What is FQA?

Improving maternal and newborn outcomes requires understanding a) when and how mothers are accessing and experiencing care, and b) whether the system gives providers the conditions to deliver quality care. 

PULSE, our dashboard co-designed with government partners, triangulates data from mothers and providers on uptake, experience and provision of care and DHIS2 to give managers real-time visibility into gaps in timely, quality care. But we recognize that outcomes are influenced by a wider range of factors at the systems level, which is where Facility Quality Assessments (FQA) come in. As part of the PULSE ecosystem, FQA assesses whether facilities have the readiness, resources, and systems required to deliver safe and respectful care. It reviews the foundations of quality across major service areas: maternity, outpatient, newborn care, pharmacy, laboratory, operating theatre, the central store, and facility-wide systems. It measures: 

1. Staffing: Assesses whether the facility has enough skilled staff available, monitors absenteeism and duty coverage.
2. Equipment: Checks whether essential clinical equipment is available, functional, and maintained.
   1. Infrastructure: Reviews the physical environment (e.g., space, electricity, ventilation, and facility conditions) needed for safe care. 
   2. Water, sanitation and hygiene: Ensures reliable access to clean water, sanitation, infection prevention, and waste management systems.
   3. Commodities: Verifies the availability and proper storage of essential drugs, supplies, and consumables.
   4. Documentation: Examines whether records, registers, and reporting tools are present, complete, and accurately maintained.
   5. Standard operating procedures: Confirms that protocols exist, are accessible, and are consistently followed.
   6. Training: Assesses whether staff have received recent, relevant training and can apply it in practice.
   7. Service availability: Checks whether required services are offered consistently and during the appropriate operating hours.

   For each service area, facilities receive a score indicating their percentage adherence to quality standards. 

FQA strengthens this ecosystem by adding the “systems readiness” lens, revealing whether facilities are equipped to deliver the services that PROMPTS (our AI-enabled digital health tool) and DHIS2 shows mothers are missing.

How FQA is being used by counties

By revealing the system-level reasons behind the service gaps flagged in PULSE, FQA gives counties the evidence they need to target fixes (e.g., reallocating staff, improving workflows, or strengthening documentation). In combination, PULSE has helped county and facility managers to: 

1. Identify the system barriers behind missed services: In Riruta, Nairobi, PULSE showed that mothers were being turned away without ANC services. FQA revealed why: staff shortages, commodity gaps, and workflow issues. With this evidence, the team restocked supplies and reorganized staffing, raising ANC coverage from 42% to 85% in seven months.
2. Budget and allocate resources: In Embakasi, Nairobi, PULSE showed repeated reports of missed ANC services. Using FQA insights, the sub-county budgeted for essential commodities like IFAS and planned an EmONC training to address identified gaps.
3. Strengthen facility management: In Makueni County, FQA showed that inpatient departments were performing well, but the newborn unit (NBU) had critical gaps across HRH, WASH, infrastructure, equipment, and SOPs. These insights helped the county identify where to focus quality improvement efforts, including strengthening NBU readiness and prioritizing human resources for health deployment.

FQA strengthens PULSE’s role as a co-designed decision-support tool for government partners. By revealing the system conditions behind missed services or poor outcomes, FQA ensures that county teams can act on data to strengthen the foundations of maternal and newborn care.