Publications and tools

About the Program

USAID SQALE program brochure

The USAID SQALE program aims to improve Maternal and Child Health in Kenya by improving the quality of community health services. This short document provides an introduction to our aims and objectives and our model. Read the brochure...


How can we achieve Universal Health Coverage with quality? A quality improvement model for community health from Kenya

This brief describes how the USAID SQALE program has taken quality improvement to the community level in Kitui, Migori and Nairobi Counties in Kenya. It gives an overview of the model used and key lessons that have been learned in the course of implementation. It concludes with lessons for policy and practice. Read the brief...


Making the Invisible Visible




We want to encourage the scale up of the USAID SQALE model to other counties in Kenya and other countries. To facilitate this we have made public a selection of the tools used by the program. Browse the tools...


Creating a forum for shared learning and advocacy in strengthening community health systems

The USAID SQALE program has implemented simple, innovative, quality improvement capacity building for front line workers. County teams were brought together in events that created a dynamic, interactive learning environment. They ensured inclusive participation across cadres and levels of the health system.

Event reports

Quality Improvement for community health services: Learning Event Report

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. Twenty-four Work Improvement Teams from Nairobi and Kitui counties came together for the first time to share their experiences. 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. Read the report...

USAID SQALE program symposium report

The USAID SQALE symposium (Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services) was held on the 29 September 2016 and brought together a wide range of stakeholders – from government, communities, the health service, non-governmental organizations, research institutes and universities, and funders – to share learning on quality improvement. It aimed to strengthen knowledge of how these methods can be applied at the community level. During the symposium different speakers shared information on the success of Kenya's community health program and some of the ways that quality improvement can help tackle challenges that are being faced in the country. Read the report...


Publications from the REACHOUT consortium

How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework

We present the holistic conceptual framework to show how gender roles and relations shape close-to-community provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a close-to-community provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities. Gender roles and relations shape close-to-community provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of close-to-community programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of close-to-community programmes.