1. Nancy Amayo Health Information System, Ministry of Health, Kenya
PEPFAR Applied Learning Summit (PALS) DHIS2 Use in Kenya – HIV programme & Broader Health System
12 September, 2017
Kopanong Hotel & Conference Centre, Johannesburg, SA
Nancy Amayo
Health Information System, Ministry of Health, Kenya

2. Outline Introduction Evolution of health data systems in Kenya DHIS2:
HIV programme
Broader health systems
Lessons learnt & innovations
Challenges in use of DHIS2
Summary

3. Introduction
Huge investment has been made in availing strategic health information
The Health information System has evolved over time
Paper based system in the 80 and 90s
Paper forms transported by Road to the HQ
Transmission of data forms through the post office
Facility and District Level Microsoft Excel data files transmitted through File transfer Protocol (FTP) early 2000
DHIS2 in 2009/10
Facility Level Data
Kenya’s HIS is flexible and responsive to the country’s information needs

4. Evolution of Strategic Health Information in Kenya
1980s and 1990s
Early to Late 2000s
2009/2012
Integrated HIS(DHIS2)
-Integrated Health Programs
-Dashboards and Analytics
-Vertical data exchange (EMR-DHIS2)
-Horizontal Data Exchange (KMHFL-DHIS2; KEMSA-DHIS2; VLDB- DHIS2; iHRIS- DHIS2 and DHIS2- DSL
-DHIS2- DATIM??
-Integrated HIS Service Desk
Web-Based HIS(DHIS2)
-Facility Level data entered at District Level using GSM Modems
-Above site Aggregation and Dashboards
Microsoft Excel Files:
- Facility and District Level Microsoft Excel data files transmitted through File transfer Protocol (FTP)
Paper based system:
-Paper forms transported by Road to the HQ
-Transmission of data forms through post office

5. The Kenya HIS: https://hiskenya.org (DHIS2)
HIS Kenya (DHIS2) is the:
platform for information management on biomedical interventions for all stakeholders in Kenya
primary source of HIV program data available to GoK
Comprehensive summary forms (MOH 731, MOH 711)
One M&E System – Bio-medical; Service Delivery, Surveys and MIS

6. Patient Encounter Forms/Cards
Current Data Flow
DHIS2 Kenya
FACILITY/Community Health Units
Patient Encounter Forms/Cards
30% Direct Data Entry
-facility level or
-automated indicator reporting from EMRs
Data Transcription
Registers
Data Entry
Collation
70% Transportation of summary forms for upload at sub-county level
Summary Forms
Sub County

7. DHIS2 in the HIV programme: A synopsis…

8. Source: Kenya HIV Estimates, 2015
HIV Programme
Kenya has the 4th largest HIV epidemic globally
Source: Kenya HIV Estimates, 2015

9. Data Review PMTCT Cascade EMTCT Stock taking meeting
Key objective was identifying the missed opportunities – national, county , sub-county and facility
**PMTCT Cascade

10. Monitoring - ACT DASHBOARD (90-90-90 Cascade) - 1

11. Monitoring - ACT DASHBOARD (90-90-90 Cascade) - 2

12. Continuous data quality reviews/assessments
….the how….
Routine review of the data
Reporting
Inconsistencies – sub-analyses
Data analysis
Source: NASCOP National DQA Report, 2016

13. Broader Health Sector use of DHIS2
Maternal, Neonatal, Child and Adolescent Health– DHIS2 data used to inform maternal outcomes through RMNCAH Scorecard
Weekly Epidemic Reporting and Case based surveillance
Results Based Financing (RBF) – using DHIS2 data to inform allocation of funds to health facilities
Intergrating DHIS2 with other Health Information Systems such as TIBU, CAPR, LMIS etc

14. Use of DHIS2: Lessons learnt

15. Launch of the HIV Situation Room
Increased data use
Visualization of data increases usage and in return data quality improved:
ACT dashboard
HIV Situation Room
(Data from DHIS2 forms part of the data sources utilized)
Launch of the HIV Situation Room

16. Improved service and data quality
Source: DHIS2

17. Improved monitoring - Improved Indicators
Maternal ART coverage versus 6 weeks and 18 month MTCT rate

18. Increased data use - Improved M&E System (1)
Improvement of tools
Age disaggregation
Cascade data elements included
New data elements such as linkage to care added
Revised HIV M&E Tools (2016)

19. Improved M&E System (2)
Revised HIV M&E Tools

20. Use of DHIS2: Challenges

21. Key challenges Data and System Governance
Modalities of access rights needs to be made much more efficient
Provision of API link during development of the various dashboards is easier said than done
Underutilization of the other applications available such as GIS
DHIS2 vs. Case based surveillance – how should this be envisioned given that it is primarily an aggregate reporting system?

22. Summary Better Client/Patient Management
….We don't collect data simply for the sake of collecting data. It is a means to an end…..
Better Client/Patient Management
Improved data quality for use:
Planning
Review of guidelines and tools
Policy making
High level commitment required at all levels

23. Acknowledgements NASCOP – Ministry of Health
Div M&E, Health Informatics - MoH
County Governments MoH
NACC – SI Multiagency Task team
Centers for Disease Control and Prevention (CDC – Kenya)
USAID – KEA

24. Thank you