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Access to Health Services and Infrastructure

The County has 170 health facilities ranging from level 2 to 6. Most of the facilities are concentrated within Eldoret Municipality but whose catchment extends upto Uganda, Rwanda and South Sudan. At the apex of the health system is the Moi Teaching and Referral hospital. Whereas the number of existing facilities is quite appreciable they are not sufficient to service the wide catchment area including the health needs of the County itself.

The ideal situation would be for each Sub County to have a level 4 facility and several level 3 and 2 facilities. The aim would be to decongest the Moi Teaching and Referral facility especially of diseases that could be handled by lower level facilities. More facilities would be required to provide access to health services for populations living in rural areas with limited access due to bad roads and long distance away from existing health facilities. The average distance to a health facility in the County is 7 Kms which is higher than the target of 5 Kms. Table 4 below provides a summary of the current number of health facilities in the County.

Commodity Supplies & Management

Kenya Medical Supplies Agency (KEMSA) is responsible for the procurement, distribution and proper use of medicines and medical supplies in the public health facilities. However, the greatest challenge in UGC relates to the shortage of essential medicine and non-pharmaceuticals due to supply chain management. As a result patients are forced to purchase over the counter drugs, leading to risk of drug resistance due to under/over-dosage.

There is need to improve service delivery by KEMSA to eliminate shortage of drugs in the health facilities. It might be useful to consider local tendering for supply of some proportion of medical needs. All health facilities should use the „Pull‟ system in ordering medical supplies to avoid shortages and at the same time avoid having dead stocks. The system should constantly provide an update of stocks of medical and non-medical dispensed as well as estimate of remaining stock. This is necessary in order to avoid constant drug stock-outs reported in most of the facilities.

Reproductive and Child Health

Reproductive health services focus on safe motherhood, including antenatal, safe delivery, and postnatal care, especially breastfeeding, infant health and women‟s health. The aim of the service is to reduce cases of infant and maternal mortality. The main issue relating to reproductive and child health care in Uasin Gishu County is that not all the public health facilities established offer reproductive health services. Moreover, those that offer the services are overstretched; and staff has inadequate skills and knowledge on safe motherhood. An underlying factor is the low community involvement and participation in public health activities.

There are a number of institutions that complement the Government‟s efforts in providing reproductive health services in the County. These include the National Aids Control Council (NACC), National Council for Population and Development (NCPD) that deals with advocacy for reproductive health services, Non-governmental Organizations (NGO) such as Family Planning Association of Kenya (FPAK), Faith Based Organizations and private health facilities. In view of the increased need for reproductive health care, more non-state providers need to be encouraged to participate in providing services.

Child Mortality Rates

Child mortality is a major problem in the County. The neonatal mortality rate is high at 52/1000; the infant mortality rate at 48/1000 while the under 5 mortality rate is 59/1000. A reduction in child mortality rates can be addressed effectively through improved management of childhood illnessesThe diseases responsible for the high mortality rate in children under 5 are: malaria, pneumonia, diarrhea, malnutrition and measles. These same diseases are prevalent in Uasin Gishu County; but could be addressed through primary health care interventions. The Kenya Demographic and Health Survey, 2008/2009 shows that the death rate at 74/1000 is way above the national target of 32/1000 deaths. The achieved mortality rate of 48/1000 in 2012 is also higher than the national average.

Immunization Coverage

The County has immunization coverage of 79% for children less than 5 years. This is way below the County target level of 98% coverage. Efforts to increase coverage for children less than one year will require doubling considering that the County coverage for this category is only 35%. Urgent action is needed in light of the fact that the County has a high infant mortality rate of 48/1000 most of whom die from immunizable diseases.

Access to Family Planning Services

The population growth rate in the County is 3.8% which is high compared to the national population growth rate of 2.8%. Family Planning services are available in Uasin Gishu County in government and private health facilities. Family Planning prevents up to one third of maternal deaths by helping women avoid „risky births‟. However, contraceptive acceptance is low standing at only 34% compared to national average of 46%. The County will need to emerge with strategies to scale up the acceptance rate.

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