Sustainability and scale-up of KenyaEMR: a mixed-methods needs assessment of an HIV-related digital health solution beyond donor support in Kenya
Embargo Date
2027-05-27
OA Version
Citation
Abstract
BACKGROUND: KenyaEMR is one of Kenya's longest and most widely implemented digital health solutions. Initially implemented for HIV-centered patient services with donor support from PEPFAR, this study aims to understand KenyaEMR within the HIV digital health landscape, its maturity, and local sustainability and scale-up considerations. METHODS: The study utilized a mixed-methods approach, engaging stakeholders with diverse organizational representation, roles, and expertise in KenyaEMR and HIV digital health solutions. KenyaEMR’s maturity was quantitatively assessed across five domains using a Health Information System Stages of Continuous Improvement (HIS SOCI) survey, a modified two-round Delphi process for consensus-building on final maturity scores, and an improvement roadmap development. Qualitatively, the study validated the accuracy and completeness of the HIS landscape map of digital health solutions for HIV through informational interviews and conducted in-depth, semi-structured interviews to understand KenyaEMR’s sustainability and scale-up using a sustainability conceptual framework.
RESULTS: In 2024, KenyaEMR’s maturity level was 3.2/5 (current status, August 2024) and 4.6/5 (goal/desired status, December 2027). The standards and interoperability domain scored the highest (4.4), while management and workforce scored the lowest (2.3). The HIS landscape mapping found ten digital health solution groupings for HIV-related services. KenyaEMR is the most connected system, allowing data exchange with eleven digital solutions. Key enabling factors for KenyaEMR’s sustainability and scale-up include clear system goals, patient support capabilities, local system championing, routine system enhancements, alignment with national strategies, harmonious Ministry of Health (MoH) and donor relationship, political commitment, incremental local funding, and MoH’s training capacity on KenyaEMR updates. Challenges include financing, training and workforce, MoH’s institutional capacity weaknesses, and the need for improved HIS infrastructure. CONCLUSION: KenyaEMR’s maturity is further along compared to its regional neighbors. The HIS landscape map provides a centralized visual map of the HIS ecosystem, which can complement Kenya’s Digital Health Superhighway and data exchange across the health system. KenyaEMR’s sustainability-enabling factors outweigh the perceived challenges. While there is strong technical support for KenyaEMR from partners, improvements are needed in the MoH’s technical capacity, workforce, and local financial commitments. Lessons from Kenya can benefit other countries with historically donor-funded digital health systems aiming for local sustainability.
Description
2025