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