County Organizational Capacity Assessment Report

The assessment aimed to establish a baseline for health systems performance, develop specific systems strengthening interventions, and conduct measurement of systems strengthening over time. The OCA process was facilitated by Afya Ziwani and involved county staff systematically evaluating essential county health system elements in a structured manner. The OCA approach used by Afya Ziwani is to facilitate counties to conduct a self-assessment framed around the USAID developed county OCA tool. The tool outlines eight key capacity domains of health systems: governance and legislative framework, service delivery, human resources for health, health infrastructure, health products and technologies, health information, health financing, and research and development. Each domain is further divided into standard elements that encompass critical issues identified as essential for capacity to be sufficient. During the OCA, participants assessed the capacity of the health system in their respective counties and subcounties by reviewing the standard elements under each domain, discussing existing practice and evidence, and gaining consensus on the appropriate score for each assessed standard and domain. The scores were then aggregated as an overall score, which measures the capacity of the health system. The scores for individual domains and overall capacity are presented in a dashboard using traffic lights as per the OCA Likert scale. The county has seven subcounties: Kisumu East, Kisumu West, Kisumu Central, Nyando, Seme, Nyakach, and Muhoroni, with a total of 35 wards. The county has an estimated population of 1,107,755 comprising of 545,670 males (49%) and 562,085 females (51%). HIV prevalence in Kisumu is at 16.3%, which is 3.4 times higher than the national prevalence. The prevalence among women in the county is higher (17.4%) than that of men (15%), indicating that women are more vulnerable to HIV infection than men in the county. The OCA identified key findings and critical gaps in the county's health system. The assessment revealed that the county has some capacity but there are areas requiring additional support. The capacity development plans (CDPs) recommended by the county officials to address the gaps identified through the OCA include strengthening county health systems to better plan and budget for HIV service delivery, improving the availability of appropriately skilled human resources, strengthening the distribution of quality commodities, enhancing the effective use of data for decision-making, and operationalizing national quality assurance and improvement mechanisms. The CDPs aim to improve the sustainability of HIV/AIDS service delivery in the county. The plans include providing support to county and subcounty governments to strengthen health systems, improving the availability of essential medicines and medical supplies, enhancing the effective use of data for decision-making, and operationalizing national quality assurance and improvement mechanisms. The CDPs also aim to improve the capacity of the county's health system to deliver its mandate, including providing high-quality HIV/AIDS services to the population. The assessment revealed that the county has a high HIV prevalence, with women being more vulnerable to HIV infection than men. The county's health system has some capacity but requires additional support to improve the availability of essential medicines and medical supplies, enhance the effective use of data for decision-making, and operationalize national quality assurance and improvement mechanisms. The CDPs aim to address these gaps and improve the sustainability of HIV/AIDS service delivery in the county.