Health systems research

Grace Irimu

Dr Grace Irimu evaluates the effect of introducing Ministry of Health basic pediatric protocols and ETAT+ in a university teaching hospital.

The KEMRI-Wellcome Trust research programme

The KEMRI-Wellcome Trust Research Programme is a major Wellcome Trust’s overseas programmes. Its work has had a major influence on national and international health policy. Research spans a wide variety of topics and disciplines including research on malaria and bacterial and viral infectious diseases, work to map disease risk and intervention coverage and work on research ethics and health systems strengthening.

Grace Irimu: Improving quality of care

I am a senior lecture in paediatrics and child health at the University of Nairobi, which is the biggest medical school in Kenya. I am a paediatrician and also paediatric nephrologists so I deal with children and those with kidney diseases. I am also a researcher and a public health specialist, I hold a PhD in public health, and I collaborate in research with KEMRI Wellcome Trust.

My current area of research is collaborative research between the Ministry of Health, Kenya, Kenya Paediatric Association, KEMRI Wellcome Trust and the participating hospitals in that project.  It is project to help the hospitals and also the Ministry of Health improve the quality of patient data. So far we are in fourteen hospitals spread over the country and it is a project which we are running from 2013-2017.

This is a very important area of study because currently the data that we have, particularly for inpatient care is very scarce and insufficient for use both for hospitals and Ministry of Health to inform policies, to allocate resources and also to inform initiatives. So I feel that this is important because if we help hospitals generate data then hospitals can use that as evidence to inform quality initiatives and also resource allocation. Currently when we get quality data from hospitals it is mainly from research projects, so we want to establish mechanisms for hospitals to generate data on a routine basis and not just wait for research and also to enable them (hospitals) to use that same research to improve quality of care.

For this particular research we are using quantitative research methods - we are doing an audit and comparing it with the standard guidance of care. We are also using qualitative methods. For this collaborative research we are in fourteen hospitals at the moment. We started this project in September last year and we recruited four hospitals and then in October we recruited another five hospitals, and a month ago we recruited another five hospitals so in total we have fourteen hospitals,which are spread all over the country. These hospitals were selected by the Ministry of Health because they are hospitals which have a high population and they are county hospitals and also level five hospitals.

We started our research in October last year and we have so far analysed data and given feedback to the hospitals. As for the impact, I will talk to the authorities as to when we will be able to tell you the exact impact. So far I think one thing is that the hospitals and the Ministry of Health are actually appreciating the gap, I think that is one big achievement. Because when people appreciate that there is a gap in care then it’s possible for them to think of alternative ways of delivering that care.

I would like to tell young people that research is good. It’s good because you generate evidence to do what is best and you are also in a good position to adapt things from other context to suit your context. You find that it isn’t good in research to use evidence from a different context even without data predicting your context and sometimes it doesn’t work well.