FIELD ATTACHMENT REPORT HELD AT KIJAURI SUB-COUNTY HOSPITAL

NYAMIRA COUNTY FROM 17TH MAY TO 20TH AUGUST 2024.

PREPARED BY: OBARE OSEBE RISPER

COURSE: COMMUNITY HEALTH ASSISTANT

FACILITY: KIJAURI SUB-COUNTY HOSPITAL

COLLEGE NO: CCHM23/0152

THE KISII NATIONAL POLYTECHNIC

DEPARTMENT OF HEALTH SCIENCES

ATTACHMENT REPORT HELD AT KIJAURI SUB-COUNTY HOSPITAL IN PARTIAL

FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF CERTIFICATE IN
COMMUNITY HEALTH AND DEVELOPMENT FROM 17TH MAY 2024 TO 20TH
AUGUST 2024.

BY: OBARE OSEBE RISPER REG NO: CCHM23/0152

SIGN…………………………………………… DATE……………………

FIELD SUPERVISOR: MR. SAMUEL OSORO

SIGN…………………….. DATE………………………….. STAMP…………………..

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Declaration
I declare that this report is my original work, completed during my attachment. The information
presented in these documents has been obtained and prepared in accordance with academic rules as
outlined in the log book.

Acknowledgement
I would like to express my gratitude to all those who, in one way or another, contributed to and
supported me throughout my attachment. Special thanks go to the Kijauri Sub-County Health
Facility and its staff for their unwavering support during my time at Kijauri.

Dedication
I dedicate this report to the entire Kijauri Sub-County Hospital Department, under the leadership of
Mr. Samuel Osoro, for providing a valuable experience during my attachment. I also extend my
heartfelt gratitude to my loving parents for their unwavering moral and financial support throughout
this journey. Their encouragement was instrumental in helping me achieve my objectives.

Abstract
The purpose of this report is to provide the details of an institution of attachment on distribution of
all activities undertaken during the attachment lessons rant and challenges during the attachment.
The essence of the attachment was to put all the theoretical work done in class practical experience.

Abbreviations
PMTCT -Prevention of mother to child transmission
ANC-Antenatal care
CHU-Community health unit
CHEW-community health extension worker
BMI-Body mass index
MUAC-Mid upper arm circumference
FP-Family planning

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Table of Content
Declaration
Acknowledgements
Dedication
Abstract
Chapter 1
Introduction
Background information
Demography of Kijauri Sub-county
Social economic
Socioeconomic
Social culture
Objective mission vision and the core values of the organization
Chapter 2
Structure and the daily reality of the community health barrier
Health education and promotion
Major roles
Community reporting tools
Chapter 3
Community dialogue
Family planning
Monitoring and evaluation
Community nutrition
Antenatal clinics
Comprehensive care clinics
Comprehensive care Clinic
Chapter 4
Immunization
Immunization
Reproductive health
Common issue in the community

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Maternal health issue
Child health problem
Epidemiological issue
Health statistics and health indicators
Chapter 5
Factors that promote learning
Experience achievements
Challenges faced
Conclusion
Recommendation

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1.0 Introduction
1.1 Background information
Dates 17th to 25th May. My week to experience I continued with my different appointment and also
meeting with various program officers of this sub-county health management. I also got a chance to
attend one of the sub account health management team monthly meetings where various health
indicators in different departments were discussed.
Kijauri Sub-county hospital Facility located in Kijauri, Nyamira County, Kenya established to address
the local population .The hospital plays a crucial role in providing medical services and improving
health get outcome in the region. This Health Center was officially opened by Mr. Maurice S.M
Makhamu district commissioner Kisii on 29th October 1984.

1.2 Demographic Information

Nyamira is one of the 47 counties in Kenya it has Sub counties namely; Borabu and North Mogirango.

Baraboo Sub County has a population of 17,000 according to 2019 national census. Kajauri subcounty
hospital covers an area of 2 acres. It is a border to Bomet County. It has wards namely Nyasiongo and
Rigoma ward.

1.3 Social economic

The main economic activity is farming and cattle keeping. Christianity is the major religion followed by
Muslim.

1.4 Social Culture

Majority of the population is Kisii and Kajenjins.

1.5 Objectives

 Providing accessible and affordable health care services to resident of the sub county regardless
of their socio economic background.
 Promoting the is resident.
 Conducts preventive health programs.
 Ensuring that residents have access to essential health care services and facilities.

1.5 Mission

To provide accessible affordable and quality to preventive, promote, curative and rehabilitative
services in an effective and efficient manner.

1.5 Vision

To be a center of Excellency in provision of health care services in Nyamira County.

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1.5 Goal

To contribute towards the reduction of the health inequalities and improving health impacts and
outcome indicators.

1.5 Core values of Kajauri Sub-County Hospital

 Integrity
 Professionalism
 Teamwork
 Meritocracy
 Partnership

1.5 Departmental and services offered

 Outpatient services
 MCH
 Consultant clinic
 Laboratory
 Pharmacy
 Maternity
 Comprehensive care clinic
 In -patient

Structure and delivery of community health services

I learned the key component that commonly involved in the delivery of this these services

Health assessment: The first step in delivering community health services is to assess the specific
health needs of the community

Health education and promotion: Once the health needs have been identified community health
workers and educators can work to raise awareness and promote charity behavior among the
community members.

Preventive care: Community heritage services often focus on profiting the spread of diseases and
promoting overall health and well-being.

Care managerial support services: Any community had its services it’s also involved providing care
management and support services to help community members navigate the health care system and
access the resources they need to manage their healthy conditions

Health education and the promotion

I learnt on the key components of health education which are;

Need assessment; Conducting a thorough assessment to understand the specific health needs and
priorities of target population.

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Clear objective: establishing clear and measurable objectives for health education program which also
divine a program aims to achieve.

Evidence based information: Providing accurate and up-to-date evidence passed information on
health topics.

Cultural sensitivity: recognizing and respecting the cultural beliefs practice and value of the target
population.

Community involvement: engaging community members and stakeholders in the planning,

implementation and evaluation of health education programs.

Engagement strategies: employing engaging and interactive teaching methods to capture the
audience attention and facilitate learning.

Major roles

Health promotion offices

Roles

 Develop health materials

 Creating awareness in relationship to health
 Research on community attitude and behavior that affect health
 Initiate plan implement and monitor health promotion programs
 Coordinate communication aspect of Primary Health care
 Organize exhibition and shows
 Create demands for services

Public health offices

Roles

 Ensure proper sanitation

 Conduct school health programs
 Public health law and enforcing
 Communicate Disease Control
 Ensure access to save water to the people
 Ensure management of public health
 Participate in evaluation and supports supervision

Disease surveillance coordinator

 Provide Technical Support and pro-act study community health workers

 Assist in data management and report writing
 Provide supervision as surveillance Technical Support
 Coordinate and collaborate with the team members
 Conduct field visits as needed

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HIV program coordinators

Roles

 Assist with the planning and the coordination of activities within the sub county.
 Monitor environmental action of programs policies and practices.
 Coordinate program communication.
 Schedule and organize program related meetings
 Writing reports and presents to the county.
 Coordinate interaction between staff and programs stakeholders.

Reproductive health coordinator

Roles

 Gives verbal autopsy after death.

 Referral strategy.
 Train to train others.
 Working with the community vocal persons to reduce maternal and prenatal deaths.

Sub -county quality coordinator

Roles

 Carrying out supervision to Harris centers and dispensaries.

 Provide education and training about quality management and networks.
 Participate in quality improvement meeting and specialty training sessions.

Community dialogue

Community dialogue is a collaborative and inclusive process where members of the community come
together to discuss share idea and address various issues and concerns.

Community dialogue can address a wide range of topics including social issues , environmental
concerns, health and Wellness education and community development

I also learned that of community dialogue include;

a) Planning and preparation

b) Setting the stage
c) Presenting perspectives
d) Identity the common ground
e) Brainstorming solutions
f) Action planning

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Family planning

I was taken through the various family planning methods and the side effect some of the family
planning methods include;

 Reduction of unwanted pregnancies

 Had it been individual to get desired number of children they want
 Help couples have family they can Manage

Monitoring and evaluation

Monthly report reviews by the CHVs and CHA during this time I was able to take the CHVs on how to
test for Malaria and how to dispense the drugs.

They were also taught how to make referral of severe cases to health facility

Community reporting tools

I also learned tools used by the community health worker which include MOH 100 MOH 513 MOH 515
MOH 518 and MOH 516 which is chalkboard that is updated monthly.

MOH 100- Referral term

MOH 513 -Household register

MOH 514 -Service delivery

MOH 515- Monthly summary

Community nutrition

Under nutrition I did dietary for clients to access food intake and analyze whether it is apparent that or
not and tell them on what to increase in their diet and one of the lower for better health

I also thought matters of the importance of breastfeeding and the importance of inclusive
breastfeeding of their puppies for six months without introducing any food or fluid

I also did anthropometric measurement for children both weight and ranked to check on growth
monitoring cases such as kwashiorkor marasmus and odema

Antenatal clinics

I visited some various departments where in ANC I ensured all expectant mothers. Visited all the ANC
visits that should any complication arise they should visit hospital for immediate treatment or checkup
trust all expectant mothers visits all the end see visits that should any complication arise

Provided with them treated mosquito nets for malaria prevention and a IFRS for iron supplementation.

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 I provided Harris education to our ANC mothers on the importance of eating green vegetables, liver for
iron supplementation and also taking maintained well balanced diet and the nutritious diet for the
health of mother and that of the foetus.

Provision of insurance and “Linda Mama” to all ANC mothers in ensuring bill payment and treatment
during pregnancy and delivery.

Comprehensive care clinics

I learned about the documentation of prop to patient for data entry;

 Prep is administered to persons who are HIV negative.

 This is common in corpus either married or not married where one member is HIV positive and
the other one is HIV negative.
 Prep is taken before they've exposure their daily bills for the HIV negative individuals to
prevent HIV.
 Most effective when used with condoms and other preventive measures.
 It can only be up to 99 percent effective against HIV.

Immunization

Immunization services include vaccination schedule vaccination clinics public health campaigns school
and community past vaccination travel vaccination and vaccination records.

Types of vaccines include;

 Live activated vaccine which include MCASTER mumps, rubella vaccine and polio vaccine
 Inactivated a killed vaccine which includes polio vaccine and the hepatitis vaccine
 Sub unit recombined or conjugate vaccine such as hepatitis b vaccine
 Toxoid vaccine such as tetanus and diphtheria vaccines
 Messenger RNA (MRNA) vaccine such as the OPV, Covid 19 MRNA vaccine
 Recombinant vector vaccine such as the Ebola Vaccine

Reproductive health

Reproductive health refers to overall wellbeing of an individual reproductive system including their
ability to reproduce, prevent pregnancy and access the information.

 Also I learn steps of reproductive health.

 Education and awareness
 Access to contraceptive
 Prenatal and postnatal care
 Maternal and child health
 Access to safe and legal abortion services

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Common issues in the community

a) Maternal health issue

I learnt various maternal health such as

Early pregnancy

Young girls conceive when they are not ready to have children hence they don’t take good care of their
children and this may lead to some illness for their young babies such as malnutrition because they are
not exclusively breastfeed and they don’t take foods rich in nutrients which boost their immunity.

b) Child health issue

Child health to various medical development and social concern that can affect the health and wellbeing
of a child. Some common child health issue include

a) Nutrition deficiencies
b) Infectious disease

Epidemiological Issues.

Epidemiology is the study of distribution and the determinant of diseases in population, as well as the
applications of this knowledge to Prevent and control the diseases.

Epidemiology plays a crucial role in understanding and managing both communicable and non-
communicable diseases.

a) Communicable diseases. Vaccination, hand hygiene, respiratory hygiene Such as covering

your nose and mouth when you cough or sneeze. Safe food handling. Vector control such as use
of Nets and insect repellent, Safe sex, quarantine And isolation. And public health. Measures
such as social distancing and mask wearing, healthy education, immunization.
b) Non communicable Diseases: headed diet regular physical activity tobacco and alcohol
control stress management practices like mass screening health body weight chronic disease
management.

Disease surveillance

The disease surveillance is the ongoing and systematic data collection analysis and interpretation and
dissemination of data reflecting the current health status of a community or population for action

 How to investigate a disease outbreak

 To verify diagnosis and confirm outbreak
 Define a case and conduct case finding
 Tabulate and orientate the data
 Take immediate control measure
 Plan and execute additional studies
 Implement and evaluate control measure communicate findings

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Health statistic health indicators

Health Statistics and indicators at the subaccount level profiled valuable insights into the heritage
status and healthcare needs of the local population. this statistics are essential for public health
planning resource allocation and monitoring heath trends here are some common heritage statistics
and indicators collected and analyzed at the sub county level.

1. Mortality rate
Crude death rate
Age specific death rate
2. birth rate
Crude birth rate
Total fertility
3. Life expectancy
4. loading cause of death
5. Infectious disease incidents
6. Chronic disease incidence
7. Maternal and child health indicators
8. Access to healthcare services
9. Mental health indicators
10. Vaccination coverage

Common causes of morbidity and mortality can vary by region population and the time. However
several leading causes are consistently significant contributors to both morbidity and mortality
worldwide they include;

Morbidity; Non communicable diseases, infectious diseases, mental health diseases, injuries, maternal
and child health issues, respiratory disease.

Mortality: cardiovascular disease, cancer, infectious disease, respiratory disease, lowers respiratory
infections diabetes and neurological disorder.

Factors promoting learning

 Clear communication
 Ongoing support
 Patient education
 Cultural sensitivity
 Involving family members

Experience achievements

During our sub county community health experience I got to learn different aspects of management
that encompasses quality healthcare delivery.

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I also got to:

 Learn different management styles in the working environment.

 Process of stocking vaccines and the drugs and preventing under stocking
 Learn different levels of health care within the sub county.
 Process of support supervision and it is importance.
 Learn on the beneficial core dependence between different sectors water and health.

Challenges faced

 Financial constraints
 Lack of enough drugs supply in the hospital for dispensing to clients

Conclusion

In conclusion in my attachment at Kijauri Sub- County Hospital level 4 Was a valuable experience that
exposed me to various facts of health care delivery. When did the investigation exhibits numerous
strengths addressing the identified areas for improvement can contribute to even better patient care
and staff Satisfaction.

Recommendation

 CHVs to be motivated since they play mature role in the community by giving them a token.
 Develop strong and active customer care desk with contacts to ensure customer satisfaction
that should also act as practice form in which patient can air their grievances.
 Develop community initiative that promote preventive health practices and collaborate with
local organizations to increase outreach.

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