Can Kenya's digitization of community health improve data collection?

Every day, Dismus Owido starts his day at 9 a.m. by checking tasks assigned to him by the electronic community health information system known as eCHIS. Owido is a resident of lower Makindu village in Tamu, Kisumu county, and a community health volunteer. He uses the eCHIS app — which is part of a pilot program in Kisumu — to manage his workflow and collect health data. On this day, he found that he had two tasks which include follow-up visits to two children he had seen the previous day. One is a 13-month-old baby and the other a 4-year-old, both had colds. At his first stop, Owido uses the app, which essentially guides him through questions that he should ask for the particular ailments that he is treating. In the end, the app recommends the appropriate decision whether it is a diagnosis that he will provide treatment for or referral to a health facility. “I have found that the baby isn't doing well and I have made a referral,” he declared. The app also stores medical records for the patients treated or visited in addition to other administrative data such as the number of volunteers and their details. Other data in the app include the number of pregnant mothers, the total number of children under 5, and data on malaria prevalence. Kenya’s community health volunteer program was launched in 2006 and aimed to improve health access and leverage the presence of community health volunteers and their engagement with the community to collect data for health planning services. However, delays in reporting by community health volunteers have made data collection a challenge. In response, the government has sought to digitize community health. The Ministry of Health and other partners are now piloting a community health digitization program in Kisumu following the launch of the National Community Health Digitization Strategy. The strategy highlighted that data generated at the community level is crucial for decision making, planning, and monitoring progress toward universal health care. But the paper-based process is inefficient and prone to transcription errors and data quality issues. It recommended digitization as a solution. The eCHIS program is modeled after an application called Smart Health developed by Living Goods — a nonprofit that aims to build sustainable community health systems at scale — which has partnered with the government on the digitization program. The program seeks to increase health access and integrate community health with the national health information system. “With the application, I just follow the questions and feed in the patient's answers and the diagnosis is done.” --— Dismus Owido, a community health voluteer in Tamu, Kisumu county “While it is modelled off Smart Health, the eCHIS App being piloted by community health volunteers in Kisumu covers a much wider set of primary health care issues,” said Thomas Opiyo Onyango, Living Goods Kenya country director. Adding that so far, the pilot has seen an increase in the number of assessments and treatments by CHVs effectively easing pressure on health facilities. There are 98 households in Owido’s village that are registered on the system, and he has to make at least one visit to each of the homes every month. Tamu sublocation consists of 10 villages with a population of 2,447, and each village has a community health volunteer whose work is to visit every home, according to Owido and his supervisor Jane Grace. Grace, who is in charge of Tamu sublocation’s 10 villages and 10 community health volunteers, said the application has also helped her monitor home visits that CHVs have made and the tasks they undertook. “The application makes work easier. From my end, I can tell how many children under the age of 5 are in the village and how many pregnant mothers are there,” she said. “We are now screening for cervical cancer and from the app the CHV knows which homestead to go to.” John Wanyungu, deputy head of division for community health services at the Ministry of Health, said that the application also helps with monitoring drug stocks. “The CHVs are more systematic in their service delivery, we have instant access to quality data, and there is a swiftness in reporting,” he said. Maureen Kimani, head of division of community health services, added that the pilot is set to come to an end in a few weeks and its lessons will inform the nationwide rollout, which she said will start before June. “It is going to be a phased rollout. This is because it is a resource-intensive exercise and we can’t be able to roll out the program nationally at once,” she said. While the Ministry of Health and its partners are awaiting the completion of the pilot phase to compile any challenges experienced, ministry officials said network issues have been a concern. Volunteers have also experienced minor challenges with the system. But in Tamu, Owido is happy that the application has made work easier for him. “In the past, I could refer a patient but at times I wasn't really sure what the ailment was,” he said. “But now with the application, I just follow the questions and feed in the patient's answers and the diagnosis is done.”