Attachment 1 - Summary of Digital Health Ecosystem Activity.pdf

Attachment 1: Summary /Synopsis of Digital Health Ecosystem Activity

Kenya Digital Health Ecosystem Activity Summary Concept

Background:

Digital Health Ecosystem Development Landscape in Kenya

The USAID|KEA’s Country Development Cooperation Strategy (CDCS) identified five development areas of top priority for Kenya. Inadequate systems are one of the areas impeding Kenya’s inclusive growth and self-reliance. Key health systems, especially health information systems remain vertical and this continues to pose a threat to more comprehensive and accurate reporting. The Government of Kenya

(GOK) recognizes the vital role played by information systems in measuring the performance of healthcare delivery and generating data to support program monitoring, planning and evaluation.

Therefore, GOK has identified and prioritized Information and Communications Technology (ICT) as a key enabler towards the achievement of Universal Health Coverage (UHC). Over the last decade, GOK and its development partners have made significant investments in the use of technology to improve the access and quality of healthcare delivered to Kenyans. Such investments are manifest in the various

Health Information Systems (HIS) deployed across the country, including Electronic Medical Record

(EMR) systems; Laboratory Information Systems (LIS); Logistics Management Information Systems

(LMIS); the Kenya Health Information System (KHIS); the Kenya Master Health Facility List (KMHFL);

the Kenya Health and Research Observatory (KHRO); among others.

For the past 7 years, HealthIT has spearheaded implementation of technical assistance to the Ministry of

Health on strengthening health information systems, both aggregate and patient level health informatics.

The Kenya Health Policy 2012 – 2030 identified modernizing health information systems (HIS) as one of the priority reforms and flagship programs to achieving Vision 2030. Fundamentally, HIS, as one of the health systems strengthening (HSS) building blocks, provides information for improved patient care and for evidence-based decision-making. Global development in Information and Communications

Technology (ICT) has provided the health sector with opportunities, many of which have been adopted by world leading organizations such as WHO. Key among these is Digital Health; Open Standards and Open

Source; Interoperability and Data Exchange; and Global Public Goods.

A robust National Health Information System (NHIS) is essential for tracking progress towards the attainment of United Nations Sustainable Development Goals, and of the national health goals as envisaged in Vision 2030, the Kenya Health Policy Framework (2012-2030), National Health Sector

Strategic Plans, Annual Operational Plans, Medium-Term Plans, and other plans. The Kenya National eHealth Policy (2016 - 2030) envisages Kenya having a robust national health information system that can provide information on population growth, births, marriages, mortality and morbidity, disease outbreaks, social determinants of health (such as nutrition, environment, and oral health), access to and coverage of quality services, financing, human resources for health, and other health issues.

From recent health information systems landscape analysis, most public health hospitals have continued to purchase digital health systems primarily for administrative purposes. In level 5 hospitals, radiology and laboratory management systems are commonly standalone systems with varying degrees of interoperability within facilities that have multiple systems. Significant work is still required to ensure interoperability of systems within and across public and private hospitals in the country. Digital health solutions need to be strengthened through modernization, especially in line with the constantly evolving technology, infrastructure, and human capacity development.

The health sector has also witnessed growth in digital health applications for community health programming, majority of these having been implemented over the last 5 years. However, these efforts have lacked a coordinated approach to the development, deployment, support, maintenance, and sustainability of the solutions in use. Leadership and governance from national MOH is required to create the appropriate policies and standards to guide digitization activities in community health.

Strategic Shift in Digital Health Ecosystem Investment

The strategic shifts in the design of the proposed Kenya Digital Health Ecosystem activity focuses on the facilitation of the primary health systems strengthening outcomes of equity, quality and resource optimization as envisioned in the USAID Health Systems Strengthening Vision 2030. The design follows a systems thinking and systems practice approach that offers a set of interrelated high impact digital health, institutional capacity strengthening, strategic partnerships, and legal and policy interventions that collectively contribute to the achievement of sustainable health systems outcomes of equity, quality and resource optimization to impact HIV/TB, FP/RMNCAH and malaria program outcomes positively and sustainably at population level.

In full alignment with the agency’s localization policy, the design further follows the 2010 Kenya

Constitution that devolved Kenya’s health sector’s governance to the 47 counties. In this strategic shift, the design calls for the full alignment with both the national and county governments’ ICT policies and strategic directions on the use of digital health technologies to fast track the achievement of Universal

Health Coverage. The activity design prioritizes collaboration and cooperation with the private sector, academia, and global technology giants in the transfer of technology skills and capability to drive the much-desired local capacity development. The mechanism will build on and strengthen local capacity in digital health technologies’ adoption to promote the use of an integrated and comprehensive digital health ecosystem, lead systems evolutions management, and sustain health systems outcomes of equity, quality, and resource optimization with broad based partners from the private sector, North American Technology giants and both local and global academia. The priority investment areas will include 1) collaboration and cooperation through strategic partnerships with national and global stakeholders to take an integrated and comprehensive digital health ecosystem to scale using a phased approach; 2) strengthening practices in data governance for enhanced data security and privacy; 3) modernization of the national health ICT infrastructure in particular connectivity, end user equipment, and service provision access points; 4) leveraging, optimizing and maximizing use of existing data systems through collaboration on digital transformation; 5) leveraging and exploiting global technology capabilities of the big tech American private sector firms (Amazon, Google, Microsoft & IBM); 6) building country digital health capacity

(institutional and workforce capacity strengthening; and 7) transforming data-based decision-making processes (data use). These distinct but closely interrelated investment areas are expected to contribute to improved and sustainable health outcomes and impact when implemented using collaboration, learning, and adapting with short learning loops. The implementation and programming strategies using priority guiding principles are expected to facilitate quick and flexible turnaround investments based on changes in capacity, and political and technical leadership commitment at the two levels of government.

Problem Statement. Kenya’s health care system is characterized by numerous vertical, siloed, unintegrated, and non-compatible digital-enabled data management systems that lack capability to provide quality, equitable, adequate, and triangulated data to support delivery of quality health care services. The development, implementation and oversight of these numerous vertical and non-interoperable data management systems also lacks national and county government involvement, with funding mainly coming from the development partners; limited existence of meaningful collaboration and strategic public – private partnerships; and inadequate technical expertise among the Ministry of Health workforce; thereby constraining local ownership and sustainability of the systems.

Development Hypothesis: IF 80% of county and sub county hospitals/Primary Health Care Network hubs institutionalize interconnectivity with one integrated digital health ecosystem, THEN the country will achieve true (complete and accurate) measures on morbidity and mortality burden for timely policy and programmatic interventions.

Kenya Digital Health Ecosystem Logical Framework:

Kenya Digital Health Ecosystem’s Purpose Statement: Increased country ownership and management of one national integrated and comprehensive sector-wide health information ecosystem to achieve health systems outcomes of equity, quality, and resources optimization.

Sub purpose I: Integrated digital health solutions, infrastructure, and services’ provision ecosystem.

Focus on integrating all digital health solutions in the health care delivery ecosystem is expected to improve the availability, timeliness, quality, and accessibility of health data (made up of patient level, commodity, logistics, HRH and financial data) to policy makers and health managers at all levels of service delivery. These efforts will contribute to the improved functionality of the entire health care delivery system in the country. Key policy decisions as well as day-to-day programmatic decisions will be based on better data, ultimately strengthening the management, efficiency, effectiveness, reporting, monitoring, evaluation, and learning of programs. Ability of health managers to increase their visibility into the impact of investments on patient care as well as on key programmatic impact indicators such as preventable maternal and child mortality will be enhanced, and decisions such as resource allocations in the procurement of medicines and health commodities and health workforce rationalization will be informed by timely, complete, and accurate data. The integrated and interoperable digital health solutions would benefit patients too as unique patient identifiers ensure longitudinal tracking that supports improved quality of care as their data move through disparate healthcare delivery points and programs as patients move from one geographic location to another. Data systems of interest for integration include laboratory systems, points of care, pharmacy systems, logistics systems, e-health/m-health applications, surveillance systems, insurance systems such as NHIF, data systems on social determinants of health, and management information systems such as human resources for health and financial systems.

Expected health systems outcomes:

● % health facilities by type (public, private and FBO) that are integrated with the one national integrated digital health ecosystem.

● % of Primary Health Care Network (PCN) hubs integrated with the one national integrated digital health ecosystem.

Sub purpose II: Enhanced digital health ecosystem’s vision, strategy, and governance capacity.

The government of Kenya recently enacted the Data Protection Act that spells out parameters for collecting, collating, processing, storing, and using individual level data. As technology and data management infrastructure evolves, Kenya needs to invest in a more modernized data governance strategy that provides for different data access controls to ensure that health sector players continue to get the most out of individual level data. Technical interpretation as well as translation of the health sector data governance strategy, implementation plan and other national and county operational policies, guidelines and protocols is already a high priority in the health sector. Kenya’s Ministry of Health in collaboration with its relevant digital health stakeholders will need to prioritize the operationalization of digital health governance structures, effective implementation, and oversight on policies, guidelines, and standard operating procedures if the country is to shift to a culture of a comprehensive and integrated digital health ecosystem and continuous data use. Experience from other countries such as Indonesia has shown that effective implementation of an integrated and comprehensive digital health ecosystem requires strong and robust leadership and governance structures, clear strategic directions, collaborations with the right partners, cultural transformations especially among the policy makers and health workforce, and technological know-how. The country’s long-term vision, policies, strategic priorities, and governance structures must provide an enabling environment to promote these success factors.

Expected health systems outcomes:

● % of national-level digital health governance policies, guidelines and frameworks completed and disseminated.

● % of counties where digital health governance and oversight policies and structures are established and functional.

● Number of national, county, and health facilities where national data privacy, security, and governance policies and guidelines have been operationalized at every point of care.

Sub purpose IIII: Strengthened strategic partnerships and collaborations to sustain investments in the digital health ecosystem.

The technological advancement and evolutions landscape is evolving quite rapidly at the global, regional, and national levels. Strategic partnerships and collaborative platforms with the global, regional, and national tech firms, academia, private sector, philanthropic organizations, and with the health workforce are expected to keep the country’s digital health ecosystem on the cutting edge as well as to build a more robust sustainable roadmap for digital health investments. The Ministry of Health requires technical assistance on remodeling its coordination and collaboration structures as part of strengthening its strategic partnerships for digital health investments. Instituting its own Ministry-led digital health governance structures would play an important role in convening funders operating in the country and aligning funding to country-led plans. Partnerships would transcend beyond funding opportunities to include leveraging a hybrid of international, regional, and local knowledge, networks, and assets for a more robust and agile digital health ecosystem. The alignment of all the relevant stakeholders’ data and digital health investments to Kenya’s national digital health vision, strategy and implementation road map will provide the much-needed enabling environment for the revision and updating of the 2011 Kenya Health

Enterprise Architecture in line with the latest technological advancements, which in turn will serve as the foundation for building an interoperable digital health ecosystem.

Expected health systems outcomes:

● Number of strategic partnership/collaborative frameworks between MOH and private tech firms operationalized.

● Number of strategic partnership/collaborative frameworks between MOH and academia operationalized.

● Number of strategic partnership/collaborative frameworks between MOH and private sector health providers operationalized.

Implementation Approach:

Overall, the activity will adopt an integrated approach as its implementation strategy that is expected to maximize returns on health systems investments and achieve sustainable health outcomes and impact at the devolved and national levels. The implementation focus for the sub purpose two and three investment areas will primarily start at the national level given that the national MOH retained responsibilities on national policy and strategy development under the 2010 constitutional dispensation. Systems integration investment areas under sub purpose one will start with focusing on county referral hospitals, then to the primary health care network hubs at the sub county levels. The implementation strategy will be through the adoption of a phased approach that actively embeds and utilizes collaborative, learning and adapting principles from one county referral hospital and PCN to the next.

Metrics Prioritization Logic Model:

Health systems outcomes measurement for the investment in this activity will be based on the cross functional outcomes of equity, quality, and resource optimization. The logic model holds since complete, reliable, timely and triangulated data from the one comprehensive and integrated digital health ecosystem will be used by policy makers, health managers, health service providers, and the patients themselves to ensure that the three outcomes of equity, quality, and resource optimization are achieved. Data will inform resource allocations, utilization, and accountability; while at the same time data will ensure that the excluded, unreached segment of the population are targeted and served with quality services.