Strengthening capacity for evidence use to reduce maternal deaths in Kenya: Experience from six counties with the most number of maternal deaths
By Rose N. Oronje, PhD
On June 14–16, 2017, the African Institute for Development Policy (AFIDEP) in collaboration with the UNFPA (Kenya Country Office) conducted a 3-day training workshop for senior health-sector government officials from six counties in Kenya on data analysis and research evidence synthesis and use. The six counties are the ones that account for 50% of all maternal deaths in Kenya (UNFPA 2014), namely: Mandera County (3,795 deaths per 100,000 live births), Wajir County (1,683 deaths per 100,000 live births), Marsabit County (1,127 deaths per 100,000 live births), Isiolo County (790 deaths per 100,000 live births), Lamu County (676 deaths per 100,000 live births) and Migori County (673 deaths per 100,000 live births).
The purpose of the training was to put data and research evidence at the centre of the efforts by these counties to reduce maternal deaths. This was informed by our consultations with UNFPA — which is currently working with these counties to strengthen initiatives aimed at reducing maternal deaths — that revealed that not much is being done to strengthen the use of data and research evidence in decision-making in these counties.
This training workshop was therefore a response to this need. The workshop marked the start of a long-term initiative through which AFIDEP will work with UNFPA in Kenya to strengthen county-level technical capacity in data analysis and interpretation as well as in carrying out research synthesis and operations research to inform ongoing and future efforts to reduce the deaths of mothers and children.
Current capacity for data analysis and research evidence synthesis at county level is very weak
The onset of devolved governance in Kenya in 2013 meant that most decision-making relating to health care service provision is now a function of the 47 county governments. Yet our experience with the six counties during the 3-day training workshop revealed a huge capacity gap in data management, analysis and interpretation, as well as in research evidence synthesis and application in decision-making. We conducted a pre-training test to assess the perceived level of capacity in relation to the key components of the training, which included data analysis, data presentation, data interpretation, research evidence synthesis process, developing effective policy briefs, and effective communication of evidence to decision-makers. The pre-test results revealed a need for training on the importance of evidence-informed decision-making, data analysis and research evidence synthesis concepts and skills, development of policy briefs, and communicating evidence to top decision-makers.
In addition, the training involved practical exercises in data analysis, presentation and interpretation using the DHIS-2 data for these counties, as well as practical exercises in research evidence synthesis and drafting policy briefs using relevant systematic reviews and primary studies to provide evidence-informed advice on effective strategies for reducing maternal deaths in these counties. For the data analysis exercises, our experience from the training revealed critical gaps in data management, analysis, presentation and interpretation. Similarly, our experiences with the research evidence component revealed notable gaps in appreciating different types of research evidence and their role in decision-making, research evidence review and synthesis process, and policy brief drafting.
What difference did the training make?
The training post-test revealed an improvement in knowledge and skills in data analysis, research evidence synthesis and communicating of evidence to decision makers. On a scale of 1 to 5, with 1 being lowest and 5 being highest, participants scored the training above 4 for improving all these aspects. From the practical sessions, county officials acquired hands-on skills in analyzing own county data on specific aspects of maternal health including causes of maternal deaths, maternal health services provided, among others. County officials also developed the very initial drafts of a policy brief on ‘effective strategies for tackling maternal deaths’ in their specific counties, using their own data and research evidence from systematic reviews and primary studies in Kenya. The draft briefs were critically reviewed and feedback provided for revision; we will provide remote review and inputs to support the finalization of the policy briefs and engagement of top county leaders on the recommendations in the briefs.
Reacting at the end of the training workshop, Dr. Gregory Ganda, Director of Health, Migori County said: “This training comes at a time when we had just identified the need for us to clearly define our challenges and communicate these clearly to the leaders, like the governor… This training will really help us in terms of producing evidence from our own data and published studies into something that the governor can understand and use to make a decision.”
On his part, Dr. Dahir Somow, Director of Health, Wajir County said: “With this training, we will be able to do better analysis of our data and see where resources are needed. We will use this information for resource mobilization. In fact, with this training, we will now analyse data and present to the Members of County Assembly (MCAs) at Ward level; each MCA will see how their Ward is doing. This way, they will be able to support budgets for improving health indicators in their Wards.”
“We need more of this training… and more of our staff at county and sub-county levels need this training,” county officials
This was the main message at the end of the training workshop. Between 4–5 officials were trained from each county including, the county director of health, deputy county director of health, county chief nursing officer, county health records and information officer, county reproductive health coordinator, and county project coordinator for the UNFPA initiatives in each county. At the end of the workshop, there was just one main message from county officials: “we need more of this kind of training to enable us to effectively put the skills learned to practice, and more of our staff at county and sub-county levels need this training.” The Wajir County Director of Health, Dr. Somow had this to say: “This training has a lot of value and it needs to be cascaded to the lower level. Once I go back I’ll actually brief the Executive of Health and the County Health Management Team, that I want this training to be done up to the sub-county level so that all the technical staff at these levels have these skills. And also in future, we need more time for this training so that people have more time for practicals.”
Counties will benefit not from one-off workshops, but from sustained training, mentorship and support in annual planning processes
Given the feedback from county officials above, and our past experience training technocrats in evidence use, one-off training workshops on their own are not effective. For this particular workshop, we worked with the county officials to define a follow-up plan that will enable remote support and mentorship in data analysis and research evidence synthesis for actual decision-making. As already noted, county officials started drafting policy briefs on effective interventions for reducing maternal deaths in their counties. As such, follow-up support will also include providing inputs into the finalisation, dissemination and application of the recommendations in the briefs.
For future training with county officials, we will build in more time for the data and research components, as well as build in a systematic follow-up support and mentorship programme for each county. This will ensure that by the end of the initial training workshop, county officials are close to completing their policy briefs with clear recommendations on what needs to be done to tackle the identified health issues in their counties. As such, the follow-up and mentorship will focus on dissemination and application of the evidence in the policy briefs in decision-making.
Our future training will focus on strengthening county planning by working with officials to generate timely evidence to inform annual planning processes
Moving forward, we will endeavor to conduct this training just before county annual planning cycles so that county officials can generate the evidence needed to inform decisions made during annual planning processes. Thus, the training will focus on analysis and synthesis of data and research aimed specifically at informing key decisions made during the annual county planning processes.
Since 2013, AFIDEP has been conducting capacity strengthening for increased evidence use in decision-making at the national level in the Ministry of Health and Parliament in Kenya and Malawi. With this training, AFIDEP is now extending these efforts in Kenya to the sub-national levels in efforts to directly affect decisions aimed at improving health care service delivery. This training was made possible with funding from the Norwegian Agency for Development Cooperation (NORAD) and the William and Flora Hewlett Foundation.
Dr. Rose Oronje is the Director, Science Communication and Evidence Uptake, where she provides strategic leadership in the design and delivery of evidence uptake research and interventions. Her publications have focused mainly on the areas of health policymaking, and research-to-policy in the health sector.