By Djesika Amendah – Associate Research Scientist
Evidence-based policy is the latest fashionable imperative in the development world, particularly in the health sector. It requires health policies to be based on data to inform policies that are predicated on real knowledge of what works – and what doesn’t.
But to develop the evidence base, researchers need a reliable, robust and consistent source of good-quality data. And in Kenya, much like elsewhere in sub-Saharan Africa, this is far from a foregone conclusion. There is not nearly enough publicly available routine quality health data, which means that everyone – both researchers and policymakers – are at a distinct disadvantage when it comes time for decision-making.
As a health economist working for APHRC, I am currently part of a project team trying to evaluate the comparative cost-effectiveness of free maternity and primary care, and health insurance in Kenya. We are interested in data in three main areas: on costs of primary care in dispensaries and health centers and of maternal care by level of facilities; on funding of facilities from the national, county and development partner levels; and on effectiveness, including how many antenatal visits, deliveries, and postnatal visits are offered at each facility level. We are also looking for information on maternal and infant mortality at facility-level – and at community-level, since all births do not occur in facilities.
This process has been difficult, to say the least. Actual disaggregated cost data is not publicly available; the few surveys that include questions about how much people paid for their healthcare or how satisfied they are with their healthcare are still under embargo even after many years. Effectiveness data on primary care is hard to come by beyond the data on maternal care collected by the Kenya Demographic and Health Survey (KDHS) that have been made available by the US – not the Kenyan – government. Keeping information out of the hands of those who can use it the most: the researchers, policymakers and other stakeholders who want to make the evidence-informed decisions to improve the lives of the population is harmful.
Kenya is not the only country in sub-Saharan Africa to be grappling with these data gaps; the unavailability of routine data is, well, routine. The consequences of missing data go far beyond a researcher’s own frustration; they really do make a difference in how effective policies and practices can be in targeting the right populations with the right interventions at the right time – and for the right cost.
A lack of data also prevents us from monitoring and evaluating whether we are reaching our goals – whether sustainable development is truly within our reach, or whether we are helping women not to die while giving life. It’s like we are shooting a moving target in the darkness: we hit just by chance or by the grace of God.
There does seem to be some hope in Kenya. As an ardent champion since 2012 of the data revolution in Africa, the Kenyan government has been an important partner for APHRC in committing to global targets about opening up data sources. This commitment – visionary and bold as it is – has yet to translate on the ground, especially with respect to maternal and primary health care.
There are easy, inexpensive and hugely effective ways the Kenyan government can translate its commitment to the data revolution into action, beginning with a system to clean administrative health data and ensure it is anonymized before being put in the public domain. Expanding and adapting the existing Health Management Information System platform is one way to do this.
Investing public funds in research and making research data (and not only reports) available through open source channels also demonstrates transparency and accountability of public funds. After all, this is taxpayer money and should be used to serve taxpayer interests.