Improving the Quality of Health Services towards Universal Health Coverage

by Amref Health Africa

Universal Health Coverage (UHC). That is presently THE buzzword across Kenya’s health system.

While there has been much focus and discussion on the role of the National Health Insurance Fund (NHIF) in providing financial protection for Kenyans so as to reduce out of pocket spending for health, a lot less is being said about the quality of health care services, and how this contributes towards the realisation of UHC.

The World Health Organisation (WHO) defines quality health care as services that are:

  • Safe – avoiding injuries to people for whom the care is intended
  • Effective – providing evidence-based health care services to those who need them
  • People-centred – providing care that responds to individual preferences, needs and values; and
  • Timely – reducing waiting times and sometimes harmful delays.

The Kenya Quality Model for Health (KQMH) was developed by the Ministry of Health to ensure quality health services are provided to all Kenyans, contributing to the attainment of the highest standards of health service delivery as envisaged in Kenya’s Constitution.

Through a consultancy funded by the German government through the Deutsche Gesellschaft fŸr Internationale Zusammenarbeit (GIZ), Amref Health Africa in Kenya is supporting the rollout of KQMH across 39 facilities in four counties that include Kisumu County. In Kisumu, Amref Health Africa is supporting a total of 12 facilities – eight public health facilities, two faith-based and two private health facilities.

Kisumu County is one of the four counties identified by the national government to roll out its UHC programme, part of President Uhuru Kenyatta’s ‘Big Four’ agenda. Other counties include Nyeri, Isiolo and Machakos.

A visit to Kisumu County Hospital, one of the 12 facilities supported by Amref Health Africa to rollout KQMH, showed progress and initiative on the part of the facility to improve the quality of services offered.

In January 2018, a baseline assessment of the 12 facilities was carried out to identify how the facilities were fairing on quality of health services so as to inform quality improvement. A total of 30 county and health facility staff were trained as Quality Improvement Master Trainers, four of whom were from Kisumu County Hospital. Since then, a total of 100 health care workers of different cadres drawn from all the departments at the facility have been trained on quality improvement through a cascade process.

Through the support from Amref Health Africa in Kenya quality improvement mentors, the facility can now conduct and is equipped with tools for self-assessment with a quality improvement team in place to guide quality improvement measures.

The quality improvement process

The quality improvement process


One area of quality improvement identified at the facility’s Maternity Unit was the quality of care provided to clients. Due to the high number of clients seeking delivery services at the unit and a very low nurse: patient ratio, the quality of services offered was wanting. To address this, the quality improvement strategy identified was prioritised care where attention is given first to expectant mothers in need of urgent care. To ensure that emergency supplies are readily and easily accessible when needed, measures to improve the storage, labelling and access of emergency kits e.g. the Emergency Postpartum Haemorrhage (PPH) box, have been put in place.

Emergency supplies are clearly labelled and stored in an easily accessible area for use during emergencies

Speaking of the support received from Amref Health Africa towards improving the quality of services, Nurse in Charge of the Maternity Unit Ms Lilian Otieno, said, “Going through the quality improvement process with Amref has been great because of the support and mentorship we have received from the Amref mentors as they work closely with us to facilitate quality improvement.”

Speaking during a courtesy visit to the Kisumu County Department of Health by a team from Amref Health Africa in Kenya led by Country Director Dr Meshack Ndirangu, Acting Chief Officer of Health Dr Dickens Onyango said, “The County is willing to put in resources for quality improvement but will need additional support from partners to do more and cover all the health facilities across the county.” Dr Onyango added that the County has a strong quality improvement technical working group in place that is made up of partners in health as well as representation from civil society.

The Amref Health Africa team during a courtesy call to the Kisumu County Department of Health

As part of the national pilot of UHC, Kisumu County will benefit from additional equipment to health facilities as well as support to increase the County’s health workforce.

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