An exploration of the successful scale-up of the electronic community health information system in Kenya

Healthcare delivery is swiftly evolving, adopting digital solutions to significantly enhance efficiency and effectiveness. To improve community health service delivery and advance Universal Health Coverage in Kenya, a countrywide Electronic Community Health Information System (eCHIS) was implemented. This study investigated the approaches, enablers and barriers influencing its scale-up from pilot to national level. A qualitative evaluation of the eCHIS scale-up process was conducted, involving key informant interviews with policymakers at the Ministry of Health Kenya, implementing partners and county health teams and focus group discussions with County Health Focal Persons from selected counties at the subnational level. eCHIS has been implemented countrywide. The Ministry of Health at the national level employed a sequential approach, where a pilot informed version two, which was then deployed county by county. Counties at the subnational level, however, had autonomy to select either sequential, deploying eCHIS incrementally in one subcounty at a time, or non-sequential, deploying eCHIS in all subcounties simultaneously, methods tailored to their specific context and factors. Scale-up enablers included strong leadership, supportive policies, adequate financing and resources, partnerships, readiness assessments, stakeholder engagement, contextual adaptation, training, monitoring and evaluation of outputs, infrastructure and interoperability and centralized management. Barriers included funding and resource limitations, logistical and infrastructure challenges, communication challenges and partner capacity shortfalls. This study explored these aspects of scale-up in depth and provides insights for policymakers and implementers navigating the complex landscape of Health Information Systems scale-up. These findings can inform the development of guidelines for future HIS scale-up efforts.