In October 2017 representatives from community to national level participated in a two day “festival of learning” that formed the third phase of the USAID SQALE Program quality improvement training model. The overall aim of the event was to share experiences and learn from one another.
Nairobi County hosted the event, with over 100 participants and facilitators, which comprised of twenty-four quality improvement teams, Kitui and Migori Counties and participants from the National Ministry of Health Departments for Community Health and Health Standards, Quality Assurance and Regulation.
Community members and health volunteers took a prominent role in describing the practical reality of their work on the ground to policy makers and managers. Involving senior Ministry of Health officials, paired with community health workers in judging team documentation and poster presentations provided them with insights and in-depth understanding of the work and achievements of community-based teams. Powerful interactions between Work Improvement Teams from different sub-counties gave a sense of friendly-competition and healthy debate around how to engage communities and improve quality with existing resources. We rewarded best practice through team certificates of recognition for the best poster presentations and best-kept Work Improvement Team folders.
Preliminary results of the USAID SQALE Program model for quality improvement at community level are promising and indicate that it is feasible and can have positive impacts. By using a systematic approach to collecting, analysing and using community health data, CHVs have been able to dramatically improve reporting, community engagement with the health system, and efficiency and performance by focusing on priority maternal, newborn and child health issues. These Work Improvement Teams are spearheading a quality revolution in Kenya - starting where it matters most - with the community.
In September 2016 USAID SQALE hosted a symposium in the Kenya School of Monetary Studies in Nairobi. It was an opportunity to bring together a range of stakeholders from the health sector to share learning on quality improvement. It aimed to strengthen our knowledge of how quality improvement methods can be applied at the community level.
Community systems are the bedrock of health systems. In cities and villages Community Health Workers - such as CHEWs and CHVs – support colleagues in facilities to deliver essential health services and identify individuals and families at risk of illness. These workers are a vital cadre that are helping us to meet our heath and development targets, yet often their efforts go unnoticed and uncelebrated.
There can be a tension between adding numbers of people reached by community health workers and investing in quality. Challenges associated with this include: 1) That all actors in the process need to know who is responsible for quality 2) We don’t have measures of the community experience of quality and what brings satisfaction. There is a need to strengthen the coordination structures for quality at community level and the capacity to prioritize and budget and simultaneously bring in the voices and experiences of the community.
This symposium featured expert presentations on ongoing quality improvement programs within the Kenyan health sector as well as presentations from Ministry of Health participants on what these innovations mean for policy.