title: Quality management: where is the evidence? Developing an indicator-based approach in Kenya.
abstract: BACKGROUND
  The 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage. Despite recent progress, challenges in service delivery, efficiency and resource utilization in the health sector remain.
  
  
  OBJECTIVE
  The Ministry of Health Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end, the European Practice Assessment (EPA) was adapted to the area of Reproductive and Maternal and Neonatal Health.
  
  
  METHODS
  The adaptation process made use of a ten step-modified RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method. The steps included a scoping workshop, definition of five critical domains of quality in the Kenyan context ('People, Management, Clinical Care, Quality & Safety, Interface between inpatients and outpatients care'), a review of policy documents, management and clinical guidelines, grey and scientific literature to identify indicators in use in the Kenyan health system and an expert panel process to rate their feasibility and validity.
  
  
  RESULTS
  The resulting 278 indicators, clustered across the five domains, were broken-down into 29 dimensions and assigned measure specifications. A set of data collection tools were developed to furnish the indicators and piloted at two health facilities. They were subsequently finalized for use in 30 health facilities in 3 counties.
  
  
  CONCLUSIONS
  The integrative and indicator-based aspects of the EPA process could be readily adapted to facilitate the operationalization of a practical quality assurance approach in Kenya.
authors.affiliation: evaplan at the University Hospital, Heidelberg, Germany.|Swiss Tropical and Public Health Institute, University of Basel, Basel 4002, Switzerland.
authors.forename: Helen
authors.initials: H
authors.lastname: Prytherch
authors.affiliation: Institute of Health Policy, Management and Research (IHPMR), Nairobi, Kenya.
authors.forename: Maureen
authors.initials: M
authors.lastname: Nafula
authors.affiliation: Head of Department of Standards and Regulatory Services, Ministry of Health, Nairobi, Kenya.
authors.forename: Charles
authors.initials: C
authors.lastname: Kandie
authors.affiliation: Institute for Applied Quality Improvement & Research in Health Care (AQUA), Göttingen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Brodowski
authors.affiliation: evaplan at the University Hospital, Heidelberg, Germany.
authors.forename: Irmgard
authors.initials: I
authors.lastname: Marx
authors.affiliation: evaplan at the University Hospital, Heidelberg, Germany.
authors.forename: Sandy
authors.initials: S
authors.lastname: Kubaj
authors.affiliation: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Health Programme, Kenya.
authors.forename: Irene
authors.initials: I
authors.lastname: Omogi
authors.affiliation: evaplan at the University Hospital, Heidelberg, Germany.
authors.forename: Alexia
authors.initials: A
authors.lastname: Zurkuhlen
authors.affiliation: Institute for Applied Quality Improvement & Research in Health Care (AQUA), Göttingen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Herrler
authors.affiliation: Institute of Family Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Goetz
authors.affiliation: Institute for Applied Quality Improvement & Research in Health Care (AQUA), Göttingen, Germany.|Department of General Medicine and Health Service Research, University of Heidelberg, Heidelberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.affiliation: evaplan at the University Hospital, Heidelberg, Germany.|Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Marx
mesh_terms: D036861:Delivery, Obstetric / Q000592:standards; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya; D008427:Maternal Health Services / Q000592:standards; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000592:standards*
keywords: developing countries; health services, maternal and child health; quality improvement; quality indicators, health care