The success and value of universal health coverage depends on its ability to provide safe, efficient and quality services to all people, everywhere.
Already, a high proportion of babies are now delivered in health facilities, thanks to the free maternity service introduced by the government. As we move towards improving access to more aspects of healthcare to all Kenyans, we must ask ourselves a pertinent question. Of what good is it to have affordable maternal healthcare, for instance, if the quality of care is substandard or even dangerous?
Kenyans do welcome an affordable and responsive health system, but quality care must be placed at the centre for effective universal health coverage (UHC).
We are in a new era where the quality of health service delivery takes centre stage in the pursuit of the health-related sustainable development goals (SDGs), and in particular SDG 3.8 which focuses on achieving UHC, including financial risk protection, access to quality essential healthcare services, medicines and vaccines for all.
Quality healthcare can be defined in many ways, but there is growing acknowledgment that it should be safe, effective, people-centred and timely.
The goal of leaving no-one behind requires accessible, responsive and inclusive health services that engage all population groups, and especially the most vulnerable and hard-to-reach.
On the supply side, actions are needed to improve quality by changing practices by providers, institutions and systems. On the demand side, strengthened health literacy and engagement of patients, families and communities, and especially those from disadvantaged groups, are key to achieve sustainable change.
The focus should be to bring about culture change in institutions and among healthcare providers to enable respectful and compassionate service delivery that engages and empowers patients, families and communities.
Luckily, countries are increasingly recognising the importance of delivering safe, quality and people-centred health services. However, a key challenge is how to translate plans and policies into practical actions.
A local pilot project – the revised Kenya Quality Model for Health (KQMH) – could help address quality in the health sector. KQMH is a tool that healthcare workers and facilities can use to measure the quality of their services to patients. It assesses all the six World Health Organisation (WHO) pillars namely: human resources for health, leadership, financing, health services delivery, health information systems and health product, vaccines and technologies, thus offering a critical systems approach to universal health coverage.
With support from GIZ, Amref Health Africa is working with health professionals in 38 public, private and faith-based facilities in Nairobi, Kwale Kisumu and Vihiga counties. So far, more than 120 health workers have been trained on the revised KQMH model. Baseline assessments have also been done and monthly mentorship is ongoing for the next six months.
At the community level, there is a Quality Improvement (QI) team, formed from an existing committee or group that meets regularly for a specific purpose. Ideally, the QI team includes representatives from groups that have to do with health services and resource mobilisation, and has members with skills in health resource mobilisation and outreach.
The QI team includes representatives from local government, schools, health centres, religious groups, savings and credit and income-generating groups, women’s groups, and other similar groups. The local government representative leads the team, while the community health worker arranges and manages the meetings and maintains close contact with health centre personnel.
There are also coaches drawn from the staff of a regional hospital, the county health team or health centres, who visit and support the QI teams to make changes in the organisation and delivery of health services at the community level.
As we move our health systems towards UHC with increased access to safe, effective, integrated and people-centred services, quality of care must take centre stage.
Dr Wala is the Programme Director, Health Systems Strengthening, Amref Health Africa in Kenya.