By John Walubengo
Last week, on October 19, 2023, the Kenyan President signed four health-related bills aimed at realizing Universal Health Coverage plans. These include the Primary Health Care Act, the Digital Health Act, the Facility Improvement Financing Act, and the Social Health Insurance Act, of 2023.
The Digital Health Act (2013) is particularly impressive from a digital or data governance perspective and is perhaps the first law in Kenya that gives us a glimpse of what is needed to get us to think of data as an asset as opposed to data being simply a by-product of our transactions.
Data governance seeks to provide policies, rules and structures around data collection, curation and sharing so that a group of actors can collaboratively create value out of their data interactions.
The health sector presents one of the most diverse groups of actors, each with its own local and complex challenges that could be resolved through synergies that arise from better data governance systems.
The actors include but are not limited to the patient, the health facility (hospital, clinics, etc) they visit, the medics attending to him, the pharmacy, the health insurer, and medicine distributors like KEMSA amongst others.
Each of these actors has its information systems, which in most cases do not talk to each other – in technical terms, they lack interoperability.
Health Information System
Some of the challenges that patients go through are as a result of this lack of system interoperability. They are well documented and range from lack of medics, lack of drugs, lack of health equipment, and fraud between hospital facilities and the medical insurers amongst others.
The new Digital Health Act establishes an Integrated Health Information System whose role is stated as:
‘a health ecosystem designed to manage health and health-related system data that provides the foundations for decision-making and includes system that collect, collate, store, manage, analyse, synthesise, transmit patient’s or client’s electronic health record and use health and health-related data for operational management or a system supporting healthcare policy decisions.”
In other words, there shall be a pre-defined core information system upon which all the other actors or stakeholders would be expected to plug in – even as they continue to act autonomously in their respective roles as patients, medical doctors, nurses, pharmacies, insurers, hospital facility operators or whatever.
The overall objective is to ensure that all the actors – including the Ministry of Health – have a single source of truth regarding health activities across the country.
There will be a Digital Health Agency to oversee this Health Information System and the associated data governance concerns. A few of the critical functions the Digital Health Agency would oversee are listed in the Act as:
(a) to develop, operationalise and maintain the Comprehensive Integrated Management Information System, to manage the core digital systems and the infrastructure required for its seamless health information exchange;
(b) to establish registries, in consultation with other statutory authorities, at appropriate levels to create a single source of truth in respect of clients, health facilities, healthcare providers, health products and technologies;
(c) to promote the adoption of best practices and standards for digital health that facilitate data exchange; amongst others.
Whereas the functions listed are critical and necessary, it is not too clear why we would need a whole new agency to execute data-related issues, particularly when we already have the Office of the Data Protection Commission (ODPC).
Perhaps it may be due to the complexities of health issues, including the fact that it is a shared responsibility between the two layers of government – National and County.
However, the risk of this precedent is that other ministries may assume that they too, need a whole agency and its pertaining board of directors to oversee data governance issues. In the end, we may end up with over twenty ‘agencies’ focusing on the various line ministry data governance agendas, when we could have just set up one, or extended the mandate of the existing ODPC to oversee these issues at a national level.
Another concern, though it would come later as an operational issue is whether the proposed health info system would be deployed as a decentralized, high-integrity blockchain system or it would be deployed as a regular, centralised client-server system.
The centralised systems have over the years not managed to sort out our low-integrity issues that continue to haunt the various other ministries such as in Lands where the validity of the title deeds sometimes depends on which technician was last to access the system.
That said, the Ministry of Health with its Digital Health Act has set the tone and direction for data governance in Kenya.