Summer in the Field: 5 Ways to Sustain Health Information System Gains in Kenya

Nairobi, Kenya. Photo by Amani Nation via Unsplash.

The matter of project sustainability is often prevalent in the field of global health. There are numerous well-funded donor projects with eventual end dates. Project sustainability and transitions to local agencies are not always thoroughly considered in the initial project planning process, but mostly closer to the end of a funding cycle. The Kenya Health Management Information Systems project (KeHMIS) is one of the largest health information system initiatives in Kenya. KeHMIS is funded through the US President’s Emergency Plan for AIDS Relief (PEPFAR) by way of the US Centers of Disease Control and Prevention.

As part of the 2022 Summer in the Field Fellowship program sponsored by the Boston University Global Development Policy Center, I worked with Palladium Kenya, a consultancy group working to formulate strategies and implement solutions that generate lasting social, environmental and financial benefits. This research is expected to benefit the Kenya Ministry of Health and Kenya as a whole, as policy changes will strengthen the health system structure. This work will also be instrumental for PEPFAR and other countries in sub-Saharan Africa with PEFPAR funded health information system (HIS) initiatives. The project also entailed collaboration with the Kenya Ministry of Health, HIS service delivery partners and local stakeholders.

KeHMIS is implemented by Palladium Kenya, which supports the Ministry of Health, Division of National AIDS and STI Control Program, county health offices and service delivery partners. Palladium Kenya provides HIS products (i.e., electronic medical records and mobile health solutions) to primarily meet the HIV and tuberculosis (TB) health needs of the country. Implemented in three phases: KeHMIS phase I focused on digitizing HIV data collection with the Kenya electronic medical records system (KenyaEMR), while phase II expanded data availability and use of KenyaEMR in more health facilities. As of 2021, the KeHMIS project is in phase III and focusing on care that is patient centered and improving data demand and use with expected PEPFAR funding until September 2026.

Figure 1: Kenya Electronic Medical Records System Distribution, 2020

Source: KenyaHMIS EMR Implementation, Palladium Kenya.

Working towards sustaining KeHMIS will be a big undertaking. Despite this, there are five avenues for consideration that can support sustaining the HIS through long-term local public and private sector commitments:

Engaging organizations with digital transformation priorities: The African continent has experienced growth in the digital space in various sectors. Digital transformation is now one of the prominent priorities among communication and banking private sector organizations in Kenya. Digital transformation keeps the customer in mind and at the center of the work they do, which aligns with the patient-centered approach of KeHMIS. Kenyan organizations prioritizing digital transformation can become potential long-term investors in KeHMIS. These include: Safaricom aiming to support digital transformation in the health sector, Equity Group Foundation investing in improving health service access and offering financing to those most in need, Standard Charter building resilient digital transformation and Co-operative Bank Kenya making customer-centered digital transformation to changes and improvements.
Connecting with pharmaceutical agencies: Approaching pharmaceutical companies with a presence in Kenya to collaborate on KeHMIS is worth exploring. A strong business proposal showing how patient adherence to therapeutics will have an impact not only on people living with HIV, but also the overall population can be of interest to support the HIS. There are pharmaceutical companies in Kenya with priorities on advancing digital health innovations and increasing access to medicines for chronic conditions. For instance, the Novartis Foundation prioritizes advancing digital health, supporting health system tech start ups and transforming population health policy utilizing data, while Novo Nordisk has priorities in increasing access to medicines for chronic illnesses.
Strengthening health information technology (IT) infrastructure: Kenya is a growing tech hub and home to international IT companies over the years. Tech companies can contribute to the long-term growth and expertise of Kenya’s IT workforce, which will benefit the KeHMIS human resource base. Microsoft Africa has invested $27+ million so far through programs focusing on growing and sustaining the IT infrastructure through their African Development Center, Microsoft Africa Research Institute and the Africa Transformation Office (ATO). One of the ATO’s five key areas include strategic partnerships with government, multinational corporations and others. Headquartered in Nairobi, Google Africa has also dedicated more than $1 billion over a five-year span to fast-track digital transformation.
Collaborating with non-government organizations (NGOs) with similar HIS improvement goals: Non-governmental and philanthropic organizations play a key role in pushing innovations in developing countries. For example, the Merck Foundation’s philanthropic focus on chronic health conditions, expanding digital maternal health care and clinical decision support is instrumental in providing digital health solutions in Kenya. Cross-collaboration among NGOs working at the national and facility levels is important, because it pools the health system knowledge base and aids in institutionalizing and transitioning the HIS support to the Kenya Ministry of Health and local partners in collectively working towards one common goal – improving the health of all Kenyans regardless of disease area.
Broadening inter-government sector commitments: The pre-service training for clinicians and other health care professionals going into the workforce can be an ideal phase to incorporate teaching the HIS components and use of the system. Integrating HIS training on the Kenya electronic medical records system into their curriculum can facilitate collaboration between the Ministry of Health, Ministry of Education and others. Adding this dynamic to the public sector will include HIS training to clinicians more routinely to reduce the HIS learning curve on-the-job. Overall, health HIS capacity should be increased early on.

These five avenues can assist in navigating the road to sustaining the KeHMIS, however there are complicating factors that may emerge. The inclusion of various organizations may pose hurdles in aligning diverse interests. It will also be important to avoid a repeat of heavy reliance on external donor support when approaching collaborating partners and focusing more on longstanding local support.

The decade long KeHMIS project has primarily received funding from PEPFAR, with support past 2026 currently unclear. Transitioning donor funded projects to be locally sustained can be challenging. However, the recommendations offer considerations to navigate these challenges, including diversifying and maintaining future support on the different components of KeHMIS from both the public and private sectors across technology, HIS workforce capacity, funding and more.

To engage local private sector organizations, the KeHMIS project should watch for strong business proposals demonstrating impact and alignment among common priorities. Investing in the HIS will improving the health of their customers and enable these organizations to retain a healthier customer base that will continue to seek their services.

By locally sourcing and sustaining KeHMIS, high quality health data will continue to be more readily available to support clinical decision-making and assist in evidence-based public health actions for the Kenyan population. All of which contribute to providing better quality services and care for patients seeking HIV and other healthcare services. Taking an integrated approach in creating policies and strategies will be essential and can aid in embedding long-term commitments into the foundation of Kenya’s HIS future.

Anisa Saleh is a second year Doctor of Public Health student at Boston University School of Public Health and a 2022 Summer in the Field Fellow. Learn more about the Summer in the Field Fellowship Program.