Kwale Kenya - Opportunities and challenges in data collection

As large parts of Africa embrace modern technology, the access to smart phones offers many opportunities, not just for communication but for many other uses, including data collection and analysis. There are many programmes being rolled out in the continent, from environmental monitoring to health projects, all using smart phones and tablets as a central feature of the programmes.

Kenya’s Strategy for Community Health, revised in 2014, as part of Kenya Vision 2030 and the Kenya Essential Package for Health (KEPH), embraced community based data collection and analysis as a central part of the Strategy. However, the model initially planned involved the use of many registration and log books, which have proved expensive, unwieldy to carry and time consuming for Community Health Assistants (CHAs) to collect and aggregate the data before it is even integrated into the government DHIS2 health information system. This has led to data not being collected and analyzed, creating much redundancy in the plan.

Various countries, for example Rwanda, Malawi and now Kenya, have experimented using smart phones and tablets to collect data at community level, using the DHIS2 platform. In Kenya, our project has been working in Kwale County, supporting the development of Community Health Units and utilizing smart phones and apps to collect data, which automatically aggregates it and uploads to a dedicated server. The goal is to make data accessible, relevant and to facilitate a more economically sustainable and efficient system of data collection.

The predominant challenge we have in Kenya is that the majority of the Community Health Strategy actions and the maintenance of the DHIS2 health information system relies on funding from private organizations and international bodies like USAID. The government at both central and county level (the latter being empowered politically since the new Kenyan Constitution in 2010), have not formally allocated funds for the development and maintenance of its Community Health Strategy. Therefore, there is little built in sustainability and private organizations can come and go without being able to truly make a long term impact. So the key, especially at county level is a political one – the counties have to embrace the government CH Strategy by putting funds into their budget. This involves paying the volunteers/workers who collect data, training and employing more Community Health Assistants for their specific community role in monitoring Community Health Units (and not relying on public health officers who are too busy to do all the work), and embracing technologies that allow for better data collection and analysis.

Another issue is the lack of monitoring of CH Strategy at a central level of government, partly from the devolution of healthcare in the country since the new constitution, creating a gap in communication and accountability. As the CH Strategy is a central government initiative, its role out at a county level has been very mixed, with some counties embracing it to some extent, while others have done very little. Creating a more cohesive strategy here could make a big difference.

Embracing smart phones to collect and monitor health data, and integrating it into the DHIS2 system has real advantages. The current log book model is not sustainable unless significant funds and person power are employed. Even then, unless the central government emphasizes the importance of community based data, the counties will not see its significance. Here, more training in the analysis and ownership of data at a county level could make a difference and lead to a greater use of county data to make health policy.

However, even as the DHIS2 system has been embraced by 55 countries and is an open sourced software, the app used to collect community based data, called DHIS2 tracker has had some real technical challenges and hasn’t been ready to use totally successfully. It has also led to either dependence on a limited number of HISP experts to support and train people or projects have had to develop their own internal IT capacity as we have to do in Kenya, being supported from afar when needed. The capacity of the DHIS2 tracker will have much more capacity once these technical glitches are ironed out and the developers get more feedback from users in the field. This can be important in order to make the DHIS2 tracker fully integrated for community based data collection.

Therefore, our experience shows that if the Kenyan government can take full financial ownership of the CH strategy, it will lead to much more sustainability and accountability, especially if both national and county health systems work toward a greater monitoring and evaluation. Also, for community data to be more usable and relevant, the ownership and analysis of data needs to happen at both county and national level and the necessary technical support systems need to be put in place in order to facilitate the necessary technical developments that will make health data much more efficient and relevant. This will have implications for many African countries that have embraced a national Community Health Strategy and seek to make health data an important part of this policy.

Richard Pitt

Kwale County