PEPFAR Applied Learning Summit PALS DHIS 2 Use

PEPFAR Applied Learning Summit (PALS) DHIS 2 Use in Kenya – HIV programme & Broader Health System 12 September, 2017 Kopanong Hotel & Conference Centre, Johannesburg, SA Nancy Amayo Health Information System, Ministry of Health, Kenya

Outline • Introduction • Evolution of health data systems in Kenya • DHIS 2: • HIV programme • Broader health systems • Lessons learnt & innovations • Challenges in use of DHIS 2 • Summary

Introduction • Huge investment has been made in availing strategic health information • The Health information System has evolved over time • Paper based system in the 80 and 90 s • Paper forms transported by Road to the HQ • Transmission of data forms through the post office • Facility and District Level Microsoft Excel data files transmitted through File transfer Protocol (FTP) early 2000 • DHIS 2 in 2009/10 • Facility Level Data • Kenya’s HIS is flexible and responsive to the country’s information needs

Evolution of Strategic Health Information in Kenya 1980 s and 1990 s Paper base em: d syst s: cel File soft Ex Micro y rted b ranspo rms t aper fo P the HQ ata forms oad to R n of d smissio office -Tran h post throug - Early to Late 2000 s Level District and Facility a files cel dat ile transfer oft Ex gh F Micros d throu itte transm (FTP) ol Protoc - 2009/2012 S 2) IS(DHI rams ted H g Integra ed Hea 2013 -2017 lth Pro cs i at nalyt -Integr s and A ge (EMRoard IS 2) -Dashb data exchan HIS(DH red at ased cal Web-B Level data ente Modems -Verti ) ange M DHIS 2 al Data Exch Facility vel using GS nt SAe n and -Horizo DHIS 2; KEM istrict L regatio D gg RISHFLe site A IS 2; i. H (KM -Abov DB- DH oards IS 2; VL HIS 2 - DSL DH Dashb and D DHIS 2 TIM? ? sk IS 2 - DA IS Service De DH ated H -Integr

The Kenya HIS: https: //hiskenya. org (DHIS 2) • HIS Kenya (DHIS 2) is the: • platform for information management on biomedical interventions for all stakeholders in Kenya • primary source of HIV program data available to Go. K • Comprehensive summary forms (MOH 731, MOH 711) • One M&E System – Bio-medical; Service Delivery, Surveys and MIS

FACILITY/Community Health Units Current Data Flow Patient Encounter Forms/Cards Data Transcription DHIS 2 Kenya 30% Direct Data Entry -facility level or -automated indicator reporting from EMRs Data Entry Registers Collation Summary Forms 70% Transportation of summary forms for upload at sub-county level Sub County

DHIS 2 in the HIV programme: A synopsis… 7

HIV Programme • Kenya has the 4 th largest HIV epidemic globally Source: Kenya HIV Estimates, 2015

Data Review PMTCT Cascade EMTCT Stock taking meeting Skilled delivery among HIV+ pregnant women Infant prophylaxis issued Maternal prophylaxis issued Identified positive pregnant women 0 Mothers Reached 50000 100000 Missed Opportunities Unreached mothers **PMTCT Cascade - 2014

Monitoring - ACT DASHBOARD (90 -90 -90 Cascade) - 1

Monitoring - ACT DASHBOARD (90 -90 -90 Cascade) - 2

Continuous data quality reviews/assessments …. the how…. • Routine review of the data • Reporting • Inconsistencies – sub-analyses • Data analysis Source: NASCOP National DQA Report, 2016

Broader Health Sector use of DHIS 2 • Maternal, Neonatal, Child and Adolescent Health– DHIS 2 data used to inform maternal outcomes through RMNCAH Scorecard • Weekly Epidemic Reporting and Case based surveillance • Results Based Financing (RBF) – using DHIS 2 data to inform allocation of funds to health facilities • Intergrating DHIS 2 with other Health Information Systems such as TIBU, CAPR, LMIS etc

Use of DHIS 2: Lessons learnt 14

Increased data use • Visualization of data increases usage and in return data quality improved: • ACT dashboard • HIV Situation Room (Data from DHIS 2 forms part of the data sources utilized) Launch of the HIV Situation Room

Improved service and data quality MATERNAL HIV CASCADE ( January – August 2016) Skilled delivery 19, 962 24, 492 8, 529 Infant Prophylaxis 42, 056 2, 398 8, 529 Maternal Prophylaxis 41, 936 2, 518 8, 529 Identified HIV+ Pregnant 44, 454 In Need of PMTCT 8, 529 52, 983 0 10, 000 Achievement 20, 000 30, 000 Missed Opportunities 40, 000 50, 000 Unreached Source: DHIS 2 60, 000

Improved monitoring - Improved Indicators Maternal ART coverage versus 6 weeks and 18 month MTCT rate 2012 -2015

Increased data use - Improved M&E System (1) • Improvement of tools o Age disaggregation o Cascade data elements included o New data elements such as linkage to care added Revised HIV M&E Tools (2016)

Improved M&E System (2) Revised HIV M&E Tools

Use of DHIS 2: Challenges 20

Key challenges • Data and System Governance • Modalities of access rights needs to be made much more efficient • Provision of API link during development of the various dashboards is easier said than done • Underutilization of the other applications available such as GIS • DHIS 2 vs. Case based surveillance – how should this be envisioned given that it is primarily an aggregate reporting system?

Summary …. We don't collect data simply for the sake of collecting data. It is a means to an end…. . • Better Client/Patient Management • Improved data quality for use: • Planning • Review of guidelines and tools • Policy making • High level commitment required at all levels

Acknowledgements • NASCOP – Ministry of Health • Div M&E, Health Informatics - Mo. H • County Governments Mo. H • NACC – SI Multiagency Task team • Centers for Disease Control and Prevention (CDC – Kenya) • USAID – KEA

Thank you