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Slicing the elephant into manageable pieces: How Kenyan women are improving healthcare quality with SafeCare

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In Kenya, the SafeCare initiative sparks the inclusion of women in the journey to lift healthcare quality.

The regional director: Millicent Olulo

When Millicent Olulo joined PharmAccess in 2011 as Kenya’s first SafeCare employee, she connected with the initiative “from the word go”.

“I had that feeling because SafeCare aligns with my mission of linking people,” says Millicent. “I speak about quality healthcare on behalf of those who cannot, underserved women included. And the beauty is, with SafeCare you can see visible impact because we target facilities serving all populations. It’s about inclusivity; about everyone having access to quality health.”

Starting as the sole SafeCare employee, Millicent rose through the ranks to become regional director for East Africa, building a large team around her. In 2021, the SafeCare team signed up Catholic Relief Services (CRS) as a license partner in Malawi, and in 2023, a regional license agreement was concluded to include Kenya. This involves 20 faith-based facilities in Kisumu and Siaya counties receiving access to all the SafeCare tools with people working there being trained to conduct assessments.

“When you ask many health professionals: ‘Are you offering good quality?’, they would say: ‘For sure my quality is not good but where do I start?’ That’s normally the big problem because they realize there’s so much to do but they don’t know how to slice the elephant into manageable pieces.”

This is where SafeCare offers facilities a way to improve in a step-by-step manner, based on internationally accredited quality standards and covering both medical and non-medical aspects of care.

“Before learning about SafeCare, health workers often don’t conduct triaging in emergency cases. Severely ill patients need to receive antibiotics within the hour, otherwise they can die,” says Millicent.

SafeCare grows and expands through license partners such as CRS and the team seeks to expand into other countries in collaboration with local partners.

The facility manager: Lydia Mbuya

Sister Lydia Mbuya is a member of the Franciscan Sisters of St. Anna and has qualifications in nursing and health system management. She heads up the St. Anne’s Nyang’oma Health Centre, a 15-bed facility in Siaya county.

At its first assessment in 2023, the Centre achieved SafeCare Level 3 status. Since receiving training to become a SafeCare assessor in mid-2023, Sister Lydia has been inspired by other health facilities she visited.

“One thing I believe in is that every person has the right to access quality healthcare services,” says Sister Lydia. “And through SafeCare, I trust that we shall improve the quality of services we offer in the Catholic Archdiocese of Kisumu. It means we are going to win the trust of those seeking healthcare services in our facilities.”

She has introduced numerous improvements at St. Anne’s Nyang’oma Health Centre, such as building a booth in their pharmacy to ensure patients receive their medicine with privacy. Sister Lydia has also learned to do a needs assessment and based on that, will be seeking funding to offer radiology services.

“When somebody needs to get an X-ray, I have to send that person to the next facility 12 kilometers away from us,” she explains. “If we continue implementing SafeCare, I believe we are going to go far. We will increase our clientele and that means the resources will also increase.”

The laboratory scientist: Lilian Khivali

Lilian Khivali is the laboratory manager at Nyabondo Mission Hospital in Kisumu county. The facility currently has 70 beds but will be expanded to 250 beds when its trauma center is completed. The hospital reached the next-highest SafeCare level earlier this year after starting at Level 3.

Lilian received training as a SafeCare assessor and expects to be certified in April. She became interested in quality after undergoing mentorship in internal auditing.

“I was really passionate about it and thought: Why can’t we expand it to the entire hospital?”

Once a SafeCare assessor, Lilian will be responsible for mentoring and encouraging quality improvement at several CRS facilities. SafeCare has been empowering, she says.

“You see in Africa; people believe men are everything. We are really struggling so that there is equity, so that when employment is considered, women are considered for any position. The challenges are there, but I think we are overcoming them.”

Catholic Relief Services (CRS) was founded in 1943 by the US Conference of Catholic Bishops to assist the poor and disadvantaged overseas. Within the health and nutrition sector, CRS and its partners served over 175 million people in 46 countries in areas such as emergency health services, child health & protection & health systems strengthening.

CRS and SafeCare, together with the network of the Kenyan Conference of Catholic Bishops (KCCB), joined forces to institutionalize quality improvement using the SafeCare approach and Quality Platform. The aim is to establish the processes for stepwise quality improvement within the networks and to build the capacity to manage a Quality Evaluation System efficiently and effectively. While SafeCare provides its methodology, technical assistance, and training support to promote local capacity building, CRS assists SafeCare with its implementing power in the countries in which it operates.

More than 5 million people die every year, not because of lack of access to healthcare, but because of poor quality. Many causes are preventable or treatable, however, with limited resources improving the quality of healthcare can be overwhelming. Implementing quality standards is often not perceived as an opportunity. But it should be because improved healthcare delivery raises patient safety & improves efficiency. Quality builds trust.