Interrogating Health Systems in Resource-Constrained Settings

Abstract

Although the term quality might mean different things to different people, all are in agreement that we can easily recognize quality service when we see it. Everybody is looking for quality wherever they go. Quality is an attribute of a product or service that is superior and excellent that leaves one feeling that it was worth the reasons spent. In respect to health service, quality is that extra thing that one gets when they access health provision outlets and may make the difference in the disease outcome. The history of quality started out with inspection, where a product or a service would be retrospectively examined for compliance to a standard. This gave way to quality control where all factors involved in producing a product or service were reviewed to meet set requirements. Today, total quality management (TQM) is commonly used referring to organization wide efforts to continually provide a permanent climate to deliver high quality products or services to clients. TQM developed by W. Edwards Deming, shifted the focus of quality from adherence to a standard to satisfaction of the client. Deming insisted that this would only be possible when management accepted responsibility for building good systems with features and characteristics that have the ability to satisfy stated or implied needs. In provision of health care, quality can thus be achieved when there are systems to ensure that the needs of those who seek medical care are satisfied. What health care seekers get must be reliable by delivering expected service right the first time and honoring set promises. For instance, the tests carried out must be accurate as compared to known control or gold standards. Furthermore they should be precise, reliable, repeatable and reproducible. In this regard, repeated analysis on the same sample, under the same conditions at different times by different people should give similar results. Decision makers should be able to say that care and costing data are accurate, timely, appropriate, and reported in a useful manner. The leadership ought to be able to view the information in such a way that it supports their organization’s ability to drive change. Such quality service can only be achieved when service provision is responsive to the needs of the clients by ensuring that service providers are competent and accessible. In this regard, health care service providers communicate effectively and are trustworthy, honest and believable. This book is basically a case study of Kenya, a resource limited country in sub-Saharan Africa (SSA). It is the believe of this author that Kenya stands out in the region in its efforts towards ensuring quality health care for its citizens, the challenges she faces are not unique but typical of many low income countries. Access to quality health care in Kenya is not a privilege but a basic human right. Constitution of Kenya, Article 25 of the Declaration of human rights states that “Everyone has the right to a standard of living adequate for the health …and medical care...” Furthermore, article 43 states that “Every person has the right to the highest attainable standard of health, which includes the right to health care services”.Achieving the goal of provision of quality health services cannot be through laws, models or frameworks. Neither can it be a matter of chance. All must recognize that provision of quality health services is a matter of ethics, and embrace a deliberate strategy of ensuring development of a culture of doing things right the first time around to the satisfaction of the customer. This book is about provision of such health services. Simon has written it in a user friendly manner from his extensive experience in the field. It will be an invaluable companion of people providing health care in a resource constrained environment such as Kenya