Over the past 15 years Kenya has made marked, but insufficient progress in improving key health outcomes. Maternal, infant and under-five mortality rates have declined but remain high, and communicable diseases, including HIV/AIDS, still account for half of all deaths and disability. At the same time, the health burden posed by non-communicable diseases is rising steadily.
The poor quality of basic health services offered by public and private facilities is a major contributor to this unsatisfactory situation. Management deficiencies, personnel and financial constraints, lack of adherence to hygiene standards, and shortages of medical equipment undermine the quality of care. This, in turn, leads to low utilisation of health services, particularly by the millions of Kenyans who do not have health insurance and must pay directly for care.
In line with the Sustainable Development Goals, Kenya Vision 2030 and the country’s 2010 constitution, the Government of Kenya is committed to expanding access to affordable, high-quality basic health care. National quality standards for health services – the Kenya Quality Model for Health (KQMH) – have been formulated and adopted, but still need to be institutionalised in the routine operations of health facilities and county health departments.
On behalf of Germany’s Federal Ministry for Economic Cooperation and Development (BMZ), the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH has been working with the Government of Kenya since 2001 on the development and implementation of quality management strategies for the health sector.
Under the current Support to the Health Sector project (2017-2018), the focus is on strengthening the implementation of KQMH standards and mainstreaming these into management and reporting processes at hospital and county level, using IT-supported approaches wherever possible. The project is also supporting the development of national accreditation structures for health facilities.
To improve the quality of basic health services, the project supports mentoring on quality improvement measures for health professionals in 47 hospitals in Kisumu, Kwale, Siaya and Vihiga counties. Health workers are introduced to quality improvement concepts and then build practical skills through the implementation of quality improvement projects aimed at improving maternal and neonatal health indicators.
These quality improvement initiatives are augmented by regular assessments of quality of care using a web-based version of the KQMH checklist. The tool enables health personnel to assess quality standards in their facilities at periodic intervals and to track progress over time. Because it was designed to be interoperable with the District Health Information System (DHIS 2) software, the tool will eventually allow for quality management data to be integrated into the national health information system.
To ensure the sustainable application of quality management concepts, the project supports the establishment of quality management structures at both county and facility level. It has worked with County Health Management Teams (CHMTs) in Kisumu, Siaya and Vihiga counties to establish or consolidate Quality Management Technical Working Groups, whose role is to provide technical oversight on issues pertaining to quality of care within the counties and to monitor the implementation of measures to address identified gaps.
In 47 hospitals in Kisumu, Kwale and Siaya counties, quality improvement teams have been set up to drive quality management efforts at facility level. A similar initiative is underway at the Kenyatta National Hospital in Nairobi, where the project works to strengthen the capacity of the Patient Safety and Quality of Healthcare Department to address gaps in the implementation of quality improvement approaches in the hospital. The project also facilitates the establishment of institutional partnerships between Kenyan and German hospitals, with a focus on quality improvement.
Finally, the project supports a range of initiatives in the area of eHealth. It works with health facilities to identify, through technology assessments, areas where IT-based solutions such as electronic medical records or pharmacy management systems could improve the quality of service delivery. It strengthens the capacity of health professionals and CHMTs to analyse and use data from DHIS 2 for health sector planning and budgeting. To strengthen local capacities in health informatics, the project collaborates with partners like the Kenya Health Informatics Association (KeHIA) and supports local eHealth initiatives, such as hackathons and start-up pitches to private sector entities. This has included support for a fact-finding mission by German industry to inform the creation of a Bachelors curriculum for biomedical engineers in Kenya.
To download, click on the link below to read offline