This is to assess data quality from Kenya R1 CEHS. Part A focuses on survey data aginst HMIS data for the sentinel sites. Part B examines missing and variation in data.

Part A: HMIS data

Among 91 facilities assessed for CEHS, 86 had annex information collected from HMIS. Below results are only among the 86 facilities.

1. What are trends of service utilization reported in HMIS?

1.1. Percent change in OPT, IPT, Delivery and DPT from 2019 Aug-Nov to 2020 Aug-Nov: with and without outliers (i.e., above the >95th percentile).

1.2. Percent change in OPT, IPT, Delivery and DPT from 2019 Aug-Nov to 2020 Aug-Nov: by facility level, excluding outliers

2. Do responses to service volume changes in the survey correlate with the trends in HMIS data?

See Annex A2 for survey questions. Below shows percent changes in HMIS data (excluding outliers) by survey response.

2.1. Out patient

OPT change (%) by survey response
Survey response	Number of facilities	Average percent change in HMIS data
1.Yes, increased in all areas	6	-14.2
2.Yes, decreased in all areas	36	-21.8
3.Yes, increased in some but decreased in some	16	-8.1
4.No changes in any	12	-27.4

2.2. Immunization

DPT change (%) by survey response
Survey response (Immunization)	Number of facilities	Average percent change in HMIS data (DPT)
1.Yes, increased	6	-20.5
2.Yes, decreased	24	-7.8
3.No	22	-15.5
4.N/A	6	-100.0

2.3. Inpatient

Inpatient change (%) by survey response
Survey response	Number of facilities	Average percent change in HMIS data
1.Yes, increased	4	9.6
2.Yes, decreased	26	-11.0
3.No	15	-10.1

Part B: Missing dta and variation in data

forthcoming

Annex

A1. What are typical 4-month service volume among the sentinel sites?

A2. Survey questions

In the continuity of EHS tools, a set of questions are about service volume change in the last three months, compared to same three months a year ago. First question is about overall outpatient services: Q4.9.a "Has the facility observed changes in outpatient attendance (excluding emergency unit visits, if any) in the previous 3 months, compared to the same 3 months last year?"
Response options are:
1. Yes, increased in all service areas
2. Yes, decreased in all service areas
3. Yes, increased in some but decreased in other service areas
4. No change in all service areas

Then, for 18 individual services, service-specific volume change is asked. Three services are related with available HMIS data: Q4.9.3 Antenatal care, Q4.9.4 Postnatal care, and Q4.9.5 Immunization services
Response options are:
1. Yes, increased
2. Yes, decreased
3. No
4. Not applicable, the service is not offered in the facility

Finally, facilities are asked about inpatient volume changes if they offer inpatient servics: Q4.13 "Referring to previous calendar month, each night on average, how many patients had spent night in the facility?" and Q4.14 "Has the facility observed changes in inpatient admissions in the previous 3 months, compared to the same 3 months last year?"
Reponse options are:
1. Yes, increased
2. Yes, decreased
3. No