HIS Strategic Plan 2009-2014 REPUBLIC OF KENYA HEALTH SECTOR STRATEGIC PLAN FOR HEALTH INFORMATI ON SYS TEM 2009-2014 MINISTRY OF MEDICAL SERVICES AFYA HOUSE P.O. BOX 30016- NAIROBI MINISTRY OF PUBLIC HEALTH AND SANITATION AFYA HOUSE P.O. BOX 30016- NAIROBI
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TABLE OF CONTEN TSACRONYMS......................................................................................................................................................................... ii i
FOREWORD .........................................................................................................................................................................viACKNOWLEDGEMEN T ................................................................................................................................................... vii
EXECUTIVE SUMMARY.................................................................................................................................................. vii i
CHAPTER 1: INTRODUCTI ON ..........................................................................................................................................1
1.1 Background .................................................................................................................11.2 Purpose/Rationale for HIS Strategic Plan......................................................... ............1
1.3 Approach and Methodology for developing the Strategic Plan .....................................21.4 The Organization of the Strategic Plan.........................................................................2
CHAPTER 2: H EALTH INFORMATI ON SYSTEM (H IS) .........................................................................................3
2.1 Definition of HIS........................................................................................................32.2 Primary objectives of HIS............................................................................................3
2.3 Current HIS Subsystems..............................................................................................42.4 Health Information System (HIS) Data Sources ..........................................................4
2.5 Users of Health Information........................................................................................52.6 Institutional Review of HIS .........................................................................................5
AOP - Annual Operational PlanAWP - Annual Work Plan
AMREF- African Medical and Research FoundationAfriAfya- African Network for Health Management and CommunicationCHIS- Community Health Information SystemCSO - Civil Society OrganizationCS- Catholic SecretarialCHAK Christian Health Association of KenyaDHMT- District Health Management TeamDPM - Directorate of Personnel ManagementDH S - Demographic Health SurveyDSS- Demographic Surveillance System
EHRS Electronic Health Records SystemFBO- Faith Based OrganizationFIS Financial Information System Facility Information SystemFTP- File Transfer ProtocolGoK - Government of KenyaGIS - Geographical Information SystemHSPS- Health Sector Programme SupportHR - Human ResourceHIS –
H IS TWG-
Health Information System
Health Information System Technical Working GroupHMI S - Health Management Information SystemHMN Health Metrics NetworksHRIO - Health Records and Information OfficerICT - Information Communication TechnologyIT - Information TechnologyJPOW-JHPIEGO
Joint Programme of WorkJohns Hopkins Programme for International Education in Gynaecology and Obstetrics
KDHS- Kenya Demographic Health SurveyKEPH- Kenya Essential Package for Health
KEC Kenya Episcopal ConferenceKHPF - Kenya Health Policy FrameworkKNBS - Kenya National Bureau of StatisticsKNASP - Kenya National HIV/ AIDS Strategic PlanKMTC K M di l T i i C ll
Baseline:- A reference point used to indicate the initial condition against which futuremeasurements are compared
Baseline data:- A set of data collected at the beginning of the study or before intervention hasoccurred.
Core Values Core Organizational Values are a set of beliefs that specify universal expectations andpreferred modes of behavior in an institution. Core values guide the actions ofeveryone in the organization.
Evaluation: - Periodic assessment of the relevance, performance, efficiency effectiveness and impact
of the projects activities
End – termEvaluation:
End-term evaluation is conducted towards the end of the project to provide decisionmakers and planners with the information with which to review the achievements ofthe programme and generate lessons to guide the formulation and/ or implementationof a new programme/ project.
Goals:- Are general targets to be accomplished that are translated into actionable objectives.
GuidingPrinciples:-
H IS: -
Broad philosophy that guides an organization throughout its life in all circumstances,irrespective of change in its goals, strategies or the top management
The health information system is a comprehensive and integrated structure thatcollects, collates, analyses, evaluates, stores, disseminates, health and health-relateddata and information for use by all.
HMIS: - It is defined as an Efficient collection, Collation, Analysis, Evaluation Strategy,
Dissemination and use of Information about individual patients, population,resources used and health outcomes of intervention and the state and nature ofsystems through which the intervention are applied
Monitoring:- A systematic process covering routine collection analysis and use ofinformation about how well a project/ programme is going on. It involvescontinuous review of the performance of all the components in the project
to ensure that input deliveries, work schedules, targeted outputs and otherrequired actions are proceeding as per work-plans.
Mid-term Evaluation:- It is conducted to take an assessment of how the project is performing halfway through the project
Needs Assessment:- It is a process to identify the gaps in services and arrange them in priorityorder for resolution
Operational Planning:- The process of setting short-range objectives and determining in advancehow they will be accomplished
Objectives:- State what is to be accomplished in singular, specific and measurable termswith a target date
Outputs/ Results:- Outputs comprise of specific products or services, which an activity isexpected to produce from its inputs.
Strategy:- A plan for pursuing the Mission and achieving objectives
Strategic Planning:- It is defined as the process by which the guiding members of anorganization envision its future and develop the necessary procedures andoperations to achieve that future
Stakeholders:- Refers to individuals, groups of people or institutions which have vestedinterest in an issue or matter
Vision Statement:- Refers to broadest statement of what an organization hopes to achieve orto become
Verifiable (Performance) Performance Indicators are specif ic and objectively verif iable measures of
Since 2003 various studies have been undertaken to assess Health Information System (HIS). Thefindings of the assessments outlined areas that required immediate attention to strengthen HIS inthe country. One of the priority areas identified was the need to develop a comprehensive StrategicPlan for HIS to guide the implementation of its activities.
This Strategic Plan (2009-2014) is the first to be developed by HIS and is intended to respond to theaspirations of National Health Sector Strategic Plan II (NHSSPII), Health Sector M&E Framework,and Vision 2030. I t was developed through an inclusive, participatory and consultative approach
intended to ensure ownership, commitment and leadership by the key stakeholders. This documentis indeed a great milestone for taking HIS ahead in the health sector to enable it provide better datato inform evidence-based decision making, better policy framework and better health.
The Plan provides a roadmap and strategic direction on key priorities in line with the Health SectorStrategic Plan and articulates the agreed vision, mission, mandate and core values of HIS. I t also setsstrategic objectives, strategies, activities, time frame, resource requirements and assignedresponsibilities for achieving expected outputs in the next five years. It is envisaged that the
implementation of the activities outlined in the Strategic Plan will require a total of Kshs 1.9 billion(US $ 25.3 Million).
The successful implementation of this Strategic Plan is expected to provide a basis for qualityinformation that can be used at all levels of the health system for planning, managing, monitoringand evaluation of desired outputs. The Ministries of Health in partnership with key stakeholders willprovide leadership and finance the implementation of this Plan to build one universal HealthInformation System for the health sector.
In conclusion, we appeal to our development partners and all stakeholders to support theimplementation of the Strategic Plan through collaboration and partnership to enable us achieve thestrategic goal of this Plan: “ Establish a functional robust effective and efficient Health
This Health Information System (HIS) strategic plan was developed through a comprehensiveconsultation process, intensive health sector Health Information System assessments and detailed
information gathering. The process was driven by the HIS Technical Working Group (HIS TWG)in liaison with Professional Training Consultant (PTC).
We would like to acknowledge the efforts of all those institutions and individuals who participatedand contributed in the development of this document. These include government ministries andAgencies, Development partners, UN Agencies, faith based organization, NGOs, and private sector.
We acknowledge the Director of Medical Services and Ag. Director of Public Health and Sanitation
for their leadership and stewardship, the HIS Technical Working Group (HIS TWG) members forthe coordination, technical input and commitment during the process of developing the Strategicplan. We wish to thank all heads of departments and divisions, programme managers, Governmentparastatals (KEMRI, NHIF, KEMSA), the Provincial Directors, District Directors and HealthManagement Teams for their participation and invaluable inputs during the process of development.
We commend the Professional Training Consultants (PTC) for their critical review andconsolidation of this Strategic plan.
We also extend our gratitude to Ministry of Planning and Vision 2030 (KNBS), Ministry ofImmigration and registration of persons (Vital Registration), Ministry of Home affairs and Nationalheritage (National Archives), Implementing partners (CHAK, KEC, SUPKEM, AfriAfya, AMREF,Aga Khan Health Services, Aga Khan Foundation, APHIAs, KNADS, FHI, NACC, JHPIEGO,Professional bodies (Kenya Medical Practitioners and Dentist Board, Nursing Council, KenyaLaboratory Board), training institutions (Kenyatta University, KMTC) for their participation andpractical inputs in the development process.
We are particularly grateful to the Health Metrics Network (HMN) Secretariat and Department forInternational Development (DFID) through Essential Health Services (EHS), in providing technicaland financial support in the development of this strategic plan We also appreciate the role of
The overall policy guidance for the health sector is through the Government of Kenya Vision 2030and the Kenya Health Policy Framework (KHPF, 1994-2010). One of the key challenges in the
health sector identified in First Medium Term Plan of Vision 2030 is weak health informationsystems. Various weaknesses identified in the existing information systems include lack of guidelinesand policy, inadequate capacities of HIS staff, lack of integration, many parallel data collectionsystems, and poor coordination, amongst others.
Rationale for H IS strategic PlanThis strategic plan is intended to respond to the aspirations of National Health Sector Strategic PlanII (NHSSPII), Health Sector Monitoring and Evaluation Framework and the Kenya Health Policy
Framework envisioning Vision 2030 activities that will ensure a robust HIS to inform on progress ofattainment of set targets. The strategic plan provides a roadmap and direction on key priorities inline with the health sector strategic plan. It sets the vision, mission, strategic objectives, strategiesand activities of HIS.
Methodology for Developing the Strategic PlanThe Strategic Plan was developed through an inclusive approach and a methodology intended toensure ownership, commitment and leadership by the key stakeholders namely Ministries of Health,
Vital Registration, Kenya National Bureau of Statistics, NGOs and development partners.
Desk and literature reviews were carried out. Consultations were done through meetings with theofficials from Ministries of Health, Technical Working Groups and Stakeholder Workshops.Questionnaires were also posted to the sampled provinces and districts, heads ofdepartment/ divisions of ministries of health, development partners and implementing partners.Interviews were also undertaken with selected institutions.
H ealth Information SystemHealth Information System (HIS) is defined as a comprehensive and integrated structure that
ll t ll t l l t t di i t h lth d h lth l t d d t d
Vision StatementBe a centre of excellence for quality health and health-related data and information for use by all.
Mission StatementTo provide timely reliable and accessible quality health service information for evidence-baseddecision making in order to maximize utilization of scarce resources in the health sector.
MandateTo generate, analyze and disseminate health information to facilitate effective policy formulation,management, planning, budgeting, implementation, monitoring and evaluation of health services and
programme interventions in the health sector by all.
Core Values
• Integrity:
• Commitment:
• Professionalism:
• Respect:
Strategic ThrustStrategic thrusts are outstanding concerns that have been identified by health sector to haveconsiderable effect on HIS. The strategic thrust identif ied and in line with the First Medium Plan2008-2012 of vision 2030 is Weak Health Information System in the health sector. Consequentlystrategic thrust or priority of HIS is to:“ Establish functional, robust, effective and efficient Health Information System”
The overall policy guidance for the health sector is through the Government of Kenya Vision2030 and the Kenya Health Policy Framework (KHPF, 1994-2010). One of the key challenges inthe health sector identified in First Medium Term Plan of Vision 2030 is weak health informationsystems. Various weaknesses identified in the existing information systems include lack ofguidelines and policy, inadequate capacities of HIS staff, lack of integration, many parallel datacollection systems, and poor coordination, amongst others. Overall the current HIS provideslimited information for monitoring health goals and empowering communities and individualswith timely and understandable information on health and health related interventions.
In view of the above weaknesses, the ministries of health, i.e. the Ministry of Medical Servicesand the Ministry of Public Health and Sanitation together with her partners decided that this 5year coasted Strategic Plan for Health Information Systems be developed and institutionalized toguide the implementation of HIS activities at all levels.
The Ministries are keen to play their part in improving the efficiency and effectiveness in deliveryof health services by strengthening governance, decentralizing health services and management,
improving resource allocation and enhancement of collaboration with stakeholders under sectorwide approach.
1.2 Purpose/Rationale for HIS Strategic Plan
The strategic plan is intended to respond to the aspirations of NHSSP II, Health sector M&EFramework and the Kenya Health Policy Framework envisioning the Vision 2030 activities thatwill ensure a robust HIS to inform on progress on attainment of set targets.
The primary purpose of an HIS is to support informed strategic decision-making by providingquality data which help managers and health workers at all levels of the health system in planningand managing the health services; monitoring disease trends and control epidemics; and
1.3 Approach and Methodology for developing the Strategic Plan
The Strategic Plan was developed through an inclusive approach and a methodology intended to
ensure ownership, commitment and leadership by the key stakeholders namely Ministries ofHealth, Vital Registration, Kenya National Bureau of Statistics, NGOs and developmentpartners. It is recognized that a properly organized health information system is a prerequisite forefficient administration of health services and hence the need for using a participatory andconsultative approach in developing the Strategic Plan.
Desk and literature reviews were carried out. Consultations were done through meetings with theClient, Technical Working Groups and stakeholder Workshop. Questionnaires were also posted
to the sampled provinces and districts, heads of department/ divisions of ministries of health,development partners and implementing partners. Interviews were also undertaken with selectedinstitutions.The key steps of the methodology included;§ Confirmation of the vision, mission and core values§ SWOT analysis to confirm the relevant internal and external factors that impact on the
performance of the Division/ Departments of HIS§ Identification of key challenges which HIS department will need to specifically respond
to as part of its strategy.§ Identification of key priority areas that the ministries will focus on during the strategy
period§ Preparation of Action Plans for each priority area
In adopting the HMN methodology for preparing a strategic plan, the steps used for thepreparation of the strategic plan included analysis of HIS assessment reports and identif ication ofareas which required priority attention in health systems domains. The second stage was working
with Technical Working Groups in the confirmation of strategic objectives, strategies andactivities. The final stage was through preparation of an implementation matrix and costing.The results of the above stated reviews and analysis generated appropriate data and formed thebasis for thedevelopment of HISStrategic Plan for theperiod 2009-2014.
Health Information System is composed of producers of health statistics including Ministries ofHealth, Kenya National Bureau of Statistics (KNBS), Vital Registration, private healthinstitutions, research institutions, and Faith Based Organizations (FBOs), amongst others.The health information system is defined as a comprehensive and integrated structure thatcollects, collates, analyses, evaluates, stores, disseminates, health and health-related data andinformation for use by all.
The value and importance of a health information system is that it supports the management of
the health system whose ultimate goal is to improve and maintain the health of individuals,families and communities. HIS is considered as a system that provides health and health relatedinformation to facilitate evidence-based decision making processes at all levels of the healthpyramid (Level 1 to Level 6) which are: From the level of individual patient care to themanagement of specific health programmes through to the policy levels where strategic decisionsare made. The current levels of care in the health sector are:Level 1 = CommunityLevel 2 = Dispensary and Clinics
Level 3 = Health Centre including maternity and nursing homesLevel 4 = Sub-district and District Hospitals (Primary hospitals)Level 5 = Provincial and general hospitals (secondary hospitals)Level 6 = National referral hospitals (tertiary)
2.2 Primary objectives of HIS
The primary goal of an HIS is to provide the right information to the right user at the right time.It is therefore considered that properly organized HIS is a prerequisite for the effective and
efficient management of health services. No HIS can afford to discourage the successful use ofits information resources by producing information products that are not aligned with the needsof the user in the forefront. HIS should be developed with a careful assessment of the levels ofthe information generation feedback mechanisms and use by all
Since a properly organized HIS is needed to produce information for taking action, thedevelopment of HIS strategic plan will provide clear road map for implementation of plannedactivities.
2.3 Current HIS Subsystems
There are various subsystems in HIS. These subsystems are summarized in three categoriesnamely population based data, management information and health services based data as shownin Fig 2.1. The sub-systems exist with their own databases with no links to the centralized HISthus creating disjointed information systems in the health sector.
Population based data include census, vital registration and surveys while managementinformation covers administrative records, and health services and disease records as shown inFig 2.2
Generates information which can be used to evaluate health policies for planning healthprogrammes and the efficient provision and management of health servicesOpens up continuous dialogue and coordination between those who collect data and the users ofinformation with the aim of improving health services.Disseminates timely information to users, including those who work in research and health
administrationProvides regular feedback to all personnel in the information system which helps to emphasizethe important role each of them plays.Creates and maintain a health information data base at district and community levelsProvides health information required for health planning, monitoring and evaluation of healthprogrammes.
2.6.1 Existing Producers of Health Information
Health Information exists at the Ministries of Health where routine health data collection isconducted through a network of community units, 6190 health facilities (Government, FaithBased, Non-governmental Organization and Private) that are distributed throughout the country.
Other key health information producers are Civil Registration Department of the Ministry ofImmigration, the Kenya National Bureau of Statistics, Research Institutions, and AfricanNetwork for Health Management and Communication (AfriAfya) which is a consortium of seven
Kenya based health development agencies. In all these institutions major support to HIS comesfrom development partners namely DANIDA, Global Fund, UNICEF, WHO, World Bank,DFID through STATCAP project and EHS, USAID, CDC, European Union, PEPFAR andClinton Foundation.
2.6.2 On-going and Planned HIS Strengthening Activities
Assessment reports on Health Information System identified priority actions required to
strengthen HIS. These included instituting mandatory reporting from private providers andNGO facilities, building capacity for data collection at all levels, developing integratedharmonized data collection tools and conducting census of health providers. The achievementshave been in the areas of harmonization and rationalization of the health sector data
Registration of births and deaths at the Department of Civil Registration is still manual.However, data entry of records of births and deaths is being computerized on pilot basis. This isexpected to be rolled out to cover more districts once the Pilot is over. Secondly, the
Government is collaborating with Plan Kenya (International) in awareness creation on birthregistration in selected districts. The Statistical Capacity Project (STATCAP) being implementedby KNBS is planning to undertake social mobilization and training in Mandera and IsioloDistricts. This is expected to scale up registration of births and deaths in marginalized ruralareas.
Kenya National Bureau of Statistics (KN BS)
Analysis of the Kenya Demographic Health Survey 2008. The support for this activity wasthrough the collaboration of Government of Kenya, World Bank, DFID, with technicalsupport from Macro international – Measures evaluation among others.
Mapping of the districts and the enumeration areas through the support from GOK, WorldBank, and DFID.
Preparation for the National Census 2009 to take place in August 2009.
On-going activities National Coordinating Agency for Population and Development(NCAPD)
Preparation of the Service Provision Assessment (SPA). This has been proposed to take placebetween September and December 2009.
Note: Measuring health is conceptually and technically complex, requiring statistical, public
health and biomedical knowledge and expertise unique to each disease or programme area.Accurate measurement depends upon the availability of disease- specific biometric tests,
clinical diagnoses and the feasibility of measuring population behaviours and the coverage of health services. As a result, health statistics may vary greatly in terms of scientific
This section gives a summary of internal strengths and weaknesses as well as opportunities andthreats to HIS which were identified The results were achieved through extensive consultationswith key stakeholders by undertaking a Strength, Weaknesses, Opportunity and Threats (SWOT)analysis. The summary of the results are given in Table 3.1.
Table 3.1 SWOT Analysis of HIS
Internal Strengths
Existence of vital registration systemRegular periodic population based surveyssuch as KDHS (every 5 years), census(every 10 years)HIS structure and reporting system in placeTechnical personnel availableExisting Training curriculum for healthrecords and information staff.
Provinces and Districts are proactive onHIS activitiesAvailability of manuals and guidelines fordata collectionAvailability of computers at national,provincial and district levelsAvailability of basic communicationinfrastructure
Minimum set of indicators establishedPartnership arrangements in placeDraft Policy document in placeAvailability of harmonized Data Collection
Internal Weaknesses
Lack of clear policy guidelines and legal frameworkfor HISLow reporting rate below 80%Inadequate personnelInadequate financesUnclear funding mechanismLack of/ inadequate M&E skills at all levelsInadequate provision of data collection tools at
facility levelsLack of centralized data base at all levelsLack of mechanisms for enforcing use ofstandardized tools (data collection)Inadequate working and storage spaceInadequate supply of equipments such computers,printers, calculators at all level.Inadequate Facilitative supervision
Weak feedback mechanism and poor dissemination atall levelsPoor coordination of HIS ActivitiesWeak linkages and data sharing
External OpportunitiesGood working collaboration with thedivisions/ departmentsCollaboration and networking with other
stakeholdersCapacities built on various verticalprogrammes would help to roll out a betterHISRecognition and support of HIS by keystakeholders in the Health SectorDevelopment of a national ICT policyDevelopment of E- health policy and strategy
Implementation of the HIS policyTraining of HIS staff in various institutionse.g. Degree at KUOther existing strategic plans within theministries of healthImplementation of the community healthinformation systemTechnological advancement
External ThreatsHigh staff turnoverPoor scheme of services leading to non-retention ofqualified staff
Donor driven programmes and projects establishingparallel data management systems.Inconsistency in political good willKeeping pace with ICT developmentGlobal economic melt downCorruptionFreeze on EmploymentNatural and manmade calamities
Over dependence on development Partners/ Donorsupport
CHAPTER 4: STRATEGIC MODEL AN D ANALYSIS OF STRATEGIC ISSUES
This chapter summarizes the agreed Vision, Mission, Mandate and Core Values of HISThe chapter also discusses the strategic issues, objectives, and strategies based on the challenges
outlined in the SWOT analysis.
4.1 Vision, Mission and Mandate Statements
VisionBe a centre of excellence for quality health and health-related data and information for use by
all.
Mission StatementTo provide timely reliable and accessible quality health service information for evidence-baseddecision making in order to maximize utilization of scarce resources in the health sector.
MandateTo generate, analyze and disseminate health information to facilitate effective policy formulation,management, planning, budgeting, implementation, monitoring and evaluation of health services
and programme interventions in the health sector by all.
Core ValuesThe core values are the behavior and attitudes that will be practiced and embraced by HIS inorder to create the desired culture to drive towards the vision. HIS recognizes that having theright values will result in more efficient production of quality timely and focused health data. Theattributes are:-Integrity: To be accountable, transparent and devoid of corrupt practices in service delivery
Commitment: To devote all official time to our duties and undertake to deal with those seekingour services without unnecessary delaysProfessionalism: To create and maintain public trust in health statistics by acting professionallyand promoting professionalism and transparency in data production and dissemination.
• Presence of many data collection systems with poor coordination
4.2.2 Strategic Thrust (Priority)Strategic thrusts are outstanding concerns that have been identified by health sector to haveconsiderable effect on HIS. The strategic thrust identified and in line with the First MediumTerm Plan 2008-2012 of Vision 2030 is Weak Health Information System in the health sector.Consequently strategic thrust or priority of HIS is to:“ Establish functional, robust, effective and efficient Health Information System”
4.2.3 Strategic ObjectivesThe key strategic issues identified in the HIS assessment of 2006 revolved around improving datarepresentativeness, quality of data and information. In order to address the strategic issues thefollowing strategic objectives have been developed.
4.3 Strategic Objectives
4.3.1 Strategic Objective 1: To improve Data managementData management is considered as the weakest area under HIS. This was as a result of the
existence of too many tools, supporting parallel initiatives/ programmes, inadequate capacity ofstaff collecting, collating, analyzing and managing data, training not geared towards datamanagement or in monitoring and evaluation, and lack of policy guidelines, amongst others.
Strategiesi) Developing HIS Policy and Strategic Planii) Reviewing data management processes, procedures and linkagesiii) Review minimum data sets
iv) Determining the need for key sub-systems and the linkages in the health sectorv) Establishing a manual integrated Community Health Information System (CHIS)vi) Establishing a robust integrated electronic community Health Information Systemvii) Reviewingand developing Facility Information System (FIS)
4.3.3 Strategic Objective 3: Enhance Capacity of H IS staffCapacity development for the implementation of HIS Strategic Plan is critical at all levelsamongst:-
• HIS staff who produce analyzed information
• Managers who use the information
• Facility staff that produce raw data and primarily use the information.
The reviews undertaken on HIS indicate that while the basic data capture and reporting skills arepresent, there is little attention to data quality and the staff is not skilled to competentlyundertake analysis and interpretation of data. There is therefore urgent need for a comprehensivetraining program for staff in-post and those studying to become health workers. There is alsoneed to have pre-services training for M&E officers, District Health Managers and curricula onHIS principles should be introduced into the courses for nurses, clinical officers, doctors andother health professionals
Strategiesi) Developing focused pre and in-service training program for health professionals in
HISii) Strengthening human resource capacity at all levels by undertaking focused practical
training program on HISiii) Organizing best practice tours in areas with the best performance within and
outside Kenyaiv) Enhancing HIS staff career developmentv) Employ, deploy and retain appropriate health records and information personnel at
all levelsvi) Employing and deploying HIS staff appropriatelyvii) Enhancing transport for HIS operationsviii) Improving general off ice supplies and equipment
4.3.4 Strategic Objective 4: Improve Financial Resources and sustainabi li tyThere is inadequate allocation of financial resources for HIS. This is mainly because the amountallocated is not based on information needs. For purposes of sustainability HIS requires adequate
Strategiesi) Procuring hardware and software to support data managementii) Developing user friendly integrated web-enabled database system.iii) Rolling out the integrated system at all levelsiv) Supporting data flow, information use and sharing through the FTP
v) Developing capacity for Health Records and Information Officers, ICT personnel andmanagers on use of the software for data management
vi) System maintenance and sustainabilityvii) Data security and backupviii) Developing capacity of ICT personnel and managers to develop, administrate,
implement and manage software for data management
4.3.6 Strategic Objective 6: Improving Monitoring, Feedback, Reporting, Supervision and
Data AuditsAlthough a lot of health data exist there is minimal interaction with the data by health staff.Consequently very little data is used for decision making, performance assessment and resourceallocation. There is therefore need to review selected indicators and therefore reduce the numberof data reported along indicators.
There are a number of vertical systems collecting and reporting data in systems that are parallel toHIS and have no links to it. There is need to harmonize these systems with a view of developing
one standardized system which will interface the parallel systems that exists and the HIS system.The integration of existing data sources into one data warehouse that uses modern technology toenable easy access to information from a variety of platforms at a single point will ensuremaximum use of available information.
Improved information use requires that coordination be strengthened vertically (between levelsof health services) and horizontally (with other stakeholders, health related ministries, NGOs andCSOs). Secondly coordination of surveys such as DHS, facility survey, vital registration and
other surveys should be improved and placed under M&E steering committee. Further, one ofthe frequent problems is lack of feedback at all levels (horizontal and vertical feedback).Feedback of information should therefore be improved by ensuring that reports and publicationsare distributed to Community units facility staff district levels both paper based and
4.3.7 Strategic Objective 7: Enhancing Governance, partnership, collaboration andcoordinationCommunication, partnership and coordination of HIS activities undertaken by variousstakeholders are weak. The existing HIS are designed with limited involvement and participationwith those who operate the systems and those who use the information from the systems. There
is therefore need to share information with partners and close coordination with other statisticalconstituencies
Strategy
• Establishment of intra and inter sectoral linkages
• Establishment of governance structures at all levels
• Evaluation of the HIS strategic plan
•
Evaluate the implementation of the HIS strategic plan
Currently HIS at the Ministries of Health is grossly understaffed as indicated in Table 4.1 below.The statistics from Table 4.1 shows that at the current staffing level there is a gap of 4774 staff.This means that only 11% of the total human resource requirements are in post. The major gapsare in the cadre of Health Records & Information Officers (88.3%), ICT officers (96.6%) andstatisticians (100%). In order to effectively implement activities of the strategic plan, it isimperative that staff is recruited and trained. There will also be need to undertake serviceworkload analysis for the staffing.
Table 4.1 Staffing Levels
CADRE Total H umanResourcerequirements as perstaffing norms andstandards
Existingstaffcurrently tosupport H IS
Gap Staff to berecrui ted as perthe strategic plan( 2009-2014)
5.2.1 Governance Structure.In order to implement this Strategic Plan the following governance structure is to beimplemented during the plan period:-
i) Establishment of a National H ealth Information System CoordinatingCommittee (NH ISCC).This is the oversight committee with representative from key partners at senior level inthe ministries of Health, private sector, NGOs and development partners to strengthenHIS function. The committee will ensure periodic review of the data collection tools,ensure that we have minimum data sets, and give guidelines on data quality audit andsupervision. Similar coordinating committees will also be at provincial, district andcommunity levels.
ii) Establishment of an HIS Management StructureAt each level of data collection there will be management teams. At the central level inministries of Health, Technical Working Group will form the management team. Themanagement teams will also be formed at the provincial, district and community levels.
This section defines roles and responsibilities of the various actors at all levels of the healthsector.
5.3.1 National H IS Coordinating Committee (N H ISCC)A NHISCC with representation from senior level officers in the Ministries of Health, Statisticalconstituencies, implementing partners and development partners shall be formed to strengthenNHIS function. The Permanent Secretary shall appoint a chairperson to steer HIS CoordinatingCommittee. The Ministries of Health together with other participating stakeholders shallprovide the Committee with the financial and human resources needed to undertake its day-to-day activities. The Committee will establish its own internal procedures and work agenda.
The NHISCC shall provide technical advisory role for health and social welfare datamanagement in close collaboration with other strategic partners including KNBS, VitalRegistration and private sector. The committee shall ensure unified and timely data collection,collation, processing and dissemination. To maximize efficiency, the NHISCC shall developstrategic options for human resource development in data and information management andparticipate in operational research.
5.3.2 The General PublicThe public shall ensure that any vital events or other significant health occurrences in thecommunity are reported to the responsible authorities.
On the other hand the public shall be entitled to information on the Ministries of Healthperformance through relevant publications by the Ministries or on specific special requests.
5.3.3 The Private Sector
Currently there is no legal obligation for the private sector to provide their activity data toMinistries of Health. However through the HIS policy private health providers will be enforcedto submit their data regularly as stipulated in order to give a comprehensive picture of thesector.
5.3.5 Ministries of H ealth (Roles by level)i) Community level
• Every Community Unit (CU) shall maintain and update its CHIS that shall beshared regularly with household members in a forum as stated in the health sector
community strategy.• The community health workers shall maintain registers recording daily activities
and reporting regularly to supervising health facility.
i i) Health faci li ty level
• The health facility shall maintain and update its HIS which shall include records,filing system(s) and registry for primary data collection tools (such as Registers,cards, file folders), summary forms (such as reporting forms, CDs, electronicbackups) safeguarded from any risks e.g. fire, floods, access by unauthorized person,etc.
• Every health facility shall summarize health and health related data from thecommunity and health facility, analyse, disseminate and use the information fordecision-making, provide feedback, then, transmit summaries to the next level.
iii) District level
•
The District shall have oversight responsibility to manage all health and healthrelated data from all service providers within their area of jurisdiction.
• The district shall give technical, material and financial support to all serviceproviders in HIS.
• The District shall create and maintain a data repository.
• The district shall collaborate and work in partnership with other statisticalconstituencies at the district level to built one HIS.
• The district shall collate, analyse, disseminate, use health and health related data
from all health facilities/ providers and give feedback to all health care providers.
• The national level shall collate, analyse, disseminate and use health and healthrelated data from all districts, provinces and service providers and give feedback toall.
• The National level shall create and maintenance a data repository.
• The national level shall collaborate and work in partnership with other statistical
constituencies at the national to built one HIS.
5.3.6. Other statistical consti tuenciesi. KNBSii. Vital Registrationiii. Research and training institutions
There shall be close working relationship and partnerships with HIS to provide data onpopulation- based statistics, vital events (births and deaths) and health related research data forcomparative analysis and warehousing.
5.3.7 Other MinistriesThere shall be close collaboration and partnership with other ministries in strengthening HISsuch other ministries include, Ministry of education, Ministry of home affairs and nationalheritage- Kenya national archives.
5.3.8 Training institutions
• Will be engaged in harmonization of the human resource requirements of HIS to thetraining curricular offered by training institutions.
5.3.9 Mass media
• Shall be involved in advocacy on health and health related information
5.3.10 Implementing partners• Support to strengthen HIS in their areas of operation.
• Work within the existing HIS framework and meet the reporting requirements as definedby minimum datasets
The overall purpose of Monitoring and Evaluation (M&E) is to track inputs, activities(processes) outputs and ultimate outcome (impact) of strategic Plan implementation. It is a
process of ensuring that resources are spent as planned within the framework of strategic planprojections and Annual Work Plans (AWPs) budgets; and that activities take place as plannedwithin the planned time frames to realize the stated strategic objectives. Specifically, Monitoringof strategic plan implementation will assist in:
• Checking whether the implementation is on schedule as planned (work-plans arefollowed as closely as possible)
• Assisting in making adjustments and corrective action when and where necessary.
• Keeping management and stakeholders informed on time
• Assisting in making timely solutions where bottlenecks are identified• Checking that allocated resources are used efficiently and effectively
• Ensuring that inputs are ready on time.
Evaluation is defined as periodic assessment of the relevance, performance, efficiency,effectiveness and impact of the activities. The relevance will respond to the question to whatextent are the operations responding to the needs and priorities of the system?. Efficiencyfocuses on whether available resources (financial and non-financial) have been optimally usedwhile effectiveness responds to the question, to what extent the beneficiaries are benefitingfrom the system? The purpose of evaluation will therefore be to improve planning andmanagement; to strengthen organization; promote institutional learning and to inform policy.
The HIS recognizes that there will be need for, adequate resources (both human and non-human) to successfully implement the strategic plan within the five year period and beyond. Inlight of this, appropriate strategies and mechanisms will be put in place internally and withsupport from partners to mobilize financial/ funding and material resources to supportimplementation of the plan in terms of recurrent and development expenditures.
In order to justify and enhance funding and resources mobilization to support plan
• Appropriate data collection tools/ instruments at all levels from community toSecretariat for purposes of monitoring and evaluation
• Preparation of Monitoring and Evaluation indicators
• Monitoring and evaluation process at all stages of inputs, processes, outputs andoutcomes, frequencies (monthly, quarterly, half yearly and annual etc)
• Feedback reporting mechanism including reporting formats, reports writing,documentation and dissemination processes
The financial and other resources monitoring and evaluation will constitute part of the M&Esystem to ensure that all the resources are utilized according to approved work plans andbudgets, and in accordance with the approved financial management guidelines and regulationsto ensure accountability.
The following activities will generate the information required as process, output and impactindicators to monitor and evaluate the work of the programme.
• Expected outputs, strategic objectives, strategies and respective major activities
• Capacity needs assessments conducted and subsequent capacity building
• Standard M&E instruments and guidelines including report formats, standard checklistsand other tools developed
• Supervision and monitoring visits
• Periodic review meetings• Quarterly and annual reports on performance of the system
• Data bases developed and used to inform policies, planning, decision making and planimplementation.
Interim, Mid-term and End of Period evaluation by external agencies will be undertaken asappropriate.
The HIS Strategic Plan, 2009 2014 implementation Matrix is presented below. For ease of
presentation, an implementation framework for each objective is provided but should beviewed as integrated components. The matrix consists of:-
• Stated Strategic Objectives
• Expected Output based on the Strategic Objective
• Strategies
• Main activities for the respective strategies
• Responsibility
•
Strategic Partners• Implementation Time Frame within the five year period
• Performance Indicators
• Budget Projections
The Implementation Matrix is a critical management tool for mobilization, allocation andutilization of resources for plan implementation; management and coordination of StrategicPlan implementation; and monitoring progress as well as evaluating results/ outputs and impact
of the Health Information System.
It is important to note that detailed Annual Work Plans (AWPs) as well as shorter term AnnualOperational Plans (AOPs) are to be developed for each year of the plan as initial andsubsequent operationalization of the Strategic Plan processes.
In addition to the Implementation Matrix as well as Annual Operational Plans (AOPs), therewill be a comprehensive Monitoring and Evaluation System to be developed to facilitate
efficient and effective monitoring and evaluation of Strategic Plan implementation includingfeedback reporting mechanism, documentation and information dissemination.
Enhanced and Published HIS reports 129,600 129,600 150,360 150,360 129,600 51,714,000 689,520R-HFA and SAM reports - 131,867 78,711 93,263 40,107 25,796,033 343,947
Performance monitoring of health sector,HIS strategic plan, legislation and otherstatistical constituencies