Understanding the Effects of Decentralization on Health Information Systems in Developing Countries: A Case of Devolution in Kenya

Devolution of government functions is becoming widespread in developing countries. However, its effects on health information systems are not well understood. To gain more understanding, a study was conducted in Kenya, a country that has recently adopted devolution and is implementing a new web-based health information system; the District Health Information System (DHIS2). The empirical data for this study were obtained from extensive desk reviews, participant observations and key informant interviews conducted in eight administrative counties. The study shows that devolution has both positive and negative effects on the effectiveness of health information systems. By giving more power to lower administrative levels, the demand for health data for planning and implementation of programs significantly goes up; positively enhancing the culture of information use by the devolved units. Furthermore, the elected local leaders have a keen interest in statistics from their area of jurisdiction, increasing information demand and data quality. Any large variations in data from health information systems would easily be detected by the stakeholders, due to the small size of devolved governments. On the negative side, devolution has weakened the national government's control on the overall governance of the health system, resulting in inadequate supportive supervision from the national level, reduced nationally organized trainings, increased tensions in management of the country's health information system database (DHIS2) and lack of requisite data reporting tools. The findings further show that the sub national units prefer to invest in visible infrastructural projects like roads, buying new ambulances, building hospitals instead of investing in health information systems. In conclusion, devolution has more positive effects on health information systems. However, to gain full benefits, it is recommended that proper coordination and collaboration between the national and county governments is required.