Promoting Data Use to Manage a Transitioning Kenyan Health Sector

Constitutionally, national and county governments in Kenya responsible for providing quality, affordable health care for all must do so in a responsive, transparent manner. Following the devolution of governance, county health departments have recently assumed more visible roles in health service provision at a time of complex administrative transition, compounded by resource constraints, and high citizen expectations.

Early this year, the Ministry of Health (MOH), working with county departments of health and development partners, convened the country’s first National Health and Leadership Congress under the theme of “Transforming Healthcare in a Devolved System through effective Leadership, Management and Governance.” The meeting aimed to review progress, identify best practices and implementation constraints, and agree on steps to address constraints in health service delivery at national and county levels.

MEASURE Evaluation PIMA (MEval-PIMA), a project funded by USAID to strengthen monitoring and evaluation (M&E) capacities in the health sector, provided extensive support to establishing the conference agenda. This included emphasizing the primacy of data as a critical ingredient to support result-driven health sector reforms, conduct effective performance reviews, and make critical policy choices to address emerging health challenges.

MEval-PIMA also supported the preparation of technical presentations in plenary and parallel sessions, and held a skills building session covering data use.

Reflecting on the congress, Edward Kunyanga, MEval-PIMA’s Project Director, reflected that the congress played an important role in highlighting the important linkages between financial and political accountability, strategic decision making, and data use.

“Accountability requires data. With devolution of health services, the need for the use of data to make judgement calls on how much money is required at the county is all the more critical,” says Mr. Kunyanga.

“Transforming healthcare in a devolved system will work if everyone feels accountable. Accountability should not be limited to the government.  The private sector, non-governmental organizations, and the community also need to be responsible with the resources allocated. Accountability is mutual,” he adds.

At the end of the five-day deliberations on a wide range of issues and perspectives, a consensus was generated that included:

• The congress was concerned that only 20 of 47 counties were able to provide complete data for consolidation and review. Consequently, the meeting emphasized the need to invest comprehensively to strengthen the culture of evidence-based planning and decision making at all levels of the health system;

• Weak performance reviews in the counties were preceded by the non-existence, or poor quality, of annual health work planning processes. The lack of data-driven work planning with poor quality data has the potential to weaken the health sector’s reform momentum, result in the duplication of resources and effort, misdirect funding to non-core areas, and lead to overall sectoral underperformance. It also leads to weak implementation, leadership, and governance systems affecting national and global targets, such as improved maternal and child programs and meeting demand for family planning services.

• Inadequate resources allocated to health generally and specifically to M&E mean this function is left to unpredictable donor funding.

In light of these and other issues shared at the congress, MEval-PIMA supported the development of a congress communiqué highlighting the joint commitment by all actors to address the following M&E-related challenges:

• Provide stewardship in sector planning and strengthening data management and M&E;
• Disseminate the M&E framework at county and national levels;
• Develop clear sector guidelines for M&E institutionalization;
• Assist counties to set up M&E units;
• Develop and generate a consensus on a sector-wide health research agenda;
• Facilitate annual sector review stakeholder meetings;
• Provide a framework for translation of research findings into policy;
• Develop and implement a health information policy;
• Allocate funds for health information systems (HIS); and
• Integrate program information systems (e.g., malaria, HIV, TB) into a centralized HIS.

These commitments were adopted by the health sector stakeholders. MEval-PIMA later supported the MOH M&E Unit to consolidate and translate the commitments into actionable activities that are now being tracked by the inter-governmental forum on health services.