REGISTERS AND SURVEYS IN HEALTH AND SOCIAL SERVICES MONITORING
JOSEPH N. MUKUI
CENTRAL BUREAU OF STATISTICS
MINISTRY OF PLANNING AND NATIONAL DEVELOPMENT
P.O. BOX 30266
NAIROBI, KENYA
1.0
IN KENYA
Introduction
The sustainable improvement of human welfare is the main objective of most governments.
However, the measurement of human welfare is not an easy task. In the past, the main indicator used in
the measurement of human welfare was the Gross Domestic Product (GDP) or the Gross National
Income (GNI) per capita. However this indicator does not reveal whether there is any progress
achieved in the standard of living. Therefore a need for other indicators emerged. Data on social
statistics depicting service levels, trends and conditions are increasingly being resorted to as a measure
of monitoring progress.
In Kenya, the Central Bureau of Statistics (CBS) in the Ministry of Planning and National
Development is charged with the responsibility to collate and co-ordinate the collection of a variety of
social and economic data. To a large extent CBS uses or applies international standards and practices,
This paper presents an overview of sources of data, social and health indicatorsjvariables
covered, data analysis and dissemination, and the limitations of the data used in monitoring progress.
2.0
Sources of data for Monitoring
of Health and Social services
There are three main sources of data necessary for the monitoring of health and social services.
These include censuses, surveys and administrative retords. CBS conducts mainly two types of
surveys namely; establishment based surveys and household based surveys. However, most data
necessary for the compilation of health and social indicators is obtained through household based
surveys. On the other hand, the CBS utilises administrative retords from various government
ministries and departments to generate requisite indicators.
The generated indicators are usually in the following areas: demographic including vital
registration, health, education, women in development, justice/crime, housing and poverty .
2s
Censuses
The Central Bureau of Statistics (CBS) conducts a regular population and housing census once
after every 10 years. Enurneration of the defacto population at a point in time is usually undertaken.
Census taking were done in 1948, 1962,1969, 1979 and 1989. The next population and
housing is expected to be undertaken in August, 1999. The census night of 24/X’ August has been
adopted as a time reference point.
The population and housing census is the main source of data necessary for the compilation of
demographic indicators and covers such areas as: population density, urbanisation, population
structure, population tomposition, fertilny, mortality, migration pattern, literacy, labour forte and
housing conditions.
2.2
Surveys
Various household based ad hot surveys have been conducted by the CBS or by other
government departments in collaboration with the CBS. To facilitate the surveys, CBS maintains a
National household master sample commonly known as the National Sample Survey and Evaluation
Programme (NASSEP). This is the sampling frame for all household based surveys conducted by the
CBS. Using this master frame, the CBS has conducted various surveys which include:-
(9
Welfare Monitoring Survey (WMS)
Welfare mormoring surveys were conducted to monitor changes in human welfare as a result of
the introduction of Struttural Adjustment Programmes with a view of easing the burden of the
vulnerable groups as part of the Social Dimensions of Development. Three rounds of these surveys
were conducted in 1992, 1994 and 1997. The key variables covered were:- income levels, expenditure
levels, consumption patterns, education levels, sources of drinking water, ownership of tonsumer
durables, distance to the nearest health institution, distance to the source of water, distance to the
nearest school, type of dwelling unit, cooking facilities, lighting facilities.
(ii)
The Kenya Demographic and Health Survey (KDHS)
The fnst Kenya Demographic and Health Survey (KDHS was conducted in 1989. Thereafter,
there have been two such surveys in 1993 and 1998. The main objective of this survey was to monitor
the impact of the various family plantring initiatives on the overall population growth and reproductive
health. The key variables collected are:- fertil@, mortality , farmly planning awareness, family
planning acceptante and awareness of Sexually Transmitted Diseases (STDs) including AIDS
(iii)
Housing Survey
The housing survey is conducted by the CBS and is normally divided into two components.
There is the urban housing survey and the rural housing survey. The last rural housing survey was
conducted in 1987 while the last urban housing survey was conducted in 1982/83. The key variables
covered include: type of dwelling unit, tenure of the dwelling unit, type of Wall, type of floor, number
of living rooms, type of toilet and kitthen facilities.
(iv)
Nutrition Survey
The nutrition survey focuses on the nutrition and health aspect of children aged 5 years and
below. So far, CBS has conducted a series of 5 surveys. The last nutrition survey was conducted in
1994 as a module of the Welfare Monitoring Survey. The survey collected data on the following: age
of child, number of siblings, trumber of months breast fed, type of food used for weaning the child,
wastage levels, stunting levels, imrnunisation status, type of ailments during the last week, type of
health institution treatment was sought.
w
Literacy survey
Though literacy rates can easily be computed from the results of a population census, they do
not really reflect the true picture. This is due to the fatt that the collection of data on literacy in a
population census is rather subjective. The enumerator is instructed to ask whether the respondent can
read or write. In a literacy survey the respondent is actually tested whether he or she can read and
write. The last survey was conducted in 1988. Literacy surveys conducted by CBS have provided data
on levels of literacy in the country. Indicators produced include: percentage adult literacy and number
attending Government aided centres.
(vi)
Household Budget Survey
The furst Rural Household Budget Survey was conducted in 1970. Between 1974 and 1978,
four Integrated Rural Survey (IRS) were conducted by the CBS and had a module on household income
and expenditures. In 1974, the CBS conducted a household expenditure survey in Nairobi. The first
national urban household budget survey was conducted in 1982/83 and a subsequent one was conducted
in 1994. The key variables collected through these surveys include: - income levels, expenditure levels
and consumption pattems.
2.3
Administrative retords
A number of government departments produce a lot of data as a by-product of their day to day
operations. Some of this data can be very useful in the compilation of social and health indicators.
Some of the most important data sources are:
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Registrar of Births and Deaths
Every birth or death occurring within Kenya is by law supposed to be registered with the
Registrar of births and Deaths. This information can be very useful in the computation of indicators
such as current fertil@ rates and infant fertility rates. However, not every vital event is registered and
hence data from this source is not complete. Hence, the data collection system does not yield all the
required data for computation of demographic indices. Quarterly bulletins are produced to disseminate
the collected data.
(ii)
Registrar of Persons
Every Kenyan who attains the age of 18 is by law supposed to be registered with the Registrar
of Persons for the issuance of the national identification card. The completed registration forms
contain very useful demographic information. However, the statistical potential of this information has
not been fully realised though the coverage is pretty good.
(iii)
Ministry of Culture and Social Services
This Ministry is the main source of information pertaining to women groups. Occasionally , the
Ministry tommissions specialists to conduct studies and produce various forms of gender statistics.
The women’s Bureau also conducts studies to document and prepare background for policy initiatives
in this area.
(iv)
Minisby of Health
The Ministry of Health maintains a Health Information System which contain information on
hospital retords for all hospitals and health centres in the country. The information maintained relate
to: number of health institutions, number of hospital beds, number of medieal personnel, number of
visits to family planning clinics, number of diseases treated by type (out-patient morbidny),
immunisation, laboratory fmdings and inventories of health institutions.
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Ministry of Education
The Ministry of Education has the responsibility of collecting, analysing, and disseminating
data on education. These statistics which are compiled by use of administrative retords include:
number of schools, enrolment by elass and sex, number of classes, physical facilities, teaching forte by
qualification and sex, educational attainment .
(vi)
Lmal Authorities
Lotal Authorities administer lotal affairs and provide services to particular localities, ranging
from city and municipalities to urban and county councils. In undertaking their activities they collect
information covering such areas as curative services, family planning , environmental health, publit
health, primary education, water and sewerage services, refuse removal and disposal, slaughterhouses,
homes for elderly and orphans, street children, roads, municipal housing estates and sports.
3.0
Data analysis and dissemination
Prior to the mid-1980s CBS was using a main frame computer for data entry and analysis.
With the advent of microcomputers in the mid 198Os, the CBS has shifted from the use of main frame
mode to the microcomputers for most of its data analysis requirements. On the other hand, other
organisations involved in this field are gradually becoming computerised in their operations.
The CBS uses various forms of data dissemination. The most widely used data is normally
published in the two annual publications of the CBS viz the “Economic Survey” and the “Statistical
Abstract”. Again after the conclusion of any ad hot survey , a subjett specific report is released to
disseminate the results. Monthly progress reports are usually generated by organisations that produce
health and social indicators, Annual reports mainIy produce indicators of performance.
4
4.0
Problems encountered in compiling Health and Social Indicators
With the exception of the population and housing census, all the surveys lack periodicity. This is
caused by lack of funds mainly from donors. The setond problem is incomplete coverage. Thirdly ,
there is lack of trained manpower in health and social indicators who can appreciate the statistical
potential of various administrative retords as sources of data for health and social indicators. Fourth,
computing capacities are lacking in some organisations limiting the usage of data collected. Finally,
data that is sourced from surveys is not availed on a timely basis owing to delays in analysis of
information collected during these surveys. These critical problems should be addressed to enhanced
production of health and social indicators.