Snapshot

Estimated annual deaths, neonatal: 32,991

Estimated annual deaths, infant: 50,272

Estimated annual deaths, up to 5 years: 64,411

Geographic Scope: 47 counties

Targeted facilities: 52CRHs, 362SCHs, 109 HCs (High volume facilities)

(Source: KDHS, 2022)

*KDHS under 5 mortality trends

**Hypoxemia and non-hypoxemia case fatality rates as reported for patients admitted to hospitals in South West Nigeria in Graham, 2019

The Problem:

Over 70% of children die as a result of preventable and treatable conditions. Oxygen is critical in the management of top drivers of child mortality & morbidity such as neonatal causes, which contribute to 51% of deaths in children under the age of 5 years in Kenya. Despite the notable decline in under 5 mortality from 52/1,000 live births in 2014 to 41/1,000 live births in 2022, neonatal mortality has stagnated and remains a critical area of concern. In Kenya, over ~23,000 of neonates die as a result of prematurity, birth asphyxia and neonatal sepsis, which are both preventable and treatable conditions. Children with these conditions have up to a 7-fold greater risk of dying if they have hypoxaemia, or low blood oxygen levels.

Oxygen therapy is the only treatment for hypoxaemia. Reliable oxygen services are crucial for every health facility that cares for sick children and newborns.

*Hypoxaemia baseline assessment data-18 counties

Goal:

To accelerate the reduction of child morbidity & mortality attributed to hypoxemia-related causes through:

1.      Early screening and identification of hypoxaemia

2.      Timely provision of emergency interventions

3.      Access to quality oxygen, accessories and supplies for the management of hypoxaemia

4.      Strengthening of data systems

 Summary of gaps and Intervention through the patient journey

Service Delivery

Objective: Early screening and identification

Gaps:

• Of the 82% of caregivers who seek care when the child has a respiratory infection, majority will go to the closest facility when the child is at an advanced stage. As such, emergency interventions are critical in all levels of care.
• Pulse oximetry reading is key in timely identification of hypoxaemia. Pulse oximetry practice and documentation of oxygen saturation is still low among health care workers. At OPD, only 18% of children get screened for oxygen saturation and 25% of the readings recorded in MOH registers.
• The capacity of health care workers in providing timely assessment and emergency care [ETAT] remains a critical gap due to low numbers of health care workers trained at pre-& in-service. The lack of a structured mentorship package hinders effective application of critical skills.
• Inadequate referral mechanisms results in delayed management. This contributes to preventable deaths.
• The documentation and monitoring practice of patients on oxygen is suboptimal across all levels of care.

Intervention:

• Strengthen the awareness of danger signs and timely care-seeking through health talks and respective counseling touch points with caregivers
• Establish a newborn core team comprised of ETAT & IMNCI TOTs, KPFP graduates and county focal persons to intensify mentorship, CMEs and OJTs roll out, dissemination of technical guidance and activation of newborn mortality audits
• Support the incorporation of relevant BME modules, ETAT & oxygen trainings as part of pre-service curriculum & ensure effective roll out
• Develop and disseminate minimum ambulance checklist and sensitize counties on timely & effective pre-referral and referral mechanisms
• Establish linkages with the lab and clinical teams to support comprehensive assessment and informed early admission care by ensuring timely investigation and follow up care
• Integrate IPC measures as part of quality of care trainings, support supervision and mentorship
• Disseminate cohort specific checklist of supplies and equipment to strengthen effective management of severely sick children
• Disseminate oxygen administration algorithm and other key protocols through ETAT champions & county TOTs.

Access To Appropriate Drugs & Supplies

Objective:Availability of quality oxygen and diagnostics

Gaps:

• The coverage of oxygen at lower level facilities remains low, which affects timely management and pre-referral care for servery sick children.
• Poorly maintained oxygen sources, such as concentrators, are still widely used especially in sub county hospitals with inpatient departments.
• Regular planned preventive maintenance (PPM) of medical equipment remains a gap due to capacity issues and the lack of spare parts.
• Poor oxygen infrastructural systems such as poor-quality piping or incomplete piping to key units limits the coverage of oxygen in key departments within the facility. 
• The unavailability of cohort specific (paediatric & newborn) administration devices such as nasal prongs, non-rebreather masks and flowmeters compromises on quality of care and infection prevention measures due to sharing/re-use of key supplies.
• Lack of standardized oxygen accessories in the country has contributed to incompatibility issues at point of care, thus affecting the delivery of oxygen.
• There are currently no guidelines on production, delivery, storage of medical oxygen in Kenya.
• Majority of outpatient departments and ambulances lack fully equipped emergency trays that are key in handling emergencies

Intervention:

• County engagements to increase investments in oxygen, diagnostics and spare parts for PPM
• Roll out and disseminate policy guidelines on production, delivery and handling of medical oxygen
• Work with KEMSA to procure cohort specific oxygen administration supplies for peadiatric and newborn patients at affordable cost
• Support immediate standardization of oxygen accessories and delivery devices through DHPT
• Coordinate donor support especially in ensuring quality and effective roll out of new technologies/equipment in public health facilities e.g. CPAP machines
• Engage BMEs & DHPT team to review/develop/disseminate Essential Equipment List by level of care, which incorporates pulse oximeters and key oxygen equipment

Data Systems

Objective:Strengthening data systems

Gaps:

• The absence of key oxygen indicators in paediatric and newborn registers makes it difficult for health facilities to monitor oxygen utilization and patient management. The existing MOH tools with oxygen indicators are poorly documented.
• Lack of oxygen tracking and consumption tools in public health facilities is a major gap 
• Poor roll out of mortality audits for the pediatrics and newborn cohort. Mortality audits are critical in strengthening timely course correction and the adoption of local solutions in ending preventable deaths.
• There is suboptimal reporting of oxygen indicators in DHIS. This remains a critical area of focus.

Intervention:

• Support the development and roll out of pediatrics IPD register and inclusion of hypoxaemia assessment and management indicators
• Work with DHPT team to include oxygen management system in existing data tools and strengthen overall tracking of oxygen availability across all levels of care 
• Leverage on existing forums to sensitize & promote the reporting of oxygen indicators in DHIS through rigorous DRMs
• Roll out and scale up neonatal mortality audit tools
• Support regular support supervision through structured facility assessments & share findings with counties to help in tailoring interventions
• Continually track and monitor key program indicators through existing platforms e.g. DHIS

Health Financing

Objective:Sustainable Engagement

Gaps:

•  The lack of effective forecasting, measurement, and visibility on oxygen need in counties contributes to low supply of oxygen and other emergency drugs.
• There is need to strengthen active engagement of DHPT in coordinating county and stakeholder engagement and investments.

Intervention:

• Leverage on existing oxygen investments in increasing oxygen coverage, network (piping) and overall infrastructure in facilities.
• Enhance the utilization of existing financial initiatives such as Linda Mama, NHIF and FIF
• Support ongoing county planning mechanisms e.g. CIDP to prioritize resource allocation towards the availability of quality oxygen especially in lower level facilities