In Kenya, efforts are underway to embed quality improvement approaches into the core of national health programs and community health practices.1 Pathways to developing a systematic focus on quality include efforts to strengthen the national coordination of community health programs. They involve building the capacity of county-level decision makers to effectively prioritize and plan for equity-oriented community health programs. And they include improving the quality and performance of community health programs by generating demand through engagement with communities.1 2
Locally, health service boards and health facility governing committees are two types of citizen-engagement programs being established to increase accountability through community participation.3 4 In addition, in response to the need for greater sensitization of health managers and providers to the notion of quality and the benefits a quality focus could have in the work of health providers and the outcomes for their patients, the Kenyan Ministry of Health has created a Kenya Quality Model for Health that includes a training course to guide health staff and managers in strengthening quality management in every setting, from health service delivery to health policy development.5 6 Nationally, the Ministry of Health anchors quality improvement methodology and processes within regulation to receive licenses and rewards.7 In order to receive licenses, and to have them renewed, facilities have to show evidence of quality improvement processes – for example, the establishment of improvement teams, demonstration of clinical audits, and regular feedback loops.7
Community engagement is critical to ensuring health services are designed, delivered, and monitored in such a way that they meet local health needs, but Kenya’s experience shows that work must be done throughout the whole system to ensure that the quality of community health services reflects values demonstrated at service delivery, management, and policy levels as well.8 9In a context of institutional readiness – where community health programming and functions are in alignment with national guidance and managers are committed to supporting quality improvement activities – quality-oriented efforts are most likely to be successful and sustained.8