Improving Health Centers’ Outreach

Activities

Kampot ProvinceApplied Health Research by the

Kampot PHD

Kampot PHD

Context

Capacity building support to Kampot PHD

TrainingCoachingSkills development

Particular interest on improving problem identification and developing innovative solutions

Kampot PHD

Context

Create a pool of researchers within the Kampot PHD to conduct applied health research when needs arise.GTZ-Kampot PHD-Racha-NIPH discussion came up with a research topic:

Look into the performance of outreach activities provided by the HC staff in Kampot.

Kampot PHD

Rationale

1997 MOH Guidelines for Operational Districts2001 MOH Guidelines for Outreach Services from Health CentersHealth Sector Strategic Plan 2003-2007

Kampot PHD

Rationale

Per diems and transport allowance given

3 – 6 months after the actual conductMore often reduced amount

Leaves the HC staff to shoulder expenses or not to conduct it – but reporting anyway

Kampot PHD

Rationale Poor performance of outreach services recognizedTriggers discussion between PHD and NGOs whether this is due to non-timeliness of per diemProposal from Racha and later GTZ to support initial funding of OA to most HCs

Kampot PHD

is it really the timeliness of per diem?

what other factors contribute to OA performance?

Kampot PHD

Problem Diagram

Supplies, Material and

Drugs

Outreach Activities not

performed properly

according to MOH Guidelines

Financial

Factors

Human Resour

ce Factors

Environmental conditions/ locations/

situations of villages

Coordination between HC

staff and local

authorities

Community involvement is

low

Low level of participation of

community intermediaries –

FBCs, VHW

Per Diem

Transportation

Ice

Not on time

Inadequate

No standard*

Difficult to

reimburse

Low capacity

Inadequate

number

Wrong staff doing

OA

COMMUNITY RELATED FACTORS

PROVIDER RELATED FACTORS

Budget not on time

Kampot PHD

Research Objectives to assess the performance of the OA in selected health centers to identify constraints and other contextual factors affecting OA performance to provide feedback and recommendations to the PHD/OD to improve performance of OA

To build capacity of the PHD team in conducting qualitative researchTo establish and promote links between NIPH and the provinces

Kampot PHD

Research Questions

How do the HC staff perceive outreach activities? How does a properly performed outreach activity look like? What are the constraints/barriers faced by the HC staff providing outreach activities?What are the environmental factors affecting the provision of outreach activities in the village?

Kampot PHD

Research Questions

How does the community perceive the provision of health services in the village? What are the existing community-based mechanisms supporting health outreach activities? How far are the poor reached by outreach activities of the HC staff?

Kampot PHD

Research Questions

What measures or remedies should be undertaken to improve the quality and quantity of outreach activities?Does payment of per diem on time lead to better quality or more outreach activities?

Kampot PHD

Methodology

Study design descriptive – to provide a clear picture of the functioning of outreach activities, comparative and quasi-experimental intervention – between HCs receiving per diem on time (cases) and HCs receiving delayed per diems (control)

Kampot PHD

Methodology

Phases of the Research baseline – captures present situation intervention – timely per diem will be given to the HCs except the control HCs evaluation – assess outcome of the intervention and identify/measure changes

Kampot PHD

Methodology

COMMUNITY RELATED FACTORS

PROVIDER RELATED FACTORS

Supplies, Material and Drugs

Human Resource Factors

Environmental conditions/locations

/ situations of villages

Coordination between HC staff

and local authorities

Community involvement is low

Low level of participation of community intermediaries –

FBCs, VHW

Low capacity

Inadequate number

Wrong staff doing OA

Outreach Activities not performed properly according to MOH

Guidelines

Financial Factors

Per Diem

Transportation

Ice

Not on time

Inadequate

No standard*

Difficult to reimburse

Budget not on time

Kampot PHD

Methodology

COMMUNITY RELATED FACTORS

PROVIDER RELATED FACTORS

Outreach Activities not performed properly according to MOH

Guidelines

Financial Factors

Per Diem

Transportation

Ice

Not on time

Inadequate

No standard*

Difficult to reimburse

Budget not on time

Kampot PHD

Methodology

COMMUNITY RELATED FACTORS

PROVIDER RELATED FACTORS

Supplies, Material and Drugs

Human Resource Factors

Environmental conditions/locations

/ situations of villages

Coordination between HC staff

and local authorities

Community involvement is low

Low level of participation of community intermediaries –

FBCs, VHW

Low capacity

Inadequate number

Wrong staff doing OA

Outreach Activities not performed properly according to MOH

Guidelines

Financial Factors

Per Diem

Transportation

Ice

Not on time

Inadequate

No standard*

Difficult to reimburse

Budget not on time

Kampot PHD

Methodology

Sampling and Study Population nine health centers

selection is based on:• Categorization used in the Reward and

Sanction Mechanism for Health CentersKampong Trach Kampot Chhouk

A A A

B2 B1 B1

C B2 C

Note that HCs in Angkorchey OD are excluded.

Kampot PHD

Methodology

Sampling and Study Population 3 villages in each HCs

selection is based on:• Identification of the participating

researchers and OD chief• With criteria to be developed and

generally agreed by all

Kampot PHD

Methodology

HCs excluded in the study

N = 14

HCs as sample

population

N = 9

AngkorChey HCs

N = 10

47 HCs

10 HCs

33 HCsas study

units

4

Kampot PHD

Research Team

Steering Committee: 3 PHDs, PHD EPI Chief, PHA, 1 NIPH + consultant, & Racha Provincial Coordinator (tent.)Researchers: 2 in each OD (M/F), 2 PHD (M/F), 2 GTZ staffResearch Groups: 2-3 Kampot researchers and 1 NIPH researcher per OD

Kampot PHD

Limitation of the StudyPHD/OD staff new to research internal researchers OD supervisor – HC staff relationship other unforeseen changes/improvement in other factors

Kampot PHD

How to minimize limitation?

Training will be conducted on how to do researchOD researchers will not work in their own OD e.g., Researchers from Kampot will work in Chhouk OD.

Will only choose researchers who are willing to participate and learn new ideas

Kampot PHD

Ethical Issues

are results to reflect the real situation?

Kampot PHD

Proposed Budget

DescriptionEstimated

Cost

OA Per Diem $ 8,257.50

Research Proper $ 3,072.00

Research Materials $ 390.50

Training for Researchers $ 835.00

SC Meetings $ 1,288.00

Contingency Costs (10%) $ 558.55

Total $ 14,401.55

Kampot PHD

Thank you for your kind attention!

OA Steering Committee