partnership defined quality_beth outterson_10.16.13
TRANSCRIPT
PDQ: A Methodology to Build Social Accountability
Partnership Defined Quality: A Methodology to build Social
Accountability
Beth OuttersonReproductive Health Advisor
October 16, 2013
PDQ: A Methodology to Build Social Accountability
Partnership Defined Quality (PDQ)• Improves quality and accessibility of services with greater
involvement of the community in defining, implementing and monitoring the QI process.
• Providers and community members (both users and non-users) work together to identify and address priority problems.
• Recognition that quality may be defined from different perspectives (client/ provider)
• Recognition that providers and clients can work together as allies to address problems – overcomes blame
• Process for identifying problems separately, bringing providers and community members together, and establishing QI teams of providers and community members to address problems and continue to identify new ones in cyclical review.
PDQ: A Methodology to Build Social Accountability
When to Use PDQ?
• When action is needed -- not just information sharing
• When stakeholders - both providers and community want change
• When there is a willingness to listen and change how things are done locally
PDQ: A Methodology to Build Social Accountability
How PDQ builds Social Accountability
• Marginalized members address duty bearers
• Community takes ownership to improve health using existing resources
• Client satisfaction and provider performance increase along with overall health status
• Creates mechanism for rapid mobilization around health priorities
PDQ: A Methodology to Build Social Accountability
PDQ Process
PDQ: A Methodology to Build Social Accountability
Country example – AfghanistanACCESS /HSSP Project
Context:• Low coverage for safe motherhood services:• ANC coverage (45%)• Deliveries by skilled birth attendant (19%)• Postnatal care (29%)
Program goal • Increase access to safe motherhood services • Enhance quality of safe motherhood services
Expected outcomes:• Increased coverage of ANC, SBA and PNC
PDQ: A Methodology to Build Social Accountability
Preparation and Planning
• Orientation sessions with provincial and district MoPH and NGO staff
• Involved MoPH and NGO staff in the preparation and planning process
• Community Mapping (identifying areas with low coverage)
• Data analysis (HMIS) and discussions• Prepared agenda for community shuras (male and
females)• Feedback on health indicators• Orientation on PDQ process and role of community
shuras• Time/date for PDQ inquiry
PDQ: A Methodology to Build Social Accountability
Phase 1 – Building Support
• Two day workshop with community shuras (religious leaders, teachers, communityrepresentatives): • Feedback on health indicators• Community Mapping (re-confirming areas with
low coverage)• Discussions – access problems• Orientation on PDQ process – role of community
shuras• Developing PDQ inquiry checklist• Setting time and dates for PDQ inquiry
PDQ: A Methodology to Build Social Accountability
Phase 2 – Exploring Quality
Exploring quality (Community) • Checklist developed in consultation with
community shura (male and female)• Women using health services • Women not using health services • Caregivers • Family members
Exploring quality (Health workers) • FFSDP conducted• Staff interviews• FGDs (PDQ inquiry)
PDQ: A Methodology to Build Social Accountability
Phase 3 – Bridging the Gap
• Involved MoPH and NGO staff in the preparation and planning of bridging the gap workshop
• One day in advance notification (male and female sessions separate; same agenda)
• Participants:• Community shuras (male and female)• Health facility staff • Selected caregivers or clients
• Both health facility staff and community presented their point of view to each other (categorized information)
• Developed shared vision by using Venn diagram• Problems are identified and prioritized• Root causes identified (problem tree analysis)
PDQ: A Methodology to Build Social Accountability
PDQ: A Methodology to Build Social Accountability
Phase 4 – Working in Partnership
• Quality Improvement Team developed • Members from existing community shura• Health Facility staff • Selected caregivers/clients• Village administrators• 6-8 members
PDQ: A Methodology to Build Social Accountability
Example of action plan
PDQ: A Methodology to Build Social Accountability
Accomplishments• ANC coverage increased
• 45% in 2004 to 62% in 2006• Deliveries by SBA increased
• 19% in 2004 to 25% in 2006• PNC increased
• 29% in 2004 to 41% in 2006• DPT3 vaccination coverage increased
• 43% in 2005 to 77% 2006• Community participation – meaningful; sustainable• PDQ recognized as national quality assurance
standard• ACCESS/HSSP project
• Scaled up to 13 provinces
PDQ: A Methodology to Build Social Accountability
Measuring community capacity• Measurement tools:
• Exit interviews: client satisfaction• Supervisory checklist for QIT Function (rotational
leadership, gender equity, inclusion, joint decision making)
• Findings:• PDQ communities vs non PDQ communities: >
improved provider performance (Pakistan, Nepal, Armenia)
• Empowerment: sustainability, QITs (return visits)• Sense of pride, ownership of health center was
expanded to other aspects of community life
PDQ: A Methodology to Build Social Accountability
Challenges
• Working with the least advantaged—the poor
• Frequent postings and transfers of health center staff
• Time consuming process
PDQ: A Methodology to Build Social Accountability
ResourcesPDQ Manual
PDQ for Youth Manual
PDQ Facilitator's Guide
PDQ M&E Toolkit
11 PDQ MonographsPlease contact Beth Outterson at