Community COPE in Kenya: Results and Lessons Learned

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Community COPE in Kenya Results and Lessons
Learned

• MAQ-CDQ January 27, 2003

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Quality Health Services
Rights and needs of clients and communities
Quality Services
Needs of providers and health care staff
Needs of countries and institutions
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Clients Rights and Staffs Needs

• Information
• Access
• Informed Choice
• Safe services
• Privacy confidentiality
• Dignity, comfort expression of opinion
• Continuity of care

• Facilitative supervision management
• Information, training development
• Supplies, equipment infrastructure

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Rationale for Community COPE

• Service providers and clients often have
  divergent views of the quality of care
• Even when clients are asked their opinions of
  services, they may feel too shy or intimidated to
  share negative opinions
• Many community members do not seek services at
  all, and they will not be heard unless staff go
  to them

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Goal - Reaching Beyond the Facility

• To understand the communitys needs and
  definition of quality services
• To establish an ongoing dialogue between
  community members and providers
• To close the gap between the communitys
  definition of quality and actual performance

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Community COPE - Part of a Continuous Quality
Improvement Process
1. Information Gathering Root Cause Analysis
2. Action Planning Prioritization
Actual Practice
4. Follow-Up Evaluation
3. Implementation
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Community COPE Tools
Group Discussions
Individual Interviews (current, former
potential clients)
Mapping Exercises
Site Walk- Through
INFO
Discussions with local leaders
Identify needs and gaps between actual and
desired practices
INFO
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One intervention site

• Mission hospital in Kenya
• Referral hospital for the district
• 110-bed capacity
• 60-70 occupancy
• Provides a wide range of preventive and curative
  services
• Located in a poor rural area

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Process

• June 1998
• Oriented hospital staff
• Met with community leaders
• Conducted interviews, group discussions, and
  meetings in the community (50-63 participants in
  each round)
• Analyzed issues raised and developed action plan
• Expanded QI committee membership
• September December 1998 repeated interviews
  and group discussions, updated action plan
• February March 1999 Evaluation

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Key Measurements

• Communitys opinions on service quality expressed
  through
• interviews
• group discussions
• Staff review of the action plan
• problems solved
• problems not solved
• problems in the process of being solved

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Village Council Meeting
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Group Discussions
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Problems Identified (1)

• Access
• Long waiting time
• Lack of specialized services
• Distance of hospital from community members

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Problems Identified (2)

• Client-provider interaction
• Unfriendly, inattentive staff
• Staff not giving sufficient information

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Problems Identified (3)

• Safety
• Inadequate cleanliness
• Rats in mortuary
• Privacy
• Crowded wards
• Men and women admitted on same wards
• Insufficient screens

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Results (1)

• Access
• Shortened waiting time by reorganizing staff
  duties
• Trained staff to offer specialized services
• Increased outreach services and coordinated with
  other hospitals to reach different populations

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Results (2)

• Client-Provider Interaction
• Improved staff attentiveness and friendliness
  to clients
• Recognized need to give FP information,
  including to adolescents
• Clarified fees for services

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Results (3)

• Safety and Cleanliness
• Instituted ward cleanliness competition
• Cleaned and renovated mortuary
• Privacy
• Added screens and curtains for privacy

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Results (4)

• More regular communication between providers and
  community members
• More hospital staff started attending weekly
  baraza meetings (including the hospital matron
  and secretary)

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Lessons Learned (1)

• Consumers are not a uniform group but diverse
  groups with different needs
• Community discussions revealed more than earlier
  COPE client interviews alone

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Lessons Learned (2)

• Participatory exercises reinforced staffs own
  efforts to improve quality
• Consumers are effective advocates for health and
  health services when they are actively engaged in
  a quality improvement process.
• We now own the hospital.

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Lessons Learned (3)

• People in the community have opinions about the
  health services they receive and suggestions for
  ways to improve services, but they are generally
  neither asked nor heard

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Lessons Learned (4)

• Community meetings provide an additional
  opportunity for health workers to increase the
  communitys level of knowledge about particular
  health issues and meet its needs.

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Lessons Learned (5)

• The issue of how to communicate with the
  community is an important one, and some
  methodologies are more effective than others

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Lessons Learned (6)

• Community involvement is more than soliciting the
  community perspective of the services learned
  the importance of developing the action plan
  together with community members