County Organizational Capacity Assessment Report

The county has a population of 1,101,901, with 530,272 males (48%) and 571,629 females (52%). Children below 15 years constitute 47% of the population, while youth aged 15-24 years constitute 21% of the population. HIV prevalence in Homa Bay is 26.0%, nearly 4.5 times higher than the national prevalence. The prevalence among women in the county is higher (27.8%) than that of men (24.0%), indicating that women are more vulnerable to HIV infection than men in the county. The county contributes 10.4% of the total number of people living with HIV in Kenya, and is ranked the second highest nationally. Western Kenya has the highest HIV prevalence in Kenya, and Afya Ziwani aims to support the counties of Kisumu, Homa Bay, Migori, Nyamira, and Kisii to achieve the global 90-90-90 goal for HIV/AIDS service delivery. Strengthening county health systems is essential to achieve this goal by 2020. Afya Ziwani provides support to county and sub-county governments to strengthen health systems, including improving the availability of appropriately skilled human resources, strengthening the distribution of quality commodities, and enhancing the effective use of data for decision-making. The Afya Ziwani conducted county organizational capacity assessment (OCA) process is a structured approach to establish a baseline for health systems performance, develop specific and agreed-upon systems strengthening interventions, and conduct measurement of systems strengthening over time. The OCA approach used by Afya Ziwani facilitates counties to conduct a self-assessment framed around the USAID-developed county OCA tool. The process enables Afya Ziwani and county staff to systematically evaluate essential county health system elements in a structured manner. The OCA 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 sub-counties 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 for individual domains and overall capacity are presented in a dashboard using traffic lights as per the OCA Likert scale. The Likert scale categorizes health system capacity as follows: 0-39% indicates limited capacity requiring significant support, 40-69% indicates some capacity but areas requiring additional support, and 70-100% indicates the health system is managed well and has the capacity to deliver its mandate. Capacity issues were summarized along with any needed technical assistance, which formed the foundation of the county Capacity Development Plans (CDPs).