The Clinical Learning Network: maintaining essential health services during the COVID-19 pandemic

The Clinical Learning Network (CLN) is a project established in 2021 aimed at optimising the translation of Government investments in inputs such as medical supplies and equipment, capacity building and training, structural investments to measurable improvements in the quality of services at health facility level, and in so doing contributing towards maintaining and improving essential health services during the COVID-19 pandemic.

Funded by the World Bank this project targets up to 15 county hospitals and their linked primary care facilities. A sister project, the Tanzania Clinical Learning Network has recently been established on similar principles under the leadership of the Paediatric Association of Tanzania. Key features of the CLN are:

• Development of consensus-based quality of care goals,
• Expert outreach combined with mentorship from a central team,
• Use of information to improve care through performance feedback while linking this information to local quality improvement efforts,
• Focused technical and leadership/management skills training,
• Creation of peer to peer shared learning about what works through communities of practice,
• Rapid operational and observational research using the same data that provides performance information.

The CLN structure relies on the Ministry of Health at national and county levels to provide oversight and leadership. A central network team which comprises content experts, works with the hospital teams to coordinate and offer and direct mentorship to hospital teams. Heads of Department in the participating hospitals lead local implementation, fostering a culture of continuous learning and improvement both internally in their hospitals and across the network hospitals through peer groups. A team of hospital champions (up to two per site) offer day-to-day bedside coaching, and facilitate local improvement.

In August, the project hosted a highly engaging 2-day virtual meeting during which the hospital champions were equipped with practical skills to offer effective mentorship on quality improvement (QI) activities including the use of clinical audits and health facility assessments. The partners meeting, held from 9th-10th August 2021, had 75 participants representing the hospitals, Ministry of Health, KEMRI-Wellcome and content experts in attendance culminating in the development of initial site-specific QI action plans.

Upcoming activities in the CLN include trainings focused on ETAT + principles and direct mentorship at the facility level with a focus on the use of routine clinical audit and out-patient/MCH and emergency departments as new areas of work. CLN is also working towards developing a dashboard for monitoring performance as part of wider plans to improve reporting with the Department of Family Health in the Ministry of Health.