putting the politics into international health

Quality improvement and community healthDr Miriam TaegtmeyerPI, REACHOUTLiverpool School of Tropical Medicine

The REACHOUT project is funded by the European Union 1

ODI

20th January 2016

Aim and objectives

Aim: To maximize the equity, effectiveness and efficiency of CHW services in rural areas and urban slums in six countries: Mozambique, Indonesia, Kenya, Malawi, Bangladesh and Ethiopia.

CHWs and universal health coverage

• CHWs seen as a solution to UHC and achieving sustainable development

• They risk becoming the final common pathway of many vertical programmes

"UHC focused soley on expanding access and NOT simultaneously addressing quality will have limited impact on population health”

HLSP Summary Brief, June 2014

A unique platform

• Works with range of types of CHWs

• Across different countries over 5 years

• Research that goes beyond single disease programmes – a health systems approach

• Innovative methods

• Building capacity for embedded research on CHWs

In a nutshell

Context analysis

Quality improvement

Quality embedded

Improved equity, effectiveness and

efficiency of CHW services

1. Build capacity in health systems research

2. Identify influence of

context, policy and health

system 3. Develop and

assess interventions

4. Inform evidence based,

context appropriate

policy making

Multiple methods

Context analysis

Context analysis framework Kok M et al. 2014

Quality Assurance Cycle

Embedding Quality

• REACHOUT is an unique opportunity for analysis within and between countries on what works, for whom and where

• Our QI approaches have been successful but are not sustainable on their own

• The challenge now is to move from researcher led to district led systems that assure the quality of community health

• This requires a culture shift in the thinking of national programmes, donors, vertical projects.

Embedding a cycle

Each stage needslocal ownership

Our additional research questions

• What worked and how can it be sustained?

– What does it mean to embed?

– How do we measure whether a culture of quality assurance is embedded? What methods and indicators?

• What do communities and community health workers understand by embedded quality?

Summary

• REACHOUT is a unique platform for testing and embedding quality improvement initiatives in community health.

• Shifting from project-led to district-led approaches raises questions that go beyond health and provides opportunity for PEA.

• We need context specific understandings of ownership against each stage of the quality assurance cycle for community health.

Find out more

• Visit us on http://www.reachoutconsortium.org

• Follow us www.twitter.com/REACHOUT_Tweet

• Papers in thematic series on close-to-community providers in Human Resources for Health

• Join the Thematic Working Group at Health Systems Global, contact Faye Moody –faye.moody@lstmed.ac.uk