THE NEONATAL CHILD AND ADOLESCENT HEALTH UNIT
The Neonatal, Child and Adolescent Health Unit of the Ministry of Health was established in 2001 to
implement activities that will lead to the improvement of child health and nutrition and thus contribute to
the Economic Recovery Strategy and Millennium Development and other national and international
Goals.
The Vision of the Neonatal, Child and Adolescent Health Unit is to create an efficient and high quality
healthcare system that is accessible, equitable and affordable by every Kenyan child and its Mission is to
promote and participate in the provision of an integrated and high quality promotive, preventive, curative
and rehabilitative healthcare services to all Kenyan children. The division derives its Mandate from
National Health Policy, Public Health Act Cap.242 and Children’s Act Cap.586.
The core functions of the unit are:
 Formulation of Policies and strategies on Child and Adolescent Health.
 Planning and budgeting for child and adolescent health.
 Co-ordination of child and adolescent health activities.
 Capacity building for counties to implement child and adolescent health programmes.
 Support supervision of child and adolescent health activities through counties
 Monitoring and evaluation of child and adolescent health programmes.
 Resource mobilization for child and adolescent health.
 Advocating for child health rights
Goal: To enhance child survival, growth and development
The main objectives are:
 To ensure survival, growth and development of children aged below five years
 Health promotion in all children – pre-school and school age including adolescents (up to 18
years) both in school and out of school.
 To promote good nutrition for children, expectant and nursing mothers
 Promotion of the health rights of the child
Programmes in the Neonatal, Child and Adolescent Health Unit:
1. The Integrated Management of Childhood Illness (IMCI) strategy
The under-5 mortality rate is 74 per 1,000 live births, against an MDG target of 32/1000 by 2015.
Newborn mortality has also not changed over the last two demographic health surveys suggesting that
safe motherhood initiatives have not had significant impact on its reduction. Neonatal mortality stands at
31/1,000 live births and the gains made in the reduction of under five mortality have been eroded by the
spiraling newborn deaths as it contributes to approximately 28% under five mortality.
Diarrhoea mortality rate of 21% remains above the Africa rate of 17% and global rate of 15% (WHSR,
2011). Only 1 in 3 children with diarrhea are provided lifesaving oral rehydration solution (ORS) in
Kenya. The situation is worst in the ASAL counties, where only 1 in 10 children with diarrhoea received
ORT and increased fluids. Zinc is not commonly used for diarrhoea treatment at the moment, but
coverage is expected to improve rapidly now that the national drug policy allows zinc to be provided
without a prescription and the MOH has endorsed community-based treatment of diarrhoea with ORS and
zinc.
Pneumonia is implicated in the deaths of about 21,000 Kenyan children under the age of five each year
and is the second leading cause of death and leading cause of childhood morbidity in areas with low
prevalence of malaria (WHO 2010 and Kenya Population and Housing Census 2009). Less than one in
two children with symptoms of ARI/ pneumonia receives antibiotics.
Most of the child deaths are concentrated in three provinces: Nyanza, Rift Valley and Western. Nyanza
Province has the highest U5 mortality rate at 149/1000 live, according to the KDHS 2010 mortality
estimates. One in 6 children born alive in Nyanza’s Siaya County and 1 in 10 in Homa Bay County does
not reach their fifth birthday. Nyanza’s Siaya County may have the highest under-five mortality rate in
the country, at an estimated 158 per 1000 live births.
For this reason, eminence needs to be given to acceleration of evidence based high impact interventions
on maternal and newborn health that will likely reverse this trend and be sustained by integrated
management of child hood illnesses (IMCI).
2. Newborn care:
Neonatal mortality rate stands at 31 per 1000 live births and has not changed substantially in the last
decade. Health facilities report show good basic newborn care practices: 95% support early initiation of
breastfeeding, 92% support rooming-in, and 91% examine the newborn from head to toe before
discharge, and only 7% give prelacteal feeds and full-immersion baths. In practice, however, they are not
consistent: only 46% of babies observed for the Service Provision Assessment received all three essential
newborn care interventions (dried and wrapped, placed skin-to-skin with their mothers, and encouraged to
breastfeed within one hour of delivery). Furthermore, very few facilities provide outreach services or
tracking to ensure adequate postnatal care for the majority of babies who are delivered at home
3. Health Promotion
The IMCI strategy has three components namely: improvement of skills for the health workers,
improvement of the health systems and the community component. In the initial stages of
implementation, the country gave priority to the first two. Implementation of the third component:
Household/community component; Community-Integrated Management of Childhood Illnesses (c-IMCI)
began in 2007 and so far different districts are at different levels of implementation. Community Dialogue
(CD) is a participatory methodology which can be used in Schools and in community capacity building
resulting to individuals, families and communities taking charge of their own health and development.
Community Dialogue for Child Survival growth and Development is guided by a set of key family
practices that are aimed at improving the quality of care offered to the child at the household and
community level. The MOH Community Health Strategy forms a base for implementation of Community
IMCI and Community Dialogue, thus the capacity in the community units targeting Community Health
Extension Workers and Community Health Workers.
4. Child Health Rights and Child protection
Across nations, Early Childhood Development (ECD) programs are of great interest to policymakers,
service providers, and families. Early Childhood development refers to the period of child development
from pre-conception to 8. During this period children develop central visual and auditory systems,
emotional control, habitual ways of responding, peer social skills, language and cognitive functions.
ECD programs are cross-cutting, often involving the health, education, child welfare, and other sectors,
and their emphases shift over the early childhood years. Equity is thus a construct central to the provision
of ECD programs in an international context. Quality is a key feature in ECD programming because when
programs of low quality are provided, they are unlikely to generate the child and family outcomes
intended. Moreover, quality is a relevant feature across all levels of the ecological system. To effect
sustainable and meaningful change in ECD programs in developing countries, features of access and
quality, must be addressed at each level of the ecological system.
Kenya is a country with a population of approx. 40 million of whom 29.9% (11,537,022) are children
aged 0-9 years (Census 2009). More than a half of the country’s population lives below the poverty line,
on less than one US dollar a day. The most vulnerable are families and children living in the urban slums,
in the arid lands of northern Kenya and in areas of the country worst affected by HIV. These are also the
areas with high child mortality and low enrolment in school. The National HIV and AIDs prevalence (age
15-49) is 7.8%; Under 5 mortality rate of 74/1000 live births; Immunization coverage of 68% and preschool Net Enrolment rate of about 50%. These data is at a national average and masks the regional
disparities.
Non attainment of the appropriate development milestones in children under the above mentioned
categories has negative consequences to attainment of full potential. For ECD program to be effective it
should therefore address the needs of the whole child, multiple deprivations (health, nutrition, protection,
education) and be inclusive and affirmative to address inequalities at an early age. Despite this growing
evidence, few children have access to quality early childhood programs in Kenya. It is disheartening that
largely due to social isolation, poverty, stigma and discrimination, even fewer vulnerable children
especially those affected by HIV/AIDS, disabilities or orphaned are enrolled in ECD programs.
5. Health system
Implementation of child-mother health and nutrition weeks concept, also called Malezi Bora in
Kiswahili in Kenya started in the first quarter of 2007. The strategy involves accelerated promotion and
delivery of maternal and child health interventions. The event is held twice in a year (May & November)
to deliver specific package of health interventions targeting mothers and children under five years old.
The ultimate goal of the ‘Malezi Bora’ strategy is to increase demand for health and improve delivery of
routine health and nutrition services- targeting Children, expectant women and lactating mothers and to
contribute to achievement of Kenya’s MDGs 4&5 and vision 2030.
The initiative is not considered to be campaigns but rather enhanced routine delivery of maternal and
child health services. Part of the activities include an intense community social mobilization done by the
service providers and partners in a coordinated way to increase awareness of the public on the available
services at the routine sites with the intention of encouraging service utilization for child mother and
nutrition services. Outreach services to reach the hard to reach population and use of community strategy
have been adopted recently.
The implementation has been made possible through collaborative efforts of the Ministry of Public Health
Sanitation and ministry of medical Services with various partners in the health sector. Among these are
WHO, UNICEF, USAID/MCHIP, IRCK, World Vision, PSI, Red Cross and Micronutrient initiative.
Analyzed ‘Malezi Bora’ data have shown an increase in uptake of health services within the health
facilities, outreach services and improved knowledge on maternal and child health. The strategy is good
to deliver integrated services to children and mothers.
6. School Health Promotion
A number of partners including JICA, UNICEF, GTZ, World Bank, AMREF, CARE, IRC and others, are
currently supporting implementation of school health and hygiene programmes through MOH and MOE.
Personal Hygiene and Sanitation Education (PHASE),Community Led Total Sanitation(CLTS) and
similar school health and hygiene programmes support teacher and community health worker training,
development and dissemination of school health education curriculums and educational materials,
establishing school health clubs, improving hygiene and sanitation facilities in schools, outreach
education to parents and communities, and public information campaigns.
School health education programmes offer an important entry point for public health education. Current
net primary school enrolment is 76%, which presents a key opportunity to promote good behaviours to
students, and through students to channel messages and good hygiene behaviors to households and
communities.
Since diseases occur at the household level where these pupils come from, there is need to use the skills
and knowledge acquired by the pupils and the teachers to take health messages to their parents. Pupils are
good in receiving and transmitting messages to their parents and the community. These can be effectively
done if an acceptable methodology like the community dialogue is introduced to the 30 piloted schools.
Since most households are represented in the school community, there exists an opportunity to implement
the community dialogue through the schools resulting to delivery of health messages to the families and
community at no extra cost. Further, the teaching staff and the school community in general will acquire
useful knowledge on communication of health information to the community. In addition, since the
school age children spend most of their time at schools, the application of the community dialogue will
allows the pupils and teachers build on the already successful comprehensive school health program in
the schools and enable peer modeling by both teachers and pupils.
The application of community dialogue model at schools will have an added advantage of sustainability
in that the pupils will develop and adopt a culture of healthy practices which they are likely to carry on to
adulthood and their individual families.
8. Adolescent Health Promotion
Kenya’s population estimated at 39 million in 2009 (census 2009), and almost half of the current
population is under the age of 15 (NCPD 1997). These young Kenyans are very much like their parents
and grandparents, but the problems of today that confront millions of adolescents are different from those
of past generations. The modern world presents its own complicated set of challenges to the young, and
when problems persist in such a large segment of the population, they exact a tremendous price from
society. The social, economic, and cultural
repercussions of uninformed behavior by youth pose a serious threat to the country’s growth and
development. Unwanted pregnancies, sexually transmitted diseases (STDs), abortions, and the related
consequences of dropping out of school, ill health, unemployment, and poverty burden all of society and
jeopardize its future stability. According to research, there were 142,000 unwanted pregnancies last year
among girls age 15 to 19 and 252,000 abortions in the same age group, despite the fact that abortion is
illegal in Kenya (CSA 1995). Almost 50% of girls who reach the age of 20 have had a pregnancy. The
incidence of HIV infection is increasing, with 515,000 youth age 15 to 24 estimated to be HIV positive by
the year 2000.
In Kenya, progress has been made in improving the health of children especially the under five as
reflected in the 2008/09 KDHS. However, nothing much has been done for the health of older children
(adolescents).
Adolescents face major health challenges
but their health needs have not been addressed
comprehensively. The traditional, culturally accepted societal nurturing of children and youth among
African society is weakened due to modernization and globalisation.The breakdown of these traditional
systems/structures has given rise to issues related to individualism, near absent parenting, a rat race
economy as mentioned above among others.
The country does not have a comprehensive adolescent health policy that would provide strategic
direction on their care. Also a comprehensive adolescent health care package has not been developed, to
provide guidelines for training of health workers on adolescent care.
The problems facing adolescents in Kenya include; Teenage pregnancies, alcohol, drug and substance
abuse, nutritional and mental health issues among others. These are observed in the society but
comprehensive surveys have not been conducted to provide a country wide situation.
Some various un coordinated services are provided by different actors across regions in the country
affording standardization and reporting system challenges.