                                         - Strengthen case-based surveillance                        - Provide funds for maintenance of transport for DDSCs,
                                                                                                                                     PDSCs and NDSOs
                                                                                                                                     - Provide funds for communication for DDSCs, PDSCs,
                                                                                                                                     NDSOs
                                                                                                                                      - Provide funds for National Disease surveillance
                                                                                                                                     coordinators, PDSCs, NPCC, NPEC and NTF
                                                                                                                                     - Provide access to laboratory network capacity to
                                                                                                                                     neighboring countries
 Achieve high       NPEV isolation rate - By end of 2006 all districts   - Strengthen monitoring of VPDs                             - Develop guidelines for introduction of community                  1
quality AFP         of > 10%            achieve and sustain the standard - Strengthen inter-country surveillance                     surveillance
surveillance                            of NPEV > 10%                                                                                - Support procurement of laboratory supplies and
                                        - By end of 2008 - guidelines on                                                             equipment in liaison with IDSR Unit
                                        community surveillance                                                                       - Create/enhance local laboratory networks
                                        developed                                                                                    - Provide all levels with adequate reporting tools
                                                                                                                                     - Co-opt DDSCs as members of DHMT
                                                                                                                                     - Train DHMT to analyze and use data at their level
                                                                                                                                     - Conduct annual cross border meetings with inter-
                                                                                                                                     country surveillance officers
                                                                                                                                     - Annual inter-country surveillance meetings starting
                                                                                                                                     2007




                                                              Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                46
      Table 8.4: Advocacy and Communication
 National         Targets                          Strategies                                        Key Activities                      National goals (until   Order of
 objective                                                                                                                                      2010)            priority
Strengthen
ICC




Sustain high                    - Develop and implement communication plan          - Produce EPI bulletin
routine                         - Use existing structures within the community      - Feedback to health workers following supervisory
immunization                    - Greater partnerships in childhood interventions     visits.
                                                                                    - Hold regularly meetings with DHMTs on
Achieve                                                                               prioritisation of EPI services.
elimination                                                                         - Review meetings with Health workers
status for                                                                          - Develop key messages and IEC materials on EPI.
measles                                                                             - Conduct ICC meetings
                                                                                    - Conduct sensitisation of communities on the
                                                                                      importance completing immunisation
                                                                                    - Conduct social mobilisation activities on
                                                                                      immunisation and surveillance through public
                                                                                      rallies
                                                                                    - Airing of radio & TV messages
                                                                                    - Discussions with local leaders on scheduling and
                                                                                      sustaining outreach services
                                                                                    - Hold press conferences & press releases
                                                                                    - Conduct meetings with NGOs other childhood
                                                                                      disease interventions
                                                                                    - Broaden partnerships in ICC
                                                                                    - Conduct advocacy meetings local MPs, councilors,
                                                                                      and other local leaders




                                              Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                             47
 National                     Targets                                   Strategies                                             Key Activities                            National goals (until        Order of
 objective                                                                                                                                                                      2010)                 priority
Ensure              Baseline Lack of appropriate     - Improve communication and dissemination of            - Develop and maintain inventory of IEC materials          By 2007 an IEC inventory
availability of     IEC EPI messages for             information                                                and messages                                            report of survey in place.    1
appropriate         various populations:             - Technical support of communication expert for EPI     - Identify communication gaps on routine EPI
IEC                                                                                                             messages
messages for        2006: A representative                                                                   - Develop plan to address gaps
various target      sample districts would have                                                              - Translate various IEC materials appropriately
audiences           done the IEC inventory                                                                      according to set-up.
                    survey.                                                                                  - Distribute as brochures, leaflets etc to community
                                                                                                               members, schools, popular meeting spots.
                    2007: relevant IEC materials                                                             - Develop radio; TV, internet and other media spot
                    developed and disseminated
                                                                                                              messages for Routine Immunization.
                    to 100% districts.



                                                     - Ensure adequate and sustainable financing for         - Advocate for increased and sustained budget              By 2008: All levels to have   2
Establish and       Baseline: Weak                   advocacy and communication activities.                    allocation for advocacy and communication.               advocacy and communication
strengthen          communication and advocacy       - Develop and implement cost effective                  - Encourage business partners to support advocacy          component in integrated
functional          strategy.                        immunization information communication plan.              for immunization                                         plans
communicatio        2006: 40% districts achieved.    - Apply multimedia approach to social mobilization -    - Create liaison offices at provincial and district
n structures in     2007: 100% districts             - Strengthen and sustain Inter-sector collaboration       levels                                                   BY: 2010 or sooner EPI
all the districts   achieved.                        with partners and stakeholders at all levels by 2010.   - Recruit and train officers at national, provincial and   messages on routine
by 2010.            2006: 50% achieved.                                                                                                                                 immunization should be
                                                                                                               district levels.
                                                                                                                                                                        disseminated at 80% of all
                    2007:100% achieved.                                                                      - Create partners forums at all levels for advocacy of
                                                                                                                                                                        levels through audio and
                                                                                                               routine immunization and special immunization
                                                                                                                                                                        videotapes.
                                                                                                               events
                                                                                                             - Conduct quarterly joint meetings with partners and
                    2007: 100% Audio and
                                                                                                               other stakeholders
                    videotapes developed.
                                                                                                             - Develop joint work plans
                    2008: Distribute developed                                                               - Review progress of implementation
                    tapes to all district, sub                                                               - Shoot 4 videos on routine EPI messages
                    district and major hospitals                                                             - Record 4 audio tapes on routine EPI messages
                                                                                                             - Disseminate and Distribute IEC materials
                                                                                                             - Develop and distribute newsletters on
                                                                                                               immunization information on a quarterly basis.
To ensure all       2006: Integrate EPI              Include EPI communication plans in the annual           - Attend annual district planning workshop and                                           1
districts have      communication plan in annual     district plan.                                          ensure EPI communication plan is integrated into
EPI                 district health micro plans in                                                           district health plans.
communicatio        all districts and sustained to                                                           - Develop an integrated routine reporting tool which
n integrated        2010                                                                                     include social mobilization activities of EPI
within district
plans
To achieve          2006: train health workers in    Capacity building for communication for EPI staff       Train health workers in IPC (including attitude                                          3
100% of             IPC in 50%                                                                               change)
districts with      2007: train health workers in    Institutionalize health worker – community dialogue
health              IPC in 100%



                                                                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                             48
 National                  Targets                                 Strategies                                       Key Activities                        National goals (until   Order of
 objective                                                                                                                                                       2010)            priority
workers who
are trained in
IPC focusing
on attitude
change
To strengthen    -2006-2010: Sensitize          - Build partnerships with the community and the    - Sensitize CORPs, key community leaders and                                   2
advocacy for     CORPs and community            media for EPI mobilization activities              stakeholders on the benefits of immunization
EPI at all       leaders on benefits of         - Monitor communication activities at all levels   - Conduct biannual meetings with community
levels           immunization,                                                                     leaders to provide feedback and plan for
                 -2006: develop systems for                                                        mobilization activities
                 monitoring communication                                                          - Orientate/sensitize broadcasters, and reporters on
                 activities at all levels and                                                      immunization.
                 providing feedback.

                 -2006-2010:                                                                       - Develop an integrated routine reporting tool which
                 orientate/sensitize                                                               include social mobilization activities of EPI
                 broadcasters, reporters in                                                        - Prepare message and for broadcast using
                 media and broadcasting                                                            appropriate media
                 houses on immunization
                 issues.


                                                .




                                                              Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                              49
Table 8.5: Management
 National        National                   Targets                                   Strategies                                        Key Activities                           Order of
  goals          objective                                                                                                                                                       priority
  (until
  2010)
-100% of all    Ensure            Recruit 4500 nurses for SDPs    - Improve management of human resource               - Rationally re-distribute available HWs within the           1
the Districts   availability of   by 2010                         - Establish links between private service provider   districts and the country as whole
will have       trained,                                          and GoK facilities                                   - Motivate HWs and CORPs by recognition,
>90%            motivated         95% health workers to be EPI    - Advocacy with MOH for recruitment of staff         appraisals and allowances
immunization    staff at all      updated/training by 2010                                                             - Carry out training needs analysis
coverage by     health                                                                                                 - Draw and implement a training plan in all the
2010            facilities                                                                                             districts
                                                                                                                       - Advocate for staff employment for specific
                                                                                                                       disadvantaged areas
                                                                                                                       - Annual review of the KEPI organogram to fit the
                                                                                                                       demand of the future
                Ensure high       Conduct field visits at all     Improve management of human resource                 - Strengthen supportive supervision at all levels             4
                quality service   levels and give written                                                              - Strengthen role, accountability and resources for
                delivery at all   feedback:                                                                            EPI at district level
                SDPs              National to Province:                                                                - Where appropriate consider addition of supervisory
                                  Quarterly                                                                            responsibility for division coordinator
                                  Province to district: Monthly                                                        - Disseminate use of supervisory checklist
                                  District to LHF: Monthly                                                             - Develop two way information pathway between
                                                                                                                       various operational levels
                                                                                                                       - Provide instant, monthly, and quarterly feedback
                                                                                                                       (verbal and written)
                90% of GOK        Baseline: 43%                   Advocacy with MOH for recruitment of staff           - Align staff, cold chain and management resources            6
                health            2006- 60%                                                                            with increase in number of health facilities delivering
                facilities will   2007- 70%                                                                            EPI services
                deliver EPI       2008- 80%
                services by       2009- 85%
                2010
                By 2010 or        Baseline: 60% districts below   Implement Rapid Results Initiatives in districts     - Collaboration between national, provincial                  5
                sooner all        80% coverage for one or         targeted for breakthrough improvement                management teams in targeting districts for RRIs
                districts will    more antigen                                                                         and monitoring progress of districts
                have routine      2006- 45% districts
                immunization      2007- 30% districts
                coverage of       2008- 20% districts
                >= 80%            2009- 10% districts




                                                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                   50
National    National                   Targets                                   Strategies                                            Key Activities                          Order of
 goals      objective                                                                                                                                                          priority
 (until
 2010)
           Ensure that all   Baseline: Lack of EPI plans in   Strengthening annual Programme review and              - Develop annual plans at all levels                          2
           districts have    most districts and health        planning                                               - Monitor districts plans at Provincial level
           current RED       facilities                                                                              - Hold Provincial bi-annual review meetings with
           micro-plan        2006- 45%                                                                               DHMTs, PHMT and National EPI staff
                             2007- 55%                        Strengthening decentralization process                 - Provide logistical and financial support to districts
                             2008- 70%                                                                               - Develop and disseminate timely AOPs
                             2009- 80%                                                                               - Provide timely funding, logistic support and
                             2010- 90%                                                                               supplies to every district
                                                                                                                     - Conduct micro-planning for the district and facility
                             2006 – 10% of districts fully                                                           facilites
                             implementing the RED                                                                    - Re-establish regular outreach services for hard to
                             strategy                                                                                reach communities
                             2007- 50% of districts                                                                  - Conduct supportive supervision: on-site training
                             implementing the RED                                                                    - Create community links with service delivery
                             strategy                                                                                - Monitor and use of data for action
                             2008 – All districts fully                                                              - Improve planning and management of human and
                             implementing the RED                                                                    financial resources
                             strategy

           All districts     2006- 80%                        - Develop a cost effective and sustainable transport   - Conduct a study on fleet management system for              7
           have access       2007- 90%                        management system for PHC                              PHC services
           for 90% of the    2008-2010 - 100% districts       - Implement fleet management                           - Advocate at various levels for fleet management
           time to           have adequate access to                                                                 - Provide appropriate serviceable transport
           appropriate,      serviceable vehicle for EPI                                                             - Develop and implement vehicle maintenance and
           serviceable,                                                                                              replacement plan
           and adequate
           transport for
           EPI activities
           by 2010
           Construct         Baseline: 40% of depots with     Improve infrastructure space and layout                - Review vaccine storage capacity of EPI at all levels        10
           national KEPI     adequate vaccine storage                                                                (technical report)
           office complex    capacity                                                                                - Procure land for KEPI HQ for construction of
                                                                                                                     offices and cold rooms
           Increase          2006- 65%                                                                               - Increase vaccine storage capacity at depots with
           storage           2007- 70%                                                                               inadequate capacity
           capacity for      2008- 75%
           vaccines at       2009- 80%
           national and      2010- >80%
           depot levels




                                                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                     51
National    National                 Targets                                     Strategies                                             Key Activities                           Order of
 goals      objective                                                                                                                                                            priority
 (until
 2010)
           Increase        Baseline: Inadequate              - Advocacy meetings with MOH top management              - Set up national immunization resource mobilization           10
           government      allocation for new vaccines       and treasury                                             steering committee
           allocation      and EPI support activities                                                                 - Conduct joint biannual meeting of ICC, MOH and
           from 1% to      Lack of a sustainability plan                                                              treasury staff to mobilize GOK resources for
           13% of EPI      after GAVI funding                                                                         immunization
           activities by                                                                                              - Create inventories of all potential private /corporate
           2010            1% GOK contribution to                                                                     organization
                           Penta vaccine purchase            - Establish partners forum at all levels                 - Organize meeting with potential private sector
                                                             - Advocacy meeting with organized private sector         partners/ donors
                           2006_1%                           and H/F committee and boards for resource                - Contract an organization to coordinate resource
                           2007_4%                           mobilization to support EPI operational costs            mobilization
                           2008_7%                           - Strengthen immunization programmes within the          - Assess and develop appropriate interventions for
                           2009_10%                          context of health systems development                    integration with EPI
                           2010_13%
           Implement       2006 - roll out EPI INFO          Strengthen the management, analysis,                     - Capacity build EPI staff on data collection,                 3
           M&E systems     Immunization Module and           interpretation, use and exchange of data at all levels   management and use
           all districts   DQS to 30% of districts                                                                    - Implement EPIINFO Immunization Module to
                                                                                                                      districts
                           2007-2010: EPIINFO and                                                                     -Train data managers on EPI INFO at district levels
                           DQS to 100% of districts                                                                   - Expand the existing EPI INFO program to include
                                                                                                                      collection, analysis and feedback of information on
                           Accurate EPI information                                                                   wastage
                           exist at all levels and is used                                                            - Update health workers on EPI data collection,
                           for monitoring and planning                                                                presentation, reporting and use
                           immunization activities                                                                    - Provide and maintain computers and accessories
                                                                                                                      for all levels
                           District technical monthly                                                                 - Provide monitoring tools for immunization services
                           progress report submitted to                                                               - Train supervisors at all levels on EPI reporting
                           KEPI                                                                                       - Provide quarterly feedback to districts on their
                                                                                                                      performance
                                                                                                                      - Monitor data quality through DQS at all levels
           Protect more                                      Expand vaccination beyond traditional target groups      - Develop and implement protocol to address                    11
           people                                                                                                     immunization needs of HIV-exposed children and
           against                                                                                                    immuno-compromised populations
           vaccine
           preventable
           diseases




                                                  Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                         52
National    National         Targets                             Strategies                                          Key Activities                        Order of
 goals      objective                                                                                                                                      priority
 (until
 2010)
           Introduction of                    - Strengthen capacity to determine and set policies   - Conduct disease burden study                             9
           new                                and priorities for new vaccines                       - Technical review
           vaccines                           - Develop a systematic process for the introduction   - Ensure appropriate disease surveillance to support
                                              of new or under-used vaccines                         disease burden study
                                                                                                    - Conduct advocacy with ICC, financing ministry,
                                                                                                    NGOs/partners to create financial support for new
                                                                                                    vaccines w on feasibility of introduction of new
                                                                                                    vaccines
                                                                                                    - Develop recommendations and protocols for use
                                                                                                    new vaccines
                                                                                                    - Introduce new vaccines




                                       Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                              53
  8.0        MYP ACTIVITY TIMELINE

Key Activities                                                                                                          2006   2007   2008   2009   2010
Service Delivery
1. Intensify & sustain outreach services                                                                                 X      X      X      X      X
2. Conduct supplementary SNIDs                                                                                           X      X      X      X      X
3. Develop facilitative supervision schedules                                                                            X      X      X      X      X
4. Screen all children <5years who present to the health facility to reduce   missed opportunities                       X      X      X      X      X
5. Open more SDPs in far to reach population                                                                             X      X      X      X      X
6. Conduct daily maintenance of cold chain                                                                               X      X      X      X      X
7. Maintain vaccine potency at all levels                                                                                X      X      X      X      X
8. Distribute vaccines and other supplies to SDPs on monthly basis.                                                      X      X      X      X      X
9. Involve facilities in the EPI planning processes                                                                      X      X      X      X
10. Replace the un-serviceable refrigerators                                                                             X      X      X      X
11. Train/update health workers on cold chain maintenance                                                                X      X             X
12. Review KEPI policy on immunization sessions particularly BCG and measles                                             X      X
13. Hold meetings with school management to develop schedule for school health programmes (TT)                           X      X      X      X      X
14. Conduct the school health programmes (TT)                                                                            X      X      X      X      X
15. Print, disseminate and distribute immunisation schedules                                                             X      X             X
16. Conduct TT SIAs for child bearing women in high risk districts (14 districts)                                        X      X      X      X      X
17. Conduct routine immunization as per schedule (TT)                                                                    X      X      X      X      X
18. Screen mothers (CBAW) to reduce missed opportunities                                                                 X      X      X      X      X
19. Motivate clients to return for immunization by providing services & information for the need to complete schedule    X      X      X      X      X
20. Provide quality EPI services (SOPs)                                                                                  X      X      X      X      X
21. Provide home visiting tools for CORPs                                                                                X      X      X      X      X
22. Liase with community leaders and FBO leaders – Drop out rates                                                        X      X      X      X      X
23. Sensitise PEER educators on EPI                                                                                      X      X             X
24. Develop/review and provide defaulter tracing tools                                                                   X      X
25. Motivate CORPs                                                                                                       X      X      X      X      X
26. Update/training CORPs on EPI including home visiting                                                                 X      X             X
27. Conduct catch up campaigns for integrated measles in 2008                                                            X             X
28. Conduct outreach/mobile clinics                                                                                      X      X      X      X      X
29. Provide & sustain transport for districts hard to reach                                                              X      X      X      X

VACCINE SUPPLY, QUALITY AND LOGISTICS
1. Train on forecasting, requisitioning and prompt reporting by facilities                                               X      X             X
2. Integrate procurements by the agents                                                                                  X      X
3. Forecast Vaccines at facility, district, province and national levels                                                 X      X      X      X      X



                                                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                     54
Key Activities                                                                                    2006    2007   2008   2009   2010
4. Distribute vaccines and other supplies to SDPs on monthly basis                                 X       X      X      X      X
5. Distribute vaccine management guidelines                                                        X       X
6. Train and update staff on vaccine management guidelines                                         X       X
7. Computerize vaccine management system                                                                   X      X      X
8. Regularly monitor vaccine wastage at all levels                                                    X    X      X      X      X
9. Support Pharmacy and Poisons Board to establish a system for vaccines quality checks               X    X      X      X      X
10. Institute vaccine quality task force                                                              X    X
11. Develop guidelines for quality assuarance                                                         X    X
12. Regularly monitor adherence to guidelines                                                         X    X      X      X      X
13. Carry out an inventory of all cold chain equipment in the country                                 X                  X
14. Replace non CFC free and un-serviceable cold chain equipment                                      X    X      X      X      X
15. Procure and distribute cold chain equipment to new SDPs                                           X    X      X      X      X
16. Support KEMSA to stock cold chain spare parts at regional KEMSA stores                            X    X      X      X      X
17. Decentralize cold chain maintenance workshop to regional level                                    X    X
18. Update staff on cold chain management and maintenance                                             X    X             X
19. Provide cold chain technicians with appropriate cold chain tool kits                              X    X             X
20. Avail AD syringes and safety boxes to all immunization service points                             X    X      X      X      X
21. Design cost effective incinerators at district and sub-district levels                            X    X
22. Support districts to construct incinerators at district and sub-district levels                   X    X      X      X      X
23. Support immunizing facilities to burn and bury waste for those with no incinerators               X    X      X      X      X

SURVEILLANCE
1. Conduct quarterly progress meetings between KEPI, PHMTs, DHMTs and Partners                        X    X      X      X      X
2. Train health workers on VPDs and redefine their role on disease surveillance                       X    X             X
3. Develop guidelines for introduction of community surveillance                                      X    X
4. Revise surveillance guidelines for health workers                                                  X    X
5. Train existing CORPs and facility health committees on disease surveillance                        X    X             X
6. Establish links for surveillance reports at district level                                         X    X      X      X      X
7. Provide financial support to district level regularly for AFP/measles/MNT surveillance             X    X      X      X      X
8. Provide funds for maintenance of transport for DDSCs, PDSCs and NDSOs                              X    X      X      X
9. Provide funds for communication for DDSCs, PDSCs, NDSOs                                            X    X      X      X      X
10. Provide funds for WHO surveillance officers, NDSCs, PDSCs, NPCC, NPEC and NTF                     X    X      X      X      X
11. Provide funds for Hib, MNT, Measles and Rotavirus surveillance                                    X    X      X      X      X
12. Train focal point persons on IDSR (VPDs) at all levels                                            X    X             X
13. Support procurement of laboratory supplies and equipment in liaison with IDSR Unit                X    X      X      X      X
14. Create/enhance local laboratory networks                                                          X    X      X      X      X
15. Provide all levels with adequate reporting tools                                                  X    X      X      X      X
16. Train DDSCs to analyse and use data at their level                                                X    X      X      X      X
17. Provide and maintain computers and accessories for all levels                                     X    X      X      X      X
18. Conduct annual cross border meetings with inter-country surveillance officer                      X    X      X      X      X



                                                  Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                   55
Key Activities                                                                                                                   2006   2007   2008   2009   2010
19. Conduct field visits at all levels and give written feedback: National-quarterly; Prov.- Monthly; District – daily/monthly    X      X      X      X      X
20. Provide instant, monthly, & quarterly feedback (verbal & written)                                                             X      X      X      X      X
ADVOCACY AND COMMUNICATION
1. Conduct a survey on communication gaps on routine EPI messages                                                                 X
2. Translate various IEC materials appropriately according to set-up.                                                             X      X
3. Distribute as brochures, leaflets etc to community members, schools, popular meeting spots                                     X      X      X      X      X
4. Train social mobilizers from community on the translations                                                                     X      X             X
5. Develop radio, TV, Internet and other media spot messages for Routine Immunization.                                            X      X      X      X      X
6. Recruit and train liaison officers, provincial, district and divisional levels                                                 X      X
7. Develop and distribute newsletters on immunization information on a quarterly basis                                            X      X      X      X      X
8. Develop an integrated routine reporting tool on EPI activities                                                                 X      X
9. Conduct quarterly joint meetings with partners and other stakeholders                                                          X
10. Develop joint work plans                                                                                                      X      X      X      X      X
11. Shoot 4 video productions                                                                                                            X      X
12. Record 4 audio tape messages                                                                                                         X      X
13. Disseminate and Distribute copies of (1) and (2) above                                                                               X      X      X      X
14. Advocate for increased and sustained allocation in the national budget for advocacy and communication                         X      X      X      X      X
15. Encourage business partners to support advocacy of particular immunization events                                             X      X      X      X      X
16. Attend annual district planning workshop and ensure EPI communication plan is integrated into district plans                  X      X      X      X      X
17. Train health workers in IPC (include attitudinal change)                                                                      X      X             X
18. Sensitise CORPs, key community leaders and stakeholders                                                                       X      X             X
19. Monitor communication activities at all levels and provide feedback                                                           X      X      X      X      X
20. Develop an integrated reporting tool                                                                                          X      X      X      X      X
21. Hold feedback meetings                                                                                                        X      X      X      X      X
22. Orientation/sensitisation of broadcasters and reports on EPI                                                                  X      X
23. Prepare messages for broadcasting and for feedback meetings                                                                   X      X      X      X      X

MANAGEMENT
1. Rational re-distribution of available h/workers within the districts and the country as whole                                  X      X
2. Motivate H/workers and CORPs by recognition, appraisals and allowances                                                         X      X      X      X      X
3. Carry out training needs analysis                                                                                              X      X
4. Draw and implement a training plan in all the districts                                                                               X      X      X      X
5. Advocate for staff employment for specific disadvantaged areas                                                                 X      X
6. Annual review of the KEPI organogram to fit the demand of the future                                                           X      X      X      X      X
7. Develop annual plans at all levels                                                                                             X      X      X      X      X
8. Hold quarterly review meetings at the Districts with stakeholders involvement                                                  X      X      X      X      X
9. Provide logistical and financial support to districts                                                                          X      X      X      X      X
10. Develop and disseminate timely Annual Operation Plans                                                                         X      X      X      X      X
11. Carryout and implement a study on fleet management system for PHC services                                                    X      X      X      X      X
12. Provide appropriate serviceable transport                                                                                     X      X      X      X      X
13. Review office and storage capacity of EPI at all levels (technical report)                                                    X      X
14. Land procurement for KEPI HQ for construction of offices and cold rooms                                                       X      X
15. Construct new, and rehabilitate existing cold rooms and stores in the regions and districts                                   X      X      X      X      X
16. Construct incinerators in 40% of all health facilities                                                                        X      X      X      X      X



                                                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                              56
Key Activities                                                                                         2006   2007   2008   2009   2010
17. Carry out assessment of cold chain inventory                                                        X             X             X
18. Replace 90% of old fridges with CFC free fridges                                                    X      X      X      X      X
19. Procure CFC free fridges for new facilities                                                         X      X      X      X      X
20. Procure assorted cold chain spare parts                                                             X      X      X      X      X
21. Provide appropriate source of energy to support cold chain                                          X      X      X      X      X
22. Avail AD syringes and safety boxes to all SDPs                                                      X      X      X      X      X
23. Mobilize locally available resources to avail documentation tools and consumables                   X      X      X      X      X
24. Set up national immunization resource mobilization steering committee                               X
25. Joint biannual meeting of ICC, MOH and treasury staff to mobilize GOK resources for immunization    X      X      X      X      X
26. Inventories of all potential private /corporate organization                                        X      X
27. Organize meeting with potential private sector partners/ donors                                     X      X      X      X
28. Contract an organisation to coordinate resource mobilization                                        X      X      X      X      X
29. Re-establishment of regular outreach services                                                       X      X      X      X      X
30. Supportive supervision: on-site training community links with service delivery                      X      X      X      X      X
31. Monitoring and use of data for action                                                               X      X      X      X      X
32. Better planning and management of human and financial resources                                     X      X      X      X      X
33. Reduce the number of immunization dropout through micro planning at the district or local level     X      X      X      X      X
34. Strengthen managerial skills of immunization providers at all levels                                X      X      X      X      X
35. Provide timely funding, logistic support and supplies in every district                             X      X      X      X      X
36. Develop monitoring tools for immunization services                                                  X
37. Train supervisors at all levels on monitoring systems                                               X      X             X




                                                 Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                        57
9.0     Cost, Budget and Financing for the cMYP

The success of the programme largely depends on adequate financing for all proposed
activities to be undertaken during the planning period. It will be the responsibility of the EPI
through the Ministry of Health to ensure that the programme gets adequate financial and
material support both locally and internationally.

In this section, we review the cost implications of the proposed programme activities, and
relate these to the known available financing for respective cost categories of the
programme to derive information relating to financing gaps. Also proposed are strategies
and interventions the programme needs to carry out, to improve its financial viability.

9.1     Methodology for costing the cMYP

The cMYP includes a series of interventions, which have associated activities, and inputs
needed to actualise. These are illustrated in the table 9 below.

Table 9: Inputs to different EPI systems components
    System Components                            Inputs                              Activities
1. Service delivery           Human resources/salaries, outreach        Training, workshops
                              perdiems, fuel for transport, operation
                              costs for campaigns
2. Advocacy and               IEC materials, radio, print media         Social mobilization, IEC,
communication                 advertisements etc.                       developing advocacy and
                                                                        communication plan
3. Surveillance               Surveillance equipment, laboratory        Surveillance meetings and
                              networking and reagents etc.              activities (sentinel sites, outbreak
                                                                        investigation)
4. Vaccine, supply, quality   Vaccines, AD syringes, safety boxes,      Monitoring, vaccine stock
and logistics                 other injection supplies, cold chain      management activities
                              equipment, vehicles, spare parts,
                              incinerators etc.
5. Programme Management       Procurement of land and construction of   Meetings, planning, research, data
                              KEPI HQs, computers, office supplies .    management, EPI reviews, cold
                                                                        chain assessment.



The above listed activities and inputs are what are costed. The costs for the programme are
derived in a variety of costing methodologies, depending on the interventions planned.
These include:
     The ingredient approach, based on the product of unit prices, and quantities needed
        each year, adjusted for the proportion of time used for immunization. This is used for
        costing inputs such as vaccines, personnel, vehicles, cold chain equipment, etc.
     Rules of thumb, which are based on immunization practice, such as a percentage of
        fuel costs as representative of maintenance costs for vehicles. This is used for
        deriving costs for injection supplies, and maintenance of equipment, and vehicles.
     Past spending, where lump sum past expenditure is used to estimate future
        expenditure. For example, past cost per child for specific campaigns, training
        activities etc.
These different approaches are all brought together in a pre-designed cMYP excel costing
tool. This derives costs based on the following components:
     Vaccines and injection supplies
     Personnel costs (EPI specific and shared)
     Vehicles and transport costs
     Cold chain equipment, maintenance and overheads
     Operational costs for campaigns


                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                      58
       Programme activities, other recurrent costs and surveillance
       Other equipment needs and capital costs
       Overhead costs.

9.1.1   Macroeconomic Information

For purposes of placing the costing and financing information within the wider financing
framework, some macroeconomic information is included. This information is detailed in the
table 10 below.

Table 10: Macro Economic Trends in Kenya, 2006 - 2010

                                                      2005     2006     2007      2008     2009     2010
                                                       $         $        $        $         $        $
             GDP per capita                         460        483      507       533       559       587
             Total health expenditures per capita
 (THE per capita)                                   19.2       19.2     19.2      19.2      19.2      19.2
             Government health expenditures
 (GHE%THE)                                         30.0%     30.0%     30.0%    30.0%     30.0%      30.0%
THE and GHE%THE estimates are derived from the NHA country estimates. The GDP is estimated to increase
at 5% per annum.

9.1.2   Vaccines and Injection Equipment

Costs are a function of the unit prices for individual vaccines, with quantities determined by
the target population, adjusted for by coverage and wastage objectives. Prices are based on
UNICEF prices, as supplied by the UNICEF Supply Division. Target populations for different
antigens, coverage, and wastage objectives have been expounded on in earlier chapters.

9.1.3   Personnel Costs (EPI specific and shared)

As with vaccines and injection equipment, cost estimates are based on unit expenditure on
different personnel cadres working in EPI at the different levels of the system, and numbers
of personnel, adjusted for by time spent on EPI-related activities. In addition, costs and time
spent on supervision and outreach activities were included for the different cadres at the
different levels of the system. Unit expenditures are based on Government gross wages.
Time spent on EPI was estimated by a panel of experts, made up of operational staff at
national, provincial and district levels. Quantities available and needed in the lifetime of the
cMYP were included.

9.1.4   Vehicles, and Transport Costs

The costs for vehicles were derived in the same manner as personnel. Additional
maintenance costs were estimated as represented by 15% of fuel expenditure. Quantities
available and needed in the lifetime of the cMYP were included.

9.1.5   Cold Chain Equipment, Maintenance and Overheads

Costs were derived as with personnel and vaccines. Quantities available and needed in the
life time of the cMYP were included.

9.1.6   Operational Costs for Campaigns

These were based on operational costs for past campaigns, with the cost per child derived.



                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                59
       9.1.7    Programme Activities, other Recurrent Costs and Surveillance

       Costs for programme activities were also derived based on the past trends in expenditure,
       with future estimates for costs based on these, modified where necessary. Social
       mobilization costs for 2006 are based on the social mobilisation plan, with estimates for
       future years adjusted for the reduction in start-up activities. Costs for trainings, meetings and
       surveillance activities are based on the 2005 expenditures, with future costs estimated with
       an adjustment factor to cater for activities not included in 2005.

       9.1.8    Other Equipment Needs and Capital Costs

       Additional costs for equipment such as computers etc. were included and costed using the
       same methodology as with other equipment. Overhead costs were included in the estimates,
       based on past expenditure trends.

       9.2      Immunization program costs

       Information above is collated, and compared against expenditure for the baseline year,
       2005/06.

                                                            Expenditures                     Future Resource Requirements

   Cost Category                                               2005           2006          2007          2008             2009         20

Routine Recurrent Cost                                          US$           US$           US$           US$               US$         U
     Vaccines (routine vaccines only)                       $16,160,795    $23,463,115   $23,349,098   $24,194,932    $25,109,585    $26,0
          Traditional vaccines                               $1,800,498    $2,442,229    $2,518,832    $2,618,789     $2,753,662     $2,89
          New and underused vaccines                        $14,360,298    $21,020,887   $20,830,265   $21,576,143    $22,355,923    $23,1
     Injection supplies                                       $663,917     $1,623,932    $1,824,134    $2,048,575     $2,279,060     $2,52
     Personnel                                               $1,786,740    $1,822,475    $1,999,453    $2,039,442     $2,080,231     $2,12
          Salaries of full-time NIP health workers            $879,540      $897,131      $998,971     $1,018,951     $1,039,330     $1,06
          Per-diems for outreach vaccinators/mobile teams     $453,600      $462,672      $500,241      $510,246          $520,451    $530
          Per-diems for supervision and monitoring            $453,600      $462,672      $500,241      $510,246          $520,451    $530
     Transportation                                           $40,845       $42,911       $45,083       $47,364           $49,760     $52
          Fixed site and vaccine delivery                     $27,778       $29,183       $30,660       $32,211           $33,841     $35
          Outreach activities                                 $13,067       $13,728       $14,423       $15,153           $15,919     $16
     Maintenance and overhead                                 $671,649      $982,767     $1,186,415    $1,399,676     $1,616,383     $1,50
          Cold chain maintenance and overheads                $457,111      $738,927      $923,336     $1,117,487     $1,314,424     $1,20
          Maintenance of other capital equipment              $23,738       $49,224       $64,570       $79,711           $95,431     $85
          Building overheads (electricity, water…)            $190,800      $194,616      $198,508      $202,478          $206,528    $210
     Short-term training                                      $155,500      $791,416      $78,246       $115,185          $81,408     $83
     IEC/social mobilization                                  $36,067       $73,437       $75,195       $76,699           $77,330     $78
     Disease surveillance                                     $301,110      $664,055     $1,510,322    $1,534,585     $1,565,818     $1,59
     Programme management                                     $334,465      $341,948      $349,827      $357,885          $375,867    $394
     Other routine recurrent costs                                                        $56,354                         $58,631
  Subtotal Recurrent Costs                                  $20,151,088    $29,806,056   $30,474,126   $31,814,343    $33,294,073    $34,4
   Routine Capital Cost
     Vehicles                                                                             $72,250
     Cold chain equipment                                                  $2,924,681    $1,596,431    $1,590,369     $1,622,176     $1,65
     Other capital equipment                                   $2,400       $150,643      $97,223       $91,563           $93,394     $95
   Subtotal Capital Costs                                      $2,400      $3,075,323    $1,765,904    $1,681,932     $1,715,571     $1,74
   Campaigns
     Polio                                                   $1,018,896     $145,661      $153,807      $162,416          $171,515    $181
          Vaccines                                            $274,707      $19,888       $20,644       $21,428           $22,242     $23




                           Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                         60
                                                                    Expenditures                               Future Resource Requirements

   Cost Category                                                          2005                2006            2007          2008             2009         20

Routine Recurrent Cost                                                     US$                 US$            US$           US$               US$         U
         Other operational costs                                        $744,189            $125,773        $133,163      $140,988          $149,272    $158
     Measles                                                            $799,867            $895,121                                    $1,046,699
         Vaccines and supplies                                           $55,678            $228,870                                        $255,965
         Other operational costs                                        $744,189            $666,251                                        $790,733
  Subtotal Campaign Costs                                               $1,818,763         $1,040,782       $153,807      $162,416      $1,218,213      $181
   Other Costs
     Shared personnel costs                                         $14,717,006           $23,427,262      $32,499,565   $34,780,081    $37,138,818    $39,5
     Shared transportation costs                                          $361                 $368           $376          $383             $391         $3
     Construction of new buildings                                                           $20,400        $20,808       $21,224
   Subtotal Optional                                                $14,717,368           $23,448,031      $32,520,749   $34,801,689    $37,139,209    $39,5
   GRAND TOTAL                                                      $36,689,619           $57,370,192      $64,914,586   $68,460,380    $73,367,066    $75,9
       Routine (Fixed Delivery)                                     $34,108,463           $55,586,866      $64,044,184   $67,572,240    $71,412,761    $75,0
       Routine (Outreach Activities)                                    $762,392            $742,544        $716,595      $725,724          $736,092    $744
       Campaigns                                                        $1,818,763         $1,040,782       $153,807      $162,416      $1,218,213      $181


       We see the program expenditure in the baseline year at over US$ 36 million, of which US$
       million is attributable to the routine recurrent program, with just under US$ 2 million to the
       immunization campaign activities.

       The expenditure breakdown for the routine immunization program is further illustrated in the
       figure below.

                               Baseline Cost Profile (Routine Only)*

                                                              7%   0%       9%
                                                    0%
                                             9%


                                       3%




                                                                              72%
                                         Traditional Vaccines              New and underused vaccines
                                         Injection supplies                Personnel
                                         Transportation                    Other routine recurrent costs
                                         Vehicles                          Cold chain equipment
                                         Other capital equipment




       We see the new vaccines contributing to over 70% of the routine immunization program
       expenditure in the baseline year. This was followed by the traditional vaccine, and the
       immunization program personnel as cost drivers (9% each). These trends in program costs
       are maintained in the period of the cMYP, as seen in the table above, and in the figure
       below.



                           Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                           61
                                          Projection of Future Resource Requirements
                                          $40.0




                               Millions
                                          $35.0

                                          $30.0

                                          $25.0

                                          $20.0

                                          $15.0

                                          $10.0

                                           $5.0

                                             $-
                                                  2006           2007         2008             2009          2010

                                                  Traditional Vaccines              New and underused vaccines
                                                  Injection supplies                Personnel
                                                  Transportation                    Other routine recurrent costs
                                                  Vehicles                          Cold chain equipment
                                                  Other capital equipment           Campaigns
                                                  Shared Costs




The new vaccine continues to be the cost driver for the immunization program in the years of
the cMYP.

Within the immunization program, the costs are driven by activities related to the fixed site
delivery of services, as opposed to outreach activities, or campaign activities (see figure
below).

                   Costs by Strategy

                              $40.0
                   Millions




                              $35.0

                              $30.0

                              $25.0

                              $20.0

                              $15.0

                              $10.0

                               $5.0

                               $0.0
                                                  2006            2007          2008            2009           2010
                                                                    Campaigns

                                                                    Routine (Fixed Delivery)

                                                                    Routine (Outreach Activities)




9.3    Immunization program financing

A number of partners are supporting the immunization program, during the period of the
cMYP. Those identified so far are:


                 Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                    62
            Government
            GAVI
            UNICEF
            WHO
            DFID
            JICA
            European Union
            MERCK vaccines

    The sources of financing provided for the immunization activities in the baseline year (to
    cover 2005/06 expenditures), are illustrated in the table below.

                          Baseline Financing Profile (Routine Only)*

                                                        0%
                                                         0%
                                                        0%




                                  41%




                                                                                    58%




                                           0%
                                           0%
                                  Government       Sub-national Gov.     UNICEF
                                  WHO
                                             1%    DANIDA                JICA
                                  GAVI             DfID                  European Union
                                             0%
                                  MERCK Vaccines
                                            0%

             Financing profile above are for the routine program; not involving shared costs and campaigns

    Financing for the immunization activities in the baseline year is mainly provided from
    Government (58%), and GAVI (41%). Financing trends for the years covered in the cMYP
    are further elaborated in the table below

Resource Requirements, Financing and Gaps*                     2006             2007         2008            2009           2010

Total Resource Requirements                                $33,922,162     $32,393,837    $33,658,691   $36,227,857      $36,349,813   $
Total Resource Requirements (Routine only)                 $32,881,379     $32,240,030    $33,496,275   $35,009,643      $36,168,683   $
   per capita                                                  $0.9            $0.8           $0.8          $0.8             $0.8
   per DTP targeted child                                     $25.3           $22.7          $22.7         $22.8            $22.7
   % Vaccines and supplies                                    76%             78%            78%           78%              79%

Total Financing (Secured)                                  $32,138,341      $5,241,294    $5,396,926    $5,143,224       $5,080,675
              Government                                    $7,206,200      $5,169,044    $5,396,926    $5,143,224       $5,080,675
              Sub-national Gov.                                 $0              $0            $0            $0               $0
              UNICEF                                         $248,758           $0            $0            $0               $0
              WHO                                           $1,456,079          $0            $0            $0               $0
              DANIDA                                            $0              $0            $0            $0               $0
              JICA                                          $3,456,417          $0            $0            $0               $0



                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                           63
Resource Requirements, Financing and Gaps*               2006              2007         2008          2009           2010

              GAVI                                   $19,770,887        $72,250           $0           $0             $0
              DfID                                        $0              $0              $0           $0             $0
              European Union                              $0              $0              $0           $0             $0
              MERCK Vaccines                              $0              $0              $0           $0             $0
Funding Gap                                           $1,783,821      $27,152,543    $28,261,765   $31,084,633    $31,269,139    $
   % of Total Needs                                          5%            84%          84%           86%            86%

Total Financing (Not Secured / Probable)               $791,416       $23,927,238    $24,768,888   $26,126,514    $27,355,055    $
              Government                                  $0           $1,162,275     $1,215,329    $1,764,167     $2,112,973
              Sub-national Gov.                           $0               $0             $0            $0             $0
              UNICEF                                      $0               $0             $0            $0             $0
              WHO                                         $0           $1,510,322     $1,534,585    $1,565,818     $1,597,907
              DANIDA                                      $0               $0             $0            $0             $0
              JICA                                        $0           $1,596,130     $1,577,645    $1,609,198     $1,641,382
              GAVI                                        $0          $19,580,265    $20,326,143   $21,105,923    $21,919,757
              DfID                                        $0               $0             $0            $0             $0
              European Union                              $0               $0             $0            $0             $0
              MERCK Vaccines                           $791,416         $78,246        $115,185      $81,408        $83,036
Funding Gap                                            $992,405       $3,225,305     $3,492,878     $4,958,119    $3,914,084
   % of Total Needs                                          3%            10%          10%           14%            11%

    Financing is either classified as secured, or probable. Financing that is probable refers that
    which is indicated as potentially available, but still requires some interventions (proposal
    development, negotiations, etc) before it is secured.
    Secured financing represents a very small proportion of the total program costs, particularly
    after 2007. however, even in 2006, some financing is not secured.
    Breakdown of the financing gap, by program component is needed to better understand
    where financing gaps are. This is illustrated in the tables below.


      Composition of the funding gap with secured
                                                                    2006             2007             2008             2009
      financing only
      Vaccines and injection equipment                            $1,221,114      $22,099,098      $22,944,932     $23,859,585
      Personnel                                                       $0          $1,000,482        $510,246       $1,040,901
      Transport                                                    $13,728          $14,423          $15,153         $15,919
      Activities and other recurrent costs                        $1,080,715      $2,191,080       $2,947,086      $3,234,444
      Logistics (Vehicles, cold chain and other equipment)        -$531,737       $1,693,654       $1,681,932      $1,715,571
      Campaigns                                                       $0           $153,807         $162,416       $1,218,213
      Total Funding Gap*                                          $1,783,821      $27,152,543      $28,261,765     $31,084,633


      Composition of the funding gap with both
                                                                    2006             2007             2008             2009
      secured, and probable financing
      Vaccines and injection equipment                            $1,221,114       $2,518,832      $2,618,789       $2,753,662
      Personnel                                                       $0               $0              $0               $0
      Transport                                                     $13,728         $14,423         $15,153          $15,919
      Activities and other recurrent costs                         $289,299         $537,942        $683,796         $957,346
      Logistics (Vehicles, cold chain and other equipment)        -$531,737           $301          $12,724          $12,979
      Campaigns                                                       $0            $153,807        $162,416        $1,218,213
      Total Funding Gap*                                           $992,405        $3,225,305      $3,492,878       $4,958,119




                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                    64
It is seen that in 2006, there is still 1 significant financing gap for vaccines and injection
equipment. This represents the partial financing for traditional vaccines, with only half the
required vaccines available. Beyond 2006, there is no identified source of financing for the
traditional vaccines.

Costs attributed ot the planned additional personnel are also not yet secured, as are the
other cost components as illustrated in the table.

Probable resources are seen from WHO, JICA, GAVI and MERCK vaccines. All these
require interventions to complete negotiations for these resources to make the resources
secure.


9.4     Interventions to Improve the Financial Viability of the Programme

The program appreciates the need to include, as part of its activities, interventions to
improve its financial viability. These are in 2 categories:
   a) Activities to make probable resources secure, and
   b) Activities to seek additional resources to close the financing gaps


9.4.1   Securing Probable Resources

These are resources from GAVI, WHO, JICA, and MERCK vaccines. The GAVI probable
resources reflect the expected contribution from GAVI bridge financing for the new vaccine,
to supplement the Government contribution annually. The country negotiations for this will
have to be completed in 2006, to enable re-classification as secured resources.

The WHO and UNICEF funding is assumed to remain at present levels. To secure this, the
programme will have to participate with these multi laterals when they are developing their
respective programmes of work for the coming years.

12.12.2        Securing Additional Resources

Additional resources are needed by the programme to ensure it is able to implement its
strategic objectives as outlined in this plan. Additional funding will focus on the interventions
in the respective system components where the funding gaps exist, for the respective years.
The programme will, as part of its regular monitoring process, monitor the trends in
financing, to ensure it is moving towards improved financial sustainability by reducing its
financing gaps, and converting more probable financing to secure financing. Indicators for
financial sustainability the programme will use will include:
      % of funding gap to total programme needs for period of cMYP (…% is baseline;
        target of …..%)
      % total programme costs financed by in country sources of financing (…% baseline;
        target of ….%)
      % of total programme costs financed by Government (….% baseline; target of ….%)




                  Kenya EPI Comprehensive Multi-Year Plan 2006-2010                            65
Kenya EPI Comprehensive Multi-Year Plan 2006-2010   66
  9.0     Using the GIVS framework as a checklist

        GIVS strategies                                     Key activities                                      Activity included in MYP
                                                                                                          Y      N       Not          New activity
Strategic Area One: Protecting more people in a changing world                                                           applicable   needed
                                      National Commitment on ongoing immunization services            Partial
                                      through policy and strategy development that also includes
                                      human resources and financial planning
                                      Formulate and implement comprehensive multi-year                y
                                      national strategic plans and annual workplan based on data
 Strategy 1: Use a combination of analysis and problem solving
    strategies to reach everyone      Sustain high vaccination coverage, where it has been            y
      targeted for immunization       achieved
                                      National strategies to immunize children who were not           y
                                      immunized during infancy
                                      Where and When appropriate, include supplementary               y
                                      immunizations activities as an integral part of the national
                                      plans
                                      Engage community members, NGOs and interest groups in           y
                                      immunization advocacy and implementation;
                                      Assess the existing communication gaps in reaching all          y
  Strategy 2: Increase community
                                      communities and develop and implement a communication
      demand for immunization
                                      and social mobilization plan
                                      Provide regular, reliable and safe immunization services that   y
                                      match demand
     Strategy 3: Ensure that the      Micro-planning at the district ct or local level                y
  unreached are reached in every Reduce the number of immunization drop-outs (incomplete
  district at least four times a year vaccination) through improved management
                                      Develop and update supervisory mechanisms and tools             y
                                      Provide timely funding, logistic support and supplies for       y
                                      programme implementation
                                      Define target populations and age groups for vaccination        y
Strategy 4: Vaccinate beyond the
                                      appropriate to the national situation
traditional target group
                                      Assess the cost-effectiveness of strategies                                N


                                             Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                       67
        GIVS strategies                                   Key activities                                  Activity included in MYP
                                                                                                      Y    N       Not          New activity
Strategic Area One: Protecting more people in a changing world                                                     applicable   needed
                                   Procure vaccines only from sources that meet internationally   y
                                   recognized quality standards
                                   Ensure long-term forecasting for existing and new vaccines     y
                                   by improving vaccine management skills
Strategy 5: Improve vaccine,       National self-reliance in quality assurance and regulatory              N
immunization and injection safety oversight
                                   Introduce, sustain and monitor safe injection practices,       y
    Strategy 5: Improve vaccine,   including the use of autodisable (AD) syringes and other
 immunization and injection safety safe methods of vaccine administration
                                   Surveillance and response to adverse events following          y
                                   immunization
                                   Be responsive to potential vaccine safety issues and                    N
                                   address these urgently
                                   Accurate demand forecasting at national and district levels    y
                                   to ensure the uninterrupted supply of assured quality
                                   vaccines, AD syringes and safety boxes
                                   Build capacity for effective vaccine management through
      Strategy 6: Improve and      training, supervision and the development of information
 strengthen vaccine, management systems
              systems              Increase access and coverage through a “safe chain”
                                   approach which includes taking vaccines beyond the cold
                                   chain, using a VVM-based vaccine management system
                                   Move towards coordinated and sector-wide financing and
                                   management for transportation and communication
                                   Regular immunization programme evaluations at local,
                                   district and national levels and provide feedback on
      Strategy 7: Evaluate and
                                   performance
    strengthen the immunization
                                   Perform operations research and evaluation of “what works”
            programme.
                                   to improve the delivery of immunization and to make to
                                   make systems more effective, efficient and equitable




                                            Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                  68
 10.0      KEPI Annual Work plan (2006)




                                                                                                                                         Responsible
          OPERATIONAL                                                                                                                                              Funds




                                                                                                                                                       Cost
                                                                                                                                            Unit
             AREAS               TARGET/OUTPUT                                                                                                                    Available      Shortfall




                                                        where




                                                                                                    JULY
                                                                            MAR



                                                                                        MAY




                                                                                                           AUG




                                                                                                                             NOV
                                                                                  APR




                                                                                                                                   DEC
                                                                                                                       OCT
                                                                      FEB




                                                                                                                 SEP
                                                                JAN




                                                                                              JUN
         Consolidated and                                                                                                                                     Govt.   Partners
        Integrated activities


SERVICE DELIVERY
 1 Intensify & sustain                                                                                           X     X     X     X
    outreach services
 2 Conduct supplementary                                                                      X     X      X     X
    SNIDs
 3 Develop facilitative         45% districts achieve                                               X      X     X     X     X     X
    supervision schedules       Penta 3 coverage of
 4 Screen all children          ≥80%                                                    X     X     X      X     X     X     X     X
    <5years who present to
    the health facility to
    reduce missed
    opportunities
 5 Open more SDPs in far                                                                X     X     X      X     X     X     X     X
    to reach population
 6 Conduct daily                                                                        X     X     X      X     X     X     X     X
    maintenance of cold
    chain
 7 Maintain vaccine                                                                                 X      X     X
    potency at all levels
 8 Distribute vaccines and                                                              X
    other supplies to SDPs      80% districts with no
    on monthly basis            stock outs
 9 Involve facilities in the                                                            X     X     X      X     X     X     X     X
    EPI planning processes
10 Replace the un-                                                                                               X     X     X     X
    serviceable refrigerators
11 Train/update health          Reduce Penta 3                                          X     X     X      X     X     X     X     X
    workers on cold chain       wastage rate to 15%
    maintenance
12 Review KEPI policy on                                                                            X      X     X     X     X     X
    immunization sessions
    particularly BCG and
    measles




                                                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                    69
13   Hold meetings with                                                       X   X   X   X   X   X   X
     school management to
     develop schedule for        45% TT5 coverage
     school health               achieved
     programmes (TT)
14   Conduct the school                                                   X   X   X   X   X   X   X   X
     health programmes (TT)

15   Print, disseminate and                                               X   X   X   X   X   X   X   X
     distribute immunization
     schedules
16   Conduct TT SIAs for                                                  X   X   X   X   X   X   X   X
     child bearing women in
     high risk districts (14
     districts)
17   Conduct routine                                                      X   X   X   X   X   X   X   X
     immunization as per
     schedule (TT)
18   Screen mothers                                                       X   X   X   X   X   X   X   X
     (CBAW) to reduce
     missed opportunities
19   Motivate clients to                                                  X   X   X   X   X   X   X   X
     return for immunization
     by providing services &     80% districts achieve
     information for the need    Penta 1 to Penta 3
     to complete schedule        drop out rate of ≤5%
20   Provide quality EPI                                                          X   X   X   X   X   X
     services (SOPs)
21   Provide home visiting       60% districts achieve                            X   X   X   X   X   X
     tools for CORPs             Penta 1 to measles
22   Liase with community        drop-out rate of <10%                            X   X   X   X   X   X
     leaders and FBO
     leaders
23   Sensitise PEER                                                               X   X   X   X   X   X
     educators on EPI
24   Develop/review and                                                   X   X   X   X   X   X   X   X
     provide defaulter tracing
     tools
25   Motivate CORPs                                                                   X   X   X   X   X
26   Update/train CORPs on       80% measles                                          X   X   X   X   X
     EPI including home          coverage achieved
     visiting
27   Conduct catch up                                                                 X   X   X       X
     campaigns for               ≤5 districts with <
     integrated measles in       50% immunization
     2008                        coverage
28   Conduct                                                                  X   X   X   X   X   X   X
     outreach/mobile clinics



                                                         Kenya EPI Comprehensive Multi-Year Plan 2006-2010   70
29    Provide & sustain                                                         X   X   X   X   X   X   X
      transport for districts
      hard to reach
                                                                                        X   X   X   X   X
Vaccine, supply, quality and Logistics
 1 Train on forecasting,                                                X   X   X
     requisitioning and
     prompt reporting by
     facilities                   80% of antigens and
 2 Integrate procurements         supplies procured/                    X   X   X   X   X   X   X   X
     by the agents                distributed timely
 3 Forecast Vaccines at                                                 X   X   X
     facility, district, province
     and national levels
 4 Distribute vaccines and
     other supplies to SDPs
     on monthly basis
 5 Distribute vaccine                                                   X   X   X   X   X   X   X   X
     management guidelines
 6 Train and update staff                                               X   X   X   X   X   X   X
     on vaccine
     management guidelines
 7 Computerize vaccine                                                  X   X   X   X   X   X
     management system
 8 Regularly monitor              80% districts achieve                 X   X   X   X   X   X   X
     vaccine wastage at all       required standards
     levels
 9 Support Pharmacy and                                                 X   X   X   X   X       X
     Poisons Board to
     establish a system for       Vaccine quality Task
     vaccines quality checks      force set up.
10 Institute vaccine quality                                            X   X   X
     task force
11 Develop guidelines for                                                           X   X   X   X   X
     quality assurance
12 Regularly monitor                                                    X   X   X   X   X   X   X   X
     adherence to guidelines
13 Carry out an inventory                                                               X   X   X   X
     of all cold chain
     equipment in the
     country                      Inventory of all cold
14 Replace non CFC free           chain equipment                                   X   X   X   X   X
     and un-serviceable cold      carried out
     chain equipment
15 Procure and distribute                                                           X   X   X   X
     cold chain equipment to
     new SDPs




                                                          Kenya EPI Comprehensive Multi-Year Plan 2006-2010   71
16   Support KEMSA to                                                   X   X   X   X   X   X   X   X
     stock cold chain spare
     parts at regional
     KEMSA stores
17   Decentralize cold chain                                                        X   X   X   X
     maintenance workshop
     to regional level
18   Update staff on cold                                                           X   X   X   X   X
     chain management and
     maintenance
19   Provide cold chain                                                             X   X   X   X
     technicians with
     appropriate cold chain
     tool kits
20   Avail AD syringes and                                              X   X   X   X   X   X   X   X
     safety boxes to all
     immunization service        100% availability of
     points                      safety boxes
21   Design cost effective                                                              X   X   X   X
     incinerators at district
     and sub-district levels
22   Support districts to                                                                       X   X
     construct incinerators at
     district and sub-district
     levels
23   Support immunizing                                                 X   X   X   X   X   X   X   X
     facilities to burn and
     bury waste for those
     with no incinerators

Surveillance
     Conduct quarterly                                      X   X   X   X   X   X   X   X   X   X   X   X
     progress meetings
     between KEPI, PHMTs,        25% districts trained
     DHMTs and Partners.
     Train health workers on                                    X   X   X   X   X   X   X   X   X   X   X
     VPDs and redefine their
     role on disease
     surveillance.
     Develop guidelines for                                                     X   X
     introduction of
     community surveillance
     Revise surveillance                                                                X   X   X
     guidelines for health
     workers.




                                                         Kenya EPI Comprehensive Multi-Year Plan 2006-2010   72
Train existing CORPs                                                              X   X
and facility health
committee on disease
surveillance.
Establish links for                                                   X   X   X   X   X   X   X
surveillance reports at
district level.
Provide financial                                             X   X   X   X   X   X   X   X   X
support to district level
regularly for
AFT/measles/MNT
surveillance.               25% of districts
Provide funds for           implementing IDSR                 X   X   X   X   X   X   X   X   X
maintenance of
transport for DDSCs,
PDSCs and NDSOs
Provide funds for                                         X   X   X   X   X   X   X   X   X   X
communication for
DDSCs, PDSCs,
NDSOs
Provide funds for WHO                                         X   X   X   X   X   X   X   X   X
Surveillance Officers,
and National Disease
Surveillance Officers,
PDSCs, NPCC, NPEC
and NTF.
Provide funds for HiB                                     X   X   X   X   X   X   X   X   X   X
and Rotavirus
Surveillance
Provide funds for                                         X           X           X           X
quarterly meetings for
PDSCs and DDSCS.
Provide funds for                                         X           X           X           X
NPEC/NPCC/NTF
committees.
Support training of                                               X   X   X   X   X   X   X   X
focal point persons on
IDSR (VPDs) at all
levels
Support procurement                                       X   X   X   X   X   X   X   X   X   X
for laboratory supplies
and equipment in liaison
with IDSR Unit
Create/enhance local        NPEV will be 10%                  X   X   X   X   X   X   X   X   X
laboratory networks.        and above
Provide all levels with                                       X   X   X   X   X   X   X   X   X
adequate reporting
tools.



                                                Kenya EPI Comprehensive Multi-Year Plan 2006-2010   73
     Train DDSC to analyse                                           X           X               X
     and use data at their
     level.
     Provide and maintain                                                        X   X   X   X   X   X   X
     computers and
     accessories at all levels.
     Conduct annual cross                                                    X   X   X   X   X   X   X   X
     border meetings with
     inter-country
     surveillance officers.

     Conduct field visits at all
     levels and give written
     feedback
              National –                                            X           X           X           X
               Quarterly
                             25% support
              Provincial –  supervision                     X   X   X   X   X   X   X   X   X   X
               Monthly
              District –                                    X   X   X   X   X   X   X   X   X   X
               Daily/monthly
     Provide instant,                                        X   X   X   X   X   X   X   X   X   X
     monthly, and quarterly
     feedback (verbal and
     written).
Advocacy and communication
     Conduct baseline                                                                X   X   X
     survey on
     communication gaps on
     routine EPI messages.

     Translate various IEC         IEC inventory survey                  X   X   X   X   X   X   X   X
     materials appropriately       carried out in a
     according to set-up           representative
     Distribute as brochures,      sample districts                      X   X   X   X   X       X   X
     leaflets etc to
     community members,
     schools, popular
     meeting spots
     Train social mobilizers                                         X           X           X
     from community on the
     translations
     Develop radio, TV,                                              X           X           X
     Internet and other
     media spot messages
     for Routine
     Immunization




                                                          Kenya EPI Comprehensive Multi-Year Plan 2006-2010   74
Recruit and train liaison   40% districts with                                     X   X   X   X
officers, provincial,       established/
district and divisional     strengthened
levels                      functional
Develop and distribute      communication                          X   X   X   X   X   X   X   X
newsletters on              structures
immunization
information on a
quarterly basis
Develop an integrated                                                          X   X   X   X   X
routine reporting tool on
EPI activities              50% of all levels with
Conduct quarterly joint     strengthened and                   X               X               X
meetings with partners      sustained inter-
and other stakeholders      sectoral collaboration
Develop joint work          with partners and                                          X
plans                       stakeholders
Advocate for increased                                         X   X   X   X   X   X   X   X   X
and sustained allocation
in the national budget
for advocacy and
communication
Encourage business                                                 X   X   X   X   X   X   X
partners to support
advocacy of particular
immunization events
Attend annual district      Integrate EPI                                          X   X   X
planning workshop and       communication plan
ensure EPI                  in annual district
communication plan is       health microplans in
integrated into district    all districts
plans
Train health workers in     Train health workers                   X   X   X   X   X   X   X
IPC (include attitudinal    in IPC in 50% of the
change)                     districts
Sensitise CORPs, key        Sensitise CORPs,                       X   X   X   X   X   X   X
community leaders and       key community
stakeholders                leaders and
Monitor communication       stakeholders in 40%                    X   X   X   X   X   X   X
activities at all levels    districts
and provide feedback
Develop an integrated                                                      X   X   X   X
reporting tool
Hold feedback meetings                                             X   X   X   X   X   X   X
Orientation/sensitisation                                                      X   X   X   X
of broadcasters and
reports on EPI




                                                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010   75
    Prepare messages for                                               X   X   X   X   X   X   X
    broadcasting and for
    feedback meetings
Management
    Rationale re-distribution                                          X   X   X   X   X   X   X   X
    of available h/workers
    within the districts and     60% of all H/Fs will
    the country s whole.         be offering EPI
    Carry out training needs     services                                      X   X   X   X
    analysis.
    Advocate for staff                                                 X   X   X   X   X   X   X   X
    employment for specific
    disadvantaged areas.
    Annual review of the                                                                   X
    KEPI organogram to fit
    the demand of the
    future.
    Develop annual plans at      45% of districts                          X   X   X   X   X   X   X
    all levels                   prepared
    Hold quarterly review        comprehensive                         X   X   X   X   X   X   X   X
    meetings at the Districts    operational plans in-
    with stakeholders            corporating EPI
    involvement
    Provide logistical and                                                                 X   X
    financial support to
    districts
    Develop and                                                    X           X           X
    disseminate timely
    Annual Operation Plans
    Carryout and implement       All districts have                X   X   X   X   X   X   X   X   X
    a study on fleet             access to
    management system for        serviceable/adequate
    PHC services                 transport for EPI 80%
    Provide appropriate          of the time                                           X   X   X   X
    serviceable transport
    Review office and                                                                      X   X   X
    storage capacity of EPI
    at all levels (technical     Scale up
    report)                      establishment of
    Land procurement for         KEPI offices and                          X   X   X   X
    KEPI HQ for                  storage capacity to
    construction of offices      65% at all levels
    and cold rooms
    Construct new, and                                                         X   X   X
    rehabilitate existing cold
    rooms and stores in the
    regions and districts




                                                         Kenya EPI Comprehensive Multi-Year Plan 2006-2010   76
Construct incinerators in                                             X   X   X   X
40% of all health
facilities
Carry out assessment         30% of immunizing                        X   X   X   X
of cold chain inventory      facilities have CFC
Replace 90% of old           free cold chain                          X   X   X   X   X
fridges with CFC free        equipment
fridges
Procure CFC free                                                              X   X   X   X   X
fridges for new facilities
Procure assorted cold                                                             X   X   X   X
chain spare parts
Provide appropriate          90% of immunizing                        X   X   X
source of energy to          facilities to have
support cold chain           adequate and
Avail AD syringes and        consistent vaccine                                   X   X   X   X
safety boxes to all          and related supplies
SDPs
Mobilize locally                                                                  X   X   X   X
available resources to
avail documentation
tools and consumables
Set up national                                                   X   X   X   X   X   X   X   X
immunization resource
mobilization steering        GOK allocation at 1%
committee
Joint biannual meeting                                            X   X   X   X   X   X   X   X
of ICC, MOH and              Number of proposals
treasury staff to            drawn for funding.
mobilize GOK
resources for
immunization
Inventories of all                                                X   X   X   X   X   X   X   X
potential private
/corporate organization
Organize meeting with                                             X   X   X   X   X   X   X
potential private sector
partners/ donors
Contract an                                                       X   X   X   X   X   X   X
organisation to
coordinate resource
mobilization
Re-establishment of                                                           X   X
regular outreach
services




                                                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010   77
Supportive supervision:                                           X                       X
on-site training
community links with
service delivery
Monitoring and use of                                             X   X   X   X
data for action
Better planning and                                               X   X   X   X   X   X   X   X
management of human
and financial resources
Reduce the number of                                                  X           X       X
immunization dropout
through micro planning
at the district or local
level
Strengthen managerial                                                     X   X   X   X   X
skills of immunization
providers at all levels
Provide timely funding,                                           X   X   X   X   X   X   X   X
logistic support and
supplies in every district
Strengthen managerial                                             X   X   X   X   X   X   X   X
skills of immunization
providers at all levels
Provide timely funding,                                                       X   X
logistic support and
supplies in every district
Develop monitoring           Roll out EPI Info to                 X   X   X   X   X   X   X   X
tools for immunization       30% of districts
services
Train supervisors at all     M&E carried out                      X           X           X
levels on monitoring         during the year
systems




                                                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010   78
11.0       KEPI Annual Work plan (2006) - BUDGET SUMMARY 2006/7

           Activity                                                                                            COST “KES’            Total Cost    % of
                                                                                                                                       “KES”       Total
                                                                                                                                                  Budget
                                                                                                Recurrent           Development
A          PROCUREMENT
           Central Level
    1      DPT-HepB+Hib vaccine (in kind from GAVI)                                             812,000,000                       1,403,700,000    80.4
    2      Traditional Vaccines                                                                 491,700,000
    3      GOK contribution to procurement of Pentavalent Vaccine                               100,000,000
    4      Injection Safety Materials                                                           206193844                         206,193,844      11.8
    5      Other EPI logistics including gas                                                    33,655,000          8,809,000     42,464,000       2.4
    6      Cold chain equipment and workshop consumables (Cold chain spare parts etc.)          5,865,000
    7      Lab. Materials, suppliers & Equip                                                    230,000                           230,000          0.01
    8      Purchase of Uniforms & Clothing - Staff (drivers)                                    60,000                            60,000          0.003
    9      Office & General Suppliers & Services                                                816,000                           816,000          0.05
    10     Purchase of Office Furniture and Gen. Equip                                            900,000                         900,000          0.05
    11     Purchase of Specialized Plant, Equip., & Machinery (Purchase of vaccine refrigerators) 15,000,000

           SUB TOTAL                                                                            1,666,419,844       8,809,000     1,654,363,844    94.7


B          Operations
    1      Central Level
    i.     Basic Wages - Temporary Employees                                                    93,840                            93,840          0.005
    ii.    Personal Allowances paid as reimbursements (Leave expenses)                          82,400                            82,400          0.005
    iii.   Communication, Suppliers & Services                                                  1,248,000                         1,248,000        0.07
    iv.    Domestic travel & Subsistence                                                        2,350,000           3,122,020     5,472,020        0.3
    v.     Foreign travel, Subsistence, & other transport costs                                 1,150,000                         1,150,000        0.07
    vi.    Printing, Advertising & Information/Advocacy supplies                                34,855,000                        34,855,000       1.9
    vii. Training                                                                               3,210,000                         3,210,000        0.18
    viii. Hospitality Suppliers & Services                                                      100,000                           100,000         0.006
    ix.
          Fuel oil & lubricants (including for generators and LPG for
          refrigerators                                                                         772,225             21,406,100    22,178,325       1.27



                                                   Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                       79
           Activity                                                                                        COST “KES’                 Total Cost    % of
                                                                                                                                        “KES”       Total
                                                                                                                                                   Budget
    x.     Other operating costs e.g. Port clearance; contracted guards etc                   10,600,000                          10,600,000        0.6
    xi.    Maintenance of vehicles & other transport                                          2,363,900           7,600,500       9,964,400         0.57
    xii. Routine maintenance - Other Assets                                                   2,302,500           897,000         3,199,500         0.18
           Sub - Total                                                                        59,127,865          33,025,620      92,153,485        5.28


    2      Support to Provinces
    I.     Allowances for supervision of EPI services                                         880,000
    ii.    Surveillance                                                                       14,533,120
    iii.   Regional depots AIEs                                                               720,000
    iv.    Provincial AIEs                                                                    4,440,000
    v.     Generator fuel for regional depots                                                 480,000

    vi.    Maintenance of vehicles & other transport & fuel for supervision of EDI services   3,560,000
    vii. Regional depots Routine Maintenance of generator                                     240,000
           Sub-Total                                                                          24853120


    3      Support to Districts
    I.     District AIEs                                                                      42,900,000
    ii.    Surveillance activities                                                            20,363,280
    iii.   Allowances for distribution of supplies                                            5,640,000
    iv.    LPG for refrigerators                                                              16,600,000
           Maintenance of vehicles & fuel for distribution of supplies
    v.                                                                                        13,480,000
    vii. Refrigerator maintenance                                                             1,420,000
           Sub Total                                                                          100,403,280


C          Supplemental Immunisation Activities
           Central and district activities


           GRAND TOTAL KES                                                                        1,850,804,109         41,834,620 1,746,517,329




                                                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                      80
 ANNEX 1: SWOT ANALYSIS
 1.1  MANAGEMENT
ACHIEVEMENTS/ STRENGTHS                           CHALLENGES/ WEAKNESSES                                          RECOMMENDATIONS                            CONCLUSIONS

National
-Capacity building of health workers at           -Inadequate cold chain equipment, the current fridges           KEPI Central Management should             -Inadequate       funding        affecting
various levels on EPI activities                  have not been replaced with the CFC free equipment.             endeavor to hold monthly meetings to       equipments, staffing, and logistics due to
                                                  There has been frequent breakdown of the old fridges            review progress on the programme           unsustainable funding have been a major
Strong collaboration between KEPI, KNH            interrupting services at facility level.                        components without failure and critical    contributor to static trends in
and KEMRI Welcome trust at Kilifi district                                                                        issues;                                    immunization;
hospital for Hib surveillance.
                                                  Lack of a well-established system for outreach and drop         KEPI Central Management Unit urgently      -Staff training could be an integral part
Conducted successful Supplemental                 out monitoring activities in most districts.                    needs a new roomy working space;           of the programme management to
Immunization Activity (SIAs) for polio,                                                                                                                      improve efficiency;
measles and MNT                                   Lack of reliable transport for vaccine distribution at          Transport problems at the KEPI
                                                  district level.                                                 headquarters should be looked into and
Increased immunization coverage (45% fully                                                                        solved urgently for delivery of services
immunized in 2000 to 65% in 2005)                 Inadequate numbers of health workers in the hard to reach       efficiently;
                                                  districts.
Supportive Supervision                                                                                            Improve resource mobilization
Planning done at all levels                       Inadequate personnel (number, quality, training and
                                                  distribution)                                                   Recruitment of more health workers
Resource mobilization/ allocation at all levels
                                                  Poor motivation of health workers handling immunization
                                                  at lower levels

                                                  Despite the increased allocation of funds for EPI
                                                  activities over the last 5 years it has not yet been possible
                                                  to reach national goal of 80/80 for all antigens.

                                                  Lack of a sustainability plan after the GAVI funding

                                                  High staff turnover at facility levels.

                                                  Inadequate storage facility at national level

District




                                                      Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                   81
ACHIEVEMENTS/ STRENGTHS                           CHALLENGES/ WEAKNESSES                                          RECOMMENDATIONS                            CONCLUSIONS
Improving of data management, which               -Inadequate cold chain equipment, the current fridges           Quality review meeting                     Inadequate        funding        affecting
resulted to the country passing the GAVI          have not been replaced with the CFC free equipment.                                                        equipments, staffing, and logistics due to
DQA in 2004                                       There has been frequent breakdown of the old fridges            Exchange visits                            unsustainable funding have been a major
                                                  interrupting services at facility level.                        DHMT TOTs for health facilities            contributor to static trends in
Supportive Supervision being done                                                                                                                            immunization;
Planning done at all levels                                                                                       Transport facilities
                                                  Lack of a well-established system for outreach and drop                                                    Staff training could be an integral part of
Resource mobilization/ allocation at all levels   out monitoring activities in most districts.                    KEPI Central Management should             the programme management to improve
                                                                                                                  endeavor to hold monthly meetings to       efficiency;
                                                  Lack of reliable transport for vaccine distribution at          review progress on the programme
                                                  district level.                                                 components without failure and critical
                                                                                                                  issues;
                                                  Inadequate numbers of health workers in the hard to reach
                                                  districts.                                                      KEPI Central Management Unit urgently
                                                                                                                  needs a new roomy working space;
                                                  Inadequate personnel (number, quality, training and
                                                  distribution)                                                   Transport problems at the KEPI
                                                                                                                  headquarters should be looked into and
                                                  Poor motivation of health workers handling immunization         solved urgently for delivery of services
                                                  at lower levels                                                 efficiently;

                                                  Despite the increased allocation of funds for EPI               Improve resource mobilization
                                                  activities over the last 5 years it has not yet been possible
                                                  to reach national goal of 80/80 for all antigens.               Recruitment of more health workers

                                                  Lack of a sustainability plan after the GAVI funding

                                                  High staff turnover at facility levels.

                                                  Inadequate storage facility at facility level


Facility
Supportive supervision being done                                                                                                                            Inadequate        funding        affecting
                                                  Inadequate cold chain equipment, the current fridges have       Improve resource mobilization              equipments, staffing, and logistics due to
Planning done at all levels                       not been replaced with the CFC free equipment. There                                                       unsustainable funding have been a major
                                                  has been frequent breakdown of the old fridges                  Recruitment of more health workers         contributor to static trends in
Resource mobilization/allocation at all levels    interrupting services at facility level.                                                                   immunization;
                                                                                                                  Quality review meeting
                                                                                                                                                             Staff training could be an integral part of
                                                  Lack of a well-established system for outreach and drop         Exchange visits                            the programme management to improve
                                                  out monitoring activities in most districts.                                                               efficiency;
                                                                                                                  DHMT TOTs for health facilities
                                                  Lack of reliable transport for vaccine distribution at          Transportation facilities for outreach
                                                  district level.


                                                  Inadequate numbers of health workers in the hard to reach




                                                      Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                    82
 ACHIEVEMENTS/ STRENGTHS                            CHALLENGES/ WEAKNESSES                                      RECOMMENDATIONS                                CONCLUSIONS
                                                    districts.


                                                    Inadequate personnel (number, quality, training and
                                                    distribution)

                                                    Poor motivation of health workers handling immunization
                                                    at lower levels

                                                    High staff turnover at facility levels.

                                                    Supportive Supervision

                                                    Low resource mobilization/ allocation at all levels
 Inadequate storage at facility level

 The establishment of outreach services still
 inadequate


   1.2        VACCINES SUPPLY AND QUALITY
ACHIEVEMENTS/ STRENGHTS                            CHALLENGES/ WEAKNESSES                                      RECOMMENDATIONS                                 CONCLUSIONS

National
Procurement of vaccines by GOK and partners        Abandonment of the outreach strategy was mostly             KEPI should put a mechanism in place to         Few vehicles were available, and there
(UNICEF, WHO, JICA, DFID)                          attributed to the lack of vehicles/motorcycles and funds    conduct investigations of adverse events        was low funding for transport. This put
                                                   for maintenance                                             following immunization (AEFI) reported to       all KEPI activities at all levels at a
Introduction of pentavalent and yellow fever                                                                   it.                                             disadvantage in meeting its transport
vaccine in 2001 with GAVI support.                 Funding allocated by budgets for transport is very small                                                    requirements.
                                                                                                               Kenya should develop a capability and
Production of the vaccine management               Single sourcing for pentavalent results in high costs of    capacity to test the viability and potency of   Those in charge of ordering vaccines did
manual/ guidelines with UNICEF/WHO                 vaccines.                                                   vaccines imported into the country.             not know how to forecast their needs.
assistance.
                                                   Copies of vaccine management manual/guidelines not          There is need for on the job training in        Storage capacity was found to be
KEPI has operationalized the Opened Vial           enough for all facilities.                                  documentation, financial management and         adequate
Policy and trained health workers at all levels.                                                               vaccine quality and management for all
                                                   Vaccine wastage still high in some regions.                 those concerned in ordering of vaccines at      Energy (power) sources were generally
Guidelines have been issued on vaccine                                                                         all levels.                                     available.
forecasting.
                                                   Facilities still have poor accountability for vaccines.     A policy on cold chain equipment should         Due to staff turnover, a number of health
There is a policy in place that ensures uniform                                                                be developed.                                   workers have not been trained. There is
distribution of vaccines.                          Not using the forecast information at National level.                                                       need for training.
                                                                                                               Capacity building on vaccine management
KEPI, with the assistance of development           Efforts of health workers in submitting the vaccine         needs to be sustained at all levels; hence      Poor accountability for vaccines
partners has made good attempts of buying          forecasting forms at the headquarters, for the time being   funding for future trainings should be in       attributes to the high wastage rate
and making available spare parts for the           is a waste of their time.                                   KEPI AOPs for the next plan period (2006-       especially in polio.
available refrigerators.                                                                                       2010).




                                                         Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                 83
ACHIEVEMENTS/ STRENGHTS                            CHALLENGES/ WEAKNESSES                                       RECOMMENDATIONS                          CONCLUSIONS
                                                   Vaccine supplies still not demand driven in all regions.                                              From the national level vaccines are
District and Regional vaccine stores where                                                                      Consider single dose vials for BCG and   distributed to various levels not based on
electricity is accessible have made a good         Erratic vaccine supply during some quarters in the period    measles to reduce the wastages.          requirements of each level, but on
attempt in acquiring stand-by generators.          under review (2001-2005).                                                                             immediate needs and the availability of
                                                                                                                MOH budget to be reviewed to cater for   transport.
Health facilities are in possession of gas         Other competing activities lead to delay in vaccine          future vaccine procurement and reduce    Vaccine distribution has not been
cylinders from the supplier in case of             deliveries at all levels.                                    donor dependency.                        reliable.
electricity failures.
                                                   Bureaucracy when collecting imprest for vaccines                                                      The Health Sector reforms have done
Solar units are maintained by KEPI where           distribution.                                                                                         away with the vertically available KEPI
they are already in place.                                                                                                                               vehicles/motorcycles. Now KEPI must
                                                   But some spare parts are not there and take long to get in                                            compete with other programmes to get
Solar powered generators have been installed       place.                                                                                                vehicle allocations and/or money for
where appropriate.                                                                                                                                       public transport for the provincial and
                                                                                                                                                         district staff.
The Ministry of Health HQ has deployed
technicians at all the regional/zonal depots.                                                                                                            KEPI to provide for and purchase spare
                                                                                                                                                         parts.

District
KEPI has operationalized the Opened Vial           In most cases DHMTs point to the lack of transport as the                                             Storage capacity is inadequate.
Policy and trained health workers at all levels.   cause to in-effectiveness of their immunization
                                                   operations, and the low rate of implementation of
Health workers in all districts have been          supervision schedule.                                                                                 Energy (Power) sources are generally
trained on vaccine handling and storage and                                                                                                              available.
the cold, chain preparation of vaccines for        Not all health workers have been trained.
administration.                                                                                                                                          Serious concerns have been raised about
                                                   Policy is there but the capacity to hold the vaccines at                                              the handling of vaccines used in KEPI
Guidelines have been issued on vaccine             district level is inadequate.                                                                         because of the vaccine storage
forecasting.                                                                                                                                             conditions observed at provincial,
                                                   Transport to carry out the exercise is not adequate                                                   district and health facilities.
Efforts of health workers in submitting the
vaccine forecasting forms at the headquarters,                                                                                                           Districts to be provided with transport to
for the time being is a waste of their time.                                                                                                             carry out the exercise

There is a policy in place that ensures uniform
distribution of vaccines.

The districts have increased the number of
personnel trained in refrigerator maintenance
and provided them with adequate transport.

Facility
Health workers in all districts have been          Lack of vaccines racks in some facilities (RCW 42 EG)                                                 Serious concerns have been raised about
trained on vaccine handling and storage and        for proper arrangement of antigens.                                                                   the handling of vaccines used in KEPI
the cold, chain preparation of vaccines for                                                                                                              because of the vaccine storage
administration.                                    Policy is there but the capacity to hold the vaccines at                                              conditions observed at provincial,




                                                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                             84
ACHIEVEMENTS/ STRENGHTS                           CHALLENGES/ WEAKNESSES                                    RECOMMENDATIONS                              CONCLUSIONS
                                                  district level is inadequate                                                                           district and health facilities.
Guidelines have been issued on vaccine
forecasting.                                                                                                                                             Storage capacity is inadequate.

Efforts of health workers in submitting the                                                                                                              Energy (Power) sources are generally
vaccine forecasting forms at the headquarters,                                                                                                           available.
for the time being is a waste of their time.
                                                                                                                                                         Need to increase the allocation for gas
There is a policy in place that ensures uniform                                                                                                          cylinders to facilities.
distribution of vaccines.

Health facilities are in possession of gas
cylinders from the supplier in case of
electricity failures.


   1.3        LOGISITCS
ACHIEVEMENTS/STRENGTHS                            CHALLENGES/WEAKNESSES                                     RECOMMENDATIONS                              CONCLUSIONS
National
The central level is providing cold chain         No defined budget line for cold chain equipment and       Cold chain maintenance needs to be           Logistics base has increased through
maintenance support services to regional          maintenance respectively.                                 decentralized to regional levels.            support from DANIDA (previous donor),
depot cold rooms.                                                                                                                                        WHO, UNICEF and JICA.
                                                                                                            Reliable transport is required for vaccine
Currently, KEPI has the capacity to distribute    Inadequate cold chain equipment: 50% of dispensaries do   distribution and supportive supervision.
vaccine supplies up to the district level.                                                                                                               EPI is ensuring continuous supply of gas
                                                  not have cold chain equipment.                                                                         for cold chain; two standby cylinders are
                                                                                                            Bio-medical Engineers compliant with cold
Cold chain is reliable; there have been very                                                                chain need to be trained as TOTs to offer    at the district and health facilities
few incidences of disruption of immunization                                                                training at district levels.                 respectively.
services due to cold chain failure.               Cold chain maintenance is constrained by delayed
                                                  availability of spare parts.                              Sustained strict Adherence to “bundling      Forecasts for vaccines and injection
All immunizing centers are using AD                                                                         policy” for vaccines, AD syringes and        safety materials is being done long term
syringes and safety boxes.                                                                                  safety boxes supplies is required.           (5 years).
                                                  Most cold rooms are now old, with the Mombasa and
Procurement and distribution of vehicles,         Kisumu being the most problematic. The Kisumu cold        Consider service contracts for cold chain    Vaccines and procurement procedures
motorcycles and bicycles to needy districts       room has performance problem of not allowing automatic    rooms at central and regional depots.        have conformed to WHO and UNICEF
has been done during the plan period 2001-        switching on to back up of electricity supply for the                                                  standards and guidelines.
2005.                                             depot.                                                    Introduce ledger for monitoring syringes
                                                                                                            and general supplies (a recommendation by    Currently there is no data tool for
Staff at central level has capacity to forecast                                                             data quality audit in 2004).                 documenting AD syringes and safety
annually for vehicles and cold chain                                                                                                                     boxes.
                                                  The island districts of Lamu, Siaya, Kwale and Suba
equipments.                                       received motor boats through DANIDA support. These        A policy on KEPI logistics and a logistics
                                                                                                            strategic plan is required to ensure         The ageing cold rooms will require more
                                                  motor boats are no longer operational due to the high
The four (4) trucks at central level (for                                                                   budgetary allocations and sourcing for       of curative maintenance in the future.
                                                  maintenance costs.
vaccine distribution) are currently adequate.                                                               external funds.
                                                                                                                                                         Incinerator coverage is still low at
GAVI funds availed supplementation for                                                                      Provide support for continued education      district level.
                                                  Lack of funds to continue the construction of district
transport operation during the plan period.                                                                 and refresher training in logistics



                                                       Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                             85
ACHIEVEMENTS/STRENGTHS                             CHALLENGES/WEAKNESSES                                     RECOMMENDATIONS                                 CONCLUSIONS
                                                   incinerators.                                             maintenance and operations.                     All levels are preparing schedules for
Stakeholders have provided support in                                                                                                                        vaccine distribution.
planning and procurement of necessary                                                                        Institutionalize training in injection safety   Bio Medical Engineers have received
logistics.                                         Stock outs for BCG needles, diluents and syringes were    and vaccine waste management.                   training in cold chain maintenance with
                                                   experienced for short period. This was mainly due to                                                      UNICEF support.
AD syringes and safety boxes are being             procurement problems.                                     Annual updating of cold chain inventory is
procured by GOK with support from GAVI                                                                       required.                                       There is weak supervision in some
and DARE.                                                                                                                                                    districts due to constrained availability of
                                                                                                             A policy for disposal and replacement of        transport for support supervision.
Health staff received training on safe injection   There is no waste management focal person at provincial   cold chain equipment require to be effected.
and waste management (with JSI                     and district levels.                                      The indicated life spans for each equipment     Whereas logistics data (consumption,
collaboration). Training materials in injection                                                              and replacement dates should be adhered to.     stock at hand, losses and adjustments) is
safety was developed in 2005.                                                                                                                                collected at all levels, this information is
                                                                                                                                                             not used to supplement the demographic
Health workers have been trained on cold                                                                     KEPI’s transport inventory is required. A       data used in forecasting of vaccines and
chain management.                                                                                            transport policy and implementation plan        injection materials, reason being it is not
                                                                                                             should then be developed for improved           forwarded to the national level.
Districts have been provided with Gas                                                                        transport management system.
cylinders and accessories.
                                                                                                             Consider collaborating with stakeholders to     There is no waste management focal
KEPI supports 3,322 (60%) service delivery                                                                   ensure cost effective & continuous              person at provincial and district levels.
points nationally. 275 hospitals; 875 H/Cs;                                                                  availability transport.
and 50% of 4,409.


District




                                                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                   86
ACHIEVEMENTS/STRENGTHS                            CHALLENGES/WEAKNESSES                                         RECOMMENDATIONS                               CONCLUSIONS
Fifty (50) Denmont incinerators have been         There is inadequate technical capacity for cold chain         Standard health units should include dry      There is inadequate technical capacity
constructed at District Hospital and sub-         maintenance in some districts.                                storage rooms during construction.            for cold chain maintenance in some
district levels with UNICEF support.                                                                                                                          district s.
                                                                                                                Ensure district health plans include waste
District levels have received capacity building   Inadequate availability of transport in some districts.       management.
on cold chain maintenance.                                                                                                                                    There is inadequate availability of
Districts receive quarterly AIE for transport     Storage space for bulky supplies is inadequate in most        Construct additional district incinerators.   transport in some districts.
operation.                                        districts.
                                                                                                                Provide timely funds for gas.                 Storage space for bulky supplies is
                                                  In-experienced drivers especially at district levels.                                                       inadequate in most districts.

                                                  Poor roads.                                                                                                 There are in-experienced drivers
                                                                                                                                                              especially at district levels.
                                                  Tools for maintenance of the new CFC free equipment are
                                                  not available.                                                                                              Poor roads.

                                                  The funds sent to districts for purchase of gas has                                                         Tools for maintenance of the new CFC
                                                  remained constant and yet price of gas has gone up.                                                         free equipment not available.

                                                  Small ice packs for vaccine carriers are in short supply at
                                                  some district and facility levels.



FACILITY
All (100%) MOH’s health facilities (hospitals,                                                                  Updates on injection safety should not be     All (100%) MOH’s health facilities
health centers and dispensaries), private and     Very little provision for fridge maintenance.                 limited to nurses only, should include all    (hospitals, health centers and
Faith Based immunization centers are                                                                            cadres and casual workers.                    dispensaries), private and Faith Based
currently using AD syringes and safety boxes.     Irregular and slow supply of cold chain equipment and                                                       immunization centers are currently using
                                                  replacement of old refrigerators with CFC free                Quality of syringes needs to be improved.     AD syringes and safety boxes.
All GOK hospitals and health centers are fully    refrigerators.
equipped with cold chain equipments.                                                                            Provide timely funds for gas.                 All GOK hospitals and health centers are
                                                                                                                                                              fully equipped with cold chain
Over 50% of 4,050 dispensaries in the country     Poor practices of waste handling and management.              More dispensaries to be equipped with cold    equipments.
are equipped with cold chain equipments.                                                                        chains.

There is high level of awareness among health     Inadequate funding for waste management at facility
workers on the importance of cold                 level.
maintenance.

Cold chain is reliable; there has been few
incidences of disruption of immunization
services due to cold chain failure.


   1.4        SERVICE DELIVERY
ACHIEVEMENTS/STRENGHTS                            CHALLENGES/WEAKNESSES                                         RECOMMENDATIONS                                      CONCLUSIONS




                                                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                87
ACHIEVEMENTS/STRENGHTS                            CHALLENGES/WEAKNESSES                                         RECOMMENDATIONS                                          CONCLUSIONS

National
GoK is committed to funding part of EPI           Last plan period’s set objectives and targets for ensuring    Improve accessibility by opening more                    Generally, immunization
activities, especially procurement of vaccines.   at least 90 percent of children under 12 months of age        immunization centers.                                    coverage has increased albeit
                                                  were protected against all vaccine preventable diseases                                                                slow. This is more in
GoK is working harmoniously with partners         through immunization by 2005 were not attained.               Improve supervision and monitoring of                    economically better districts than
on investment in EPI programme; e.g.                                                                            immunization performance at all levels.                  in poorer ones. Poverty has
UNICEF, WHO, JICA, DANIDA, ADRA.                  Utilization of EPI services is not increasing rapidly                                                                  negatively impacted on the level
                                                  though coverage is on upward trend for most districts.        Improve administrative systems through report
Pentavalent vaccine was successfully                                                                            completeness and timeliness at all levels; and           of healthcare especially
introduced in the national immunization           Many Provinces and districts are still having very low        deployment of much needed health workers.                immunization utilization rates.
schedule in July 2001.                            immunization coverage and causes need to be                                                                            The newly introduced additional
                                                  investigated.                                                 Scale up support and implementation of the new
Immunization coverage has been increasing                                                                       TT schedule.                                             vaccines to the national
nationally since 2001 to date, albeit too         Annual programme reviews though very important to                                                                      immunization schedule have not
slowly; but some districts are below              identify shortcoming and delayed milestones were not          Improve the estimation of target population in the       impacted negatively on the
expectation due to shortage of staff.             carried out by KEPI.                                          catchments areas for better estimation of                overall utilization of
                                                                                                                immunization coverage.                                   immunization services.
KEPI adopted performance based                    The impact of AEFI on utilization of immunization
management approach in 2002;                      services could not be estimated. Because the completed        Implement, improve and integrate outreach services       The MOH’s Injection safety and
                                                  information in the forms sent from the field to KEPI, was     in areas where accessibility is poor.                    disposal of health waste and
KEPI annually sets new targets, and develops      not followed up with investigations, unless in the case of                                                             management policy is in place.
annual micro-plans;                                                                                             Review, finalize and disseminate policy on               The EPI one is in draft and
                                                  death.                                                        immunization to health workers.                          should be finalised and effected
New vaccines and technologies have been           Dropout rates between Penta 1 and 2 or Penta 1 and                                                                     throughout the country.
added to the national immunization schedule:                                                                    Mount and sustain intensive sensitization of the
                                                  measles are still very high in some districts and action is   community on importance of immunization.
Hepatitis B, Haemophillus influenzae b and        needed to bring them down;                                                                                             GAVI has been the leading
yellow fever vaccine in four districts of Rift                                                                  Support districts and health facilities to develop       supporter of KEPI.
Valley with GAVI support.                         Occurrence of vaccine stockouts for more than two             micro plans and conduct regular reviews.
                                                  months;                                                                                                                The RED strategy has not been
Injection safety and disposal of immunization                                                                   Selections of supervisors should be guided by a          implemented effectively. There is
waste and management policy is in place and       User fees for immunization services (scraped in July          well-defined criteria.                                   need to scale up its
being implemented;                                2004).                                                                                                                 implementation and roll it out to
                                                                                                                Supervision should be strengthened at all levels by      other districts. It should be
Waste management incinerators constructed         Near absence of immunization outreach services in all                                                                  effectively implemented together
in major healthcare institutions in the           districts.                                                    ensuring availability of necessary tools (monitoring     with the strategic outreach
country;                                                                                                                                                                 strategy/SOS.
                                                  Lack of community and social mobilization activities at
Ministry of Health has developed a Strategic      the national, district and sub-district levels.               tools including a register for TT to capture all the
                                                                                                                                                                         The MNT campaigns was
Plan for institutionalization of Healthcare                                                                                                                              conducted successfully and the
Waste Management in December 2005. It’s           Some facilities charging for TT injections.                   five dose schedule at the clinic site to enable follow
                                                                                                                                                                         following were observed:
yet to be implemented.                            AEFI forms poorly distributed.                                up of clients) and resources.                            -Improved surveillance system in
KEPI carried out data quality audit in 2001       Inadequate supply of CWC cards, ANC cards, TT cards                                                                    place has enabled more cases of
and 2002 with GAVI support.                       and TT register.                                                                                                       MNT to be identified by both the
                                                                                                                Distribution of logistics and supervision in the
Cost sharing funds are being used to purchase                                                                   districts require reliable transport.                    health and community.
                                                  Health worker overwhelmed by many reporting tools.
gas and fuel.                                                                                                                                                            -Improvement in TT vaccination
                                                  Shortage of essential drugs.                                  Funds for social mobilization during NIDS/
Feedback from PMO motivate to staff;                                                                            training and logistic support should be released         coverage has been observed over
                                                  Vandalism of the solar panels.                                early at least two weeks in advance.                     the last 2 years in the intervention
Monitoring charts keeps staff alert at all



                                                        Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                       88
ACHIEVEMENTS/STRENGHTS                          CHALLENGES/WEAKNESSES                                         RECOMMENDATIONS                                       CONCLUSIONS
levels.                                                                                                       Need for continued support for social mobilization    Districts.
                                                                                                              at the district level in support of routine
KEPI supervisory book improves follow ups.                                                                    immunization.                                         -Despite meager resources, health
                                                                                                                                                                    workers were committed to
                                                                                                              Strengthening collaboration between MOH (KEPI)        carrying out the MNT
                                                                                                              and their development partners will be necessary      vaccination exercise with
                                                                                                              for implementation of the five TT schedule.           commendable results
                                                                                                              Community sensitization on focused antenatal care     Implementation of the above
                                                                                                              and provision of integrated reproductive health       recommendations will go along
                                                                                                              services to include immunization and safe             way to reduce cases of maternal
                                                                                                              motherhood should be strengthened.                    and neonatal tetanus in the
                                                                                                                                                                    country as well as attaining
                                                                                                              Improve documentation of MNT activities and           elimination of this deadly yet
                                                                                                              ensure continuous feedback at all levels, provision   preventable disease.
                                                                                                              of additional resources for IDSR.
                                                                                                                                                                    The low immunization coverage
                                                                                                              Improve documentation of EPI activities.              assessment based on routine
                                                                                                              Implement school based TT in high-risk districts.     reports (administrative) data is
                                                                                                                                                                    due to poor reporting by
                                                                                                              Integrate EPI activities with other childhood         immunizing facilities,
                                                                                                              programmes e.g. Nutrition, IMCI.                      completeness and determination
                                                                                                                                                                    of the denominator (target
                                                                                                                                                                    population). However this has
                                                                                                                                                                    improved with time.


DISTRICT
KEPI carried out data quality audit in 2001     Utilization of EPI services is not increasing rapidly         Improve accessibility by opening more health          Same as for national level
and 2002 with the support of GAVI.              though coverage is on upward trend for most districts.        delivery points with immunization services.

KEPI supervisory book has improved follow       Many Provinces and districts still have very low              Improve through supervision the monitoring of
ups.                                            immunization coverage and their causes need to be             immunization performance at all levels.
                                                investigated.
                                                                                                              Improve administrative method by improving
Monitoring charts keeps staff alert at all      Dropout rates between Penta 1 and 2 or Penta 1 and            report completeness and timelines at all levels and
levels.                                         measles are still very high in some districts and action is   deploying more health workers.
New vaccines and technologies have been         needed to bring them down.
                                                                                                              Implement new TT schedule and provide cards for
added to the national immunization schedule,    Occurrence of vaccine stockouts for more than two             the same.
namely: Hepatitis B, Haemophillus               months.
influenzae b and yellow fever vaccine in four                                                                 Improve the estimation of target population for
districts in Rift Valley with the support of    User fees for immunization services (scraped in July          better estimation of immunization coverage;
GAVI;                                           2004).
                                                                                                              Implement, improve and integrated outreach
Injection safety and disposal of immunization   Near absence of immunization outreach services in all         services in areas where accessibility is poor.
waste and management annual work plans          districts;
have been developed at national level during                                                                  Mount and sustain an intensive sensitization of the
the plan period. However, implementation        Lack of community and social mobilization activities at       community on importance of immunization.
has not been effective.                         the district and sub-district levels;
                                                                                                              Selections of supervisors should follow a well-




                                                      Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                 89
ACHIEVEMENTS/STRENGHTS                          CHALLENGES/WEAKNESSES                                         RECOMMENDATIONS                                          CONCLUSIONS
Waste management incinerators constructed       Some facilities are charging TT injections                    defined criteria.
in major healthcare institutions in the
country;                                        AEFI forms are poorly distributed                             Supervision should be strengthened at all levels by
                                                                                                              ensuring availability of necessary tools (monitoring
                                                Inadequate supply of CWC cards, ANC cards, TT cards           tools including a register for TT to capture all the
                                                and TT register                                               five dose schedule at the clinic site to enable follow
                                                Health worker overwhelmed by many reporting tools.            up of clients) and resources.

                                                Shortage of essential drugs                                   Distribution of logistics and supervision in the
                                                Vandalism of the solar panels                                 districts requires reliable transport.
                                                                                                              Community sensitization on focused antenatal care
                                                                                                              and provision of integrated reproductive health
                                                                                                              services to include immunization and safe
                                                                                                              motherhood should be strengthened.
                                                                                                              Improvement on documentation of MNT activities
                                                                                                              and continuous feedback at all levels, provision of
                                                                                                              additional resources for IDSR.
                                                                                                              Improve of documentation of EPI activities
                                                                                                              Implement school based TT in high risk districts.
                                                                                                              Integrate EPI activities with other childhood
                                                                                                              programmes e.g. Nutrition, IMCI.

FACILITY
KEPI supervisory book improves follow ups       Dropout rates between Penta 1 and 2 or Penta 1 and            Improve accessibility by opening more health             As in national above
                                                measles are still very high in some districts and action is   delivery points with immunization services.
Monitoring charts keeps staff alert at all      needed to bring them down;
levels.                                                                                                       Improve through supervision the monitoring of
                                                Occurrence of vaccine stockouts for more than two             immunization performance at all levels.
KEPI annually sets new targets, and develops    months;
annual micro-plans;                                                                                           Improve administrative method by improving
                                                User fees for immunization services;-scraped in July          report completeness and timelines at all levels and
New vaccines and technologies have been         2004.                                                         deploying more health workers.
added to the national immunization schedule,
namely: Hepatitis B, Haemophillus               Lack of community and social mobilization activities at       Implement new TT schedule and provide cards for
influenzae b and yellow fever vaccine in four   the national, district and sub-district levels.               the same.
districts in Rift Valley with the support of
GAVI;                                           Some facilities are charging for TT injections.               Improve the estimation of target population for
Injection safety and disposal of immunization                                                                 better estimation of immunization coverage;
waste and management annual work plans          AEFI forms are poorly distributed.
have been developed at national level during                                                                  Implement, improve and integrated outreach
the plan period. However, implementation        Inadequate supply of CWC cards, ANC cards, TT cards           services in areas where accessibility is poor.
has not been effective.                         and TT register.
                                                                                                              Mount and sustain an intensive sensitization of the
Waste management incinerators constructed       Health worker is overwhelmed by many reporting tools.         community on importance of immunization.
in major healthcare institutions in the




                                                      Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                       90
ACHIEVEMENTS/STRENGHTS                          CHALLENGES/WEAKNESSES                                         RECOMMENDATIONS                                          CONCLUSIONS
country.                                        Shortage of essential drugs                                   Distribution of logistics and supervision in the
                                                Vandalism of the solar panels                                 districts requires reliable transport.

                                                                                                              Community sensitization on focused antenatal care
                                                                                                              and provision of integrated reproductive health
                                                                                                              services to include immunization and safe
                                                                                                              motherhood should be strengthened.

                                                                                                              Improvement on documentation of MNT activities
                                                                                                              and continuous feedback at all levels, provision of
                                                                                                              additional resources for IDSR.

                                                                                                              Improvement of documentation of EPI activities

                                                                                                              Implement school based TT in high risk districts.
                                                                                                              Integrate EPI activities with other childhood
                                                                                                              programmes e.g. Nutrition, IMCI.




  1.5         SURVEILLANCE
ACHIEVEMENTS/STRENGTHS                          CHALLENGES/WEAKNESSES                                         RECOMMENDATIONS                                       CONCLUSIONS

National
Improvement in timeliness and completeness      Lack of adequate finances in most provinces, especially for   Provide adequate finances for reimbursement of        No province has prioritized health
of reporting.                                   transport costs reimbursements during measles case            transport costs incurred in measles case              facilities for surveillance to guide
                                                investigation.                                                investigation.                                        the frequency of active surveillance
Technical and financial support from partners                                                                                                                       visits. This has impacted negatively
(WHO, UNICEF, JICA, DANIDA).                    Lack of adequate funding constrained implementation of        The IDSR forms should be adequate and                 in Nairobi where up to 40% of
                                                IDSR POA.                                                     equitably distributed at all levels.                  health facilities are not being visited
Improved indicators due to decentralization                                                                                                                         regularly.
of EPI Disease surveillance activities to the   Delayed training of Health workers on IDSR.                   Immunization and surveillance data should also
lower level.                                                                                                  be collected from non-GOK health facilities.          In several provinces, the lack of
                                                Inadequate IDSR forms due to shortcomings in production                                                             transport, shortage of staff and
Good relationship with Partners.                and distribution.                                             All staff should be sensitized to participate in      competing priorities are often
                                                                                                              case investigations as part of their                  identified as factors that constrain
No reported case of wild poliomyelitis since    Resources for AFP and measles case-based surveillance         responsibilities.                                     the implementation of high quality
1984.                                           used to support production of IDSR forms, which were in                                                             active surveillance activities.
                                                shortage.                                                     Peripheral health facilities staff should be
Launched both polio eradication certification                                                                 trained in case investigation for measles and         The strong commitment by senior



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ACHIEVEMENTS/STRENGTHS                             CHALLENGES/WEAKNESSES                                        RECOMMENDATIONS                                  CONCLUSIONS
committee (NPCC) and National Polio                Continued score of less than 10% for NPEV for AFP            NNT case-based surveillance.                     managers and health workers at all
Eradication Expert Committee (NPEC).               specimens.                                                                                                    levels to attaining highest quality
                                                                                                                Ensure proper guidelines on measles case based   surveillance performance; is
The level of organization and coordination of      Inadequate finances for reimbursing transportation           surveillance are in place and followed           believed to have made a major
surveillance is variable at district and           expenses for measles specimens to lab.                       surveillance in case of outbreaks.               contribution to the improved quality
h/facility level. The vast majority of the sites                                                                                                                 of surveillance in the last 2-3 years.
are having a written organogram that include       Lack of proper guidelines on measles case based              Ensure provision of the delayed training of
surveillance.                                      surveillance in case of outbreaks.                           Health workers on IDSR.                          Quality of implementation of
                                                                                                                                                                 surveillance activities varies across
Establishment of PBM sentinel surveillance         Lack of guidelines for introduction of community             Provide finances for ALP surveillance at         provinces and districts.
in KNH.                                            surveillance.                                                provincial and district levels.
                                                                                                                                                                 Poor surveillance implementation is
Establishment of P/Pneumococcal sentinel           No frequent funding for ALP surveillance at Province and                                                      reported for Nairobi and North
surveillance in five major hospitals (KNH,         district levels.                                                                                              Eastern Provinces. Both provinces
Coast, Nyeri and Embu PGHs and Kilifi ).                                                                                                                         have poor organizational and quality
                                                   Inadequate data collection tools, data analysis capacity,                                                     active surveillance (priority health
In the process of establishing sentinel            and downward feedback particularly from provincial to                                                         facilities not visited regularly,
surveillance for Rota virus.                       district levels and to health facilities.                                                                     clinicians and health workers not
                                                                                                                                                                 sensitized etc), The very poor AFP
Established task force for polio survey lab        There are major knowledge, skills and practice gaps in the                                                    surveillance performance indicators
containment.                                       implementation of surveillance among health workers in                                                        and high levels of human traffic
                                                   GOK and non-GOK health facilities. This is critical in                                                        from Somalia (which still has
Disease surveillance review 2003                   areas with migrant communities e.g. refugees, urban                                                           ongoing wild poliovirus
                                                   centers, districts bordering neighbouring countries.                                                          transmission); provides a real risk of
                                                                                                                                                                 delayed detection of any imported
                                                                                                                                                                 wild poliovirus.

                                                                                                                                                                 AFP surveillance has been used to
                                                                                                                                                                 support case-based surveillance for
                                                                                                                                                                 other EPI diseases targeted for
                                                                                                                                                                 elimination (measles and neonatal
                                                                                                                                                                 tetanus). Measles case based
                                                                                                                                                                 surveillance, is notably improving.
                                                                                                                                                                 In general, there is under-reporting
                                                                                                                                                                 of NNTcase-based surveillance in
                                                                                                                                                                 all provinces.

                                                                                                                                                                 Kenya is committed to
                                                                                                                                                                 implementation of IDSR and plans
                                                                                                                                                                 of action (POAs) are in place at the
                                                                                                                                                                 central level. However,
                                                                                                                                                                 implementation rates reported in
                                                                                                                                                                 different provinces vary. With most
                                                                                                                                                                 provinces not having fully
                                                                                                                                                                 implemented IDSR.

                                                                                                                                                                 Despite the progress noted, the




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ACHIEVEMENTS/STRENGTHS                          CHALLENGES/WEAKNESSES                                          RECOMMENDATIONS                                     CONCLUSIONS
                                                                                                                                                                   quality of implementation of
                                                                                                                                                                   surveillance activities is still
                                                                                                                                                                   variable across provinces and
                                                                                                                                                                   districts. There is a direct
                                                                                                                                                                   relationship between poor quality
                                                                                                                                                                   implementation of active
                                                                                                                                                                   surveillance and the AFP
                                                                                                                                                                   surveillance performance indicators.

District
Improvement of commitment at provincial         Inadequate supervision at district level.                      Provide adequate transport for support              Although draft integrated reporting
and district level due to direct funding.                                                                      supervision and surveillance activities.            forms have been distributed to
                                                Lack of adequate transportation at district level.                                                                 almost all districts, relatively few
Disease surveillance is now semi integrated                                                                    Sensitize health care providers including cadres    districts have started reporting using
but with emphasis on diseases to be             Inadequate data analysis capacity and feedback                 such as physio and occupational therapists who      the new IDSR forms.
eradicated or eliminated, which happens to be   downwards, from provincial to districts and health             are likely to come across paralyzed cases.
KEPI target diseases.                           facilities.                                                                                                        In several provinces, lack of
                                                                                                               Capacity build health workers at the health         transport, shortage of staff and
Trained DDSCs, PDSC and DMLT on lab             The frequency of meetings at provincial and district level     facilities in measles and NNT surveillance.         competing priorities are often
containment and surveillance                    varies. In several districts, there is lack of enthusiasm to                                                       identified as factors that impair the
                                                hold regular meetings. In provinces where regular PHMT         Support extension of surveillance activities        implementation of high quality
                                                meetings are held, the surveillance performance and data       beyond the public health sector and involve the     active surveillance activities.
                                                are often not discussed. There is no sharing of surveillance   private-for-profit (including TBAs), the private-
                                                information among health managers and health workers.          not-for-profit as well as non-health public         The recent establishment and
                                                                                                               sector e.g. local administration structures (e.g.   recruitment of the District Disease
                                                In most of the provinces, there is no evidence of any          chiefs).                                            Surveillance Coordinators (DDSC)
                                                attempt to extend surveillance activities beyond the public                                                        is expected to have a major impact
                                                health sector and involve the private-for-profit (including    Address factors constraining surveillance           on the strengthening of surveillance
                                                TBAs), the private-not-for-profit as well as non-health        activities in the North Eastern Province.           activities at district level.
                                                public sector e.g. local administration structures (e.g.
                                                chiefs).                                                       Ensure effective support supervision for the
                                                                                                               provincial, district and health facility levels.
                                                The implementation of surveillance activities in the North
                                                Eastern Province, which borders Somalia is constrained by      Harmonize surveillance training and refresher
                                                the very high turnover of provincial health management         training and ensure sharing of training
                                                staff coupled by an acute shortage of health workers at        information among staff.
                                                health facility level
                                                                                                               District MOHs who are not providing resources
                                                With the exception of 2 provinces (Nyanza and Coast),          for sending measles specimens to lab should be
                                                supervision in most of the areas is very poor. Supervision     encouraged to provide support.
                                                is rare, erratic and not structured. There is minimal use of
                                                supervisory checklist and little follow up on findings and
                                                recommendations/ suggestions following a supervisory
                                                visit.

                                                In most provinces, health worker sensitization and
                                                refresher training is conducted very irregularly. In most of




                                                      Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                     93
ACHIEVEMENTS/STRENGTHS                        CHALLENGES/WEAKNESSES                                            RECOMMENDATIONS                                      CONCLUSIONS
                                              the health facilities at least one health worker has received
                                              training in surveillance, but the sharing of information with
                                              other health workers at the facility is poor. Often the same
                                              people are repeatedly selected to attend surveillance
                                              refresher training who does not share the gained
                                              knowledge with their colleagues.

                                              In some Districts MOHs are not providing resources for
                                              sending measles specimens to lab.

Health Facility
Established divisional coordinators for       Major gaps in knowledge are noted among private and              Provide capacity building and training to             High quality activities (including
Nairobi province                              NGO health facilities, both in urban and rural areas. Many       address gaps in knowledge among staff in             presence of focal points at all health
                                              of these health facilities serve communities that are at high    GOK, private, and NGO facilities.                    facilities, presence of written active
                                              risk of the priority diseases e.g. refugees, migrants, and                                                            surveillance work-plans and
                                              visitors from countries that have ongoing wild poliovirus        Address staffing issues that are constraining        schedule, regular active surveillance
                                              transmission, and their lack of participation in active          effective and efficient implementation of            visits, regular records reviews) in
                                              surveillance, for AFP, poses a risk of delayed detection of      surveillance activities.                             some provinces, particularly
                                              imported wild poliovirus.                                                                                             Western Province explain the
                                                                                                               The level of organization and coordination of        consistent attainment of certification
                                              Shortage of staff, overburdened staff with numerous              surveillance is variable at province, district and   quality AFP surveillance in the
                                              priorities, untrained staff due to very high staff turnover      health facility level. Vast majority of the          province.
                                              and infrequent refresher training as well as infrequent          immunization sites have an organogram that
                                              feedback are identified as some of the factors that              includes surveillance.
                                              compromise health worker commitment to surveillance.
                                                                                                               Ensure feedback to both partners, DHMT and
                                              Knowledge and practice gaps of health workers in                 district level peripheral H/F staff to maintain
                                              surveillance at the health facilities is generally found to be   and sustain enthusiasm in immunization,
                                              very low, especially in regard to measles and even lower         disease surveillance and timely data collection.
                                              for NNT surveillance.

                                              Inadequately sensitized health care providers including
                                              cadres such as physio and occupational therapists who are
                                              likely to come across paralyzed cases.


  1.6 ADVOCACY AND COMMUNICATION
ACHIEVEMENTS/STRENTHS                         CHALLENGES/WEAKNESSES                                            RECOMMENDATIONS                                      CONCLUSIONS

National
There is a draft advocacy and communication   EPI has major challenges of increasing drop out rates,           There is need to intensify social awareness and      Immunization coverage is dropping
strategy developed by KEPI.                   missed opportunities, and slow increase in immunization          increase public demand for immunization              and the high drop out rates is
                                              coverage. The planned address to these challenges will           services through community involvement and           worrying. The communication and
A national social mobilization committee      need to include strengthening of communication and               Intersectoral collaboration, particularly in the     social mobilization strategies are
formed in 2002 has representation from        social mobilization strategies so as to abate as well as         areas with low immunization coverage and high        key to addressing the inherent
various stakeholders and development          reverse these undesirable situations.                            dropout rates.                                       factors that are contributing to the
partners i.e. WHO and UNICEF.                                                                                                                                       down ward trend in immunization




                                                    Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                        94
ACHIEVEMENTS/STRENTHS                            CHALLENGES/WEAKNESSES                                         RECOMMENDATIONS                                      CONCLUSIONS
Advocacy and social mobilization planning        Inadequate funding. This has negatively impacted on           There is need to support communication and           coverage,
committees have been formed at district level    implementation of planned activities.                         social mobilization at the district levels for
(active during NIDs/SNIDs).                                                                                    support of routine immunization.                     The reasons why some districts
                                                 The communication and social mobilization unit has                                                                 especially in the North Eastern
There has been annual operation plans for        limited logistical support and has been operating without     Operations research needs to be supported to         Province have consistently recorded
advocacy and communication prepared each         a strategic plan.                                             document best practices and best communication       low immunization coverage over the
year at the national level since 2002.                                                                         channels, also their effectiveness and utilization   years will need to be identified.
                                                 Problems identified by KEPI review of 1999/2000 as            at all levels. Additionally, operations research
Has been successful in disseminating                                                                           will document community perception of the            Most of the communication and
messages through multi-media channels i.e.       constraining effective mobilization are the same ones                                                              social mobilization efforts were for
                                                 highlighted in the communication and social mobilization      communication channels.
TV, Radio, and newspapers for NIDs and                                                                                                                              SNIDs. Radio and TV messages
SNIDs.                                           operational of 2006, no achievement has been recorded in      A reporting and documentation system should be       were made and disseminated to
                                                 addressing them. These include: EPI communication             established on the communication and social          support polio, measles, tetanus and
Health staff has received training in            strategy was lacking at all levels; advocacy was done on      mobilization status.                                 yellow fever supplemental
communication and social mobilization for        ad hoc basis or occasionally as in polio NIDs; social                                                              immunization.
NIDs and SNIDs.                                  mobilization was done only during campaigns; potential        A defined funding source is required for routine
                                                 stakeholders have not received appropriate information;       immunization communication and social                Communication and social
Has initiated f measles case based and           transport and logistic problems are a major handicap to       mobilization (budget line).                          mobilization has given very little
laboratory surveillance after catch-up           health workers who are willing to carry out social                                                                 support to routine immunization.
campaigns.                                       mobilization activities in the communities.                   Community participation in communication and
                                                                                                               social mobilization, and use of CORPS and            Communication and social
Supported production of PBM standard                                                                           opinion leaders should be supported.
definition posters for H/workers.                Diverse cultural beliefs and practices; changing lifestyles                                                        mobilization is key to MOH’s
                                                 and behavioural patterns; and the diverse levels of           A survey is required to determine the adequacy       achievement of KEPH strategies.
Production and dissemination of “Lay case        infrastructural develop in the different regions of Kenya     and effectiveness of the current IEC materials.      Financing of KEPI’s
definition posters” for the general public.      are complicating the implementation of communication          This will inform the review and development of       communication and social
                                                 and social mobilization strategies.                           relevant IEC which is adapted to suit local          mobilization strategy needs to be
Through DFID support has printed annual                                                                                                                             ensured.
calendars.                                                                                                     culture and with the appropriate language.
                                                  The EPI communication and social mobilization
                                                 implementation structures are weak at district and            Develop TV/video/DVD and radio cassette to           The KEPI communication and
Supported development of Job Aide for                                                                                                                               social Mobilization unit lacks
clinicians (measles, tetanus and polio)- WHO     community levels. There is no defined focal person for        disseminate messages, should be supported for it
                                                 EPI communication and social mobilization at district         is more effective. It provokes a discussion and      capacity at all levels.
support
                                                 levels.                                                       hence better uptake of the messages                  Low staffing levels and the high
Case investigation poster for pediatric                                                                                                                             workload at the peripheral Rural
bacterial meningitis for H/worker with WHO       Weak linkages between staff in charge of EPI                  Sustain and scale up use of communication
                                                                                                               channels that have proved to be effective.           Health Facilities makes it difficult
support.                                         communication and social mobilization and the existing                                                             for routine interpersonal
                                                 community structures i.e. community leaders, religious        The communication and social mobilization            communication to take place
Quarterly EPI Newsletter, two issues have
                                                 organizations, community based organizations.                 strategies should include mobilization of            between the health worker and
been produced since November 2005 – with
WHO support                                                                                                    resources for KEPI at all levels.                    mothers/caretakers.
                                                 Implementation of communication and social
Developed one brochure for H/workers and         mobilization has not been in partnership with                 EPI communication and advocacy activities            The community, community leaders
the public “ Improving immunization              communities, religious leaders, the local administration,     should be included in the annual district health     and local administration have not
services”.                                       community based organizations, local NGOs. They are           plan.                                                been involved in planning for
                                                 only involved during NIDs and SNIDs.                                                                               immunization services and social
Ad hoc information dissemination through                                                                                                                            mobilization for EPI
newspapers and radio for all targeted diseases
(polio, measles, tetanus).
Has participated and supported in the making
of BCC strategies for Injection Safety –



                                                       Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                   95
ACHIEVEMENTS/STRENTHS                          CHALLENGES/WEAKNESSES                                 RECOMMENDATIONS                                    CONCLUSIONS
MOH/JSI project.
Disseminated messages for SNIDs through
mass media channels, megaphones, and print
media.
The National Communication and
mobilization Officer is a member of the ICC.
KEPI exhibition at the Nairobi International
Trade Fair (within the MOH stand).


District
Lay case definition posters for the general    Inadequate funding. This has negatively impacted on   The communication and social mobilization          The reasons why some districts
public                                         implementation of planned activities.                 strategies should include mobilization of          especially in the North Eastern
                                                                                                     resources for KEPI at all levels.                  Province have consistently recorded
Case investigation poster for pediatric        There has been no communication and advocacy plan                                                        low immunization coverage over the
bacterial meningitis for H/worker – WHO        developed for the district level.                     Sustain and scale up use of communication          years will need to be identified.
support                                                                                              channels that have proved to be effective.
Has participated and supported in the making                                                                                                            Communication and social
                                                                                                     Develop TV/video/DVD and radio cassette to         mobilization has given very little
of BCC strategies for Injection Safety –                                                             disseminate messages, should be supported for it
MOH/JSI project.                                                                                                                                        support to routine immunization.
                                                                                                     is more effective. It provokes a discussion and
Disseminated messages for SNIDs through                                                              hence better uptake of the messages
mass media achannels, megaphones, and                                                                A reporting and documentation system should be
print media.                                                                                         established on the communication and social
KEPI exhibition at the Nairobi International                                                         mobilization status.
Trade Fair (within the MOH stand).
DHMB assist in advocacy and
communication

Facility
Has participated and supported in the making   Inadequate funding. This has negatively impacted on   Sustain and scale up use of communication          The reasons why some districts
of BCC strategies for Injection Safety –       implementation of planned activities.                 channels that have proved to be effective.         especially in the North Eastern
MOH/JSI project.                                                                                                                                        Province have consistently recorded
                                               There has been no communication and advocacy plan     There is need to support communication and         low immunization coverage over the
Disseminated messages for SNIDs through        developed for the district level.                     social mobilization at the district levels for     years will need to be identified.
mass media channels, megaphones, and print                                                           support of routine immunization.
media.                                                                                                                                                  Communication and social
                                                                                                     A reporting and documentation system should be
Health facility committee assist in advocacy                                                         established on the communication and social        mobilization has given very little
and communication.                                                                                   mobilization status.                               support to routine immunization.

                                                                                                     Community participation in communication and
                                                                                                     social mobilization, and use of CORPS and
                                                                                                     opinion leaders should be supported.




                                                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                        96
  1.7        EPI CAPACITY BUILDING
ACHIEVEMENTS/STRENGTHS                         CHALLENGES/WEAKNESSES                                           RECOMMENDATIONS                               CONCLUSIONS

National
There is a technical working group for EPI     Health staff shortages at the rural health facilities (RHFs);   A well-organized and coordinated              There are health staff shortages at the rural
training.                                      the freeze in hiring new staff; and deployment of staff to      Continued Medical Education (CME) for         health facilities (RHFs); the freeze in hiring
                                               MCH clinics is not based on EPI specifications.                 KEPI is what is required for addressing       new staff; and deployment of staff to MCH
An implementation structure for EPI training                                                                   gaps identified. It is important to involve   clinics is not based on EPI specifications.
has been defined at all levels.                Staff not trained in EPI management are manning some            all stakeholders in KEPI training – adopt
                                               MCH clinics.                                                    the MTRH approach.                            Staff have received refresher training and
There is established continued education for                                                                                                                 continuing education for update.
SNIDs and Disease surveillance. Training       There has been no inventory/mapping of EPI trained staff.       Study and adopt the best approaches to
modules for disease surveillance have been     To identify areas of mal-distribution and to determine          stakeholder involvement and partnership       Training Needs Assessment has never been
developed with WHO support.                    optimal staffing level for MCH clinic.                          for KEPI training.                            carried out.

Training has been conducted for different      Inadequate technical capacity:                                  Develop guidelines for MCH clinic staff       Financial support is needed for CME and
levels of staff in various districts in:       -Depot managers at KEMSA and regional depots are                deployment.                                   for production and dissemination of training
-Cold chain maintenance;                       ignorant of KEPI cold chain procedures and processes.                                                         materials, handbooks etc.
-KEPI operational cold chain;                  -There is knowledge and practice gap in the management          Provide financial support for production
-Introduction to pentavalent vaccine.          of tetanus doses. Health workers need capacity building         and ensure use of the handbook
                                               for tetanus which is currently a neglected antigen.             developed by KEPI on management of
MLM training has been given to Bio Medical                                                                     tetanus vaccination to train new staff
Engineers and operational levels between       Inadequate funds for training and production of training        (CME) and also provide refresher
2001-2005.                                     materials to meet the growing demand for EPI continued          training and:
                                               education including refresher training.                         -Distribute the handbook to every
MLM Training of Trainers (TOTs) are being                                                                      vaccination center. Follow up with
trained by Moi Teaching and Referral           No Training Needs Assessment (TNA) has been done so             monitoring and supportive supervision.
Hospital (MTRH) in collaboration with KEPI     far. A TNA proposed in 2001 is still awaiting guidance          -Establish a resource cabinet (center) for
and development partners. Training has been    from WHO.                                                       technical materials. Ensure inventory of
done for Rift Valley, Western, and Nyanza                                                                      materials in the cabinet is updated
provinces.                                     The planned strategy for pre-service training for doctors       regularly.
                                               has not been implemented.
An EPI training manual for clinicians have
been developed (for basic and in-service                                                                       Provide sustained financial support and
doctors), currently being reviewed.                                                                            out source technical assistance for KEPI
                                                                                                               CME (includes refresher training).

                                                                                                               Provide support for EPI TNA, which
                                                                                                               should be carried out continuously.

                                                                                                               Provide budget line for in-service
                                                                                                               training.

                                                                                                               Provide financial support for rolling out
                                                                                                               of MLM TOT training to other provinces
                                                                                                               and scaling up of MLM training.




                                                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                        97
ACHIEVEMENTS/STRENGTHS                         CHALLENGES/WEAKNESSES                                           RECOMMENDATIONS                            CONCLUSIONS

District
There is established continued education for   There has been no inventory/mapping of EPI trained staff.       Provide sustained financial support and    Staff not trained in EPI management mans
SNIDs and Disease surveillance. Training       To identify areas of mal-distribution and to determine          out source technical assistance for KEPI   some MCH clinics.
modules for disease surveillance have been     optimal staffing level for MCH clinic.                          CME (includes refresher training).
developed with WHO support.                                                                                                                               Staff is receiving continued education,
                                               Staff not trained in EPI management are manning some            Develop guidelines for MCH clinic staff    refresher training and updates.
Training has been conducted for different      MCH clinics.                                                    deployment
levels of staff in various districts in:
-Cold chain maintenance;
-KEPI operational cold chain;
-Introduction to pentavalent vaccine.

MLM training has been given to Bio Medical
Engineers and operational levels between
2001-2005.

Facility
Training has been conducted for different      Staff not trained in EPI management are manning some            Develop guidelines for MCH clinic staff    Staff not trained in EPI management mans
levels of staff in various districts in:       MCH clinics.                                                    deployment.                                some MCH clinics.
-Cold chain maintenance;
-KEPI operational cold chain;                  There has been no inventory/mapping of EPI trained staff.       Advocate for employment of new staff.      There is inadequate staffing at some health
-Introduction to pentavalent vaccine.          To identify areas of mal-distribution and to determine                                                     facilities.
                                               optimal staffing level for MCH clinic.
Has received continued education for SNIDs                                                                                                                Staff are receiving continued education,
and Disease surveillance.                      Health staff shortages at the rural health facilities (RHFs);                                              refresher training and updates.
                                               the freeze in hiring new staff; and deployment of staff to
Training has been done in injection safety     MCH clinics is not based on EPI specifications.
and waste management.




                                                     Kenya EPI Comprehensive Multi-Year Plan 2006-2010                                                                                                  98

								
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