PowerPoint Presentation

SQALE: Sustaining quality approaches for locally embedded community health services in Kenya

Dr Miriam Taegtmeyer and Dr Lilian Otiso, 29th September 2016

OverviewWhere we have come from?What we are trying to achieve?Who we are?How we will do thisWhat next?

Community Health Volunteer (Diana) in Turkana County by Rosalind McCollum

Community Health Workers and universal health coverageCommunity Health Workers seen as a solution to Universal Health Coverage and achieving the Sustainable Development GoalsThey 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 healthHLSP Summary Brief, June 2014

Second bullet and this undermines quality 3

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

Using the REACHOUT platformREACHOUT is an unique opportunity for analysis within and between countries on what works, for whom and whereOur Quality Improvement approaches have been successful but are not sustainable on their ownThe 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

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Barriers to embedding quality for Community Health ServicesTension between scale up and embedding qualityPlanning hampered by lack of clarity in defining roles and responsibilities for quality at each levelLack of clear definition on what we mean by quality of community health servicesPoor data quality and limited data useNo measures of community experience and satisfaction

Goal: Reduce maternal and child deaths in Kenyan communities using a Quality Improvement approach

USAID SQALE (2016-2019)

SQALE provides a mechanism to scale up REACHOUT work and demonstrating how you can use QI approaches within CHW programs to achieve specific health outcomes e.g. MNCH 7

USAID SQALE ObjectivesStrengthen national coordination for improved quality of community health programsIncrease capacity to prioritize and budget for community health programs using an equity approach for improved service availabilityImprove community health program performance in maternal child healthStrengthen community engagement in community health services

Roles and partners

Leadership, project management, technical expertise, knowledge management, research and evaluation and international visibilityIn-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 supervisorsBuild on track record with quality in community health in Kenya, Quality Improvement training of trainers, capacity development, curriculum development, harvest meetings

Hi Kate please include MoH logo9

Quality Improvement principlesAlignment with existing standards, models and toolsMaternal Newborn and Child Health priority focus areasSimple, jargon-free materialsClearly defined roles and responsibilitiesRecognizing best practiceIncorporating the voice of the community

Cut and paste from draft QI strategy10

Components of the USAID SQALE intervention

Three year Programme8 counties12 sub counties 36 community units

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County selection criteriaPoor Maternal,Newborn and Child Health indicatorsBuilds on existing programmes for Quality Improvement in community healthFunctional Quality Improvement teams at county level

USAID/UNICEF priority countiesMoH priority for Community Health Services standards dissemination12

Training strategyClear link to KQMH level 1 manualPiloting material in two countiesAction learning through a three- phase approachCoaching and mentoring support between phasesIdentifying Quality Assurance champions

Three-phase approach

QI spiral action learning

Mentoring between training

Month 1, 4, 9Duration: 1:2:1

Advante action learning mentoring and supporting through process as opposed to one-off traing

Will come back to this on Friday14

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

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Post-Symposium WorkshopDiscuss alignment with KQMH training manualSelection of sub-counties and Community Health UnitsReview results of Data Quality AnalysisReview tools for Quality ImprovementReviewing roles and responsibilities of Quality Improvement teams

Next six months: Focus on Nairobi and KituiActivity OctNovDecJanFebMarBaseline data collection Establish QI TeamsQI training Phase 1Mentoring /coaching support for QI teamsQITs and WITS data collectionQI training Phase 2Finalise curriculum based on pilot testing

Find out more and keep in touchWebsite: http://usaidsqale.reachoutconsortium.org/

Twitter: @REACHOUT_Tweet

REACHOUT research http://www.reachoutconsortium.org/learn-more/