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By Kate Hawkins

We are delighted to announce the launch of the USAID SQALE project: an initiative to embed and study quality improvement interventions in eight counties in Kenya. This project brings together REACHOUT partners LVCT Health and the Liverpool School of Tropical Medicine with a new partner, URC, and will run for three years.


“The community health strategy provides a great opportunity to achieve significant reductions in maternal and child deaths. With USAID SQALE, we get an opportunity to enhance efficiency and effectiveness of the community health services based on research findings to achieve greater results with minimal additional investments by focusing on continuous quality improvement.”

Lilian Otiso, LVCT Health

Why we need USAID SQALE

The 2014 Demographic and Health Survey shows that under-five child mortality in Kenya is 52 per 1000 live births and that 68% of children have received complete vaccination. Only 58% of pregnant women attend four antenatal care visits and 61% deliver in a facility. Hard-to-reach areas are particularly poorly served, and skilled delivery attendance varies significantly across counties. Women and children make up the majority of users of the public healthcare system and community health services. However, because women often do not manage household finances for travel and illness, they may not be able to access services for themselves and for their children when they need them. These challenges are compounded by delays in seeking care due to cost, distance, poor ambulance services and roads, and delays in receiving care due to poor facilities, lack of supplies, inadequately trained or poorly motivated staff and lack of functioning referral systems.

The organization of Kenya’s health services is changing as it undergoes full decentralization to county level. Alongside devolution the revised Community Health Strategy places more emphasis on the equity of services. In this time of rapid change there is a potential risk to both service quality and equity as new funding mechanisms, lines of accountability and supervision are implemented as power is devolved.

Our goal is to contribute to the reduction of maternal and child deaths by increasing the quality of services at community level and the use of services at facility level.

What exactly will we do?

USAID SQALE will embed quality improvement methods into the community health system in four counties in Kenya and disseminate current national standards to an additional four (control) counties. The project will:

  • Strengthen national coordination of community health programmes;
  • Build the capacity of county decision makers to prioritize and budget for community health programmes using an equity approach; and
  • Improve community health programme quality and performance and generating demand through ongoing provider and community engagement.

Our legacy

Through project monitoring and evaluation and a focus on capturing learning through a robust research agenda we hope not only to contribute to maternal, newborn and child health, but also to create new knowledge which we can share at sub-national, national and international levels. Our close links with the Kenyan Government have helped us to define an agenda that responds to very real challenges that are being faced at the frontline of the health system and we look forward to supporting them with the evolution of the Community Health Strategy over the coming years.

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