Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by Charles Kandie on behalf of the Ministry of Health (Kenya). http://usaidsqale.reachoutconsortium.org/

1. An Overview of the Kenya
Quality Model for Health
Standards for Level 1
(KQMH)

2. Objectives of Community Health
standards
• To provide optimal community health service
• To achieve and maintain an acceptable standard of
quality of care
• To ensure that services at community are
commensurate with universal best practice and are
responsive and sensitive to the client
needs/expectations
• Introduction of quality management to health
managers and service providers at community level

3. Development of KQMH
The community health services unit and
DHSQAR spearheaded the process
•A task force was formed to work closely with
the consultant during the process
•Inception report was presented to taskforce
members
•Presentation of the standard process and
content outline to the ICC/partners was done
•Situation Analysis was conducted in 7 counties;
Nairobi, Embu, Isiolo, Homabay, Kakamega,
Baringo, Kilifi

4. • Situation Analysis results sharing meeting
was held
• Five day retreat workshop was held to
develop the standards
• 47 county validation meeting was held
• Five day retreat to finalize the standards
• Five day retreat finalize the M&E
• Four day retreat to finalize the standard
indicators
• In 2015, final draft developed and approved
for ownership by the Ministry, now renamed
the KQMH Quality Standards for Community
Health Service

5. What is KQMH?
• A conceptual framework for an
integrated approach to improved
quality of healthcare
• It provides a framework for
holistically and systematically
addressing a range of organizational
quality issues with the main aim of
delivering positive health impacts

6. What can be achieved with
KQMH ?
KQMH aims at :
Quality
Improvement
as a process…
…improving adherence to
standards and guidelines
based on evidence-based
medicine
… improving structure –
process –outcome by
applying quality principles
and tools
…satisfying patient / client
needs in a culturally

7. KQMH integrates
with
and
Evidence-based
medicine
 Develop / revise and
disseminate clinical and public
health standards and guidelines that
are based on evidence
Total Quality
Management
 Input > Process > Outcome:
Use of the Master Checklist
 Application of QM principles
Patient Partnership
 Patients / clients are co-producers
of health outcomes
 Promote community involvement
and participation
 Respect patient rights and views

8. KQMH standards
Standards are written expectations of structures,
processes or performance expectations
•KQMH outlines standards for each domain
of quality
•Quality improvement teams and units can
use these standards to measure and evaluate
their improvement
•Each standard is scored on a scale of 1 to 5

9. Key Highlights of standards

10. KQMH Scoring System
The scoring is based on a 5-point scoring system.
A score of 1or 0 % is the lowest score: A score of 5
or 100 % is the highest possible score.
•1 or 0-24 %: A minimum standard has not been met.
There are no visible signs of any efforts to address
compliance with the standards, only excuses. Self
assessment has been initiated
•2 or 25-49%: A minimum standard has not been met.
However, there is evidence for commitment to change
for the better, particularly by the top management.
There are some demonstrated efforts to improve the
situation.

11. • 3 or 50-74 %: A minimum standard has been met. This
score refers to meeting the standard as outlined
• 4 or 75-99 %: A minimum standard has been met.
Moreover, there is some demonstrated additional effort to
surpass the standards under score 3. There is visible
commitment to continuous improvement. Evidence can be
produced to demonstrate quality improvement
• 5 or 100 and above%: Evidence to demonstrate positive
results and trends over a period of one year can be
produced. An excellence distinction has been achieved and
the Community health Unit is recognized as a Centre of

12. Standards Scoring Criteria (example)
1: Very
Poor
There are
no action
days
informed
by dialogue
for a
convened
by CHEW
2: Poor
There are
health action
days but not
informed by
dialogue for
a convened
by CHEW
3: Average
There are
health action
days
informed by
dialogue for
a convened
by CHEW
4: Good
There are
health action
days informed
by dialogue for
a convened by
CHEW with
feedback to
the relevant
stakeholders
5: Very Good
There are
health action
days informed
by dialogue for
a convened by
CHEW with
feedback to the
relevant
stakeholders
and follow up
Score
There shall
be health
action days
informed
by dialogue
and
convened
by the
CHEW

13. Indicators for standards
• A total of 54 indicators have been identified,
defined, frequency of collection determined to aid
in establishing the baseline performance of
Community Health Units
• Source of the data for the indicators is indicated
and point of use
• The information generated will assist various level
of service delivery in decision making

14. Implication of the KQMH to health
The introduction of this policy document will
ensure:
•Adherence to set standards
•Regular assessments and audits for
community health services
•Institutionalize culture of Quality
Management at the community
Pursuance of constitutional requirement to
meet the highest standards of quality
health care

15. Quality - Whose responsibility?
National
County Health System
Institutional
Individual

16. LET US ALL EMBRACE KQMH STANDARDS
FOR LEVEL 1
Thank you very much!
Quality Safety