By Isaac Ntwiga,
The last decade of the millennium development goals (MDGs) era substantially witnessed a renewed focus on reaching the bottom economic class in low income countries. However, the inordinate focus on reducing financial risk burden in service delivery and increasing coverage without sufficient focus on expanding quality of services may account for slow progress in reaching many countries.
According to the World Health Organization (WHO) goals for Universal Health Coverage (UHC), access to quality and affordable health care is integral for individuals and communities to lead productive and fulfilling lives and for countries to have strong economies. As advocacy for UHC gains momentum across Africa, there is growing acknowledgement of the need to focus on improvement in the quality of health services.
While WHO recommends that governments around the world should establish national led systems and specify quality improvement in legislation and published policy, UHC goals in Kenya will draw huge returns though effective structures and processes for continuous improvement in delivery of quality health services.
Establishing Quality Improvement Interventions basically describes the commitment to continuously improve the quality of healthcare, focusing on the preferences and needs of the people who use them. It encompasses a set of values including a commitment to self-reflection, shared learning, the use of an improvement theory, team work, leadership and an understanding of context; and a set of methods which include measurement, benchmarking and a set of tools and techniques
The five year Afya Timiza project by USAID implemented in Samburu and Turkana counties to provide enhanced access to and utilization of quality Reproductive and Maternal care, for instance demonstrates that In addition to developing quality models and tools, development of quality structures and processes that might inform local improvement of health services is essential in promoting universal health coverage especially in resource limited settings.
Even as access to health care in nomadic areas continues to face challenges due to the economic activities practiced, the counties have collaborated with the Project to ensure establishment of a robust system anchored in the county health law to ensure provision of and access to quality health services.
This is an indication that incorporating Quality Improvement (QI) in the day to day implementation of UHC , will allow governments and stakeholders to be able to demonstrate accountability and how services positively impact health outcomes. With well defined QI, programs and processes, relevant information is collected ,analyzed, and data-informed decisions guide service improvements.
Both levels of government involved in the implementaton of UHC woud be able to use evidence to continually improve services with the goal of achieving the best possible outcomes in programming. Regularly assessing performance is the best and most ideal way to know how current conditions are impacting the quality of services and outcomes produced.
To achieve better health outcomes at a societal level, it is important to emphasize quality across the spectrum of health systems from the sub-national to the national and across primary, secondary and tertiary levels of care. Primary care is the basic or general healthcare focused on the point at which a patient ideally first seeks assistance from the medical care system. It is the basis for referrals to secondary and tertiary level care.
Poor quality healthcare interventions prevail at most levels of health care, manifesting every day through inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, and inadequate or unsafe clinical facilities or practices. The implications are devastating for patients, their families and the economy.
For example according to the World Bank Service Delivery Indicators initiative, healthcare workers in seven low- and middle-income African countries were only able to make accurate diagnoses one third to three quarters of the time, and clinical guidelines for common conditions were followed less than 45 per cent of the time on average .
A recent study however found that even if access to care is improving around the world, the clinical benefits for patients and populations remain limited; this indicates that a renewed focus should be towards enhancing access and improving quality of health care services. This will ensure better health outcomes in Kenya and the Africa as a whole.
Isaac Ntwiga, is the Health Systems Strengthening Advisor at USAID/AFYA TIMIZA Project