Finance and Economic Planning

The department works with a vision of being the most efficient and effective County Treasury that supports sustainable economic development. It has set up the following strategies to achieve its goals:

• To maximize revenue collection
• To facilitate optimal allocation of resources within the county
• To promote sound financial management practices
• To achieve value for money in the procurement of goods and services
• To ensure proper management of the county assets
• To strengthen financial and fiscal relations between the national and the county governments.

The department has a mandate to coordinate all other departments, approve their budgets and allocate each one of them necessary finances they require for their priority projects.

Agriculture Livestock, and Fisheries

The county works towards a vision of being innovative, commercially oriented and modern Agriculture, livestock and fisheries development. The department of Agriculture, Livestock and Fisheries encompasses Crop, Livestock and Fisheries development as well as the Agricultural Mechanization Station and Agricultural Training Centres. Its Mandate is:

1. To promote and facilitate production of crop,
2. To promote livestock and fish products for food security and household incomes through value addition;
3. Enhance sustainable use of land as a resource for agricultural production Agriculture.

The department strategic include:

Core Strategies:

1. Promote adoption of appropriate technologies for crop, livestock and fisheries in the county for sustainable food security
2. Create an enabling environment for the sector to develop
3. Increase agricultural productivity through facilitating access to affordable inputs and services.
4. Increase market access of agricultural produce and products
5. Promote sustainable land use in agricultural activities
6. Enhance institutional efficiency and effectiveness in implementation and service delivery.

Livestock and fisheries is recognized as the back born of Kwale County economy, contributing over 80% both directly and indirectly to the livelihoods of the community. Agricultural enterprises and activities are guided by the ecological conditions with 33% of the total land area having medium to marginal potential in terms of agricultural production and 67% being rangelands receiving annual rainfall below 700mm.

The main food crops grown in Kwale County include: maize, cassava, sweet potatoes, beans, peas and green grams while main cash crops grown include: cashew nuts, coconut, sugarcane, bixa and semi-commercial crops like citrus, passion and mangoes. Even though there is high production potential, of these crops, current yields are very low due to poor agronomic practices.

Livestock production is the main economic activity in the rangeland where local breeds of both cattle and small ruminants mainly goats are kept in large numbers with very few crosses of improved breeds. Though livestock population are high, production has remained low due to low quality breeds compounded with poor husbandry and high incidences of pests and diseases.

Kwale has abundant fisheries reserves along the coastline but fish catch is very low due to in appropriate and limiting fishing equipment. Major fish reserves include: Shimoni, Vanga, Msambweni, Diani, and Tiwi. The main types of fish catch are Rabbit Fish, scavengers, Jack Fish and King Fish. In addition, there are 338 fish ponds in the county and the number is expected to go up through aquaculture promotion targeting institutions as income generating project.

Based on the above scenario, the department intends to make Kwale County food secure and increase household income through development projects that promote improved agronomic practices in terms of land preparations, use of high quality planting materials and farm inputs as well as promote irrigation in areas with reliable water sources; improved livestock breeds and husbandry as well as efficient and effective pest and disease control and empowering fisher folks to increase marine and aquaculture catch and total incomes from fish and fish products.

Tourism Trade and Entrepreneurship

This is a key sector in the county due to its immense potential for achieving the county economic
transformation agenda. Kwale County ranks among top three leading beach tourism destinations in Kenya hosting some of Africa’s finest hotels and resorts. The tourism industry has particularly been a key driver to trade and investment among major towns and villages along the County’s Main Coastline. ICT on the other hand has been an enabler to trade, commerce and industry and it therefore remains a key pillar for the County’s investment strategy. Accelerated development and diversification of the sector therefore would create more income generating opportunities among both the rural and urban poor in the County.

The department works towards the vision of being a globally competitive, informed economy with sustainable and equitable socio-economic development. Its mandate include:

1. Regulation of the industry: Inspection, investigation and maintenance of hotels & restaurants   standards
2. Development of community-based tourism projects and programs
3. Identification and development of tourism products
4. Dissemination of tourism information
5. Liaison with other government departments, NGOs and Tourism stakeholders on implementation of tourism policy issues
6. Marketing and promotion of the County

Main Tourist Attractions, National Parks/Reserves

The main tourist attraction sites are Shimba Hills National Reserve, Mwaluganje Sanctuary, marine reserves and parks, historic sites (Shimoni Holes and Diani Mosques)
forest, coral and sandy beaches, bird habitat areas, hotels and turtle breeding grounds. There still exist potential in this sector such as untapped cultural resources, plenty of potential tourist sites that could offer accommodation facilities and sport tourism.

Main Wildlife

The dominant wildlife species include elephants, baboons, monkeys, buffalos, giraffes and sable antelope (only found in Shimba Hills in Africa).

Shimba Hills National Reserve

The national reserve lies approximately 33km south of Mombasa town, in Kwale district of coast province. The coastal ecosystem comprise of a heterogeneous habitat including forestlands, exotic plantations, scrublands and grasslands. The ecosystem holds one of the largest coastal forests in East Africa after Arabuko-Sokoke forest. The reserve is rich in flora and fauna and hosts the highest density of African elephant in Kenya. Other animal species found in the area are Sable antelope, black and rufous elephant shrew, bushy tailed mongoose and other small mammals like fruit bat. The forest is an important bird area and is endowed with forest birdlife while the grasslands hold localized species such as red-necked-Spurfowl, Croaking Cisticola and Zanzibar Red Bishop.

Kisite Mpunguti Marine Park

The marine park is located on the south coast, 40km from Ukunda town in Msambeni District of coast province.  The ecosystem covers a marine area with four small islands surrounded by coral-reef. Kisite island is covered in low grass and herbs while Mpunguti Islands have dense coastal equatorial forest. Sea grasses Cymodocea serrulata and Syringodium isoetifolium cover a large area of the sub-littoral zone of the reef. Marine algae include Padina commersonii, Dictyota bartayresiana, Bostrychia binderi, Ulva lactuca, Dictyosphaora sp., Udotea indica, and Halimeda opuntia. Major attractions include the Dolphins, coral gardens and it is an important site for snorkelling, diving and bird watching. The beautiful sandy beach is good for  enviromental friendly recreational activities

Tourist Class Hotels/Restaurants, Bed Capacity

There are 22 tourist class hotels in the county with a bed capacity of 5098. The county has high potential for investment in the tourist hotel sector particularly implementation of vision 2030 flagship project namely Diani Resort City whose construction is on course.

1. Low Participation of Locals in Trade, Tourism and Industry-There is a dearth of local investment in trade, industry and tourism.
2. Overdependence on traditional tourist attraction
   The tourism industry has been mainly focusing on marketing traditional attractions such as leisure and wildlife. Other products like cultural attractions, sports tourism, events tourism and conferencing are not fully developed hence not fully exploited due to lack of resources and inhibitive regulatory framework.
3. Under exploitation of local cultural heritage
   Local music, dances, poetry, artefacts and technologies (such as lala, ryaka, etc) and natural resources like the Kaya have not been fully exploited for the benefit of the people of Kwale.

Kwale County Flagship Projects in Tourism

Project 1: Manufacturing and value addition industries/plants to facilate:

• Establishment of commercially viable fruit processing inside Mkongani ward
• Fish processing in Shimoni
• Silica sand and Cement processing in Msambweni
• Industrial processing of Slates in Maji ya chumvi/Makamini
• Revival of the Kwale-Mariakani Milk scheme

Project 2: Resort City in Diani

This project shall lead to attracting high network tourist, employment creation, Improved living standard, Infrastructure development, Make Kwale county preferred destination in Africa and word resort cities, promote other forms of tourism attraction like event tourism, sports tourism and conference tourism.

Economic Objectives of the department

1. The overall objective is to ensure that tourism retains its position as a leading export and that it becomes a major vehicle for job creation, poverty reduction and wealth creation for the people of Kwale County.
2. Achieve recognition and acceptance of tourism as a priority growth sector.
3. Maximize tourism revenues by increasing the number of visitors and their average length of stay and expenditure.
4. Spread tourism earning widely throughout the county, including previously neglected regions, with maximum participation of local communities.
5. Enhanced linkages between tourism and other economic sectors.
6. Encourage the creation of conducive investment climate.

Social Objectives.

1. Create awareness among the general public of the importance of and general role of tourism in the development of the county.
2. Encourage participation by the community on the ownership and operation of tourism
3. Increase community participation in the planning development, management and implementation of tourism project
4. Provide appropriate tourism education, awareness and capacity building programmes especially for previously neglected religions and community.
5. Ensure all citizens including the disabled have equitable access to travel opportunities and tourism attractions.
6. Eliminate all forms of discrimination in tourism on the basis of language, religion, culture race, disability and gender
7. To monitor and minimize potential adverse social impact of tourism i.e sex tourism.
8. Provide a superior destination experience for visitors by developing and expanding the number and quality of tourists attraction product offerings .
9. To Improve Workplace Environment For beach Traders.
10. To diversify tourists attraction products.
11. To increase media coverage and internet connectivity in the County offices/departments.
12. To provide quality, efficient and timely service delivery to clients.

Community Development and Talent Management

The department has a vision to be transformed social institutions utilizing their common cultural assets to achieve development.

Department’s mandate

• Enhance socio-cultural integration
• Enhance women and youth empowerment.
• Ensure equitable distribution of resources.
• Community capacity strengthened towards perception change.
• Enhance integrity in leadership at all levels.
• Enhance meaningful public participation in all aspects of development.

This is a key sector for the socio-cultural progress of the county and also for shaping social change for rapid county transformation. This thematic area was allocated Kshs 1.1 Billion which accounted for about 7 per cent of the proposed development budget in the CIDP 2013-2017.

The department has the following planned activities:

Enhance women, youth and people with disabilities (PWD) empowerment through:

• Establishment of a youth talent center
• Establishment of youth and women enterprise development fund
• Strengthening existing youth vocational training
• Promotion of sports for meaningful engagement of the youth through
• Provision of sports grounds and sports equipment per ward and county stadia at the talent academy.
• Establishment of Kwale sports lottery fund that would provide a basket funkitty (to facilitate the county’s sports program)

Roads and Public works

The sector of Roads and Public works is one of the key strategic sectors to realize rapid and sustainable county economic growth. This sector provides the requisite foundation for rapid county economic transformation. Roads not only link markets with producers and entrepreneurs in hard-to-reach areas but also facilitate movement of people, goods and services to and from many areas including remote villages where most poor communities live. Further, efficient and effective Roads and Transport System aid timely access and sustainable utilization of natural resources while public works being labour intensive generates jobs which collectively contribute to wealth creation even among the poor and vulnerable populations

The department has a vision to be a globally competitive county economy with sustainable and equitable socio-economic development.

It works under the following mandate

• Promote cooperative movement
• Enhance value addition through SMEs
• Explore markets for trade within and outside the County
• Develop relevant policies
• Micro and Small Enterprise development
• SME training
• Establish linkages with National Government to promote industrialization.
• Develop incubation centers
• Promote of Industrial parks
• Promote industrial innovations.
• Betting control and licensing.
• Weights and Measures.

The department has set the following strategic objectives

Strategic Objectives:

• To Increase integration of county entrepreneurs into market value chain.
• To improve workplace Environment for traders.
• To enhance consumer protection and fairness in trade.
• To Promote Public Private Partnerships
• To promote Kwale County as a favourable investment destination.
• To promote industrialization by growing the Jua Kali sector into medium and large industries.
• To facilitate formation, growth and development of Cooperative Societies in the County in line with global Cooperative principles.

The Roads division is responsible for, construction, and maintenance of all county roads infrastructure and facilities. Public Works division deals with the construction and management of all county buildings and related services and infrastructure. The Mechanical Division is responsible for the provision, supervision and management of transport services, advise on procurement and disposal of county vehicles and machines. In the next 5 years the County will invest resources to expand and maintain the mechanical workshop in order to enhance its capacity to contribute to accelerated development.

The Roads sub-sector will continue with the function of rehabilitating the county access roads. The sub-sector will also give priority to tarmacking and improvement of feeder roads and opening of other rural roads. Maintenance and improvement of the rural roads will permit easy access to markets, goods and social amenities such as health and education facilities and open up areas for development activities.
The Public Works sub-sector will focus on proper designing, construction and maintenance of county infrastructural facilities including county government buildings. The county electrification programme will also be intensified to improve on street lighting and high-mast floodlights to encourage business and enhance security.

Public Service and Administration

The department has a vision to improve governance structures where citizens fully participate for effective development and service delivery.

Strategic goals/objectives of the Department

• To provide an enabling environment for effective citizen participation in governance and for closer and efficient public service delivery.
• To build community ownership of public institutions and self determination
• To streamline security policy implementation processes through increased public participation
• To create well planned urban centres offering all essential services with interlinking networks
• To open up all urban centres for investments through structured infrastructural development.

Department and its Mandates

• To coordinate citizen participation in governance, service delivery and development.
• To undertake urban planning activities and enforcement.
• To provide interdepartmental linkages in public service delivery.
• To provide a supervisory role in delivery of public service and in development projects.
• To co-ordinate with the national government in matters patterning to security as stipulated in the intergovernmental relation Act 2013.

Environment and Natural Resources

The department has a vision to be a well-managed environment where land, mining, and natural resources are utilized sustainably to create wealth for the citizens of the county and a missionof Enabling environment created for accelerated investments on land, mining and natural resources to achieve rapid industrialization of the county.

Strategic goals/objectives of the Department

The  strategic  goals  for  the Department are:

• To attain sustainable land management and development.
• To increase forest cover for sustainable development in a clean and secure environment;
• To manage mineral resources for the County Development and community empowerment

Sub-sectors and their mandates

The Department derives its mandate from the major sub-sectors, i.e., lands, mining, environment and natural resources.

Land sector

Mandate include Lands Policy Management, Physical Planning, Land Transactions,  Survey and  Mapping, Settlement  Matters,  Rural  Settlement planning i.e. eco-village,  Land  Reclamation,  County  Spatial data, and land  Information  System, Administration of public land in the County.

Mining

Mineral exploration,  inventory, and mapping of mineral resources in the County,  and County level mining policy and management mining,  policies  on  the management of quarrying and mining areas, management of health and safety standards in mines.

Environmental management, forest development and management (including re-afforestation and agro-forestry), conservation and protection of wildlife and marine ecosystems, water catchment area conservation and coordination of climate change affairs,

Land, and Land Use

Along the coastal strip and the coastal uplands, land is mainly owned by absentee landlords, leading to the squatter settlement problem. The trust and government land within these areas have since been adjudicated and government settlement schemes established. In the drier areas of the Nyika Plateau in Kinango, Kasemeni, Samburu Ndavaya and some parts of Lunga Lunga Divisions land is held in trust and under group ranches. Land is viewed as communal asset where every member of the community has the right to use it. In most areas adjudication has not been done. Most of the group ranches currently are non-functional and this has resulted in unplanned human settlements in the land. The land is also used for small scale farming, mining and quarrying as well as settlements.

Mean Holding Size

Land as a resource is evidently under-utilized in Kwale County. According to 2005/06 Kenya Integrated Household Budget Survey (KIHBS) the main holding size is 4.4 acres.

Percentage of Land with Title Deeds

Only 22.5 per cent of the land in the county has title deeds. Most land in Kinango, Msambweni and Matuga Sub-counties do not have title deeds.

Incidence of Landlessness

There is a high incidence of landlessness and squatters in Kwale County. Most households are landless specifically in Matuga and Msambweni constituencies. Such households are clearly vulnerable because of their low incomes and inaccessibility to land.

Major Challenge

Land Ownership

Most smallholders who are the majority farmers do not have title deeds. Only 22.5 per cent of the farmers in Kwale have title deeds to their farms. Most of them are squatters who may be evicted at any time thus limiting the farmer’s capacity to use land for sustainable development. Consequently, this has led to poor land use systems leading to environment degradation which further limits the exploitation of county potentials. Further, the lack of tittles limits farmers’ ability to access credit facilities as they cannot use the land as collateral.
Fish production has also been hampered by the illegal acquisition of fish landing sites by unscrupulous private developers. The few fish landing sites that are not yet grabbed are at risk of being illegally acquired as they lack proper documentation.

Water and Sanitation

Water Resources and Quality

The main water resources in Kwale County comprise of rivers (7), shallow wells (693), springs (54, protected and unprotected), water pans, dams (6), rock catchments and boreholes (110). However, most of the rivers are seasonal thus cannot be relied upon to supply the much-needed water in the county for both agriculture and household uses.

Water Supply Schemes

Kwale Water and Sewerage Company is mandated by the Coast Water Services Board to supply/distribute, control and manage all the water supply schemes within the county. Private water service providers in liaison with the Kwale water services board have been supplying water to the community to ensure water is available for all. Other water supply schemes include community owned and managed boreholes, dams and even water pans. Local community participation in the projects has been poor, thus creating problems of operation and maintenance.

Water Sources

The main sources of water are boreholes, springs, dams, water pans and rock catchments. The average distance to the nearest water point in the County is two (2) Kilometres. This is well above the internationally required five (5) meters distance to the nearest water source. More stakeholders are called upon to contribute towards the provision of this important resource to improve the lives of majority of the population in the county through access to safe and clean water.

Sanitation

Latrine coverage is a key component as far as household sanitation is concerned. The main type of toilet facility in the County is the pit latrine accounting for 34.7 per cent of the total population in the County followed by uncovered pit latrine at 33.5 per cent. Generally, the latrine coverage in the County is at 41.4 per cent, which is below the national target of 90 per cent.

Education

The department has a vision to be the best education and training provider in the region and a mission to impart timely, adequate and relevant knowledge, skills and attitude to the youth and ECD going children for enhance economic development.

The department works towards the following goals:

• To increase access to early childhood education & training
• To improve the quality of ECD and training.
• To implement the ECD and youth polytechnics curriculum.

Pre-School Education

The ECD has been mainly supported by private sector and has improved in the recent past. The County has a total of 820 Early Childhood Development (ECD) centres spread evenly in the county with total enrolment of 43,874 pupils comprising of 22,042 boys and 21,832 girls. This translates to a gross enrolment of 57.95 and 58 per cent for boys and girls respectively. The teacher pupil/ ratio is at 1:32 and the average ECD attendance age is 4.5 years. The ECD enrolment of 58 per cent is very low, this may account for the poor performance at national examinations such as KCPE due to weak educational foundation by the pupils as some of them join primary school without having attended ECD education.

Primary Education

Kwale County has total of 415 primary schools comprising of 363 and 52 public and private primary schools respectively with a total enrolment of 167,318 pupils which constitute a gross enrolment rate of 99.7 per cent. The primary school teacher population is 3,192 which translate to a teacher/pupil ratio of 1:52. However, of concern is the performance in national examinations which is very poor. The main challenges include poor and inadequate school infrastructure such as classrooms, toilets and desks and dilapidated infrastructure as well as inadequate number of teachers.

Literacy

The literacy levels in the county have been recording an increasing trend over the last few years. With the introduction of the free primary education for all and adult classes in the County, the literacy levels have reached an average of 57 per cent. However, the female literacy levels stands at 47.4 per cent against 66.6 per cent for the male. There are a total of 143 adult education learning centres in the county with a total enrolment of 5,870 learners.

Secondary Education

The county has a total of 54 secondary schools with a total enrolment of 19,194 students comprising of 10,037 and 9,157 boys and girls respectively. This constitutes a gross enrolment rate of 29.75 per cent. The secondary school teacher population is 572 this translates to a teacher student ratio of 1:37 though the teacher distribution is uneven with hinterland schools experiencing high teacher shortage.

Tertiary Education

The tertiary institutions in the county include a Kenya School of Government (KSG), Kenya Medical Training College and 4 registered youth polytechnics. The county has no National University to offer training at this level to the local population despite the growing demand for higher education. There are a few commercial colleges mostly at Ukunda/Diani that offer courses related to hospitality, salon and beauty, computer and IT training, among others.

Tabular information is recommended, containing population data as at the last national census, current estimates, and medium-term projections. Similar projections should be done for urban population in key towns in the County, and population distribution & density per division and constituency.

The department has achieved the following

1. 40 ECD centers in the county constructed four polytechnics in the county
2. Supplied teaching, learning materials to all the ECD’s and polytechnics.
3. Supply of “uji” to 300 ECD centers
4. Supplied furniture & water tanks for 40 ECD in the county
5. Construction of arts and play facilities
6. Paid for more than 20,000 students and dispatched 100 million shillings as bursary fund.

The project is working towards accomplishing the following projects

1. Anticipating to construct 60 ECD centers
2. There are plans of employing more ECD teachers and other ECD officers i.e. quality assurance officers.
3. Equipping the ECD with Arts & play facilities.
4. There are plans to upgrade the polytechnics to be Training Institutes.

Health Services, and Nutrition

The sub-sectors in the health sector include Medical Services, Public Health and Sanitation. Poor health services in Kwale County are attributed to inadequate health workers; high disease incidences of preventable diseases such as malaria, diarrhoea, and HIV/AIDS;  drugs and substance abuse due to lack of employment opportunities for the youths; inadequate medicines  due to poor supply chain for medicines and inadequate health facilities and services due to skewed budget allocation.

Sector vision and mission

The sector goal is to have developed and well-equipped health facilities for improved health services.

The department’s vision is to have functional and health services that contributes to  holistic development in the County and has a county whose health services and facilities resonate with the health needs of its residents for sustained development in the county

Access to Healthcare

The County has a total of three (3) government hospitals, eight health centres and sixty- four (64) dispensaries located in Msambweni, Kwale and Kinango constituencies. The doctor and nurse population ratio stands at 1: 76,741 and 1: 3,133 respectively. In addition, the county has two (2) private hospitals both located in Diani town. The average distance to the nearest health facility within the County is seven (7) kilometres as compared to the required maximum of three (3) kilometers.

Morbidity

The five most common diseases as recorded in the health facilities within the county are Malaria, Diarrhoea, Flu, Respiratory diseases and Stomach- ache with a prevalence rate of 37.7, 4.6, 16.4, 5, and 3.1 per cent respectively. These diseases highly contribute to the morbidity in the county which stands at 22.5 per cent. This calls for tailor – made interventions to address this health challenge in the community.

Nutritional Status

Nutritional status in the county is very low especially in the arid and semi-arid areas of the county. The predominant form of manifestation of malnutrition in the county are stunting, underweight and acute malnutrition accounting for the percentages 35, 21 and 6 respectively.

Immunization Coverage

Immunization against preventable diseases is key to ensuring a healthy future human resource generation. Immunization coverage in the county stands at 77 per cent of thechildren under one year compared to the national target of 85 per cent.

Access to Family Planning Services/Contraceptive Prevalence

Family planning (FP)/contraceptive use for the fertile generation of between 15- 49 years is still very low in the County recorded at 38 per cent. In order to realize improvement in contraceptive usage, more health facilities need to be established in addition to up scaling of the services in the existing facilities. This will improve on the access for those services at the health facilities and reducing the average distance to a health facility which currently stand at seven kilometers.

Ministry’s Major Challenges

Poor delivery of quality health services

The county delivery of health services is still poor. As a result child mortality rate is very high at 149 compared to the national figure of 116 deaths for 1000 live births. Most (77.2%) mothers still deliver at home without the assistance of skilled health personnel. Morbidity rate in the county is at 22.5 and Malaria prevalence rate is at 40 percent which is higher than the national average. Poor delivery of health services is a major challenge in Kwale County and is attributable to a number of causes:

Inadequate health workers

Health services delivery is poor mainly due inadequate health workers in the health facilities. Currently the 73 health facilities comprising of 3 district hospitals, 5 health centres and 65 dispensaries are manned by only 612 staff both medical and non-medical. The deficit of health workers in the county is estimated to be 300.  Kwale’s lack of adequate health workers in various cadres is attributed to a shortage of local trained health staff workers as a result of few training opportunities provided to locals who are qualified to undertake medical courses. Locals who are qualified to undertake medical courses are unable to get admission to medical training institutions because of the centralized system of recruiting students for medical courses. Health workers from other parts of the country who are posted to the county often resign when they are posted in remote health facilities. Most of them prefer working in health facilities located in urban areas or along the Mombasa – Lunga-Lunga road.

High disease incidences

Prevalence of preventable diseases such as malaria, diarrhoea, HIV/AIDS among others is high mainly due to lack of information, knowledge, poor practice and behaviour change on disease prevention and control by the community.  Due to the inadequate trained staff required to promote preventive primary care to the community, levels of health knowledge and health seeking behaviours are still quite low.

Shortage of medicines, medical supplies, and equipment

Shortage of medicines, medical supplies and medical equipment is a common phenomenon in all public health facilities in the county. Patients who visit health facilities are often requested to purchase medicines and other medical supplies such as gloves from private pharmacies.  These perennial shortages are mainly caused by poor management of the supply chain for medicines. Due to inadequate capacity for health staff, they are unable to properly manage the stock of medicines and medical supplies and timely provide information for re-stocking.
Medical equipment is broken due to poor maintenance. Most health facilities lack modern equipment. For example, the county referral hospital lacks specialized diagnostic and treatment equipment such as CT scan, X-Ray machines, Ultrasound machine, cryotherapy machine, dialysis machine, and radiotherapy machine. Machines and equipment for specialized laboratory tests such as CD4 machine, coulter machine, urea and electrolyte, thyroid function tests are inadequate. Sub-county hospitals which are supposed to offer basic diagnostic and treatment services, lack equipment such as X-Ray machines, Ultrasound machine, and specialized laboratory tests (CD4 count, coulter, urea and electrolyte). The situation is worse in Health centres and dispensaries where equipment required for offering basic diagnostic and treatment services such as basic lab equipment, delivery beds, blood pressure machines, BMI machines are lacking and where available they are not in a working order.

Inadequate health facilities

Medical facilities in Kwale County are inadequate in terms of the number of health centres and the service provided to the local population. People travel long distances for treatment, with the average distance to the nearest health facility being 7 kilometres. This coupled with poor road network, force many to forgo treatment. Over the years skewed budget allocation has resulted in disproportionate availability of health facilities and health services. Even with the few facilities available in the County, they are largely under-resources and inaccessible to many people.

Poor management of health facilities

Poor management of health facilities is a key contributor to the poor delivery of health services in the county. The hospital management boards of the three district hospitals face numerous challenges and hence unable to effectively discharge their responsibilities and hence deliver on their mandate. Political interference, lack of budgets, lack of commitment among the board members and lack of cooperation and team work between the boards and the hospital management teams are some of the key reasons to poor performance of the hospital management boards.

As a result of the poor management of the health facilities and especially Msambweni, Kwale and Kinango hospitals, the available limited resource are not well managed. Pilferage of medicines is common, health workers are often absent from duty, hospital equipment not properly maintained and patients not served well.

In order to achieve the sector vision, dilapidated health facilities will be rehabilitated for effective service delivery while other facilities shall be expanded. To check on infant mortality, immunization, nutrition and IMCI programmes shall be expanded and scaled up with active involvement of the Community health units. Appropriate strategies will be initiated to upscale activities under the HIV & AIDS, TB, Malaria, and Reproductive Health and Communicable diseases control programmes.