Strengthening government primary reproductive healthcare services through social franchising: The “tinh chi em” ( Sisterhood ) model in rural of Vietnam

SLIDE 1

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

Presenter: Nguyen Thi Bich Hang, Country Representative, Marie Stopes International in Viet Nam

Authors: Nguyen H Thang1, Nguyen Thi Quy Linh1, Dinh Thi Nhuan1, Erik Munroe2, Thoai D Ngo2 1 Marie Stopes International in Viet Nam, 2 Marie Stopes International

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 2

Content

Country context: Vietnam

Government Social Franchise (GSF) Model

Effectiveness

Conclusions

Lessons learnt & implications

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 3

Viet Nam Population: 90 million people, 50% <

25 years old

Women of reproductive age: 55.6%~25 million; approx 1.8 million women deliver a baby each year

CPR: modern methods account for 67.5%

Abortion rate: 2.5 abortions/woman per lifetime*; 30% among women < 20 years of age

Sources: Viet Nam Health Plan 2011-2015; DHS, 2010; Viet Nam JAHR, 2010

* http://www.guttmacher.org/pubs/journals/25s3099.html

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 4

Vietnam health system:key issues Health Insurance Coverage: 68%

Private sector providing 60% outpatient visits; out-of pocket accounts for 52% of total health expenditure

Underutilization of local (commune) level care and overburdening of higher level services (district and provincial)

Disparities in health between regions and population groups: • MMR in rural areas (145) remains high compared to national (79) with

gaps between regions remaining the same despite overall decreasing MMR

• CPR gradually decreasing in rural/remote areas (Red River delta, Northern Midlands, Mountains Region)

• Unmet need for modern contraceptives: 29,4% for married women; 50,4% for unmarried women (UNFPA 2012)

Source: Vietnam JAHR 2012

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 5

SRH service delivery system in Viet Nam

Provincial general or Gyn/Obs hospitals

National/central Gyn/Obs hospitals

District health centre/ hospital

Provincial centre for reproductive healthcare

Commune people’s committee

Village health workers

Population collaborators

Commune Health Station (CHS)

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 6

Commune Health Stations (CHS) Key point of primary care for

rural/remote communities

Limited investment - perceived poor quality of services

Under-utilization of SRH services

Low level of awareness of SRH/FP services

Need for service improvement– Training: client focused– Adequate medical supplies– Adequate medical equipments

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 7

Government Social Franchise (GSF) Model

Franchisor: Department

of Health

Franchisees: Commune Health

Stations

Technical Support:MSI Viet Nam

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 8

Implementation:1. Mapping/recruitment of CHS

2. Needs assessment

3. Brand and guideline development

4. Training of provincial master trainers & service providers

5. Branding of CHS

6. Certification of participating CHS

7. Brand promotion/Demand generation strategy development

8. Pre-launch/launching of GSF

9. Brand communication/demand generation activities

10. Continuous Quality assurance, monitoring and improvement support

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 9

Phases and scale-up

Phase Provinces Donor Funded

DOH Funded Scale Up

Total GSF Established

Phase I - Pilot

2007-2009

Khanh HoaDa Nang

38 38 76

Phase II

2010-2012

Thai NguyenHueVinh Long

130 59 189

Phase III

2013-2015

Ca MauDak LakYen Bai

90 (Planned)

NA NA

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 10

Franchise membership associated with increased utilisation:

453% increase in total use, 393% increase in SRH use, 178% increase in FP use

Women in poor communes were 1.6x more likely to access the TCE services than in less poor communes. Ethnic Minority were 1.2x more likely than Kinh.

Service utilisation

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 11

Service quality improvement

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 12

Provider and client satisfaction

Providers reported feeling “more confident in our abilities to provide accurate diagnoses and treatment and thus confident when promoting our services to clients”

Client’s reported increased perceptions of service quality: -95% reported that health workers seemed knowledgeable -100% reported staff were friendly

Client satisfaction and likeliness to return to CHS high (>80%)

Increased willingness to pay extra service fees for what clients perceived as higher quality services

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 13

Sustainability

“The ‘tinh chi em’ model has developed solutions to improving the quality of services in the context of the country becoming a Middle Income Country” (MOH representative)

Core provincial training networks are established to ensure retraining/supervision systems remain in place post project phase out.

Gained commitment of local authorities to budget allocation towards the expansion of the model

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 14

Conclusions

Harnessing existing public health system infrastructure to increase SRH service delivery is highly effective

Model improves quality and utilization of services, especially amongst vulnerable and hard to reach groups, which reduces the burden on provincial and central hospitals

Lower income segments are able to access affordable high quality RHFP services locally

Clients willing to pay for high quality services at affordable prices

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 15

Lessons learnt & implications

Project monitoring and evaluation play an important role

Strong collaboration and local ownership amongst partners is key to success and sustainability

Potential for successful replication by local health authorities & other donors due to its integration into existing health system

Need for evaluation on the effectiveness of GSF in improving health outcomes and the cost-effectiveness of the model

Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

SLIDE 16

Thank you!

To find out more about how we are addressing unmet need by reachingthe most underserved, please visit www.mariestopes.org