The document discusses Amref Health Africa's implementation of the Kenya Quality Model for Health (KQMH) in four counties between 2018-2020. Key points: - KQMH is an online quality assessment tool introduced in Kenya in 2017 to improve health services quality and achieve universal healthcare. - Between 2018-2020, Amref implemented KQMH in 38 facilities across Kwale, Kisumu, Vihiga and Nairobi counties through training, mentoring visits and assessments. - Facilities showed quality improvements over time through self and external assessments. Successful strategies included monthly mentorship, engaging quality champions, and integrating quality reporting into routine data systems.

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Amref Health Africa In Kenya
Health Systems Strengthening Programme
Kenya Quality Model for Health (KQMH) Implementation experience
Walter Kibet Kiptirim
HSS and Quality Advisor
Walter.Kibet@Amref.org
Quality Improvement week-Kenyatta National Hospital
27th October, 2020

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Outline
•Introduction & Background of KQMH
•Components on KQMH & Technology for KQMH
•Assessment levels of KQMH
•Amref KQMH Implementation Road map
•Lessons Learned

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Introduction, definition & Background of KQMH
Global increase in demand for Quality health Services and struggle towards
Universal Health Coverage achievement by 2030
 The Lancet Global Health Commission on High Quality Health,
approximately 8 million deaths occur globally, 5.6m (70%) are due to poor
quality of health and the remaining are due to access barriers.
Increased demands to enact Health Quality standards in LMICs
Kenya Quality Model for Health (KQMH) in 2017 Introduced an online open
source system hosted at the DHIS2 platform
In 2018, Amref health Africa in Kenya, HSS programme with funds from GIZ,
constituted a team of Quality Mentors to implement KQMH standards in 4
Counties in Kenya.
Previous KQMH implementations did not go beyond the pilot stage due to scale
up and implementation challenges

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Dimensions of KQMH

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1. Structural Dimensions (1-10)
• Dimension 1: Leadership
• Dimension 2: HRH
• Dimension 3: Policies standards and guidelines
• Dimension 4: Facilities and infrastructure
• Dimension 5: Supplies management
• Dimension 6: Equipment management
• Dimension 7: Transport and fleet management
• Dimension 8: Referral system
• Dimension 9: Health records and information management systems
• Dimension 10:Financial management

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Process-Dimension 11.1-11.14
• Dimension 11.1-Outpatient services
• Dimension 11.2-Patient centred care
• Dimension 11.3-Infection prevention and control
• Dimension 11.4-Inpatient care
• Dimension 11.5-Accidents and emergency
• Dimension 11.6-Surgical emergencies
• Dimension 11.7-Anaesthesia
• Dimension 11.8-Safe delivery
• Dimension 11.9-Neonatal care

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2. Process Dimensions & Outcomes………..
• Dimension 11.10- Dialysis
• Dimension 11.11-Laboratory
• Dimension 11.12-Pharmacy
• Dimension 11.13-Radiology
• Dimension 11.14-Mortury
Total 25 Dimensions
3. OUTCOMES Dimension 12: Results: Ratios percentages and
proportions that summarizes indicators in the two dimensions above

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Assessment levels and facilities recognitions
•Self Assessment by
facilities
•County Assessment
•External Assessment
All facilities with MFL Codes
• Public
• Private
• Faith based facilities with
• An Auto intelligence system with
weighted scores
• Sensitive to level of facility and
services offered

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Amref Health Africa KQMH Implementation Road map
January 2018
• KQMH
training need
assessment
TNA
February 2018
• Inception
meeting,
• Pretesting of
KQMH e-tool
March 2018
• Conduct
KQMH
training
April 2018
• KQMH Baseline survey
May 2018
• KQMH
Baseline
Assessment
June 2018
• Monthly mentorship
visits
• Self assessment by
facilities
July 2018
• Monthly
mentorship
visits
October 2018
• Final
Assessment
November 2018
• County Quality
Learning
forum and
Awards
Celebration
Sept 2018
• Monthly
mentorship
visits
• County QI
review
August 2018
• Monthly
mentorship
• County QI
review

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4 Counties 38 HF implemented KQMH
Kwale County
38 facilities
5 Nairobi
12 HF Kisumu
11 HF in Vihiga
10 HF Kwale

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Vihiga County: KQMH standards baseline & final
0
10
20
30
40
50
60
70
80
90
Vihiga County
Refferal hospital
Mbale PRHTC Coptic Hospital Emuhaya
Subcounty
Hospital
Sabatia Health
Centre
Hamisi
Subcounty
hospital
Lyanaginga
Health Centre
Mugoma HospitalEbusiratsi Health
Centre
Ipali Health
Centre
Jumuia Friends
hspital-Kaimosi
Average
score

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Lessons learned: In 2018, Amref Health Africa in
Kenya KQMH implementation
• Monthly Mentor ship
approach to staff in
facilities works
• Engage passionate QI
Champions and teamwork
• Capacity build and Coach
HCW include CME cascade
• Integrate Quality to routine
reportring at all levels

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Celebrating brilliant performance excellence
• Routine Data Review forums
• Celebrate, Award excellent
performance .
• Build up to the National
Quality Awards –QHKAs
• Change the narrative by build
a culture that motivate for
improved performance
• Promote medical tourism in
Kenya to the region and from
county to another

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Leadership for Quality Healthcare
• Leadership support for QI structures at all
levels
• Establish a vote head dedication to QI-budget
• Establish and Integrate Quality structures at
all levels. No department or cadre own QI
• Focus System for improvement not individual
fault finding or punishment
• Collaborate will all stakeholders-MOH, Public
private and FBOs

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Technology use, Framework and policies for
Quality Health Systems in Kenya
• Use of technology to ease analysis
and fun sharing new knowledge
• Assessment (Baseline & endline)
• Establish Certification process for
all facilities with policy and
framework
• Conformity Assessment bodies and
promote self assessment
• Address data integrity and safety of
patient level information

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Kisumu Nairobi
QHKA 2019
Kwale Vihiga
Celebrating success together as team

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Acknowledgement
Ministry of Health in Kenya Dept. Quality standard & regulations.
GIZ department for Health program
Amref Health Africa in Kenya & all stakeholders represented in this forum
The Health Facilities QI teams
Counties- Kisumu, Vihiga, Nairobi, Kwale
KNH and all participants for opportunity to be part of this Quality discussion