18.2 Health Information Systems, Records & KHIS Reporting

18.2 Health Information Systems, Records & KHIS Reporting

Quick Summary: Every figure on a national health dashboard began as a line a clinical officer wrote in a register. The chain is register → monthly summary tool → sub-county → KHIS (DHIS2) → county and national dashboards, on a rhythm of facility submission by about the 5th and KHIS entry by the 15th. Learn the tool numbers, the deadlines, and the five dimensions of data quality.

---

Why the Register Entry Matters

Routine health information in Kenya is used for four things: planning (how many staff and commodities a facility needs), resource allocation (county budget lines follow reported burden), monitoring (whether coverage targets are being met), and outbreak detection (an unusual rise in a reported condition). All four depend on an entry made in a consulting room by someone under time pressure.

The governing principle: data quality is decided at the point of capture. Nothing downstream — no audit, no dashboard, no analysis — can recover information that was never accurately recorded. A facility that under-reports its malaria burden will be allocated fewer antimalarials, and the people harmed by that will be its own patients.

---

The Two Layers: Registers and Summary Tools

Primary (source) tools are completed at the moment of care — patient cards and registers. Secondary (summary) tools aggregate those entries at the end of the month for reporting.

Learn the 705A / 705B pair. Splitting outpatient morbidity by under-5 and 5-and-over is the most frequently examined tool distinction, and these two forms also carry the highest reporting rates in the national system, so they are the ones a supervisor will open first.

---

The Reporting Chain and Its Deadlines

   POINT OF CARE                                   REGISTERS (MOH 204A/B, 240, 512 …)
         │  daily entry at the moment of care
         ▼
   FACILITY                                        SUMMARY TOOLS (705A/B, 710, 711, 717)
         │  compiled at month end and submitted     ── by about the 5th of the next month
         ▼
   SUB-COUNTY HEALTH RECORDS OFFICER               Verifies, compiles, enters into KHIS
         │                                         ── by the 15th of the next month
         ▼
   COUNTY                                          Review, feedback, county dashboards
         │
         ▼
   NATIONAL — KHIS (DHIS2)                         Indicators, dashboards, national planning

The 15th is the date that counts. National reporting timeliness is scored against it, which means a facility that submits on the 12th has not made the deadline late — it has made it just in time for someone else to do their part.

Feedback is the weakest link in the chain and the most examinable. Data that flows only upward demoralises the people collecting it and degrades quality over time. A functioning system returns analysis downward — county dashboards, comparative performance, and discussion of the facility's own numbers at supervision. If a vignette describes staff who "fill the forms but nobody ever tells us anything," the system deficiency is absent feedback, and the fix is a scheduled data review meeting at facility level.

---

The Five Dimensions of Data Quality

How a Data Quality Audit Works

A data quality audit does exactly one thing conceptually: it recounts from the source and compares.

1. Select an indicator and a reporting period.
2. Recount the cases from the primary register for that period.
3. Compare that recount with the figure reported in the summary tool and with the figure in KHIS.
4. Compute the verification factor: recounted value ÷ reported value. A factor of 1.0 is perfect agreement; below 1.0 indicates over-reporting and above 1.0 indicates under-reporting.
5. Investigate the cause, agree corrective action, and retrain where needed.

Note the direction of the logic carefully, because it is a favourite trap: a recount that is lower than the reported figure means the facility over-reported.

---

Constructing an Indicator Correctly

Most reported health indicators are proportions, and most errors are denominator errors.

$\text{Indicator} = \frac{\text{Numerator: those who received the service}}{\text{Denominator: the population who should have received it}} \times 100$

For coverage indicators the denominator is normally a catchment population estimate — for example, surviving infants for immunisation coverage, or expected pregnancies for antenatal coverage — and not the number of people who happened to attend the facility. A facility that uses attendees as the denominator will report coverage close to 100% while missing every child who never came, which is precisely the group the indicator exists to find.

---

The National Platforms

---

The Legal Duties Attaching to Records

The Digital Health Act 2023 supplies the legal framework for health information systems, interoperability of records between facilities, recognition of e-health as a mode of service delivery, and the protection and retention of health data — the Act contemplates retention of an individual's health data for a substantial minimum period, with disposal governed by regulations. Alongside it, the Data Protection Act 2019 classifies health data as sensitive personal data requiring a lawful basis for processing.

At facility level the practical duties are unglamorous and examinable:

• The physical record belongs to the facility; the information belongs to the patient. A patient may access their own information, but does not simply remove the file.
• Confidentiality applies to the record as much as to conversation. Files left open on a desk, results discussed in a corridor, and unlocked registers are all breaches.
• Entries are contemporaneous, legible, dated, timed, and signed, with the writer identifiable.
• Never erase or obliterate. Correct an error by striking a single line through it so that the original remains readable, then write the correction, date, and initial it. An obliterated entry looks like concealment and destroys the evidential value of the whole record.
• Retain records for the statutory period and store them securely; do not dispose of them informally.