In 2018, three global healthcare quality reports were published which resolutely move the UHC discourse from coverage to quality but fail to extend this to the quality of community health worker (CHW) programmes. Late in 2018, the WHO released its guidelines for optimising CHW programmes and health systems, in line with the renewed global focus on primary health care and community health workers as critical to achieving UHC. Quality improvement (QI) is not explicit in these guidelines due to a paucity of quality improvement models focused on community health, with the existing models being geared towards facility-based care. QI therefore risks being down-played by national and local government as a non-priority issue for CHW programs. Current quality improvement practice often relegates CHWs to a vehicle for ‘getting people to the facility’ and community involvement as a way of supporting facilities in quality improvement. Community-level treatment expansion has not been accompanied by a focus on ensuring competency at the community level. Achieving quality UHC requires meaningful engagement with communities, where CHWs are valued and trusted as genuine co-producers of care, who are passionate about the quality of their work and want to improve it.
Highlighting case examples from two countries and a broader perspective from the Lancet Global Health Commission on High Quality Health Systems in the SDG era, this webinar presents the successes and challenges of quality improvement for community health. Presenters representing the NGO sector (Lilian Otiso), the MoH (Andre Likaka) and academia (Lisa Hirschhorn) will explore how traditional QI models and approaches have been adapted for community health systems and the needs to move beyond the more micro-system focus of traditional QI approaches. They will reflect on the challenges of measuring quality as delivered by CHWs and as perceived by community members who receive their services.
- Shams Syed – Coordinator Quality Systems & Resilience, WHO
Panelists will give ten-minute presentations that share lessons learned from the following initiatives:
- Dr Lilian Otiso, LVCT Health will present the Kenyan Quality Model for Community Health developed in a context of devolved health care, where CHWs are volunteers working within (or sometimes in parallel to) sub county and county health systems.
- Dr Andrew Likaka, Director, Quality Management Department, Ministry of Health, Malawi will give an overview of the quality of care initiative in Malawi and how the community component have been integrated into policy.
- Dr Lisa Hirschhorn, the Lancet Commission on High Quality Health Systems will give an overview of the Commission’s findings and how these recommendations can be used for community health systems. She will reflect how some of the more meso and macro level changes recommended are needed with CHWs – changes in training, measurement, governance and system design. She will also discuss the importance that as work continues to expanding access to front line that there must also be a prioritization on quality and right care in the right place and the right time.
A 30 minute moderated discussion will then explore implications and overlapping issues for quality improvement in community health and how community health programmes can better link with the lowest level facilities and the health system.