Assessing the ability of health information systems in hospitals to support evidence-informed decisions in Kenya

Abstract

Background

Hospital management information systems (HMIS) is a key component of national health information systems (HIS), and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. We conducted an evaluation of core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making.

Design

The survey was a cross-sectional, cluster sample study conducted in 22 hospitals in Kenya. The statistical analysis was descriptive with adjustment for clustering.

Results

Most of the HMIS departments complied with formal guidance to develop departmental plans. However, only a few (3/22) had carried out a data quality audit in the 12 months prior to the survey. On average 3% (range 1–8%) of the total hospital income was allocated to the HMIS departments. About half of the records officer positions were filled and about half (13/22) of hospitals had implemented some form of electronic health record largely focused on improving patient billing and not linked to the district HIS. Completeness of manual patient registers varied, being 90% (95% CI 80.1–99.3%), 75.8% (95% CI 68.7–82.8%), and 58% (95% CI 50.4–65.1%) in maternal child health clinic, maternity, and pediatric wards, respectively. Vital events notification rates were low with 25.7, 42.6, and 71.3% of neonatal deaths, infant deaths, and live births recorded, respectively. Routine hospital reports suggested slight over-reporting of live births and under-reporting of fresh stillbirths and neonatal deaths.

Conclusions

Study findings indicate that the HMIS does not deliver quality data. Significant constraints exist in data quality assurance, supervisory support, data infrastructure in respect to information and communications technology application, human resources, financial resources, and integration.

• health information system
• hospital management information system
• data quality

Authors’ contributions

The roles of the contributors were as follows: EK, RN, WM, and ME conceptualized the study. All the authors participated in the design of the survey and data collection tools. EK was responsible for the design of data and conducted the analyses with support from ME. EK drafted the initial manuscript with support from ME and feedback on drafts was provided by all authors.

The SIRCLE/Ministry of Health Hospital Survey Group included: David Gathara, Koigi Kamau, Elesban Kihuba, Francis Kimani, Rose Kosgei, John Masasabi, Wycliffe Mogoa, Simon Mueke, Stephen Mwinga, Rachel Nyamai, Arnold Njagi, Isaac Odongo, Jim Todd, and Elizabeth Allen. Data collection was led by JA, DG, EK, RK, MM, JM, and SM. All authors reviewed the draft manuscript and approved the final manuscript.

Funding

This survey was made possible by a grant from the Consortium for National Health Research (Kenya) to the SIRCLE Collaboration. ME has been supported by funds from The Wellcome Trust (#076827 and #097170). Additional funds from a Wellcome Trust Strategic Award (#084538) and a Wellcome Trust core grant awarded to the KEMRI–Wellcome Trust Research Program (#092654) supported DG and the contribution of JT and EA. These grants supplemented salary support from the University of Nairobi (FW), the Ministry of Health (RN), and London School of Hygiene and Tropical Medicine (JT and EA). The Wellcome Trust and other funders had no role in developing this manuscript or in the decision to submit for publication.

Acknowledgements

We thank the Director of Medical Services, Ministry of Health, for permission to conduct the study in government hospitals, the medical superintendents of the hospitals for providing access, and all the research assistants and hospital staff who were essential for data collection. We also thank the Director of KEMRI for permission to publish this work.

Conflict of interest and funding

There are no conflicts of interest.