Achieving the impossible: Implementing quality improvement at the community level

Thursday, 26 Jul 2018

By Nelly Muturi, LVCT Health

Lydia Kwamboka is the Lang’ata Sub-County Health Records Information Officer. Her role is to coordinate data management in the sub-county. She is accountable for all data collected – ensuring its quality and supporting the Community Health Volunteers (CHVs) and their supervisors. Lydia explained to us that for her, data quality was about accuracy and completeness of all data reported as health decisions are made based on the monthly reports received.

Lydia thought that implementing quality improvement at community level was impossible because it usually uses complex terminologies, is resource intensive and therefore would be difficult for Community Health Volunteers to understand.

Lydia has been working as a Quality Improvement Coach for the program, supporting teams at the community level to agree targets related to data and strengthen its qualities. She says,

“To define a Quality Improvement Coach I will use the analogy of a football team; a football coach ensures that each of the players are able to meet the team’s objectives.”

The SQALE programme has had many beneficial effects. Lydia thinks that the teams are working more cohesively, and they are empowered to give feedback when they need support such as tools.

Reporting rates in the CHEW summary (MoH 515) have improved from 40% in some Community Health Units and are now at 90%. The CHEW summary is an Ministry of Health tool that aggregates data collected monthly by CHVs. The accuracy of the data that is being reported is better.

Before the USAID SQALE program CHVs would falsely increase their numbers for some of the indicators that they were supposed to measure, such as coverage of maternal health and water and sanitation. This does not happen now. Now the numbers reported are accurate/authentic and this can be confirmed using facility data.

Some of the teams have seen improvements in health outcomes; such as reduced diarrheal disease, reduced morbidity rates and improvement in facility deliveries due to improved referral. Now the referral system is complete, facility referral has increased as reflected in the facility reports.

CHVs are now more empowered as they are trained and their capacity has been built. They are more accountable for what is happening in the Community Health Unit because they feel a sense of responsibility for the program.

“When USAID SQALE came in with an element of quality I embraced it. Now CHVs understand what quality is about; and now unlike before they ask about their progress, they monitor their activities every month, they ask “how are we doing?”, “What is our progress?” Now CHVs understand what quality means for them and the household.”