Scaling Up Service Quality Assessments (SQA) for Community Health in Zambia

By: Financing Alliance for Health (FAH)

Despite the inclusion of Service Quality Assessment (SQA) tools in the Ministry of Health (MoH) Quality Improvement and Quality Assurance (QIQA) guidelines, their operational use to monitor compliance with service delivery standards has remained limited—particularly in Community Health. Recognizing this gap, the Community Health Unit, with support from the Financing Alliance for Health, is scaling up the use of SQA tools to strengthen monitoring and continuous quality improvement (CQI) in community-level health services.

Purpose and Importance of SQAs
SQA tools are essential for assessing whether health services are being delivered in accordance with national standards. They enable health workers and supervisors to document service delivery performance and identify gaps. The insights gained are then used to implement remedial actions, including targeted training, mentorship, and the development of costed quality improvement plans.

Key Achievements to Date
In March 2024, the MoH, through the Community Health Unit and the Performance Improvement Unit—supported by the Financing Alliance for Health (BIRCH) and Partners revised the SQA tools to align with updated community health guidelines. Key milestones include:

• Orientation of multi-disciplinary teams comprising representatives from Provincial Health Offices (PHOs), District Health Offices (DHOs), hospitals, and health facilities.
• Completion of SQAs across 20 districts, targeting two health facilities per district in Eastern, Luapula, Northern, Southern, and Copperbelt provinces.
• Initial SQA findings are being used to inform quality improvement interventions and guide technical assistance, capacity building, and mentorship programs.

Next Steps

1. Institutionalization: Support MoH to institutionalize the routine use of SQAs for monitoring compliance with primary health care standards, with a focus on expanding implementation to all provinces.
2. Targeted Mentorship: Continue supporting mentorship of polyvalent Community-Based Volunteers (CBVs) by multi-disciplinary teams, based on specific gaps identified through the SQAs.

By embedding SQA use into routine practice, Zambia aims to strengthen service delivery quality at the community level and accelerate progress toward universal health coverage.

Watch: How Zambia is Responding to Global Health Financing Cuts

Watch: How Sierra Leone’s Government is Responding to Health Funding Cuts

Watch: From Aid to Ownership: Rethinking Primary Health Care Financing in Africa

This article was originally published on Financing Alliance for Health