Table 3.
Description of JHI pilot activities by phase
| Activities | Description of tasks |
|---|---|
| Development phase (October 2013 to December 2014) | |
| Development of JHIC | JHIC developed by a Technical Working Group based on views of a wide range of healthcare regulation stakeholders through a series of meetings. World Bank team tested draft checklist in 42 health facilities in Nairobi and simulated results for a range of scoring systems to inform the Technical Working Group discussions |
| Consensus building | Two KePSIE Task Force (KTF) meetings with representatives from World Bank to agree on the JHIC design and content |
| JHIC Gazettement | JHIC gazetted (official public communication of statutory change) under Legislative Supplement No. 25 as part of Legal Notice No. 46 in the Public Health Act (Cap. 22) on March 21, 2016, to be applied at the national level. This process was overseen by a legal counsel. The final gazettement date was delayed until 2016 but the cost of the legal counsel for this activity was included in the development phase as it was categorized as a development activity |
| Start-up phase (January 2015 and November 2016) | |
| Implementation preparation | National launch followed by Kickoff meetings in the three pilot counties. Sub-county representatives and inspectors distributed copies of JHIC to county health management teams (CHMTs) and health facility managers |
| Development of implementation manual | Manual prepared by World Bank staff and consultants contracted by World Bank to cover all details of pilot implementation |
| Training & recruitment of inspectors | 25-day training of 8-member Inspector Training Expert Group (ITEG) representing all regulatory agencies. ITEG then trained 20 potential inspectors for 20 days (only 8 of these were subsequently involved in inspection at any one time) |
| Facility mapping | A census and mapping of all health facilities in each pilot county conducted, to supplement official government facility list |
| Preparation of materials | Contracts to private firms for: scorecard design and piloting through focus group discussions with general public in Nairobi County; SMS verification for checking authenticity of scorecards; printing of patient information leaflets |
| Development of e-JHIC | JHIC customized and converted into an electronic version to be used on tablets. The pilot e-JHIC was developed by the World Bank and had over 40 rounds of revision during the one-year pilot to apply updates to inspection protocols and guidelines. The revision to the e-JHIC continued into the implementation year but these costs are categorized as start-up phase as these revisions would not be expected to continue in future years |
| Development of monitoring systems | Concept and system designed by the World Bank, including both offline and web-based management information systems |
| Printing of JHIC | Printing of JHIC by private printing firm contracted by KMPDC |
| Implementation phase (November 2016 to December 2017) | |
| Inspection | Health facility inspections conducted by 8 full-time inspectors supervised by MoH coordinator with support from World Bank team |
| Printing of score cards | Printing of scorecards by a private firm contracted by KMPDC |
| Closure visits | Closure visits to facilities by MoH coordinator accompanied by county officials. Involved posting a closure scorecard and notifying in-charge of the decision and process to obtain a license. Closure visits happened on average 70-days after the closure report from the inspection [15] |
| System maintenance | Routine maintenance of online monitoring system and SMS verification system for checking scorecard authenticity by the World Bank |
| General management | General JHI management, including meetings to discuss issues arising in the field and amend inspection protocols and procedures; 5-day refresher training of inspectors in Meru led by ITEG and World Bank team; monitoring and quality control activities including feedback to inspectors |