Bridging the Healthcare Data Divide in Kenya

1. Bridging the Divide: Interdisciplinary Partnerships for HIV and Health SystemsHealth Informatics - Leveraging HIV Scale-up for HIS/HM Kenyan Case Dr. Charles M. Nzioka, MD, MPH Public Health Specialist 16 – 17th July 2010, Vienna, Austria Ministry of Health

2. Outline • Vision/mission/Goal • HIV Program overview • Data sources for HIV program • Initiatives to achieve one M and E system • Challenges • Way forward

3. Vision HIS • Be a centre of excellence for quality health and health-related data and information for use by all

4. Mission • To provide timely, reliable and accessible quality health service information for evidence-based decision making in order to maximize utilization of scarce resources

5. Goal • Establish a functional, robust, effective and efficient Health Information System

6. HIV IN KENYA • Current prevalence is 6.3% among 15-49yr olds (KDHS 2009) • Males 4.3% • Females 8.0% • Provincial prevalence range 0.9% -13.9% HIV Service data by December 2009

7. Routine HIV Data Sources Routine Health Information System (HMIS): monthly collection and reporting of facility health data through file transfer protocol (FTP) system National Tuberculosis Control Programme Reporting (NLTPR): quarterly cohort reporting for tracking case finding and treatment outcomes for TB patients that receive HIV-related interventions National Blood Transfusion Services Reporting (NBTSR): monthly reports on blood collection/screening by regional & satellite blood transfusion centres Logistical Management Information System (LMIS): used for tracking commodities and supplies from the Kenya Medical Supplies Agency Essential Medicines and Medical Supplies System (EMMS): facilities use EMMS forms to procure drugs for (OI) and sexually transmitted infection (STI) drugs from KEMSA and reporting to NASCOP Early Infant Diagnosis for HIV Reporting (EIDR): independent database at Clinton Foundation for reporting by 3 DNA-PCR testing laboratories Kenya Programme Monitoring System (KePMS): MS-Access database capturing M&E data for PEPFAR-supported HIV/AIDS treatment and prevention programs. Managed by APHIA II Evaluation/ICF Macro Community Health Information System

8. Non-Routine HIV Data Sources ANC Sentinel Surveillance (ANC SS): ANC-based HIV testing at designated sites to monitor HIV seroprevalence among the general population Kenya AIDS Indicator Survey (KAIS): national population-based survey that collects information on HIV and STI prevalence and treatment, conducted every 5 years Kenya Demographic and Health Survey (KDHS): national population-based survey conducted every 5 years to generate information on HIV knowledge and sexual behavior Kenya Service Provision Assessment (KSPA): cross-sectional country-wide survey every 5 years to assess the capacity and quality of health services, including STI/HIV services

9. Information Flow for Routine and Non-Routine Data Sources for HIV and AIDS USG-PEPFAR Division HIS DLTLD • OTHERS: • KNBS • NCAPD NBTS NASCOP CHAI NPHL CENTRAL LEVEL NTPR MFL HMIS-FTP KePMS EMMS ANC SS NBTSR EIDR LMIS LIS KAIS, KDHS RBTC Data Clerks PCR Testing Labs PTLC PHRIO PROVINCIAL/ REGIONAL LEVEL DTLC District Pharmacist DHRIO DMLT District Stores BTC Data Clerks DISTRICT LEVEL TB Clinic In-Charge HRIO MCH & Laboratory In-charges Field Data Collectors Lab In-Charge Pharmacy In-Charge FACILITY LEVEL In-charges for MCH/FP, CCC, VCT, STI, OPD, IPD, Blood Banks

10. Towards one M and E system - HIS strengthening ( HIS Policy, HIS SP) -Country picked to be one of the initial countries to implement Global Health Initiative • All inclusive process of Indicator harmonization • Development of Master Facility List • Development of standards for EMR for Patient level monitoring • Adoption of DHIS for aggregate facility level reporting • Mechanisms for routine data quality checks and assurance • Governance for the Health Sector

11. HIV Indicator harmonization • Deliberate and concerted effort to review and harmonize HIV indicators includes; Global Fund, PEPFAR, UNGASS and others • Use of a standardized and integrated reporting tool (MOH 711)from all health facilities

12. Integrated tool MOH 711 - Data Element – Number of HIV +ve Tests NASCOP MOH FTP At District MOH FTP National KEMSA Facility 711 District MOH 711 Spreadsheet or Database LMU Facility 711 SCMS Facility 711 Facility 711 KPMS Facility 711 Facility 711 USG Partner Database MAPPING ? Facility 711

13. Development of Master Facility List (MFL) • List of all existing facilities and services offered • Each facility assigned a Unique identifier(code) • Helps accurately determine number of expected reports hence computation of Reporting rates and completeness of reports • In-built mechanism for regular updates • Can be found at : www.ehealth.go.ke

14. The ultimate goal –integrated HIS G.I.S. / MAPPING Human Resources Drugs & Supplies Financial and Expenditure Systems Disease Surveillance Annual Operational Plans Master Facility List H.I.V. Malaria / Other Programmes SURVEYS / RESEARCH/ HDSS/ VR Infrastructure / Equipment Morbidity / Mortality / HMIS

15. EMR: Electronic Medical Records • Up to now the country had been relying on using paper based systems expect in a few donor run facilities • Steps in adapting EMR • Assessment of all existing EMRs: Done • Development of standards for EMR: Done • Identification of an appropriate EMR • Upgrading Existing EMRs • Identification of Model sites for use of EMRs

16. Adopting of DHIS for aggregate facility level reporting • DHIS: District Health Information systems Used in South Africa and Botswana • Open source software that allows sending of facility reports into a National Database (Web • Has inbuilt decision support systems hence allowing data use at the District level • Customized to generate automatic reports for: UNGASS, UA, PEPFAR, AOP, etc.

17. Data Quality • National TWG on data quality formed • Have developed standard tools and methodologies to conduct Routine DQA • Configured DHIS to have internal checks • Regular supervisions, review meetings and feedback

18. Governance in the Health sector Joint planning and priority setting Joint monitoring Common management arrangements Mutual accountability Stewardship Public-private partnerships

19. Governance-achievements Joint planning, M&E cycle established (JPW). Code of Conduct signed, JFA development in progress. Coordination Framework (HSCC,ICCs) in place. Coordination network for implementing partners established (HENNET) Coordinating structure for private practitioners in place

20. Challenges and constraints Timeliness of reporting for service delivery at health facility level Limited data use/utilization and mechanisms to inform decision making process Data quality – lack of systematic validation process to ascertain the accuracy

21. Challenges Inadequate resources • Human resource • Inadequate numbers • Limited skills • Limited financial allocation

22. Donor Collaboration and alignment, a challenge we are overcoming WHO INT NGO CIDA 3/5 UNAIDS GTZ RNE UNICEF Norad WB Sida USAID T-MAP MOF UNTG PMO CF DAC GFCCP PRSP PEPFAR HSSP GFATM MOEC MOH SWAP CCM NCTP CTU CCAIDS NACP LOCALGVT CIVIL SOCIETY PRIVATE SECTOR Source: WHO: Mbewe

23. Way forward [1] • Implementation of HIS strategic plan • Resource Mobilisation & Collaboration for development - integrated system • Enforcement of the HIS policy especially • Mandatory reporting by all service delivery points

24. Way forward [2] • Utilization of ICT in health information System • Creation of district, provincial and national databases • Continuous capacity development • Strengthening & advocacy for data demand and information use at all levels

25. Thank you…