Annex 2: SS3 key informant interview questionnaires

1. Ministry of Health & Population KII guide

1. Has the MoHP seen any changes in the past 5 years in terms of decentralization processes?

2. Has administrative and political decentralization specific to health systems had any impacts on MoHP use of evidence in decision making?

3. Has administrative and political decentralization specific to health had any impacts on MoHP access + inputs to + use of digital health data + data systems in decision making?

4. (How) has the Kuunika project addressed the MoHP's specific digital data needs and challenges

5. Has Kuunika supported Districts in management of digital health data?

6. To what extent have Kuunika outputs supported the MoHP to facilitate the creation of capabilities for digital health data use at the district level?

7. Has Kuunika been agile in identifying + responding to decentralization activities that may have an impact on project work?

2a. What if any have been the changes in terms of health decision-making + service delivery from the perspective of the MoHP?

2b.What if any have been the changes in terms of health decision-making + service delivery at District and sub-District levels, from the perspective of the MoHP?

3a. What if any have been the changes in terms of use of digital data in health decision making at the MoHP?

3b. What if any have been the changes in terms of health decision-making + service delivery at District and sub-District levels, seen from the perspective of the MoHP?

4a. (How) has Kuunika involved the MoHP in project planning (including its pivots)?

4b. (How) has Kuunika involved the MoHP in project delivery?

4c. (How) has Kuunika supported MoHP capacity development in terms of digital health data systems + use?

5a. What has Kuunika done to facilitate MoHP support to Districts' use of DHIS2?

5b. What has Kuunika done to facilitate MoHP support to Districts' use of other digital health data systems?

From the perspective of the MoHP + in terms of optimizing comparative advantage, coherence + effectiveness:

6a. Has Kuunika supported the setting of performance and quality targets?

6b. Has Kuunika provided assistance in routinely measuring performance against targets?

6c. Has Kuunika been responsive to Districts' + Health Facilities' digital health data technical + other challenges?

From the perspective of the MoHP + in terms of optimizing comparative advantage, coherence + effectiveness: (How) has Kuunika contributed to the centre supporting the Districts?

Have Kuunika inputs + outcomes in any way promoted/supported decentralization of health systems + digital data?

Have any of Kuunika’s intended outcomes at the District level been undermined by any tensions/ delays/changes in the decentralization agenda?

8. Does Kuunika’s 2020 ‘Covid pivot’ of Kuunika represent a 'recentralization' of health sector resources and decisionmaking?

Does the pivot have potential for generating unanticipated benefits for central-District/local relations and interactions?

What has the pivot meant specific to management of + access to digital data for the MoHP overall, for the QMU specifically (+ any other closely involved departments/ divisions/units)?

2. District Health Office, Council and DHMT KII guide

1. Has your District seen any changes in the past 5 years in terms of decentralization processes?

2. Has administrative and political decentralization specific to health systems had any impacts on your (personal + District's) use of evidence in decision making?

3. Has administrative and political decentralization specific to health had any impacts on your (personal + District's) access + inputs to + use of digital health data + data systems in decision making?

4. (How) has the Kuunika project addressed Districts’ specific digital data needs and challenges

5. Has Kuunika supported Districts in management of digital health data?

6. To what extent have Kuunika outputs been adopted and ‘capabilities created’ for digital health data use at the District level?

7. Does Kuunika’s 2020 ‘Covid pivot’ of Kuunika represent a 'recentralization' of health sector resources and decisionmaking?

1a. If there have been changes, will these have any impacts on the development of the new DDPs and DIPs?

2a. What if any have been the changes in terms of health decision making at District and sub-District levels?

2b.What if any have been the changes in terms of health service delivery at District and sub-District levels?

3a. What if any have been the changes in terms of health decision making at District and sub-District levels?

3b. What if any have been the changes in terms of health service delivery at District and sub-District levels?

4a. (How) has Kuunika involved Districts in project planning (including its pivots)?

4b. (How) has Kuunika involved Districts in project delivery?

4c. (How) has Kuunika supported District capacity development in terms of digital health data systems + use?

5a. What has Kuunika done to support the District's use of DHIS2?

5b. What has Kuunika done to support the District's use of other digital health data systems?

6a. Has Kuunika supported the setting of performance and quality targets?

6b. Has Kuunika provided assistance in routinely measuring performance against targets?

6c. Has Kuunika been responsive to Districts' + Health Facilities' digital health data technical + other challenges?

What impacts has the pivot had on Kuunika's support to the Districts?

3. Kuunika and Cooper/Smith KII guide

1. Has Kuunika and/or C/S seen any changes in the past 5 years in terms of decentralization processes?

2. Has Kuunika and/or C/S seen any administrative and political decentralization having any impacts on use of evidence in decision making?

2a. What if any have been the changes in terms of health decision making at District and sub-District levels?

3. Has administrative and political decentralization specific to health had any impacts on Kuunika and/or C/S supporting Districts' access + inputs to + use of digital health data + data systems in decision making?

4. (How) has Kuunika addressed Districts’ specific digital data needs and challenges ?

5. (How) has Kuunika supported Districts in management of digital health data?

6. To what extent have Kuunika outputs been adopted and ‘capabilities created’ for digital health data use at the District level?

7. Has Kuunika been agile in identifying + responding to decentralization activities that may have an impact on project work?

2b.What if any have been the changes in terms of health service delivery at District and sub-District levels?

3a. What if any have been the changes in terms of health decision making at District and sub-District levels?

3b. What if any have been the changes in terms of health service delivery at District and sub-District levels?

4a. (How) has Kuunika involved Districts in project planning (including its pivots)?

4b. (How) has Kuunika involved Districts in project delivery?

4c. (How) has Kuunika supported District capacity development in terms of digital health data systems + use?

5a. What specifically has Kuunika done to support Districts' use of DHIS2?

5b. What specifically has Kuunika done to support Districts' use of other digital health data systems?

Has Kuunika collaborated with other programmes/projects working on digital health data?

6a. Has Kuunika supported the setting of performance and quality targets? How specifically?

6b. Has Kuunika provided assistance in routinely measuring performance against targets? How specifically?

6c. Has Kuunika been responsive to Districts' + Health Facilities' digital health data technical + other challenges? How specifically?

7a. (How) has Kuunika contributed to the centre supporting the Districts?

7b. Have Kuunika inputs + outcomes in any way promoted/ supported decentralization of health systems + digital data?

7c. Have any of Kuunika’s intended outcomes at the District level been undermined by any tensions/delays/changes in the decentralization agenda?

8. Does Kuunika’s 2020 ‘Covid pivot’ represent a 'recentralization' of health sector resources and decisionmaking?

8a. Does the pivot have potential for generating unanticipated benefits for central-District/local relations and interactions?

8b. What impacts has the pivot had on Kuunika's support to the Districts?

4. KII guide: other programmes/projects

1. Has your organization seen any changes in the past 5 years in terms of decentralization processes?

2. (How) has your programme/ project addressed Districts’ specific digital data needs and challenges?

2a. (How) has your programme/project involved Districts in project planning (including its pivots)?

2b. (How) has Kuunika involved Districts in project delivery?

3. Has your programme/project supported Districts in management of digital health data?

4. Has your programme/project managed to be agile in identifying + responding to decentralization activities that may have an impact on project work?

2c. (How) has Kuunika supported District capacity development in terms of digital health data systems + use?

3a. What has it done to support the District's use of DHIS2?

3b. What has it done to support the District's use of other digital health data systems?

Has your programme/project collaborated in any way with Kuunika?

4a. (How) has your programme/project contributed to the centre supporting the Districts?

4b. Have your programme/project's inputs + outcomes in any way promoted/supported decentralization of health systems + digital data?

4c. Have any of your programme/project’s intended outcomes at the District level been undermined by any tensions/ delays/ changes in the decentralization agenda?

5. Has your programme/project changed its focus in order to respond to the pandemic?

5a. Does any such change of focus have potential for generating unanticipated benefits for central-District/local relations and interactions?

In addition, a small number of KII with national programme partners and international experts on decentralization focused on the following questions.

1. The autonomy and authority of Districts in the context of decentralisation

2. Degree of appetite for genuine decentralisation

3. Challenges, achievements in the context of decentralisation of health systems

4. The current status of decentralisation in the context of health service financing, governance, data collection and use and service delivery.

5. The role of digital data: how data can be/are used at District and national levels to plan and improve health service delivery

6. Any developments over the past 5 years and any projected changes

7. The role and importance of projects such as Kuunika in this context

8. Any changes due to the GoM and MoH response to the pandemic, specific to digital data and the role and remit of Districts