Quality management: where is the evidence? Developing an indicator-based approach in Kenya

Area of Science:

• Health Services Research
• Quality Improvement Science
• Public Health Policy

Background:

• The 2030 Sustainable Development Agenda highlights the critical role of quality of care in achieving universal health coverage.
• Despite progress, the health sector faces persistent challenges in service delivery, efficiency, and resource utilization.

Purpose of the Study:

• To operationalize the Kenya Quality Assurance Model for Health.
• To adapt the European Practice Assessment (EPA) for Reproductive and Maternal and Neonatal Health services in Kenya.

Main Methods:

• A ten-step modified RAND/UCLA Appropriateness Method was employed for adaptation.
• Key steps included defining quality domains, reviewing literature and guidelines, and an expert panel process to validate indicators.
• Five critical quality domains were identified: People, Management, Clinical Care, Quality & Safety, and Interface between inpatient and outpatient care.

Main Results:

• A total of 278 indicators were developed, categorized into five domains and 29 dimensions.
• Measure specifications were assigned, and data collection tools were created.
• Tools were piloted in two facilities and finalized for use in 30 facilities across three counties.

Conclusions:

• The European Practice Assessment (EPA) process, with its integrative and indicator-based approach, is readily adaptable for practical quality assurance in Kenya.
• This adaptation facilitates the operationalization of a robust quality assurance system for Reproductive and Maternal and Neonatal Health.