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  • Implementing a Community Strategy within the Aphia II Nyanza Project | Community Resource

    This document describes Aphia II Nyanza's 2006-10 strategy to support Kenya's Ministry of Health as well as FBOs and CBOs to: improve and expand facility based services, civil society activities to increase healthy behaviors and care, and support for people and families affected by HIV and AIDS.

  • Strengthening Community Health Systems to Improve Health Care at the Community Level | Publications

    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.

  • Brief 3: Effectiveness of Community-based Distribution of DMPA | Community Resource

    This brief outlines how community based distribution (CBD) of injectable DMPA (Depo-Provera) can be effective. It posits key elements to ensure CBD success: workers must have consistent links to supplies, a system for follow up of clients to ensure they receive their injections every three months and training in how to counsel new DMPA users about side effects, and knowledge of how to rule out pregnancy.  

  • Taking Critical Services to the Home: Scaling-up Home-based Maternal and Postnatal Care, including Family Planning, through Community Midwifery in Kenya | Community Resource

    In Kenya, with USAID support, the Population Council's FRONTIERS in Reproductive Health project supported the scale up of a model that enabled women to give birth at home or to be referred to a hospital when attended by a self-employed skilled midwife living in the community. This report describes the project and provides recommendations on skills development for the community midwives in: maintaining quality of care, business skills and support to achieve financial sustainability, and strengthening linkages among midwives, the formal health sector and District Health Management Teams.

  • Implementing the HMC Resolution on Task Shifting- Focus on Injectables. Evidence Review and Development of Country Workplans | Community Resource

    The East, Central and Southern Africa Health Community (ECSA-HC) in collaboration with Family Health International (FHI), held a regional workshop on expanding community-based access to family planning- focus on injectable contraception.  

  • APHIA Plus OVC QI Workshop | Publications

    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.

  • Community-Based Care and Support within the APHIA II Nyanza project | Community Resource

    APHIA (AIDS, Population and Health Integrated Assistance) is a USAID-financed program in Kenya that works with the Ministry of Health and faith-based and community-based organizations to reduce the risk of HIV transmission and the fertility rate in Nyanza. Specifically, the project focuses on improving and expanding facility-based HIV/AIDS, tuberculosis, reproductive health, malaria, maternal and child health, and male circumcision services and improving and expanding care and support for people and families affected by HIV/AIDS.

  • Kilifi Orphans and Vulnerable Children Project - A Case Study | Community Resource

    This case study was conducted to impart a thorough understanding of Catholic Relief Services’ (CRS) OVC program model in Kenya and to document lessons learned that could be applied to other OVC initiatives. This case study is based upon a program document review; program site visits, including discussions with local staff, volunteers, beneficiaries and community members; as well as observations of program activities.

  • Community driven initiatives for quality care of OVC | Improvement Report
  • Meeting multiple needs of vulnerable children in Kenya | Improvement Report
  • PEPFAR | Care that Counts: Improving the Quality of Programs for Orphans and Vulnerable Children | Publications

    Lessons Lessons learned from OVC programs have revealed the need to improve service quality and to strengthen harmonization across partners around the questions: How can our programs make a measurable difference in children’s well-being? What are the essential actions that we all agree need to be part of a service to best to mitigate the impact of HIV/AIDS on children and families, in the pursuit of efficiency, effectiveness, equity, reach, and scale and sustainability? In response to the observed need to improve the quality of services provided to orphans and vulnerable children, in 2007, PEPFAR, through the United States Agency for International Development (USAID), sought to create a regional initiative to support countries and implementing partners in improving the quality of OVC programming. With support from the USAID Health Care Improvement Project (HCI), a regional OVC quality improvement initiative was organized. The initiative, which has come to be known as Care that Counts, has engaged national stakeholders, program implementers, and donor agencies throughout sub-Saharan Africa in improving the quality of OVC programming. 

    This short report describes the efforts of the Care that Counts Initiative to support to implementers at the country level to:
    1) Build constituencies and commitment for quality in OVC programming,
    2) Develop OVC service standards through consensus processes involving key stakeholders, including children and their families,
    3) Undertake quality improvement activities at the point of service delivery with community-based volunteers and organizations, and
    4) Gather evidence that standards and other quality improvement approaches have a measurable impact.

  • COPE® for Child Health in Kenya and Guinea: An Analysis of Service Quality | Publications

    This study reports on the results of a quasi-experimental study evaluating the introduction and use of the COPE quality improvement process at 16 health facilities offering child health services in Kenya and Guinea. The study demonstrated that the use of COPEresulted in significant improvements in service quality, including improved provider performance, greater client satisfaction with the care received, and increased client knowledge about ways to protect and preserve their children's health.  The authors reported that staff at the intervention sites were observed to treat clients with more respect, provided clients with more information and privacy, and demonstrated improved personal communication skills, improved diagnostic skills, improved home care instructions, somewhat improved prescribing practices, and improved immunization practices.  The intervention sites were also found to have better informed clients, better immunization coverage for first polio shots and tuberculosis vaccination (BCG), and more satisfied clients.  On almost every quality indicator, whether it was reported by staff, observed by evaluators, or reported by clients, the intervention sites performed significantly better than the control sites.

  • Job aids to improve diagnosis and treatment of malaria in Kenya and Malawi | Publications

    An evaluation of job aids to improve the diagnosis and treatment of malaria in Kenya and Malawi.
    A presentation from the Job Aids Symposium.

  • Vendor-to-Vendor Education to Improve Malaria Treatment by Private Drug Outlets in Bungoma District, Kenya | Publications

    This article is available for free at: Private outlets are the main suppliers of uncomplicated malaria treatment in Africa. However, they are so numerous that they are difficult for governments to influence and regulate. This study's objective was to evaluate a low-cost outreach education (vendor-to-vendor) programme to improve the private sector's compliance with malaria guidelines in Bungoma district, Kenya. The cornerstone of the programme was the district's training of 73 wholesalers who were equipped with customized job aids for distribution to small retailers.

  • Evaluación del desempeño en AIEPI de los trabajadores de salud en Kenya | Publications

    Quality assessment is the measurement of the quality of healthcare services. A quality assessment measures the difference between expected and actual performance to identify opportunities for improvement. Performance standards can be established for most dimensions of quality, such as technical competence, effectiveness, efficiency, safety, and coverage. Where standards are established, a quality assessment measures the level of compliance with standards. For dimensions of quality where standards are more difficult to identify, such as continuity of care or accessibility, a quality assessment describes the current level of performance with the objective of improving it. A quality assessment frequently combines various data collection methods to overcome the intrinsic biases of each method alone. These methods include direct observation of patient-provider encounters, staff interview, patient focus group, record review, and facility inspection, among others. The assessment is often the initial step in a larger process, which may include providing feedback to health workers on performance, training and motivating staff to undertake quality improvements, and designing solutions to bridge the quality gap. This case study describes how five Integrated Management of Childhood Illness (IMOI) trainers and supervisors conducted an assessment of provider knowledge and skill, to carry out IMCI at 38 facilities in two districts in Kenya. (excerpt)

  • Kenya: Assessment of Health Workforce Competency and Facility Readiness to Provide Quality Maternal Health Services | Publications

    This report presents the findings of a 2006 assessment of three types of facilities that provided maternal and newborn care within six representative districts in Kenya. Providers were given a 50-question knowledge test, and their skills were analyzed as they performed five delivery and neonatal procedures on anatomical models: active management of the third stage of labor (AMTSL), manual removal of the placenta, bimanual uterine compression, immediate newborn care, and neonatal resuscitation with ambu bag. Facilities were assessed in the areas of human resources, infrastructure, care standards, and drugs and equipment. The report concluded that health provider competency at performing basic, life-saving skills waslow, and the tendency to refer patients with complications was high, despite weak referral and counter-referral mechanisms.

    The findings indicate areas needed for improvement, in particular, hand washing practices and bimanual uterine compression skills. Recommended interventions for addressing inadequate skill levels included competency-based training, supportive supervision, and coaching. The report’s findings also indicate the need for strengthening infrastructure at a basic level and for ensuring the availability of all necessary supplies and equipment, which are critical for safe deliveries in health facilities. Appendices provide the knowledge test and answer key, observation instruments for the skill assessments, the facility assessment instrument, and a list of equipment and supplies needed to perform the entire assessment.

  • Vendor-to-vendor education to improve malaria treatment by drug outlets in Kenya | Publications

    Private drug outlets have grown increasingly important as the main source of malaria treatment for residents of malaria endemic areas. Unfortunately, the quality of information and the quantity and quality of drugs provided is often deficient. The World Health Organization has included the private sector in its Roll Back Malaria strategy, but has noted that it is notoriously difficult to change private sector practices without burdening the governments of developing countries. In the Bungoma district of Kenya, the Quality Assurance Project (USA) teamed up with the Bungoma District Health Management Team and African Medical and Research Foundation to test an innovative, low-cost approach for improving the prescribing practices of private drug outlets. The intervention, called Vendor-to-Vendor Education, involved training and equipping wholesale counter attendants and mobile vendors with customized job aids for distribution to small rural and peri-urban retailers. The job aids consisted of: (a) a shopkeeper poster that described the new malaria guidelines, provided a treatment schedule, and gave advice on the appropriate actions to take in various scenarios; and (b) a client poster that depicted the five approved malaria drugs and advised clients to ask for them. The training of wholesalers began in April 2000. (author's)

  • Using problem-solving teams to improve compliance with IMCI guidelines in Kenya | Publications

    The Quality Assurance Project (QAP) tested whether facility-based teams, trained and coached to develop and implement improvements in providers' IMCI performance, achieved improvements in case management after one year. IMCI, the Integrated Management of Childhood Illness, is an algorithm that informs healthcare providers how to treat sick children under five. In this study, 21 facility-based improvement teams in two districts of Kenya received several days' training from coach-supervisors who themselves had received three weeks of training. IMCI case management performance by IMCI-trained providers was measured by direct observation in 14 control facilities (no improvement teams) and in the 21 facilities with teams. These measurements were taken both before the team training and about one year later. The nature of the improvement efforts made by the teams during the year was also assessed. The pooled proportion of critical IMCI case management tasks performed to standard increased 55% in the facilities with teams compared to an increase of only 14% in the control facilities, a significant difference. (author's)

  • Neighbor-to-neighbor education to improve malaria treatment in households in Bungoma district, Kenya | Publications

    This study's main objective was to determine the impact of a low-cost outreach "neighbor-to-neighbor" (jirani kwa jirani or JKJ) education program on caretaker purchase and consumption of antimalarial drugs in Bungoma District, Kenya. The Bungoma District Health Management Team (DHMT) implemented this intervention with technical support from the Quality Assurance Project (QAP) and facilitation from the African Medical Research and Education Foundation (AMREF). The intervention was intended to complement another intervention to improve anti-malarial prescribing practices of drug sellers in the same district (vendor-to-vendor; see Tavrow et al. 2002 and 2003). Forty MOH extension health workers (EHWs) received a one-day orientation from the DHMT on the JKJ approach and several copies of two illustrated brochures explaining proper malaria treatment and recommended drugs. About 30 EHWs then led a pyramid distribution of the brochures in 112 villages. They also organized 30 contests where village residents presented songs, dramas, or poems they had created to promote the use of effective anti-malarial drugs. The DHMT and public health officers, who directly supervise the EHWs, monitored the intervention during the six- to eight-week implementation period. (excerpt)