Data driven performance improvement in primary care

Digitization of primary health facilities in Kenya: a study on implementation and acceptance, as well as performance enhancement through data-informed continuous improvement cycles

About

This project aims to show the potential of enhancing healthcare outcomes through the digitization of health facilities in Kenya. An electronic health record system, integrated with a solution for maternal obstetric monitoring, will be deployed in several facilities. The success of the implementation and the acceptance from the targeted users will be studied in detail. Furthermore, the system will be used to run continuous improvement cycles, aimed at realizing measurable impact on various performance parameters.

Partners

How

The project implementation focuses on several NGO/faith-based hospitals and primary care facilities. The settings consist of a hospital and related primary health centers (hub and spoke).

The integrated digital solution consists of two elements that complement each other: The AfyaPro electronic health record (EHR) based facility-wide implementation, digitizing all departments and services in a typical health facility, and the Philips mobile obstetric monitoring solutions which provides a smart phone or tablet-based solution that supports pregnant women and infant health.

Two parallel studies are performed to measure the success and potential of digitization:

A scientific study led by Prof. Peter Waiganjo Wagacha (University of Nairobi), with contribution from Dr. Ken Redekop (Erasmus University Rotterdam) and overseen by a team from Philips Research East Africa. The purpose of this study is to understand the implementation of the solution, to evaluate the factors that influence the acceptance and use of an EHR system by health professionals and patients, as well as to evaluate the healthcare costs associated with the eHealth solution.
A practical, facility-led series of performance improvement cycles making use of the data available from the digital system. These are aimed at realizing measurable impact on health outcomes, patient experience and convenience, cost effectiveness, performance of health workers and performance of the health facilities and the referral chain.

Results

The project is currently in implementation. The digital solution has been fully implemented in three dispensaries in Kiambu County, Kenya: Mangu Dispensary, Ting’ang’a Catholic Dispensary, and Githunguri Health Centre, and in the level 4 hospital, the Githunguri Holy Family Hospital.

In all facilities a baseline study has been done to measure expectations, performance, and readiness before implementation. A midline evaluation has been concluded halfway the study implementation period to assess the same parameters, after completing the installation and initial experience. The facility-led continuous improvement initiatives were launched around the same time. The endline evaluation is planned to be completed in the first half of 2022.

Learnings and next steps

The baseline study has shown that the facilities score well on overall ‘readiness’ for successful implementation of the digital solution. It is expected that the staff capabilities and acceptance, the management support and the technical infrastructure provide a good basis to absorb the opportunities provided by digitization to enhance healthcare outcomes. The baseline study was also done for two public sites and showed good readiness for these as well.

The midline study for the three dispensaries, after several months of implementation, confirmed this view, although overall scores had marginally declined, reflecting start up issues. The endline study will give further insight into the acceptance of the AfyaPro solution and the impact on the health facility.

Facility led continuous improvement cycles (CIC) are being conducted. Digitization of processes ‘as is,’ should provoke change in terms of ease of use, speed of services, better data management, etc. However, the real strength of digitization is continuous improvement of processes and services based on well informed and data driven change management.