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Sustaining quality approaches for locally embedded community health services in Kenya


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This presentation was given at the Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services Symposium which was held in September 2016

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Sustaining quality approaches for locally embedded community health services in Kenya

  1. 1. SQALE: Sustaining quality approaches for locally embedded community health services in Kenya Dr Miriam Taegtmeyer and Dr Lilian Otiso, 29th September 2016
  2. 2. Overview • Where we have come from? • What we are trying to achieve? • Who we are? • How we will do this • What next? Community Health Volunteer (Diana) in Turkana County by Rosalind McCollum
  3. 3. Community Health Workers and universal health coverage • Community Health Workers seen as a solution to Universal Health Coverage and achieving the Sustainable Development Goals • They risk becoming the final common pathway of many vertical programmes "Universal Health Coverage focused solely on expanding access and NOT simultaneously addressing quality will have limited impact on population health” HLSP Summary Brief, June 2014
  4. 4. REACHOUT works to maximize the equity, effectiveness and efficiency of Community Health Worker services in rural areas and urban slums in six countries: Mozambique, Indonesia, Kenya, Malawi, Bangladesh and Ethiopia
  5. 5. Using the REACHOUT platform • REACHOUT is an unique opportunity for analysis within and between countries on what works, for whom and where • Our Quality Improvement approaches have been successful but are not sustainable on their own • The challenge now is to move from researcher led to district led systems that assure the quality of community health – SQALE is an opportunity • This requires a culture shift in the thinking of Technical Working Groups, counties and donors
  6. 6. Barriers to embedding quality for Community Health Services • Tension between scale up and embedding quality • Planning hampered by lack of clarity in defining roles and responsibilities for quality at each level • Lack of clear definition on what we mean by quality of community health services • Poor data quality and limited data use • No measures of community experience and satisfaction
  7. 7. Goal: Reduce maternal and child deaths in Kenyan communities using a Quality Improvement approach USAID SQALE (2016-2019)
  8. 8. USAID SQALE Objectives • Strengthen national coordination for improved quality of community health programs • Increase capacity to prioritize and budget for community health programs using an equity approach for improved service availability • Improve community health program performance in maternal child health • Strengthen community engagement in community health services
  9. 9. Roles and partners Leadership, project management, technical expertise, knowledge management, research and evaluation and international visibility In-country scale-up, liaising with and providing support to national and county teams, convening workshops, drafting meeting ToRs and minutes, drafting partner engagement frameworks, conducting participatory approaches, training, supporting supervisors Build on track record with quality in community health in Kenya, Quality Improvement training of trainers, capacity development, curriculum development, harvest meetings
  10. 10. Quality Improvement principles • Alignment with existing standards, models and tools • Maternal Newborn and Child Health priority focus areas • Simple, jargon-free materials • Clearly defined roles and responsibilities • Recognizing best practice • Incorporating the voice of the community
  11. 11. Components of the USAID SQALE intervention National Full Intervention 2 Counties - Establishing QI teams - Capacity building and mentoring support - Independent budget for QI teams activities - Dissemination of Standards Partial Intervention 2 Counties -Establishing QI teams -Capacity building & mentoring support -Support for QI team activities - Dissemination of Standards Control 4 Counties Dissemination of Standards
  12. 12. County selection criteria • Poor Maternal,Newborn and Child Health indicators • Builds on existing programmes for Quality Improvement in community health • Functional Quality Improvement teams at county level
  13. 13. Training strategy • Clear link to KQMH level 1 manual • Piloting material in two counties • Action learning through a three- phase approach • Coaching and mentoring support between phases • Identifying Quality Assurance champions
  14. 14. Three-phase approach Phase 1 • Establishing Quality Improvement teams • Quality Improvement concepts • Tools for monitoring quality Phase 2 • Presentation and analysis of data • Problem identification and root cause analysis • Quality Improvement Change plans Phase 3 • Evaluation of change plans • Comparison of data • Action planning
  15. 15. Expected Outcomes • Is the training methodology effective? • Does the SQALE approach improve MNCH outcomes? • At what cost? • Lessons on embedding QI into CHS
  16. 16. Post-Symposium Workshop • Discuss alignment with KQMH training manual • Selection of sub-counties and Community Health Units • Review results of Data Quality Analysis • Review tools for Quality Improvement • Reviewing roles and responsibilities of Quality Improvement teams
  17. 17. Next six months: Focus on Nairobi and Kitui Activity Oct Nov Dec Jan Feb Mar Baseline data collection Establish QI Teams QI training Phase 1 Mentoring /coaching support for QI teams QITs and WITS data collection QI training Phase 2 Finalise curriculum based on pilot testing
  18. 18. Find out more and keep in touch Website: Twitter: @REACHOUT_Tweet REACHOUT research