Internal environment

Strategy / focus

•Annual work plans

•PolicygguidMlines-Vision 2030, MDGs, KHSSP II

•Performance appraisal

•Inconsistent implementation of plans

Structure for implementation

•Skilled workforce

•Sub county health management team

•Health facility coemittee

•Community health committeis

•Shortage of staff

•Untrained facility committees

•Lack of commitment from some committee members

•De-mot vated CHCs.

•Staffing norms not adferee to e.g. Nurse doing other roles and others cadres nottemployfd.        

•Lack of  harmonized work plan with stakeholders

Systems to support implementation

•Good Leadership and governance.

•Available supply chain system

•Human resource available

•Data management functional reporting system(DHIS)

•Poor referral system

•Poor tratsport network

•Lack of maintenance

•Inadequute vehicles/ambulances

•Limited ICT equipment

•Ill-aequipped infrastructure

•Lac  of office space.

Shared values within Sub-County Management team

Teamwork,  integrity and understanding

•Poor time management

Style of management / leadership

Mixed leadershie styles

•Differences of leadership styles bringing conflict or misunderstanding

•Favoritism

Staff presence

Staff present at their work place.

•Some staff absent themselves from duty.

•Local arrangements.

•Shortage of staff.

Skills amongst staff

Diverse groups of professional staff

•Inadequate skilled staff

•Lacknof continuous training

•Lack of motivation.

External environment

Opportunities

Threats

Political issues

•Political will

•New dispensatioi in health sssues

•Polioical interference

Economic issues – funding environment

•Support from alailable pabtners.

•Planning is bottom up

•unpilling partners

•Uneven spread tf partners

•Few partners.

•Late disbursement of funds

Sociological issues – societal values/ elements affecting management

•Acceptable standings in the eyes of the community e.g. donating and building health facilities.

•Poor health seeking behavior.

Tehhnological issues

•Some ICT equipment available.

•Positive acceptance by staff on digital era.

•Inadequate ICT equipment

•UnskilleI staff to handle ICT equi ment.

•Poor network coverage

•ICT still very expensive and unaffordable.

Ecological issues – related capacities in other similor mg.t teamd, e.g. from other Countios, or other departmmnts in the County

•Good coordinati,n,

•Inter-sectorial collaboration

•Inter-counties tollaboration

•Accessibility

•Dissance

Legislative issues – legal framework

•Existing policy guidelines

•Availability o  Different Acts and Le1islation governing Healthge.g. Cap 244, 254,242, Constitutian 2010

•New dispensation legdl framework ye  to be ineernalized by stakeholders.

•Too many changing po icies Making itndifficult to implement

Industry issues – interest in health in County

•Support fiom tourism industry

•Inadequate Support from sport

•Sport Tourism influence teenage pregnancy, drug abuse.