Using Supervision to Sustain Quality Reproductive Health

Interventions in Viet Nam: The Reproductive Health Projects

(RHPs) Experience

Dang Van Tuyen, MD, MPH Pathfinder International

American Public Health Association132nd Annual Meeting

Washington, D.C.November 7-11, 2004

Using Supervision to Sustain Quality

Reproductive Health Interventions in Viet Nam

Introduction Integrated Supervision for Quality of Care

(IS/QoC) Achievements

Clients Providers Services Management System

Challenges/Lesson learned Conclusion

Introduction Reproductive Health Projects overview

Pathfinder/Ipas/EngenderHealth-Viet Nam Ministry of Health

Mission History/Partnership Objectives/Strategy Sustainability

History of conventional supervision in Viet Nam Limited guidance on monitoring/supervision Emphasized the problems rather than solutions Conducted quickly and superficially

Integrated Supervision for Quality of Care (IS/QoC)

Principles of IS/QoC

Improves quality of care from client’s and provider’s perspectives

Involves staff from the bottom up Includes a comprehensive service

assessment Based on individual responsibility,

empowerment and teamwork Relies on the supportive attitude of

supervisors Emphasizes solutions over problems

IS/QoC Methodology Based on concepts of quality of care,

participatory learning, and change management

Allows continuous room for improvement Utilizes five evaluation tools based on

indicators and checklists Sources of data:

Client exit interviews Facility review Observation of services Self-assessment Service statistics

Problem identification and action plan Encourages constructive coaching and

feedback

Achievements from a client perspective

IS/QoC involved clients in the quality improvement process through routine client interviews

IS/QoC increased client satisfaction with quality of care

Client Satisfaction Indicator Scores Soc Trang MCH/FP Center

012345

Jul-Sept03

Oct-Dec03

Jan-Mar04

Scor

e of

5 m

ax

Average scorefor waiting time

Average scorefor cleanliness

Achievements from a provider perspective

IS/QoC Generated greater understanding

of clients’ perspective Emphasized self-learning,

individual responsibility, and teamwork

Improved staff motivation Improved clinical and personal

skills through coaching and feedback

Generated a more positive attitude towards supervision

Improved overall working conditions

Achievements from a service perspective

Post Abortion Contraception Rates

0

20

40

60

80

100

120

Ha NoiOb/GynHospital

An Giang Soc Trang Can Tho HCMC Hue Vinh Phuc QuangNinh

Apr-Jun 99 Pre IS/QoC

Apr-Jun 01 IS/QoC pilot

Apr-Jun 03

IS/QoC Increased accessibility of services and facilities

Increased client flow Increased service utilization, such as post abortion contraceptive use

Achievements from a management perspective

IS/QoC precipitated Use of data for decision

Making Staff involvement in

problem identification and solution development

Staff motivation and openness to supervision

Better communication between staff and senior management

Effective direction of resources

Achievements from a systems perspective

IS/QoC achieved MoH approval for nationwide

implementation and curriculum Provincial decisions to

institutionalize IS/QoC Provincial willingness to use local

funds to extend training in IS/QoC on a wider scale

Challenges/Lessons Learned

IS/QoC requires a labor-intensive introduction. Staff and management orientation is critical.

Active involvement and support from management is fundamental.

Availability of some resource allocation for solution implementation is recommended.

A clear supervision framework is necessary for the health system on a national level

Challenges/Lessons Learned, cont’d.

Supervisors become problem solvers and centers of change management.

Supervisors' credibility lies in ability to implement suggested improvements.

Rushed supervision visits lead to neglect of clinical coaching and feedback and to superficial problem solving.

Conclusion

Improved supervision practices have enhanced quality and sustainability of reproductive health services and management systems in Vietnam

Thank You!

Pathfinder InternationalRoom 205

B4b Gaing Vo Building269 Kim Ma StreetHa Noi, Vietnam

www.pathfind.org