This case study describes the experience of piloting quality service standards to improve the quality of care for orphans and vulnerable children in Kenya, where there are roughly 2.5 million vulnerable children. When the President’s Emergency Plan for AIDS Relief (PEPFAR) was launched in 2003, interventions to meet the needs of orphans and vulnerable children were designed with a sense of urgency to help address the devastating effect of the epidemic on children. While much progress has been made since then, the “emergency response approach” is no longer adequate.

This short film demonstrates how quality improvement (QI) methodology can be used to improve services for orphans and vulnerable children (OVC).  It tells the story of how implementing standards of care and improvement efforts made a difference in service delivery to orphans and vulnerable children by two organizations in Kenya: FHI-360’s Speak for the Child Project, through Okoka community-based organization (CBO) in Nyanza Province, and Maua Methodist Hospital ZOW Project in Eastern Province. These two organizations, along with five others, were selected to pilot OVC quality service standards in Kenya in order to improve services offered to orphans and vulnerable children. This QI initiative was implemented by the USAID Health Care Improvement Project (HCI) in partnership with the Department of Children’s Services of the Ministry of Gender, Children and Social Development with funding support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

Due to an increase in the number of children affected by HIV and AIDS in Kenya, efforts to provide services for orphans and vulnerable children have expanded quickly in recent years. Lately, stakeholders have realized more attention should be given to outcomes and service quality. To address this, seven implementing organizations were identified to participate in the piloting of standards for services to vulnerable children in four districts. This study evaluates the effectiveness, efficiency and equity of implementation of standards of service to vulnerable children, which are of particular interest to USAID and the government of Kenya.

1. 1) Was there a difference in the welfare of children receiving services from participating community-based organizations as measured by the difference between baseline and end line CSI scores?
2. 2) What was the incremental cost to the implementing partners and USAID / HCI of implementing the new standards?
3. 3) What was the proportion of girls and boys enrolled in vulnerable children care in the participating sites?
4. 4) Were there differences in the effectiveness of the service delivery in improving child welfare between boys and girls and between younger and older children?
5. 5) As reported by coaches and QI team members, what were key activities, the progress seen, the challenges and the role of stakeholders in implementing the new standards of vulnerable children care?

This short report summarizes the ways in which the USAID Health Care Improvement Project (HCI) is working with local groups and partners to apply quality improvement (QI) methods within the Community Health System in order to strengthen the impact of CHWs and other service providers at the community level, while at the same time increasing sustainability of programmatic impacts. Currently carrying out activities in more than 30 countries globally, HCI seeks to develop the capacity of health systems to apply modern QI approaches to make essential services better meet the needs of underserved populations; improve efficiency and outcomes; reduce costs from poor quality; and improve health worker capacity, engagement, and performance.

From March 23-24, 2011, the USAID Health Care Improvement Project (HCI) convened a two-day workshop in Nairobi, Kenya to orient AIDS Population and Health Integrated Assistance Plus (APHIA-Plus) implementing partners providing orphan and vulnerable children (OVC) services to Quality Improvement (QI) tools and how these tools can be implemented in their work to increase the impact of their efforts in improving children’s lives. The APHIA-Plus implementing partners also developed annual work plans that included QI techniques, receiving support and feedback from HCI and USAID personnel who were present. The report below summarizes the proceedings of this workshop.