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Health

The sub-sectors in the health sector include Medical Services, Public Health and Sanitation. Poor health services in Kwale County are attributed to inadequate health workers; high disease incidences of preventable diseases such as malaria, diarrhoea, and HIV/AIDS;  drugs and substance abuse due to lack of employment opportunities for the youths; inadequate medicines  due to poor supply chain for medicines and inadequate health facilities and services due to skewed budget allocation.

Sector vision and mission

The sector goal is to have developed and well equipped health facilities for improved health services.

Vision is to have a functional and health services that contributes to  holistic development in the County.

Mission:  A county whose health services and facilities resonate with the health needs of its residents for sustained development in the county

Health Access and Nutrition

Access to Healthcare

The County has a total of three (3) government hospitals, eight health centres and sixty- four (64) dispensaries located in Msambweni, Kwale and Kinango constituencies. The doctor and nurse population ratio stands at 1: 76,741 and 1: 3,133 respectively. In addition, the county has two (2) private hospitals both located in Diani town. The average distance to the nearest health facility within the County is seven (7) kilometres as compared to the required maximum of three (3) kilometers.

Morbidity

The five most common diseases as recorded in the health facilities within the county are Malaria, Diarrhoea, Flu, Respiratory diseases and Stomach- ache with a prevalence rate of 37.7, 4.6, 16.4, 5, and 3.1 per cent respectively. These diseases highly contribute to the morbidity in the county which stands at 22.5 per cent. This calls for tailor - made interventions to address this health challenge in the community.

Nutritional Status

Nutritional status in the county is very low especially in the arid and semi-arid areas of the county. The predominant form of manifestation of malnutrition in the county are stunting, underweight and acute malnutrition accounting for the percentages 35, 21 and 6 respectively.

Immunization Coverage

Immunization against preventable diseases is key to ensuring a healthy future human resource generation. Immunization coverage in the county stands at 77 per cent of thechildren under one year compared to the national target of 85 per cent.

Access to Family Planning Services/Contraceptive Prevalence

Family planning (FP)/contraceptive use for the fertile generation of between 15- 49 years is still very low in the County recorded at 38 per cent. In order to realize improvement in contraceptive usage, more health facilities need to be established in addition to up scaling of the services in the existing facilities. This will improve on the access for those services at the health facilities and reducing the average distance to a health facility which currently stand at seven kilometers.

Ministry's Major Challenges

Poor delivery of quality health services

The county delivery of health services is still poor. As a result child mortality rate is very high at 149 compared to the national figure of 116 deaths for 1000 live births. Most (77.2%) mothers still deliver at home without the assistance of skilled health personnel. Morbidity rate in the county is at 22.5 and Malaria prevalence rate is at 40 percent which is higher than the national average. Poor delivery of health services is a major challenge in Kwale County and is attributable to a number of causes:

Inadequate health workers

Health services delivery is poor mainly due inadequate health workers in the health facilities. Currently the 73 health facilities comprising of 3 district hospitals, 5 health centres and 65 dispensaries are manned by only 612 staff both medical and non-medical. The deficit of health workers in the county is estimated to be 300.  Kwale’s lack of adequate health workers in various cadres is attributed to a shortage of local trained health staff workers as a result of few training opportunities provided to locals who are qualified to undertake medical courses. Locals who are qualified to undertake medical courses are unable to get admission to medical training institutions because of the centralized system of recruiting students for medical courses. Health workers from other parts of the country who are posted to the county often resign when they are posted in remote health facilities. Most of them prefer working in health facilities located in urban areas or along the Mombasa – Lunga-Lunga road.

High disease incidences

Prevalence of preventable diseases such as malaria, diarrhoea, HIV/AIDS among others is high mainly due to lack of information, knowledge, poor practice and behaviour change on disease prevention and control by the community.  Due to the inadequate trained staff required to promote preventive primary care to the community, levels of health knowledge and health seeking behaviours are still quite low.

Shortage of medicines, medical supplies and equipment

Shortage of medicines, medical supplies and medical equipment is a common phenomenon in all public health facilities in the county. Patients who visit health facilities are often requested to purchase medicines and other medical supplies such as gloves from private pharmacies.  These perennial shortages are mainly caused by poor management of the supply chain for medicines. Due to inadequate capacity for health staff, they are unable to properly manage the stock of medicines and medical supplies and timely provide information for re-stocking.
Medical equipment is broken due to poor maintenance. Most health facilities lack modern equipment. For example the county referral hospital lacks specialized diagnostic and treatment equipment such as CT scan, X-Ray machines, Ultrasound machine, cryotherapy machine, dialysis machine, and radiotherapy machine. Machines and equipment for specialized laboratory tests such as CD4 machine, coulter machine, urea and electrolyte, thyroid function tests are inadequate. Sub-county hospitals which are supposed to offer basic diagnostic and treatment services, lack equipment such as X-Ray machines, Ultrasound machine, and specialized laboratory tests (CD4 count, coulter, urea and electrolyte). The situation is worse in Health centres and dispensaries where equipment required for offering basic diagnostic and treatment services such as basic lab equipment, delivery beds, blood pressure machines, BMI machines are lacking and where available they are not in a working order.

Inadequate health facilities

Medical facilities in Kwale County are inadequate in terms of the number of health centres and the service provided to the local population. People travel long distances for treatment, with the average distance to the nearest health facility being 7 kilometres. This coupled with poor road network, force many to forgo treatment. Over the years skewed budget allocation has resulted in disproportionate availability of health facilities and health services. Even with the few facilities available in the County, they are largely under-resources and inaccessible to many people.

Poor management of health facilities

Poor management of health facilities is a key contributor to the poor delivery of health services in the county. The hospital management boards of the three district hospitals face numerous challenges and hence unable to effectively discharge their responsibilities and hence deliver on their mandate. Political interference, lack of budgets, lack of commitment among the board members and lack of cooperation and team work between the boards and the hospital management teams are some of the key reasons to poor performance of the hospital management boards.

As a result of the poor management of the health facilities and especially Msambweni, Kwale and Kinango hospitals, the available limited resource are not well managed. Pilferage of medicines is common, health workers are often absent from duty, hospital equipment not properly maintained and patients not served well. 

In order to achieve the sector vision, dilapidated health facilities will be rehabilitated for effective service delivery while other facilities shall be expanded. To check on infant mortality, immunization, nutrition and IMCI programmes shall be expanded and scaled up with active involvement of the Community health units. Appropriate strategies will be initiated to upscale activities under the HIV & AIDS, TB, Malaria, and Reproductive Health and Communicable diseases control programmes.

Kwale County strategic Intervention in Health

The County will promote Public-Private participation in the provision of health services as a way of scaling-up both preventive and curative services. In this regard private health practitioners, NGO‘s and religious representative will be strategic partners for the County in Health training activities and provision of  critical health services such as immunization, maternal and child health services and treatment of sexually transmitted diseases. Emphasis on Community health units shall be the sector's main thrust in the County.
Kwale County shall develop strategies and intervention to address the current challenges as follows:

  1. Training of more medical staff: The Msambweni and Matuga Kenya Medical Training Colleges that now train nurses, medical records and public health officers will be supported to improve their infrastructure. The colleges will also be supported to expand and introduce new courses for training clinical officers, more nurses, nutritionists, laboratory and pharmaceutical technologists.
  2. Equipping Health facilities: to address the lack of medical equipment, efforts shall be made to equip county referral hospital with specialized diagnostic and treatment services such as machines for CT scan, X-Ray, Ultrasound, cryotherapy, dialysis and radiotherapy amongst others; specialized laboratory tests  for CD4 count, coulter, urea and electrolyte, thyroid function tests;  and specialized care (ICU/HDU). Sub-county hospitals shall be provided with the necessary basic diagnostic and treatment services such as, X-Ray machines, Ultrasound machine, and specialized laboratory tests (CD4 count, coulter, urea and electrolyte). Health centres and dispensaries shall be equipped with basic diagnostic and treatment services  such as functional lab to carry out basic lab tests, delivery beds, blood pressure machines, BMI machines, maternity services, and referral mechanisms to the sub-County and County hospitals. At the Community level, efforts shall be made to establish functional community units and referral mechanism to and from the health centres and dispensaries.

These establishments at various levels of the health units will enable the County to improve the capacity of health institutions to deal with major health challenges such as HIV, tuberculosis, malaria inter alia. Eefforts to improve health outcomes will be enhancedthrough mobilization of key affected populations and community networks and an emphasis on strengthening community based and community led systems for: prevention, treatment, care and support; advocacy; and development of an enabling and responsive environment. To enhance the performance of the community health units, incentives such as bicycles, uniforms, medicines kits and regular allowances to community health workers will be instituted to increase utilization of health services.

  1. Improving the Supply of Essential medicines and medical supplies: The Supply of essential medicines and non-pharmaceutical commodities is key to the delivery of effective and quality health services in the County. Therefore establishing a robust supply chain system will enhance services delivery in all health facilities in all the tiers. For this to be effective, Kwale County shall establish a pull supply system as well as centralized procurements from KEMSA/MEDS for quality assurance.
  2. Management of Health Facilities: the management of health facilities shall be improved through revamping of all hospital management boards. The Hospital boards shall be reconstituted and people with the requisite skills, experience, commitment and integrity appointed to the boards. All the new board members shall be trained so that they can effectively deliver on their roles and responsibilities.
  3. Community Level Mitigation of Health Risk Factors: Risk factors to health especially drug abuse, alcohol use, unsafe sex,  unsafe water, sanitation and hygiene, indoor air pollution may result in severe medical conditions like unipolar depressive disorders. To minimize/reduce exposure there is need to educate, provide skills and knowledge on risk factors to health. This will be done through the containment of the main risk factors to health, focusing on the top 12. These are (1) unsafe sex, (2) unsafe water, sanitation and hygiene, (3) suboptimal breastfeeding, (4) childhood and maternal underweight, (5) indoor air pollution, (6) alcohol use, (7) Vitamin A deficiency, (8) high blood glucose, (9) high blood pressure, (10) zinc deficiency, (11) iron deficiency, and (12) lack of contraception. Development of at least two rehabilitation centres to carter for the rising drug and substance abuse cases in the county shall be prioritized

PROJECT 1: FOOD SECURITY INITIATIVE PROJECT

Project start date : July, 2013/14 End date June 2017

Located: County wide Project period 2013/14 :

Procurement of 20 tractors, 63 Tonnes of Cowpeas and 27 Tonnes of Green Grams for short rains,33 tonnes of PH4 and 17 tonnes of PH1 for the long rains; 600 tons fertilizer and 18 tons of stalk borer dust.

Implementation status for 2013/14: 100%

Social benefits: Food security and increase income at household level through improved land preparation, use of certified seeds, fertilizer and other farm inputs

seeds distribution
Launch of the 20 Tractors at the County HQ Tractor handover at the ward level

Seeds distribution to farmers

PROJECT 2: ECONOMIC EMPOWERMENT AND FOOD SECURITY THROUGH LIVESTOCK DEVELOPMENT

Project start date : July, 2013/14 End date June 2017
Located: County wide

Implementation status: 100%
Duration :Project 2013/2014

Social benefits: Food security and Economic empowerment to livestock keepers through improved breeds, improved management and disease control, livestock diversification and improved market access.

cattle vaccination Launch goats
cattle vaccination Launch Goat improvement project(Meat goat bucks for distribution to community at Kinango ward

Dairy improvement project: Dairy cattle distributed to farmers at Golini/Tsimba war

PROJECT 3: ECONOMIC EMPOWERMENT AND FOOD SECURITY THROUGH FISHERIES DEVELOPMENT

Project start date: July, 2013/14 End date June 2017

located: County wide

Implementation status:100%

Project 2013/2014: : provision of fishing accessories, provision of 2 rescue boats and construction of 16  fish ponds
Social benefits: economic empowerment and  food security through provision of fishing accessories, provision of rescue boats and construction of fish ponds

cattle vaccination Launch cattle vaccination Launch

Rescue boats boat purchased by the county government

Rescue boats boat purchased by the county government

Rescue boats boat purchased by the county government