Reporting of rapid diagnostic testing in Kenya's health system, 2018-2020: triangulation of routine and survey data

Abstract

Abstract Background Understanding access to and availability of rapid diagnostic tests (RDTs) is essential for attaining universal health care and reducing health inequalities. Although routine data helps measure RDT coverage and health access gaps, a significant proportion of healthcare facilities fail to report their monthly diagnostic test data to routine health systems, which affects routine data quality. This study sought to understand whether non-reporting by facilities is due to a lack of diagnostic and service provision capacity by triangulating routine and survey data in Kenya. Methods Monthly facility-level data on ten RDTs (malaria, HIV, syphilis, blood transfusion, anaemia, diabetes, pregnancy, urinary tract infections, kidney disease, and meningitis) was sourced from Kenya's health information system (2018–2020), and 2018 harmonised health facility assessment. After harmonization and linking the two data sources, we compared reporting in the routine system among facilities with i) diagnostic capacity only and ii) both confirmed diagnostic capacity and service provision. We also assessed trends in reporting for facilities without diagnostic capacity. Analyses were conducted at the national level, disaggregated by RDT, facility level and ownership. Results Twenty-one per cent (2821) of all facilities expected to report routine diagnostic data in Kenya were included in the triangulation. Majority (86%) were primary-level facilities under public ownership (70%). Overall, survey response rates across facilities were high (> 70%). Malaria and HIV had the highest response rate (> 96%) as well as the broadest coverage in diagnostic capacity across facilities (> 76%). Reporting among facilities with diagnostic capacity varied by test, with HIV and malaria having the lowest reporting rates, 58% and 52%, respectively, while the rest ranged between 69% and 85%. Among facilities with both service provision and diagnostic capacity, reporting ranged between 52% and 83% across common tests. Public and secondary facilities had the highest reporting rates across all tests. A small proportion of health facilities without diagnostic capacity submitted testing reports in 2018, most of which were primary facilities. Conclusion Non-reporting in routine health systems is not always due to a lack of capacity. Further analyses are required to inform other drivers of non-reporting to ensure reliable routine health data.