Electronic community-based health information system in Kenya
In 2006 the Government of Kenya initiated the community health strategy. Community Health Units (CHUs), provide to the people in Kenya essential health prevention and promotion services, and refer to health facilities when needed. The CHUs each exist of 10 community health volunteers (CHVs), covering 500 - 1000 households in a village or neighbourhood, and work together with a Community Health Committee. Community Health Assistants (CHAs), working in health centres supervise the CHUs.
The SPHIP project in Kwale County strengthens the community-based health services by initiating 24 CHU in two wards (with in total 240 CHVs) and by training CHAs (a one-year certificate course). The project applies the government curricula for training. In addition to this, the project - in close collaboration with the health information unit in the Ministry of Health - introduces a community health information system, using smartphone technology. The open-source DHIS2tracker software is applied, which is links to the national internet-based DHIS2 information system. Kwale is the first County in Kenya that embarks on this innovative approach of supplying community health workers with smartphones for collecting data electronically and communicating information via internet to the supervisors in the health centres. Data collected are baseline data on households (composition of the family, housing, latrines, bed nets, etc.) and monthly data on vaccinations, antenatal care, diseases experienced and use of health services.
Recently the training of CHUs in using DHIS2tracker was evaluated, and an assessment was made of data quality using the new technology. The survey showed a significant increase in knowledge of trained CVHs with regard to health promotion and prevention, as well as skills in using the smartphone for data entry. However, the training was too short to teach how to handle problems of internet access, or use of power banks for charging. Continuous coaching after training is needed in case CHVs run into problems with technology.
Data quality of the electronic system was analysed. Around 95% of electronically recorded baseline data was correct when checked. This is nearly as good as the paper-based recording (98% correct). Communication and aggregation of electronic data is nearly real-time and without calculation errors, which is much better than the paper-based system. The conclusion is that the electronic community health information system is viable, even when used by low-level trained volunteers. This offers new possibilities in monitoring health and service delivery at community level, especially because information can be linked to the national system. It will be possible to measure the impact of health promotion and prevention on health status of the people and service utilisation.