Project Design Document 2010-2015

Project Design Document 2010-2015
KENYA
AID
PROJECT DESIGN DOCUMENT 2010-2015
|www.kenyaaid.org |
Kenya Aid
Project Design Document 2010=2015
Table of contents
1. Introduction
2. Background and Needs Analysis
3. Demographic Profile of Target Population
4. Log Framework of Proposal
5. Literature Review
6. Plan of Action
7. Monitoring and Evaluation Framework
8. Risk Evaluation
9. References
10. Appendix
1. Introduction
Kenya Aid is an Australian not for profit organisation which through funding and operational
support provides essential health services to rural communities in Western Kenya. Our focus
is on preventative health measures, maternal and child health, primary health care and
health education.
Kenya Aid works in partnership with a local non-government organisation, MURUDEF. This
partnership ensures that there is a local and culturally sensitive framework around all the
projects that we run. Kenya Aid also works closely with the Kenyan Ministry of Health with
the aim to providing services that are responsive to the needs of local and central
government. Kenya Aid fully recognises that a close working partnership with the Kenyan
Ministry of Health is essential in creating sustainable change and advocating on behalf of
the community is a crosscutting theme through all of our programs.
It is important to recognise that prior to Kenya Aid’s presence in Western Province there
was no existing health care facilities or services for the population in Shikunga village. This
presents a number of unique challenges for Kenya Aid to identify and overcome. These
include a lack of existing health knowledge in the communities, a degree of distrust of
western medicine and reliance on traditional approaches and poor health infrastructure. It
is also important to note the remoteness of the region in which Kenya Aid is working in,
which creates additional challenges in access and service delivery.
The comparative advantages of Kenya Aid’s service delivery strategy for the Shikunga region
include:
-
-
-
A close relationship between the Kenya Aid Board and its partner organisation
MURUDEF; a well-established and highly successful locally based NGO owned and
operated by domestic staff;
Relevant expertise of the Kenya Aid Board, which includes 3 medical doctors with
significant experience in delivering health care services in Kenya and Africa more
generally; and
Kenya Aids minimal administrative cost policy which ensures that any costs not
directly related to purchasing labour or capital goods for the Shikunga community
hospital are to the greatest extent absorbed by board members.
Some of the goals Kenya Aid was able to achieve during its last project design time frame
2007-2009 include;
-
Construction and opening of the Shikunga Hospital;
Immunisation program
-
Creation and scaling up of HIV testing and prevention of mother to child
transmission (PMTCT) of HIV program; and
- Sanitary Health and Reproductive Education (SHARE) program
2. Background and Needs Analysis
Through its indigenous partners, Kenya Aid hopes to be able to deliver health care services
in a sustainable manner that is both in accordance with the priorities of the Government of
Kenya and meets the health care requirements of the people. For this to occur it is
important that the organisation have a firm understanding of the health care situation in
Kenya and of the existing Kenyan health care system.
Located in East Africa, Kenya is a low income, developing country with a population of 32
million1. 50% of Kenya’s population are under 15 years of age, and 75-80% live in rural
areas1 To address these issues the Kenyan Ministry of Health (MoH) implemented the Kenya
Health Policy framework (KHPF) in 1994, setting policy agenda to the year 2010 2. To
operationalise the KHPF Paper, the National Health Sector Strategic Plan (NHSSP) was
created to assist in decentralising health care delivery. Following this, the NHSSP II (20052010) was developed to address poverty reduction and reinvigorate the KHPF 3. The latest
health sector policy is Kenya Vision 2030 which focuses on sustained economic growth,
equitable social development and an accountable, democratic political system 4.
Over the last 2 decades, Kenya has seen a plateau or decline in many key health and
development indicators. Health in Kenya is characterised by a large burden of
communicable disease which results in significant economic and social burden 5. 75% of
deaths in children under 5 are attributable to HIV/AIDS, diarrhoeal disease, pneumonia and
malaria6. Available data shows the incidence of infectious disease is increasing, Tuberculosis
has tripled since 1990 from 112 cases per 100,000 population to 353 in 2007, life
expectancy has declined from 59 years in 1990 to 54 in 2007 and under 5 mortality has risen
each year from 1990 to 20077. Malaria is the leading cause of morbidity and mortality
accounting for 30% of outpatient visits8. These indicators suggest that over the last decade
Kenya has suffered considerable declines in the health of its population.
Figure 1. Key socio-development and health indicators for Kenya. Source Wamai 2009 3.
Kenya adopted the MDG's in 2000 as part of the Millennium declaration and since then the
Kenyan government has mainstreamed them into the country’s development framework
requiring all ministries to have MDG units1. Stumbling blocks to the achievement of the
MDG’s include poor economic growth, debt burden and decreasing overseas development
assistance (ODA) 1. From the data that is available, Kenya’s progress could best be described
as mixed. In order to have a chance of achieving the MDG’s by 2015 increasing attention to
child health, including communicable disease and education, is key as almost half of the
population is under 15 years of age9.
Kenya has recently implemented a new development strategy covering 2008 to 2030, Kenya
Vision 2030, which builds upon the Economic Recovery Strategy for Wealth and Employment
Creation which saw GDP growth from 0.6% in 2003 to 6.1% in 20064.
Kenya Vision 2030 has two approaches, firstly decentralization of resources and
management of health centres to the community and district medical officers and secondly
shifting emphasis from curative to preventative care4.
Kenya Aid has designed its programs to address the specific health issues that face rural
communities in Kenya. This includes non-existent health infrastructure, lack of basic health
knowledge, high levels of communicable disease and extreme poverty. This document seeks
to build on the work that was achieved from Kenya Aids last project design document 20072009. During this time frame Kenya Aid was able to accomplish much of what was set out in
this document and is now looking to build on this success into the future.
3. Demographic Profile of Target Population
Ikolomani division is one of 7 administrative divisions in Kakamega district in Kenya’s
Western province. Its population in 2001 was 92,104 with a population density of 142.9
people per square kilometre10. There are 14 health facilities within the division which are
limited in regards to the services offered with only one providing HIV testing and only three
offering services for the PMTCT both of which are offered at the Shikunga hospital11.
Ikolomani division is a remote and rural region of Kenya. It is characterised by high levels of
communicable disease, minimal access to health care and high levels of poverty 10. The main
source of income in the division is agriculture, with a high level of subsistence farming.
This project will be implemented across Ikolomani division. It will target all community
members with focus on those most vulnerable and susceptible to disease such as children,
women and HIV patients.
Figure 2. Ikolomani Division, Kakamega District. (Sourced from
http://www.marsgroupkenya.org/constituencies/?constID=50&task=about&page=3)
4. Log Framework
4.1 Program Goal
The goal of this program is to improve the quality and access to health care in Ikolomani
division, Kakamega district, Western Province, Kenya.
4.2 Purpose of the Project
The purpose of the project is to increase the number of patients seen across the board
through all programs supported by Kenya Aid by 15 0%, increase the number of health
programs available by 50% and increase the proportion of people seeking medical attention
when ill by 25% over the next 5 years.
4.3 Project Objectives
4.3.1 Objective 1
To increase the number of people accessing Kenya Aid supported health services in
Shikunga Village, Kenya, so that there is a 150% increase in people attending outpatient
services and a 200% in the number of inpatient services over the next 5 years.
4.3.2 Objective 2
To improve the health knowledge and education in the Village of Shikunga, Kenya by a 2 fold
increase in the attendance of community outreach education sessions over the next 5 years.
4.3.3 Objective 3
To highlight the importance of women’s and children’s health through the creation of
specific programs that address their health needs and increasing the number of women
accessing antenatal care and delivering their children at a Kenya Aid supported health
facility by 3 fold over the next 5 years.
4.3.4 Objective 4
To reduce the high levels of preventable communicable disease through increasing
vaccination rates 4 fold, increase insecticide treated net (ITN) distribution by 2 fold and
creating disease specific programs to address malaria and HIV/AIDS over the next 5 years.
5. Literature Review
The goal of this program is to reduce the burden of disease in Ikolomani division, Western
Province, Kenya. This high level of disease burden is due to many factors including limited
access to health care, lack of health knowledge and education in the target population, a
poor focus on the most vulnerable members of the community - namely women and
children - and also the presence of high levels of communicable disease. Strategies designed
to address any of the above factors will have positive outcomes on reducing disease burden.
A thread common to each of the strategies identified above is that they are all dependant
on the accessibility of health services, an issue which will be addressed in this document.
5.1 Increased access to health services
Kenya Aid has funded the construction of a rural hospital in the village of Shikunga in
Ikolomani division, Western Kenya. This is the only non-government facility in the Western
Province of Kenya and was our first step in increasing access to health care for rural
communities.
5.1.1 Reducing or abolishing user fees for health services
In remote and rural areas any cost associated with accessing health care can act as a
barrier12. In Western Kenya households often have small and irregular incomes resulting
from small scale sale of agricultural goods13, resulting in difficulties in paying for health
related costs as they arise.
A study in 2005 by James et al also highlights the burden that costs associated with health
care can place on communities in 20 African countries including Kenya. The study found that
the elimination of user fees could prevent approximately 233 000 deaths in children under 5
annually.
5.1.2 Providing outreach health care
As 80% of the Kenyan population live in rural areas15 and the cost of transportation is often
prohibitively expensive, home based care is an attractive alternative to facility based care in
remote places. 30% of women in Kenya’s western province take at least 1 hour to reach a
health facility13.
Home based care has been shown to be cost effective and to improve outcomes in a variety
of patient populations including HIV/AIDS16, maternal mortality and in reducing neonatal
deaths17, 18.
5.1.3 Improving health care infrastructure
Rural communities in Western Kenya have very poor health care infrastructure. Improving
health infrastructure in developing countries was identified as a priority during the WHO
Jakarta Conference19. One of the main contributors to mortality is the inability to refer and
transport patients that require a higher level of care. The importance of timely referral has
repeatedly been shown to reduce mortality and is a cornerstone of the Integrated
Management of Childhood Illness (IMCI)20 which has been a widely accepted model of care
throughout the developing world.
Transport with an ambulance is the most common way to move patients that have been
referred to other facilities. Currently there is no ambulance in the Kakamega South Subdistrict in which Ikolomani district resides. This serves as a large obstacle to patient care and
demonstrates the lack of current health infrastructure.
5.1.5 Improving working relationship with Kenya Ministry of Health
Kenya Aid fully recognises the limitations it has in service delivery and in its ability to affect
health infrastructure in Kenya, this is largely the role of local and national government.
Advocacy by NGO’s has served as a major influence to government policy and health
strategies over the last 20 years21 and can result in improved outcomes for rural
communities.
5.2
Improved health knowledge and education
5.2.1 Community based education programs
Education is the key to lasting behavior change. Providing community based, relevant health
education has been shown to be effective in reducing disease prevalence such as malaria22
and HIV23. Health care messages are even more important in remote regions of western
Kenya such as Shikunga village due to their isolation and limited previous exposure to even
the most basic public health principles and practices.
5.2.2 School based health education
Health education has been proven to have positive impacts on health outcomes. School
based education programs are one of the most effective and timely ways to deliver these
health messages24, 25.
5.3 Focus on women’s and children’s health
5.3.1 Women’s and children’s health programs
Women and children are particularly vulnerable to disease in developing countries and
therefore shoulder much of the burden of disease26. Because of this an approach that
encourages women’s and children’s attendance to health services and focuses on their
specific health needs will improve health outcomes.
Additionally, integrated interventions that address women and children’s health in a
continuity of care model have been shown to be most effective improving health
outcomes27.
5.3.2 Women’s community health groups
Women play a vital role in health promotion in developing countries and should receive
more recognition from policy makers and institutions28. In the communities of Ikolomani
district there are few avenues for women to raise health concerns and limited support
available in the antenatal period and for new mothers.
5.4 Reducing high levels of preventable communicable disease
5.4.1 Improved delivery of primary health care services
The World Health Organisations world health report 2007, stated that the delivery of
primary health care is an essential prerequisite for health 29. As is the case in Kenya as a
whole, Ikolomani district in western province has very low levels of primary health care
service provision and this contributes to a high level of disease burden30.
Key to ensuring the sustainable delivery of primary health care is reliable staffing for
medical facilities.
Creating disease specific health programs will help to combat some of the largest causes of
mortality in Ikolomani district such as HIV and malaria30.
5.4.2 Emphasis on preventative health care
Preventative approaches to health care have obvious advantages when combined with
adequate curative services, and their importance in primary health care has been
recognised since the Alma Ata declaration31. Preventative programs providing vaccinations,
mosquito nets, health screening, antenatal care and education are low cost and effective in
preventing disease32, 33.
5.4.3 Improved health promotion
Community mobilisation and use of community health workers in health promotion have
been shown to be successful and cost effective in reducing mortality of children and
mothers34. In rural areas where the population is spread over large distances, the use of
community health workers to identify sick patients and deliver health messages is crucial in
reducing burden of disease.
6. Plan of Action
Purpose
Goal
6.1 Program Theory and Logic
Table 1
Project Description
Performance
Indicators
The goal of this program is to
improve the quality and access
to health care in Ikolomani
division, Kakamega district,
Western Province, Kenya.
-Number of patients
accessing health services
- Number of health
programs available
- Higher proportion of
population
seeking
medical attention when
ill
-Comparison of baseline
data
from
hospital
records.
The purpose of the project is to
increase the number of patients
seen across the board through all
programs supported by Kenya Aid
by 150%, increase the number of
health programs available by 50%
and increase the proportion of
people seeking medical attention
when ill by 25% over the next 5
years.
Means of Verification
Assumptions
-Audit of health records
to determine service
delivery
- Number of health
programs created
- Survey of patients
attending hospital
-Accuracy of health
records
- A greater range of
health programs will
improve health overall
- Hospital records
-Baseline community
survey’s assessing patient
behavior when sick
-Endline community
survey assessing patient
behavior when sick
-Audit of Kenya Aid’s
programs at baseline and
at project completion
-Data from hospital is
accurate
-Community
participation
-Support from staff in
health facility
-Increasing the number
of available health
programs will result in
healthier population
-Compare number of
people
accessing
outpatient services at
baseline and at end of
project
-Compare number of
inpatients
at
the
hospital at baseline and
at project completion
-Hospital records of
outpatient numbers
- Hospital records of
inpatient numbers
-Accuracy of hospital
records
- Increased number of
patients seen will result
in improved health
outcomes
-Compare number of
people attending
community health
education sessions at
baseline and at
project completion
-Records of attendance
of community health
sessions
-Education provided is
culturally sensitive
and appropriate
-Increased health
knowledge will affect
behaviour change
-Accuracy of records
-Comparison of baseline
community survey of
patient attendance to
hospital when ill to
community survey at
project completion
Objectives-1
- Comparison of baseline
number
of
health
programs available to
number available at
project completion
To increase the number of people
accessing Kenya Aid supported
health services in Shikunga
Village, Kenya, so that there is a
150% increase in people
attending outpatient services and
a 200% increase in the number of
Objectives 2
inpatients over the next 5 years.
To improve the health knowledge
and education in the Village of
Shikunga, Kenya by a 2 fold
increase in the attendance of
community outreach education
sessions over the next 5 years.
Objectives 3
Objectives 4
Outputs 1
To highlight the importance of
women’s and children’s health
through the creation of specific
programs that address their
health needs and increasing the
number of women accessing
antenatal care and delivering
their children at a Kenya Aid
supported health facility by 3 fold
over the next 5 years.
-Compare number of
health programs
designed for women and
children at baseline and
at project completion
-Compare number of
women accessing
antenatal care at
baseline and at project
completion
-Compare number of
deliveries at the
Shikunga hospital at
baseline and at project
completion
-Audit of Kenya Aid’s
programs designed for
women’s and children’s
health at baseline and at
project completion
-Hospital records of
antenatal attendance
-Hospital records of
number of deliveries
To reduce the high levels of
mortality in Shikunga through
access to primary health care
with focus on preventable,
communicable disease.
Increasing vaccination rates 4 fold
and creating disease specific
programs to address malaria and
HIV/AIDS over the next 5 years.
-Compare number of
children vaccinated at
baseline and at
project completion
-Creation of disease
specific programs to
address malaria and
HIV/AID
-Hospital vaccination
records
--Audit of Kenya Aid’s
Increase the number of people
accessing Kenya Aid supported
health services
1.1 Community Awareness
Increase community awareness of
the Shikunga hospital through
flyer distribution and public
announcements
-Number of flyers
distributed
-Number of public
announcements
-Advertising flyers
-Transcripts of public
announcements
-Awareness of health
facility will lead to
usage
-People will trust new
health facility
1.2 Reduction of user fees
-Compare user fees
per visit per patient at
baseline and at
project completion
-Hospital financial
records
-Hospital patient
records
-Alternative means of
funds can be sourced
-Able to convince local
health services to
abandon charging fees
to patients
-Willingness of local
health facilities to
disclose financial
information
-Creation of outreach
health care program
-Audit of Kenya Aid’s
programs at baseline
and at project
completion
- Sick and remote
patients will be able
to be reliably
identified
-Mobile outreach
service will be
Over the next 5 years user fees will
have been reduced by at least 25%
1.3 Outreach health care
Creation of outreach health care
program to allow remote or
immobile patients to access
health care
-Accuracy of hospital
records
-Women accessing
antenatal care will be
able to access referral
centres if problems
are found
- Increased number of
women and children
specific programs will
result in improved
health outcomes
programs at baseline and
at project completion
- Creation of specific
malaria and HIV/AIDS
programs will result in
improved health
outcomes
-Accuracy of vaccination
data
effective
-Finding funds for
additional health staff
-Number of referral s
made from the
Shikunga hospital
-Audit of hospital records
to identify the number of
referrals made and
transported to referral
centers
-Referral centres will
have capacity to care for
additional patient load
-Financial resources to
pay for transportation
-Appropriate medical
records are kept by local
health facilities
-Patients will be willing
to be moved to a facility
further from their family
1.5 Working with Kenyan
Ministry of Health
Foster close working relationship
with district ministry of health
-Biannual reports of
activities to district
minister of health
-Yearly meeting with
district minister of
health
-Copies of
correspondence with
ministry of health
-Minutes from meetings
-Scheduling will allow
meeting to occur
Improve community health
knowledge and education
2.1 Community and school based
education seminars
Perform community education
session at local schools quarterly
over the next 5 years
-Number and
frequency of health
talks at local schools
-Review hospital
records of school
health education talks
-Schools will be happy
to allow education
sessions
-Staff will be happy to
travel and talk at
schools
-Children will be
receptive to health
messages
2.2 Increased number of people
attending community education
seminars
A 2 fold increase in the
attendance of community
outreach education sessions over
the next 5 years
-Number of people
attending community
health education
sessions
-Review of hospital
attendance records
from community
education talks
-People have
time/transport to
attend seminars
-Appropriate material
used in seminars for
audience
-Increased health
knowledge will affect
behaviour change
Highlight the importance of
women’s and children’s health
3.1 Women’s and children’s
health programs
Creation of specific women’s and
children health programs in a
continuity of care model
-Creation of specific
women’s and
children’s health
programs
-Audit of Kenya Aid’s
programs at baseline
and at project
completion
-Programs specific for
women’s and
children’s health will
have improved health
outcomes
-Funds can be raised
to run additional
programs
1.4 Improving health care
infrastructure and referral
systems
Outputs 3
Outputs 2
A strengthened referral system
between Shikunga hospital and
secondary/tertiary hospitals over the
next 5 years
Outputs 4
3.2 Women’s community health
groups
Creation of women’s community
health groups to raise and discuss
women’s health issues
-Creation of women’s
community health
groups
-Audit of Kenya Aid’s
programs at baseline
and at project
completion
-Avenues for women’s
health issues to be
raised will improve
overall health
outcomes
-Funds can be raised
to run additional
programs
Reduce the high levels of
preventable communicable
disease
4.1 Improved delivery of primary
health care services
Sustainable delivery of primary
health care through retaining
staff for a minimum of 12months,
creating and sustaining laboratory
services and a reliable supply of
medication
-Length of staff
employment
-Hospital
administration records
of beginning of staff
employment to end of
contract
-Funds available to
increase staff wages
- Staff happy to live
and work in rural
community
4.2 Disease specific programs
Creation of disease specific health
programs eg malaria and HIV
-Creation of disease
specific health
programs
-Audit of Kenya Aid’s
programs at baseline
and at project
completion
-Disease specific
programs will improve
health outcomes
-Funds can be raised
to run additional
programs
4.3 Emphasis on preventative
care
Scaling up of vaccination 4 fold
and ITN delivery 2 fold
-Number of mosquito
nets distributed
-Number of
vaccinations provided
-Hospital register of
number of mosquito
nets distributed
-Hospital register of
number of vaccinations
provided
-Accuracy of hospital
records
-People using nets in
correct manner
-Parents willing to
vaccinate their
children
4.4 Improved health promotion
Community health workers
identifying sick people and
delivering health messages
-Number of trained
community health
care workers
-Audit of records at
baseline and project
completion to
determine number of
community health
workers
- Sick and remote
patients will be able
to be reliably
identified
-Mobile outreach
service will be
effective
-Finding funds for
additional health staff
Project Description
Inputs
Means of
Verification
Assumptions
Activities 1
1.1 Community awareness
1.1.1Distribute 500 flyers
promoting the hospitals opening
1.1.2 Public announcements of
hospital services
1.1.1 Stationary,
1.1.1 Copies of flyers
distributed
1.1.2 n/a
-Awareness messages
will result in greater
attendance to
hospital
-Literate population
1.2 Reduction of user fees
1.2.1 Create small scale agriculture
1.2.1Project officer,
land, seeds, community
volunteer to look after
land and sell produce
1.2.1 Amount of money
raised from selling
produce at market
-People will attend
hospital if user charges
are removed
-Hospital administration
willing to reduce or
abolish fees
-Volunteer participation
1.3.1 Project manager,
project officer, willing
community members,
funds,
1.3.2 Stationary,
photocopier, funds,
project officer
1.3.3 Funding, nursing
staff
1.3.1 Register of
community workers,
report of number of
homes visited etc
1.3.2 Copies of posters
distributed
1.3.3 Contractual
agreements with nursing
staff
-Community members
willing to identify and
report people requiring
care
-Community members
willing to let CHW into
their homes
-Availability of funds
-Posters will not be
removed
-Nursing staff willing to
work in remote area
1.4 Improving health care
infrastructure and referral
systems
1.4.1 Purchase an ambulance to
transport critically unwell patients
to referral centers
1.4.2 Audit local health facilities
to identify number of referral
made to higher level facilities in
the previous calendar year and
repeat annually
1.4.3 Develop referral guidelines
outlining the referral process and
for what clinical scenarios
patients should be referred
1,4,1 Funding for
vehicle
1.4.2 Project officer,
stationary
1.4.3 Project officer,
medical staff,
stationary,
photocopier
1.4.1 Receipt from
purchase from van
1.4.2 Report from audit
of hospital
1.4.3 Copy of referral
guidelines
-Guidelines will be
adhered to
-Funds available for
ambulance
-Referral facilities will
be able to accept
additional patients
1.5 Working with Kenyan
Ministry of Health
1.5.1 Hold annual meeting of
Kenya Aid board members with
district minister of health
1.5.2 Quarterly correspondence
with district ministry of health
2.1 Community and school based
education seminars
2.1.1 Run second monthly talks by
hospital staff at schools in the
local area
2.1.2 Community seminars to be
1.5.1 Staff, stationary
1.5.2 Stationary
1.5.1 Copy of minutes
from meeting
1.5.2 Copy of quarterly
correspondence
2.1.1 Hospital staff,
material for talks,
transport
2.1.2 Hospital staff,
material for talks,
transport, chairs
2.1.1 Attendance
numbers at talks,
records of number of
schools visited
2.1.2 Records of
-Ministry of health
has time to hold
meeting
-Ministry of health is
in the position to
support Kenya Aid
programs
-Health messages in
talks will translate
into behaviour
change
-Schools will be happy
project to raise alternative revenue to
subsidise patient costs
1.3 Outreach Health care
Activities 2
1.3.1 Organise 5 community health
workers to identify people requiring
health services in Ikolomani division
1.3.2 Develop and distribute 100
posters alerting public of home care
services
1.3.3 Provide funding for 1 outreach
nurse
photocopier, funds,
project officer
1.1.2 Loudspeaker,
vehicle, project officer
Activities 3
held at the hospital or in the
community held at least 5 times
weekly
number of seminars
held, attendance
numbers at talks
to allow hospital staff
to talk to students
-People form
community will
attend seminars
2.2 Increased number of people
attending community education
seminars
2.2.1 Provide lunches at
community seminars
2.2.2 Run community health
seminars to be held in
surrounding villages as well as
Shikunga
2.2.1 Staff, food,
cooking facilities,
funding
2.2.2 Staff, transport,
chairs
2.2.1 Receipts for food
purchased for use at
seminars
2.2.2 Register of places
where community
health education
sessions are held
-People will attend
seminars and listen to
health messages if
food is provided
-People from other
communities would
be willing to attend
talks
-Health messages in
talks will translate
into behaviour
change
3.1 Women’s and children’s
health programs
3.1.1 Develop specific programs
aimed at addressing women’s
health issues. In particular
reproductive health such as
antenatal care, menstrual hygiene
(SHARE) and obstetric care
3.1.2 Develop specific programs
aimed at addressing children’s
health issues. In particular
preventable disease such as
malaria, vaccination and
improving access to primary care
by providing free medical care to
all children under 5 who have
been born at the Shikunga
hospital
3.1.1 Program coordinator, funding,
appropriately
qualified staff,
laboratory services
(blood grouping, HIV
testing etc), sterile
equipment for
childbirth, fabric,
medications, sewing
machine
3.1.2 Program coordinator, staff,
reliable supply of
vaccinations, reliable
supply of
medications, funding,
3.1.1 Patients records
of number women
attending antenatal
classes, number of
deliveries at the
hospital, number of
fabric pads sewn
3.1.2 Hospital records
of number of cases of
malaria treated,
number of vaccinations
provided, percentage
of patients under 5
years of age
-Programs specific to
women’s or children’s
health will result in
improved outcomes
for these groups
-Sustainable funding
able to be found
-Sustainable supply of
medication and
vaccinations can be
sourced
-Communities
receptive to the idea
of antenatal care,
vaccination, obstetric
care
-Reliable source of
funding
3.2 Women’s community health
groups
3.2.1 Create Safe Mother’s Group
composed of mothers that have
delivered at the Shikunga
hospital. To deliver positive
health messages and function as a
forum for women’s issues to be
raised. Group to meet weekly.
3.2.2 Provide lunch at the
meetings to encourage
participation and ensure nutrition
to new mothers
3.2.1 Group coordinator, chairs,
program co-ordinator
3.2.2 Staff, food,
cooking facilities,
funding
3.2.1 Records of
attendance of group
3.2.2 Receipts for food
purchased for use at
seminars
-Women able to find
time to attend
meetings
Activities 4
4.1 Improved delivery of primary
health care services
4.1.1 Prevent high turnover of
hospital staff by ensuring wages
are similar to that in government
institutions
4.1.2 Create laboratory service at
the hospital
4.1.3 Ensure a reliable supply of
essential medication to the
hospital
4.1.1 Funding,
contractual
agreements with staff
4.1.2 Laboratory
equipment, funding
for laboratory
technician, electricity
4.1.3 Funding for
medication, transport,
reliable medication
supplier
4.1.1 Hospital contracts
with staff
4.1.2 Hospital records
of number of
laboratory tests
performed, contract
with laboratory
technician
4.1.3 Receipts of
medications bought
-Retaining staff for
longer periods will
result in improved
service delivery and
patient satisfaction
-Reliable electricity
supply
-Reliable source of
funding
-People will seek
medical attention
when sick
4.2 Disease specific programs
4.2.1 Create specific program to
address malaria. Consisting of
education, distribution of
mosquito nets, prompt diagnosis
and treatment and IPT
4.2.2 Create specific program to
address HIV/AID. Consisting of
HIV testing, HIV support groups,
PMTCT and ARV program,
4.2.1 Funding, staff,
program co-ordinator,
educational material,
ITNs, anti-malarial
medication,
laboratory equipment
to perform thick and
thin films
4.2.2 funding, staff,
HIV tests, HIV coordinator, ARV
medication, place to
dispense ARVs,
4.2.1 Number of
malaria education
seminars held, number
of ITNs distributed,
number of cases of
malarial treated,
number of pregnant
women receiving IPT
4.2.2 Number of HOV
tests performed,
record of attendance of
HIV support group,
number of women
receiving PMTCT
treatment and register
of number of patients
accessing ARV program
-Programs specific to
diseases will have a
positive health
outcome
-Reliable source of
funding
-People willing and
able to take
medication correctly
and reliably
-People willing to get
tested for HIV
-People will use nets
correctly
-People will seek
medical attention
when sick
-Reliable source of
ARVs
4.3 Emphasis on preventative
care
4.3.1 Distribute ITN free to
children under 5 and pregnant
women. At the hospital and
during community seminars
4.3.2 Provide vaccinations free to
children at the hospital and
fortnightly hold outreach
vaccination camps in surrounding
villages
4.3.1 Reliable supplier
of ITN, funds, storage
area for nets, staff
4.3.2 staff, transport,
refrigerator, cool box,
funds, government
store of vaccinations,
program co-ordinator
4.3.1 Number of ITN
distributed
4,3,2 Number of
vaccines provided
-ITNs will be used
correctly
-Families willing to
have their children
vaccinated
- Reliable source of
funding
-Reliable electricity
source
4.4 Improved health promotion
4.4.1 Train 10 community health
workers in identifying sick
patients, delivering health
messages and preventative health
4.4.1 Program coordinator, funds,
educational material,
government supplied
teaching staff,
4.4.1 Record of
community health
workers trained
- Community health
workers will be able
to attend training
seminars
-Community
members will accept
care
transport
health workers into
their home
-Trainees will feel
comfortable after
training to provide
health messages and
advice on
preventative health
care
-Availability of funds
7. Monitoring and Evaluation Framework
The OECD (2002:21-27) defines monitoring and evaluation (M&E) as follows35:
Monitoring is a continuous function that uses the systematic collection of data on specified
indicators to provide management and the main stakeholders of an ongoing development
intervention with indications of the extent of progress and achievement of objectives and
progress in the use of allocated funds.
Evaluation is the systematic and objective assessment of an ongoing or completed project,
program, or policy, including its design, implementation, and results. The aim is to
determine the relevance and fulfilment of objectives, development efficiency, effectiveness,
impact, and sustainability. An evaluation should provide information that is credible and
useful, enabling the incorporation of lessons learned into the decision making process of
both recipients and donors.
Delivering on each of these requirements must also be balanced with the human resource
constraints faced by Kenya Aid and the volunteer nature of its Australia-based staff. As such,
the M&E Framework of Kenya Aid is designed to ensure that the organization remains
outcome-focused with appropriate feedback mechanisms whilst not placing excessive
reporting burdens on either the hospital staff in Kenya or the program staff based in
Australia. This has resulted in an M&E Strategy which capitalizes on the ordinary on-goings
of the organization as well as the introduction of some additional and more formal feedback
mechanisms.
The Monitoring and Evaluation Framework for Kenya Aid is based on 4 key actions, each of
which varies in its degree of formality. Each of these actions are linked to the list of activities
generated in the LogFrame. This approach is summarized in Table 2.
Firstly, is the Annual M&E Mission to be carried out by a number of members from the
Kenya Aid Board to Shikunga. This mission will provide the basis for a number of important
annual assessment and feedback sessions. This will include meetings with Kenyan Ministry
of Health (MOH) officials, local government officers, representatives from the medical
supplies provider based in Kakamega, hospital staff, as well as board members from
MURUDEF. Each of these meetings will provide the opportunity for Kenya Aid partners to
disclose any issues that have arisen as a result of our operations over the preceding year or
any issues which they perceive may arise in the upcoming period. The members of the
Kenya Aid team that are present on the M&E trip will be responsible for the recording of
these conversations and in consultation with the other Kenya Aid Board members be
responsible for compiling a list of activities to address each of the concerns raised during the
consultations. If appropriate, the annual M&E mission will also provide the Kenya Aid board
with the opportunity to assess the capabilities of the hospital staff and to provide them with
some informal training and information sessions.
Secondly, is the on-going informal contact with the MURUDEF program co-ordinator as per
the Memorandum of Understanding which was signed in 2006 (Appendix 1). This more
frequent (generally weekly) contact with the MURUDEF representative will provide the basis
for reporting on the performance of hospital staff, number of patients treated and other
relevant numbers, as well as any minor capital or inventory upgrades which the hospital
facility may need in the coming weeks to months. As part of this correspondence the
MURUDEF program co-ordinator will send summarised monthly reports outlining detailed
information of the hospital activity during the previous month and a detailed financial
summary.
The introduction of Point of Delivery (PoD) patient feedback cards at the clinic will also act
as a key mechanism for the Monitoring and Evaluation strategy. These cards are given to
patients before receiving treatment at the hospital and require the patient to provide
information on basic demographic and epidemiological data. It is Kenya Aid’s aim to have
these feedback cards be completed by at least 10 patients per month. Over time these
reports will enable the hospital to better respond to the needs of the community through
more accurate inventory supplying as well as staffing levels.
This reporting mechanism has been designed to be both simplistic (quick and easy to fill in)
as well as culturally appropriate – with cards being translated into Kiswahili. This will help
ensure that this reporting mechanism does not provide an excessive time or emotional
burden on either the hospital staff or the patient. Although Kenya Aid notes that all care
must still be taken in maintaining flexibility to individual circumstances and their desire to
give out personnel information. In practice, this will be left to the discretion of the locally
employed hospital staff that have a greater degree of knowledge of cultural norms and
acceptable conduct.
The principal method of delivering formal feedback of each of these activities throughout
the year will be the preparation and dissemination of the Kenya Aid Annual Report. As per
the organizations constitution (attached in Appendix 2), this report will comprise a financial
breakdown of all of the organizations financial activities as well as a summary of the findings
of the annual audit statement to be prepared by the accountant.
Table 2: Summary of Kenya Aid Monitoring and Evaluation
Strategy
Annual
Report
1. M&E Trip
and Annual
Consultations
2. Informal Contact
with MURUDEF
program coordinator
3. PoD
Feedback
Cards
4. Annual
Financial
Audit
1.1. Consultation with
Local Kenyan Health
Ministry Officials
1.2. Consultation with
Local Kenyan Medical
Supplies Provider
1.3. Consultation with
Clinic Staff
1.4. Consultation with
MURUDEF Partners
8. Risk Evaluation
Kenya Aid’s risk evaluation framework is consistent with the strategies outlined in AusAIDs
AusGuide Risk Management Guidelines36. Kenya Aid defines risk as the chance of things
happening that could have an impact on Kenya Aid, on the outcomes it achieves, or on the
objectives of the various functions it undertakes. Risk arises out of uncertainty. When
deciding on a course of action to deal with the risks facing the organisation, Kenya Aid
considers that there are two elements of risk to be considered.
They are:
- the likelihood of something desirable or undesirable happening and,
- the likely consequences if any one or all of the things that could happen do
eventuate.
Risks can arise from both internal and external sources. They could include:
- adverse change in economic factors such as exchange rates;
- incorrect assumptions regarding activity logic or sustainability considerations;
- client dissatisfaction or unfavorable publicity;
- a threat to physical safety or breach of security;
- mismanagement;
-
failure of equipment;
a breach of legal or contractual responsibility; and
fraud and deficiencies in financial controls and reporting.
These risks vary in their probability and their impact and those which Kenya Aid has greatest
exposure to are listed in Table 3 below. Each Risk is listed in terms of its likelihood and the
danger is poses to the ability of Kenya Aid to deliver on each of its objectives. Each risk has
also been accompanied with the Risk Management Strategy that has been identified in
order to neutralize or minimize the threat posed by each eventuality.
Table 3: Risk Assessment Matrix for Kenya Aid 2007-2009
1
Assumption/Risk
Risk Level
Impact
Project Actions
High turnover of hospital
staff
Low
High
Unreliable power supply
Medium
Medium
-Increase salary to at least
match that in
government facilities
-Provide staff housing
Purchase generator
Overextending MURUDEF
management capabilities –
compromise quality of
projects
Low
Medium
Lack of medical knowledge of
local community
Low
Low
Lack of knowledge and
contact with on the ground
operations
Low
High
Security risk of existing clinic
Low
High
Ensuring an impartial an
objective M&E team
Medium
Medium
2
3
4
5
6
7
-Utilize a risk
management process to
prioritize current and
future projects.
- Additional training for
MURUDEF co-ordinator
-Incorporate community
education into projects
-Hold community health
education seminars
-Integrate programs with
MURUDEF
-Receive regular reports
on the operations of the
clinic
-Collect baseline data on
local health conditions
-Provide night time
security guard on hospital
premises
-Meetings with MOH
officials that have
registered and reviewed
hospital practices
- Field trips by Kenya Aid
clinic staff to other health
centers operating within
western province
References
1. MDG’s Status Report For Kenya 2005, United Nations Development Program, Government of
Kenya, Government of Finland, 2005
2. Wamai, Richard G 2009, 'The Kenya Health System- Analysis of the situation and enduring
challenges’, Japan Medical Association Journal, Vol. 52, No. 2, pp.134-140.
3. Glenngard, Anna H, Maina, Thomas M 2007, ‘Reversing the trend of weak policy
implementation in the Kenyan health sector? – a study of budget allocation and spending of
health resources versus set priorities’, Health Research Policy and Systems, Vol. 5, no. 3, pp.
1-9
4. Kenya Vision 2030; The Popular Version, The National Economic and Social Council of Kenya,
2007
5. Sachs J, Malaney P 2002, ‘The economic and social burden of malaria’, Nature, Vol 415, pp.
680-685
6. Country Health System Fact Sheet Kenya 2006, World Health Organisation
7. United Nations Millennium Development Goals Indicators, 2009, viewed August 27 2011,
<http://mdgs.un.org/unsd/mdg/>.
8. Country Cooperation Strategy; At a glance, World Health Organisation 2009
9. United Nations Development Assistance Framework (UNDAF); Kenya 2004-2008, United
Nations Kenya Country Team, 2003
10. Kakamega: District Strategic Plan 2005-2010, National coordinating agency for population
and development, Government of Kenya, 2005
11. Annex 1, Service Availability Mapping Kenya, World Health Organisation, 2004
12. Zupan J 2005, Perinatal Mortality in Developing Countries, New England Journal of Medicine,
352;20 pp 2047-2048
13. Safe Motherhood Demonstration Project Western Province: Approaches to providing quality
maternal care in Kenya, Ministry of Health, 2004
14. James et al 2005, Impact on child mortality of removing user fees: simulation model, BMJ,
331, pp747-749
15. Kenya Human Development Report 2001; Addressing Social and Economic Disparities, 2001,
United Nations Development Programme, Nairobi, Kenya
16. Johnson B A, Khanna S K 2004, Home-Based Care Programs For HIV Clients, Journal of the
National Medical Association, Vol 96, pp 496-502
17. Home and Community-Based Health Care for Mothers and Newborns, United States Agency
for International Development (UNAIDS), 2006
18. Haines et al 2007, Achieving child survival goals: potential contribution of community health
workers, The Lancet, Vol 360, Issue 9579 pg 2121-2131
19. Milestones in Health Promotion, Statements from Global Conferences WHO 2009 pg 8 and
20
20. Patwari AK and Raina N 2002, Integrated Management of Childhood Illness (IMCI) : A robust
strategy, Indian Journal of Pediatrics, Vol 69, Number 1, pg 41-48
21. RG Wamai 2000, NGO and public health systems: Comparative trends in transforming health
care systems in Kenya and Finland, International Society for Third Sector Research
22. Kroeger et al 1996, Health education for community-based malaria control: an intervention
study in Ecuador, Colombia and Nicaragua, Tropical Medicine and International Health, Vol
1, Issue 6, pg 836-846
23. Ngugi et al 1988, PREVENTION OF TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS
IN AFRICA: EFFECTIVENESS OF CONDOM PROMOTION AND HEALTH EDUCATION AMONG
PROSTITUTES, The Lancet, Vol 332, Issue 8616, pg 887-890
24. O’Reilly et al 2006, The impact of a school based water and hygiene programme on
knowledge and practices of students and their parents: Nyanza Province, Western Kenya.
Epidemiology and Infection, Vol 135, Issue 01, pg 80-91
25. Gallant M and Maticka-Tyndale E 2004, School-based HIV prevention programmes for
African youth. Social Science and Medicine, Vol 59, Issue 7, pg 1337-1351
26. Bhutta, et al 2008, Interventions to address maternal, newborn, and child survival: what
difference can integrated primary health care strategies make? The Lancet, Vol 372, Issue
9642, pg 972-989
27. Ekman B 2008, Integrating health interventions for women, newborn babies, and children: a
framework for action. The Lancet, Vol 372, Issue 9642, pg 990-1000
28. Milestones in Health Promotion; Statements from Global Conferences, WHO 2009, pg 8 and
20
29. The World Health Report 2007. A safer future. Global public health security in the 21st
century. WHO 2007
30. Kenya National Bureau of Statistics (KNBS) and ICF Macro. 2010. Kenya Demographic and
HealthSurvey 2008-09. Calverton, Maryland
31. Hall J and Taylor R 2003, Health for all beyond 2000: the demise of the Alma-Ata Declaration
and primary health care in developing countries. MJA, Vol 178, pg 17-20
32. Bryce et al 2005, Can the world afford to save the lives of 6 million children each year? The
Lancet, Vol 365, Issue 9478, pg 2193
33. Cowgill et al 2006, Effectiveness of Haemophilus influenzaeType b Conjugate Vaccine;
Introduction Into Routine Childhood Immunization in Kenya. JAMA, Vol 296, pg 671-678
34. Rosato et al 2008, Community participation: lessons for maternal, newborn, and child
health. The Lancet, Vol 372, Issue 9642, pg 962-971
35. Glossary of Key Terms in Evaluation and Results-Based Management. OECD 2002
36. AusGUIDE: Principles of Activity Design, Commonwealth of Australia, Canberra. AusAID 2005
Appendix
Appendix 1.
MOU
Appendix 2.
Kenya Aid Constitution
Was this manual useful for you? yes no
Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Related manuals

Download PDF

advertisement