1. A county view; opportunities and Challenges of decentralized data driven decision making Mohammed Kombo Bwana And Isabel Maina, Kenya PHCI GLOBAL STAKEHOLDERS MEETING IN GENEVA 6-8 TH APRIL 2016

2. Outline of the presentation Introduction Constitution and Devolution of health Opportunities Challenges Recommendations/ way forward

3. County Administrative Units Kenya; Administrative Units

4. Demography and Population

5. Introduction Kenya health system been devolved since March 2013 (as a result of new constitution Constitution envisaged; Right to health –---to the highest attainable standards of health Equity in distribution of resources and services Demand for accountability Transparency Efficiency Citizens participation Devolution with full transfer of responsibility; decision making, and resources and revenue generation to the counties. N/b Counties are autonomous units

6. Introduction National Government is in charge of policy formulation, setting standards and Technical assistance to counties Counties in charge of health service delivery Both levels work on basis of mutual understanding, consultations and consensus building. Hence; Need for robust HIS/ME system Need for a common planning and monitoring framework to enhance decision making in the sector

7. Overarching Planning and Monitoring framework

8. Opportunities The current constitution has presented opportunities such as;\ Review of the overall health law which includes issues of data demand and use; reporting by all entities County specific plans –Development plans; County strategic plans and M/E plans (elaborate data use as a priority ) Elaborate information sharing forums at the National and county level (Health congress and county review meetings Opportunity to build a robust system (sub-national as well as National system Opportunities for new structures M/E units/ at both levels For accountability Governors are required to hold a governors summit to review performance including health and set priorities (Presidential summit at National level) Resources closer to the people ICT data systems with inter-linkages e.g. county Electronic Health Records (EHR)

9. Agreed on Scope of Sector M&E

10. Opportunities Citizenry involvement ; People demand for services; for accountability ; also driven by constitutional bodies New Governance and management structures Presented an Opportunity to carry out assessments in order to establish baselines for the new entities (e.g. SARAM done in 2013) Routine data analysis on regional basis Regional (county, sub counties) specific trends

11. Opportunities Use of existing opportunities for data collection outside the traditional systems e.g. use of mobiles; automated systems Improved data governance Counties/ sub counties have used information to plan for their most pressing needs Increased use of innovative approaches/ products e.g. community dashboards; facility scorecards

12. Reporting Index by County July - Dec 2015/2016

13. Fully immunized children by county July- Dec 2015

14. Challenges Counties still in process of building their ICT data systems; especially at lower levels of care (challenge in real time reporting) Insufficient expertise and capacity for data driven decision making Imbalance in the distribution of information between National Government and counties; counties and sub counties Different counties/ sub counties at different levels Proliferation of data collection systems (user; donor; political as well as commercial interests ) Ensuring stakeholders can and will voice their opinion

15. Challenges Initial loss of gains that had been made in the sector (e.g. sector plans, reviews. Partnerships) Coordination Parallelism –partners interests Enforcing the policies Planning (challenge of one plan) Non adherence to health sector planning budgeting and accountability cycle Delays coz –must build consensus.

16. Challenges Data use not priority for some – Reporting still low in some Counties – Lack of comprehensive reporting tools at health facilities to capture all the indictors Weak Data quality attributed to lack of the proper tools and adequate capacity to handle data and use information Inadequate supportive supervision

17. Recommendations Data driven decision making is an ongoing systematic process rather than a one time event Strive to model decision making on data and present decisions relevant data when announcing policies Need for counties to have data systems that give timely and relevant data for improved decision. Analyze the data to meaningful products Get the data to the hands of those who need it Communicate data driven decisions to stakeholders. Use existing information to bridge gaps in counties e.g. High Maternal mortality ration in some counties—GFF RMNCH investment case Sharing bets practices

18. END THANKYOU