Table of Contents

1. Title
2. Acronyms 2
3. Acknowledgement 3
4. Abstract 4
5. Introduction 5
6. Property Inspection 6
7. Food Safety Inspection 6
8. Institutional Sanitation Inspection 6
9. Occupational Health And Safety 7
10.Land Use/ Change Of User Approval 7
11.Approval Of Structural Plan 7
12.Prevention And Control Of Communicable Diseases 8
13.Siting Of Wells, Boreholes, Pit Latrines And Other Utilities 8
14.School Health Education 8
15.Hygiene Education (Hand Washing, Jigger Prevention) 8
16.Solid And Liquid Waste Management 9
17.Pollution Control 9
18.Licensing Procedures 9
19.Enforcement Of Public Health Laws 9
20.Food And Water Sampling 10
21.Health Problems In Informal Sector 10
22.Community Sensitization And Mobilization 11
23.Vector And Vermin Control 11
24.Integrated Disease Surveillance And Response 11
25.Disease Outbreak Investigation And Control 12
26.Disaster Preparedness And Response 12
27.HIV/AIDs Control And Prevention Strategy 12
28.Malaria Control And Prevention 13
29.Communicable Disease Intervention 13
30.Infection Control In Health Facilities 13
31.Immunization Programs 14
32.Port Health Services 14
33.Health Information System/Data Management 14
34.Community Based Health Care 15
35.Project Planning, Implementation And Evaluation 15
36.Disposal Of Hazardous Waste 15
37.Public Health Workshops/Conference 16
38.Office Management And Report Writing 16
39.Manpower And Financial Management 16
40.Meat Inspection 17
41.Mortuary Inspection 17
42.Conclusion 18
43.Recommendation 18
44.References 19
45.Appendix - Seizure Form, workshop program, photographs, Circular

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ACRONYMS

MoE - Ministry of Education

CDF - Constituency Development Fund
ECD - Early Childhood Development
PHO - Public Health Officer
NEMA - National Environmental Management Authority
WASH - Water and Sanitation Hygiene
CLTS - Community Led Total Sanitation
LLINTs - Long Lasting Insecticide Treated Nets
WRP - Walter Reed Research Program
EIA - Environmental Impact Assessment
DNA - Di-oxy ribo-Nucleic Acid (test)
CHWs - Community Health Workers
IHR - International Health Regulations
IRS - Indoor Residual Spraying
PwP - Prevention with Positives
HIV/AIDS - Human Immune-Deficiency virus
DASCO - District Aids STI Coordinator
DHMT - District Health Management team
DMOH - District Medical Officer of Health
SCPHO - Sub County Public Health Officer
NGOs - Non Governmental Organizations
CHEWs - Community Health Extension Workers

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ACKNOWLEDGEMENT

I would like to acknowledge and give gratitude to the Almighty GOD for enabling me reach this
far.

I appreciate the support given to me by the following persons during my attachment period; The
Dean and lecturers at the School of Health Science –department of Public Health, especially Dr
Louisa and Mr. Omemo. The health management team (HMT) of kibera sub county especially
the Medical officer of health (DMOH) Mr. Elijah, the Sub-County Public Health officer
(SCPHO); Ms. Mary, all heads of departments of health programs within the county and lastly
myself for this great achievement.

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ABSTRACT

The practicum was undertaken in Kibera sub county in Nairobi County the attachment period
was between October to December, 2021. The main objective of the practicum was to expose the
trainee to actual health issues and the functions of a public health officer, through various
activities such as property and institution inspection which was done at miranga primary school.
The attachment also exposed the trainee to actual health problems and enabled the trainee
acquire and apply skills to deal with health issues and problems which included disease outbreak
investigation done at kajulu - koker sub location. It further exposed the trainee to the process of
planning, design, implementation and evaluation of health related projects through the activity of
a stakeholder’s forum convened by the health management team (HMT) held at Rock Motel
under the Support of a nongovernmental organization (NGO) - plan international. The learner
was also exposed to the acquisition, analyzing of reports and dissemination of data undertaken
through data audit at miranga sub district hospital. In decision making process and developing
team building attitude, spirit and skills in management, the trainee attended weekly Monday
morning brief held in the office of the District medical officer of health (DMOH) and a facility in
charges’ review meeting at Mbagathi Hospital. By the end of the attachment period the trainee
was also exposed to information sharing and networking process by use of short message
service(SMS) adopted by the service providers to remind clients of their clinic appointment days
in the HIV care.

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CHAPTER ONE

1.0 INTRODUCTION

The practicum was undertaken in Kibera Sub-County which is one of the six sub-counties of
Nairobi County. Kibera Sub-County is situated on the western side of Nairobi city. The sub
county has 16 locations 43 sub locations, covers an area of 190.2 square Kilometers and has a
population of 98,805 persons; the population density is 519 per Km², The sub county has is
divide into 4 wards. The Health administrative headquarters is located within Mbagathi sub
county hospital which is situated along Raila Ondiga road on the right-hand .

The sub county has 22 Health facilities which deliver comprehensive health services. 2 utility
vehicle 2 ambulance and 15 motor cycles for transport. The service delivery is coordinated by a
health management team headed by the DMOH; other members of the team coordinate different
health programs such as community health services, malaria prevention and control, integrated
disease surveillance and responce, water and sanitation hygiene, HIV prevention and control,
reproductive health services, nutrition health services and health information systems
department. The health workforce is majorly supported by the government and partially the
NGOs and comprise of different cadres as indicated in the table¹ below:

1.2 Table ¹
Health Workforce in Kibera Sub-county
1. Medical doctors 2 2
2. Clinical Medicine Officers 20
3. Nurses 80
4. Laboratory Technologists 16
5. Public Health Officers 14
6. Radiographers 3
7. Pharmacists 8
8. Nutritionists 6
9. Health Records and Information Officers 4
10. Medical Engineering Technologists 2
11. Physiotherapist 2
12. Counselors and Social workers 30
13. Administrators and Clerks 7
14. Drivers, Cooks and General Support Staff 8
15. Data clerks, Clinical Health Assistants 20
16. CHEWs 5
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 TOTAL 198

CHAPTER TWO

2.1 Property Inspection: Date- 13th October, 2021

An inspection of Kibera Primary school was carried out in the company of the PHO, for
purposes of proposal writing to the CDF in an attempt to help upgrade the schools infrastructure.
The school is owned by ministry of Education (MoE) and has an enrolment of 256 boys and 318
girls with a teaching staff of 9.

At the time of inspection, the classrooms were dilapidated and very dusty. Most windows and
doors did not have shutters. However, the classrooms housing standard 7 and 8 were in good
condition having been newly constructed. The school has two tanks that stores harvested rain
water; refuse is managed by crude burning. There are sanitary facilities provided four doors for
boys and six doors for girls, this however is inadequate based on the school population.

2.2 Food Safety Inspection: Date: 14th October, 2021

Conducted inspection of food preparation premises and store outlets at Kenyata market
accompanied by the Public Health Officer (PHO) in-charge of market sanitation. Specific areas
of interest included storage facilities for the cooked and uncooked food to ascertain sources of
contamination. In the general stores, packaged foods were inspected for wholesomeness in terms
of packaging and sale-by-dates.

2.3 Institutional Sanitation Inspection: Date: 15th October , 2021

The institution had three blocks; the administration, lower primary and upper primary blocks.
The Early childhood Education (ECD) is inside the lower primary block. Sanitary facilities are
providing though not adequate. The institution compound was overgrown with vegetation at the

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time of inspection water source is through roof catchment and two tanks are provided for storage.
The administration block has the staffroom, deputy and head teachers office conditions observed
include lack of hand-washing facilities and dilapidated classrooms.

Recommendations were made to the administration to develop regular cleaning program s to

maintain cleanliness in the school.

2.4 Occupational Health And Safety: Date - 17th October, 2021

The above activity was undertaken at The Nairobi International Airport safety department under
the supervision of the PHO; the department is divided into two (ground safety and the fire/rescue
section). The ground safety is responsible for the safety of all persons who use the airport on the
air-side; this is done by ensuring that anybody who accesses the air-side uses protective
equipments such as reflector jackets and ear-plugs. The fire-fighting section ensures availability
of emergency response (fire-fighting equipment) and testing the contingency plans through drills.

2.5 Land Use/ Change Of User Approval: Date –

The above was done at the department of County Physical Planning department. The oversee
management of available land for various uses within the county and including the city. It also
controls the development of the urban centers through zoning for specific facilities such as health
facilities, commercial premises. Also approves plans for change of use of land e.g. agricultural
land to settlement.

2.6 Approval of Structural Plan: Date –

A briefing session by the officer in charge at the department of physical planning informed the
learner that, Building plans presented to the department of county physical planning are
approved based on certain factors such as accessibility of the plot, coverage, density of the other
existing and other types of development in relation to the area. The approved plans are then

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circulated to other line departments such as public health and National environmental
management authority (NEMA) that checks on other aspects such as plumbing and drainage
plans.

2.7 Prevention and Control of Communicable Diseases: Date –

The above activity was undertaken with the supervision of the PHO in charge of Water and
Sanitation Hygiene (WASH) The sub county of kibera has various activities and interventions
geared towards prevention of diseases such as Community Led Total Sanitation (CLTS) that
promotes construction and use of latrines through community participation. The main objective
of CLTS is to reduce diarrheal diseases in the community. The other interventions include
distribution of Long Lasting Insecticide Treated Nets LLITNs mainly targeting pregnant mothers
and children aged below 5 years.

2.8 Siting of Wells, Boreholes, Pit Latrines & Other Utilities: Date – 12th February, 2014

The above activity was undertaken under the supervision of the sub- county WASH coordinator
in south central kibera location. The main activity involved taking a transect walk in the Estates
to carry out verification of the existing number of functional latrines two Estates covered were;
Ngumo and Kibera having met the standards for elimination of open defecation sites in the
Estates in order for the Estates to be declared open defecation free (ODF)

2.9 School Health Education:

2.10 Hygiene Education (Hand Washing, Jigger Prevention): Date –

The activity was taken at Kibera primary school, Health talk was given to pupils of class 5.6 and
7. The methods of teaching used were brain storming lecture and demonstration. The topics
covered included house hold water treatment,(boiling, use of chlorine and filtration).importance
of hand washing during the four critical times and modes of transmission of jigger infestation

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which was noted as dusty floors, the pupils were encouraged to regularly clean the classrooms to
prevent jigger infestation.

2.11 Solid and Liquid Waste Management: Date-

Kibera sub-county is a rural set up where waste generation is minimal. Most residential premises
manage their waste at source; for solid – waste is segregated and managed according to the type;
the combustible ones are burnt. For example in Kibera District hospital, the biological wastes are
disposed in a pit, combustible are burnt in a refuse pit, while the sharps are incinerated at the
WRP-Malaria Research Centre. Liquid waste is managed by use of septic tank and soak pit,
since there in no public sewer system in entire Kibera-sub County.

2.12 Pollution Control & Date:

2.13 Licensing Procedures

The activity was undertaken at the department of NEMA. Learning took place by lecture and
method which revealed that the main function of NEMA is to carry out environmental audit to
individuals and firms for purposes of construction of various project e.g. residential and
commercial buildings. This is done by carrying undertaking an Environmental Impact
Assessment (EIA). It also carries out surveillance and coordination of environmental activities
such as garbage collection, storage and disposal. Other activities include incident management
and environmental planning for protection of natural resources e.g. wetlands.

NEMA issues licenses to waste handling companies and any project valued at more than
Kshs.1M, the Authority issues a license at a fee of 1% of the total values.

2.15 Enforcement of Public Health Laws: Date –

The activity was done at the Nairobi City Council Court. The court prosecutor highlighted on
the procedure of presenting a suspect to court, the process begins by identifying the offence that
has contravened a particular act such as the Food drugs and chemical substance act CAP.254 and
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arresting the offender, who is then arraigned in court for plea. If the suspect pleads guilty he/she
is given a sentence either by fine of confinement. If the offender pleads not guilty a trial process
is initiated. During the trial process the prosecutor proceeds by presenting witnesses and other
forms of evidence such as seized goods and documents to support the case, the accused is given a
chance to defend themselves either by presenting witnesses, thereafter the magistrate makes a
ruling and delivers the sentence which can later be appealed in a higher court. During the
attachment the ongoing cases of public health relevance was the presence o adulterated sugar
being sold in the local supermarkets (find attached a copy of seizure forms ‘’B’’issued to
Tumaini supermarket of the same).

2.16 Food and Water Sampling: Date – 11thNovember

2021

The above activity was undertaken at the department of government chemist Nairobi branch. The
main mandate of the department is to undertake quality analysis and investigation on various
items such as portable water quality for domestic use and industrial use. It also undertakes DNA
analysis for parity parentage and rape cases for police investigation and analysis of effluent from
factories and municipal disposal plants, criminal investigation on counterfeit products e.g.
currencies can also be investigated in the department and prosecution initiated if necessary.

2.17 Health Problems in Informal Sector: Date – 7th November

2021

The above activity was undertaken in the slums of Kibera through Afya jijini Community Health
Program. The officer in charge of the facility accompanied the student and two CHWs in
undertaking a transect walk in the slum from the facility to Kowino market. The major problems
identified during the session include lack of latrines, inadequate water supply, heavily
contaminated water from open shallow wells and poor housing. The above problems predispose
the residents from the slums to diarrheal diseases which is the most commonly reported disease
in the Health facility data base.
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2.18 Community Sensitization and Mobilization: Date – 21st December 2021

Participated in the mobilization of the community for Polio Immunization Campaign exercise.
The mobilization involved conducting meetings with various stakeholders such as Estates elders,
education officer in schools and church leaders who were sensitized on the same activity. A
public address system mounted on a vehicle was also used to conduct a road show to mobilize
citizens on the same immunization campaign. Also participated in a Dialogue day in Ngumo
Estates, Kibera sub-location to guide the community in identifying their health problems. The
major problem identified was inadequate water supply.

2.19 Vector and Vermin Control: Date - 28th November

2021

Participated in planning and implementing of vector control activities at the Nairobi International
Airport. The main activity undertaken was Indoor Residual spraying (IRS) of the terminal
building to control mosquitoes and laying of poison baits to control rats. Spraying of marine
vessels was also undertaken at the port pier station the chemicals used included insecticides such
as icon, diazinon and KO-Athrine. The rat poison used was barraki baits.

2.20 Integrated Disease Surveillance and Response: Date – 28th October 2021

Participated in screening of international travelers for clearance into other countries which is a
requirement under the International Health Regulations (IHR) guidelines.

IHR requires any person travelling out/into a country be vaccinated against certain diseases e.g.
yellow fever and polio (specific for India).

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The department of surveillance within the sub-county also collects weekly data on disease
incidence and prevalence this is use d to determine whether the reported cases have surpassed the
threshold for an outbreak in order to initiate outbreak control interventions.

2.21 Disease Outbreak Investigation and Control: Date – 22nd December

2021

Participated in the investigation of suspected Omicron cases in Ngumo together with the Kibera
Sub-county Disease Surveillance Officer. The reported cases were 2 in number, but upon
investigation only 1 were confirmed to be actually positeve, unfortunately the 1 succumbed
while undergoing treatment.

The Sub-county Health management team also conducts weekly meetings on Mondays to verify
the data from the surveillance department and other health facilities as a strategy to monitor any
disease that has increased number of cases.

2.22 Disaster Preparedness and Response: Date - 16th December, 2014

Attended a session presented by the duty officer on the above. The Duty officer was at the
Nairobi international Fire and Rescue department. The core function of the department was
highlighted as; Response to emergency with an objective of saving lives and preventing
destruction of property at the scene of the accident. In order to implement this, the airport has
developed a contingency emergency plan that in corporate all relevant stakeholders who are
called upon to respond when an emergency occurs. The plan is tested every two years to
ascertain its efficiency. The last drill was done in December 2019.

2.23 HIV/Aids Control and Prevention Strategy: Date – 27th November,

2021

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The sub county HIV/AIDS control and prevention programs are implemented the health
management team led by the District Aids and STI Coordinating Officer (DASCO). The main
functions of DASCO include, partners and inter-sectoral collaboration, resource mobilization,
HIV Testing and Counseling (HTC), Prevention of Mother to child (PMTC), couple testing and
counseling which is majorly done at home and treatment and care for person living with HIV
through HAART.

During the attachment period, I participated in the training of community health workers on
community PwP (Prevention with Positives), at Lower Mbagathi sub-location.

2.24 Malaria Control and Prevention: Date –

Malaria control programs are implemented within the sub county through different activities, the
coordination is done by a PHO. The activities include distribution of LLITNs, distribution of
rapid diagnostic kits, and intermittent prophylactic therapy for pregnant mothers given at least 4
times during the pregnancy and case management by use of Artemether Lumefarntrim the first
line treatment.

Continuous health education is also given to the community in other prevention interventions
such as IRS, screening of windows and door shutters by use of gauze wire and maintaining
general cleanliness in the homesteads.

2.25 Communicable Disease Intervention: Date -

The above activity was undertaken through various disease preventions interventions programs
such as CLTS, jigger control activity by washing the infected feet using Kerol disinfectant at
Ngumo East sub-location, after the disinfection the infected persons were issued with rubber
shoes to help reduce the infection. Continuous health education and promotion is also undertaken
by the department of public health targeting school going children and participants at the chief’s
barazas. Community Health service approach is also employed in educating the public on disease
prevention, this is majorly done by trained community health workers.

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2.26 Infection Control in Health Facilities: Date – 30th November 2021

Most waste generated within Mbagathi Sub county health facility are segregate at the point of
generation into three categories and stored into clearly colour coded waste as; black for non-
infectious waste such as food remains, yellow for infectious wastes e.g. gauze and swabs and
lastly red for highly infectious wastes such as sputum and placenta. The hospital has a cleaning
program that states ‘cleaning should be done twice a day’ by use of detergents and disinfectants.
Most health workers use protective clothing while on duty to prevent infection

2.27 Immunization Programs: Date – 22nd December 2021

Participated in the National Polio Campaign activity that also included vitamin-A from 18 th-22nd
January. The campaign targeted children below 5 years within the sub county. During the
campaign the health team managed to reach 95% of the target population.

Participated again at the MCH department of Miranga sub-district hospital and Mbagathi sub-
county hospital where routine immunization is administered to children aged below 1year.
Growth monitoring is also given to children aged 0-5years within the MCH department, other
services provided include, nutritional supplements for malnourished children.

2.28 Port Health Services: Date - 28th November 2021

Participated in vaccination of international travelers against yellow fever and polio, disease
surveillance activities by screening passengers arriving from outside the country. Also
conducted food quality control within the food outlets at the airport by inspecting the food stores
and ascertaining medical fitness of food handlers.

Inspection of other vessels such as ships and aircrafts was also undertaken during the period.
Areas of interest during the inspection include; food storage facilities and waste disposal
strategies used by the vessels.

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2.29 Public Health and Health Information System/Data Management:
Date: 31st October 2021

The sub-county health information officer receives data from all health facilities both private and
government owned by the 5th day of every month. The data is then used to compile a report
which is then submitted to the National Health Information systems data base by the 13 th day of
every month.

The reports are collected by use of various tools e.g MOH 717, MOH 711, MOH718, MOH 705,
cold chain sheets and commodity request/ consumption tool.

2.30 Community Based Health Care: Date – 19th October 2021

The above activity was undertaken in collaboration with an NGO (Afya Jijini) which operates in
Kibera sub-county supporting health related activities. The organization is s child centered and
has 3 focal areas; adolescence and sexual reproductive health, community health services and
water and sanitation activities. The NGO partners with the ministry of Health in implementing
their programs through capacity building, staff motivation and paying stipend to the community
health worker.

2.31 Project Planning, Implementation And Evaluation: Date – 23rd November

2021

Participated in a stakeholders’ meeting for the Adolescence Sexual Health Reproductive

Program. The meeting was to deliberate on the challenges faced by the adolescence while
accessing sexual health services. After the stakeholders’ forum, training was conducted for the
community health extension workers (CHEWS) within the sub county with an objective of
empowering them on how to give youth-friendly health services.

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During the training participants noted that the biggest challenge faced by the youths is teenage
pregnancy, which majorly affect girls. The program is meant to run for 2 years.

2.32 Disposal of Hazardous Waste: Date - 31st October 2021

Kibera sub-county hospital generates two categories of hazardous wasted; infectious waste
which include gauze and fluids etc., and highly infectious pathological waste e.g. stool, sputum
and sharps. The wastes are collected in colour-coded containers and taken for incineration at
Chulaimbo Hospital or at the WRP research center.

2.33 Public Health Workshops/Conference: Date – 4th December 2021

Attended a workshop at Rock Motel on Reproductive and Sexual Health for the Adolescents, the
workshop was convened by the health management team supported by plan international. Issues
discussed during the workshop included, preventing teenage pregnancy, rehabilitation of the
already affected girls and access to family planning services to the adolescents including condom
use. Another workshop covered under the above was a WASH stakeholders’ forum held at poly
view hotel convened by the WASH coordinator and supported by plan international.

2.34 Office Management and Report Writing: Date – 20th December, 2021

The sub county conducts monthly meetings for health facility in-charges. During the meetings,
management issues are discussed. The issues include human resource management, continuous
medical education and auditing of facilities reports. Data review and mentoring of new personnel
is also done. The DHMT also holds weekly meetings where they discuss all issues affecting
health service delivery within the sub county. The issues discussed during such meetings include
disciplinary and staff movement among others including witch-hunting.

2.35 Manpower and Financial Management: Date – 20th October, 2021

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The sub county receives funds from the county government, NGO support funding and National
government through the Health Ministry. The funds are managed by the DHMT headed the
Administrator through the Financial Management System. Most personnel are employed by the
government. However, the NGOs employ few addition staff to support the government.

2.36 Meat Inspection: Date – 12th March, 2014

Participated in meat inspection at Ndonyo slaughter slab and Kibera salaughter house under the
supervision of the Meat Inspector which slaughters 2 to 3 cows every day. The most common
conditions witnessed are infestation of liver flukes leading to cirrhosis that may lead to total
condemnation of the whole liver. During inspection, one bovine carcass had its lungs
condemned due to emphysema. After inspection the meat inspector stamps on the carcass as a
sign to indicate that the meat is fit for human consumption and has been inspected.

2.37 Mortuary Inspection: Date – 5th October, 2021

Conducted an inspection of Mbagathi sub-county hospital mortuary the session was conducted
under the supervision of the Mortuary Attendant. The mortuary receives dead bodies majorly
from within the hospital but a few cases are brought in by the police road traffic accidents. Upon
reception, bodies are treated by means of embalmment using formaldehyde, the treated bodies
are then stored in the cold room awaiting collection by the relatives. Unclaimed bodies are
disposed of through a court process and buried at the municipal public cemetery. The layout of
the mortuary is designed into three major areas; the receiving area, the storage area and dispatch
area. Cleaning is done is done twice every day and whenever necessary.

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CONCLUSION:

The practical attachment was highly participatory involving different stakeholders which actively
participate in health service delivery such as WRP and Afia Jijini. Different methodologies were
employed during the session such as lecture during the workshops, field trip, focused group
discussion and demonstration to acquire the knowledge. The immense support given by the
health management team made the learning session very interactive. At the end of the practicum
the main objective of exposing the student to actual health issues and functions of a PHO was
achieved through the various activities reported in chapter two of this report. A major
observation noted during the attachment was the poor quality data management from facilities to
the DHIS officer. The available health work force is inadequate based on the population
catchment to be served. The sub county health service is lacking in terms of transport both for
staff and ambulatory services for the patients with only one utility vehicle and one serviceable
ambulance to serve the entire sub county.

RECOMMENDATION:

The sub county health information system should train staff on data management to improve
completeness and quality.

The team spirit witnessed among the health management team is highly commendable and
should be rolled to all the levels of health service delivery points.

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The government should recruit 20 nurses, 3 doctors and 7 public health officers among other
health personnel to address the gap on staff shortage personnel including community health
workers to address existing shortage challenges.

The HMT should coordinate and control the activities of the NGOs to avoid duplication and
maximize resource value.

References:-

1. Field attachment log book

2. Nairobi county development profile –May 2020
3. Community led total sanitation trainers manual May 2020
4. Public Health Act CAP.242
5. Food Drugs and Chemical Substance Act CAP.254
…….END….

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