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REPUBLIC OF KENYA
MINISTRY OF PUBLIC HEALTH AND SANITATION
DIVISION OF VACCINES AND IMMUNISATION COMPREHENSIVE MULTI YEAR PLAN
2013-2017
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 2
TABLE OF CONTENT
TABLE OF CONTENT......................................................................................................................................... 2
LIST OF TABLES ................................................................................................................................................ 4
LIST OF FIGURES .............................................................................................................................................. 5
LIST OF ANNEXES ............................................................................................................................................ 6
LIST OF ACRONYMS ......................................................................................................................................... 7
FORWARD ..................................................................................................................................................... 11
1 BACKGROUND ..................................................................................................................................... 13
1.1 HEALTH SITUATION IN KENYA .............................................................................................................................. 13 1.2 CHILD HEALTH INTERVENTIONS IN KENYA .............................................................................................................. 15 1.3 COVERAGE TRENDS FOR IMMUNIZATION .............................................................................................................. 15 1.4 HEALTH SECTOR PRIORITIES ................................................................................................................................ 18
2 HEALTH CARE DELIVERY SYSTEM IN KENYA ......................................................................................... 20
2.1 EXTERNAL POLICY ENVIRONMENT ....................................................................................................................... 20 2.2 SECTOR STRATEGIC FRAMEWORK, AND DOCUMENTS .............................................................................................. 21
2.2.1 Policy level documents ....................................................................................................................... 22 2.2.2 Strategic level documents .................................................................................................................. 22 2.2.3 Investment level documents .............................................................................................................. 22 2.2.4 Operational level documents ............................................................................................................. 23
2.3 SECTOR TARGETS AND INDICATORS ...................................................................................................................... 23 2.4 RECAP OF SECTOR STRATEGIC PRIORITIES .............................................................................................................. 23
2.4.1 Recap of Vision 2030 .......................................................................................................................... 23 2.4.2 Recap of the First Medium-Term Plan, 2008–2012 .......................................................................... 24 2.4.3 Recap of NHSSP II 2005–2012 ............................................................................................................ 24
3 IMMUNIZATION PROGRAMME IN KENYA ........................................................................................... 26
3.1 SERVICE DELIVERY ............................................................................................................................................. 26 3.2 VACCINE SUPPLY, QUALITY AND LOGISTICS ........................................................................................................... 26 3.3 DISEASE SURVEILLANCE ...................................................................................................................................... 28 3.4 ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION .................................................................................... 28 3.5 GOAL OF ROUTINE IMMUNIZATION ...................................................................................................................... 30 3.6 IMMUNIZATION SCHEDULE FOR KENYA................................................................................................................. 30
4 IMMUNIZATION SYSTEM COMPONENTS ............................................................................................. 32
4.1 SERVICE DELIVERY ............................................................................................................................................. 32 4.2 VACCINE SUPPLY, QUALITY AND LOGISTICS ........................................................................................................... 32 4.3 DISEASE SURVEILLANCE ...................................................................................................................................... 33 4.4 ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION .................................................................................... 34
5 SITUATION ANALYSIS .......................................................................................................................... 35
5.1 ROUTINE IMMUNIZATION PERFORMANCE, GAPS AND CHALLENGES ......................................................................... 35 5.2 POLIO ERADICATION .......................................................................................................................................... 39 5.3 ACCELERATED DISEASE CONTROL ......................................................................................................................... 40
6 PRIORITIES, OBJECTIVES AND MILESTONES FOR EPI ............................................................................ 42
7 IMPLEMENTATION PLAN ..................................................................................................................... 49
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 3
8 COSTING, FINANCING AND FINANCIAL SUSTAINABILITY ..................................................................... 59
8.1 COSTING AND FINANCING METHODOLOGY ............................................................................................................ 59 8.2 MACROECONOMIC INFORMATION ....................................................................................................................... 61 8.3 COST PROJECTIONS 2011-2015 FOR IMMUNIZATION PROGRAMME ........................................................................ 61 8.4 COST PROFILE ................................................................................................................................................... 62 8.5 BASELINE FINANCING ......................................................................................................................................... 63 8.1 COST BY IMMUNIZATION STRATEGY ..................................................................................................................... 64 8.2 PROJECTED FUTURE RESOURCE REQUIREMENTS FOR IMMUNIZATION FROM ALL SOURCES FROM 2011-2015. ............... 65 8.3 PROJECTED FUTURE FINANCING: SECURED, PROBABLE AND GAPS FOR IMMUNIZATION FROM 2011-2015. ................... 66
9 ANNEXES ............................................................................................................................................. 71
9.1 ANNEX 1: ACTIVITY TIMELINE 2011-2015 ........................................................................................................... 71 9.2 ANNEX 2: ANNUAL OPERATIONAL PLAN 6 (AOP 6) FAMILY HEALTH DEPARTMENT .................................................... 78 9.3 ANNEX 3: ANNUAL WORK PLAN 2011/2012, DIVISION OF VACCINES AND IMMUNIZATION ........................................ 79 9.4 ANNEX 4: USING GIVS FRAMEWORK AS A CHECKLIST ............................................................................................. 93
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 4
LIST OF TABLES
TABLE 1: TABLE HEALTH SECTOR STRATEGIC DOCUMENTS ............................................................................................................ 21 TABLE 2:CURRENT ROUTINE VACCINATION SCHEDULE FOR CHILDREN UNDER 1 YEAR ............................................................ 30 TABLE 3:SITUATIONAL ANALYSIS OF ROUTINE EPI BY SYSTEM COMPONENTS BASED ON PREVIOUS YEARS' DATA (2007-2009) ........................................................................................................................................................................................................ 37 TABLE 4:SITUATIONAL ANALYSIS BY ACCELERATED DISEASE CONTROL INITIATIVES, BASED ON PREVIOUS YEARS' DATA
(2007-2009) ......................................................................................................................................................................................... 41 TABLE 5:NATIONAL OBJECTIVES AND MILESTONES, AFR REGIONAL AND GLOBAL GOALS ......................................................... 42 TABLE 6: SERVICE DELIVERY AND PROGRAMME MANAGEMENT .................................................................................................... 49 TABLE 7: ADVOCACY AND COMMUNICATION ...................................................................................................................................... 55 TABLE 8: SURVEILLANCE........................................................................................................................................................................ 56 TABLE 9:VACCINE SUPPLY QUALITY AND LOGISTICS ........................................................................................................................ 56 TABLE 10: INPUTS TO DIFFERENT EPI SYSTEMS COMPONENTS ...................................................................................................... 59 TABLE 11:MACRO ECONOMIC TRENDS IN KENYA, 2010 – 2015 ................................................................................................. 61
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LIST OF FIGURES
FIGURE 1:TOP CAUSES OF OUTPATIENT MORBIDITY IN KENYA ....................................................................................................... 14 FIGURE 2:TRENDS IN HEALTH IMPACT INDICATORS (1994-2008) ............................................................................................ 15 FIGURE 3:TRENDS OF DTP 3 IN KENYA, 1980-2008 ..................................................................................................................... 16 FIGURE 4:PROPORTION OF DISTRICTS WITH AT LEAST 80% DTP3 COVERAGE AMONG CHILDREN 12-23 MONTHS. .......... 17 FIGURE 5:DTP3 COVERAGE TRENDS BY RESIDENCE AND BY MOTHER'S LEVEL OF EDUCATION ................................................. 17 FIGURE 6: DTP3 COVERAGE AMONG CHILDREN 12-23 MONTHS BY PROVINCE ........................................................................... 18 FIGURE 7: PILLARS OF KENYA’S DEVELOPMENT FRAMEWORK – VISION 2030 ........................................................................... 19 FIGURE 8: ORGANOGRAM OF DIVISION OF VACCINES AND IMMUNIZATION: ..................... ERROR! BOOKMARK NOT DEFINED. FIGURE 9: TRENDS OF IMMUNIZATION PERFORMANCE FOR SELECTED INDICATORS, 1992-2009, KENYA ............................ 35 FIGURE 10: ROUTINE IMMUNIZATION PROGRAMME EXPENDITURE BREAKDOWN ......... ERROR! BOOKMARK NOT DEFINED. FIGURE 11: BASELINE FINANCING PROFILE ........................................................................... ERROR! BOOKMARK NOT DEFINED. FIGURE 12: COSTS BY STRATEGY .............................................................................................. ERROR! BOOKMARK NOT DEFINED. FIGURE 13: PROJECTION OF FUTURE RESOURCE REQUIREMENTS 2011-2015 ............... ERROR! BOOKMARK NOT DEFINED. FIGURE 14: PROJECTION OF FUTURE FINANCING GAP ........................................................... ERROR! BOOKMARK NOT DEFINED. FIGURE 15: THE FUNDING GAP AND SELECTED INDICATOR .............................................................................................................. 70
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 6
LIST OF ANNEXES
i. ANNEX 1: Action plan & timeline for 2011-2015
ii. ANNEX 2: AOP 6
iii. ANNEX 3: First year annual plan 2011
iv. ANNEX 4: GIVS checklist
v. ANNEX 5: Logistics forecasting tool [Soft copy]
vi. ANNEX 6: Costing tool [Soft copy]
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 7
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 Bacille Calmette-Guerin (Vaccine)
CAG Cash Assistance to Government
CBAW Child Bearing Age Women
CBHC Community Based Health Care
CBO Community Based Organization
CBS Central Bureau of Statistics
CDC Communicable Disease Control
CFC Chloro Flouro Carbon
cMYP Comprehensive Multi Year Plan
CORPS Community Own Resource Persons
DALYs Disability Adjusted Life Years
DANIDA Danish Aid National Development Agency
DARE Decentralized Aids and Reproductive
DDSC District Disease Surveillance Coordinator
DIFD Department for International Development
DFH Divison of Family Health
DHE Division of Health Education
DHEO District Health Education Officer
DHMT District Health Management Team
DHP District Health Programme
DoHP Department of Health promotion
DMOH District Medical Officer of Health
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 8
DMS Director of Medical Services
DPT/ (DTP) Diphtheria Pertusis and Tetanus
DQA Data Quality Audit
DRCO District Registered Clinical Officer
DVI Division of Vaccines and Immunization
EPI Expanded Programme on Immunization
FBO Faith Based Organization
FIC Fully Immunized Children
GAVI Global Alliance for Vaccines and Immunization
GDP Gross Domestic Product
GIVS Global Immunization Vision and Strategy
GOK Government of Kenya
HepB Hepatitis B
Hib Haemophilus 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
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
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 9
KHPF Kenya Health Policy Framework
KMTC Kenya Medical Training College
MCH Maternal Child Health
MDGs Millennium Development Goals
MDVP Multi Dose Vial Policy
MLM Mid Level Management
MNT Maternal Neonatal Tetanus
MoH Ministry of Health
MTEF Mid Term Expenditure Framework
MTP Medium Term Plan
MTRH Moi Teaching and Referral Hospital
MYP Multi Year Plan
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
PHC Primary Health Care
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
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 10
PS Permanent Secretary
RED Reaching Every District
SIA Supplemental Immunization Activities
SDP Service Delivery Point
SNID Supplemental National Immunization Days
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 11
FORWARD
The Ministry of Public Health & Sanitation through the Division of Vaccines and Immunization aims to increase access to immunization services nationwide in order to reduce morbidity and mortality due to vaccine preventable diseases. This is in acknowledgement of the proven fact that immunization is the most cost effective intervention for vaccine preventable diseases. The reduction of infant and child morbidity and mortality in line with the United Nations Millennium Development Goals (MDG 4) by the end of this Multi Year Plan, 2015 cannot be over emphasized. The other major consideration is to implement the WHO/UNICEF Global Immunization Vision & Strategy (GIVS), Global Vaccine Action Plan (GVAP) and Decade of Vaccines (DoV) which challenges national governments to immunize more people, from infants to seniors, with a greater range of vaccines and new technologies. Routine immunization currently includes OPV, BCG, Pentavalent (DPT-Hib-Hep), PCV10, Measles plus Vitamin A with Rotavirus vaccine introduction scheduled for next year 2013. The Division is also giving hepatitis B vaccine for health workers and meningococcal vaccine for travelers proceeding for Hajj during the period of this MYP. The non-EPI vaccines include typhoid vaccine for food handlers and other special populations at high risk, anti rabies vaccine, anti snake venom and yellow fever vaccine for travellers. This multi year plan 2011-2015will serve as a reference point in the implementation of immunization activities and the preparation of annual action plans. The cMYP highlights the national goals, objectives & strategies for the improvement of the health of Kenyans in reference to specific vaccine preventable diseases. The Government of Kenya recognises vaccination as a high impact intervention of national importance and has projected to continue supporting the costs of expansion of immunization services. It is anticipated that the development partners and agencies that have assisted the Government of Kenya so far in the immunization arena will continue with us for the duration of the cMYP. The success of the immunization programme depends significantly on adequate and timely financing of all proposed activities. Other contributory factors include committed coordination through the Child Health Inter-agency Coordinating Committee (ICC) and other bodies such as the Kenya National Immunization Technical Advisory Group (KENITAG) that is in the process of formation. The main areas of focus are improving and sustaining the disease control gains achieved through improved routine and supplemental immunization coverage and increasing the range of vaccine preventable diseases covered for infants and the general population. The latest Kenya Demographic & Health Surveys (2008-09) show progressive improvement in the proportion of children fully immunized. The cMYP has detailed how these gains are to be sustained and improved.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 12
There will however be risks in achieving the goals outlined in the cMYP due the transitional challenges that the country will invariably experience as it implements a radical new constitution which will, among other things, devolve governance of health service delivery from the current national level coordination to 47 new county governments. The new constitution should be fully implemented by 2012 and therefore rapid restructuring of national and regional levels of administration are expected in all government departments by then, including the Ministries of Health. This is a grey period and the Division of Vaccines & Immunization intends to mitigate any regression of gains achieved so far through close consultation with immunization stakeholders and dialogue with the health departments of County governments. The implementation of this cMYP will be relooked upon the election of County governments early next year, 2013 since they will be in charge of Health service delivery at this level. Kenya is committed to implement the cMYP 2011-15 through the dedication of health workers, community participation and support from partners in health to achieve the MDGs 4 & 5 targets. Community involvement and ownership of the EPI agenda is still our overall goal to guarantee success and sustainability of our programme.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 13
1 BACKGROUND
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. It has a surface area of 582, 646 square kilometres and approximately 80% is either arid or semi-arid while only 20% is arable. Following the promulgation of the new Constitution of Kenya in August 2010 the country is now administratively divided into 47 counties. Kenya’s projected population for the year 2011 is 41,822,715.
1.1 Health situation in Kenya
The Kenyan epidemiological profile indicates that disease burden is still high. A high disease burden is a barrier to economic growth - Most of sicknesses are caused by preventable conditions. Top five causes of outpatient morbidity namely Malaria, Diseases of the Respiratory System, Diseases of the Skin, diarrhoea, and accidents account for about 70percent of total causes of morbidity. Malaria contribute about a third of total morbidity. The leading causes of mortality are: Infectious and parasitic diseases (42 percent of total mortality in 2008) followed by Diseases of Respiratory System (11 percent), and Diseases of Circulatory System (7 percent).
HIV prevalence estimates vary widely, but the latest estimates from the 2008/09 Kenya Demographic and Health Survey (KDHS) place the prevalence rate at 6.3 percent, slightly lower than the previous estimate of 6.7 percent (KDHS 2003). Although this reduction is small in terms of number of cases as compared to the total population, effective prevention programmes are considered for keeping infection rates low in the future.
In the recent past, Government’s efforts and support of Development Partners have resulted in reversing the downward trend in health status indicators of the population observed in the 1990s. Remarkable achievements have been made in the reduction of Under Five Mortality from 115 per 1,000 live births in 2003 to 74 per 1,000 live births in 2008/9 and Infant Mortality from 77 per 1000 live births to 52 per 1000 live births in the same period. The proportion of children fully immunized against communicable diseases increased from 64percent in 2005/06 to 82 percent in 2011. Maternal mortality still remains high at 488 per 100,000 population.
Nutritional status of children has also not shown significant improvement over the years. An estimated 16 percent of children under-five years are underweight, 7 percent are wasted, and 35 percent are stunted.
Regional level health indicators show that North Eastern, Coast, Nyanza and Western Provinces have the worst infant and child mortality indicators. High poverty levels and inadequate environmental sanitation among other factors may be contributing to these differentials. .
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 14
Figure 1: Top causes of outpatient morbidity in Kenya The health sector will play its part in the attainment of the Vision goals. In this regard, the need for a robust health infrastructure; a financing mechanism that allows Kenyans, especially the poor to access affordable and quality services; an increased focus on preventive and promotional healthcare and the delinking of the Ministries of Health from service provision are identified as some of the key interventions that need to be implemented in the medium to long term period
Impact indicators are a good measure of trends in overall health of the population. The most commonly used impact indicators relate to the mortality indicators – Adult Mortality Rate (AMR), Maternal Mortality rate (MMR), Under-5 Mortality Rate (UMR), Infant Mortality Rate (IMR), Neonatal Mortality Rate (NMR) and other similar measures. Improvements in the mortality indicators suggest impact of interventions meant to improve the health of the population.
The trends in mortality impact indicators during the period 1993-2008 are shown in the figure below
Malaria31%
Disease of the Respiratory System
25%
Disease. of the Skin (Incl. Ulcers)
7%
Diarrheal Diseases5%
Pneumonia3%
Accidents (incl.. fractures, burns etc)
2%
Rheumatism, Joint pains
etc2%Eye Infection
2%
Urinary Tract Infections
1% Intestinal Worms
1%
All Other Diseases 21%
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 15
Figure 2: Trends in Health Impact indicators (1994-2008)
Source: Respective Demographic and Health Surveys
The general trend in impact indicators suggests a stagnation of the health situation during that period that is only appearing to improve during its last few years. Infant, and Under 5, and Mortality are starting to show improvements, while maternal and neonatal mortality have stagnated.
Data from the 2009 Demographic and Health Survey is also suggestive of improvements in Adult Mortality. A comparison of the rates from the 2008-09 KDHS and the 2003 KDHS indicates a decline in adult mortality for both women and men, but the patterns differ slightly.
Female adult mortality rates from the 2008-09 data are lower for all ages, except from age 35 upward, where the rates are nearly the same as those from the 2003 survey. Male adult mortality is lower for most of the age groups, except age groups 15-19 and 45-49.
1.2 Child health interventions in Kenya
Kenya's child health strategy includes a range of interventions in early childhood, neonatal health care, school health services and adolescent health. Integrated management of childhood illness (IMCI) for children less than five years of age was introduced in selected districts in the late nineties and expanded during the following decade.
NHSSP-II 2005-2010 specified the Kenya essential health package (KEPH). It is based on the life cycle approach. The key indicators for phase 1 (pregnancy, delivery and the newborn child) include BCG vaccination. Phase 2, early childhood, includes nine indicators on service access, notably IMCI, and coverage such as bed nets, breastfeeding, immunization coverage, vitamin A supplementation. Phase 3 concerns late childhood with community interventions focused on de-worming of children and school health programmes and phase is about adolescence and the access to youth friendly services.
1.3 Coverage trends for Immunization
Long term annual trends in immunization coverage are derived from facility reports and regular household surveys. The best estimate of DTP3 coverage during 1980-2009 is
0
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1993 1998 2003 2008
U5M
R, IM
R, N
MR
/ 1,
000
U5MR IMR NMR MMR Linear (MMR)
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 16
shown in Figure 3 below. DTP3 coverage reached a peak of over 90% in 1995, gradually declined to a low of just over 70% during 2002-2004 and climbed in recent years to 85% in 2008. The other vaccines - BCG and measles - show a similar pattern. DTP dropout rates, the proportion of children who receive the first dose but not the third, was well below 10% in 1993, but increased to 17% in 1998 and 19% in 2003. The KDHS 2008 however showed that the DPT 1-3 dropout rate had reduced to 10%.
Figure 3: Trends of DTP 3 in Kenya, 1980-2008
The health facility reports show that the proportion of districts that have reached at least 80% coverage of DTP3 increased during 2003-06 to a high of 64%, but that in 2007 and 2008 a large decline was observed. The decline during this period should be interpreted with a background of the socio-political instability that resulted to disruption of health services, dislocation of populations and withholding of donor support.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 17
Figure 4: Proportion of districts with at least 80% DTP3 coverage among children 12-23 months.
The household surveys can provide further insight into what population groups are affected most by the changes in coverage over time. It is notable that KEPI has succeeded in reaching rural populations just as well as urban children and that this has remained unchanged since 1998. Both urban and rural children were equally affected by the declining trend until 2003 and the subsequent upturn 2003-2008. The situation by mother's level of education is different. There were large differences in DTP3 coverage by level of mother's education and especially children of mothers with no education has lower coverage and were affected more severely during the weaker performance period of the immunization programme. The 2008 KDHS however indicates that immunization coverage among children of mothers with no education increased more than for other children, reducing the gap.
Figure 5:DTP3 coverage trends by residence and by mother's level of education
Source: KDHS 1998-2008.
The provincial differences are shown based on data from the 1993 and 2008 KDHS. Overall, DTP3 coverage was the same in both years (86%). North Eastern Province was for the first
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1988 1993 1998 2003 2008
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1988 1993 1998 2003 2008
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Kenya DVI Comprehensive Multi-Year Plan 2013-2017 18
time included in 2003. It is notable however that, even though DTP3 coverage is lower than in other provinces, there was a dramatic increase from 25% in 2003 to 57% in 2008. Four out of eight provinces had DPT3 coverage of over 85% both in1993 and 2008. Nairobi province has shown a declining trend of the same, while Nyanza and Western province hardly achieved coverage beyond 80%. The data from North eastern province is limited to ascertain coverage and trends.
The proportion of pregnant women who received one or two doses of tetanus toxoid was very close to antenatal care coverage and was 85% in 2003. In the KDHS 2008 it was computed that 72% of mothers had their last live birth protected from neonatal tetanus1
The KDHS shows that most of the pregnant women receive Tetanus toxoid vaccine during their first ANC visit as demonstrated by the comparable coverage for both interventions.
1.4 Health Sector Priorities
The Government of Kenya (GOK) is determined to improve both access and equity of essential health care services, and to ensure that the health sector plays its essential role in the realization of the Vision 2030 and the five year Medium Term Plans (MTPs). As a signatory of the Millennium Declaration with its internationally defined Millennium Development Goals (MDGs), Kenya has expressed its commitment to reach these targets by 2015. 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
1 Includes mothers with two injections during the pregnancy of the last live birth, or two or more injections (the last within 3 years of the
last live birth), or three or more injections (the last within 5 years of the last live birth), or four or more injections (the last within ten years of
the last live birth), or five or more injections prior to the last live birth
50.0
55.0
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65.0
70.0
75.0
80.0
85.0
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Nairobi Central Coast Eastern Nyanza Rift Valley
Western N
Eastern
1993 KDHS
2008 KDHS
Figure 6: DTP3 coverage among children 12-23 months by province
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 19
allocation. Specific outcomes to be achieved in the Vision 2030 represent the achievements of the targets by MOH, through the implementation of the annual operational plans.
Figure 7: Pillars of Kenya’s development framework – Vision 2030 Source: Kenya National Economic and Social Council. At national level, the Vision 2030 and the First Medium Term Plan 2008-2012, whose three pillars are economic, social and political aims at achieving a globally competitive and prosperous nation with a high quality of life. The above will be achieved through strengthening the institutions of governance; rehabilitating and expanding physical infrastructure; and investing in the poor. A key component of the Vision 2030 is the introduction of the Social Health Insurance in a phased approach to eventually achieve universal coverage of free health care to the Kenya Population.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 20
2 HEALTH CARE DELIVERY SYSTEM IN KENYA
Kenya’s Ministries of Health (Ministry of Medical Services and Ministry of Public Health and Sanitation) offer health services through their public sector health facilities that account for 46% of the 6,761 health facilities in Kenya. FBO/NGO and the private for-profit sector ‘own’ the remaining 54%. However, all EPI services in 4100 Public/FBO/NGO/Private facilities are supported by the Division of Vaccines and Immunization (DVI). The major NGO/FBO health care providers include: AMREF, CHAK/NCCK (Christian Health Association of Kenya), KCS (Kenya Catholic Secretariat), and the Kenyan Aga Khan Foundation. FBOs/NGOs and Private for Profit health providers are key actors in 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.
2.1 External Policy Environment
The Kenya national health system is operating within the context of other international health initiatives. In this regard, achievement of the MDGs targets is of primary importance, especially MDG 4 for DVI. Other policy documents are the Global Immunization Vision and Strategies (GIVS) and the African Region EPI Strategic Plan for 2006-2009. The National Health Sector Strategic Plans (NHSSPs) are translated into annual activities that are aligned to the available resource envelope for a particular fiscal year. An AOP, therefore, defines the year’s priorities, targets, activities and resources, on the basis of the ideals, strategies and targets spelt out in a particular NHSSP as well as on the lessons learnt from the implementation of preceding AOP. This annual operational plan is the sixth in the series. The Second National Health Sector Strategic Plan (NHSSP II)2, whose end date has been extended from 2010 to 2012 for the following reasons, forms the basis for this AOP:
• To align health sector strategic planning cycle to the Government of Kenya’s strategic planning cycle
• The NHSSP II strategic priorities are in line with the Kenya Vision 2030 and the First Medium- Term Plan (MTP) for 2008-2012
• The economic down turn, the post election events and the associated reorganisation of the Government health services had a negative impact on the implementation of the Roadmap for Acceleration of Implementation of Interventions to Achieve the
Objectives of the NHSSP II,3 and as such the extension will provide an opportunity to ensure the implement the roadmap hence achieving the NHSSP II objectives.
2 Ministry of Health, Reversing the Trends-The second National Health Sector Strategic Plan for Kenya: NHSSP 11, 2005-
2010, September 2005. 3 Ministry of Health, Roadmap for Acceleration of Implementation of Interventions to Achieve the Objectives of the NHSSP II
,
December 2007.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 21
The country is currently developing the third Kenya Health Sector Strategic Plan (KHSSP III) which has its goal, ‘accelerating attainment of health impact goals’ as defined in the Kenya Health Policy (2012-2030). The sector places its main emphasis on implementing interventions, and prioritizing investments relating to maternal and newborn health, as it is the major impact area for which progress was not attained in the previous strategic plan.
The Health Services objective for the Kenya Health Policy is to attain universal coverage with critical services that positively contribute to the realization of the overall policy goal. Six policy objectives, therefore, are defined, which address the current situation – each with specific strategies for focus to enable attaining of the policy objective. Objectives that have a clear link to the health MDGs and immunization, and that have a clear intent to strengthen the national health system are highlighted below:
• Eliminate communicable conditions: This is to be achieved through reducing the burden of communicable diseases, till they are not of major public health concern.
• Provide essential health care. These shall be medical services that are affordable, equitable, accessible and responsive to client needs.
• Minimize exposure to health risk factors. This aims at strengthening the health promoting interventions, which address risk factors to health, plus facilitating use of products and services that lead to healthy behavior in the population.
• Strengthen collaboration with other sectors. This aims to adopt a ‘Health in all Policies’ approach, which ensures the Health Sector interacts with and influences design implementation and monitoring processes in all health related sector actions.
2.2 Sector strategic framework, and documents
The sector has a comprehensive set of strategic documents guiding its actions. These are either primary guidance documents, or secondary guidance documents that represent a re-arrangement of information in the primary documents, based on expectations of different constituents. These different documents, and their relations, are highlighted below.
Table 1: Table Health Sector strategic documents
Area of guidance
Primary documents Secondary documents
Policy level Kenya Health Policy Framework
Program – specific policy guidelines
Strategic level National Health Sector Strategic Plan
Investment level
Joint Program of Work and Funding
National Health Strategic Plan Ministry strategic plans Department investment / strategic plans
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 22
Program – specific investment / strategic plans System – specific investment / strategic plans
Operational level
Annual Operational Plans
• Departmental AOP 6 plans
• Provincial AOP 6 plans
• Parastatal AOP 6 plans
AOP 6 consolidated plan
The sector results chain is defined around the primary documents. The secondary documents re-package the information in the primary documents, depending on the constituent needs.
2.2.1 Policy level documents
These define the long term direction the country is taking in health. The Kenya Health Policy Framework is the primary policy document for health in Kenya. This is being updated during this AOP 6, to cover the period 2011 – 2030, to provide the key policy directions for the health sector leading to attainment of the Vision 2030. Specific policy guidelines are developed, for key areas in the sector, but which are all linked to attainment of the policy imperatives of the KHPF.
2.2.2 Strategic level documents
These outline the Medium Term strategic direction for the health sector in the country. It is captured in the five strategic objectives of the National Health Sector Strategic Plan II. Originally intended to guide the sector up to 2010, its timeframe has been extended to 2012 (see proceeding section).
2.2.3 Investment level documents
These outline the investment priorities during the period of the sector strategic plan. The overall sector investment plan is the Joint Program of Work and Funding (JPWF), 2005 – 2010, around which all investments in the sector are aligned. It forms the basis for the sector partnership process, which is designed to align and coordinate efforts of the sector in attaining the respective priority investments. Most current sector documents are a re-packaging of the investment priorities in this JPWF
• The roadmap for acceleration of NHSSP II objectives: This is the way forward, arising from the Mid Term Review of the NHSSP II. It highlights the investment
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 23
priorities the sector needs to focus on, to accelerate movement towards the NHSSP II objectives.
• The Ministry Strategic Plans: These re-package the JPWF investment priorities, around the respective mandates of each Ministry, and provide more detail on implementation priorities
• The Health Strategic Plan: This brings together the investment priorities from the strategic plans of both Ministries into one document
• The departmental / division strategic plans: These re-package the JPWF investment priorities around the mandate of a given department, and provide more detail on the deliverables.
• The program investment plans (e.g. EPI MYP, Malaria strategy): These re-package the JPWF investment priorities around the mandate of a given program area, and provide more detail on the deliverables.
• The system investment plans (e.g. HRH strategic plan): These re-package the JPWF investment priorities around the mandate of a given system area, and provide more detail on the deliverables.
2.2.4 Operational level documents
These represent the guide for the activity priorities for different sector constituents. Each health facility or management unit in the sector has an annual operational plan (AOP). These are consolidated at each level, up to the single sector wide Annual Operational Plan 6 document.
The above results chain is comprehensive in structure, covering all the sector planning and monitoring needs. The only gap is in the timeline of the NHSSP II, which ends in 2010.
2.3 Sector targets and indicators
These remain the same as in the NHSSP II document. Overall impact sought is outlined in Annex 6.
2.4 Recap of sector strategic priorities
2.4.1 Recap of Vision 2030
Kenya Vision 2030 articulates the national development agenda for the country. The Vision specifies strategies for achieving the following economic, social and governance targets that are expected to transform Kenya from low income to a rapidly industrializing middle-income nation by the year 2030:
• Sustainable economic growth of 10% per year over the next 25 years.
• A just and cohesive society enjoying equitable social development in a clean and secure environment.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 24
• An issue-based, people-centred, result-oriented and accountable democratic political system.
Kenya’s Vision 2030 for health is to provide equitable and affordable health care at the highest affordable standard to all citizens, involving (among other things) the restructuring of the health care delivery systems in order to shift the emphasis from curative to preventive and promotive health care. Improved access, equity, quality, capacity and institutional framework are the main focus areas that will be achieved through a devolution approach that will allocate funds and responsibility for delivery of health care to hospitals, health centres, dispensaries and communities
2.4.2 Recap of the First Medium-Term Plan, 2008–2012
The first MTP sets out the policies, reform agenda, projects and programmes that Kenya’s Grand Coalition Government is committed to implement during the period 2008–2012 in line with Vision 2030. The MTP health sector objectives are to:
1. Reduce under-five mortality from 120 to 33 per 1,000 live births;
2. Reduce the maternal mortality ratio (MMR) from 410 to 147 per 100,000 live births;
3. Increase the proportion of deliveries by skilled personnel from the current 42% to 90%;
4. Increase the proportion of immunized children below one year from 71% to 95%;
5. Reduce the number of cases of TB from 888 to 444 per 100,000 persons;
6. Reduce the proportion of in-patient malaria fatality to 3%; and
7. Reduce the national adult HIV prevalence rate to less than 2%.
The MTP flagship projects for health are rehabilitating health facilities, strengthening the Kenya Medical Supply Agency (KEMSA), fully implementing the Community Strategy, de-linking the health ministry’s from service delivery, building the human resource capacity and developing equitable financing mechanisms.
2.4.3 Recap of NHSSP II 2005–2012
NHSSP II outlines the health sector strategies aimed at achieving the national development priorities and the Millennium Development Goals (MDGs). NHSSP II has as its overall goal is to reduce inequalities in health care services and reverse the downward trend in health-related outcome indicators. Five strategic objectives were set for the realization of this goal:
� Equitable access to health services increased.
� The quality and responsiveness of services in the sector improved.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 25
� The efficiency and effectiveness of service delivery improved.
� The fostering of partnerships enhanced.
� The financing of the health sector improved.
The main innovations of NHSSP II in terms of service delivery are the definition of the Kenya Essential Package for Health (KEPH)4 and the re-definition of service delivery levels – most particularly the inclusion of level 1 (community level) services as part of the service delivery units. In order to deliver the essential health services effectively, core support systems to be strengthened are also articulated.
4 Ministry of Health, Reversing the Trends: The Second National Health Sector Strategic Plan of Kenya – The Kenya Essential
Package for Health, July 2007.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 26
3 IMMUNIZATION PROGRAMME IN KENYA
The immunization system components include service delivery, vaccine supply, quality,
logistics, disease surveillance and advocacy, communication and social mobilization.
3.1 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, primarily most of immunizations take place in fixed posts and the programme will endeavour to re-energise the outreach strategy within the RED strategy framework and sustain it. In addition SIAs will be implemented periodically. .
3.2 Vaccine Supply, Quality and Logistics
The EPI programme will ensure that adequate vaccines bundled with injection materials are procured through WHO/UNICEF approved mechanisms. The Child Health ICC will advocate for the adequate and timely release of funds, procurement of vaccines and other logistics to be prioritised to avoid disruption of services. The current storage capacities for both vaccines and dry store materials at central and regional vaccine stores will be expanded in tandem with the growing population and range of vaccines. There is reinforcement of our cold chain capacity ongoing through support from the Japanese government in Central Vaccine Store-Kitengela, Nairobi and six other regional depots to be ready for hand over by Mid next year 2013.
The cold chain inventory showed that the Central Vaccine stores has adequate capacity to accommodate the current vaccine schedule and rotavirus vaccine up to the year 2015, after which capacity will be strained.
The regional stores also have adequate capacity and will be able to accommodate PCV 10 and Rotavirus for the foreseeable future. The regional vaccine stores are currently operating at approximately 30% capacity.
Deficiencies at other level of the cold chain were identified at district and facilities level and these issues are being addressed with the provision of new equipment and increasing the number of fixed facilities offering immunizations.
Solar energy was identified as the most abundant and underutilized source of energy. The Government of Kenya is currently in the process of acquiring over 500 solar chill refrigerators which are solar powered refrigerators that are directly powered by solar
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 27
without an external battery. These refrigerators will reduce the energy cost, lower maintenance cost and reduce carbon foot print of maintaining the cold chain.
COLDCHAIN CAPACITY AT CENTRAL VACCINE STORE AND REGIONAL DEPOTS
Figure 8: Cold Chain capacity at central vaccine store
Figure 9: Cold Chain capacity at regional depots
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
2011 2012 2013
National vaccine stores forecast 2011- 2013
Capacity
Requirements
0
5000
10000
15000
20000
25000
Regional Store Capacity and requirements
Capacity
Requirement 2011
Requirement 2012
Requirement 2013
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 28
DVI internal quality assurance mechanisms will in-turn ensure vaccine quality is maintained up to the point of utilization. .
A computerised stock management system is in place at the regional vaccine store rooms so as to improve management of vaccines and injection materials and is being rolled out to the regional stores with assistance from Clinton Health Access Initiative (CHAI).
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. In addition a number of cold-chain equipments will be procured to expand our total cold-chain capacity. The programme will therefore advocate for adequate resources to achieve this obligation and also explore other cost effective options for logistics management.
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. National Health Care Waste Management Policy will guide the managements of Immunization waste. 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 MOPHS and other stakeholders by providing support for the construction of incinerators to cover the remaining District Hospitals to achieve 100% coverage during the planned period.
3.3 Disease Surveillance
The division of disease surveillance and response (DDSR) is responsible for disease surveillance and response activities, but DVI will liaise closely with DDSR for all vaccine preventable diseases.
Vaccine preventable disease surveillance data (Polio, measles, PBM and MNT) will be monitored so as to address gaps in immunization coverage in a timely manner as appropriate. PBM, Rota virus surveillance will be used to inform the introduction of rota virus vaccine and meningococcal vaccine. In this multiyear plan, we hope to maintain or improve the tempo of detection and notification of AFP, measles, and NNT at current levels efficiently.
3.4 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
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 29
for effective implementation of the planned activities. Of priority, will be the development and dissemination of the EPI communication plan informed by the KAP survey. The advocacy plan 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 (DHMTs) 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 DVI newsletter will continue to be published and distributed to all health facilities and pre-service health institutions. The communication plan is finalized and will be rolled before the end of this year, 2012.
DIRECTOR FOR PUBLIC HEALTH AND SANITATION
HEAD:
DEPARTMENT OF FAMILY HEALTH
HEAD: DIVISION OF VACCINES AND IMMUNIZATION
POLICY DIRECTION, ADVOCACY, TRAINING &
MONITORING AND EVALUATION
ADVOCACY TRAINING DATA
COMMODITY SECURITY & QUALITY CONTROL
CENTRAL VACCINE STORE
GENERAL ADMINISTRATION
SUPPORT UNIT
Figure 10: Organogram of Division of Vaccines and Immunization
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 30
3.5 Goal of routine Immunization
The goal of the Division of Vaccine and Immunization is to reduce morbidity, mortality and
disability due to life threatening infections due to vaccine preventable diseases.
The Government of Kenya provides vaccines for the vaccine preventable diseases free of
charge through DVI. During the period of this plan, the following diseases have been
targeted: Tuberculosis, poliomyelitis, diphtheria, pertusis, tetanus, hepatitis B,
Haemophilus influenza type b, measles, yellow fever and pneumococcal disease. Rota virus
vaccine is planned for introduction in 2013 subject to availability of GAVI support as the
Government has already expressed intent of introducing this vaccine to GAVI.
3.6 Immunization Schedule for Kenya
Kenya has been expanding its package of immunization in line with advances in technology
in development of vaccines. The table below is a summary of Kenya’s immunization
schedule:
Table 2: Current Routine Vaccination Schedule for Children under 1 year
Vaccine
Ages of administration of routine immunization services
Indicate by an “x” if given in:
Comments Entire
country
Only in part of
the country
BCG At birth X
OPV At birth, 6wk, 10wk and 14wk X SIAs planned for 2011
DPT-HepB-Hib
6wk, 10wk and 14wk X
Pneumococcal vaccine (PCV 10)
6wk, 10wk and 14wk X To be introduced in January 2011
Measles 9 months X Measles SIA planned for 9 to 59 months old in 2012 and 2015
Yellow Fever 9 months X Given in four districts ( Baringo, Keiyo,
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 31
Koibatek and Marakwet) at high risk of yellow fever disease. Follow up SIAs planned for 2012
TT Pregnant women, WCBA and School aged children 7to14years
X Given in pregnancy under the 5TT schedule.
SIAs in high risk districts targeting WCBA in 2011
Vitamin A 6m,12m,18m,24m,30m,36m,42m,48m,54m and 60m. Less 6 weeks Postpartum mothers.
X To be integrated with measles/OPV SIAs
Unlike other antigens, Yellow fever vaccine is not administered throughout the country, but
in only four districts that are high risk of yellow fever, whereas additional strategies are
used for TT also in high risk districts. The additional strategies for TT include SIAs for
women of child bearing age (WCBA) districts and School-Based TT immunization activities.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 32
4 IMMUNIZATION SYSTEM COMPONENTS
The immunization system components include service delivery, vaccine supply, quality, logistics, disease surveillance and advocacy, communication and social mobilization.
4.1 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, primarily most
of immunizations take place in fixed posts and the programme will endeavour to re-
energise the outreach strategy within the RED strategy framework and sustain it. In
addition SIAs will be implemented periodically. .
4.2 Vaccine Supply, Quality and Logistics
The EPI programme will ensure that adequate vaccines bundled with injection materials
are procured through WHO/UNICEF approved mechanisms. The Child Health ICC will
advocate for the adequate and timely release of funds, procurement of vaccines and other
logistics to be prioritised to avoid disruption of services. The current storage capacities for
both vaccines and dry store materials at central and regional vaccine stores will be
expanded in tandem with the growing population and range of vaccines.
DVI internal quality assurance mechanisms will in-turn ascertain vaccine quality is
maintained to the point of utilization. AEFI surveillance will be improved through
production of guidelines, adequate tools and specific AEFI training.
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. Ongoing projects, such as the
construction of the new DVI headquarters, additional national and regional stores are
expected to be completed in the duration of this cMYP through the support of JICA.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 33
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. In addition a number of cold-chain equipments will be
procured to expand our total cold-chain capacity. The programme will therefore advocate
for adequate resources to achieve this obligation and also explore other cost effective
options for logistics management.
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. National Health Care Waste Management Policy will guide
the managements of Immunization waste. 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 MOPHS and other stakeholders by providing support for the construction of
incinerators to cover the remaining District Hospitals to achieve 100% coverage during the
planned period.
4.3 Disease Surveillance
The division of disease surveillance and response (DDSR) is responsible for disease
surveillance and response activities, but DVI will liaise closely with DDSR for all vaccine
preventable diseases.
Vaccine preventable disease surveillance data (Polio, measles, PBM and MNT) will be
monitored so as to address gaps in immunization coverage in a timely manner as
appropriate. PBM, Rota virus surveillance will be used to inform the introduction of rota
virus vaccine and meningococcal vaccine.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 34
In this multiyear plan, we hope to maintain or improve the tempo of detection and
notification of AFP, measles, and NNT at current levels efficiently.
4.4 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 communication plan informed by the KAP survey. The
advocacy plan 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 (DHMTs) 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 DVI newsletter will continue to be
published and distributed to all health facilities and pre-service health institutions.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 35
5 SITUATION ANALYSIS
This chapter presents the performance of the immunization system components focusing on the status, gaps and challenges over the last five to ten years.
5.1 Routine Immunization Performance, Gaps and Challenges
Since the inception of Kenya Expanded Programme on Immunization in the 1980s,
immunization coverage increases albeit slowly till the early 1990s. In the 1990s, political
and economic changes negatively impacted the programme. Coupled with donor
withdrawal, these changes led to rapid decline in immunization coverage till late 1990s
when the government committed to fully procure all EPI vaccines. This led to progressive
increase in coverage with fully immunized child coverage of >80% in 2011 (fig 9)
Figure 11: Trends of immunization performance for selected indicators, 1992-2009, Kenya
Despite these gains, the programme has experienced challenges in the recent past that have
caused the coverage to either plateau or decline. These challenges include:
0
20
40
60
80
100
120
1992 1993 1994 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Measles BCG DPT/Penta 3 FIC
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 36
• Inaccessibility of immunization services because of distant health facilities
especially among the nomadic communities, poor health seeking behaviour of
caregivers due to socio-cultural issues and insecurity in some parts of the country.
• Inadequate or late disbursement of finances for procurement and operations.
• Vaccine stock outs at the service delivery points due to delay in vaccine distribution
from national to regional levels or inadequate planning by the districts.
• Limited community participation in planning of health services
• Shortage of staff to man the health facilities due to shortage and mal-distribution of
existing health workers
• Poor motivation of health workers due to lack of supervision, requisite skills,
knowledge and low morale.
• Lack of quality support supervision at all levels compounded by lack of adequate
transport to facilitate movement. Support supervision has been infrequent, poorly
coordinated, unplanned and not evidence-driven
• Increase in the number of districts resulting to inadequate finances and resources
for programmatic management including purchase and maintenance of cold chain
equipment.
• Lack of communication strategy and plan to create demand for immunization
services due to lack of necessary expertise and social profiling.
• Inadequate human resources at service delivery points to provide immunization
services.
The table below summarizes the situation analysis of EPI progress of each system
component.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 37
Table 3: Situational analysis of routine EPI by system components based on previous years' data (2007-2009)
System components
Suggested indicators
(National∗∗∗∗ )
2007
2008 2009 2010 2011
Routine Coverage
National coverage of fully immunized child (FIC)
77 71 69 81 82
National
DPT3/Hib/HepB(Penta3)
coverage
81 72 75 83 88
% of districts with > 80%
coverage(Penta 3)
57 56 58 53 63
National DPT1-DPT3
dropout rate
9 14.2 6.3 10 7.7
Percentage of districts
with dropout rate DTP1-
DTP3>10%
34.6 28.3 34 46 26.8
New vaccines National HepB3 coverage NA NA NA NA NA
Routine Surveillance
% of surveillance reports
received at national level
from districts compared
to number of reports
expected
No data No data No data
92 92
Quality of surveillance
data sufficient? (Y/N)
Y Y Y Y Y
Cold chain/Logistics
Percentage of districts
with adequate number of
functional cold chain
equipment
65 70 72 61 65
Immunization safety and Waste Management
Percentage of districts
supplied with adequate
(equal or more) number
of AD syringes for all
routine immunizations
100 100 100 100 100
Percentage of districts
supplied with safety boxes
100 100 100 100 100
Percentage of districts
with proper sharps waste
management systems
No Data No Data No Data
No Data No Data
Vaccine supply Was there a stock-out at
national level during last
year? (Y/N)
Y Y Y N Y
If yes, specify duration in 3 1/1 3*/1/ NA 1week
∗ It is useful to include the data source for each data set. GRF 2011
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 38
months 1
If yes, specify which
antigen(s).
BCG BCG/OPV
BCG, OPV, Measles
NA TT
Vaccine wastage
monitoring at national
level for all vaccines?
(Y/N)
N N N N N
Communication
Availability of a plan?
(Y/N)
N N N N N
Percentage of districts
which have developed EPI
communication plans
0 0 0 0 0
Percentage of caretakers
of children < 1yr
understanding the
importance of routine
immunization.
No data No data No data No data
Financial sustainability
What percentage of total
routine vaccine spending
was financed using
Government
funds?(including loans
and excluding external
public financing)
100 100 100 17.3 10.3
Management planning
Are a series of district
indicators collected
regularly at national
level?(Y/N)
N N N Y Y
Percentage of all districts
with micro plans.
No data No data No data
67 100
Research/studies
Number of vaccine related
studies conducted/being
conducted
1-PCV 7 trial
1-PCV 7
1-Rotateq
PCV-10, Rotateq, Malaria vaccine, Hiv vaccine studies
3- Malaria vaccine, Yellow Fever, VVM Vs Vaccine potency study
NRA Number of functions
conducted-registration of
vaccines to determine
efficacy
0 0 0 2 02 0
National ICC Number of meetings held
last year-withy EPI
4 4 4 4 4
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 39
agenda discussed
Human Resources availability
Percentage of sanctioned
posts of vaccinators filled-
no vaccinator cadres in
Kenya
N/A N/A N/A N/A N/A
Percentage of health
facilities with at least 1
health worker
60 90 100
Percentage of health
workers time available for
routine EPI
40 40 40 40 40
Number of health workers
/ 10.000 population
11 17
Transport / Mobility
Percentage of districts
with a sufficient number
of supervisory/EPI field
activity
vehicles/motorbikes/bicy
cles in working condition
100 80 70 60 50
Waste Management
Availability of a waste
management plan
Y Y Y Y Y
Linking to other Health Interventions
Were immunization
services systematically
linked with delivery of
other interventions
(Malaria, Nutrition, Child
health etc)?
Y Y Y Y Y
Programme Efficiency
Timeliness of
disbursement of funds to
district and service
delivery level
N0 No No No No
\
School
Immunizatio
n Activities
Age Antigens provided
Coverage 2007
Coverage 2008
Coverage
2009
Coverage 2010
None
7-15 YRS
TT, Abendazole 90 %** None None
**school based TT campaign in Coast Province in 2006/2007
5.2 Polio eradication
After 22 years of being polio free, Kenya unfortunately confirmed wild polio outbreak in
Garissa district in North Eastern province bordering Somalia in October 2006. This was
quickly contained. Another wild polio outbreak was confirmed in Turkana districts, Rift
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 40
Valley in January 2009 following importation of wild polio virus from Southern Sudan. A
total of 19 cases were reported. This followed a previous outbreak of wild polio in North
Eastern province in 2006 imported from Somalia. Kenya followed the recommendations of
the Advisory committee on Polio Eradication and responded to the outbreaks that were
contained at both times.
Kenya has attained the national AFP surveillance indicators although sub-optimal
performances have been reported in some regions. The immunity of the population has
been low due to low immunization coverage of OPV3 which has been declining in the last
three years (2007-2009) as shown in the table below hence putting Kenya at risk of wild
polio importation from the neighbouring countries. This poor performance has resulted
from challenges facing the immunization programme as discussed under routine
immunization.
Table 4: Situational analysis of polio eradication 2011
System components
Suggested indicators
National∗∗∗∗
2007
2008 2009 2010 2011
Polio OPV3 coverage 76 74 72 83 88
Non polio AFP rate per
100,000 children under 15
yrs. of age
2.56 2.23 3.2 2.83 3.29
Extent: NID/SNID
No. of rounds
Coverage range
SNID
2
92
SNID
8
SNID
2
107
SNID
6
86-92
5.3 Accelerated disease control
The immunization coverage of measles and maternal and neonatal tetanus has been
declining for the last 3 years (2007-2009) as shown in table 5. Measles outbreaks have
been reported in various parts of Kenya and 1218 cases were reported in 2009. See table 5
below. So far the about 94 cases of measles (29 lab confirmed, 57 epi-linked and 8
∗ It is useful to include the data source for each data set. JRF IM
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 41
compatible) have been reported from Jan to Jun 2010, however more than 90% of the cases
are above 15years of age (outside the EPI target group). The reasons for the downward
trend in the immunization coverage are discussed in detail under routine immunization.
Table 5: Situational analysis by accelerated disease control initiatives, Based on previous years' data (2007-2009)
System components
Suggested indicators
National
∗∗∗∗
2007
2008 2009 2010 2011
MNT TT2+ coverage 78 71 60 72 76
Number of districts
reporting > 1case per 1,000
live births
NONE NONE NONE NONE NONE
Was there an SIA? (Y/N) N Y N N N
Measles Measles coverage 80 76 74 86 87
No. of outbreaks reported
(Cases)
262 1280 1218 1271 3096
Extent: NID/SNID
Age group
Coverage( under 1 yr to 15+)
NID
9-59 mths
83
N N/A
∗ It is useful to include the data source for each data set. JRF IM
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 42
6 PRIORITIES, OBJECTIVES AND MILESTONES FOR EPI
Based on the situational analysis, the priority activities for immunization programme for
the planned period are the following:
i) Polio eradication
ii) Accelerated disease control
iii) Improving performance of routine Immunization
iv) Supplemental Immunization
v) Improving financial flows
vi) Creating demand of immunization services through evidence-driven
advocacy
vii) Improving the capacity of health workers
The table below gives in detail the priority areas, objectives and the milestones. Table 6:National objectives and milestones, AFR regional and global goals
National priorities
NIP Objectives NIP Milestones
AFRO Regional goals
Order of Priority
Penta 3 To attain immunization coverage (Penta 3) of 90% nationally with at least 80% coverage in every district by 2015
2011: 88% National and at least 37% in every district 2012: 90% /60% 2013: 90% /67% 2014: 90% /74% 2015: 90% /80%
By 2010 all countries will have routine immunization coverage of 90% nationally with at least 80% coverage in every district.
1
Fully Immunized Child
To attain fully immunized child national coverage of 90% by 2015
2011: 82% (Achieved) 2012: 84% 2013: 86% 2014: 88% 2015: 90%
1
Polio To attain immunization
2011: 88% National and at least 35% in every district
. 1
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 43
National priorities
NIP Objectives NIP Milestones
AFRO Regional goals
Order of Priority
coverage (OPV3) of 90% nationally with at least 80% coverage in every district by 2015
2012: 90% /60% 2013: 90% /67% 2014: 90% /74% 2015: 90% /80%
Measles To attain measles immunization coverage of 90% nationally with at least 80% coverage in every district by 2015 To introduce Measles Second Dose (MSD)by 2013
2011: 87% National and at least 34% in every district 2012: 90% /60% 2013: 90% /67% 2014: 90% /74% 2015: 90% /80% 2013-MSD II rollout
1
TT2 + To attain TT2+ immunization coverage among pregnant women of 80% nationally with at least 80% coverage in every district by 2015
2011: 76% 2012: 77% 2013: 78% 2014: 79% 2015: 80%
3
Yellow Fever To attain 80% coverage in the high risk districts by 2015
2011: 56% 2012: 68% 2013: 72% 2014: 76% 2015: 80%
5
Vitamin A Supplementation
To attain 80% coverage (2 doses ) of Vitamin A by 2015
2011: 33% 2012: 50% 2013: 55% 2014: 60% 2015: 80%
1
Pneumococcal
To attain immunization coverage (PCV-10) of 90% nationally with at least 80% coverage in every district by 2015
2011: 85% National and at least 37% in every district 2012: 90% /60% 2013: 90% /67% 2014: 90% /74% 2015: 90% /80%
1
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 44
National priorities
NIP Objectives NIP Milestones
AFRO Regional goals
Order of Priority
Rota To introduce rotavirus vaccine by 2013
2011: Proposal developed and conditional approval given by GAVI board. 2012: Approval with clarifications 2013: Introduction of Rotavirus vaccine 2014: Post introduction evaluation
8
HPV Vaccine To set up HPV demonstration project in Kenya by the year 2013
Demonstration project
Immunization Safety
To sustain 100% supply of safe injection supplies and practices by 2015
All districts are supplied with adequate quantities of AD syringes and safety boxes during planning period (2011-2015)
20
Waste Management
All districts to have and implement a waste management plan by 2015
2011: 50% of districts with incinerators 2012: 70% 2013: 80% 2014: 90% 2015: 100%
6
Surveillance To attain and sustain core indicators for AFP and Measles by 2015 To attain MNT elimination.
2011-2015: Non Polio AFP rate: 4 2011-2015: Non measles febrile illness: 3.3/10,000 2012: NNT incidence in 80% districts: <1/1000 live 2013: NNT incidence in 90% districts: <1/1000 live 2014: NNT incidence in 100% districts: <1/1000 live births
4
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 45
National priorities
NIP Objectives NIP Milestones
AFRO Regional goals
Order of Priority
To attain PBM and Rotavirus indicators by 2015 Maintain surveillance reporting rates (timeliness and completeness) above 90% in all districts
2013-2014: Proposal development for surveillance of intussusception. 2013: 100% timely reporting for PBM and Rota surveillance 2014: Data on intussusceptions rate available 2011-2015: Maintain reporting rate (timeliness and completeness) above 90% in all districts
Vaccine Supply
To attain 100% of districts with no stock outs of vaccines at the district stores by 2013
2011-2015: To have National level vaccine stocks within min-max zone 2013: 80% of districts with no stock outs 2014- 2015: 100% of districts with no stock outs
1
Cold Chain / Logistics
To increase the number of districts with adequate cold chain capacity at the district stores from 61% to 85% by 2015
2011: 65% of districts have adequate cold chain capacity 2012: 70% 2013: 75% 2014: 80% 2015: 85%
3
Advocacy and Communications
To develop and implement a communication plan for immunization in all districts by 2013
2012: National Communication plan for immunization Finalized 2013-2015: All districts adapt & implement communication plan for immunization
7
Management and Planning
To increase the proportion of districts with immunization
2012: 80% of districts 2013-2015: 100% of districts have micro-plans that are
2
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 46
National priorities
NIP Objectives NIP Milestones
AFRO Regional goals
Order of Priority
specific micro-plans to 100% by 2015
implemented and tracked
Programme Efficiency
To increase and maintain timelines of disbursement of funds to districts from 0% to 100% by 2015
2011: 30% Timeliness of disbursement 2012: 50% 2013: 60% 2014: 70% 2015: 100%
2
Financial Sustainability
To increase and ring fence financial allocation from 550million to 830million for immunisation activities by 2015
2011: Co-financing for pneumo factored in 2011/2012 budget and subsequent years 2011: Financial allocation for purchase of traditional vaccines and injection material increased from Kshs. 400million to Kshs.670million 2011: Financial allocation for operations at sub-national level increased from Kshs. 40million to Kshs. 160million 2012: Co-financing for rota virus factored in annual budget of 2012/2013 2013: Availability of sustainability plan for pentavalent, pneumococcal and rota vaccine beyond 2015 2014: Financial allocation for immunization increased in tandem with population growth
Human Resources Management
To increase proportion of public health facilities with at least one nurse from 90% to 100% by
2012-2015: Identify critical HR gaps for immunization and share the with HR department and all partners 2012-2015: Recruitment and
10
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 47
National priorities
NIP Objectives NIP Milestones
AFRO Regional goals
Order of Priority
2015.
Re-deployment of additional health workers
Transport To improve service delivery of immunization services through provision of at least one vehicle per district
2011: Inventory of vehicles done 2012: 70% of districts with vehicle 2013: 80% of districts with vehicle 2014: 90% 2015: 100%
Training and capacity building
To improve the capacity (knowledge and skills in EPI) of health workers offering immunization services on EPI in all health facilities in the country by 2015
2011: Training needs assessment conducted and training materials developed 2012 pre-service curricula on immunization revised 2012: 50% of eligible health workers capacitated 2013: 70% of eligible health workers capacitated 2014: 90% of eligible health workers capacitated 2015: All health workers capacitated
Research / Studies
To determine the impact of vaccination on the burden of selected targeted VPDs 2015
2011: Review baseline data on burden of pneumococcal disease and Rota virus 2012-2015: 1 Operational Research supported annually 2012-2015: Impact studies of the introduction of PCV10 and Rota virus vaccine.
National Regulatory Authority
To establish a mini lab for vaccine quality assurance by 2012
2011: Secure financial resources for establishment of Mini Lab 2012-2015: Equip and operationalize the mini lab and link up with NQCL 2013-Report on vaccine potency
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 48
National priorities
NIP Objectives NIP Milestones
AFRO Regional goals
Order of Priority
Linking to Other Health Interventions
To integrate EPI with implementation of high impact child survival interventions to reach all districts by 2015
2012: identify areas for integration at National levels. 2013-2015: Availability of integrated plans at district and facility level that prioritize high impact interventions
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 49
7 IMPLEMENTATION PLAN
The focus of the implementation plan is on the core areas that will improve the immunization coverage and control of vaccine preventable diseases. The plan focuses on the following areas:
• Service delivery and programme management
• Advocacy for immunization
• Surveillance
• Vaccine supply, quality and logistics Under service delivery the focus will be on the roll-out of all components of RED strategy and monitor its implementation. Other issues to be implemented are integration as best practices and data management. In order to create demand for immunization services, we will develop and implement an advocacy and communication plan at all levels. Surveillance will be strengthened through improvement of capacity of health workers, enhanced supervisory capacity, improving laboratory capacity in diagnosis and strengthening use of data for action. Vaccine supplies, quality and logistics will be improved through guaranteed availability of quality vaccines and injection materials, expansion of the cold capacity, improved efficiency of the supply chain and vaccine distribution, improved vaccine handling and storage and effective waste management. The tables 7, 8, 9 and 10 below provide detailed strategies and activities to achieve the objective. Table 7: Service delivery and Programme Management
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 50
National Objective
Strategy Key Activities
To attain immunization coverage (FIC, Penta 3, OPV3, Measles and PCV 10) of 90% nationally with 80% of the districts attain 90% by 2015
Roll out of RED /DQS in districts that contribute 80% of un-vaccinated children
Conduct monthly defaulter tracing
Institutionalize outreach in priority areas
Conduct quarterly review meetings at national, provincial and district levels
Hold periodic community stakeholders meetings at the health facility
Conduct monthly data analysis and dissemination meetings at each level Conduct quarterly data verification, validation and written feedback
National child health days [Malezi bora]
Carry out periodic intensification of routine immunization
To attain TT2+ immunization coverage of 80% nationally with at least 80% coverage in every district by 2015
Implement the 5 TT schedule targeting WCBA within and outside pregnancy using routine and high risk approach SIAs
Institutionalize outreach in priority areas
Implement SIAs for WCBA in high risk areas
TT validation
To attain 80% coverage (at least 2 doses) of Vitamin A by 2015 in children up to1 year
Acceleration of RED Institutionalize outreach in priority areas
Conduct quarterly review meetings at national, provincial and district levels
Conduct monthly defaulter tracing
Hold quarterly community stakeholders meetings
Conduct monthly data analysis and dissemination meetings at each level
Conduct quarterly data verification, validation and written feedback
Using Malezi bora Carry out periodic intensification of routine immunization
To increase immunization coverage of yellow fever from 13% to 90% in the high risk districts by 2015
Roll out of RED/DQS
Institutionalize outreach in priority areas
Conduct quarterly review meetings at national, provincial and district levels
Conduct monthly defaulter tracing
Hold quarterly community stakeholders meetings
Conduct monthly data analysis and
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 51
dissemination meetings at each level
Conduct quarterly data verification, validation and written feedback
Follow up immunization of yellow fever
To conduct follow up immunization campaign of high risk population
To introduce measles second dose by 2017
Planning for measles second dose introduction
Constitution and launch of the national steering committee, technical coordinating committee and sub-committees
Development of district micro plans
Resource mobilization
Develop a budget and mobilize resources for introduction of measles second dose
Lobbying for sustained annual financial increment for co-financing commitment for vaccine procurement
Source for technical and financial assistance from partners
Commodities, supplies and logistics
Conduct EVMA
Develop a cold chain replacement and expansion plan
Distribution of vaccines and other supplies to all levels
Build human resource capacity
Development of training materials
Training of health workers
Advocacy and communication
Develop, print and distribute communication materials Conduct stakeholders sensitization meetings at all levels
National, provincial an district launch
To introduce ten valent pneumococcal conjugate vaccine (PCV-10) by 2011
Planning for pneumococcal introduction
Constitution and launch of the national steering committee, technical coordinating committee and sub-committees
Development of district micro plans
Resource mobilization
Develop a budget and mobilize resources for introduction of PCV-10
Lobbying for sustained annual financial increment for co-financing commitment for vaccine procurement
Source for technical and financial assistance from partners
Commodities, supplies and
Conduct EVMA
Develop a cold chain replacement and
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 52
logistics expansion plan
Distribution of vaccines and other supplies to all levels
Build human resource capacity
Development of training materials
Training of health workers
Advocacy and communication
Develop, print and distribute communication materials
Conduct stakeholders sensitization meetings at all levels National, provincial an district launch
To monitor adverse events and the impact of introduction of PCV10 in Kenya by 2014
Monitoring and evaluation
Conduct PVC10 impact studies
Conduct AEFI studies
To introduce rotavirus vaccine by 2013
Planning for Rota virus vaccine introduction
Constitution and launch of the national steering committee, technical coordinating committee and sub-committees
Development of district micro plans
Resource mobilization
Develop a budget and mobilize resources for introduction of rota virus vaccine
Lobbying for sustained annual financial increment for co-financing commitment for vaccine procurement
Source for technical and financial assistance from partners
Commodities, supplies and logistics
Develop a cold chain replacement and expansion plan Distribution of vaccines and other supplies to all levels
Build human resource capacity
Development of training materials
Training of health workers
Advocacy and communication
Develop, print and distribute communication materials
Conduct stakeholders sensitization meetings at all levels
National, provincial and district launch
Monitoring and evaluation
Revise, print and distribute all data collection tools
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 53
Monthly review of performance of rotavirus vaccine
Conduct AEFI study including intussusception
To introduce HPV Vaccine by 2015
Set up of demonstration project sites
Development and submission of proposal to GAVI
Set up sites
Document lessons from the study
Plan for national rollout of HPV
To prevent outbreaks of vaccine preventable diseases targeted for eradication, elimination and control by 2015
Supplemental immunization activities
Conduct measles follow up SIA
Conduct preventive polio SIAs in high risk districts Conduct TT SIAs in high risk districts
Determine burden of MNT and prioritize districts for intervention
Conduct risk assessment for MNT
Carry out MNT validation exercise
To increase the proportion of districts with immunization specific micro-plans to 100% by 2012
Dissemination of cMYP
Seek approval from child ICC and endorsement from HSCC
Print and distribute the plan to all stakeholders
Carry out stakeholders dissemination meeting
Hold monthly immunization technical working group meeting
Develop annual operation plan from cMYP
Develop district micro-plans
Annual update of the cMYP
Monitoring & evaluation of implementation of cMYP
Annual, mid-term and end term evaluation
To increase financial allocation for immunization from Kshs 550million to
Evidence driven high level advocacy
Prepare an economic evaluation brief on immunization
Develop a costing model for immunization activities
Prepare a resource mobilization information
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 54
Kshs830million and ring fence financial allocation for immunisation activities by 2015
package
Conduct a meeting with high level stakeholders
Sustainability plan for Penta/pneumo and other new vaccines
Fostering partnership
Broaden ICC membership to include Ministry of finance etc
Conduct joint planning and coordination meetings Conduct joint review of performance
Resource mobilization at sub-national levels
Mapping of immunization stakeholders and potential funding agencies.
Lobby for increased resources for immunization from local stakeholders
To increase timeliness of disbursement of funds from 0% to 100% by 2015
Advocacy
Conduct regular consultative meeting with finance and accounts
To increase proportion of health facilities with at least one nurse from 60% to 100% by 2015.
HR gap analysis Conduct immunization HR gap assessment
Disseminate the HR gap analysis report to all stakeholders
Advocacy Lobby deployment of HR to critical areas of need
Lobby for recruitment of critical HR
To improve capacity of health workers on immunization in 80% of all health facilities in every district by 2013
Training of health workers on immunization
Carry out training needs assessment
Revise immunization training materials
Carry out phased training incorporating the RED/DQS approach targeting all health workers involved in immunization, especially newly recruited staff
Review pre-service training curriculum of middle level medical training colleges and medical schools
To improve service delivery of immunization services through provision of at least one vehicle per
Advocacy at all levels
Conduct transport inventory
Undertake advocacy of district at national, district and constituency levels
Review progress of success
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 55
Table 8: Advocacy and Communication
National Objective
Strategy
Key Activities
district
To regularize data driven quarterly EPI supervisory visits by national, provincial and district teams by 2011
Planning of supervisory visits
Prepare immunization supervisory plan
Evidence generation
Carry out monthly immunization data analysis
Monitoring performance
Undertake quarterly EPI focused support supervision
Give feedback and feed-forward on the findings of the supervisory visit
To establish the impact of vaccines on the burden of the targeted diseases and burden of disease due to congenital rubella syndrome by 2015
Surveillance Conduct a congenital rubella syndrome baseline survey
Impact studies To carry out a seroprevalence survey of yellow fever and entomological study in high risk districts
To carry out impact of introduction of rota virus vaccine
To accelerate integrated implementation of high impact child survival interventions to reach all districts by 2015
Technical support on incorporation of immunization components of the HII
Undertake joint planning, implementation and M&E
To monitor and evaluate Kenya’s immunization program by 2015
Data management Undertake on job training on data management
Conduct periodic DQS at all levels
Conduct monthly data analysis and feedback at all levels
Print and distribute data capture and reporting tools
Validation of EPI performance
To undertake EPI coverage survey
Vaccine safety Carry out AEFI monitoring
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 56
To develop and implement an advocacy and communication plan for immunization in all districts by 2013
Development of advocacy and communication plan
Do a KAP survey to identify barriers for effective communication Develop the advocacy and communication plan
Implementation of the advocacy and communication plan
Dissemination of the plan
Identify and train district level focal people in social mapping and use of data for communications
Social and resource mapping, including of underserved populations
Training package developed for IPC skill development of health workers
Media training and partnership development
Prepare communication messages for specific target audience
Monitor the implementation of plan
Table 9: Surveillance
National Objective
Strategy
Key Activities
To sustain core indicators for AFP and Measles by 2015 To attain NNT elimination by 2012
To attain PBM and Rotavirus indicators by 2015
Improve sensitivity of surveillance system
Carry out cross border surveillance
Undertake quarterly surveillance review meetings at all levels
Carry out risk assessment/analysis
Strengthen the capacity of health workers on surveillance
Carry out on job training during support supervision at all levels
Training of newly recruited health workers and the new DHMTs
Scale up IDSR roll out
Supply of essential laboratory, data documentation and communication materials
Production IEC
Stocking of polio and measles lab reagents and equipments
Print and distribute data capture tools
Improve surveillance data quality
Conduct monthly data harmonization meeting
Timely submission of surveillance data
Table 10: Vaccine supply Quality and Logistics
National Objective
Strategy Key Activities
To increase the number of districts
Planning for cold chain equipments
Conduct comprehensive cold chain assessment at all levels
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 57
with functional cold chain at the district stores from 61% to 95% by 2015
Develop and implement a cold chain maintenance plan
Develop a cold chain replacement and expansion plan at national level
Increasing cold chain capacity
Procure cold chain equipments
Secure budget for the procurement of cold chain equipments
Lobby for funding from GOK and partners
To attain 100% of districts with no stock outs of vaccines at the district stores by 2013
Planning for vaccines and other supplies
Conduct accurate vaccine forecasting at national and district levels to ensure uninterrupted supply of vaccines
Develop a procurement plan
Develop a quarterly distribution plan in line with shipment plan
Provide adequate and well functioning transportation system to all districts
Secure funds for purchase of vaccines
Lobby for adequate finances for vaccines and other supplies through high level advocacy Ring fencing funds for vaccines and other supplies
Efficient vaccine management and distribution of vaccines at all levels
Procure vaccines on time
Fasten clearance of vaccines after arrival in the country
Install stock management tool at all level
Decentralize vaccine distribution mechanism to improve vaccine availability at the lower level
Improve vaccine handling and storage
Train logisticians and health workers on vaccine handling and storage at all levels
Improve bundling of vaccines and diluents
Reduce vaccine wastage to recommended levels
Monitor vaccine wastage at all levels Develop communication system to improve reporting of wastage
To attain 100% of the districts with waste disposal mechanism by 2015
Capacity strengthening of health care workers on health care waste management
Disseminate health care waste management guideline to all levels
Train newly recruited health care workers on health care waste disposal
Provide safe methods of waste
Construct at least one incinerator in each district
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 58
disposal Construct at least a waste disposal pit in each health facility
To sustain 100% supply of safe injection supplies and practices by 2015
Planning for AD syringes and safety boxes
Conduct accurate forecasting for AD syringes and safety boxes at all levels
Develop a procurement plan
Develop a quarterly distribution plan in line with shipment plan
Provide adequate and well functioning transportation system to all districts
Secure funds for purchase of injection and safety devices
Lobby for adequate finances through high level advocacy
Ring fence funds
Efficient supply and distribution of AD syringes and safety boxes at all levels
Procure AD syringes and safety boxes on time
Fasten clearance of vaccines after arrival in the country Install stock management tool at all level
Decentralize distribution mechanism
Improve handling and storage
Train logisticians and health workers at all levels
Implement AD bundling policy with every vaccine in every district Improve district reporting on AD use
Train the providers on safe injection practices
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 59
8 COSTING, FINANCING AND FINANCIAL SUSTAINABILITY
8.1 Costing and financing methodology
The success of the programme largely depends on adequate financing for all proposed
activities to be undertaken during the planned period. It will be the responsibility of DVI
through the Ministry of Public Health and Sanitation 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 finance for respective cost categories of the programme to derive
information relating to financial gaps. The cMYP includes a series of interventions, which
have associated activities, and inputs needed to actualise. These are illustrated in the Table
11 below.
Table 11: Inputs to different EPI systems components
System Components
Inputs Activities
Service delivery Human resources/salaries, outreach per diems, fuel for transport, operation costs for campaigns
Training, workshops, outreaches, SIAs, Supervision, Monitoring and Evaluation
Advocacy and communication
IEC materials, radio, print media advertisements etc.
Social mobilization, IEC, developing advocacy and communication plan
Surveillance Surveillance equipment, laboratory networking and reagents etc.
Surveillance meetings and activities (sentinel sites, outbreak investigation), case investigation and follow-up.
Vaccine, supply, quality and logistics
Vaccines, AD syringes, safety boxes, other injection supplies, cold chain equipment, vehicles, spare parts, incinerators etc.
Monitoring, vaccine stock management activities
Programme Procurement of land and Meetings, planning, research, data
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 60
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 and derived 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
• Programme activities, other recurrent costs and surveillance
• Other equipment needs and capital costs
• Overhead costs.
Management construction of KEPI HQs, computers, office supplies.
management, EPI reviews, cold chain assessment.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 61
8.2 Macroeconomic Information
For purposes of placing the costing and financing information into wider financing
framework, some macroeconomic information has been included. This information is
detailed in the Table 12 below. The GDP per capita has been fixed at the 2010 levels
though this may increase with time but has been fixed for planning purposes. The
Government health expenditure is expected to increase in line with the government’s plans
and agenda to improve health care service and health care delivery in line with Kenya
vision 2030 which recognises health as an important pillar for development and
industrialisation of Kenya.
Table 12:Macro Economic Trends in Kenya, 2010 – 2015
YEAR 2010 2011 2012 2013 2014 2015
GDP per capita $ 761 $ 837 $ 921 $ 1,013 $ 1,114 $ 1,226
Total health expenditures (THE) per capita $42.2 $ 56.3 $ 56.3 $ 59.5 $ 61 $ 62.5
Government health expenditures (GHE) as a % of THE 29.0% 29% 29% 29% 29% 29%
National health accounts figures are available from the WHO NHA website
http://www.who.int/nha/country
8.3 Cost projections 2011-2015 for immunization programme
The projected cost of the programme in the planning period (2011-2015) is $378
million dollars. The cost will increase from 2010 to 2015. The major cost drivers are
routine recurrent costs, new vaccines, personnel and traditional vaccines continue to
dominate all other costs of the immunization program in the years of the cMYP. The
introduction of pneumococcal vaccine in January 2011 and Rotavirus vaccine in January
2013 will lead to a rapid increase cost of vaccines and therefore an increase in co
financing requirement by the government. The Government is cognisant of these
requirements and will ensure funds are available. To mitigate the increasing cost of
vaccines the Government is also converting to a 10 dose liquid formulation of
pentavalent vaccine from a 2 dose lyophilized formulation. This vaccine formulation
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 62
will reduce costs to the Government and GAVI and also reduce pressure on our cold
chain requirements.
More details on the cost categories are shown in table 13 below.
Table 13: Programme costs and Future Resources Requirements
2011 2013 2014 2015 2016 2017
$ $ $ $ $ $
Traditional vaccines (BCG; OPV; Measles; TT; DTP) $2,106,938 $3,478,677 $3,566,948 $3,663,252 $3,762,163 $3,762,163
Underused vaccines (YF; Rubella, HepB; Hib; DTPcombo) $7,510,709 $8,608,086 $9,410,969 $9,583,553 $9,842,429 $9,842,429
New vaccines (Rota, Pneumo, HPV...) $19,963,300 $24,785,829 $24,027,522 $24,263,527 $24,918,192 $24,918,192
Cost of Injection Supplies $ $ $ $ $ $
Traditional vaccines (BCG; OPV; Measles; TT; DTP) $394,030 $553,371 $567,493 $582,817 $598,506 $598,506
Underused vaccines (YF; Rubella, HepB; Hib; DTPcombo) $222,050 $239,563 $261,912 $266,694 $273,927 $273,927
New vaccines (Rota, Pneumo, HPV...) $290,000 $243,636 $249,903 $254,689 $261,876 $261,876
Table 14: Programme costs and Future Resources Requirements
8.4 Cost profile
Program expenditure in the baseline year was US$ 206,600,722 of which US$194,588,492
is attributable to the routine recurrent program, with just under US$ 12,012,230 to the
supplemental immunization campaign activities. The expenditure breakdown for the
routine immunization program is further illustrated in the Figure 10 below.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 63
Figure 12: Basline Cost Profile Routine Only
The major cost drivers in the baseline year are new vaccines that contribute 49% of the
baseline cost while traditional vaccines account for 5% the total cost. Personnel account for
15% and other recurrent costs account for 11% of the total cost. The use of new and under
used vaccines such as pentavalent vaccine, yellow fever vaccine and PCV contribute heavily
to the cost of vaccines. Kenya plans to introduce rotavirus vaccine and second dose of
measles in 2013 which will increase the cold chain requirement and total cost of vaccines.
8.5 Baseline Financing
In terms of baseline financing, Government of Kenya (GoK) contributed 20%. The GAVI
alliance contributed to 65% of the cost and this was due to the cost of new vaccines. Other
partners contributed 15% of the cost. The Government fully financed all the traditional
vaccines and personnel cost associated with giving immunization. GAVI finance was used in
procurement of new and under used vaccines and injection supplies. Other partner
contributions were utilized in the financing of supplementary immunization activities and
Traditional Vaccines
5%Underused
Vaccines18%
New Vaccines49%
Injection supplies
2%
Personnel15%
Transportation0%
Other routine recurrent costs
11%
Vehicles0%
Cold chain equipment
0%
Other capital equipment
0%
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 64
surveillance and other activities. A breakdown of the contributions is shown in Figure 11
below.
Figure 13: Baseline Financing Profile
8.1 Cost by immunization strategy
From Figure 12 below, dominant strategy of immunization in Kenya is fixed strategy.
Outreach strategy is the second; while the third strategy is the mobile. Fixed strategies are
planned and expected t increase in line with government plans to increase fixed facilities at
all levels. Outreach will be a strategy for hard to reach and pastoralist communities. Major
SIAs are scheduled to take place in 2012 and 2015.
Government19%
Gov. Co-Financing of GAVI Vaccine
7%
GAVI65%
WHO5%
UNICEF4%
JICA0%
CHIA0% GSK
0%
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 65
Figure 14: Costs by Strategy
8.2 Projected future resource requirements for immunization from all sources from 2011-2015.
From the figure below, the total costs for immunization programme will increase from
about $206,602,722 in 2011 to $270,855,729 by 2015. The requirements will increase
significantly from 2011 till 2013 and then plateau till 2015 with marginal increase. This is
because Kenya plans to introduce rota virus vaccine by 2013.
$0.0
$50.0
$100.0
$150.0
$200.0
$250.0
$300.0
2013 2014 2015 2016 2017
M
i
l
l
i
o
n
s
Costs by Strategy**
Campaigns Routine Fix Site Delivery Outreach Strategy Mobile Strategy
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 66
Figure 15: Projection of future resource requirements 2011-2015
8.3 Projected future financing: Secured, probable and gaps for immunization from 2011-2015.
The secured funding for the year 2013 is over $46million and it increases to close to $60
million by 2015. The funding gap taking into account secured funds only is approximately
10% of the total needs and when probable funding is taken into account the funding gap
reduces to 8% in 2011 and by 2015 the funding gap is only 2% of the total needs.
The bulk of the funding (secured and probable) is from government of Kenya and GAVI
while WHO, UNICEF and JICA play a big role. Other partners offer programme support and
they include USAID/MCHIP, SABIN, AMP, GSK, Merck vaccine foundation and micronutrient
$-
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
$70.0
2013 2014 2015 2016 2017
M
i
l
l
i
o
n
s
Projection of Future Resource Requirements**
Traditional Vaccines Underused Vaccines
New Vaccines Injection supplies
Personnel Transportation
Other routine recurrent costs Vehicles
Cold chain equipment Other capital equipment
Campaigns
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 67
international make up probable funders. The funding projection s is line with their
historical support to the programme.
Figure 14 and 15 show the financing gaps.
Figure 16: Projection of future financing gap
$0.0
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
$70.0
2013 2014 2015 2016 2017
M
i
l
l
i
o
n
s
Government County Gov.Gov. Co-Financing of GAVI Vaccine GAVIWHO UNICEFJICA USAID/MCHIPCLINTON HEALTH ACCESS INITIATIVE MICRO-NUTRIENT INTERNATIONALMERCK VACCINE FOUNDATION SABIN VACCINE FOUNDATTIONGSK
FUNDING GAP
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 68
Figure 17:Future Secure and probable financing gaps
$0.0
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
$70.0
2013 2014 2015 2016 2017
M
i
l
l
i
o
n
s
Government County Gov.Gov. Co-Financing of GAVI Vaccine GAVIWHO UNICEFJICA USAID/MCHIPCLINTON HEALTH ACCESS INITIATIVE MICRO-NUTRIENT INTERNATIONALMERCK VACCINE FOUNDATION SABIN VACCINE FOUNDATTIONGSK
FUNDING GAP
Formatted: Caption, Don't keep with
next
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 69
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 70
Figure 18: The funding gap and selected indicator
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 71
9 Annexes
9.1 Annex 1: Activity timeline 2011-2015
Key Activities Responsibilities 2011 2012 2013 2014 2015
Conduct monthly defaulter tracing x x x x x
Institutionalize outreach in priority areas
x x x x x
Conduct quarterly review meetings at national, provincial and district levels
x x
x x x
Hold periodic community stakeholders meetings at the health facility
x x
x x x
Conduct monthly data analysis and dissemination meetings at each level
x x
x x x
Conduct quarterly data verification, validation and written feedback
x x x x x
x x x x x
Carry out periodic intensification of routine immunization
x x x x x
Institutionalize outreach in priority areas
x
Implement SIAs for WCBA in high risk areas
x
TT validation x
Institutionalize outreach in priority areas
Conduct quarterly review meetings at national, provincial and district levels
x x x x x
Conduct monthly defaulter tracing x x x x x
Hold quarterly community stakeholders meetings
x x x x x
Conduct monthly data analysis and dissemination meetings at each level
x x x x x
Conduct quarterly data verification, validation and written feedback
x x x x x
Carry out periodic intensification of routine immunization
x x x x x
Institutionalize outreach in priority areas
x x x x x
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 72
Conduct quarterly review meetings at national, provincial and district levels
x x x x x
Conduct monthly defaulter tracing x x x x x
Hold quarterly community stakeholders meetings
x x x x x
Conduct monthly data analysis and dissemination meetings at each level
x x x x x
Conduct quarterly data verification, validation and written feedback
x x x x x
To conduct follow up immunization campaign of high risk population
Constitution and launch of the national steering committee, technical coordinating committee and sub-committees
x
Development of district micro plans
x
Develop a budget and mobilize resources for introduction of measles second dose
x
Lobbying for sustained annual financial increment for co-financing commitment for vaccine procurement
x
Source for technical and financial assistance from partners
x
Conduct EVMA x
Develop a cold chain replacement and expansion plan
x
Distribution of vaccines and other supplies to all levels
x
Development of training materials x
Training of health workers x
Develop, print and distribute communication materials
x
Conduct stakeholders sensitization meetings at all levels
x
National, provincial an district launch
x
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 73
Constitution and launch of the national steering committee, technical coordinating committee and sub-committees
x
Development of district micro plans
x
Develop a budget and mobilize resources for introduction of PCV-10
x
Lobbying for sustained annual financial increment for co-financing commitment for vaccine procurement
x
Source for technical and financial assistance from partners
x
Conduct EVMA x
Develop a cold chain replacement and expansion plan
x
Distribution of vaccines and other supplies to all levels
x
Development of training materials x
Training of health workers x
Develop, print and distribute communication materials
x
Conduct stakeholders sensitization meetings at all levels
x
National, provincial an district launch
x
Conduct PVC10 impact studies x x x x
Conduct AEFI studies x x x x
Constitution and launch of the national steering committee, technical coordinating committee and sub-committees
x
Development of district micro plans
x
Develop a budget and mobilize resources for introduction of rota virus vaccine
x
Lobbying for sustained annual financial increment for co-financing commitment for vaccine procurement
x
Source for technical and financial assistance from partners
x
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 74
x
Develop a cold chain replacement and expansion plan
x
Distribution of vaccines and other supplies to all levels
x
Development of training materials x
Training of health workers x
Develop, print and distribute communication materials
x
Conduct stakeholders sensitization meetings at all levels
x
National, provincial and district launch
x
Revise, print and distribute all data collection tools
x
Monthly review of performance of rotavirus vaccine
x x x
Conduct AEFI study including intussusception
x x x
Development and submission of proposal to GAVI
x
Set up sites x
Document lessons from the study
x x
Plan for national rollout of HPV
x x
Conduct measles follow up SIA x
Conduct preventive polio SIAs in high risk districts
x x
x x
Conduct TT SIAs in high risk districts
x
Conduct risk assessment for MNT x x x x x
Carry out MNT validation exercise
x
Seek approval from child ICC and endorsement from HSCC
x x x
Print and distribute the plan to all stakeholders
x x x
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 75
Carry out stakeholders dissemination meeting
x x x
Hold monthly immunization technical working group meeting
x x
x x x
Develop annual operation plan from cMYP
x x x
Develop district micro-plans x x x x x
Annual update of the cMYP x x x x x
Annual, mid-term and end term evaluation
x
Prepare an economic evaluation brief on immunization
x
Prepare a resource mobilization information package
x
Conduct a meeting with high level stakeholders
x x x x
Sustainability plan for Penta/pneumo and other new vaccines
x x
Broaden ICC membership to include Ministry of finance etc
x
Conduct joint planning and coordination meetings
x x x x x
Conduct joint review of performance
x x x x x
Mapping of immunization stakeholders and potential funding agencies.
x x x x x
Lobby for increased resources for immunization from local stakeholders
x x x x x
Conduct regular consultative meeting with finance and accounts
x x x x x
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 76
Conduct immunization HR gap assessment
x
Disseminate the HR gap analysis report to all stakeholders
x
Lobby deployment of HR to critical areas of need
x x x x x
Lobby for recruitment of critical HR
x x x x x
Print and disseminate Immunization policy and guidelines on vaccine preventable diseases
x
Carry out training needs assessment
x
Revise immunization training materials
x
Carry out phased training incorporating the RED/DQS approach targeting all health workers involved in immunization, especially newly recruited staff
x x x x
Review pre-service training curriculum of middle level medical training colleges and medical schools
x
Conduct transport inventory x
Undertake advocacy of district at national, district and constituency levels
x x
Review progress of success x x
Prepare immunization supervisory plan
x
Carry out monthly immunization data analysis
x x x x x
Undertake quarterly EPI focused support supervision
x x x x x
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 77
Give feedback and feed-forward on the findings of the supervisory visit
x x x x x
Conduct a congenital rubella syndrome baseline survey
x x
To carry out a seroprevalence survey of yellow fever and entomological study in high risk districts
x
To carry out impact of introduction of rota virus vaccine
x x
Undertake joint planning, implementation and M&E
x x x x x
Undertake on job training on data management
x x x x x
Conduct periodic DQS at all levels x x x x x
Conduct monthly data analysis and feedback at all levels
x x x x x
Print and distribute data capture and reporting tools
x x x x x
To undertake EPI coverage survey x
x
Carry out AEFI monitoring x x x x x
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 78
9.2 Annex 2: Annual operational plan 6 (AOP 6) Family Health Department
DIVISION OF VACCINES & IMMUNIZATION – AOP-6 2010/2011
Result Area
Interventions/Activities
Responsible Person Timeframe Estimated
cost
Available Unfund
ed
Q1
Q2
Q3
Q4 Amount Source
1. Policy Formulation and Strategic Planning
Vaccination policy printed and disseminated to stakeholders
Head- DVI X X X X 5,000,000 5,000,000
WHO/GOK
Guidelines on other vaccine preventable diseases produced and disseminated
Quality Control and Commodity Assurance X X X X 6,100,000 6,100,000 WHO 0
2. Security for Public health Commodities
Forecasting of routine emergency and new vaccines and injection equipment completed Logistics X 5,000 5,000 GoK 0
Vaccines and injection equipment procured and distributed Logistics X
664,715,135
664,715,135 GoK
National Cold Chain Inventory conducted Logistics X X X X 30,000,000 30,000,000
UNICEF/GOK 0
Additional cold chain equipment installed Logistics x X X X 20,000,000 20,000,000 GoK 0
Cold chain equipment maintained Logistics X X X X 6,500,000 6,500,000 GoK 0
3. Performance monitoring
Routine immunization data by levels maintained. Data X X X X 50,000 50,000 G.O.K 0
Vaccines monitoring tools procured and distributed
Logistics and Procurement X 32,000,000 32,000,000 GoK 0
Vaccines monthly Physical stock taking Logistics 10,000 10,000 GoK 0
National routine immunization module updated. Data X X X X 500,000 0
GOK GAVI
WHO 500,000
Districts trained on Target setting , Vaccine forecasting and micro-planning for EPI improvements in 60 poor performing Districts
Data, Training, Logistics X X 11,000,000 11,000,000
UNICEF/GOK 0
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 79
Result Area
Interventions/Activities
Responsible Person Timeframe Estimated
cost
Available Unfund
ed
Q1
Q2
Q3
Q4 Amount Source
Integrated tools for vaccines preventable illness developed.
Data and Logistics X X 200,000 200,000 GoK 0
Data quality self assessment to 154 districts conducted.
Data Training, X X 13,000,000 13,000,000
UNICEF 0
4. Capacity strengthening
DVI Quarterly newsletter developed and disseminated Data X X X X 1,000,000 1,000,000 GoK 0
Health workers skills on demand creation enhanced. Advocacy X X 8,450,000 8,450,000 WHO 0
Transport, supplies and communication systems efficient
Administration and Procurement X X X X 2,861,667 2,861,667 GOK 0
DHMTs trained in MLM in Eastern and Central Provinces Training X X X X 5,000,000 5,000,000
MERCK
Vaccine
Network/GO
K 0
Media clips prepared and transmitted Advocacy X X X X 1,700,000 1,700,000
GOK/UNICEF 0
5. Resource Mobilization
Annual Work plan and Budget and Preparation of MTEF prepared Head- DVI X 10,000 10,000 GoK 0
6. Operational research
Batch testing at all levels
Quality Assurance and Commodity Assurance X X X X
2,000,000 0
GOK/WHO
2,000,000
Total X X X X 779,881,802
777,381,802
2,500,000
9.3 Annex 3: Annual work plan 2011/2012, Division of vaccines and immunization
(Aligned to Government of Kenya planning cycle)
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Sep
tem
be
r
Oct
ob
er
No
vem
be
r
De
cem
be
r
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Pa
rtn
ers
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 80
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
De
cem
ber
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Par
tne
rs
Service delivery and Programme Management
1.Conduct outreaches in identified priority areas
High risk district/Health facilities
X
X X X X X X X X X X X
2.Carry out Vitamin A supplementation in all ECD centers
X X X X X X X X X X X X
3.Conduct monthly defaulter tracing
Health facilities with defaulters/unvaccinated children
X X X X X X X X X X X X
4.Conduct quarterly reviews meetings at national, provincial and district levels
All district
X X X X
5.Hold quarterly community stakeholders meetings
Health facility/ community
X X X X X X X X X X X X
6.Conduct monthly data analysis and dissemination meetings at each level
All levels X X X X X X X X X X X
X
Conduct quarterly data verification, validation and written feedback
National/district
X X X X
Carry out periodic intensification of routine immunization
All health facility catchment areas
X X
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 81
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
De
cem
ber
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Par
tne
rs
(Malezi Bora) Conduct regular audits of yellow fever vaccine
4 high risk districts
X X X X X X X X X X X X
Constitution and launch of the national Pneumococcal steering committee, technical coordinating committee and sub-committees
National level-August 2010
Development of district micro plans for pneumococcal vaccines
Districts-October 2010
Develop a budget and mobilize resources for introduction of PCV-10
National-October 2010
Source for technical assistance (Training, Communication and Cold Chain/Logistics) from partners
National-August 2010
Conduct cold chain inventory
All levels-October 2010
Distribution of vaccines and other supplies to all levels
All levels-Oct 2010
Develop PCV-10 training materials
National-August/Sept 2010
Train health All levels-Oct.
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 82
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
De
cem
ber
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Par
tne
rs
workers PCV-10 2010 Develop, print and distribute communication materials for roll out of PCV-10
All-Nov 2010
Conduct stakeholders sensitization meetings at all levels for introduction of PCV-10
All levels-Nov 2010
National, provincial and district launches for PCV-10
Nov 2010
Revise, print and distribute all data collection tools that include PCV-10
All levels Oct-Nov 2010
Pre, process and post introduction monitoring and evaluation
All levels X X X X X X X X X X X X
Conduct catch up campaign in two districts (Bondo and Kilifi)
Conduct AEFI study
Conduct cold chain inventory
Distribution of vaccines and other supplies to all levels
X X X X X X X X X X X X
Conduct preventive polio SIAs in high risk districts
X
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 83
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
De
cem
ber
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Par
tne
rs
Conduct risk assessment for MNT
Sept. 2010
Conduct TT SIAs in high risk districts
High risk districts X
Seek approval from child Health ICC and endorsement from HSCC (cMYP)
National-August 2010
Print and distribute the cMYP plan to all stakeholders
All levels-October 2010
Carry out stakeholders dissemination meeting
November 2010
Hold monthly immunization technical working group meeting
National X X X X X X X X X X X X
Develop annual operation plan from cMYP
National-September 2010
Annual update the cMYP
National X
Annual, mid-term and end term evaluation
Annual X
Prepare an advocacy economic evaluation brief on immunization and present to policy and planning team,
National-September 2010
Develop a costing model for immunization activities and use for advocacy
October 2010-March 2011
X X X
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 84
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
De
cem
ber
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Par
tne
rs
Prepare a resource mobilization information package and present to policy and planning team
National
X
Conduct a meeting with high level stakeholders
X
Conduct regular consultative meeting with finance and accounts
X X
X
X
Develop sustainability plan for Penta/Pneumo and other new vaccines
X X X X X X
Broaden ICC membership to include Ministry of finance etc
National-October 2010
Conduct joint planning and coordination meetings
All levels X X X X X X X X X X X X
Conduct joint review of performance
National/Province/District X
Map immunization stakeholders and potential funding agencies.
All levels-starting with National
X X X X
Lobby for increased resources for immunization from local stakeholders
National-October 2010
X X X X X X X X X X X X
Conduct National level
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 85
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
De
cem
ber
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Par
tne
rs
immunization HR gap assessment
Disseminate the HR gap analysis report to all stakeholders
National level
Lobby deployment of HR to critical areas of need
National level
Lobby for recruitment of critical HR
National level
Carry out training needs assessment
National-October 2010
X
X
X
X
Revise immunization training materials
National level
Carry out training targeting newly recruited health workers and in prioritized districts
Review pre-service training curriculum of middle level medical training colleges and medical schools
Prepare immunization supervisory plan
Carry out monthly immunization data analysis
Undertake quarterly EPI focused support supervision
Give feedback and feed-forward on the
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 86
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
De
cem
ber
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Par
tne
rs
findings of the supervisory visit
Conduct a congenital rubella syndrome baseline survey
To carry out a sero-prevalence survey of yellow fever and entomological study in high risk districts
To undertake impact study of pneumococcal vaccine introduction
To carry out impact of introduction of rota virus vaccine introduction
Select high impact interventions HII at the districts
Develop of operation of high impact intervention
Undertake joint planning, implementation and M&E
Undertake on job training on data management
Conduct periodic DQS at all levels
Conduct monthly data analysis and feedback at all
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 87
Act
ivit
ies
Consolidated
and Integra
ted activiti
es
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
De
cem
ber
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it r
esp
on
sib
le
Co
st$
Funds availabl
e
Sh
ort
fall
Go
ve
rnm
en
t.
Par
tne
rs
levels Print and distribute data capture and reporting tools
To undertake EPI coverage survey
Carry out AEFI monitoring
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 88
Activities W
her
e
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
ve
mb
er
Dec
emb
er
Jan
uar
y
Feb
rua
ry
Mar
ch
Ap
ril
May
Jun
e
Un
it
Co
st$
Advocacy and communication
Do a KAP survey to identify barriers for effective communication
Develop the advocacy and communication plan
Dissemination of the plan
Prepare communication messages for specific target audience
Monitor the implementation of plan
Activities
Wh
ere
July
Au
gu
st
Sep
tem
be
r
Oct
ob
er
No
vem
be
r
De
cem
be
r
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
Un
it
Co
st$
Surveillance
Undertake quarterly surveillance review meetings at all levels
Carry out risk assessment/analysis
Carry out on job training during support supervision at all levels
Training of newly
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 89
recruited health workers and the new DHMTs
Scale up IDSR roll out
Production IEC Stocking of polio and measles lab reagents and equipments
Print and distribute data capture tools
Conduct monthly data harmonization meeting
Timely submission of surveillance data
Activities
Wh
ere
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
vem
be
r
Dec
emb
er
Jan
uar
y
Feb
rua
ry
Mar
ch
Ap
ril
May
Jun
e
Un
it
Co
st$
Vaccine supply, quality and Logistics
88.Conduct comprehensive cold chain assessment at all levels
89.Develop and implement a cold chain maintenance plan
90.Develop a cold chain replacement plan at national level
91.Procure cold chain equipments
92.Lobby for funding from GOK and partners
93.Conduct accurate vaccine forecasting at
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 90
national and district levels to ensure uninterrupted supply of vaccines
94.Develop a procurement plan
95.Develop a quarterly distribution plan in line with shipment plan
96.Provide adequate and well functioning transportation system to all districts
97.Lobby for adequate finances for vaccines and other supplies through high level advocacy
98.Ring fencing funds for vaccines and other supplies
99.Procure vaccines on time
100. Fasten clearance of vaccines after arrival in the country
101. Install stock management tool at all level
102.Decentralize vaccine distribution mechanism to improve vaccine availability at the lower level
103. Train logisticians and health workers on vaccine handling
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 91
and storage at all levels
104.Improve bundling of vaccines and diluents
105. Monitor vaccine wastage at all levels
106. Develop communication system to improve reporting of wastage
107.Disseminate health care waste management guideline to all levels
108.Train newly recruited health care workers on health care waste disposal
109.Construct at least one incinerator in each district
110.Construct at least a waste disposal pit in each health facility
111.Conduct accurate forecasting for AD syringes and safety boxes at all levels
112.Develop a procurement plan
113.Develop a quarterly distribution plan in line with shipment plan
114.Provide adequate and well functioning transportation system to all
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 92
districts
115.Lobby for adequate finances through high level advocacy
116.Ring fence funds
117.Procure AD syringes and safety boxes on time
118.Fasten clearance of vaccines after arrival in the country
119.Install stock management tool at all level
120.Decentralize distribution mechanism
121.Train logisticians and health workers at all levels
122.Implement AD bundling policy with every vaccine in every district
123.Improve district reporting on AD use
124.Train the providers on safe injection practices
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 93
9.4 Annex 4: Using GIVS framework as a checklist
GIVS strategies
Key activities Activity included in MYP
Strategic Area One: Protecting more people in a changing world Y N Not
Applicable
New activity needed
Strategy 1: Commit and plan to reach everyone
Strengthen human resources and financial planning
x
Protect persons outside the infant age group x
Improve data analysis and problem solving x
Sustain high vaccination coverage where it has been achieved
X
Include supplemental immunization activities
x
Strategy 2: Stimulate community demand for immunization
Assess the existing communication gaps in reaching all communities
x
Engage community members and non-governmental organizations
x
Develop communication and social mobilization plan
x
Match the demand X
Strategy 3: Reinforce efforts to reach the unreached in every district
Micro-planning at the district or local level to reach the unreached
X
Reduce drop-outs X
Strengthen the managerial skills X
Timely funding, logistic support and supplies
X
Strategy 4: Enhance injection and immunization safety
Procure vaccines from sources that meet internationally recognized quality standards
X
Ensure safe storage and transport of biological products under prescribed conditions
X
Introduce, sustain and monitor safe injection practices
X
Establish surveillance and response to adverse events following immunization
X
Strategy 5: Strengthen and sustain cold chain and logistics
Conducting accurate demand forecasting activities
X
Building capacity for stock management X
Kenya DVI Comprehensive Multi-Year Plan 2013-2017 94
GIVS strategies
Key activities Activity included in MYP
Strategic Area One: Protecting more people in a changing world Y N Not
Applicable
New activity needed
Effective planning and monitoring of cold chain storage capacity
X
Firm management system of transportation and communication equipment
x
Strategy 6: Learn from experience
Regular immunization programme reviews X
Operations research and evaluation X
Model disease and economic burden as well as the impact
X