Success in Primary Health:Success in Primary Health:A Multi-sectorial CollaborationA Multi-sectorial Collaboration

Preliminary Presentation -Preliminary Presentation -Quality Care EvaluationQuality Care Evaluation

March 2006March 2006

Zoe Kopp MPHZoe Kopp MPHDirector, Pfizer Global Health FellowDirector, Pfizer Global Health Fellow

Teresa NarvaezTeresa Narvaez Country Director, Project HOPECountry Director, Project HOPE

Working together for a smile, improved health and a better life

for mothers and children

2994152990

6264078284

113355126282 117364

103293

22648

108922

52821

107315

59004

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Monte PlataHerrera

More than a More than a million services million services providedprovided

Evaluation ObjectivesEvaluation Objectives Evaluate the quality of care of services offered in Evaluate the quality of care of services offered in

the Herrera and Monte Plata clinics through a the Herrera and Monte Plata clinics through a quantification of the actual level, according to the quantification of the actual level, according to the international standards, with the objective of international standards, with the objective of improving the quality. improving the quality.

Provide the base of a strategy that assures the Provide the base of a strategy that assures the quality of the clinics program supported by quality of the clinics program supported by Project HOPE in the Dominican Republic. Project HOPE in the Dominican Republic.

Conduct a profound financial analysis of both Conduct a profound financial analysis of both clinics to identify the key factors and conditions clinics to identify the key factors and conditions to achieve financial sustainability. to achieve financial sustainability.

Quality Care Evaluation TeamQuality Care Evaluation Team Zoe Kopp MPH – Pfizer, International Public Zoe Kopp MPH – Pfizer, International Public

Health EvaluatorHealth Evaluator Teresa Narvaez – Country Director, Project Teresa Narvaez – Country Director, Project

HOPEHOPE Dr. Karen Cuevas – Director, Herrera Clinic Dr. Karen Cuevas – Director, Herrera Clinic Angela Alban – Coordinator, Monte Plata Angela Alban – Coordinator, Monte Plata

Clinic Clinic Dr. Ramon Alcequiez – Medical EvaluatorDr. Ramon Alcequiez – Medical Evaluator Dr. Anyinet Belen – Medical EvaluatorDr. Anyinet Belen – Medical Evaluator Lcda. Arelis Gil – Statistician, SESPASLcda. Arelis Gil – Statistician, SESPAS Lcdo. Luis Gonzalez – Statistician, SESPASLcdo. Luis Gonzalez – Statistician, SESPAS

What is Quality Care?What is Quality Care?The right of clients to:The right of clients to: informationinformation accessaccess choosechoose securitysecurity privacy and confidentialityprivacy and confidentiality dignity and comfortdignity and comfort form their own opinionform their own opinion continued carecontinued care

Evaluation:Evaluation:Quality CareQuality Care

User Perspective:User Perspective: Exit interviews at the clinic (160)Exit interviews at the clinic (160) Interviews in the community (20)Interviews in the community (20)

Managerial PerspectiveManagerial Perspective Interviews with managers at HOPE and ADOM Interviews with managers at HOPE and ADOM

(3)(3) Audit of medical files (60)Audit of medical files (60) Observation of medical consultations (4)Observation of medical consultations (4)

Perspective of Clinic Personnel Perspective of Clinic Personnel Interviews with receptionists, janitors, nurses, Interviews with receptionists, janitors, nurses,

doctors, and lab workers (10)doctors, and lab workers (10)

What did they like the best What did they like the best or the least?or the least?

Best Best Personnel/Care Personnel/Care Treatment Treatment Everything Everything The environmentThe environment Good pricesGood prices Initial information, Initial information,

discussionsdiscussions HygieneHygiene It seems to have It seems to have

everything that one needseverything that one needs OrderOrder Here they find the best Here they find the best

servicesservices

Least Least Wait time Wait time That they discourage use That they discourage use

of baby bottlesof baby bottles Bring in more pediatricians Bring in more pediatricians Need a cafeteria Need a cafeteria Wait for the lab workersWait for the lab workers Don’t permit food in the Don’t permit food in the

waiting roomwaiting room Don’t understand the shift Don’t understand the shift

systemsystem

Recommendations from Recommendations from patientspatients

More pediatric specialists More pediatric specialists Put in a cafeteriaPut in a cafeteria More seats in the waiting More seats in the waiting

room room More comfortable seats by More comfortable seats by

the labthe lab Quicker laboratory services Quicker laboratory services Open on weekends Open on weekends Attend births and Attend births and

emergenciesemergencies Psychological and Psychological and

rehabilitation consultationsrehabilitation consultations A specific doctor per patientA specific doctor per patient

Results: Results: Audit of Medical FilesAudit of Medical Files

All of the information noted in the All of the information noted in the medical files:medical files:

99%

Interviews: Key PersonsInterviews: Key Persons Dr. Schiffino - Sub-Secretary of State of Primary Care Dr. Schiffino - Sub-Secretary of State of Primary Care

and Collective Health and Collective Health Dr Héctor Eusebio –Dept. Director, Maternal InfantileDr Héctor Eusebio –Dept. Director, Maternal Infantile Dr. Marta Nina - Coordinator National Breastfeeding Dr. Marta Nina - Coordinator National Breastfeeding

Program, SESPASProgram, SESPAS Dr. Sonia Aquino – Program Coordinator, Maternal Dr. Sonia Aquino – Program Coordinator, Maternal

Infantile SESPASInfantile SESPAS Dr. Josefina Cohen -Coordinator of the National Dr. Josefina Cohen -Coordinator of the National

Commission of Maternal BreastfeedingCommission of Maternal Breastfeeding Dr. Oscar Suriel – OPSDr. Oscar Suriel – OPS Dr. David Losk - USAIDDr. David Losk - USAID Mrs. Zoraida Heredia Vda. Suncar –Evaluator, Brugal Mrs. Zoraida Heredia Vda. Suncar –Evaluator, Brugal

AwardAward Marcos Dionicio –President, SeminsaMarcos Dionicio –President, Seminsa

Results: Key InterviewsResults: Key Interviews Good reputation Good reputation Good spirit/empowering environmentGood spirit/empowering environment Good organizationGood organization Good management – Teresa, Karen, AngelaGood management – Teresa, Karen, Angela Teresa is dynamicTeresa is dynamic Warm atmosphereWarm atmosphere EfficientEfficient Quality of Care ModelQuality of Care Model They are integrated in the country’s plan for vaccines and maternal/child They are integrated in the country’s plan for vaccines and maternal/child

health; “work as partners” of SESPAShealth; “work as partners” of SESPAS Collaborate really well with SESPAS. Integrate and coordinate with Collaborate really well with SESPAS. Integrate and coordinate with

SESPAS in their health areas SESPAS in their health areas Very impressed by the environment of the clinics; the cleanliness and the Very impressed by the environment of the clinics; the cleanliness and the

organizationorganization Teresa and HOPE/ADOM have greatly assisted with the AIEPI campaignTeresa and HOPE/ADOM have greatly assisted with the AIEPI campaign

Notable Achievements (1)Notable Achievements (1) Herrera Clinic - Self-sustainable (model of Herrera Clinic - Self-sustainable (model of

care, management, and finances)care, management, and finances)

Positioning and recognition of organization Positioning and recognition of organization and high quality services and high quality services

Automated system of statistics, services and Automated system of statistics, services and finances finances

The clinic personnel feel proud and The clinic personnel feel proud and empowered by the program; they feel that the empowered by the program; they feel that the success and self-sufficiency of the clinics is success and self-sufficiency of the clinics is their responsibilitytheir responsibility

Notable Achievements (2)Notable Achievements (2) Awards/RecognitionAwards/Recognition

National Committee of AEIPI 2005National Committee of AEIPI 2005 Brugal 2004: Social AssistanceBrugal 2004: Social Assistance OPS 2002: Sustainability OPS 2002: Sustainability National Immunization Program: 2002National Immunization Program: 2002 National Commission of Maternal Breastfeeding: 2001National Commission of Maternal Breastfeeding: 2001

Collaboration network - powerfulCollaboration network - powerful ADOM and their membersADOM and their members HOPE and their international contactsHOPE and their international contacts SESPASSESPAS Cooperating Agencies: Japan, USA, ItalyCooperating Agencies: Japan, USA, Italy Private BusinessesPrivate Businesses National NGOs: Ora de DiosNational NGOs: Ora de Dios Institutions and peopleInstitutions and people

Recommendations (1)Recommendations (1)Determine how these clinic models can have Determine how these clinic models can have the maximum impact the maximum impact in the national and in the national and international field.international field. HOPE/ADOM through involvement HOPE/ADOM through involvement with others with experience in the field of health with others with experience in the field of health (SESPAS, PAHO and other groups) should consider (SESPAS, PAHO and other groups) should consider options like: options like: 1) Creating a quality center of management training 1) Creating a quality center of management training of primary health care services. of primary health care services. 2) Expanding the number of clinics to at least have 2) Expanding the number of clinics to at least have one clinic in each region to have more influence one clinic in each region to have more influence throughout the country throughout the country 3) Using and design the future clinics with the ability 3) Using and design the future clinics with the ability to offer practical training to medical personnel from to offer practical training to medical personnel from the DR and other countries the DR and other countries

Recommendations (2)Recommendations (2)Define the Mission of the Clinics Project and Define the Mission of the Clinics Project and develop a strategic plan for the next five develop a strategic plan for the next five years.years. Project HOPE and ADOM together need to Project HOPE and ADOM together need to define their vision, mission, and establish strategic define their vision, mission, and establish strategic objectives for their achievement (including objectives for their achievement (including measurable indicators). measurable indicators).

Then develop a 5-year strategic plan to reach the Then develop a 5-year strategic plan to reach the set objectives and expansion plans for the clinics set objectives and expansion plans for the clinics program. That should involve representation from program. That should involve representation from both organizations, HOPE and ADOM, and both organizations, HOPE and ADOM, and representation from their employees.representation from their employees.

Recommendations (3)Recommendations (3)Name a management sub-committee for Name a management sub-committee for the clinics programthe clinics program with representation with representation from ADOM, HOPE and clinic personnel. This from ADOM, HOPE and clinic personnel. This committee will be in charge of providing committee will be in charge of providing leadership and follow-up to the strategic plan. leadership and follow-up to the strategic plan. In addition it will guarantee the quality of In addition it will guarantee the quality of services in the clinics, supervise the services in the clinics, supervise the appropriate handling of funds, manage the appropriate handling of funds, manage the growth of the endowment fund and secure growth of the endowment fund and secure the future and the expansion of the impact of the future and the expansion of the impact of the clinics project. the clinics project.

Recommendations (4)Recommendations (4) Establish a Director of the Clinics Establish a Director of the Clinics

Project position, within ADOM, to Project position, within ADOM, to supervise and provide coordinated supervise and provide coordinated management for both clinics to management for both clinics to obtain a higher level of efficiency in obtain a higher level of efficiency in the handling and operation of the the handling and operation of the clinics and the implementation of the clinics and the implementation of the activities of the strategic plan. activities of the strategic plan.

Final ConsiderationFinal ConsiderationThe collaboration clinics The collaboration clinics of ADOM and HOPE in the of ADOM and HOPE in the DR are excellent DR are excellent examples of primary and examples of primary and maternal/child health maternal/child health clinics with a high level of clinics with a high level of quality care. These quality care. These clinics could serve as clinics could serve as quality care models for quality care models for HOPE and ADOM and HOPE and ADOM and other organizations in the other organizations in the Dominican Republic and Dominican Republic and other countries.other countries.

““There are two There are two ways of ways of spreading light: spreading light: to be the candle to be the candle or the mirror or the mirror that reflects it.”that reflects it.”

-Edith Warton-Edith Warton