Assessing health systems’ capacity to deliver quality services

Our work in Bungoma, Kenya provided us with many useful lessons and best practices, which has built a strong foundation on our MANI-Quality of Care project, implementing in four new counties in Kenya.

The World Health Organization (WHO) defines a health system as the organisation of institutions, resources and people whose primary function is to improve health. A health system therefore requires financial resources, well-trained staff, information, transport, communication and strategic leadership in order to function properly. Strengthening the health system thus implies addressing constraints and gaps in these areas.

Improving maternal and newborn health outcomes requires a strong, functioning health system. The MANI-Quality of Care project is supporting the counties of Kwale, Mombasa, Nandi and Kericho on health systems strengthening to improve maternal and newborn health indicators.

The OCA Tool

The Organisational Capacity Assessment (OCA) is a method used to assess the capacity of an organisation or institution to deliver its mandate to strengthen the health system. The purpose of an OCA is to inform and guide the technical assistance provided by a programme, and other partners, so that it is focused on key areas to improve health system performance and health outcomes.  An OCA focuses on capacity rather than performance; it is a self-assessment tool where key personnel from the organisation can assess their own strengths and weaknesses.

Putting the OCA into practice

As part of MANI-Quality of Care, our team facilitated an OCA with the county and sub-county health management teams in Kwale, Mombasa, Nandi and Kericho.  The process started by developing questions around each of the six WHO health system building blocks. The questions measured each county’s capacity and systems to offer quality health services. The teams then developed key indicators to be measured for each building block with a score between 0 – 4. Once the OCA tool was ready, the county teams came together for a one-day workshop for a self-assessment exercise.  MANI-Quality of Care analysed the scores and generated a scorecard showing counties’ rank in percentages for the different parameters.

Dr. Patta the County Director of Health in Mombasa, recognised that the OCA was critical for them; “During the OCA dissemination, we realised that despite doing well in some indicators, there are still existing capacity gaps.” He acknowledged that it helped them understand where they are as a county in terms of readiness to offer maternal and newborn services.

“We hope to use the OCA findings to improve quality of care across all our facilities” he added.

The findings also highlighted the capacity of health care facilities in terms of equipment and other resources required for the implementation of quality maternal and newborn health services.

A score of 70% or above indicates that a health system is managed well and has the capacity to deliver its mandate. The OCA results for the counties ranged from 59% in Mombasa, 58% in Kwale, 42% in Kericho and 38% in Nandi County, indicating that none of the counties have a system that is fit for purpose. Our work during MANI-Quality of Care is to strengthen the health system and ensure that by the end of the programme in 2022, we will record a significant improvement in these scores. A stronger health system that offers quality services to women and newborns is what we will be working to achieve.