7th June 2018
Garissa County in eastern Kenya faces a number of significant health challenges. The population is semi-nomadic and infrastructure is poor. Insecurity along the long porous border with Somalia disrupts health care provision. There are frequent outbreaks of vaccine preventable diseases. Maternal mortality rates are among the highest in the world.
Despite these challenges, key health indicators in the county have improved in recent years. Skilled deliveries for women in childbirth have increased from 23% in 2013 to 45% in 2017, and the number of children immunized against vaccine-preventable diseases has risen by more than 20% in the same time period. Improved health data is being seen as one of the important drivers of these advances.
With the support of development partners, the Ministry of Health in May 2016 launched the Kenya Health Data Collaborative (HDC), to bring partners together around one country-led plan to strengthen the country’s health information systems. This aims to better coordinate efforts to improve the quality of health data, which is essential to inform health policy decisions that will lead to universal health coverage.
“Good quality data in a public health system is ideally what should drive decision-making. Without it you are basically shooting in the dark,” said Dr Helen Kiarie, head of the Ministry of Health’s Monitoring and Evaluation unit.
The HDC aligns partners and governments around national priorities and plans, coordinating donor support and avoiding duplication in health data systems. “The HDC approach brings all stakeholders together in a common vision,” said Dr David Kariuki, Head of Policy, Planning and Healthcare Financing for Kenya’s Ministry of Health.
Kenya has made significant strides forward in health care in recent years, especially in infant mortality. But in a country with a rich diversity of landscapes, and a wide range of economic and logistical challenges across its 47 counties, large gaps remain in available health services, quality of care and strength of health systems.
When the health information being collected and used in a country is fragmented, this impacts the entire health system. “We have many players in the health sector in Kenya – national and county governments, private sector and faith-based organizations and development partners. If we can coordinate and get all those groups to provide information on one coordinated platform, it enables us to make a whole sector impact assessment and to plan together,” said Dr Kariuki.
Shale Abdi, Head of Policy, Planning, Monitoring and Evaluation from the Ministry of Health in Garissa County believes the Kenya HDC has changed people’s mind-set toward the value of monitoring and evaluation (M&E) in measuring impact and planning activities. “Now that people are sensitized and understand the value of M&E, every decision is evidence-based. Whether it is a decision to recruit more nurses, or to choose which health facility to invest in, or on resource allocation, the value of the data takes precedence over an individual opinion,” said Mr Abdi.
When the Kenya HDC was launched, one of its first achievements was the outlining of a comprehensive roadmap of priorities – both short- and long-term. “This means partners have been able to contribute where they felt the activities suggested by the Ministry of Health were aligned with their areas of support, and we have been able to pool resources, bringing people together for a joint purpose,” said Professor Peter Wagacha, from the University of Nairobi Health IT Project, funded by the United States Agency for International Development (USAID).
“One example of this has been national health information systems training,” Professor Wagacha explained. “Partners came together to really build capacity across counties. USAID supported the training of 27 counties, and World Bank and WHO supported the remaining counties between them, literally covering the whole country to teach people how to use health information systems.”
Other quick wins for the collaborative include establishing one M&E framework to measure quality of care in facilities throughout Kenya. “We knew there were partners working in quality of care, but we didn’t know what they were all doing. Even within facilities, there were sometimes different levels of care for patients with different diseases,” said Dr Charles Kandie, Head of Health Standards and Quality Assurance for the Ministry of Health.
“Someone with HIV might be getting one level of care through a partner programme, but the person in the next ward with a different disease could be receiving a completely different level of care,” he explained.
“We came up with a joint health inspection list with sanctions and warnings. And we have already seen impact, with initial results showing health facilities moving up to the next level once they know what they need to do to improve their score,” he concluded.
A recent review of the progress of the Kenya HDC by the Ministry of Health, county health authorities and partners shows that while there have been a number of quick wins, there are still a number of gaps to be addressed, particularly for expensive interventions that require pooling of funds.
“We are hoping with time we will be able to get more resources to strengthen the HDC as a major framework for data and health management information systems (HMIS) in general,” said Dr Kariuki. “As we move towards universal health coverage for the country, it will become more and more important to ensure that data collected is well-coordinated, of good quality, and includes all players in the health sector so that we can make plans, mobilize resources and ensure that we actually keep expanding the programmes that will take us towards UHC,” he concluded.