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

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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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