EXCLUSIVE: Kenya weighs abandoning gold-standard health survey for facility data

Anne has more than 20 years of experience working across African and international newsrooms: she was the founding Africa Health Editor at the BBC, where she launched health journalism platforms in Kiswahili, French, and... Learn more

For nearly four decades, Kenya has relied on the five-year Demographic and Health Survey (DHS) to guide policymakers, researchers, and donors in designing health priority interventions. Now, after the US government terminated the survey’s funding this year, it is considering using data collected at the facility to inform its national health decisions.

Health Director General, Dr Patrick Amoth, told Defrontera that the government has collected adequate data on multiple health indicators, including all deliveries and the outcomes.

“We have names of the mothers who deliver, we have the outcomes of the mothers who delivered, we have the outcomes in terms of the newborns, whether they survived or not, and what is the reason as to why they didn't survive, and if we strengthen the system,” Dr Amoth said, Kenya will be “one of the first countries in the global south to do away with the periodic five-year surveys,” Dr Amoth told Defrontera.

Health experts raise concerns about the approach of using facility-based data over national surveys. Caleb Mike Mulongo, a medical doctor and a health financing specialist, told Defrontera that information collected from people coming to seek care is administrative and does not give the full picture.

“These are selected indicators, numbers that will show the ‘what’ but not give you the ‘why’,” said Dr Mulongo.

Dr Mulongo explained further: “Surveys can reflect deeper and show information at the household level that may affect health, such as number of children per family, income levels, age group, and education levels, and that is information unavailable in administrative data.”

Citing the example of the triple threat – teenage pregnancy, gender-based violence and HIV – Dr Mulongo said surveys guide Kenya to make connections that would have otherwise taken longer to see using administrative data.

When it was started in 1984 by the United States government, the DHS was intended for tracking fertility. Later, it expanded to cover nearly 90 countries and a wide range of metrics. Kenya conducted its first survey five years after the survey started. Ever since, the survey has provided several decades’ worth of data coverage of child and adult mortality where there otherwise would have been none. A United Nations report assessing the potential impact of the loss of the DHS  singled out Kenya as among the countries with the greatest number of years in which the DHS was the only source of data for child mortality, alongside Zambia.

Faced with crippling donor cuts, Kenya has had to prioritise where money will flow. While important, demographic surveys are expensive due to the rigour of conducting the survey and the coverage. It uses detailed, standardised training manuals, calibrated questionnaires, and strategies that reduce or track interviewers’ and respondents’ biases. While there are no country-specific amounts, it would cost about KES 6.1 billion (US$47.2 million) each year to conduct the surveys.

DHS samples are also large. The 2022 [most recent and seventh] survey involved more than 42,000 people and collected more than 11 indicators, ranging from infectious disease prevalence to reproductive health indicators and even education. The surveys also have more than ten funders.