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Improving Care for Vulnerable Children in Kenya: Results from Piloting Service Standards

Amolo D | Were R | Masamo S | Kyeyagalire R | Kedenge O | Fatta K
Organization: USAID Health Care Improvement Project/URC

Topics: Building QI capacity in OVC implementers, Coordination of OVC care, Developing OVC service standards, Orphans and vulnerable children, OVC services

Region and Country: Kenya

Government of Kenya | HOPE Worldwide Kenya | FHI-360 | UNICEF | USAID | World Vision Kenya | Population Services International | Catholic Relief Services | SOS Children's Villages Kenya

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.

Lessons learned from OVC programs have revealed the need to improve quality in OVC services and to strengthen harmonization across partners. It was with this goal in mind that the USAID Health Care Improvement Project (HCI) began working with the Government of Kenya through the Ministry of Gender, Children and Social Development and the Department of Children Services, and other implementing partners, to develop and pilot draft service standards.
The standards were drafted with input from the Government of Kenya, HCI, and other implementing partners following a situational assessment which highlighted a number of areas for improvement in services for vulnerable children. In order to determine the utility and effectiveness of these draft standards, eight implementing partners were selected to pilot the standards for a year. The implementing partners were supported by HCI staff through regular mentoring and joint learning sessions in which they were brought together to discuss gaps they were working to address, changes they had made, and results they had achieved.
The implementing partners formed quality improvement (QI) teams and conducted baseline assessments of children’s well-being using the Child Status Index, developed by MEASURE Evaluation. QI teams used the results of these assessments to prioritize their interventions among the service areas. The teams were able to address needs in new, creative ways, and found that using the standards was not only feasible, but led to improved well-being for children they were serving. For example, implementing partner Maua Methodist Hospital adapted their existing interventions to promote better short-term food supply and enhance the households’ capacity to produce and or access food with minimal external support. Over the course of piloting, Maua Methodist Hospital saw increases in Food Security, with 42% of children scoring “fair” or “good” in the CSI at baseline and 100% of children scoring “fair” or “good” at the end of the year. Additionally, at baseline 57% of the children assessed by Maua scored “fair” or “good” at baseline and 100% scored “fair” or “good” at the end of piloting.
The year of piloting the standards culminated in a national learning session in July 2011, during which the Government of Kenya reasserted their commitment to improving the quality of services for vulnerable children and planned to finalize the standards as National Minimum Service Standards for QI in OVC Care in Kenya and scale them up nationally.