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Building the reproductive health capacity at primary healthcare facilities:
Presenter: Dinh Thi Nhuan Authors: Dinh Thi Nhuan, Thang H. Nguyen, Thoai D Ngo
Partial social franchising of community health facilities in Vietnam
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Outline Country Context: Vietnam
Partial social franchising: Government Social Franchise ( GSF) Model
Findings: service utilisation & quality
Conclusions
Lessons learnt & implications
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Vietnam Population: ~ 86.78 mil. people, 50% <
25 years old ( Vietnam Healthplan 2011-2015 )
Women at reproductive age 55.6% ~ 25 mil; about 1,8 mil women deliver baby each year ( Vietnam Healthplan 2011-2015 )
CPR: modern methods account for 67.5% (Health Statistics, 2010)
Abortion rate: – Average of 2.5 abortions/woman*
– 30% among women < 20 years of age (Vietnam JAHR 2010 )
* http://www.guttmacher.org/pubs/journals/25s3099.html
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Vietnam health system - key issues
Low health budget per capita: ~ 60 USD
Health Insurance: 60% coverage
– Private sector provides 60% of all outpatient visits
– Out-of pocket: 52% of total health expenditure
Disparities in health between regions & population groups
Source: Vietnam JAHR 2010
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SRH service delivery system in Vietnam
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)
Mass-media organizations
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Commune Health Stations Limited investment - perceived
poor quality of services
Reliance on district / provincial hospitals & private clinics
Low level of awareness on RHFP services
Need for service improvement – Training: client focused
– Adequate drug supplies
– Updated equipment
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Government Social Franchise (GSF) Model
Franchisor: Department
of Health
Franchisees: Communal Health
Stations (CHS)
Technical Support: MSI Vietnam
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GSF Business Process 1. Needs assessment
2. Mapping / recruitment of CHS
3. Brand creation and guidelines development
4. Training of provincial master trainers & service providers
5. Certification of participating CHS
6. Branding CHS
7. Demand generation strategy development
8. Pre-launch / launching of GSF activities
9. Brand communications / demand generation
10. Quality assurance / improvement
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Implementation of GSF Model
Phase II
2009
Phase III
2010-Present
Phase I
2007-8
Khanh Hoa: 28 Khanh Hoa:28 Thai Nguyen: 25
Da Nang:10 Da Nang :10 Thua Thien Hue: 25+25
Vinh Long: 20+25
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Service utilisation
• Franchise membership associated with: 40% ↑ in total use, 51%↑ in RH use, 45% ↑ in FP use
• Farmers more likely than non-farmers to visit CHS for RH/FP services
-
50,000
100,000
150,000
200,000
250,000
Q3/07 Q4/07 Q1/08 Q2/08 Q3/08 Q4/08 Q3/09 Q4/09 Q1/10 Q2/10 Q3/10 Q4/10 Q1/11 Q2/11 Q3/11
AP I AP II AP III
RH ServicesAll services
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Perceived Service Quality - Phase I Providers reported feeling “more confident in our abilities to
provide accurate diagnoses and treatment and thus confident when promoting our services to clients”
↑ client perceptions of service quality
– Staff expertise, staff attitudes, clinic environment and equipment
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
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Conclusions Harness existing public health system infrastructure to
increase service delivery
Reduce burden on provincial and central hospitals
Clients willing to pay for high quality services at affordable prices
Lower income segments able to access affordable high quality RHFP services locally
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Lessons Learnt & Implications Project monitoring and evaluation play an important role
Strong partnership among partners is key to success
Potential for successful replication by local health authorities & other donors
Need to evaluate effect of GSF on health outcomes and cost-effectiveness
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Acknowledgements Thanks to:
Study participants
Staff of CHSs
Provincial Health Departments
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Further Information Ngo AD, et al. 2010 The impact of social
franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam. BMC Health Services Research. 10; 54
Ngo AD, et al. 2009 Impacts of a government social franchise model on perceptions of service quality and client satisfaction at commune health stations in Vietnam. J Dev Eff, 1 (4)
Ngo AD, et al 2009 Developing and launching the government social franchise model of reproductive healthcare service. Social Marketing Quarterly. 15 (1)
MSI reports (accessible via www.mariestopes.org)
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Thank you
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