Abstract
IntroductionThe 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage. Despite recent progress, challenges in service delivery, efficiency and resource utilization in the health sector remain.ObjectiveThe Ministry of Health Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end, the European Practice Assessment (EPA) was adapted to the area of Reproductive and Maternal and Neonatal Health.MethodsThe adaptation process made use of a ten step-modified RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method. The steps included a scoping workshop, definition of five critical domains of quality in the Kenyan context (‘People, Management, Clinical Care, Quality & Safety, Interface between inpatients and outpatients care’), a review of policy documents, management and clinical guidelines, grey and scientific literature to identify indicators in use in the Kenyan health system and an expert panel process to rate their feasibility and validity.ResultsThe resulting 278 indicators, clustered across the five domains, were broken-down into 29 dimensions and assigned measure specifications. A set of data collection tools were developed to furnish the indicators and piloted at two health facilities. They were subsequently finalized for use in 30 health facilities in 3 counties.ConclusionsThe integrative and indicator-based aspects of the EPA process could be readily adapted to facilitate the operationalization of a practical quality assurance approach in Kenya.
Highlights
The 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage
Evidence suggests that even where health care utilization rates increase in many low and middle income countries (LMIC) [1, 2], this increase has not been matched by a corresponding decline in mortality and morbidity rates [3] and the quality of care provided in both the public and private sectors of LMIC is considered a likely explanation of this discrepancy [4]
Despite notable efforts on the part of Government, development partners and other actors, the health sector in Kenya continued to be plagued by challenges in service delivery, efficiency and resource utilization
Summary
The 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage. To this end, the European Practice Assessment (EPA) was adapted to the area of Reproductive and Maternal and Neonatal Health. A set of data collection tools were developed to furnish the indicators and piloted at two health facilities. Despite notable efforts on the part of Government, development partners and other actors, the health sector in Kenya continued to be plagued by challenges in service delivery, efficiency and resource utilization. Beyond the problems of lacking infrastructure and shortages of equipment, drugs and staff, there are known deficiencies in the quality of care These are especially pronounced in the areas of Maternal and Neonatal Care, family planning and in the provision of services for the survivors of Sexual and Genderbased violence [5]. Contraceptive prevalence is low, with less than half of married women in Kenya (46%) using any method in 2008–2009 and stock-outs of contraceptives are common [5]
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