A county view; opportunities and
Challenges of decentralized data
driven decision making
Mohammed Kombo Bwana
And Isabel Maina,
Kenya
PHCI GLOBAL STAKEHOLDERS MEETING IN GENEVA 6-8TH APRIL 2016
Outline of the presentation
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Introduction
Constitution and Devolution of health
Opportunities
Challenges
Recommendations/ way forward
County
Kenya; Administrative
AdministrativeUnits
Units
Demography and Population
Introduction
• Kenya health system been devolved since March 2013 (as a
result of new constitution
• Constitution envisaged;
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Right to health –---to the highest attainable standards of health
Equity in distribution of resources and services
Demand for accountability
Transparency
Efficiency
Citizens participation
• Devolution with full transfer of responsibility; decision
making , and resources and revenue generation to the
counties.
• N/b Counties are autonomous units
Introduction
• National Government is in charge of policy
formulation, setting standards and Technical
assistance to counties
• Counties in charge of health service delivery
• Both levels work on basis of mutual
understanding, consultations and consensus
building.
• Hence; Need for robust HIS/ME system
• Need for a common planning and monitoring
framework to enhance decision making in the
sector
Overarching Planning and Monitoring framework
Opportunities
• The current constitution has presented opportunities such as;\
• Review of the overall health law which includes issues of data
demand and use; reporting by all entities
• County specific plans –Development plans; County strategic plans
and M/E plans (elaborate data use as a priority )
• Elaborate information sharing forums at the National and county
level (Health congress and county review meetings
• Opportunity to build a robust system (sub-national as well as
National system
• Opportunities for new structures M/E units/ at both levels
• For accountability Governors are required to hold a governors
summit to review performance including health and set priorities
(Presidential summit at National level)
• Resources closer to the people
• ICT data systems with inter-linkages e.g. county Electronic Health
Records (EHR)
Agreed on Scope of Sector M&E
Opportunities
• Citizenry involvement ; People demand for
services; for accountability ; also driven by
constitutional bodies
• New Governance and management structures
• Presented an Opportunity to carry out
assessments in order to establish baselines for
the new entities (e.g. SARAM done in 2013)
• Routine data analysis on regional basis
• Regional (county, sub counties) specific trends
Opportunities
• Use of existing opportunities for data
collection outside the traditional systems e.g.
use of mobiles; automated systems
• Improved data governance
• Counties/ sub counties have used information
to plan for their most pressing needs
• Increased use of innovative approaches/
products e.g. community dashboards; facility
scorecards
120.0
Baringo
Bomet
Bungoma
Busia
Elgeyo-Marakwet
Embu
Garissa
Homa Bay
Isiolo
Kajiado
Kakamega
Kenya
Kericho
Kiambu
Kilifi
Kirinyaga
Kisii
Kisumu
Kitui
Kwale
Laikipia
Lamu
Machakos
Makueni
Mandera
Marsabit
Meru
Migori
Mombasa
Muranga
Nairobi
Nakuru
Nandi
Narok
Nyamira
Nyandarua
Nyeri
Samburu
Siaya
Taita Taveta
Tana River
Tharaka Nithi
Trans-Nzoia
Turkana
Uasin Gishu
Vihiga
Wajir
West Pokot
Percent
Reporting Index by County July - Dec 2015/2016
Reporting index
100.0
80.0
60.0
40.0
20.0
0.0
Reporting index
Percent On Time
Fully immunized children by county July- Dec 2015
Challenges
• Counties still in process of building their ICT data
systems; especially at lower levels of care (challenge in
real time reporting)
• Insufficient expertise and capacity for data driven
decision making
• Imbalance in the distribution of information between
National Government and counties; counties and sub
counties
• Different counties/ sub counties at different levels
• Proliferation of data collection systems (user; donor;
political as well as commercial interests )
• Ensuring stakeholders can and will voice their opinion
Challenges
• Initial loss of gains that had been made in the
sector (e.g. sector plans, reviews. Partnerships)
• Coordination
• Parallelism –partners interests
• Enforcing the policies
• Planning (challenge of one plan)
• Non adherence to health sector planning
budgeting and accountability cycle
• Delays coz –must build consensus.
Challenges
• Data use not priority for some
– Reporting still low in some Counties
– Lack of comprehensive reporting tools at health facilities
to capture all the indictors
• Weak Data quality attributed to lack of the proper
tools and adequate capacity to handle data and use
information
• Inadequate supportive supervision
Recommendations
• Data driven decision making is an ongoing systematic
process rather than a one time event
• Strive to model decision making on data and present
decisions relevant data when announcing policies
• Need for counties to have data systems that give timely and
relevant data for improved decision .
• Analyze the data to meaningful products
• Get the data to the hands of those who need it
• Communicate data driven decisions to stakeholders.
• Use existing information to bridge gaps in counties e.g. High
Maternal mortality ration in some counties—GFF RMNCH
investment case
• Sharing bets practices
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THANKYOU