Quality improvement— a game changer for Kenya
After the promulgation of the Kenyan constitution in 2010, the Right to Health by all Kenyans cannot be refuted. Fatuma Abdullahi, a practicing nurse, is the institutional memory of the unfolding of events in the northern frontier semi-arid regions of Kenya. Her three decades of facility and community work has been characterized by:
- low utilization of health services (even in situations where access wasn’t a problem due to short distances)
- high neonatal and maternal mortality (the region scores a Maternal Mortality Ratio of 790/ 100,000 live birth), and
- low financial resource ploughing by national and county governments (compared to resource envelop received vis-à-vis the vastness of the region).
In my interview with Fatuma, she cited erratic turnover of human resources for health, as many health workers do not stay long in such regions considered hardship zones (draught-like environment coupled with pockets of insecurity issues), posing a great challenge to health service provision. According to Fatuma, such conditions create and reinforce apathy among health workers. She stressed that the few who would remained in the region suffered from burnout in an attempt to adhere to prescribed manuals and standard operating procedures.
“Things have been very bad in the region, however, with the introduction of quality control, we have made massive progress in saving lives,” she said while seated across my desk at a policy development workshop facilitated by ASSIST project.
"ASSIST-facilitated quality improvement training was a game change in improving health outcomes in the region."
To get a practical feel, Fatuma explained a couple of problems flagged in September 2015, that is, increase in neonatal sepsis and lack of patography services for expectant women.
“With the alarm raised, the health management team and a member of ASSIST Project investigated possible causes. Having camped at the maternity area to observe the relationship between health workers and patients, it was realized that free flow of friends and relatives vising patients and lack of proper hand hygiene coupled with low supply of disinfectants were major causes of infections,” she explained.
This is a critical stage in locating, rethinking and designing of change packages towards attainable QI. ASSIST change theory is based on the fact that people and the community at large have solutions to their own problems. All they need is a little organization through the ‘science of strengthening and improving.’
“To get lasting solutions, as a facility we agreed to emphasize hand-washing at the Continuous Medical Edu-cation (CME), engage cleaners through on-job-training on facility cleanliness, regularized patient visitation, and teach mothers on how to clean the cord. This was aimed at reducing infection and saving lives,” she added. “Amazingly enough, just a few days in keeping tabs with our suggestions, the number of affected neonatal reduced.”
In talking success, the other indicator was the potential increase in the proportion of women giving birth in the health facility with a complete partograph. Fatuma’s emotional tone made me imagine that this was her pet project.
“Since January 2015, we have been able to have continuous data audits, improved maternal death reviews, shared monthly improvement data by facility, focused on processes during supervision, and offered incentive to health workers to present improvement packages at conferences,” Fatuma expressed the milestones with joy.
It is with such evidence-based approaches anchored on QI training by ASSIST and adoption of the same philosophy by health care workers in Isiolo that propels Fatuma’s hope for a standards and quality improvement guidelines.
Through the stewardship of the Ministry of Health, anchored on the Directorate of Health Standards, Quality Assurance and Regulations, Fatuma joined the nation to front the establishment of the Kenya Health Quality Improvement Policy (KHQIP 2015 – 2030) which outlines comprehensive policies and strategies to improve health out-comes. Fatuma, a convert of QI, hopes the proposed document will suffice for a national spread on how to do the lifesaving acts correctly and consistently. Equally, and playing her part in convincing the policy making team, she presented the Isiolo case as an item that projects higher probability of adopt-adapt situation for not only the norther frontier but the nation as a whole.
“I am glad that I make history with fellow Kenyans as we work on the KQHM and the Policy documents. From the Isiolo quality improvement experience, I believe the spiral effect of an institutionalized practice is what the nation has been waiting for,” a motivated County Health Nursing officer expressed.
Fatuma’s closing remarks were full of optimism.