Nguyen Thi Bich Hang's presentation at the International Conference on Family Planning, 2013 on: Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model

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:
The “tinh chi em” ( Sisterhood ) model in rural of Vietnam
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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
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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
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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
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5. SRH service delivery system in
Viet Nam
National/central
Gyn/Obs hospitals
Provincial general or
Gyn/Obs hospitals
Provincial centre for
reproductive healthcare
District health
centre/ hospital
Commune people‟s
committee
Commune Health Station
(CHS)
Village health
workers
Population
collaborators
Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam:
the “tinh chi em” (Sisterhood) model
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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
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7. Government Social Franchise
(GSF) Model
Franchisor:
Franchisees:
Department
of Health
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
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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
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9. Phases and scale-up
Phase
Provinces
Donor
Funded
DOH Funded
Scale Up
Total GSF
Established
Phase I Pilot
Khanh Hoa
Da Nang
38
38
76
Thai Nguyen 130
Hue
Vinh Long
59
189
Ca Mau
Dak Lak
Yen Bai
NA
NA
2007-2009
Phase II
2010-2012
Phase III
2013-2015
90
(Planned)
Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam:
the “tinh chi em” (Sisterhood) model
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10. Service utilisation
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.
Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam:
the “tinh chi em” (Sisterhood) model
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11. Service quality improvement
Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam:
the “tinh chi em” (Sisterhood) model
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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
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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
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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
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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
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16. Thank you!
To find out more about how we are addressing unmet need by reaching
the most underserved, please visit www.mariestopes.org
Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam:
the “tinh chi em” (Sisterhood) model
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