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

1. SQALE: Sustaining quality
approaches for locally embedded
community health services in Kenya
Dr Miriam Taegtmeyer and Dr Lilian Otiso, 29th September 2016

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. 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. 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. 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. 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. Goal: Reduce maternal
and child deaths in
Kenyan communities
using a Quality
Improvement approach
USAID SQALE (2016-2019)

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. 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. 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. 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. 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. 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. 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. Expected Outcomes
• Is the training methodology effective?
• Does the SQALE approach improve MNCH
outcomes?
• At what cost?
• Lessons on embedding QI into CHS

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. 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. Find out more and keep in touch
Website:
http://usaidsqale.reachoutconsortium.org/
Twitter:
@REACHOUT_Tweet
REACHOUT research
http://www.reachoutconsortium.org/learn-more/