Jacaranda Health co-designed a dashboard, coined ‘PULSE’, to help local health management teams see, at a glance, how their facilities are performing on key quality of care and patient experience indicators. County governments and health facility managers regularly sit down with PULSE data, identify service delivery gaps, and propose improvement activities.
We have qualitative data (i.e., open rates and active time spent) to show the dashboards are being routinely looked at. But we recently took a closer look at how counties are actually using PULSE to make decisions about how to improve quality and allocate resources.
In the first half of 2025, 600 gaps and associated ‘improvement activities’ were identified, proposed, and actioned by facility managers based on PULSE data.
Over half of all identified gaps focused on antenatal care. Examples included missed clinical exams or lack of appropriate counseling and education, low coverage, and missed ANC visits. This pattern reflects both what the dashboards highlight most clearly and what managers are used to being judged on. The result is a strong but narrow focus on ANC, with less attention to later stages of the maternity care journey.
The majority of solutions mirror the gaps being identified. Facility managers proposed feasible actions that align with ANC-focused gaps, such as health talks, continuing medical education (CME), refresher trainings, and higher PROMPTS registration. They also reflect what is in the direct control of managers: sensible “quick wins”. This means that they do not always tackle the underlying systemic barriers (e.g., commodity stock-outs, staffing shortages, or infrastructure gaps, that also affect quality of care), though some do.
Sankey diagram illustrating the types of gaps identified through PULSE data (e.g., missed visits, staff skills, record-keeping), and how they translate into targeted solutions. Note that not all identified gaps are included in this figure as they could not be categorized into broad groups.
Some counties identify more diverse gaps because they measure differently or more in depth. In most counties, the gaps flagged in PULSE focus narrowly on ANC, because that’s what counties are set up to measure. In some counties, managers look at more detailed data on maternal and newborn outcomes, which leads them to surface issues like postpartum hemorrhage, obstructed labor, and prematurity, alongside ANC coverage. As a result, their proposed solutions also reflect this wider lens, focusing more on skills-based responses such as continuing medical education on newborn resuscitation and post-partum hemorrhage, staff upskilling, and mentorship, rather than relying mainly on quick wins like health talks.
The number and nature of improvement activities varied by county, indicative of the focus of their data review and the resources available.
The improvement activities are being acted upon. Counties aren’t just identifying gaps and potential solutions, they are following through. Between Q1 and Q2, the number of activities marked “in progress” fell from 436 to 217, while “complete” rose from 98 to 120.
Improvement activities moved from in progress to complete over time.
How can we better understand the impact of PULSE?
Jacaranda is currently working with behavioural design outfit, Ideas42, to map the pathway from data access to decisions. This evaluation will:
- Trace how PULSE data moves from dashboards to decisions.
- Identify the behavioral steps that enable real change.
- Provide evidence for internal advocacy and county engagement.
By November 2025, this work will produce a playbook of decision pathways which will give insights into the conditions that unlock real, data-driven change.
PULSE is proving that when managers have the data (through co-design) and the right support (through onboarding and coaching), they act. Managers are using the dashboards to make tangible changes: holding more health talks, mentoring staff, and improving service delivery within the resources they control. The opportunity now is to evolve from these pragmatic fixes to system-level improvements in commodities, staffing, and respectful maternity care. With the added depth of our updated MENTORS program (more coming soon!) and the clarity of decision pathway mapping, PULSE can evolve to shape further improvements in care.