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Ayub Manya

University of Oslo, Department of Informatics, Graduate Student

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Papers by Ayub Manya

Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: a nationwide retrospective cohort study

BMC Health Services Research

Background In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) thr... more Background In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya. Methods We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Comple...

Understanding the Effects of Decentralization on Health Information Systems in Developing Countries: A Case of Devolution in Kenya

IST-Africa Week Conference, May 1, 2018

Devolution of government functions is becoming widespread in developing countries. However, its e... more Devolution of government functions is becoming widespread in developing countries. However, its effects on health information systems are not well understood. To gain more understanding, a study was conducted in Kenya, a country that has recently adopted devolution and is implementing a new web-based health information system; the District Health Information System (DHIS2). The empirical data for this study were obtained from extensive desk reviews, participant observations and key informant interviews conducted in eight administrative counties. The study shows that devolution has both positive and negative effects on the effectiveness of health information systems. By giving more power to lower administrative levels, the demand for health data for planning and implementation of programs significantly goes up; positively enhancing the culture of information use by the devolved units. Furthermore, the elected local leaders have a keen interest in statistics from their area of jurisdiction, increasing information demand and data quality. Any large variations in data from health information systems would easily be detected by the stakeholders, due to the small size of devolved governments. On the negative side, devolution has weakened the national government’s control on the overall governance of the health system, resulting in inadequate supportive supervision from the national level, reduced nationally organized trainings, increased tensions in management of the country’s health information system database (DHIS2) and lack of requisite data reporting tools. The findings further show that the sub national units prefer to invest in visible infrastructural projects like roads, buying new ambulances, building hospitals instead of investing in health information systems. In conclusion, devolution has more positive effects on health information systems. However, to gain full benefits, it is recommended that proper coordination and collaboration between the national and county governments is required.

Cloud Computing as a Catalyst for Integrated Health Information Systems in Developing Countries

Cloud Computing is increasingly becoming important in the generation, storage and transmission of... more Cloud Computing is increasingly becoming important in the generation, storage and transmission of information worldwide. In this paper, we discuss the potential of Cloud Computing in terms of how it can strengthen health information systems in developing countries. Like any new technology, Cloud Computing is no silver bullet; it solves certain challenges while bringing new ones to the table. Based on a case study of the innovative use of Cloud Computing for the national health information system in Kenya, we discuss how Cloud Computing can enable the integration and harmonization of fragmented systems and provide real-time information to health managers for evidence based decision making. The key contribution of the paper is to provide an understanding of how Cloud Computing can enhance health management by acting as a catalyst for the integration of health information systems.

Reporting Practices and Data Quality in Health Information Systems in Developing Countries: An Exploratory Case Study in Kenya

Journal of Health Informatics in Developing Countries, Dec 30, 2016

Despite increased attention paid to health information systems and their key role for improving h... more Despite increased attention paid to health information systems and their key role for improving health systems in in Low and/or Middle income countries (LMICs), it is believed that data from majority of the health information systems contribute little to the decision-making processes due to poor data quality. We carried out an exploratory assessment of the health information system in Kenya with the main objective of determining the quality of data in terms of accuracy, timeliness and completeness. The study also considered the reasons for the observed data quality status. Data quality audits were carried out in selected health facilities. Data from the source documents at health facilities were compared to the data in the national health information systems for the same period. Key informant interviews were conducted and focus group discussions conducted during quarterly review meetings at regional levels. The study revealed that the completeness rate for the monthly reports was 86.9 percent while the timeliness of the reports was 78.7 percent. In terms of accuracy of the reports, the study showed that while there was a significant amount of low accuracy in many reports evaluated, there was a surprisingly high accuracy of reports coming from the maternity units of all health facilities visited. The accuracy of the number of deliveries could be associated with the financial incentives provided by the government to health facilities as part of the country's free maternity care project in which mothers deliver free of charge in health facilities. While most health information systems are plagued with poor data quality, a simple and practical incentive can improve accuracy, timeliness and completeness.

The epidemiology of hospitalization with diarrhea in rural Kenya: the utility of existing health facility data in developing countries

International Journal of Infectious Diseases, Jun 1, 2010

Bondo District borders Lake Victoria in Nyanza Province in western Kenya. The district population... more

Long-Lasting Insecticidal Net Distribution: A Simple Framework to Guide Programmatic Strategies

Background: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable pop... more Background: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use. Methods: A simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger. Results: The percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations. Conclusions: The framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators.

National roll out of District Health Information Software (DHIS 2) in Kenya, 2011 – Central Server and Cloud Based Infrastructure

Developing decentralised health information systems in developing countries –cases from Sierra Leone and Kenya

The journal of community informatics, Nov 28, 2012

Health service provision is a public concern that mostly takes place at community level, through ... more Health service provision is a public concern that mostly takes place at community level, through primary health care. Using cases from Sierra Leone and Kenya, this study shows how country health information systems, producing simple information products such as quarterly bulletins and league tables being distributed widely, have enabled the communities to be engaged in improving the health status of the population. The community based information systems were part of a national system and the usefulness of comparing local data with data from other communities and from across the country in pursuing equity in health services provision is demonstrated. A community based information system is thus benefiting from being part of and integrated with the larger national system. The article presents and discusses community based participatory approaches to developing information systems which are enabling the community to take ownership and ‘cultivate’ culturally appropriate systems. Illustrated by the cases, the article argues that modern ICT and Internet based technologies, and even ‘cloud’ based infrastructures, are indeed appropriate technologies even at community level in rural Africa.

Implementing a Digital Health Information System During the COVID-19 Pandemic; a Stakeholder’s Approach from Kenya

2023 IST-Africa Conference (IST-Africa)

Management of public health emergencies takes a multi-stakeholder approach and requires prompt an... more Management of public health emergencies takes a multi-stakeholder approach and requires prompt and accurate data. To manage the COVID-19 data, the Kenyan Ministry of Health adopted the DHIS2 platform. Using a case study design, we used the stakeholder theory and data governance concepts to understand the implementation of the system. Data were collected through interviews at national and subnational levels. The main findings show that the DHIS2 had all the necessary support and capabilities to address all the COVID-19 data management activities but it was not effectively used due to coordination and governance issues. It was not easy to coordinate the multiple stakeholders with different interests and many of them continued using different systems including Microsoft Excel to achieve their data needs. The paper contributes to the emerging literature on digital platforms by identifying the pivotal importance of establishing adequate stakeholder engagement during emergencies

Understanding the Role of Institutional Incentives in Shaping Data Quality and Information Use in Devolved Health Systems: A Case of Health Information System Implementation in Kenya

Devolution, which is becoming common in developing countries, refers to the creation of subnation... more Devolution, which is becoming common in developing countries, refers to the creation of subnational governments that are substantially independent of the national level. Devolved entities have a clear legal status, recognized geographical boundaries, elect their leaders and raise their revenue. Potentially, the process of devolution generates or modifies existing institutions. Arguably, the new institutions, the incentives they create, and the behaviour of agents in the face of these incentives affords or constrains the implementation of Health Information Systems (HISs). Identifying these incentives and proposing remedies to improve the HISs is the theoretical motivation of this study. The empirical foundation for this thesis comes from studying the implementation of the District Health Information Software (DHIS2) in Kenya. During its implementation, the country adopted a new constitution, which introduced the devolution of decision making to the lowest levels of the government sy...

Long-Lasting Insecticidal Net Distribution: A Simple Framework to Guide Programmatic Strategies

Background: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable pop... more Background: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use. Methods: A simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger. Results: The percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations. Conclusions: The framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators.

From Sustainable to Continuously Adaptive Information Systems

This paper reports from three health information systemshaving been adapted to a changing environ... more

The Use of Social Learning Systems in Implementing a Web-Based Routine Health Information System in Kenya

Reporting Practices and Data Quality in Health Information Systems in Developing Countries: An Exploratory Case Study in Kenya

Despite increased attention paid to health information systems and their key role for improving h... more Despite increased attention paid to health information systems and their key role for improving health systems in in Low and/or Middle income countries (LMICs), it is believed that data from majority of the health information systems contribute little to the decision-making processes due to poor data quality. We carried out an exploratory assessment of the health information system in Kenya with the main objective of determining the quality of data in terms of accuracy, timeliness and completeness. The study also considered the reasons for the observed data quality status. Data quality audits were carried out in selected health facilities. Data from the source documents at health facilities were compared to the data in the national health information systems for the same period. Key informant interviews were conducted and focus group discussions conducted during quarterly review meetings at regional levels. The study revealed that the completeness rate for the monthly reports was 86...

Understanding the Effects of Decentralization on Health Information Systems in Developing Countries: A Case of Devolution in Kenya

2018 IST-Africa Week Conference (IST-Africa), 2018

Devolution of government functions is becoming widespread in developing countries. However, its e... more Devolution of government functions is becoming widespread in developing countries. However, its effects on health information systems are not well understood. To gain more understanding, a study was conducted in Kenya, a country that has recently adopted devolution and is implementing a new web-based health information system; the District Health Information System (DHIS2). The empirical data for this study were obtained from extensive desk reviews, participant observations and key informant interviews conducted in eight administrative counties. The study shows that devolution has both positive and negative effects on the effectiveness of health information systems. By giving more power to lower administrative levels, the demand for health data for planning and implementation of programs significantly goes up; positively enhancing the culture of information use by the devolved units. Furthermore, the elected local leaders have a keen interest in statistics from their area of jurisdi...

Adoption of Health Information Systems by health workers in developing countries — Contextualizing UTAUT

2013 IST-Africa Conference & Exhibition, 2013

Kenya recently implemented the web-based DHIS2 system as the national Health Information System (... more Kenya recently implemented the web-based DHIS2 system as the national Health Information System (HIS) that will facilitate effective management of health information from health facilities in the country. For maximum benefits to be reaped from this implementation, it is important that the DHIS2 gains acceptance from all categories of targeted users. This paper describes a research model that has been adapted from UTAUT to explain the factors that are hypothesized to affect adoption of DHIS2 in Kenya, and by extension the factors that will affection adoption of HIS in developing countries context. Among other modifications, the new model extends UTAUT by adding Computer Anxiety and Training Adequacy as important direct determinants of intention to use and actual use of HIS respectively. Once validated, the model will inform health policy makers and system developers on approaches that can enhance use of HIS in developing countries context.

DHIS2: The Tool to Improve Health Data Demand and Use in Kenya

Journal of Health Informatics in Developing Countries, 2014

Information garnered from health information systems (HIS) is essential for monitoring health, an... more Information garnered from health information systems (HIS) is essential for monitoring health, and for evaluating and improving the delivery of health-care services and programs. Yet the collection, collation, compilation, analysis and reporting of health data in most developing countries is faced with major problems resulting in incomplete, inaccurate and untimely data which is not useful for health decision-making. Increasingly there is growing demand for good quality health information from developing countries as a result of performance based resource allocation by donors. This has led to some initiatives in these countries to reform the existing paper-based systems through computerization. Kenya’s development blueprint titled ‘Vision 2030: First Medium Term Plan (2008-2012)’ identified the need to strengthen the national HIS to enable it provide timely and understandable information on health. But assessments conducted in the country in the past revealed that despite rising dem...

From Sustainable to Continuously Adaptive Information Systems

2018 IST-Africa Week Conference (IST-Africa), 2018

Many previous studies have pointed to unsustainable information systems in developing countries, ... more Many previous studies have pointed to unsustainable information systems in developing countries, meaning that software is not used after some time. When a system fails in one of seven identified dimensions, people will not use it, hence these are unsustainability criteria. This paper reports from three health information systems having been adapted to a changing environment over more than a decade. Data is collected from documents and from three of the authors’ experience and systematized and analyzed by the other authors. Sustainability was redefined to mean the ability of an information system to adapt to new requirements, where software replacement may be one of the adaptations made. Factors which contributed to sustainability were found in the seven dimensions for unsustainable systems. Taking advantage of findings from other literature, including more stakeholders in the system was identified as an additional strategy for sustaining the systems.

The Consistency and Concurrency Between the Kenya HIV/AIDS Program Monitoring System (KePMs) and the National Reporting System (DHIS2), 2012

Journal of health informatics, 2013

Background and Purpose: Kenya implemented the use of District Health Information Software (DHIS2)... more Background and Purpose: Kenya implemented the use of District Health Information Software (DHIS2) countrywide in 2011. The successful roll out of DHIS as the national reporting system provided a strong foundation for the development of “One unified and integrated, country owned, country led, National Health Information System (NHIS).” In order to achieve this, there was need to transition all existing parallel reporting systems into the DHIS. The Kenya HIV/AIDS Program Monitoring System (KePMs) was one of the major parallel reporting systems that were targeted for integration. KePMs is a computerized database for the management and analysis of the President's Emergency Plan for AIDS Relief Care (PEPFAR), treatment and prevention indicators required by United States of America Government program managers. This paper examines the current status of the implementation of the DHIS2 for use as the national health information system in order to inform transition from KePMs to DHIS2. I...

National roll out of District Health Information Software (DHIS 2) in Kenya, 2011 – Central Server and Cloud Based Infrastructure

by Ayub Manya and Jørn Braa

Recent years have seen an increasing focus on the strengthening of Health Information Systems (HI... more Recent years have seen an increasing focus on the strengthening of Health Information Systems (HIS) in countries. On the ground, however, HIS development in Africa has proved difficult due to; 1) poor and unevenly developed infrastructure, 2) fragmented health programs and donor initiatives and 3) poor capacity. In this paper, we present the case study of Kenya, where a web based system for data management was developed using the free and open source DHIS2 platform and rolled out countrywide during 2011. This case study shows that with the improvement of Information and Communication Technology (ICT) infrastructure, it is possible to deploy web based systems countrywide in Africa using central server and "cloud" based infrastructure. Further, by demonstrating success, rapid deployment and increasing data reporting rates, additional health programs and donor initiatives are now joining forces, and thereby helping integrating the previously fragmented HIS. The lessons regard...

Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: a nationwide retrospective cohort study

BMC Health Services Research

Background In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) thr... more Background In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya. Methods We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Comple...

Understanding the Effects of Decentralization on Health Information Systems in Developing Countries: A Case of Devolution in Kenya

IST-Africa Week Conference, May 1, 2018

Devolution of government functions is becoming widespread in developing countries. However, its e... more Devolution of government functions is becoming widespread in developing countries. However, its effects on health information systems are not well understood. To gain more understanding, a study was conducted in Kenya, a country that has recently adopted devolution and is implementing a new web-based health information system; the District Health Information System (DHIS2). The empirical data for this study were obtained from extensive desk reviews, participant observations and key informant interviews conducted in eight administrative counties. The study shows that devolution has both positive and negative effects on the effectiveness of health information systems. By giving more power to lower administrative levels, the demand for health data for planning and implementation of programs significantly goes up; positively enhancing the culture of information use by the devolved units. Furthermore, the elected local leaders have a keen interest in statistics from their area of jurisdiction, increasing information demand and data quality. Any large variations in data from health information systems would easily be detected by the stakeholders, due to the small size of devolved governments. On the negative side, devolution has weakened the national government’s control on the overall governance of the health system, resulting in inadequate supportive supervision from the national level, reduced nationally organized trainings, increased tensions in management of the country’s health information system database (DHIS2) and lack of requisite data reporting tools. The findings further show that the sub national units prefer to invest in visible infrastructural projects like roads, buying new ambulances, building hospitals instead of investing in health information systems. In conclusion, devolution has more positive effects on health information systems. However, to gain full benefits, it is recommended that proper coordination and collaboration between the national and county governments is required.

Cloud Computing as a Catalyst for Integrated Health Information Systems in Developing Countries

Cloud Computing is increasingly becoming important in the generation, storage and transmission of... more Cloud Computing is increasingly becoming important in the generation, storage and transmission of information worldwide. In this paper, we discuss the potential of Cloud Computing in terms of how it can strengthen health information systems in developing countries. Like any new technology, Cloud Computing is no silver bullet; it solves certain challenges while bringing new ones to the table. Based on a case study of the innovative use of Cloud Computing for the national health information system in Kenya, we discuss how Cloud Computing can enable the integration and harmonization of fragmented systems and provide real-time information to health managers for evidence based decision making. The key contribution of the paper is to provide an understanding of how Cloud Computing can enhance health management by acting as a catalyst for the integration of health information systems.

Reporting Practices and Data Quality in Health Information Systems in Developing Countries: An Exploratory Case Study in Kenya

Journal of Health Informatics in Developing Countries, Dec 30, 2016

Despite increased attention paid to health information systems and their key role for improving h... more Despite increased attention paid to health information systems and their key role for improving health systems in in Low and/or Middle income countries (LMICs), it is believed that data from majority of the health information systems contribute little to the decision-making processes due to poor data quality. We carried out an exploratory assessment of the health information system in Kenya with the main objective of determining the quality of data in terms of accuracy, timeliness and completeness. The study also considered the reasons for the observed data quality status. Data quality audits were carried out in selected health facilities. Data from the source documents at health facilities were compared to the data in the national health information systems for the same period. Key informant interviews were conducted and focus group discussions conducted during quarterly review meetings at regional levels. The study revealed that the completeness rate for the monthly reports was 86.9 percent while the timeliness of the reports was 78.7 percent. In terms of accuracy of the reports, the study showed that while there was a significant amount of low accuracy in many reports evaluated, there was a surprisingly high accuracy of reports coming from the maternity units of all health facilities visited. The accuracy of the number of deliveries could be associated with the financial incentives provided by the government to health facilities as part of the country's free maternity care project in which mothers deliver free of charge in health facilities. While most health information systems are plagued with poor data quality, a simple and practical incentive can improve accuracy, timeliness and completeness.

The epidemiology of hospitalization with diarrhea in rural Kenya: the utility of existing health facility data in developing countries

International Journal of Infectious Diseases, Jun 1, 2010

Bondo District borders Lake Victoria in Nyanza Province in western Kenya. The district population... more

Long-Lasting Insecticidal Net Distribution: A Simple Framework to Guide Programmatic Strategies

Background: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable pop... more Background: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use. Methods: A simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger. Results: The percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations. Conclusions: The framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators.

National roll out of District Health Information Software (DHIS 2) in Kenya, 2011 – Central Server and Cloud Based Infrastructure

Developing decentralised health information systems in developing countries –cases from Sierra Leone and Kenya

The journal of community informatics, Nov 28, 2012

Health service provision is a public concern that mostly takes place at community level, through ... more Health service provision is a public concern that mostly takes place at community level, through primary health care. Using cases from Sierra Leone and Kenya, this study shows how country health information systems, producing simple information products such as quarterly bulletins and league tables being distributed widely, have enabled the communities to be engaged in improving the health status of the population. The community based information systems were part of a national system and the usefulness of comparing local data with data from other communities and from across the country in pursuing equity in health services provision is demonstrated. A community based information system is thus benefiting from being part of and integrated with the larger national system. The article presents and discusses community based participatory approaches to developing information systems which are enabling the community to take ownership and ‘cultivate’ culturally appropriate systems. Illustrated by the cases, the article argues that modern ICT and Internet based technologies, and even ‘cloud’ based infrastructures, are indeed appropriate technologies even at community level in rural Africa.

Implementing a Digital Health Information System During the COVID-19 Pandemic; a Stakeholder’s Approach from Kenya

2023 IST-Africa Conference (IST-Africa)

Management of public health emergencies takes a multi-stakeholder approach and requires prompt an... more Management of public health emergencies takes a multi-stakeholder approach and requires prompt and accurate data. To manage the COVID-19 data, the Kenyan Ministry of Health adopted the DHIS2 platform. Using a case study design, we used the stakeholder theory and data governance concepts to understand the implementation of the system. Data were collected through interviews at national and subnational levels. The main findings show that the DHIS2 had all the necessary support and capabilities to address all the COVID-19 data management activities but it was not effectively used due to coordination and governance issues. It was not easy to coordinate the multiple stakeholders with different interests and many of them continued using different systems including Microsoft Excel to achieve their data needs. The paper contributes to the emerging literature on digital platforms by identifying the pivotal importance of establishing adequate stakeholder engagement during emergencies

Understanding the Role of Institutional Incentives in Shaping Data Quality and Information Use in Devolved Health Systems: A Case of Health Information System Implementation in Kenya

Devolution, which is becoming common in developing countries, refers to the creation of subnation... more Devolution, which is becoming common in developing countries, refers to the creation of subnational governments that are substantially independent of the national level. Devolved entities have a clear legal status, recognized geographical boundaries, elect their leaders and raise their revenue. Potentially, the process of devolution generates or modifies existing institutions. Arguably, the new institutions, the incentives they create, and the behaviour of agents in the face of these incentives affords or constrains the implementation of Health Information Systems (HISs). Identifying these incentives and proposing remedies to improve the HISs is the theoretical motivation of this study. The empirical foundation for this thesis comes from studying the implementation of the District Health Information Software (DHIS2) in Kenya. During its implementation, the country adopted a new constitution, which introduced the devolution of decision making to the lowest levels of the government sy...

Long-Lasting Insecticidal Net Distribution: A Simple Framework to Guide Programmatic Strategies

Background: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable pop... more Background: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use. Methods: A simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger. Results: The percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations. Conclusions: The framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators.

From Sustainable to Continuously Adaptive Information Systems

This paper reports from three health information systemshaving been adapted to a changing environ... more

The Use of Social Learning Systems in Implementing a Web-Based Routine Health Information System in Kenya

Reporting Practices and Data Quality in Health Information Systems in Developing Countries: An Exploratory Case Study in Kenya

Despite increased attention paid to health information systems and their key role for improving h... more Despite increased attention paid to health information systems and their key role for improving health systems in in Low and/or Middle income countries (LMICs), it is believed that data from majority of the health information systems contribute little to the decision-making processes due to poor data quality. We carried out an exploratory assessment of the health information system in Kenya with the main objective of determining the quality of data in terms of accuracy, timeliness and completeness. The study also considered the reasons for the observed data quality status. Data quality audits were carried out in selected health facilities. Data from the source documents at health facilities were compared to the data in the national health information systems for the same period. Key informant interviews were conducted and focus group discussions conducted during quarterly review meetings at regional levels. The study revealed that the completeness rate for the monthly reports was 86...

Understanding the Effects of Decentralization on Health Information Systems in Developing Countries: A Case of Devolution in Kenya

2018 IST-Africa Week Conference (IST-Africa), 2018

Devolution of government functions is becoming widespread in developing countries. However, its e... more Devolution of government functions is becoming widespread in developing countries. However, its effects on health information systems are not well understood. To gain more understanding, a study was conducted in Kenya, a country that has recently adopted devolution and is implementing a new web-based health information system; the District Health Information System (DHIS2). The empirical data for this study were obtained from extensive desk reviews, participant observations and key informant interviews conducted in eight administrative counties. The study shows that devolution has both positive and negative effects on the effectiveness of health information systems. By giving more power to lower administrative levels, the demand for health data for planning and implementation of programs significantly goes up; positively enhancing the culture of information use by the devolved units. Furthermore, the elected local leaders have a keen interest in statistics from their area of jurisdi...

Adoption of Health Information Systems by health workers in developing countries — Contextualizing UTAUT

2013 IST-Africa Conference & Exhibition, 2013

Kenya recently implemented the web-based DHIS2 system as the national Health Information System (... more Kenya recently implemented the web-based DHIS2 system as the national Health Information System (HIS) that will facilitate effective management of health information from health facilities in the country. For maximum benefits to be reaped from this implementation, it is important that the DHIS2 gains acceptance from all categories of targeted users. This paper describes a research model that has been adapted from UTAUT to explain the factors that are hypothesized to affect adoption of DHIS2 in Kenya, and by extension the factors that will affection adoption of HIS in developing countries context. Among other modifications, the new model extends UTAUT by adding Computer Anxiety and Training Adequacy as important direct determinants of intention to use and actual use of HIS respectively. Once validated, the model will inform health policy makers and system developers on approaches that can enhance use of HIS in developing countries context.

DHIS2: The Tool to Improve Health Data Demand and Use in Kenya

Journal of Health Informatics in Developing Countries, 2014

Information garnered from health information systems (HIS) is essential for monitoring health, an... more Information garnered from health information systems (HIS) is essential for monitoring health, and for evaluating and improving the delivery of health-care services and programs. Yet the collection, collation, compilation, analysis and reporting of health data in most developing countries is faced with major problems resulting in incomplete, inaccurate and untimely data which is not useful for health decision-making. Increasingly there is growing demand for good quality health information from developing countries as a result of performance based resource allocation by donors. This has led to some initiatives in these countries to reform the existing paper-based systems through computerization. Kenya’s development blueprint titled ‘Vision 2030: First Medium Term Plan (2008-2012)’ identified the need to strengthen the national HIS to enable it provide timely and understandable information on health. But assessments conducted in the country in the past revealed that despite rising dem...

From Sustainable to Continuously Adaptive Information Systems

2018 IST-Africa Week Conference (IST-Africa), 2018

Many previous studies have pointed to unsustainable information systems in developing countries, ... more Many previous studies have pointed to unsustainable information systems in developing countries, meaning that software is not used after some time. When a system fails in one of seven identified dimensions, people will not use it, hence these are unsustainability criteria. This paper reports from three health information systems having been adapted to a changing environment over more than a decade. Data is collected from documents and from three of the authors’ experience and systematized and analyzed by the other authors. Sustainability was redefined to mean the ability of an information system to adapt to new requirements, where software replacement may be one of the adaptations made. Factors which contributed to sustainability were found in the seven dimensions for unsustainable systems. Taking advantage of findings from other literature, including more stakeholders in the system was identified as an additional strategy for sustaining the systems.

The Consistency and Concurrency Between the Kenya HIV/AIDS Program Monitoring System (KePMs) and the National Reporting System (DHIS2), 2012

Journal of health informatics, 2013

Background and Purpose: Kenya implemented the use of District Health Information Software (DHIS2)... more Background and Purpose: Kenya implemented the use of District Health Information Software (DHIS2) countrywide in 2011. The successful roll out of DHIS as the national reporting system provided a strong foundation for the development of “One unified and integrated, country owned, country led, National Health Information System (NHIS).” In order to achieve this, there was need to transition all existing parallel reporting systems into the DHIS. The Kenya HIV/AIDS Program Monitoring System (KePMs) was one of the major parallel reporting systems that were targeted for integration. KePMs is a computerized database for the management and analysis of the President's Emergency Plan for AIDS Relief Care (PEPFAR), treatment and prevention indicators required by United States of America Government program managers. This paper examines the current status of the implementation of the DHIS2 for use as the national health information system in order to inform transition from KePMs to DHIS2. I...

National roll out of District Health Information Software (DHIS 2) in Kenya, 2011 – Central Server and Cloud Based Infrastructure

by Ayub Manya and Jørn Braa

Recent years have seen an increasing focus on the strengthening of Health Information Systems (HI... more Recent years have seen an increasing focus on the strengthening of Health Information Systems (HIS) in countries. On the ground, however, HIS development in Africa has proved difficult due to; 1) poor and unevenly developed infrastructure, 2) fragmented health programs and donor initiatives and 3) poor capacity. In this paper, we present the case study of Kenya, where a web based system for data management was developed using the free and open source DHIS2 platform and rolled out countrywide during 2011. This case study shows that with the improvement of Information and Communication Technology (ICT) infrastructure, it is possible to deploy web based systems countrywide in Africa using central server and "cloud" based infrastructure. Further, by demonstrating success, rapid deployment and increasing data reporting rates, additional health programs and donor initiatives are now joining forces, and thereby helping integrating the previously fragmented HIS. The lessons regard...