quality of care workshop| india| june 30-july 1, 2015 alive & thrive: strategic use of data to...
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Quality of Care Workshop| India| June 30-July 1, 2015
Alive & Thrive: Strategic use of data to ensure provision of good quality
IYCF counseling services
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Quality, quality, quality….
Framework for scaling up nutrition
1 2
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Alive & Thrive is funded by the Bill & Melinda Gates Foundation and the governments of Canada and Ireland and managed by FHI 360.
A&T Viet Nam Franchise Model
• In Viet Nam, 1 out of 3 children under five is stunted *• Key contributor is poor infant and young child feeding
practices (IYCF)• Functional health system in place with capacity to deliver
• Question Can large scale behavior change for improved IYCF be delivered by institutionalizing good quality standardized counseling services into the public health system using social franchising principles?
* Data Source: Nutrition Surveillance 2010, National Institute of Nutrition
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Good Quality IYCF Counseling Services?
= Leads to behavior change– Addresses key issues / concerns
of clients– Timely and relevant to context
of each mother-child pair– Clearly defined standard of
practice – becomes the ‘norm’
Strategic Use of Data
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Test & improve delivery platform
Identify priority
behaviors, define
standard package
User friendly timely data
used for decision making
Define performance
metrics, measure
outcome & impact
Good Quality IYCF
Counseling Services
Strategic use of data
A&T Viet Nam Franchise Model
• From 2010-2012, ~800 social franchises were established through the public health system across 15 of 63 provinces (all levels of facilities – province, district & commune)
• 9-15 timed and targeted counseling contacts per mother child pair over a 27 month period (3rd trimester of pregnancy to 24 months of age)
• Performance Objectives – – Double exclusive breastfeeding– Improve quality and quantity of complementary
feeding– Reduce stunting by 2 per cent points each year
Quality Data (Facility, Counseling Service, Data Management) through Supportive Supervision
Coverage – Proportion of children 0-24
months availing franchise services
Volume – Total number of
counseling contacts per month
Service Utilization – average number
of contacts per mother-child pair
Performance Metrics
4 Rounds of process evaluation and impact evaluation: Training, Franchise Management, Service delivery, service utilization and Infant
& Young Child Feeding Practices
1/'12
3/'12
5/'12
7/'12
9/'12
11/'12
1/'13
3/'13
5/'13
7/'13
9/'13
11/'13
1/'14
3/'14
0
20
40
60
80
100
120
101 10397
100
Total
Num
ber o
f con
tact
s (t
hous
and)
~100,000 contacts per month
Franchise Review
Launched 4 plans:- Target setting- Performance-based incentive- Demand generation- Supportive supervision
Performance Metrics: Quantitative
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I Quality 26 (max)
1 Facility and Staff
1 Equipments in good condition and maintained 0 – 1 – 2
2 Job aid available and in good condition (counseling card, posters, leaflet...) 0 – 1 – 2
3 Adequate trained counselors providing services (2-3) 0 – 1 – 2
4 Decree 21 compliance1 0 – 2
2 Service delivery
2.1 General Observation
5 P2 form records repeated visits by clients (check 5 copies of P2 and see the information of returned clients)
0 – 1 – 2
6 Group counseling schedule available and displayed in visible area 0 – 1 – 2
2.2 Individual/Group Counseling Observation2
7 Appropriate to the child’s age/issue/as per group counseling schedule 0 – 1 – 2
8 Follow protocol, measure weight and height of child if mother bring baby) 0 – 1 – 2
9 Content is complete and communicated clearly 0 – 1 – 2
10 Job aids and BCC materials are used correctly 0 – 1 – 2
11 Client(s) engaged and satisfied with session (observe the dialog and ask client(s) at the end) 0 – 1 – 2
3. Recording and reporting
12 Information is captured correctly (clearly recorded and complete) on P2, P3, P4 & PB 0 – 1 – 2
13 Management of forms and reports (well organised and easily accessible) 0 – 1 – 2
Sub-Total I “Quality” (1+2+3)
From 20 points (with 2 points on Dec21 and 8 point total in 2.2) High Quantity. Other Low Quality.
1 Franchises need to get 2 points on this to get into high quality criteria 2 Franchises need to get at least 8 points in this part to be high quality
Performance Metrics: Qualitative
Priority: Reward & Encourage Priority: Demand Generation
Priority: Quality Priority: Quality & Demand Generation
2HIGH QualityLOW Volume
4LOW QualityHIGH Volume
3LOW QualityLOW Volume
1HIGH QualityHIGH Volume
Performance Metrics: Qualitative and Quantitative
Client satisfactionService utilization
Capacity of providersIYCF knowledge
InterpersonalCommunication skills
Technical contentDuration of consultation
InfrastructureSpaceEquipment, Materials
Availability of servicesStaff Services offeredTime
Process
Outcome
Structure
Process Evaluation
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Issues for consideration
• Pre-service curriculum and continuing medical education
• Regulation, health facility certification & re-certification
• Financial mechanisms – performance based incentives, health insurance, fee for service
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Key Messages
• Data (both qualitative and quantitative) should drive all aspects of programming – design, implementation, monitoring and evaluation – and ensure quality
• Data collected should be relevant linked to desired outcome. “Measure what matters” (Ashish Jha)
• Data collected should be packaged (e.g. user friendly formats) with feedback loops for timely decision making and action
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Stay connected with A&T!
aliveandthrive@fhi360.org
aliveandthrive.org
@aliveandthrive
facebook.com/fhi360.aliveandthrive
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