Inside Ruto's data-driven health reforms

In a move to address longstanding issues of negligence, misdiagnosis, corruption, industrial strikes, and quackery, which have made it hard for Kenyans to access good healthcare services, the government has introduced the Building Resilient and Responsive Health Systems Project (BREHS).

The World Bank-funded and supervised initiative, tagged with tough terms, intends to reform the health sector, mainstream vulnerable and marginalized groups, promote transparency and accountability, and ensure stakeholder engagement to stop industrial strikes, corruption, and negligence, which have denied many people access to good treatment and/or led to deaths across the country.

“Complaints referred to the government’s legal complaint structures (e.g., EACC, CAJ, etc.) will be followed up until determinations are made and actions taken. Complaints regarding gender-based violence and sexual exploitation, abuse, and sexual harassment (SEA-SH) will be registered and handled following the procedure documented,” the new policy explained.

These reforms, based on the data collected, focus on healthcare infrastructure, human resources, institutional capacity, and healthcare financing. 

Addressing grievances with a data-driven approach

The data-driven management system is designed to closely monitor activities, labour, resources, stakeholders, health facilities, doctors, nurses, and health facilities, among others.

“Stakeholder engagement planning ensures timely, culturally sensitive, and inclusive information distribution, addressing language diversity, cultural sensitivities, and issues like illiteracy. Consideration for regional and socio-economic disparities aims for meaningful, equitable engagements and an effective feedback mechanism,” the policy reads.

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As a result, the government will set up a comprehensive committee to address grievances from patients and medical professionals, along with a dedicated databank to house reports on stakeholders, which include patients, suppliers, medical teams, and health institutions, among others.

The complaints will be directly sent to the project manager (PM), who must inform the World Bank as part of the terms.

The World Bank has also dictated that the funds should be disbursed on time. In addition, it has ensured that the project covers operational costs, logistical services, project monitoring and evaluation, environmental and social safeguards, stakeholder engagement, fiduciary management, staff contracting, and technical assistance for county peer-to-peer learning.

“The project should ride on the lessons learned and gaps identified in previous projects; hence the consultations in the preparation of the documents,” reads the project policy.

As part of the reform, the project introduces a Grievance Redress Mechanism (GRM) to handle complaints from stakeholders.

“Information on engagement activities is communicated through various channels, employing safe disclosure methods such as focus group discussions, internet platforms, IEC material creation, home outreach, and community consultations, as well as local media,” it reads, adding, “A grievance, whether perceived or actual, is a concern or claim that individuals or communities want addressed by the project, including compliments or complaints about impacts.”

The policy explains that “overall, grievances should be kept confidential, with the name of the complainant not recorded, only the age and gender, and whether a project worker was involved.”

This includes a commitment to follow up on complaints raised to government legal structures, ensuring determinations are made and actions are taken.

“For informal complaints, i.e., those raised through social media, print media, or not formally lodged, the committee should deliberate upon them to decide whether to investigate them based on the substance and potential impact or reputational risk to the MoH and the World Bank and take appropriate remedial action. No feedback may be provided in such a case,” the BREHS policy reads.

The emphasis is also on addressing issues related to gender-based violence and sexual abuse, with a documented procedure for handling such complaints.

“A robust GRM improves efficiency, raises awareness, prevents fraud, lowers risks, and provides staff feedback. The oversight committee, chaired by the MoH Principal Secretary, collaborates closely with the multisectoral group for guidance. MoH handles M&E, including data collection and World Bank reporting, ensuring coordination with the Project Management Team,” the policy reads.

Transparency and  accountability: The World Bank's vision

The policy, using the data collected, will ensure transparency, compliance with labor laws, and effective stakeholder engagement as part of the World Bank's terms with the government.

The project seeks to eliminate industrial strikes by doctors and medical teams, outlining a guide for transparent consultations and the establishment of communication structures.

"No disciplinary or legal action will be taken against anyone raising a complaint in good faith," assures the new policy released this month, highlighting the importance of fostering an environment where concerns can be raised without fear of reprisal.

A Comprehensive Data Bank for Informed Decision-Making

The project acknowledges the critical role of data in informed decision-making regarding staffing, medical teams, and health institutions, while also implementing a formal Grievance Redress Mechanism to promptly address concerns raised by stakeholders and project-affected individuals.

Stakeholder Engagement: A crucial element

The policy states that “stakeholder engagement is a key component of the project, with the Stakeholder Engagement Plan (SEP) serving as a dynamic framework for meaningful dialogue, public information disclosure, and a mechanism for lodging and resolving complaints.’

The SEP undergoes regular reviews and updates to ensure alignment with project goals and responsiveness to stakeholder needs.

The bank's plan includes a detailed stakeholder identification and analysis process, categorizing stakeholders into Project Affected Parties (PAPs), Other Interested Parties (OIPs), and Disadvantaged/Vulnerable Individuals or Groups. The SEP emphasizes a robust engagement process, utilizing various techniques to ensure inclusive participation and address diverse needs.

Addressing challenges and ensuring compliance

While highlighting the importance of government reforms and economic growth initiatives, the policy acknowledges persistent challenges such as the global economic downturn, unpredictable weather patterns, and insufficient institutional capacity.

“The ongoing government reforms, coupled with anticipated economic growth, were anticipated to facilitate the achievement of health goals. However, the global and local economic downturn, erratic weather patterns, and inadequate institutional capacity, among other challenges, have conspired to slow down the gains made in the sector by increasing the disease burden and the ability of the government to adequately fund the health sector reform programs."

The policy recognized that the global and local economic downturn, unpredictable weather patterns, and insufficient institutional capacity have hampered progress in the health sector in the country, saying that these challenges have increased the burden of diseases and strained the government's ability to adequately fund health sector reform programs.

“Government reforms and economic growth initiatives aim to achieve health goals, but challenges such as the global economic downturn and institutional capacity issues impede progress, increasing disease burden and limiting health funding, prompting the health sector to prioritize reforms at both national and county levels, focusing on healthcare infrastructure, human resources, and financing,” reads the policy.

It added that the project has been aligned with national health policies and focuses on addressing issues related to healthcare infrastructure, human resources, institutional capacity, and healthcare financing.

According to the policy, BREHS focuses on addressing gaps in healthcare infrastructure, human resources, institutional capacity, and healthcare financing.

The project comprises three main components: institutional capacity strengthening, improving health services at the primary care level, and project management and evaluation.

A dedicated project management team, oversight committee, and multisectoral oversight group ensure efficient execution and achievement of project goals.

The project will rely on data to carry out informed decision-making processes related to staffing, medical teams, and health institutions.

This data-driven approach is expected to empower the Ministry to create a committee dedicated to addressing issues raised by the public to ensure the public can actively monitor the activities of healthcare providers and institutions.

"For informal complaints, i.e., those raised through social media, print media, or not formally lodged, the committee should deliberate upon them to decide whether to investigate them based on the substance and potential impact or reputational risk to the MoH and the World Bank and take appropriate remedial action," the BREHS policy reads.

BREHS will also establish a formal Grievance Redress Mechanism (GRM) to address concerns raised by other stakeholders and project-affected persons, providing a clear, gender-responsive, and culturally acceptable process for lodging and resolving complaints.

"The SEP is a live document and will be reviewed and modified periodically to ensure information and interaction strategies are still pertinent and efficient within the project's context. Any significant alterations to the project's operations or schedule will be properly represented in the revised SEP,” the policy said.

The project will establish and maintain a database and activity file detailing public consultations, disclosed information, and grievance management throughout the cycle, which will be available for public review on request. Stakeholder engagement shall be periodically evaluated by the PIU.

“Evaluation criteria encompass grievance metrics (quantity, timeliness, resolution quality, escalations, overall satisfaction with GRM); stakeholder engagement (inclusive of project-affected individuals, gender, and vulnerable groups); and transparent communication of crucial information like project progress, commitment fulfilment, and updates tailored to stakeholders' information needs’” directed the policy.

BREHS comprises three main components: institutional capacity strengthening, improving health services at the primary care level, and project management and evaluation.

A dedicated project management team, oversight committee, and multisectoral oversight group have been put in place to ensure the efficient execution and achievement of project goals.

The Stakeholder Engagement Plan (SEP), a component of the BREHS project, provides a framework for meaningful dialogue with stakeholders, public information disclosure, and a mechanism for raising complaints and providing feedback on project-related activities.

"SEP is a dynamic document designed to facilitate effective stakeholder engagement and grievance redress throughout the project life cycle. Regular reviews and updates ensure alignment with project goals and responsiveness to stakeholder needs," states the BREHS document.

"These policies emphasize the importance of public participation in decision-making processes and ensure the respect of gender equity and minority rights in planning and development."

The World Bank will guide stakeholder engagement throughout the project cycle.

“This component focuses on interrelated areas aimed at strengthening institutional capacity, health financing reforms, and the availability and use of quality data for decision-making. These include institutional and operational reforms to enhance the efficiency of the Kenya Medical Supplies Agency (KEMSA), health financing and quality of care reforms, and improving the availability of quality data for decision-making,” reads the document.

The project demands early identification and fostering of positive relationships with stakeholders, promoting effective and inclusive engagement with project-affected parties, and ensuring timely and clear disclosure of project information.

The project classifies stakeholders into three groups: project-affected parties (PAPs), other interested parties (OIPs), and disadvantaged or vulnerable individuals or groups, encompassing beneficiaries, local communities, government oversight agencies, the media, and others. The second component centers on enhancing the delivery of quality services at the primary care level (community, dispensary, or health center) across all 47 counties.

The engagement process highlights the significance of vulnerable groups, such as persons with disabilities, women, children, and marginalized communities. The plan underscores special consideration for historically underserved traditional local communities, ensuring their equal representation in project consultations and decision-making.

It stresses robust stakeholder engagement using techniques like workshops, focus groups, public and community consultations, formal meetings, interviews, and site visits to ensure inclusivity, address diverse needs, and consider regional and socio-economic disparities.

“The proposed strategies for information disclosure include periodic revisions and updates to the SEP, utilizing safe approaches such as workshops, internet platforms, informational materials, home outreach, and local media,” the policy reads.

The SEP also allocates adequate resources for its implementation, with a budget reviewed biannually.

"Stakeholder engagement is crucial for project success, promoting ownership, and creating a conducive environment for goal attainment. Ensuring inclusive participation, access to benefits, and clear and consistent communication is vital, especially with those affected by the project," the report said.

Through the project, the World Bank wants all the details of the project public, asking the state to get opinions from others and giving ways for people to express their concerns or give input at different stages of the project.

The World Bank calls for early identification of all stakeholders, including staff, suppliers, and institutions, to ensure positive relationship-building, evaluating stakeholder support and interests, incorporating opinions in project design, promoting inclusive engagement with affected parties, and ensuring timely, clear, and accessible project information disclosure.

“There is a need to enrol the VMGs in the social platform for health insurance and address stigma around health-seeking behaviours for certain conditions, including cervical cancer and family planning,” the policy reads.

The Grievance Redress Mechanism (GRM) will be set up to handle complaints, with a focus on being clear, considerate of gender, culturally acceptable, easy to reach, free of cost, without retaliation, and including an appeals process, ensuring quick recording, examination, and resolution of all grievances.

The project, which addresses corruption, intends to address gaps, particularly in procurement alignment service delivery, restructuring the sector, enrolling the vulnerable in social health insurance to combat health-seeking behaviour stigma, and mitigating concerns of political interference by assigning responsibility to county leadership for sustainability.

The policy calls for timely disbursement and requires addressing participant concerns, including GBV, teenage pregnancy, and HIV/AIDS, through community engagement and safe houses.

It will support GBV risk awareness, empowerment, counterpart funding, sustainability, and co-creation beyond maternal health. In remote areas, it demands enhanced outreach, community empowerment with income-generating activities, sufficient resourcing through regular meetings, and increased funds.

“To tackle the challenges of delayed disbursement and limited access at the county level, a clear grievance redress mechanism (GRM) with defined roles and knowledge gap resolution is established,” the policy reads.

It adds that public participation in identifying priorities is ensured through participatory approaches, and learning and knowledge management are implemented through modern communication and cross-country learning.

The policy prioritises a comprehensive waste management plan, data protection, and harmonisation within the Social Protection Unit; subgroups identified through a thorough social assessment; and engagement of indigenous peoples through community groups and accurate population data.

Additionally, it advocates for training essential units like lab technicians and linking the Grievance Redress Mechanism (GRM) to community mechanisms, including the council of elders, for effective grievance resolution. The policy also mandates periodic updates of the Social and Environmental Performance (SEP) during project implementation, with quarterly summaries on public grievances, inquiries, and incidents reported to senior management, assessing the project's ability to address complaints effectively.