As befits a population that has generally been shabbily ruled and a society that has seen more than its fair share of pointless grandstanding by the political class, Kenya’s public are a skeptical lot. We are difficult to convince and, even when convinced, even more difficult to please.
And so it is to no one’s surprise that First Lady Margaret Kenyatta’s well-meaning “Beyond Zero” campaign has been met with a mixture of indifference and derision in many quarters, and sometimes with outright hostility. The post-independence history of Kenya is littered with the skeletons and carcasses of presidential public service initiatives that turned out to be little more than disguised looting opportunities and eventually matured into white elephants at best and corruption scandals at worst. We have the right to be cynical.
But there is a case for taking a pause and really re-looking at what the Beyond Zero campaign is all about. The campaign is deceptively simple, and is premised on what must be some of the most depressing statistics anywhere: 15 women die every day in Kenya due to complications related to pregnancy: Our maternal mortality rate is among the highest in the world: For every 100,000 live births in Kenya, 488 Kenyan mothers die. Kenya has committed to work towards reducing this number to 147 this year, but it is not going to happen. The reason it won’t happen is the same reason why so much healthcare in Kenya is so unsuccessful: because healthcare in Kenya is blind and tries to operate in a data vacuum.
Kenya’s health care is notoriously bad. A mere look into the ward of any public hospital is enough, goes the gallows humour, to cure one of whatever illness one is afflicted with. The situation got so bad because the healthcare sector operates in a mode that involves practically no analysis, no data gathering, and no use of information technology to better outcomes. Generally, the government simply hopes that by building health centres across the country and then throwing drugs at them plus a few doctors and nurses, healthcare will have been taken care of.
Merely providing money and drugs and hospitals will not significantly improve health outcomes, because the most important element in the healthcare mix is not any of these. It’s not even the patients: it is good, reliable, regularly collected health data that is then analysed and used accordingly in decision-making. Such data must be part of strong health information systems that are sustainable and are grounded in simple but consistent system and data standards, and which are preferably locally developed.
Many developing-world healthcare systems fail because their health information systems are imported from overseas, where they usually have been designed for a health service sector quite different from the situation in the developing country where the systems are expected to be run. To make matters even worse, many developing countries host NGOs and Western donor agencies active in healthcare. Since these come from different Western countries, they often operate their own information systems which become part of a vertical healthcare information systems ecosystem, with no shared data and zero coordination, not to mention the lack of sustainability. When the donor agency or NGO loses interest, the project dies and the data is lost. The next donor effort in the same sector and often in the same area then has to begin from scratch at some future time.
Kenya has failed to integrate health information systems in delivering healthcare, and Beyond Zero is the first healthcare project to enjoy the sort of patronage needed to template an improved service delivery model in the public health sector in Kenya. But for it to succeed, there needs to be certain ingredients that are baked into the project from the start.
The project must first carry out an extensive data collection exercise. Beyond Zero needs to identify a target population group among Kenyan mothers – maybe a region, to make coordination easier and faster – and design data collection forms that capture as much data as possible from this population. Field workers must be engaged and must be sent into the field to capture this data, which will include identification details and health information. The data captured will not be stored in dusty files at some ministry office – instead, there must be a commitment from the very beginning to convert this data to electronic format as soon as it is received from the field.
Field interviewers must work in pairs: a data collection clerk and a trained health worker. The health information they capture will be used as the basis of an electronic health record (EHR) that can subsequently be accessed anywhere by an authorised health professional at any public health facility. Perhaps just as important, the mobile phone number of each person interviewed must be recorded, because they form such an important part of the public communication chain in Kenya.
The data will be held in information system that would also be used to mark any health indicators noted during field interviews at data collection stage. Analysis is only possible with good data, and this would be the next step: are the health care statistics that the project is based upon actually factual?
Answering this and similar questions from the data collected would allow the Beyond Zero team to not only focus their efforts and interventions on the most critical population segments in their target areas, but also to actively collect data showing the response of subjects to the healthcare received, thus facilitating an outcome assessment that would be worked back into the project as feedback, so as to further improve efforts and targeting and lead to improved outcomes overall. It’s doable, but it must begin with good data..
