This presentation was given by Miriam Taegtmeyer at a meeting of the Overseas Development Institute on the 20 January 2016. In it she discusses the REACHOUT quality improvement approach.

1. Quality improvement and
community health
Dr Miriam Taegtmeyer
PI, REACHOUT
Liverpool School of Tropical Medicine
The REACHOUT project is funded by
the European Union 1
ODI
20th January 2016

2. Aim and objectives
Aim: To maximize the equity, effectiveness and
efficiency of CHW services in rural areas and
urban slums in six countries: Mozambique,
Indonesia, Kenya, Malawi, Bangladesh and
Ethiopia.

3. CHWs and universal
health coverage
• CHWs seen as a solution
to UHC and achieving
sustainable development
• They risk becoming the
final common pathway
of many vertical
programmes
"UHC focused soley on expanding access and NOT simultaneously
addressing quality will have limited impact on population health”
HLSP Summary Brief, June 2014

4. A unique platform
• Works with range of types of CHWs
• Across different countries over 5 years
• Research that goes beyond single disease
programmes – a health systems approach
• Innovative methods
• Building capacity for embedded research on CHWs

5. In a nutshell
Context
analysis
Quality
improvement
Quality
embedded
Improved equity,
effectiveness and
efficiency of
CHW services
1. Build capacity
in health
systems
research
2. Identify
influence of
context, policy
and health
system
3. Develop and
assess
interventions
4. Inform
evidence based,
context
appropriate
policy making
Multiple methods

6. Context analysis

7. Context analysis
framework Kok M et al. 2014

8. Quality
Assurance Cycle

9. Embedding Quality
• REACHOUT is an unique opportunity for analysis
within and between countries on what works, for
whom and where
• Our QI 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
• This requires a culture shift in the thinking of
national programmes, donors, vertical projects.

10. Embedding a cycle

11. Each stage needs
local ownership

12. Our additional
research questions
• What worked and how can it be sustained?
– What does it mean to embed?
– How do we measure whether a culture of quality
assurance is embedded? What methods and
indicators?
• What do communities and community health
workers understand by embedded quality?

14. Summary
• REACHOUT is a unique platform for testing
and embedding quality improvement
initiatives in community health.
• Shifting from project-led to district-led
approaches raises questions that go beyond
health and provides opportunity for PEA.
• We need context specific understandings of
ownership against each stage of the quality
assurance cycle for community health.

15. Find out more
• Visit us on http://www.reachoutconsortium.org
• Follow us www.twitter.com/REACHOUT_Tweet
• Papers in thematic series on close-to-community
providers in Human Resources for Health
• Join the Thematic Working Group at Health
Systems Global, contact Faye Moody –
faye.moody@lstmed.ac.uk