KePSIE

KePSIE was a monitoring and evaluation tool that targeted the development of the health safety standards in the country in a joint partnership project between the Kenyan Government and the World Bank Group. At the beginning of the KePSIE, the stakeholders noticed the following health system regulatory challenges:

1. Unclear and discretionary rules of the game. (e.g., ratings in the inspections were not consistent because of the lack of definitions on specific items to be inspected.
2. Inadequate government capacity to review and monitor the adequately large number of facilities which is almost 4 percent of the facilities which are inspected in a given year.
3. Lack of incentives to improve patient safety at the different levels of compliance with the standard. (e.g., unclear sanctions and weak enforcement except for the extreme cases of malpractice)

The World Bank KePSIE team, private sector team, and the local government have agreed to form a Task Force. This works on the stronger theory of change, new regulatory framework, development and authentication of the different tools to measure and monitor patient safety, and a gold standard RCT to evaluate the impact of different models of health inspection.

The M&E system was a vital element for adaptive learning. Formerly, there wasn’t any job description of inspectors, no monitoring system, no training material or protocols, and no institutional arrangement to link the MOH, the participating regulatory bodies, and the three-country governments and the inspectors for the intervention. We are designing a solution for this purpose. The extended team developed all these materials, protocols, and standards as the basis for the application and the monitoring of it. Furthermore, a low-cost system was set up to carry out the inspections on tablets and manage the process and monitoring through a web-based monitoring system that generates the progress reports, performance, and challenges in real-time.

The monitoring system includes:

1.  Data on planning and progress of the inspection pilots
2.  Inspection of the results at the facility and aggregate levels for each pilot (e.g., how are facilities performing in each intervention?)
3. Third-party monitoring indicators to assess the quality of intervention and protocol adherence (e.g., what is the quality of the inspection delivered?).

This customized solution furthermore leads to the availability of timely and actionable information to detect the challenges in the implementation. It also enhances the accountability to make mid-course corrections without the rigorous use of resources, expertise, or equipment which are commonly absent in poor-resource contexts.