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STRATEGIC PLAN

2014-2019

August 2014

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TABLE OF CONTENTS

TABLE OF CONTENTS........................................................................................................................................................... 2

ABBREVIATIONS AND ACRONYMS....................................................................................................................................... 5

EXECUTIVE SUMMARY......................................................................................................................................................... 6

CHAPTER ONE: INTRODUCTION......................................................................................................................................... 12

1.1 BACKGROUND...................................................................................................................................................................121.2 CHALLENGES FACING DECF-KENYA.......................................................................................................................................141.3 THE STRATEGIC PLAN.........................................................................................................................................................15

CHAPTER TWO: VISION, MISSION AND CORE VALUES......................................................................................................... 15

2.1 PHILOSOPHICAL FRAMEWORK...............................................................................................................................................152.2 VISION............................................................................................................................................................................162.3 MISSION..........................................................................................................................................................................172.4 CORE VALUES...................................................................................................................................................................17

CHAPTER THREE: STRATEGIC AND STAKEHOLDERS ANALYSIS.............................................................................................19

3.1 INTRODUCTION..................................................................................................................................................................193.2 SWOT ANALYSIS...............................................................................................................................................................203.3 EVALUATION OF PAST PERFORMANCE....................................................................................................................................223.4 RECENT DEVELOPMENT.......................................................................................................................................................233.5 EXTERNAL ENVIRONMENT ANALYSIS (PESTEL FRAMEWORK).....................................................................................................243.6 STAKEHOLDERS ANALYSIS....................................................................................................................................................27

CHAPTER FOUR: STRATEGIC ISSUES, OBJECTIVES AND STRATEGIES.....................................................................................42

4.1 STRATEGIC ISSUES..............................................................................................................................................................424.2 OBJECTIVES AND STRATEGIES...............................................................................................................................................424.3 STRATEGIC ISSUE 1: GOVERNANCE, LEADERSHIP AND CULTURE.................................................................................................434.4 STRATEGIC ISSUE 2: RESOURCE, FACILITIES AND INFRASTRUCTURE...............................................................................................444.6 STRATEGIC ISSUE 4: COLLABORATION AND PARTNERSHIP...........................................................................................................464.7 STRATEGIC ISSUE 5: AWARENESS CREATION ABOUT RETINOBLASTOMA.........................................................................................474.8 STRATEGIC ISSUE 6: EFFICIENT AND EFFECTIVE TREATMENT AND CARE FOR RETINOBLASTOMA PATIENTS.............................................48

CHAPTER FIVE: STRATEGIC PLAN IMPLENTATION AND ACTION PLANS................................................................................49

5.1 INTRODUCTION..................................................................................................................................................................495.2 GOVERNANCE AND ORGANIZATION STRUCTURE.......................................................................................................................495.3 THE STRATEGIC PLAN IMPLEMENTATION MATRIX.....................................................................................................................50

STRATEGIC OBJECTIVE 5: TO CONTRIBUTE TO THE DEVELOPMENT OF SOCIETY THROUGH CREATION, STORAGE, APPLICATION AND DISSEMINATION OF KNOWLEDGE.................................................................62

STRATEGIC OBJECTIVE 6: TO ENSURE ALL CHILDREN WITH RETINOBLASTOMA RECEIVE TIMELY, ADEQUATE TREATMENT AND CARE.......................................................................................................................................................................... 64

CHAPTER SIX: FINANCIAL IMPLICATIONS............................................................................................................................ 78

CHAPTER SEVEN: MONITORING AND EVALUATION...............................................................................................81

TABLE OF CONTE

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ABBREVIATIONS AND ACRONYMS

AMPATH BODCEODFID DECF IARC HMT HRICIPEKSB MOHMOUNCST OCO OSU PHC SMARTSMT SOPTBRbUSAIDCBMOEU

Academic Model Providing Access to Healthcare

Board of Directors

Chief executive Officer

Department For International Development

Daisy’s Eye Cancer Fund

International African Research Centre

Health Management Team

Human Resources

International Centre of Insect Physiology and Ecology

Kenya Society for the blind

Ministry of Health

Memorandum of Understanding

National Commission for Science and Technology

Ophthalmic Clinical Officer

Ophthalmic Services Unit

Primary Health Care

Specific, Measurable, Achievable, Realistic, and Time bound

Senior Management Team

Standard Operating Procedures

Tuberculosis

Retinoblastoma

United States Agency for International Development

Christian Blind Mission

Operation Eyesight Universal

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EXECUTIVE SUMMARY

This is the second strategic plan of DECF-Kenya, a milestone for an organization founded just

five years ago. We look forward to the challenges of implementing the plan over the next five

years to achieve our vision, mission, and objectives. The strategic plan begins with a

Background of DECF-Kenya. The vision, mission statement, and core values are discussed in

Chapter Two. The strategic and stakeholders analysis has been done in chapter three. Chapter

four outlines the key strategic issues, objectives, strategies and outcomes that this plan will

focus on. Where implementation, governance and structure framework are given. The

significance of resource mobilization cannot be overemphasized, and we want to stress the

importance of being able to mobilize locally available or “home grown” resources. Equally

significant is the ability to achieve resource building programmes that will support

implementation of DECF-Kenya strategies. To be successful, DECF-Kenya must network and

partner with other institutions, including government (both central and county), civil society, and

academic. Effective and efficient implementation of the strategies and actions outlined in this

plan will enable DECF-Kenya accomplish its mission and vision to achieve life and sight for the

children affected by retinoblastoma. DECF-Kenya will capitalize on strengths, overcome

weaknesses, take advantage of emerging opportunities, and address national and global

challenges.

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CHAIRMAN’S PREAMBLE

The plan summarizes our priorities and sets out a

series of strategic objective that we believe will

help to make Daisy’s Eye Cancer Fund Kenya

(DECF-K) more efficient and effective supporting

the development of high quality evidence based

care for children with retinoblastoma (Rb). In

particular, this plan addresses the question of how

we will implement our mission going forward.

This document was assembled as a result of a deliberate planning process and received input

from a range of stakeholders from a variety of backgrounds - Ministry of Health, Moi Teaching

and Referral Hospital, Sally Test Pediatric Centre, DECF-K, DECF-UK, DECF-CANADA,

University of Nairobi and the community sector. They represented the interests and concerns of

a wide diversity of the entire society. We acknowledge the immense support from Kenya

Community Development Fund without which we would not have achieved this strategic plan. I

must also not forget our long time partner Prof. Helen Chan who through TUYF had the vision to

strengthen our Canadian partners ability to perform specific functions to us.

We believe that working in partnership with others is key to ensuring a major leap forward in the

understanding and treatment of Rb. Therefore, we will take a leading role in forging new

strategic alliances particularly where there are opportunities to expand our efforts in providing

long term solutions and challenges faced in providing quality care for Rb patients. We also

understand the importance of Rb research, and will invest in developing an infrastructure and

environment that promotes acquisition of high quality evidence to support care.

I thank all of the people who took part in our consultation and offered us their insights, evidence,

experience and ideas. We received a lot of input without which we simply would not have been

able to develop a plan directed at the realistic targets to enhance care of children in the real

world. I must congratulate DECF team for keeping the children’s needs foremost in the

development of organizations goals and objectives, regardless of personal interests.

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A strategic plan is a dynamic document that by its very nature, will be undergoing continual

reassessment and refinement. At the same time, our main objectives are clear and important to

the long-term contribution of DECF-K to sustainable high quality care for children with

retinoblastoma.

Dr. Vijoo Rattansi (OGW)Chairman- BOD Daisy’s Eye Cancer Fund

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FOREWORD FROM CEOI am pleased to present to you DECF-K’s strategic plan 2014-

2019. I appreciate the efforts of all who were involved: the

Board, staff, consultants and other stakeholders. DECF-K has

demonstrated its ability to network, and promote trust,

solidarity, respect and unity among diverse members,

reinforcing democratic practices in a transparent manner.

Considerable work has gone into shaping this plan so that it is

a result of an intense and rigorous process of thinking,

analyzing, questioning, consulting and making challenging

choices.

After serious deliberations with all stakeholders DECF had

first considered incorporating other cancers and thus the ability to attract wider sources of

funding. There was no consensus and thus we all agreed to remain with Rb only. One of the

reasons is to avoid the dilemma of mission creep and introduction of inconsistency that is likely

to come with diversified sources associated with strong financial position. However it is key to

note that local fundraising for such a narrow cause is difficult. This also means that definitely

heavy reliance financially on our external donors will continue.

Critically this plan allows my team and I to prioritize our limited resources to meet the challenges

that exist. I also hope that this plan will improve participation of all the stakeholders in three

perspectives; quality of local participation in both locally and externally supported projects, the

depth of stakeholders influence on decision making, the range of stakeholders and the timing

which relates to the stage of the process at which different stakeholders are engaged.

It provides direction for development of high quality evidence based care for children with Rb

over the next 5years and also lays a foundation for an even higher performing and sustainable

service for many years to come. Our six strategic priorities are value driven and define our

priorities going forward. Therefore the plan seeks to give a framework of how to achieve the

promise of life and sight to all children with Rb. I am confident that this plan will enable us to

deliver the promise to all children with Rb.

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DECF team traditionally has preferred diversified but localized resource base as a strategic

option. This enhanced its ability to act on its own terms. Kenya provided more of human and

material resource as opposed financial resource and just to emphasize again this has helped

DECF to avoid introduction of inconsistency in the activities of the organization and vulnerability

of the vision. Mobilizing volunteers and community resources is a strategy that keeps DECF to

the real commitment and hence, to sustained impact. Going forward, care must be taken, least

there is compromise on continuous staff recruitment and training, denying DECF a succession

plan.

On the financial aspect of DECF, this plan subjects all our activities to a budget. DECF has

experienced ‘silent’ internal competing strategies and interests due to limited resource base.

The budget should enhance organization wide “points” of participation in joint sourcing of

resources and decision on how any material or financial resource surplus should be treated.

Budgets can create a pre-condition for joint problem solving in a complex and difficult area.

Involving all in Planning and budgeting demonstrate willingness to empower.

Within the financial options, DECF faces two immediate decision paths. One is to generate

financial resources itself. This can help protect it from having a shortfall in critical resources like

salaries and operations since it can make the decision of where the surplus should be kept. An

alternative option is to access or tap surplus funds created by others, which rotates around

shifting heavy dependency on foreign donations to heavy dependency on domestic begging.

True sustainability seems in many instances not to be an integral part of funders thinking and

practice and instead there is always a big gap in rhetoric and reality on this issue. One thing we

have not answered as a team is how we are translating into operational practice our expressed

expectation that the Rb program and DECF itself should be self-sustainable. For the Rb dream

to survive a deliberate action is needed to create an enduring funding base. There has to be a

strategy to sustain the core. Otherwise my experience and observation foresee a shameful and

unfavorable context of disengagement, which is not thought through but result from funds

running out, donor fatigue, and resignations of staff or just tiredness of DECF for ignoring a clear

sustainability objective from the start. Creation of an endowment fund is a strategic choice that is

long overdue. To put it simply in the words of David Bonbright “ how to invest in order to cease

investing.”

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Lastly assuming that the strategy is well understood then we must move to development

initiatives. It would be important to bridge the gaps that are caused by the differences in

understanding and imbalance in power between those doing the work of negotiating ‘in the field’

with stakeholders and those providing or mobilizing resources.

Brian Ouma Chief Executive OfficerDaisy’s Eye Cancer Fund

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CHAPTER ONE: INTRODUCTION

1.1 Background

DECF K is part of a global fund, whose mission revolves around the management of

Retinoblastoma (Rb). Established in 2004, DECF is a registered charity in England, a special

fund at the Hospital for Sick Children in Toronto, Canada, a registered NGO in Kenya and, since

2012, a registered nonprofit organization in the USA. We are working towards the day when no

child faces death and blindness, secondary to Rb.

The story of DECF begins with an English girl, Daisy, who endured four years of treatment in

England and Canada in a marathon battle to overcome Rb in both eyes. Her family established

a fund to help meet the costs of treatment in Toronto, Canada. Shortly after their return to

England in the summer of 2004, they learned of a child, Rati, in Botswana, who had a life

threatening Rb relapse. They wanted Rati and her family, to share the hope they had been

given, and donated money from The Daisy Fund to help her access the best chance of cure in

Canada. Rati had a single tumor in one eye. Curative treatment was available in Botswana, but

delayed diagnosis, poor understanding of pathology results and lack of follow up care, led to life

threatening relapse. Though she received expert care in Canada, Rati’s treatment came too

late. Delayed diagnosis and incomplete care in Africa led to her death, at age four and a half

years, in August 2006.

DECF evolved from the generosity of Daisy’s family, creating light from the darkness Rb brought

to her life and Rati's. They are helping to save the lives and sight of children, with Rb, in other

countries who are just as loved and valuable to the world. Their experience reminds us that

early diagnosis is critical to enable best evidence based practice to save a child’s life and sight.

Rati taught us that many opportunities to save children’s lives are missed in the developing

world, and much can be done to improve care and share hope.

John White was born in Kitale, Kenya. He was diagnosed with bilateral retinoblastoma in Nairobi

in 1946.He was subsequently treated at the London Moorfields Eye Hospital in the UK, there

being no appropriate, advanced (for the time) treatment available in Kenya. He grew up and his

daughter, Abby also has bilateral retinoblastoma. Her family history inspires her in her job as

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current CEO, DECF UK. With her family ties to Kenya, Abby White, motivated Kenya to start

DECF K, Brenda Gallie with her clinical and genetic skills advanced Kenyan Clinical, Scientific

and Technological solutions. Brian Ouma established DECF in Kenya but with all the three

individuals still tackling overlapping issues. The influence and personal contacts of Brian Ouma

and Founding Board members, Dr Vijoo Rattansi, Dr Melvin D'lima, Dr Kahaki Kimani, Lucy

Muhinga and Mitchel Ongaro were instrumental in laying a foundation in Kenya for the entry of

DECF K into the Kenyan Retinoblastoma mix. Using the personal contacts of Brian and Dr

Melvin D'lima, ties were rapidly forged with the College of Health Sciences, University of Nairobi

and in particular its Department of Ophthalmology and School of Dental Sciences in which

DECF K has invested heavily in terms of equipment and training. Brian and Vijoo took this

relationship to a higher level by bringing in their relationship with Dr George Magoha, Vice

Chancellor. University of Nairobi to enhance the DECF K/UON relationship. Melvin's influence at

the Medical Practitioners and Dentists Board considerably hastened the temporary licensing of

Brenda Gallie and other clinical instructors over the years. Brian's close ties with the then

Minister of Health, Prof Anyang Nyongo, boosted the credibility of DECF K in the government

and Kenyan Health Policy making and regulatory environment. DECF K, is characteristically an

informal organization committed to being internally and externally, people centric. It is important

to highlight that in the past, people centeredness has been an ignored area in many similar

Kenyan organizations. A significant feature of DECF Kenya organizational life is that it relies on

interpersonal networks. These networks enhance inter-organizational, formal cooperation and

resource mobilization, even if this process is sometimes perceived as informal. These networks

are familial and customary and have remained very powerful to date in shaping how DECF K as

an organization and its internal processes practically, work. Besides networking a spirit of

volunteerism has enriched the DECF K mission. Teresa Beyer (USA), Lucy Nyarwai, the Barasa

siblings; Hilda, Faith and Victor as well as Anne Nkoidila have soldiered on, often with no

financial reward, for the greater cause of Kenyan Rb Kids. They have been joined at various

times over the years, by Prof. Helen Chan, Dr.Helen Dimaras and Mr. Justin Liu and several

Canadian University of Toronto, exchange students. The success of DECF K is therefore not

measured in terms of Growth and ability to spend but rather with the profitability and output in

terms of improving treatment and early diagnosis of Rb. One agenda that DECF has

continuously perused is to look for strategies that will tie us more firmly with our own economy.

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DECFK identity boils down to the integrity and honesty with which the leaders and staff adhere

to the founding principles and voluntary values

1.2 Challenges Facing DECF-Kenya

The fund is facing major challenges, characterized by dwindling resources, against a

background of an increasing demand for treatment of retinoblastoma cases. Factors such as

economic downturns, and limited philanthropic and donor contributions coupled with the need to

ensure that treatment is affordable have seriously diminished the financial resources for DECF-

Kenya. Other challenges include scanty data which makes it difficult for the fund to make

decisions, organizational politics among stakeholders, donor dependency for funding the

organizations projects, inaccessibility to patients medical records poses the most crucial

challenge, and as a result of this, patients miss to get the timely attention from the organization.

The fund’s operations on the other hand has gaps due to lack of permanent medical experts, the

digital equipment is underutilized. as a result of lateness of data submission, Implementation of

set objectives is a bottleneck because of the contextual differences, the working style of doctors

is different depending on where they originate from (this applies more to the foreign nationals).

There is also lack of commitment from a section of medical personnel, since the incentives

provided does not match that offered by other service providers.

In the recent past, the search for the way forward has yielded significant insights into the nature

of challenges facing the fund; initiatives are being taken to deal with some of these challenges,

which include getting local donors and volunteers to provide services.

As a whole, internal stakeholder’s perception of the organization is positive, while external

stakeholder’s perceptions have improved significantly. The tremendous improvement in virtually

every aspect of the fund has influenced these positive perceptions. The fund faces competition

for scramble for donor support from local and foreign institutions, this has significant implications

for the strategic positioning of the organization.

The fund has valuable strengths, however. Its unique services, is one of the pillars this plan is

built on. The pursuit of excellence in all aspects of DECF life has been unrelenting and has

continued to receive recognition in various quarters at the national and international levels. The

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fund therefore has a strong foundation and pillars upon which to anchor its strategies for dealing

with the challenges it faces.

1.3 The Strategic Plan

The strategic plan was developed through a highly participatory and inclusive process. In order

to ensure the much-needed “ownership”, commitment and leadership of the strategic plan, as

well as the corresponding support for its implementation by its various stakeholders, a

participatory, consultative and iterative approach was employed throughout the process of its

formulation and development. This was done with a view to ensuring as far as practicable, the

necessary participation of the various categories and levels of DECF-K’s key stakeholders. With

particular regard to the procedure and methodology employed, the development of this strategic

plan involved intensive and extensive consultations with DECF-K board members and staff, as

well as other stakeholders-whereby they participated effectively in sharing and inputting ideas

into the draft plan document, as well as intensively discussing them.

During the plan formulation process, reference was made to, inter alia.s An extensive review of

relevant and related DECF-Kenya documents was also done. More data was collected from a

wide cross-section of the funds stakeholders through personal interviews, self-assessment and

consultations. List of stakeholders from whom data was collected is given in Annexure 2

The strategic plan is thus home-grown as it is a reflection of the views of the DECF-Kenya

external and internal stakeholders. The data collected formed the basis of SWOT and PESTLE

analysis and subsequent development of strategic issues, strategic objectives and strategies.

CHAPTER TWO: VISION, MISSION AND CORE VALUES

2.1 Philosophical Framework

Strategic planning is a process that attempts to shape the future of an organization. It is based

on the premise that the future of an organization can be changed. It is not pre-destined. The

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future of an organization is determined by today’s decision and actions. Such planning requires

that three fundamental questions be answered:

Where are we now? (Situation / SWOT analysis)

Where do we want to go? (Vision, mission, objectives)

How do we get there? (Strategies / road map)

Through strategic planning, organizations are able to improve efficiency, economy, effectiveness

and excellence. This way, they achieve the best use of physical, financial and human resources

available to them. The strategic plan articulates strategies to be employed in confronting

challenges facing an organization, developing sustainable competitive advantage and finding the

right place in the environment.

The development of a strategic plan is a collaborative process involving all key stakeholders.

Thus, the process is all encompassing and the implementation efforts require support by all and

sundry.

Undertaking this task, the organization is guided and energized by not only concrete

achievements of the past but also its core business of restoring life and sight for every child.

The management is responsible for the organization standards as a whole .The organization

accepts its moral responsibility to empower people’s lives and connect with stakeholders.

2.2 Vision

Vision is a common way of seeing the future. A good vision is something that people can see;

can almost taste; and that affects them at an operational level. It is an inspiring view of the

preferred future. A vision is therefore a guiding image of success formed in terms of contribution

to society. Features of an effective vision statement include clarity and lack of ambiguity; vivid

and clear picture; description of a bright future; memorable and engaging wording; and realistic

aspirations.

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The demand for a shared vision for the organization arises from the new strategic direction that

will propel the institution to higher level of effectiveness, efficiency and relevance in pursuit of its

mandate. Arising from the analysis and arguments made in section one, the fund aspires to this

common vision:

Life and sight for every child

2.3 Mission

A mission is a concise statement of the basic purpose and role of our organization. It specifies

the functions (activities) and purpose of the organization mission is any activity or programme,

individual or corporate, centrally co-ordinate or otherwise that is undertaken with the intention of

reaching out to those who do not currently access our services. Deriving from the vision, the

organization is:

To create awareness on Retinoblastoma and empower the medical fraternity to provide high quality evidence based patient and family centred care through training, innovation and research.

2.4 Core Values

Core values describe the standards that govern the operations of the Fund and its relationships

with society. Suppliers, employees, community, regulators and other stakeholders. Core values

articulate principles, which guide actions and ethical behavior. Our values are a way of

expressing how we do things. All our programmes are motivated by our primary desire to bring

quality care to each individual child and family, to protect and promote their complete well being,

we unite and inspire our supporters worldwide to champion every child’s right to special care

and protection, quality medical treatment and good health, survival and dignity, love and

understanding. We shall be guided by the following values

a) Excellence in Evidence Based Care

We focus on innovation under-pinned by solid evidence to achieve excellence in retinoblastoma

care for all children and their families worldwide.

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Our programs do not replace statutory responsibilities within any area in which we work. Our

activities provide a vehicle to maximize the application and value of available resources and

skills.

b) Collaboration

We encourage collaboration to broaden understanding and lead action that translates

knowledge and evidence into optimal care. United team spirit promotes mutual support and

respect, co-operative working, and a fun, friendly and enjoyable work environment. We nurture

multi-disciplinary, multi-centre teams that build achievable solutions to secure early diagnosis,

deliver optimal management as close to home as possible and provide effective family support

to minimize burdens on families and health care systems, and raise quality of life for patients

and their relatives. We rely on our international networks and unique expertise to test radically

new approaches to achieve optimal care in challenging circumstances. We seek to work in

partnership with all parents, survivors, medical experts, researchers, organizations, institutions,

donors and other who share our goal or improving outcomes, enhancing quality of life, building

hope and reducing burdens for children with retinoblastoma and their families worldwide.

c) Sustainability

DECF-Kenya programs seek to establish sustainable retinoblastoma care, both in resource

limited and resource rich environments. We promote unbiased collaborative application of

knowledge and resources, realistic programs based on need and available human and material

resources and development of reliable funding streams within partner countries to underpin

these programs. We encourage families, medical teams and communities to be active leaders in

this process

d) Professionalism

At all times DECF-Kenya will act professionally, thus providing quality, reliable and responsible

service

e) Creativity and Innovation

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In our effort to accomplish the vision of DECF-Kenya, the management, employees and

stakeholders will be flexible and imaginative. We will thus be open to new knowledge and skills.

Flexibility will be within the organizations principles.

f) Integrity and trustworthiness

DECF-Kenya will uphold honesty and fairness, be genuine and truthful in what it does.

g) Quality and efficient Service delivery

We are committed to helping those children who need eye care medically, materially, and

psychologically, matching the results to the desired outcome while bearing in mind that

Greatness is measured by the level of service to others.

h) Team spirit and team Work

DECF-Kenya recognizes the need to continue supporting and encouraging each other in all its

activities. It shall continue to complement each other’s effort and build trust in each other.

Together, and with child in our minds, the Fund shall develop the organization to great heights.

i) Good corporate governance and ethics

DECF-Kenya complies with applicable laws and regulations and generally accepted practices in

all its operations. Additionally, our operations are governed by DECF-Kenya corporate

governance principles, DECF-Kenya ethical principles and values, and good management

practices.

CHAPTER THREE: STRATEGIC AND STAKEHOLDERS ANALYSIS

3.1 Introduction

The need to develop a roadmap for the DECF-Kenya required a critical strategic analysis of the

key factors past performance and the recent developments, both internal and external, that

influence its success in achieving its mission and goals during the Planning period. This was

accomplished through an assessment of both the internal and external operating environments.

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3.2 SWOT Analysis

This section analyses the organizations strengths, weaknesses, opportunities and threats, which

will help the organization, determine its strategic direction.

3.2.1 Internal Environment Analysis

The purpose of internal analysis is to identity the Organizations capability, which includes its

assets, resources, and skills. This analysis resulted in identifying key strengths and

weaknesses. Strengths are aspects of DECF’s operations that represent activities that the

Organization does well or resources it controls. On the other hand, weaknesses are activities

that the DECF does not do well or resources that it lacks. The analysis was done in the areas of

DECF’s facilities and equipment, and functional areas of human resources administration and

organization, financial resources and ICT.

3.2.2 Facilities and Equipment

DECF is a relatively young organization. It is therefore yet to accumulate physical facilities and

equipment. However, within the short time it has been in existence, the Organization has

managed to acquire valuable assets which include a high-powered Digital scanner, Retcam,

Laser , microtome, cryotherapy machine,slides and block cabinet and an ultra sound machine.~

used by the organization in its operations.

3.2.3 Human Resources

DECF recognizes that people are the critical mass and its mission, vision goals and objectives

will be realized through proper management of these resources.

The DECF human resource includes the Board of Directors, employees and volunteers.

Volunteers form the largest portion of the DECF human resource. These volunteers include

doctors in almost all hospitals in the 47 counties, nurses, pathologists, parents, survivors and

child life leaders. Effective human resource management will build a strong foundation for the

organization. DECF should therefore strive to maintain its responsibility to be good stewards

over the human resource under the care of its leadership. The organization will therefore put in

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place training and development programmes to encourage peak performance, efficiency and

satisfaction for the overall growth of the organization.

3.2.4 Administration and Organization

For DECF to work more effectively, one of the identified priority areas is the governance at all

levels. When the organization and administration is smooth a good working relationship is

maintained deadlines and targets are met. The highest governing body of DECF is the Board of

Directors which provide strategic direction and is responsible for governance, financial

sustainability, and property acquisition implementation of set strategies and serve as an

important link to the Donors and other stakeholders. Board Of Management has 6 Kenyan

citizens, 1 Kenyan resident, 1 UK citizen and 1 Canadian citizen as at May 09 2014

BOARD COMPOSITION

Chair - Dr Vijoo Rattansi Kenyan

Secretary - Dr Melvin D'lima Kenyan

Treasurer - Dr Kahaki Kimani Kenyan

Member - Mitchel Ongaro Kenyan

Member - Sarah Ellen Mamlin Kenya Resident

Member - Abby White UK

Member- Prof Brenda Gallie Canadian

Ex- Officio - Brian Ouma (CEO) Kenya

3.2.5 Financial Capacity

Finance is a critical resource for the development and operational needs of an institution more

so for a young organization DECF currently relies on donors and well-wishers for its financial

requirements. As it plans its financial independence, there is a need for transparency,

accountability and probity. These will be achieved through proper budgets and policy documents

such as procurement, accounting and project management. Financial management will come

with risks that will need to be mitigated. Such risks include liquidity, credit and market risks,

which must be prudently managed.

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3.2.6 Information Communication Technology (ICT)

ICT covers any product that will store, retrieve, manipulate, transmit or receive information

electronically in a digital form. For example, personal computers, digital television and email.

Human Communication is essential in a situation where there is a wide audience that needs to

be informed as lack of information leads to gossip and misrepresentation of facts as well as

growth of an informal source of communication (grapevine). Therefore proper communication

channels need to be in place to avoid a situation where others are left to interpret actions and

events in their own ways. Communication has been defined as the sending of a message

through a medium to a recipient. For communication to be effective, it has to be timely, accurate

and relevant.

3.3 Evaluation of Past Performance

DECF has performed reasonably well since its inception. Through the Kenya National

Retinoblastoma Strategy Group and its collaboration with the universities, teaching hospitals and

the ministry of health, DECF has been able to deliver a national guideline that streamlines the

treatment and management of Retinoblastoma in Kenya. This means that all children diagnosed

with eye cancer in Kenya undergo standardized treatment and management.

DECF has worked with the Ministry of Public Health to include information about early signs of

retinoblastoma in the Mother and Child Health booklet. This systemic nationwide education to

parents and primary health workers will aid early referral, diagnosis and treatment, improving

prognosis and reducing burdens on the health system and parents. Prior to roll-out, a study of

children diagnosed with retinoblastoma in a two-year period recorded age and stage of disease

at diagnosis. This baseline data will enable assessment of the booklet’s impact on diagnosis.

DECF initiated child life training at the Sally Test Paediatric Centre in Eldoret, giving doctors,

nurses and other health advocates skills to deliver child centred care and family support. Child

life promotes effective coping through play, preparation, education and self-expression activities

based on natural child development. Training is led by our Certified Child Life Specialist,

Morgan Livingstone. In class learning and hands on practice includes training in medical play

and simple explanation to prepare children for procedures; self-expression tools for a non-verbal

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or distressed child; distraction play and comfort positioning to reduce procedure anxiety and

increase co-operation; massage and guided imagery to control pain and help the child relax;

palliative care, including grief and bereavement support for the family; and recreational activities

to lift spirits. Child life can reduce treatment costs, for example, by eliminating the need to

anaesthetise children during procedures like lumbar puncture and radiotherapy.

Cycle of Light / NHIF enrolment etc…

DECF has also improved the management of patient information through eCCRb; an online

database that ensures patient information is recorded and made available to any doctor

managing the patient wherever they are referred. We however face challenges in getting

complete data especially where physical infrastructure for example computers and Internet are

lacking.

In supporting the development of skills, DECF has facilitated training for ocular and orbital

pathology Pathology and Clinical Retinoblastoma at The Hospital for Sick Children,Toronto,

Canada, We have also facilitated training of 18 histopathology technologists in-country and we

continuously offer training on treatment and management of Rb to doctors through our

international team that operate on complicated cases together with the local doctors once a

year.

Research and Innovation is also at the core of DECF and since its inception it has supported

three research projects of which one is complete and the paper published. The other two are

currently ongoing. The research completed helped to establish baseline Rb epidemiology in

Kenya and the other two are focused on assessing the quality of processing of specimens so as

to improve histopathology and in the long run, diagnosis.

3.4 Recent Development

KNRbS scale to East African National Rb Strategies (Country Focus Strategy to Global Focus

Strategy)

There has been keen interest from Ghana, Ethiopia and Uganda for DECF K to have a presence

or invest its resources and expertise in these countries. Delegations of Rb workers from Uganda

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and Ethiopia have experienced the KNRbS making process, first hand and wish to replicate the

model in their countries, with technical support from DECF K. We have unique competencies

that can be exported to Uganda and expose workers to a new management paradigm. The

opportunities for DECF K to scale the KNRbS to an East African Country National Rb Strategies

remain a pregnant point. Uganda is particularly interested in collaborating in the development of

their own national strategy. Logistical challenges have limited the scope of DECF K outreach

activities. However DECF K technical experts have traveled to Kampala, Uganda and Addis

Ababa, Ethiopia on capacity sharing activities, which have required some financial outlay. Kenya

and Uganda in particular are socio-culturally similar countries and can easily leverage on each

other’s synergies to develop a strong Rb co-competency in the region. DECF wishes to play a

leadership and catalytic role for a renewed push for all east African countries to have their own

national Rb strategies. This wish must be communicated to all stakeholders. We have

developed a guide handbook that outlines step by step how Kenya reached where it is now,

lessons learnt and best practices. We are very excited with this next phase of DECF.

In summary, DECF must realize that with its leading competitive advantage in the region, it is in

a unique Strategic space. Moving from a domestic to an international presence has various

strategic challenges. DECF must aim to meet this challenge effectively by crafting a strategy for

the entire network that does not require strong coordination from the centre but is responsive to

national and regional environmental needs as we pursue a ‘’One Rb World” integration. The

different countries should be encouraged to respond to local needs unless there is reason for

not doing so. The degree and the level of, standardization of the future National and Regional

Guidelines is a conversation that has already been initiated by some key COECSA operators

and other stakeholders.

3.5 External Environment Analysis (PESTEL Framework)

The external environment of the DECF-Kenya is divided into general and operating

environments. The general or macro-environment includes external factors that usually affect all

or most organizations. These factors include political, economic, social-cultural, technological,

demographic and legal (PESTEL) forces. The operating environment, on the other hand,

includes those external forces and groups that external influence that affects DECF-Kenya

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growth, success and survival. These are “owners “ “customers’, “competitors”, “suppliers”,

‘government regulators”,” pressure groups” and “employees”. The outputs of external

environment analysis are the opportunities (favorable conditions) and challenges (unfavorable

conditions) facing the DECF.

3.5.2 Political Environment

Devolution has affected DECF-Kenya in the classification of hospitals.

Co-ordination office: changes no longer centralized.

Difficulty in monitoring patients.

Public Doctors boycott (due to poor remuneration and working conditions)

Understanding devolution challenges.

COECSA (EACO/OSEA) – a unifying body for all ophthalmologists and advantage to DECF-

Kenya.

Peaceful environment in the Country has encouraged doctors from other countries to come

and work and carry out research

Doctors from different regions perceive issues differently this leads to conflict of interest.

3.5.3 Economic Environment

Resources; there is a scramble for resources by all NGO’s which has lead to financial

challenges.

Government funding has gone down so DECF-Kenya is forced to pay for the services they

offer to the public e.g. (printing of posters)

Consortium – it is hard to get into the consortium to enable bid for funds/ finances, allocation

of funds in the consortium is marked with politics during the resource allocation

3.5.4 Social-cultural Environment

The socio-cultural environment encompasses characteristics, values, ideas and attitudes of

people. Family life is the pillar for socio-cultural characteristic and these might greatly be

influenced by various factors in a society including politics, education economic status and

changing lifestyle. Some of the values may be pegged on traditional and cultural beliefs,

norms, taboos and practices that may interfere with complete medication or treatment and

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care of a patient. Some ethnic groups may not have shed off witchcraft beliefs and practices,

which contradict the process of treatment. This is therefore a challenge to DECF’s mission.

High poverty levels limits chances of survival for eye cancer patients.

Minimal survival chances for eye cancer patients as a result of poor access to health care /

medical facilities. Distances to the medical facility (accessibly to medical/health care)

Age factor is an issue since it affects children of younger age between 1-7 years. Parents

abscond responsibility to take care, value older ones more than young children.

3.5.5 Demographic Environment

Population growth, shelter and housing, health and related disease pandemics are most external

issues affecting families in the communities. The segment of the population aged 1-7 years form

a critical resource for the future, it is therefore important to invest in young people’s health and

development. Disparities in the provision of health services continue to widen in Kenya

especially in terms of access and affordability. People are known to travel many kilometers in

many parts of the country to seek medical services, with the small number of Doctors offering

quality medical services may not be forthcoming. In addition many families find it difficult to meet

medical expenses due to declining income and constantly increasing costs. As a result, there’s

increasing tendency to delay seeking medical attention. Many children are therefore at risk

complications and death due to delayed medical services. DECF-Kenya is challenged in this

area and need to seek support from government and well wishers in order to provide proper

timely treatment and care to children with retinoblastoma countrywide.

3.5.6 Technological Environment

DECF-Kenya accesses minimal patient information of the thus a lot of gaps are created which

makes it difficult to monitor or assist the patient further e.g. Genetic information or doctors

detailed information which has strict procedures to obtain

E- Cancer records (physical files) unveiled, tracking the movements of the file from one point of

treatment to the next point is a challenge therefore it is difficult to monitor a child to facilitate

check up and provide for drugs and fare.

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Centralized Lab UON, Dental School/College of ophthalmic merge an advantage to DECF-

Kenya operations.

3.5.7 Legal Environment

Regulations on Ethics regarding patient’s information is an issue/challenge to DECF-Kenya

since the process of getting Ethics approvals is quite lengthy and sometimes by the time you get

it, the need for the data is long overdue.

Implication of the PBO act to be included.

3.6 Stakeholders Analysis

A stakeholder is any person, group, that can place a claim on the DECF resources, attention, or

output, or is affected by its output. A stakeholder analysis is the means for identifying who

DECF-Kenya customers/stakeholders are; how they influence DECF-Kenya; what DECF-Kenya

needs from them; and how important they are to DECF-Kenya. There are two types of

stakeholders: external and internal stakeholders.

An external stakeholder is any person or group outside DECF-Kenya who can make a claim on

DECF-Kenya attention, resources, or output or is affected by DECF-Kenya output while an

internal stakeholder is any person or group inside the and DECF-Kenya (employees and the

volunteers’ and DECF-Kenya leaders). The key stakeholders of DECF-Kenya are summarized in

table 3.1.

Table 3.1: The key Stakeholders of DECF

STAKEHOLDERS EXPECTATIONS

EXTERNAL STAKEHOLDERS To be consulted and involved when changing Rb

management strategy and policy

Children, parents, survivors and their

wider family.

They expect to receive exemplary care, to be

treated with respect and understanding, to be told

what DECF is doing to help them, how and why

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this will make a difference. They need to be

educated about how they can aid the process so

more families benefit, to be given a platform from

which to safely share their expierences without

fear, to become ambassadors for other families

and for DECF to help advance the org’s mission.

Ministry of Health-

O.S.U

K.N.H

M.T.R.H

Coast Provincial

Kenya Society for the Blind

To be involved and consulted in major key areas

affecting DECF especially those related to the

management of Rb

Private / mission hospitals working

within the KNRbS, e.g. Kikuyu, Lions,

Lighthouse,

Ministry of Education-

U.O.N-

School of Medicine (Depts of

Ophthalmology and Pathology)

School of Dental Sciences

(Dept of Oral and Maxillofacial

Surgery, Oral Medicine, Oral

Pathology and Radiology)

To be consulted and involved when changing Rb

management strategy and policy

County Authority

To be considered as key partners in the

management of Rb

Suppliers of the organization

Roche East Africa

Faram EA Ltd

To be engaged in the supply of goods and

services pertaining to the management of Rb

Eye NGO's To provide benchmark and the support in the

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CBM

OEU

Sightsavers

Kenya Society for the Blind

management of Rb

Other NGO's

Kenya Community Development Fund

Kenya Palliative Care Network

To be engaged in wider consultation in the areas

of local funding

Individual and corporate donors to the

organization.

REGIONAL STAKEHOLDERS

COECSA

Makerere University

Mbarara University

Addis Ababa University

To be engaged all the time during major decision

making affecting DECF

INTERNATIONAL STAKEHOLDERS

DECF UK, CANADA AND USA

University of Toronto - Dept of

Ophthalmology and Vision Sciences

The Hospital for Sick Children, Toronto

Indiana University

Child life trainer / facilitator

Donors to DECF International

They expect feedback on programs progress and

to be engaged widely

INTERNAL STAKEHOLDERS

DECF-Kenya -Board of Directors

- Management Team

To oversee policy formulation and

implementation and to keep operations within

country laws and policies

Volunteers

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3.6.1 Strengths, Weaknesses, Opportunities and Threats (SWOT) of the DECF-Kenya

After an in-depth analysis of the internal and external environment the following strengths,

weaknesses, opportunities and challenges (SWOT) for the DECF were agreed on Table 3.2

Table 3.2: Strengths Weaknesses, Opportunities and Threats (SWOT)

STRENGTHS IMPLICATIONS

Skilled and well-focused human resource.

Creating technical assistance

programmers' (KNRbS)- a

database of the skills available

Highly qualified super specialists

in the treatment of cancer

Teamwork amongst staff board and

stakeholders.

It creates a participatory system

of management and ownership

(programmes)

Monopoly – DECF-Kenya is the only

organization that deals with retinoblastoma

(Rb) core competency in Kenya.

There is no competition from any

other organization

DECF-Kenya is branded as Rb

champions in the region

Enjoy tax exemption. Encourages local donations and

maximum utilization of resources

KNRbS Model; Inclusion and accountability. Ensures DECF’S Legitimacy

Established in all medical teaching institutions

in Kenya.

Brings about sustainability of the

programme.

Produced The First Rb Best Practice

Guidelines in the region.

Positioned to be a leader in

Clinical care.

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Strong Institution in DECF

Better able to negotiate or make

demands on government and

public servants on behalf of the

Rb child

Unique programmes targeting capacity

building of medical personnel and eye care

workers.

Highly qualified super specialists

in the treatment of cancer

The already existing awareness of

retinoblastoma countrywide.

Provides public knowledge of Rb,

Ensures early diagnosis thus

reduced mortality rates

Published the first national guidelines on

Retinoblastoma.

There is policy change

Gives high level of treatment

sustainability (Standardized

treatment)

Partnering with centers of excellence (MTRH,

UoN-Dental School, KNH, MoH-DOS)

Encourages research

(Continuously provide solutions to

Rb patients because there is

ongoing research)

Comprehensive medical care

Encourages synergistic

relationship

Creates an opportunity for

Medical tourism in Kenya

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Modern and powerful digital microscopy

scanning machines.

Better diagnosis which means

better treatment

Comprehensive storage of data

Availing services through

technology transfer.

Diversity in Top Management Team and

Governance

Provides a multifaceted approach

in solving problems

Better leadership and direction

Experienced and highly networked board

members

Gives a better direction for DECF-

Kenya

Commitment to the children Leads to the attainment of the

DECF-Kenya Vision

Up to date Documentation of the fund by

DECF

Provides information for prudent

management of the fund

Cohesive dedicated and hardworking team Steers the organization to greater

heights

Keep close with big decision makers Good for the organization future

WEAKNESSES IMPLICATIONS

Unmet expectations due to lack of financial

resources.

Inability to achieve goals

Inability to implement the strategic

plan

Lack of control and monitoring of valuable

assets (Scanners, microtome, Retcam camera

etc.) when partnering with the Department of

The equipment will be

underutilized

DECF-Kenya inability to realize its

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ophthalmology, Department of Maxillofacial

Surgery and Dental school of the UoN

objectives and service the

equipments effectively

Over dependence on foreign donors.

The programme is limited in

scope

There is no incentive to

independently source funds

locally.

Lack of a standard operating procedure for

implementing enjoined DECF-Kenya / UoN

operations

Poor service delivery

Monitoring of patient is not effectively

streamlined due to insufficient data.

Management of patients is

compromised

Decision making is inadequate

Loss of life

Rb only affects a few patients relative to other

childhood cancers

Unattractive funding proposition

Low adaptive viability to donor

trends.

The initial intervention did not figure as highly

in terms of local motivation and so the “buy in”

has been slow.

Makes the trajectory to local

capacity and ownership much

harder. Means more staff time,

energy, patience and skill, as well

as strategic ability.

Insufficient, integration, consolidation of

sustainable benefits that arise from

development initiative

Stagnation, fatigue, collapse and

non-sustainability of tangible

benefits and other gains of the

program

Ineffective and inefficient communication

amongst the board, professionals and

stakeholders

Miscommunication

Inability to implement the strategic

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plan

Demoralized workers

Dissatisfied stakeholders

DECF-Kenya’s minimal provision to parents of

eye cancer (Retinoblastoma) patients

participation

Organization will lack experiential

information about RB

Future plans for awareness and

care will be affected

Lack of localized website for DECF-Kenya Communication breakdown

Historical weak investment in leadership,

management and structural development Looming leadership deficit

OPPORTUNITIES IMPLICATIONS

Improve psychosocial care of children and

families by expanding child life program and

family support, to all hospitals treating

children with Rb.

Equal access to family support,

improve quality of life for children

and families, reduce treatment

costs and related burdens.

Working with families and survivors as

advocates for other families and for DECF.

Greater buy-in by families and

higher visibility with donors, fight

stigma, aid peer-peer support,

ensure the #1 stakeholder has a

strong voice within the org.

Medical practitioners from mother country

(Canada)

Exchange programme, research,

training

Ability of our ECCRB model to go worldwide Formation of a One RB World and

better follow up

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Potential development of partnership with

Ruharo (Keith’s centre), Ghana, Ethiopia.

Gives DECF a chance to

benchmark.

Genetic testing and counseling with the help

of our Canadian Partners

Ability to develop a sustainable

genetic counseling model in

Kenya

Political goodwill from the Kenyan

government

Enforce the implementation of the

guidelines

Assist in distribution of guidelines

Agreeable to DECF-Kenyans

request

Strong support from and ownership by

stakeholders.

Implementation of guidelines will

be easier

Lower cost on implementation

The organization will be much

stronger

Local Willing donors

There will be leeway to work with

the money as they understand the

people therefore better

implementation of grassroots

projects

Operating Environment is conducive for

growth and development.

Research and Training.

DECF-Kenya can continue

building its brand

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Opportunity for supporting the crafting

National Strategies for the different countries

in the region.

Fosters regional collaboration.

Opportunity for supporting the Crafting and

Guiding National Strategies for the different

countries in the region.

DECFK to begin crafting a

Matching strategy, which takes

into, account its strength and

weaknesses to exploit

opportunities and deal with

threats.

Wide Scope of growth for research.

There is evidence based care

Publications and exchange

programmes

Collaboration with stakeholders.

Better understanding among

stakeholders therefore efficiency

and effectiveness in running

programs

Harmonized ideas

The paradigm shift towards non-

communicable diseases including

Retinoblastoma

More funding opportunities

Increased interest in the disease

More awareness campaigns-

Means early diagnosis and higher

survival rates

More professionals going into

cancer issues therefore more

expertise

More research opportunities

expected

Formation of College Of Ophthalmology Provides a platform to share

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East, Central and Southern Africa (COECSA)

has created an opening to the international

community.

DECF-Kenya experiences and

disseminate research

Provides an opportunity to learn

from others

Cloud computing enabling electronic medical

records specific for Retinoblastoma

Available information as and

when needed

More complete records available

Development of a business model for

sustainability (Digital Microscopic slide

scanner)

DECF-Kenya can charge for use

of scanner to raise money and

servicing of the scanner

Existence of histopathology of plants and

animals

Possibility of partnering with the

college of agriculture and

veterinary science-UoN, KARI,

ILRI and ICIPE

Create opportunity for

diversification of products and

services

Income and long term

sustainability

Establishment of a technical assistance

facility to generate revenue for DECF-

Kenya endowment

Consultancy for startups and

related NGOs

Public benefit organization Act dealing with

civil society.

We can engage in business to

raise funds for implementation of

programs

Lead in research Lack of competition which is a

plus to the organization

Creation of National Cancer Institute (NCI)

under the Kenya Cancer Prevention and

Control Act.

Increased visibility and

sponsorship opportunities

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THREATS IMPLICATIONS

Lack of much investment on

sustainability Works against true empowerment and

substantial development.

No accountability of seconded staff

and stakeholders (Doctors,

researchers) to DECF oversight role.

Shift of control to local organization will

never be achieved due to lack of

capacity.

Rb guidelines not part of National

Cancer guidelines Unsustainability

Different cultures between

collaborations partners Under achievement of goals.

Lack of a centralized budgeting

system- internationally

Slows down service delivery

Unequal distribution of funds to

programs.

Great danger of power play.

Lack / need of a proper process

through which all stakeholders

influence and share control over

decisions and resources that affect

their lives.

Threats from Individual Regional

Operators.

Internal process of engagement

occasionally simply treated as a co-opted

input, and means for making externally

supported development happen more

effectively.

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.

Emerging challenge of different

treatment regimes.

Un guided pattern of Development of

several Best practice Guidelines but

implicit; is Quality and standardization

will be in direct proportion to the skills

and expertise available.

Picks peace meal ideas on Guidelines

and Implements in their countries

Over reliance on external funding.

Reliance on project funding; Short

term in relation to ultimate goal.

Focus on deadlines.

Inability to sustain organizational projects

A lead to abrupt termination rather than

phased withdrawal as appropriate

conditions are created; creates state of

insecurity.

Inadequate source of funding for

supporting families.

Life threatening to the children with Rb.

.

Need for financial Incentives to gain

professional staff (business overlap).

Runs counter to the spirit of voluntarism

and self-motivation and the organization

culture that goes with it. Creates; tension,

conflict of conscience and personal

conflict.

Sway DECFK attention towards donors

as primary stakeholders, rather than

towards those who provide their

legitimacy.

Inconsistencies simply accepted for

reasons of organizations survival.

Inability to efficiently utilize equipment Wastage of resources

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provided by donors for research

purposes in between grants.

Compromises accountability to the donor

Obsolescence of the equipment

Inability to develop and fund locally

developed programs,

Kills innovation, morale and spirit of

innovation.

Lots of funding directed to other

strategies

Too many strategies blurs the focus of

the intended strategy

3.6.2 The Need for Change

Time has now come for DECF-Kenya to reassess its position and to strength its leadership role

in health services .To this extent it is evident that the fund has to embark on a process of

strategic change. This is necessary for greater relevance and efficiency in the manner in which it

fulfils its mandate.

The level of effectiveness also needs to be increased through, DECF having well developed

Standard Operating Procedures on how all its major activities should be undertaken.

The increase in cancer cases faces rising expectations and demands and experiences serious

resource shortfalls. Planning therefore must take cognizance of all these challenges and

respond to them effectively. DECF-Kenya has to continue to demonstrate greater accountability

and sensitivity to the needs of stakeholders. There’s an odd duality whereby the fund is taking

on greater responsibility while the level of its financial support from the donors is dwindling in

real terms.

This new paradigm requires greater autonomy for the fund and a new strategic direction guided

by a shared vision, strategic thinking and agility and positioning in a worldwide context. This

paradigm is the major driving force for strategic planning in the organization.

This strategic plan assumes that the need for change is a genuine concern for all stakeholders,

that the concerned parties will seek appropriate solutions and that they are capable of working

together for the common good. The fund’s performance has been very good as it has

maintained a leadership position locally in saving lives of children with retinoblastoma, the fund

must sustain this leadership position, to continue to be the best and maintain its leadership

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locally and regionally, it has to embrace quality assurance, lead in quality, retain the right human

capital within its rank and file and mobilize additional resources to provide the strategic direction

in the long run.

The organization is over reliant on donor funding. To strengthen its financial sustainability, this

situation has to change, and additional funding has to be sought from other sources. The

sources include endowment, fundraising, establishing private-public partnerships or alliances.

CHAPTER FOUR: STRATEGIC ISSUES, OBJECTIVES AND STRATEGIES

4.1 Strategic issues

A strategic issue also known as critical success factor is anything that must be addressed if the

organization is to succeed. Inadequate attention to these issues will adversely affect the

performance of the organization. Strategic issues In the light of the situational and SWOT

analysis the identified the major strategic issues for DECF-Kenya which are outlined below:

1: Governance, Leadership and Culture

2: Resources, Facilities and Infrastructure

3: Research, Innovation and Technology

4: Collaboration and Partnerships

5. Awareness creation about Retinoblastoma

6: Efficient and Effective Treatment and Care for Retinoblastoma Patient

4.2 Objectives and Strategies

Performance objectives are long range results needed to carry out the DECF-Kenya mission.

They represent answer to the question “Where do we want to go?” “Good” objectives must state

what, how much and by when it is to be accomplished. In summary, good objectives must be

specific, measurable, achievable, realistic, and time bound: SMART).

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Strategies are major courses of action that an organization must take to achieve its objectives.

They describe how objectives will be achieved. They answer the question “how do we get

there”. Organizational strategies should be derived from analysis of operating environmental

opportunities and problems; and resources and capabilities of the organization concerned.

After pertinent consultations and evaluations the key stakeholders of the DECF-Kenya

formulated the following objectives and corresponding strategies for every strategic issue were

formulated.

4.3 Strategic Issue 1: Governance, Leadership and Culture

The Board of Directors is the apex body in the governance structure of DECF-Kenya. The

executive management under the direction of the chairperson constitutes the decision-making

organ. Upon the promulgation of Kenya (2010) constitution and the subsequent review of

various legislations, the legal landscape upon which the organization operates dramatically

changed. The devolvement of health services to the counties has made it important for DECF-

Kenya to recast its management structure and align itself to the counties to make it effective and

efficient in the long run. As the organization charts its way forward, it is imperative that it

reposition itself to fully comply with the new demands while taking advantage of the new

opportunities in the operating environment, thus setting itself for maximum competitiveness and

growth.

Objective 1: To manage the organization efficiently

Strategies

Review the composition of the board structure, skills and competencies of the board

members

Create the oversight role of the Board

Review Administrative structures and systems at the management level

Creating a culture of ownership and effective strategy and policy execution

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Create mechanism for entrenching the core values of the organization among staff and

stakeholders

Enhance leadership skills and management capacity at all levels of DECF-Kenya

To review Mission and Vision Statement of DECF-Kenya

Create mechanisms for succession at the board and management level

Expected outcomes:

Improved efficiency and effectiveness

Effective monitoring and evaluation, and

Enhanced commitment and loyalty to DECF

Enhanced strategy implementation and execution

4.4 Strategic issue 2: Resource, Facilities and Infrastructure.

The ability of the organization to deliver on its mandate will depend on the availability and

efficiency of their resource deployment. The resources are the finances, human capital and the

total support infrastructure. This strategic plan will need an up-scaled level of resources to

deliver the planned outcomes. Failure to pay adequate attention to the resource challenges will

lead to sub-optimal performance.

Objective 1: Encourage all trusts, funds and all DECF’s confederates to give money for an endowment fund

Strategy

Establish an endowment fund as soon as possible.

Objective 2: To expand the organizations resource base and enhance productivity

Strategies

Invest in fundraising training to skill up those responsible for in-country income generation.

Increase the organization revenue by partnering with the local donors

Improve staff motivation

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Entrench the use of ICT in the organization

Aggressive resource mobilization initiatives by DECF-Kenya

Innovative mechanisms for resource mobilization

Explore alternative means of investment

Acquire property to enhance and improve financial resources

Build a home for the parents of the Retinoblastoma patients during treatment

Awaken philanthropic spirit in Kenya

Develop a plan for the maintenance of acquired equipment from suppliers and donors

Efficient utilization of available resources

Underpin all Rb activities in the overall organizational budget

Expected outcomes

Increased and sustainable financial performance

Increase of physical infrastructure

Effective use of ICT in research and administration

Productive and motivated workers

Achieve a strong financial base

Enhance savings of funds

Addresses all priority areas and prudent financial management

4.5 Strategic issue 3: Research Innovation and Technology

Research, innovation and technology transfer have great potential for wealth creation and

contribution to sustainable national development.

Objective 3: To promote Evidence Based Research and advocate for modern medical equipment that will facilitate treatment and enhance research.

Strategies

Enhance the capacity of researchers to develop winning proposals

Improve research infrastructure and grants management systems

Enhance dissemination of research outputs to society

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Partner with other stakeholders for joint research

Enhance the implementation of research findings

Expected outcomes

Enhance research output

Enhance donations and collaboration

Improve efficiency in grant and donor funds management

Increase innovations and impact of research output

4.6 Strategic issue 4: Collaboration and partnership

In age of globalization, the trend is for institutions to foster networks, partnerships and linkages

to enhance their competitiveness. The DECF-Kenya occupies a position of great advantage and

can be used in fostering mutual linkages and partnerships with peer institutions and industry.

Whereas the DECF-Kenya has a number of existing linkages, more value adding networks,

partnerships and linkages need to be established at the national, regional and international

levels if the Fund is to reposition itself in the global arena as a viable and vibrant organization.

Synergy-building relationships with various key stakeholders are critical to the overall success of

DECF-Kenya. It is important that it positions itself in such a manner that mutual benefits of all

parties are best achieved. Given the nature and scope of its activities, the various categories of

relevant stakeholders that DECF-Kenya comes into contact with, is enormous. The key

stakeholders that have been identified include the private sector, government agencies, peer

organizations, and the DECF-Kenya stakeholders. It has emerged that the various stakeholders

are positively predisposed to work on joint agenda with the DECF-Kenya.

Objective 4: To enhance value adding partnerships and collaborations

Strategies

Increase collaborations and engagement with stakeholders

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Enhance partnerships and collaborations with public and private sector locally and

internationally

Deepen partnership with UON and MTRH

Work closely with MoH department of DOS

Support development of awareness materials and facilitate workshops for eye care workers

countrywide

Strengthening existing partnerships and linkages and develop new ones

To enhance partnership and collaboration with national Cancer institute

Enhance participation in policy making, events related to cancer

Expected outcomes

Improve quality of research

Cordial relationship with stakeholders

More volunteers on board thus enhancing collaboration and performance of DECF-Kenya

Retinoblastoma information incorporated in mothers and child booklet to enhance awareness

countrywide

Field eye care workers encouraged and motivated

Adapt serious partnerships and alliances locally

Enhanced visibility

4.7 Strategic Issue 5: Awareness creation about Retinoblastoma

Strategic Objective: To contribute to the development of society through creation, storage, application and dissemination of knowledge

Strategies

Sensitizing public about retinoblastoma using electronic, print media

Mother and child Health booklet and Website.

Sensitize the maternal health workers and pediatric community on Rb

Improve communication style

Facilitate training

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Final Draft

Expand to other countries by providing retinoblastoma guidelines

Expected Outcome

Create awareness through electronic and print media

Develop awareness materials e.g. posters

Conduct workshops for eye care workers

Collaborate with ministry of health’s department of DOS to include information in the health

materials (Literature)

Improve management of Retinoblastoma information

4.8 Strategic Issue 6: Efficient and effective treatment and care for Retinoblastoma patients

Objective 6: To ensure all children with Retinoblastoma receive timely, adequate treatment and care

Strategies

Implementation of the National Rb Guideline.

Early, timely diagnosis of Retinoblastoma

Facilitating patients treatment

Improve data capture mechanism for decision making

Engage specialized doctors

Planning treatment schedule for patients who require specialized attention

Organize for patients counseling

Expected outcomes

Enhance early detection thus reduce mortality rates and increase survival rates

Fast/quick medical attention

Enhance monitoring of Retinoblastoma patients

Improved treatment and care

Improved maintenance and efficiency of equipment

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Final Draft

Restoring sight

Enhance support of patients family

Saving life and restoring sight

Psychological support

CHAPTER FIVE: STRATEGIC PLAN IMPLENTATION AND ACTION PLANS

5.1 Introduction

Plan implementation is the action stage of strategic management. The activities central to plan

implementation are establishing annual objectives; devising policies; allocating resources,

altering an existing organizational structure; revising reward and incentive systems; minimizing

resistance to change; developing a strategy-supportive work environment and organizational

culture; adapting operations, service delivery; and information systems; and developing an

effective human resource capacity to deliver the plan.

5.2 Governance and Organization Structure

The appropriateness of an organizational structure is judged according to how well it aids in the

achievement of the DECF-Kenya objectives and how it affects the behavior of the individuals in

the DECF-Kenya. In general the characteristics of an ideal organization structure are that:

The structure should clearly show the positions in the organization and the authority that go with

it;

The structure should show explicitly the chain of command in the organization, and the reporting

relationships with clear indications of who has supervisory powers over whom and what the

boundaries of such powers are;

It should bring out clearly both line and staff responsibilities, and show which positions are in the

direct line of command (those charged with the achievement of primary organizational

objectives) and which positions are advisory (staff positions) to line authority.

The structure should bring out an appropriate span of control (management), and the number of

people that can directly and effectively report to the manager;

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Final Draft

The structure should be able to show activities of each unit and how the activities relate to other

units (coordinating role) and contribute to the overall performance of the organization;

The structure should minimize bureaucracy and delays in the provision of services to

stakeholders; and indicate when and where deviations from planned performance are occurring

and therefore facilitate corrective actions.

Using the DECF-Kenya Vision, Mission, strategic objectives, and the above characteristics of an

ideal organizational structure, as frame of reference, the DECF-Kenya management has

developed an administrative structure to guide its operations and facilitate in the implementation

of the strategic plan.

5.3 The Strategic Plan Implementation Matrix

The matrix indicates what activities are going to be undertaken, by who, when, with what

resources, and the expected results. Action plans serve as a link between plan formulation and

monitoring and evaluation; help in both the appraisal of performance and in the identification of

any remedial actions, and contribute to better motivation of staff through explicit assignments of

responsibilities for implementing and monitoring the programme. The relevant action plan

matrices for DECF-Kenya are presented in Table 5.1.

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Final Draft

Strategic Objective 1: To manage the organization efficiently

STRATEGYSTRATEGIC ACTIVITIES

PERFORMANCE INDICATORS / TARGETS

TIME FRAME RESPONSIBILITY RESOURCES

Review Administrative structures and systems

-Develop a new

administrative

structure

-Undertake

gaps/skills/competenci

es assessment once in

2 years

2 years CEO-Financial Budget

-Consultants

-Develop Finance

Manual,

Succession plan,

SOP’s with

collaborators

-Draft documents

-Reviews

-Approvals

-Consultative meetings

-All documents are

developed

2 yearsAdministration &

operations manager

- Consultant

-Financial budget

-BOD

-Senior Management

Team

Review the composition of the board structure skills and competencies of the board members

-Undertake an

assessment of

BOD skills and

capacity

- Hold a BOD

workshop for

review.

-Hire a consultant

to facilitate this

- A well documented

BOD structure.

- An all round board

with required core

competencies

(balanced mix)

To be undertaken

annually

3 years -CEO

-Secretary of BOD

(CEO)

-Financial

Budget/Funds

-Consultants

-Human resource

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Final Draftprocess

Create the oversight role of the Board

-Creating relevant

BOD committees

-Meetings

-Existence of

functional BOD

committees.

-Proper documentation

of this committees

-Minutes and

resolutions

1year-Chair

-CEO

-HR

-Finance

Creating a culture of ownership and effective strategy and policy execution

-Annual meetings

with all

stakeholders.

-Inclusion of all

stakeholders in

the development

of policies.

-Drafting joint

MOU’s

-Documented outcome

of the meetings.

-Buy in by all

stakeholders.

-Existence of well

developed MOU’s.

-Training BOD /

management on

change management

1 ½ years-BOD and

management

- Finances

-BOD and top

management

Create mechanism for entrenching the core values of the organization among staff and stakeholders

-Documenting

and Framing the

core values

-Daily practice of

core values.

-Hold meetings to

assert the values

(team buildings)

-Framed core values in

DECF-Kenya office.

-Existence of the core

values in the policy

documents.

-Minutes of the

meetings held

-Training management

on change

Annually Administration &

operations manager

- BOD,

- Management

- Stakeholders

- Consultants

49

Final Draftmanagement

Enhance leadership skills and management capacity at all levels of DECF

-Undertaking

trainings at all

levels

-Attending

seminars.

-Continuous

recruitment of

required skills.

.

-Well-documented

number of trainings

and seminars

attended.

-Core competencies

gaps filled through

recruitment.

-Support from BOD

and donors

Annually -BOD

-Management.

- Finance

- Human Resource

-Consultants

To review Mission and Vision Statement

- Holding a one

day discussion

with a consultant

- A well documented,

fitting, catchy, vision

and mission.

Immediately - Consultant

- Consultants

- DECF team/

Stakeholders

Create mechanisms for succession at the board and management level

-Developing a

Human resource

strengthening

Strategy

- Developing a

Sustainability

strategy

- Developing a

Finance

strengthening

strategy

-Draft documents

-Reviews

-Approvals

-Consultative meetings

- Well-documented

HR, Finance and

Sustainability

strategies.

2 years-BOD

-SMT

-Consultants

-Management

-BOD

-Finance

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Objective 2: To expand the organizations resource base and enhance productivity

STRATEGYSTRATEGIC ACTIVITIES

PERFORMANCE INDICATORS / TARGETS

TIME FRAME RESPONSIBILITY RESOURCES

Increase the organization revenue by partnering with the local donors

- Engaging with

local donors

(corporate,

individuals,

foundations)

-Writing proposals

to local donors

-3 successful

proposals done

-1 local MOU signed

-Number of joint

activities

Annually

-Programme

Manager / BOD

- Finance

-High net worth individuals.

-

Improve staff motivation in DECF-Kenya

-Incentives

(awards,

monetary etc.

-Career

development

(training,

seminars,

workshops,

mentorship etc).

-Recognition.

-Job enrichment

-Improve

employee welfare

(e.g. medical

-Successful

implementation of a

training plan.

-Successful

implementation of

career advancement

plan.

-Favorable annual

appraisal

-Certification

Annually - BOD

- HR

- Finances

-Consultants

-Relevant Institutions

51

Final Draft

insurance).

-Competitive

compensation

-Benchmark with

industry.

Entrench the use of I.C.T in the organization

-Training

-Procuring

requisite software,

licenses and

hardware.

-Certification

-Annual relevant

trainings undertaken

-Relevant software

and licenses acquired

Annually for five

years

-BOD

-CEO

-Programmes

manager

-Finances

-Technical expertise

Innovative mechanisms for resource mobilization

-Develop a

technical

assistance facility

(KNRBS) and

equipment

servicing).

-

-Technical assistance

provided once.

In 5 years -CEO -

Finances

Technical resources

-Commercializatio

n of digital

pathology.

-Amount of revenue

raised.5 years Finance

Manager/CEO

Finances/Human Resource

-

-Documentaries

(crowd funding).

-2 successful crowd

funding initiatives

done. In 5 years

Finance

manager/CEO

Finances/Human Resource

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Final Draft-

-Formation of

strategic

alliances.

-3 Signed partnership

MOU’s

-

5 yearsCEO Finances/Human Resource

-(Create

partnerships for

skilled HR) Seek

donations of

expertise from

corporate

-Opportunity cost of

skills and services

offered

5 years CEO

Finances/Human Resource-Leverage

existing HR skills

and services with

probono support

from corporates &

skilled individuals.

-Prioritization of

resource

-Mobilization efforts.

Efficient utilization of available resources

Underpin all Rb

activities in the

overall

organizational

budget

- Spending based on

budget created

- Proper allocation of

resources to address

all priority areas.

Within two months

of the financial year

-BOD

-CEO

-Management

- Finances

-Human Resources

53

Final Draft- Existence of internal

and external

accountability,

Engaging with the central and county governments to mobilize resources

To align the

DECF-Kenya

activities to

government

policies and

instruments

-Avail documentations

e.g. cancer control Act,

PBO Act

Within 2 months

from

implementation

period

CEO/BOD-Finances

-Human Resources

Objective 3: To pursue Evidence Based Scientific Research and provide modern medical equipment that will facilitate treatment and enhance research

STRATEGY STRATEGIC ACTIVITIES

PERFORMANCE INDICATORS /

TIME FRAME RESPONSIBILITY RESOURCES

54

Final DraftTARGETS

Enhance the capacity of researchers to develop winning proposals

Training

workshop/s

Development of 3

successful grants

5 years CEO / International

and local experts

(AMPATH)

-Financial

-Human resources

Improve research infrastructure

Develop policies

for training,

maintenance of

new and existing

equipment and

Obtaining more

equipment

An increase in

publications

Improved Research

into new areas

Efficient working of

equipment

More equipment

2 -3years CEO Finances

Equipment & training

Enhance dissemination of research outputs to society

Publish in peer

reviewed journals

Present research

findings at local and

international

conferences

5 publications

5 presentations

Annually

CEO

Research

committee

Finances

Researchers

Partner with other stakeholders for joint research

Hold a

stakeholders’ forum

for NCST,

universities &

development

partners including

DFID & USAID

One forum annually Every year

Research sub-

committee appointed

by the Board/CEOFinances

Human Resource

Enhance the implementation of research findings

-Review clinical

SOPs once a year

Annual review Annually Research committee

appointed by the

Time, Financial and

Human resources

55

Final Draft-Review non-

clinical SOPs once

every two years

Bi-annual review Biannually Board/CEO

Strategic Objective 4: To enhance value adding partnerships and collaborations

STRATEGYSTRATEGIC ACTIVITIES

PERFORMANCE INDICATORS / TARGETS

TIME FRAME RESPONSIBILITY RESOURCES

Improve collaborations and engagement with stakeholders

Identify potential

collaborators eg

National Cancer

Institute, Oncology

society, Pathology

society, Pediatric

society, private

sector, MOH, DOS,

UoN.

Stakeholder forum

to identify how we

collaborate

Number of new

collaborators per

year

number of

stakeholder forums

Increased visibility

Increased

awareness

Continuous but

yearly

accountability for

5 years

Board/CEO

Time,

Financial

Human

Enhance partnerships and collaborations with public and private sector locally and internationally

Develop MOU’s and

SOPs on ways to

make collaboration

worthwhile to

partners

Increased two-way

communication,

breaking

communication

barriers

Inclusion in national

policy making

Yearly (2-3

MOUs)

Board /CEO Time

Finances

Human Resources

56

Final Draftdecisions

Deepen partnership with UniversitiesWork closely with MoH department of DOS

Develop MOU’s

&SOPs with

ophthalmologists,

Pathologists, dental

school and oncology,

college of Agriculture

and Veterinary

sciences, School of

ICT, School of

Business

Hold quarterly

meetings with the

Chief

Ophthalmologist

Sub MOU’s with the

4 departments

4 SOP’s

4 meetings in a year

<6 months

1 year

CEO

Programs Manager

Time

Consensus

Time

Enhance participation in policy making and events related to cancer

Register as members

of different cancer

societies and

consortiums

Increased

participation in

cancer societies’

events

Immediate wef

implementation of

the strategic plan

AdministratorTime,

Finances

Support development of awareness materials and facilitate workshops for eye care and primary healthcare workers

Develop awareness

materials (both print

and electronic), print

and distribute,

Plan and facilitate

Increased

awareness

Early diagnosis

Increased

Annually for 5

years

DOS in collaboration

with DECF

Time, Finances

57

Final Draftcountrywide workshops

survival rate 5 years

Strategic objective 5: To contribute to the development of society through creation, storage, application and dissemination of knowledge

STRATEGYSTRATEGIC ACTIVITIES

PERFORMANCE INDICATORS / TARGETS

TIME FRAMERESPONSIBILITY

RESOURCES

Sensitizing public about retinoblastoma using electronic, Mother and child Health booklet and print media

Update website and

social media

platforms fortnightly

Newspaper

supplements on

W.Cancer day and

W. Children’s day

24 updates/year

At least 2

newspaper articles

AnnuallyAdmin/operations

manager

Financial

Human

Equipment

Sensitize the maternal health workers and pediatric community on Rb

Identify key people

Hold workshops

with the same

stakeholders

(PHC workers

Nurses, OCO’s,

etc) from central

and county

governments

3 workshops

Increased early

detection of Rb

patients at less

than 2 yrs

Annually

DECF Secretariat/

Central and county

government

representatives

Finance,

Human Resources

Improve communication Develop

Communication

1 SOP 3 months Secretariat and

key identified

Time and consensus

58

Final Draft

style

SOPs for Internal,

external, Financial

and International

communications

recipients

Expand to other countries by providing retinoblastoma guidelines

IEC on guidelines to

Ethiopia, Uganda,

Tanzania, Rwanda,

Burundi, DRC (EAC)

Active participation

in KNRbS meetings

and modification

adoption of

guidelines at

COECSA meeting

Kenyan

participation at Rb

regional country

initiated meetings

5 years CEO

Financial

Time

Human resources

59

Final DraftStrategic objective 6: To ensure all children with Retinoblastoma receive timely, adequate treatment and care

STRATEGY

STRATEGIC ACTIVITIES

PERFORMANCE INDICATORS / TARGETS TIME FRAME

RESPONSIBILITY

RESOURCES

Target Indicator

Improve identification and early detection of those at risk of Rb

Baseline study on

awareness of Rb

-General population

-Parents – Child

bearing age

-Teachers: Pre-

primary/ECD level

-Community health

workers

Baseline report I year OSU in

collaboration

with DECF –

consultant

Finance, Research

team

Awareness raising

campaigns on Rb

targeting

-General

population

-Parents – Child

bearing age

-Teachers: Pre-

primary/ECD level

-Community health

workers

-General population

-Parents – Child

bearing age

-Teachers: Pre-

primary/ECD level

-Community health

workers

50% of community eye

workers should

undergo training within

the year; at least 3

radio station talks in a

year, continue as CME

in the hospitals, public

gatherings, produce &

-

-No of events

undertaken and

articles published

-3 events and 3

articles annually for

the next five years

Annually for the

next 5 years

Informed health

workers and

community

leaders

OSU-

AMPTH

(MTRH) use the

Ampath model

in within Ampath

areas

Ride on child

eye health in

Non ampath

Areas

Transport,

Awareness raising

material (IEC

materials),

Allowances for

promoters

60

Final Draftdistribute at least 8000

RB Charts in 1 year in

all counties.

Regular screening

sessions for infants

and children for

leukocoria, squint

etc. in:

-Schools

-General

community

47 counties

5 schools in each

county with screening

programmes

Annually for the

next 5 years

Health care

workers and

teachers

Transport,

Allowances,

Snellen (VA)

Charts for the older

children, materials

for the eye

examination

(cameras, iphone

and touches)

Refer (within 72

hours) infants /

children with

strabismus or

suspected

strabismus for red

reflex text to:

-Primary health

facility

-Secondary Rb

centre

-Tertiary Rb Centre

All referred patients to

be seen within 72 hours

Number of referrals

having reached the

referral center within

72 hours

No of children

referred from the

peripheral centers

2 years

Annually for the

next 3 years

Primary health

worker

Ophthalmologist

/Eye Care

worker,

Teachers

Comprehensive

referral forms,

transport to support

needy patients, RB

hotlines

Reproduce and

redistribute Rb

related chapters of

the Mother and

Practitioners and

pediatric clinics

Number of pediatric

clinics and

practitioners reached.

(questionnaire)

2 years DECF & OSU &

other partners

Inventory of

practitioners and

pediatric clinics,

Finances for

61

Final DraftChild Health

booklet (to

practitioners and

pediatric clinic)

-Number of

practitioners aware of

Rb issues

-5 facilities in each

county that have the

Rb related chapter in

2 years

reprinting &

distribution

Enhance Rb

awareness among

medical

practitioners [low &

middle level cadre]

Low and middle level

cadre practitioners in

47 counties

-Existence of a

training manual with

Rb related chapter in it

1 year OSU & DECF Training manuals,

CME's, workshops

-No of low and

medium level cadre

that are

knowledgeable about

Rb

4 years

Support

aggregation of Rb

patient information

in counties

Low and middle level

cadre practitioners

Number of patients

referred

1 report of Rb cases

per county

In 2 years

Annually

DECF & OSU Data capture tool

Sensitize social No. Of social workers, Administrators, Social After 2 years STPC/ KMTC Curriculum,

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Final Draftworkers Nurses

and Administrators

on childlife

nurses and

administrators (No of

institutions) sensitized

workers and nurses

in 1 county hospital

per year

Annually Training materials,

Accommodation

for participants,

Facilitation fee

Psychosocial support for children and families.

Develop

sensitization

curriculum on

childlife services for

health and social

workers on child

life to improve

access for all

children and

families to

psychosocial

support

Developed

Sensitization

Curriculum

Training curriculum in

place

1 year STPC/

KMTC/Relevant

MOH department

Consultant,

workshop

Develop simple

information kits

to sensitize

parents on the

same to enhance

their skills in

childlife services

-No of kits available

for training

Parents 1 year STPC/ Relevant

MOH department

Finances for

printing and

distribution,

Training

-Number of parents

sensitized

After 2 year

Annually

Map out childlife

service centers in

the country and

disseminate the

information to

No of centers mapped 1 center annually After 2 years STPC, consultant Checklist,

Allowances,

Inventory of Rb

centers

63

Final Draftenhance access by

those requiring the

services

Support up scaling

of visual

rehabilitation

services/provision

of aids for low

vision for the

affected children,

siblings and other

family members

Number of children,

siblings and families

supported through

visual rehabilitation &

acquisition of visual

aids if needed

Number of

institutions supported

Support 1 institution

per year

3 years KSB/DECF/Kenya

Braille Society

Visual aids,

finances (Braille,

white cane)

logistics,

allowances,

Training material

Support prosthetic

eye services

no of children given

implants and

prosthetic eyes

All children who have

undergone

enucleation

1 year DECF Prosthetic eyes,

Implants, logistics

Support the

development of

play & recreation

infrastructure for

children within the

hospital

environment

Number of play

centers developed

Hospitalised children

with Rb & caregivers

1 centre developed

5 years Tertiary Centres

administration

Space, Room, Play

material, Tvs

Advocate for

development of

palliative teams

Development of

palliative teams

2 palliative teams 5 years Moi referral

KNH /DECF

Information on

available centers

Develop and implement an

Identify and set-up

centers where

-Number of survivors

receiving post

Coast General,

Kisumu PGH Lodwar

Annually Hospital

Management

Skilled personell –

ophthalmologists,

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Final Draft

effective monitoring mechanism for all survivors of Rb

survivors can go

for post treatment

check-up visits,

routine monitoring

and counseling

treatment support

-2 number of

operational centres,

district hospital sub

centre, nakuru sub

centre and all other

level 5 centres.

team/ OSU counselors and

social workers-,

equipment, slit

lamps, formation of

support groups

Develop and give

to each survivor a

card with a unique

identifier no. for

follow-up visits to

be endorsed by

authorized

personnel

Number of cards issued

and in use

All survivors 5 years DECF and OSU

& Referring

hospital

Finance to print &

distribute cards to

hospitals

Support placement

of Rb survivors

-

-Number of Rb

survivors placed in

schools

-Number completing

primary & secondary

education

All children who are

survivors

EARC and low

vision centres,

OCO, KSB

Special needs

assesors, School

fees for the needy

children, Support to

the schools for the

development of

disability inclusive

infrastructure.

Strengthen referral system for Rb from primary to tertiary levels

Map out Rb

referral centers

and their

classifications

15 No of centers

mapped and approved.

Improve the hospitals

below Sec-Coast,

Nyanza, Meru, SEH,

KEU, Machakos, kisii,

thika, Tenwek, kijabe,

embu, kitale,

bungoma, nakuru,

2-3 centres per

year

Team of ophth/

path, OSU

Compliance

Checklists,

Transport,

communication (Rb

Hotline)

65

Final Draftmuranga, busia

Initiate community

outreach services

within health zones

to identify people

at risk of Rb

10 of trained

Community Healthcare

Workers per health

zone

Improved knowledge on

Rb

- More people seeking

eye care services

10 Trained CHEW per

zone

1 year

Every 2 years

OSU,through

Community HW

(Provincial

Health CW)

Trainers of

Community Health

Workers, transport,

Accommodation,

Facilitation fee

Stationary (posters,

checklists)

Train health

workers on

comprehensive

client information

recording and

establish elaborate

database for those

at risk of Rb

-17 Trained hw

I per institution

-Health facilities at

county level, provincial

and National level.

Train in yr 1 and

monitor annually

Ophthalmologist

s in the local

institutitons

Health Workers

from the mapped

centresTrainers,

transport,

accommodation,

Stationary

(database forms),

internet connection

Sensitize from

lowest/mid-level

health care

workers to refer

suspected cases to

the next higher

level of service

provision

10 ToTs trained

-Healthcare Workers in

different centres

sensitized

- Percentage of

low/middle level cadre

reporting referrals

-No of suspected Rb

cases referred and

- Low and middle level

health care workers.

Train in yr 1 and

retrain every 2

years

OSU through

the low and

middle level

facilities

, Checklist, (The

ABC of referral)

Transport,

Accomodation Rb

hotline

66

Final Draftpresenting in the

receiving centre

Sensitize

secondary and

tertiary Rb centers

to readily enroll for

treatment referred

Rb cases

-All secondary and

tertiary centers

- All secondary and

tertiary Rb centres.

Year 1 OSU/HMT Circular from OSU

to respective

centres

Data capture tool

for those treated

Equip different

referral centers

with appropriate

equipment to carry

out immediate and

thorough ocular

and systemic

examination on

referred patients.

[Increased

awareness results

to increased

demand; therefore,

capacity of

facilities to respond

to demand must be

ensured]

100% treatment as per

the centers ability

-100% treatment as

per the centres ability

Immediate OSU/MOH,

DECF and other

Partners

-Infrastructure,

(appropriate

equipment),

institutional

agreements,

Logistics for

equipment delivery

-Trained personnel

Establish a

mechanism for

assisting parents

-No of needy parents

assisted

-100% needy cases

assisted

1 year OSU/ HMT,

DECF

Finances, free

hotline

and agreements

67

Final Draftwho cannot afford

transport to

immediately

respond to referral

Refer patients with

difficult unilateral

cases from

secondary to

tertiary centers.

No of difficult unilaterals

refered

100% difficult

unilaterals refered

Continuous for 5

years

-

Ophthalmologist

s

-Diagnostic

equipment

-Transport, Rb

hotline, trained

OCO, or

Opthalmologists,

Referal card

Refer children with

high - risk

pathological

features to tertiary

centers

No referred to tertiary

center

100% of high-risk

pathological features

refered.

Continuous for 5

years

Ophthalmologist -Diagnostic

equipment

Transport,

communication

-Mscope

Establish effective

feedback/follow-up

mechanisms

between referring

physician & the

receiving Rb

center.

[Coordination]

- 100% of the reffered

cases that present at

the receiving facility.

- Refering physician

and the receiving

ophthalmologist

1 year Ophthalmologist

s

-

Telecommunication

Transport

-ECCrb/Mscope

-Detailed Referral

Form

-24 hrToll free

telephone centre at

DECF Kenya

Map out centers

with MRI so that

patients can

-No of equipped

centers

MTRH, Provincial

(Embu, Garissa,

Kisumu, Coast,

1 year OSU/DECF -Checklist showing

MRI centre

68

Final Draftaccess MRI

services & other

Rb-related

services

Nakuru, Nyeri,

Kakamega) and

private hospitals and

clinics.

Improve quality of treatment and care for Rb patients

Identify and

establish effective

Rb care

multidisciplinary

team

(Ophthalmologist,

Pediatrician

Oncologist,

Pathologist

Radio-oncologist,

Anesthesiologist

Palliative team/

Child psychologists

Nutritionists, Social

worker Patient

service,

coordinator,

Oncology nurse

Childlife specialist

(-(strengthen

cross-referrals /

consultations

among Rb

centres))

4 Tumor board

meetings 2 in every

centre

Ophthalmologist

Oncologist

Pathologist,

Radiologists

Social worker

Nurse

Pharmacist

Minimum 1

meeting/wk

Minimum 1 board /

month

Annually KNH- (Eye

Department)

MTRH-(eye

department)

Information

(correspondence)

Time / commitment,

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Establish within Rb

centres, units for

infants whose

parents have

family history of Rb

to undergo

prenatal

management to

facilitate the

earliest possible

treatment of

tumors (EUA)

all babies examined

and information entered

into E Cancer care data

base for tracking

Number of cases

diagnosed early (group

A, B, C)

KEU, Sabatia,

Garissa, Lighthouse,

Homabay, Jaramogi

Oginga Odinga

50 patient to have

siblings examined in

first year

1 year

Ophthalmologist

in charge

- Social

Worker

Commitment

Refresher training

Torch and smart

phones with

cameras

Develop protocols

and agree on

coordination

mechanisms

among teams/Rb

centres

Harmonized

documented guidelines

used by each centre.

Successful inter-

hospital tumor boards

- Have a coordination

board in place

1 year

(KNH)-eye

department

(MTRH- eye

department

Commitment,

facilitation for a

meeting to

harmonise existing

guidelines

Observe and

adhere to protocol

relating to various

treatments (ocular,

chemotherapy,

radiotherapy, extra

ocular)

Management of cases

as per guidelines

Positive M&E report

All parties involved in

management of

various treatments

Continuously All parties

involved in

management:

I.e. Radiologists,

Ophthalmologist

s, pathologists,

social workers

etc

A copy of

guidelines available

for Constant

reference.

70

Final DraftImprove ability of those at risk of Rb and their families to cope with post-diagnosis and treatment challenges

Develop/review

and make

available for

antenatal health

facility use data

capture tool

incorporating

detailed family

history of eye

disease; this tool

will also include a

note to refer

expectant couples

Availability of a

comprehensive tool

indicating risk factors

for Rb

Health facilities at

county and other

levels

1 year (Dr. G. Nderi)

DECF

Time, commitment.

Finance to print out

copies and

distribute to

facilities

Sensitize and train

health care teams

to refer antenatal

cases with

identified family

history of eye

disease to

ophthalmologists

No of referred cases

with Rb history

50 cases in a year.

Health care teams at

maternity and pediatric

clinics

OSU, Medical

Superintendants

Referral tool,

facilitation for

accommodation

during training

Hotline

Transport

Train medical

practitioners in

counseling

families/individuals

with Rb history

(include knowledge

on genetic testing

17 Trained personnel in

all Rb centers

A positively answered

posttest.

A genetic counselor

per Rb centre.

1 year

Every 2 years

Genetic

counselors

Flowchart

Family history

forms

Pre and post test

information

Facilitation fee for

genetic counselors

71

Final Drafttoo)

Integrate early pre-

natal counseling

for expectant

couples with family

history of Rb.

All persons and

survivors in the

database with Rb

history receive

counseling

All persons After 1 year

Continuously

Genetics

counselors,

Gaenacologists

Nurses

The flow chart (see

below) will assist

health care workers

to counsel

Transport for needy

couples for prenatal

check ups

Identify at-risk

family members

and pass to

treatment team for

screening until age

7

Successful screening of

all families at risk

100% identifying and

screening

Continuously Nurses,

gaenacologists,

Flow chart to be

developed

Organize repeated

Rb counseling

sessions for adult

survivors, relatives

and children to

understand their

genetic options,

risk of other

cancers and

appropriate care

We will have a program

design by next year,

following the model

used for TB.

Identify key

parents/survivors that

will be able to roll this

out

1 annual counseling

session held

Annually Genetic

Counselor,

social workers

and other

experienced

families.

Develop a ‘buddy

system’, link up

new families with

families with RB

experience ‘peer-

to-peer/ counseling

to see if this

improves

adherence.

72

Final Draftfor themselves and

their children

(Outreach by

counselors –

Family based

counseling)

Develop a

counseling

schedule – both

doctor and patient

get this

For those who can

afford it, the link to

genetic testing

abroad should be

organized.

Every tertiary center

has this information

Genetic testing to be

done for all patients

who can afford

1 year DECF Information sheet

for

ophthalmologists/tr

eating teams

available about

how to send

samples for genetic

testing

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Final Draft

CHAPTER SIX: FINANCIAL IMPLICATIONS

For achievement of Strategic planning goals,

STRATEGIC OBJECTIVE STRATEGY BUDGET FUNDING SOURCEStrategic Objective 1: To manage the organization efficiently

STRATEGY KES DONATION GRANTS BUSINESS FUND RAISING

Review Administrative structures and systems

694,500

      694,500

Review the composition of the board structure skills and competencies of the board members

456,750

      456,750

Create mechanism for entrenching the core values of the organization among staff and stakeholders

552,500

      552,500

Enhance leadership skills and management capacity at all levels of DECF

1,200,000

      1,200,000

Create mechanisms for succession at the board and management level

365,400

      365,400

    3,269,150

       

                          Objective 2: To expand the organizations resource base and enhance productivity

STRATEGY          Increase the organization revenue by partnering with the local donors

6,000,000

      6,000,000

Improve staff motivation in DECF-Kenya

60,000

      60,000

Innovative mechanisms for resource mobilization

31,665,400

  1,000,000

33,571,900

(2,906,500)

             

    37,725,400

       

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Final Draft

             Objective 3: To pursue Evidence Based Scientific Research and provide modern medical equipment that will facilitate treatment and enhance research

STRATEGY          Enhance the capacity of researchers to develop winning proposals

320,000

1,305,000

    (985,000)

Improve research infrastructure 25,510,720

4,500,000

    21,010,720

Enhance dissemination of research outputs to society

1,392,000

      1,392,000

Partner with other stakeholders for joint research

1,785,000

      1,785,000

    29,007,720

       

             Strategic Objective 4: To enhance value adding partnerships and collaborations

STRATEGY          Improve collaborations and engagement with stakeholders

580,000

      580,000

Support development of awareness materials and facilitate workshops for eye care and primary healthcare workers countrywide

13,235,000

      13,235,000

    13,815,000

       

             Strategic objective 5: To contribute to the development of society through creation, storage, application and dissemination of knowledge

STRATEGY          Sensitizing public about retinoblastoma using electronic, Mother and child Health booklet and print media

707,560

      707,560

    707,560

       

             Strategic objective 6: To ensure all children with Retinoblastoma receive timely, adequate treatment and care

STRATEGY          Improve identification and early detection of those at risk of Rb

5,888,000

      5,888,000

Psychosocial support for children and families.

3,904,550

      3,904,550

Develop and implement an effective monitoring mechanism for all survivors of Rb

120,000

      120,000

Strengthen referral system for Rb from primary to tertiary levels

29520270       29,520,270

Improve quality of treatment and care for Rb patients

575,400

      575,400

Improve ability of those at risk of Rb and their families to cope with post-diagnosis and

2,290,828

      2,290,828

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Final Draft

treatment challenges   

42,299,048        

             SUB TOTAL  

126,823,878        

             OPERATIONS COSTS            Staff Costs  

48,170,087 48,170,087

    -

Operation Running Costs   12,225,212

      12,225,212

KNRbS   13,402,971

13,402,971

    -

Audit Fees   12,225,212

      12,225,212

SUB TOTAL   86,023,483

       

             Contingent Liabilities (3% of budgeted costs)

  6,385,421

      6,385,421

SUB TOTAL   219,232,781

       

             M&E budget (3% of budgeted costs)

  6,576,983

      6,576,983

TOTAL   225,809,765

67,378,058

1,000,000

33,571,900

23,859,806

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Final Draft

CHAPTER SEVEN: MONITORING AND EVALUATION

Monitoring and evaluation are important aspects in the implementation of any strategic plan.

Monitoring will be carried out continuously while evaluation will be done periodically preferably

after every six months of the financial year.

Performance indicators as given in the implementation matrix and annual work plans will be

used to ensure timely implementation of this plan. The management and the implementation

units/officers will play a major role in both monitoring and evaluation.

DECF-Kenya will put in place the following monitoring and evaluation mechanisms to ensure

successful implementation of the strategic plan

a) Engage peer reviewer

b) Engage a strategic plan consultant who will give a biannual report

c) Annual work plans – these will be prepared to operationalise the strategies and activities

in the strategic plan

d) Monitoring Committee -

It is hoped that these measures will ensure effective and efficient implementation of the strategic

plan.

The objectives of the monitoring and evaluation in the strategic plan will be to measure the

plan’s performance in light of the stated objectives; provide mechanisms for accountability at all

levels; provide a means of communicating the success of the plan to stakeholders; ensure that

the plan objectives are continually informed by the best available data; and meet the need for

timely and accurate information on programme performance.

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Monitoring of the Strategic Plan

Regular monitoring will ensure that obstacles and constraints are identified and addressed early;

Monitoring will take place at various levels of the programme implementation and will involve

tracking the use and application of programme inputs such as funds, supplies, equipment and

materials; tracking programme processes such as training; tracking programme outputs such as

number of people trained; and assessing the level of interaction, coordination and support

rendered to stakeholders.

The mechanism for conducting joint monitoring activities will be through visits, review meetings

and reports, among other approaches In addition, coordinators will be charged with the

responsibility of routine monitoring and evaluation of the programmes and projects. All will

establish at all levels and the monitoring, follow up and control systems. Monthly, quarterly, bi-

annual and annual programme and project reports and plans of activities will be generated and

submitted to the Management to provide information on the programme and projects status. All

the reports will also have a summary of the programme and projects. The management will

facilitate experience sharing at all levels.

The team of consultants appointed by DECF-Kenya for that purpose would carry out monitoring

field visits. The frequency of the visits will depend on the project complexity, duration, amount of

financial commitment and requirements of the collaborating institutions(s). The visiting team will

prepare a report after each visit. As a supplement to visits at the field level, regular meetings will

be held with project partners/stakeholders to discuss progress, implementation and obstacles

encountered.

Monitoring /Performance Indicators

The indicators for monitoring will include the completion of certain activities such as number of

patients treated, number of Doctors and health care workers trained, minutes of meetings held,

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Final Draft

reports and completion of manuals. The implementation matrix will constitute a major

mechanism of monitoring and evaluation process.

Review Activities

Information on programme review will be obtained from monitoring activities. Review meetings

will be informed by reports generated at specific time periods in each section. For programme

review to be useful, the Management will require that annual targets for each DECF

(group/participant/child/) be observed. The nature and scope of reporting made against the

plan; causes of variations from the plan; areas of difficulties, and alternative strategies or

solutions to the problems that may adversely affect the plan implementation. This will be

compared with the actual achievements within a specified period.

Evaluation Activities

Internal and external evaluators will undertake different evaluations at every stage of

implementation. The evaluation will mainly focus on the outcome, effects and impact indicators

that will have been inbuilt in the plan at the objectives and out put levels. In addition,

Programme management issues such as financial management and coordination will also be

evaluated to assess the extent to which they will contribute to achieving the objectives. Given

the complexity of the issues being addressed, there will be need to undertake mid-term

evaluation around June 2015. Summative evaluation will take place around November 2017.

Results of the mid-term and summative evaluation will be measured against the baseline

information contained in the plan. In situations where information is not available there may be

need to conduct surveys during the first six months of launching the plan to establish the

baseline indicators.

The broader lesson that will be drawn from the evaluations will assist in redesigning, modifying

or maintaining particular strategies and activities in preparation for the subsequent phases of the

programmers’. A management monitoring and evaluation system will be necessary to ensure

that the plan remains on course.

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Final Draft

Evaluation Indicators

Objectives verifiable indicators (OVI’s) at all levels will be used for evaluation. For example,

programme and project performance indicators will include various activities, proportions of

facilities, equipment and guidelines available. Four categories of evaluation indicators will be

utilized. These are:

Process indicators:

Examples will include the number of people trained at workshops or seminars etc;

Indicators of service quality:

These will include completion rates in training programmes and type of service provided in

hospitals;

Indicators of efficiency:

These will include the personnel expenditure as a percentage of total recurrent expenditure

by the DECF-Kenya and budgetary Allocations versus outputs

Sustainability indicators:

These will include the percent of the total programme expenditure financial by the “donors”

and or internally generated. Evaluation indicators will assist in assessing progress on the extent

to which other components such as economic. Empowerment and environmental conservation

have been integrated in health care. In line with the theme and objectives of the DECF an

important proxy evaluation indicator will be the increase in the number of Doctors/volunteers

participating or donating their time to DECF activities.

Conclusion

Implementation of the strategies and action programme outlined in this Plan will enable DECF-

Kenya to capitalize on its strengths and overcome its weaknesses; take advantage of emerging

opportunities especially those related to technological advances; and to address any challenges

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posed by both national and global operating environments. This will in turn enable DECF-Kenya

to accomplish its mission

ANNEXURE 2: LIST OF STAKEHOLDERS REPRESENTATIVES.

Dr Francis Ndiangui Pathologist- MTRH

Dr Hellen Dimaras Researcher – University of Toronto

Dr Melvin Dlima Board Member – DECF (K)

Dr Vijoo Rattansi Chair- Board – DECF (K)

Dr. Hillary Rono Ophthalmologist - Kitale Eye Hospital

Dr. Kahaki Kimani

Board Member – DECF (K); Ophthalmologist

Univeristy of Nairobi

Dr. Wairimu Waweru Pathologist- University of Nairobi

Dr.David Ekuwam Kericho District Hospital

Dr.James Bett Ophthalmologist- MTRH

Dr.MichaeL Gichangi Director- Division of Ophthalmic Services

Mr. A.J.Odera Stakeholder (in what capacity?)

Mr. Brian Ouma CEO- DECF (K)

Mr. Mitchel Ongaro Board Member – DECF (K)

Mr. Victor Baraza Finance Manager – DECF (K)

Ms. Abby White CEO- DECF International

Ms. Anne Nkoidila

Operations and Administration Manager –

DECF (K)

Ms. Faith Baraza Programs Manager – DECF (K)

Ms. Sarah Mamlin

Board Member – DECF (K)/ Sally test

pediatric centre

Prof. Brenda Gallie Medical Director DECF- International

Prof. J.F Onyango Chairman department of maxillofacial and

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dental surgery, University of Nairobi

Prof. Dunera Ilako

Chairman department of Ophthalmology,

University of Nairobi

Sr. Perpetua Nyakundi Division of Ophthalmic Services

82