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An efficient and high quality care system that is accessible, equitable and affordable for all Kenyans.




To promote and participate in the provision of integrated and efficacious promotive, preventive, curative and rehabilitative health care services to all Kenyans.


Functions of the Health Administrative Unit


  1. Health administration is the coordination of efficient and effective management of health support services.

  2. Promoting the welfare of patients and staff at ensuring their security.

  3. Liaising with other professional and technical departmental heads in order to improve overall management and delivery of health care services.

  4. Overseeing procurement, provision and maintenance of facilities.

  5. Preparing of budgets; sound management of budgeting allocation and revenue collection.

  6. Develop structures for effective management, utilization, repair and maintenance of health fleet of motor vehicles including ambulances.

  7. Ensure health facilities, especially buildings, comply with safety, health and other laws and regulations and are well maintained.

  8. Be responsible for administration of service provider contracts in maintenance of ICT facilities, buildings, motor vehicles, security etc in the health departments.

  9. Coordinate project proposals and oversee implementation.

  10. Coordinate gazettement of health facilities and management committees.

  11. Oversee implementation of cost-sharing/ Facility Improvement Fund (FIF) programmes.


Key achievement


  1. Coordination of transport services in the department which entails timely maintenance of motor vehicles.

  2. Coordination of Makueni Universal Health Care (UHC) program across the facilities.

  3. Installation and implementation of citizen service charter in all health facilities.

  4. All mothers not on NHIF have been enrolled on Linda mama programme across all county facilities.

  5. All facilities have been gazetted.

  6. All rural facilities and hospital management committees have been gazetted.


Plans for Improvement


  1. Rolling out registration on NHIF and Universal Health Care (UHC) for those services that are not offered under Makueni care eg, Oncology and Renal unit.

  2. Training of health facility management committees.

  3. Quarterly CHMT meetings.




Market sanitation


This includes,

  1. Face lifting of premises through plastering, painting and roofing of business premises.
  2. Re-carpeting of floors or tiling of the floor to render them  into smooth finishes were dirty and dust cannot lodge.
  3. Ensuring all premises in markets have functional pit latrines.
  4. Enforcement of public health laws to abate public health nuisances.

Food quality control


  1. Frequent and regular inspection of food premises to ascertain their hygienic status.
  2. Inspection of food and food products to ensure only food of quality, nature and substance as enshrined in food drugs and chemical substance Act cap 254 is sold to the consumers.
  3. Medical examination of food handlers to stamp out transmission of communicable and food borne diseases.
  4. Seizing and sampling of suspected food stuffs in the market, and taking the samples for analysis in authorized government institutions for testing and analysis.
  5. Licensing of all food premises which is a sign of public health compliance.

Village sanitation

This is achieved through community Led Total Sanitation process which encompasses the following;

  1. Pre- triggering – This is a process which brings leaders together to plan on the actual triggering. The leaders includes, CHVS, village elders, community resource volunteers, administrators, chas/ chews, phos, chiefs and assistant chiefs and any other community resource person.
  2. Triggering – Activity carried out at village which practice open defecation and includes- Introduction of participants, drawing of village map, village transects walk, flow diagram, shit calculation, disease burden costing (fecal oral diseases) and community declaration after a trigger moment (match box in a petrol station trigger moment)
  3. Follow up – This is a six weeks activity, Natural leaders and committees formed during triggering in company of public health official visits house hold to check the following indicators.

  Non- negotiable indicators

  1. These are indicators which must be fully attained before a village is declared open defaecation free;
  2. Presence of functional pit latrine in each house hold.
  3. A pit latrine providing privacy
  4. Aperture cover in pit latrine
  5. Hand washing facilities with running water and soap preferably a tippy tap.
  6. Absence of human faeces in the village after transect walk or house hold visitations.

Negotiable indicators

  1. Cloth line
  2. Utensil dish rack
  3. Refuse pit
  4. Water treatment


  • ODF claim – The committee and natural leaders after frequent village follow up posses an ODF claim to the area PHO in the triggered villages who also informs the SCPHO on the ODF claim from the community to form a sub county verification team.


  • Verification – The verification team together with village sanitation committee visits all households checking at both negotiable and non- negotiable indicators and fills verification forms which the SCPHO and SC CLTs coordinator analyzes the data and if they are satisfied that the villages are ODF writes a report to the county PHO to prepare certification team.


  • Certification – The county public health officer forms a team of master certifiers from other sub counties who visits the verified villages checks at both negotiable and non negotiable indicators. Once the team through the lead master certifier are convinced the villages are ODF, they write a report to the county PHO for issuance of ODF certification, ODF sign post and  arranges for celebration.





The Nutrition Unit implements various programmes to prevent and manage diseases thus promoting health and wellbeing of the citizens. These programmes include:


  1. Micronutrient diseases prevention and control-Vitamin A supplementation for children aged 6-59months every 6 months ,Iron and Folic Acid supplementation to all pregnant women, Surveillance for Iodine in salt at household level
  2. Maternal infant and young child nutrition-Promoting optimal maternal nutrition, Promoting, Protecting and Supporting breast feeding, Promoting timely, appropriate and safe complementary feeding
  3. Food and Nutrition Security-Nutrition surveillance, Management of acute malnutrition, Preparation and implementation of nutrition drought response plans, commodity management
  4. Clinical nutrition-Nutrition Assessments, Counseling and Support for all nutrition related disease conditions, Promotion of healthy diets and lifestyle
  5. Nutrition Education
  6. Nutrition Advocacy
  7. Nutrition Coordination


Several achievements have been realized by the Unit which include and not limited to;


  1. Development of the Makueni County Nutrition Action plan 2018/19-2022/23
  2. Well-coordinated nutrition activities by all stakeholders
  3. Improved nutrition indicators
  4. Enhanced nutrition surveillance and response


The nutrition unit endeavors to improve services by;


  1. Strengthening nutrition coordination
  2. Enhancing nutrition education through community sensitization
  3. Initiating Adolescent health and nutrition education
  4. Intensified support on interventions focusing on the first 1000 days
  5. Enhancing resource mobilization to support nutrition interventions
  6. Enhance nutrition surveillance and response
  7. Improved monitoring and evaluation of nutrition activities to attain targeted indicators



Health products and technologies are recognized by WHO as one of the key building blocks of a health system. The Kenya Health Policy (2014-2030) outlines HPTs as one of the eight policy orientations. Investments under this policy orientation in Makueni County is aimed towards ensuring that effective, safe and affordable HPTs are available and rationally used at all times, while moving towards a strategic County HPTs reserve.


Functions of the HPT Unit include:


  1. Regulation, Policy and Governance
  2. Product Selection and Quantification
  3. Procurement of HPTs
  4. Warehousing and Distribution of HPTs
  5. Supply Chain Information Management System
  6. Human Resources and Capacity Development for pharmaceutical personnel
  7. Partnerships in HPT Supply chain
  8. Quality Management and Rational Use
  9. Financing, Resource Mobilization and Pricing
  10. Monitoring, Evaluation and Research


Good management of Health Products and Technologies (HPT) is important to ensure that the quality of these valuable commodities is maintained up to the point of use and that items required for delivery of quality health care are continuously available.


Some key achievements for the unit include consistent availability of essential medicines and medical supplies for public health facilities in Makueni County and select Faith Based Organizations via proper quantification, timely procurement and efficient logistical support to enable redistribution and avoid wastages and expiries. This is further entrenched by training staff on commodities management and other emerging topics such as antimicrobial stewardship and strengthening institutional capacities through hospital medicines and therapeutic committees, county and sub-county commodities technical working groups and the building of a county store to act as a buffer warehousing facility for the county.


The HPT unit plans to automate the management of commodities by progressively deploying a computerized systems to enable end to end visibility of all product in health facilities.





Function of the Unit


The County Government of Makueni is committed to achieving the sustainable development goals that are geared to the reduction of deaths among children under five years old. This is actualized by the Nursing and Immunization Unit. The Unit provides vaccination services for childhood and antenatal women and against other diseases outside the Expanded Programme on Immunization schedule for preventive and emergency disease outbreaks through 276 immunizing facilities. Immunization is one of the most cost effective preventative health care interventions that is available to the community.

Vaccines improve quality of life as they can prevent diseases that can cause physical and mental disability such as poliomyelitis.  Immunization is not only valuable to individuals and families but also to communities, societies and governments.


Key achievements


  1. Full immunization of over 95% of the target population. Achieving a high rate of immunization coverage through routine immunization is its main strategy for controlling, eliminating and eradicating vaccine preventable diseases. Once a high rate of immunization coverage is attained, it should be maintained and it is important that each cohort of new-born children and women of child bearing age is fully immunized.
  2. Reduced incidence of vaccine preventable disease outbreaks


Plans for improving service delivery in the unit


  1. Initiate new vaccination sites to enhance access to immunization services
  2. Conduct outreach clinics in hard to reach areas




Community health department is crucial in delivery of level one health services and strengthening of community facility linkage. Integration of community health services with other thematic areas in important for optimal positive reversal of health indicators. Makueni County has a total of 3512 active Community Health Volunteers, 219 Community Health Units attached 207 health facilities. 98% of the Community Health Volunteers are trained on basic module ,which is basically the foundation for level one service delivery  .Community health Workforce has been instrumental in reversing majority of Nutrition, WASH and Maternal New Borne and Child health negative indicators. This has been achieved through training and mentoring and supportive supervision .The County is however, experiencing increasing trend of non-communicable diseases for the last 5 years, the department of health is leveraging in community health volunteers to disseminate information on early screening and prevention measures. Medtronic labs is working with the county government closely to reverse the trend.


The county just like the rest of the globe aspires all its citizens to receive quality and affordable health care .This aspiration spurred calls for Makueni Universal Health Care, which CHVs have been instrumental in sensitizing the communities to enroll together with other available health insurance services like NHIF, Edu Afya and Linda Mama.


The department is in process of finalizing community health policy 2021-2030 and costed strategy 2021-2025 with technical support from Financing Alliance for Health .The policy and strategy are seeking to address contextual challenges which are mostly not addressed by national policy and strategy. Community strategy has outlined activities that shall be carried out in the next five financial years. Both documents are aligned to the CIDP, County Vision 2025 and the department envisions the subsequent Annual work plans shall be informed by the strategic implementation matrix.



Medical laboratory unit play a crucial role in total patient management in health care service delivery, Laboratory investigations help to determine the presence, extent, or absence of disease as well as  monitor the effectiveness of treatment, the unit also play an indispensable role in saving lives through provision of blood and blood products to needy patients.


Makueni county laboratory unit has a total of 82 public laboratories which are managed by two hundred and ten personnel across the six sub counties and one blood donor satellite.

The hospital laboratories are equipped to offer more comprehensive tests and serve as referral sites for primary health care facilities which offer basic routine tests.


Currently Makueni laboratory services unit has six sections which offer an array of tests according to the level of the facility laboratory.

Microbiology section, culture clinical specimens to isolate possible suspected pathogens which further subjected to drug sensitivity tests to determine medicine efficacy.


Parasitology section, examine specimens to determine presence, type and the density of parasites in a patient


Hematology section, analyze whole blood specimens, perform full blood counts, and examine Blood film to determine blood disorders. Carry out coagulation studies to determine blood clotting times, coagulation factors, and platelet abnormalities.


Clinical biochemistry, perform different tests on serum or plasma, these tests, mostly automated, includes quantitative testing for a wide array of substances, such as lipids, blood sugar, enzymes, and hormones.

Immunology/Serology use the process of antigen-antibody interaction as a diagnostic tool to determine presence or absence of blood pathogens

Immunohematology, or blood bank determines blood groups, and performs compatibility testing on donor blood and recipients. This section is tasked to provide safe and adequate blood and blood products to patients with emergency and chronic conditions.


Since devolution, Makueni laboratory services unit through department of health has achieved notable developments, which include: equipping County, sub-County and five primary care level laboratories with specialized automated analyzers, renovation and equipping of blood donor satellite, increasing the laboratory coverage and workforce.


The department of health has plans to operationalize two laboratories in each sub county, increase laboratory workforce, establish molecular and histopathology laboratory, enroll five hospitals in accreditation process and increase the number of automated analyzers so as to improve on service delivery.




The objective of the School Health Unit is to provide health services   towards meeting the health needs of children in and out of school together with their teachers and parents and eventually the entire community considering that children act as  agents of change .



School health functions include the following:

a. Health education and promotion on the following thematic areas;

  1. Values and life skills
  2. Gender, growth and development
  3. Child rights and responsibilities
  4. Water sanitation and hygiene including promotion of hand washing with soap, safe drinking water, food hygiene, menstrual hygiene and environmental sanitation
  5. Nutrition
  6. Disease prevention and control for both communicable and non-communicable diseases
  7. Special needs , disabilities and rehabilitation
  8. School infrastructure and environmental safety


b. School Health Services

  1. Vitamin A supplementation
  2. Deworming
  3. Immunization
  4. Counselling services
  5. Provision of Personal hygiene products like menstrual health products
  6. Screening of diseases for example HIV Testing, TB screening, COVID 19 testing among others
  7. Vaccination, for example Human Papillomavirus Vaccine to girls

NOTE: The unit achieves the above in collaboration with other units in the department, other county departments/ ministries and other stakeholders.




The school health unit has been able to achieve the following:


  1. Training of 666 teachers both from primary and secondary schools on adolescent sexual and reproductive health and life skills
  2. Mentorship of 37,257 pupils/ students on adolescent, sexual and reproductive health and life skills
  3. Hosting the National Menstrual Hygiene Day in the year 2017.
  4. Mass deworming of all primary school pupils in 2018 where we reached 289,406 pupils (102% of the target)
  5. Formation of school health clubs in 279 primary schools



The unit plans to do the following:

  1. Deworm at least 80% of children under five years twice every year
  2. Form school health clubs in 50% of primary and secondary schools  by 2022
  3. Conduct sanitary inspections in all (1030) primary and all (418) secondary schools by 2022
  4. By 2023, reach at least 50% of adolescents and young adult with prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
  5. Work with the education sector to increase the percentage of schools with adequate sanitary facilities from 54% to 80% by 2022



  1. Functions of the unit:-

a) Coordination of Clinical services i.e. patient’s history taking, examination, treatment and management.

b) Coordination of Child health activities i.e. Integrated management of Neonatal, Childhood Illnesses – IMNCI, Kangaroo Mother Care – KMC.

c) Coordination of Non Communicable Diseases activities, which includes screening for NCDs, Leakage to care and management.

d) Coordination of Malaria control activities, which include case management and distribution of mosquito nets to pregnant women and children less than 1 year.


  1. Key achievements:-

a) All health facilities with Operational Oral Rehydration Treatment Corners – (ORT Corners) for Management of dehydration in children with diarrhea, hence there has been reduction in child mortality due to diarrhea disease.

b) Screening activities for NCDs, particularly Diabetes and Hypertension has been enhanced. 1874 Diabetes patients being screened and linked to care in 2020/21 compared to 251 in 2019/20 at same time. 64,743 Hypertensive patients have been screened and linked to care in 2020/21 compared to 9,222 in 2019/20.

c)  Malaria morbidity has reduced with incidence rate being less than 1.


  1. Plans for improving service delivery in the unit guided by CIDP, Strategic plan, and AWP.-


a) Improve on NCDs screening, linkage to care and follow up by employing Reverse Referral strategy.

b) Expand scope of NCDs screening up to community level.










To provide rehabilitative care to patients with physical impairments so as to return to the highest and/or near normal level of physical function through cost effective quality service.

The rehabilitative unit is comprised of three departments:

  1. Physiotherapy department
  2. Occupational therapy department
  3. Orthopedic technology workshop

Functions of the unit


  1. Modification of our practice to meet our patients’ needs.
  2. Application of evidenced based practice through use of latest research literature to manage patients’ condition.
  3. Commitment to excel in our practice.
  4. Upholding ethical and integrity standards in the work place.
  5. Use of a holistic approach in therapy to understand the clients and look into every factor that may affect their well-being
  6. Promotion of clients’ freedom to allow personal choices and desires which in turn guides our interventions.
  7. Assessment and formulation of short and long term treatment goals.
  8. Disability assessment/screening for registration with national council for persons with disabilities.
  9. Fabrication and fitting of splints and other assistive devices.
  10. Occupational therapy health education and counseling.
  11. Environmental adaptation and modification in homes and workplace areas to suit clients’ needs.
  12. Referrals for further management.
  13. Provision of prosthetic and orthotic appliances
  14. Provision of mobility aids Correction of congenital deformities
  15. Conduct community based rehabilitation program.


Key achievements


The Makueni County Health Department in the 2020/2021 financial year committed to construct and equip a modernized rehabilitation unit at the Makueni County Referral Hospital. Currently, construction of a physiotherapy clinic is complete whereas the occupational clinic and orthopedic workshop construction is projected to take place in the next financial year.

The health department is also spearheading the Makueni Community Based Rehabilitation program that brings rehabilitative services closer to persons with disabilities and those not economically empowered at the community level.

This is a program that is running in all 6 sub counties.


Projected future plans


The Makueni County CIDP 2018-22 focuses on actualizing socio economic transformation and one of the themes that will ensure this is socio-economic development that has health care as a priority area. The county government has committed to invest in the healthcare building blocks such as adequate health infrastructure and human resource for health. 


The health department plans to equip the newly constructed physiotherapy clinic as well as other rehabilitation units in the county and commits to recruit 13 rehabilitation professionals in this financial year.



Major functions of the unit


  1. Documenting of client medical data at service delivery points
  2. Reporting on service delivery activities
  3. Analysis and dissemination of routine and non-routine reports
  4. Designing/customization of documentation and reporting tools
  5. Organizing printing and distribution of documentation and reporting tools
  6. Training and mentorship of health records and information students on practical attachments from training institution
  7. Promoting and capacity building other health workers on health records and information management.
  8. Storage and retrieval of patient/client medical records and other vital health documents.
  9. Operation and care of health records equipment and infrastructure.
  10. Initiation and supervision of health records automation


Major achievements


  1. Establishment of health records and information departments in all hospitals
  2. Establishment of terminal inpatient filling system in all hospitals
  3. Initiation of inpatient morbidity and mortality reporting in all hospitals
  4. Establishment of efficient reporting system in level 1, 2, 3, 4 and 5.
  5. Improvement of reporting rate on major reports from 65% in 2013 to 100% in 2021
  6. Automation of data management at Makueni county referral hospital, Makindu sub county hospital and Mbooni sub county hospital.
  7. Automation of reporting at hospital and sub county levels through KHIS (Kenya health information system) and KMHFL (Kenya master health facility index) platforms.
  8. Establishment of Makueni county referral hospital and Makindu sub county hospital as a teaching facility for health records and information students.
  9. Customization of SOPs (Standard operating procedure) for health records and information management.


Plans to improving health records and information services


  1. To establishment of health records and information departments at all health centres and high volume dispensaries
  2. To initiate direct reporting to KHIS (Kenya health information system) in all health facilities.
  3. Improve the skills of health workers on data management in terms data accessibility, analysis, interpretation and dissemination.
  4. To install EMR (electronic medical records) in all hospitals.
  5. To establish secondary filling for old, less active and non-sensitive documents in all hospitals

County Health Records and Information Officer busy in office.



Core functions

-alleviation of pain during surgery.

-administration of anaesthesia during surgery.

-Maintenance of patients admitted in ICU.

-provision of counseling on patients undergoing surgery.

-maintenance of anaesthetic equipment.

-ensuring patients safety during surgery.


-provision of leadership at the county level.

-provision of relevant data to the CHMT

-smooth running of all county operating theatres.

-attending CHMT meetings on data reviews and planning.

-training of anaesthetists on relevant and current trends.



-Increase in the number of anaesthetists from 3-35

-increase the number of operating theatres from 3 to 9

-approximately 20 anaesthetists have been trained on OSS (Obstetric safe surgery)

-timely resignations and promotion of anaesthetists.



-increase the number of anaesthnetists by 12

-training more anaeshetists on obstetric safe surgery

-up to date data collection and analysis.

-continuous supply of theatre drugs.


-creation of Makueni county anesthesia conference.

-proper and prudent use of resources



Description of the Unit


The unit has three components namely;


  1. Reproductive health
  2. Family planning
  3. Sexual Reproductive Health and Rights, including Adolescent Sexual Reproductive Health
  4. Reproductive tract cancers (cervical and breast cancers)
  5. Maternal Health
  6. Antenatal care
  7. Intra-partum care (safe delivery)
  8. Post-natal care
  9. Essential maternal care
  10. Emergency Obstetrics care
  11. Newborn Health
  12. Immediate care of the newborn
  13. Early initiation of breastfeeding
  14. Essential newborn care
  15. Emergency newborn care

Functions of the Unit


  1. Providing leadership on all Reproductive, Maternal and Newborn Health Services and Programs
  2. Development of Reproductive, Maternal and Newborn Health strategic plans and annual work plans
  3. Budgeting for all Reproductive, Maternal and Newborn Health activities
  4. Collaborating with reproductive health partners and stakeholders
  5. Conducting community mobilization for reproductive, maternal and new-born health activities
  6. Coordinating reproductive health training courses and mentorships
  7. Carrying out support supervision of health facility staff
  8. Preparing progress reports on the achievement of reproductive, maternal and new-born health activities and programmes
  9. Conducting advocacy for increased resource allocation for reproductive, maternal and new-born health services
  10. Monitoring and evaluating reproductive, maternal and new-born health services
  11. Disseminating and providing support for implementation of national reproductive health policies and guidelines

Key achievements


  1. Development, launch and successful implementation of a costed family planning strategic plan, the Makueni County Family Planning Strategic Plan 2020-2016
  2. Successful advocacy of the creation of a budget line for family planning services
  3. Development and enactment of a law on Reproductive and family planning services, the Makueni County Reproductive Health and Family Planning Act 2019, to ensured continued support for Reproductive, Maternal and Newborn Health Services
  4. Creation of a pool of trainers and mentors on various reproductive, maternal and newborn health programs
  5. Increased uptake of Reproductive, Maternal and Newborn Health Services, in particular skilled birth attendance over the years


Definition of health promotion according to WHO.


  1. Health promotion is defined as the process of enabling people to increase control over, and to improve, their health’ (WHO, it represents a comprehensive approach to bringing about social change in order to improve health and wellbeing.


Social Behavioral Change Communication

  1. SBCC is the systematic application of interactive, theory-based and research-driven communication processes and strategies to address change at:
  2. Individual
  3. Community
  4. Societal levels

Advocacy – The pursuit of influencing outcomes, -it is the pursuit of influencing outcomes, including public policy and resource allocation decisions within political, economic, and social systems and institutions – that directly affect people’s current lives


Social health marketing – is a process that applies marketing principles and techniques to create, communicate and deliver value in order to influence target audience behaviours that benefit society (public health, safety, the environment and communities) as well as the target audience


Building healthy public policy- Participating on policies development, dissemination and implementation process at county and national levels e.g. Primary health care policy, health promotion policy, NCDs policy etc.


Reorienting the health services- Conducting Training, mentorships, coaching to health workers, key stakeholders and multisector etc


Creating supportive environments: -Ensuring conducive environment that promotes health holistic.

Strengthening community actions: – Activities of elderly, youths, men and women cohorts etc

Developing personal skills – Furthering studies, Mentorship of health promotion students. Etc


  • Commemoration of World Health Organization days e.g. cancer, diabetes, Hypertension, cardio day, geriatrics, Contraceptive day, vasectomy day, safety day, midwives’ day, etc
  • Strengthen and Promote Public, private Partnerships.


  • Participate in global health promotion exchange programmers.


  • Design develop and disseminate Health education, communication, information materials


Evaluation and mentioning of health promotion programs-supportive supervision

  1. Participate, coordinate in health promotion research
  2. participate in international health promotion conference and symposium.
  3. coordination of health education and communication services at all levels.



  1. Improved health literacy level amongst makueni citizens by 80%
  2. Availability of very vibrant health promotion services from county level, sub county level, ward level, sub ward and cluster level100%.
  3. Availability of SBCC trainer of trainee 50.
  4. Designed, developed and disseminated health education, information and communication materials 2,000 copies.
  5. Developed digital health education information and communication materials 100.
  6. Active psychosocial Support groups for persons living with NCDs 27
  7. Participation in health policies and strategic frameworks development, dissemination and implementation 98%
  8. Improvement of health indicators holistic per WHO 90%
  9. Participation in global health promotion exchange programmes Price of Songlah university Thailand and Limpopo university South Africa 100%
  10. Strengthening community actions, trainings, mentorship on health promotion services 100%
  11. Advocacy, social behaviour changes communication, social mobilizations and social health marketing in context of health promotion 100%
  12. Effective and efficient coordination of health promotion programmes at all levels.100%
  13. Participation in local and international symposium programmes 100%
  14. public private partnership involvement and strengthening in health promotion context 100%
  15. Promotion of SDGS, equity and social inclusion in health context 100%.
  16. Media engagement in health promotion services 100%