2. SQH SDS Version 5, May 2012
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Introduction
PSIMyanmar works inpartnershipwiththe Ministryof Healthtoimprove the health of poor people
in Myanmar. The Sun Quality Health (SQH) network of private General Practitioners has played a
major part in this effort since 2001. PSI provides support to SQH doctors to help them improve
Quality, Equity, and Access to the services they provide.
PSI has developed these Service Delivery Standards (SDS) to support further improvement in the
Qualityof care provided throughSQH. SDSwill provide acommonbenchmarkforPSIand for all SQH
doctors; by clearly defining what Standards are expected, we can begin to effectively measure
service Quality. Once service Quality is defined and measured, SQH will be able to identify
weaknesses and track progress towards improved Quality, with the goal of meeting all Standards.
The Service Delivery Standards defined here are minimum standards. They are not intended to
provide a comprehensive set of rules, guidelines, or protocols. They in no way replace national
standards, as setout bythe Ministryof Health. Theydonot replace comprehensivetrainingprovided
by PSI or others, and following these SDS alone is not sufficient to provide high quality care.
As minimum Standards, these SDS should be attainable by all SQH providers. PSI is committed to
providingthe supportnecessarytohelpprovidersachieve them. SQH providers are encouraged to
consider their own performance relative to SDS, and if areas for improvement are identified, to
requestthe engagementandsupportof PSI. At the same time PSIis developingtoolsformonitoring
performance against SDS, and will offer feedback to SQH as appropriate.
The Standardsset our belowhave beendeveloped based on National Guidelines and international
best practice. Nevertheless, that are a first attempt, and they are intended to provide a starting
point for a process of development and refinement. SQH providers will be the key partners in this
development, and we will work together to ensure that each Standard is specific, measurable,
achievable, and relevant.
PSI would like to acknowledge the ongoing support of the Ministry of Health, donors and
international partners,and,mostimportantly,the continueddedicationandcommitmentof our Sun
Quality Health doctors. Together, we will continue to improve the quality of health services
available to Myanmar’s poor.
Dr Min Zaw
Director, Health Services, PSI Myanmar
Yangon 2012
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SQH Service Delivery Standards
Summary
A. Standards of SQH network members
SDS 1: The SQH clinic clearly displays an SQH signboard.
SDS 2: The SQH clinic clearly displays a current PSI/Mpricing wall sheet.
SDS 3: The SQH clinic clearly displays IEC materials at easily accessible area for the clients.
SDS 4: The SQH clinic is registered at local health authority and the SQH provider has a medical
license.
SDS 5: The SQH providerensuresthat qualityPSIhealthproductsare alwaysavailable forthe clients.
SDS 6: The SQH provider ensures that bio hazardous materials are properly handled, stored and
disposed of.
SDS 7: The SQH provider maintains accurate records.
SDS 8: The SQH provider follows the policies of PSI/Mpricing and incentive schemes.
B. Standards of SQH network services
I. Key information for clients
SDS 9: The SQH provider provides key information of health services or products before the client
receives it.
II. Respect for clients’ rights
SDS 10: The SQH provider respects a client’s right to make informed decision of health services.
SDS 11: The SQH provider respects a client’s right for privacy and dignity.
SDS 12: The SQH provider respects a client’s right to receive health services which meet PSI/M
minimum clinical standards.
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A. Standards of SQH network members
SDS 1: The SQH clinic clearly displays an SQH signboard.
The SQH brandis a valuable assetof the SQHfranchise.Clientsdecidewhetherto utilize health care
servicesata particularlocationbasedonwhat theyknow,or think they know, about the brand. The
SQH brand must have the ability to sway clients to use the SQH clinic by reminding them of the
perceived quality expected from the service.
Indicator: SQH signboard clearly displayed outside the clinic.
SDS 2: The SQH clinic clearly displays a current PSI pricing wall sheet
Display of PSI’s current pricing wall sheet helps poor clients to confidently utilize SQH services. It
helps to keep SQH providers accountable to follow PSI/M’s pricing structure.
Indicator:CurrentPSIpricingwall sheetisposted eitherinthe waitingroomorconsultationroom of
SQH clinic.
SDS 3: The SQH clinic clearly displays IEC materials at easily accessible area for the clients.
IEC isa cost-effectiveapproachtomobilizecommunitiesintomakinglife-saving behavioral changes
in their daily health practices. IEC materials are an essential component in facilitating the health
knowledge, attitude and practices about common illnesses and their causes.
Indicator: All current, appropriate IEC materials relating to SQH services and products are easily
accessible to clients visiting to the clinic.
SDS 4: The SQH clinic is registered at local health authority and the SQH provider has a
medical license.
According to law in relation to medical services in Myanmar, each medical doctor must have a
medical licensefromMyanmarMedical Council and a clinicregistration document issued from local
healthauthority. These are evidence of qualifiedmedical doctors forgeneral practice incommunity.
PSI/M is an INGO and has MoU with DoH. Therefore in order to run its health related activities
without any interruption, medical license and clinic registration must be available at all affiliated
SQH providers.
Indicator: SQH provider has medical license and clinic registration. PSI/M keeps SQH provider’s
number of medical license in provider profile.
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SDS 5: The SQH provider ensures that quality PSI/M health products are always available
for the clients.
An SQH provider is responsible for ordering adequate stocks of PSI/Mhealth products and PSI/M
staff isresponsibletodeliverthe orderedstockstimely makingensure nostock-outorexpiry. Health
products needtobe storedin a cool,dry place,outof direct sunlight, in order to keep their optimal
efficacy until the end of their shelf-life. Some may need refrigeration.
Indicator:PSI/Mhealthproductsare properly stored.Stocklevelsare adequate toprevent stockout.
No expired, damaged or otherwise defective products are found.
SDS 6: The SQH provider ensures that bio-hazardous materials are properly handled,
stored and disposed of.
BeingSQH clinicsas health care facilities, they generate infectious as well as non-infectious waste
materials. It is likely to transmit infection and endanger human health, and the environment.
Infectious medical waste is also known as biohazard waste.
During storage, handling, and transport, infectious medical waste (except for sharps) must be
contained indisposablecontainersorbagsthat are moisture resistantandstrongenoughto prevent
leakage or expulsion of solid or liquid waste. Sharps must be disposed of in impervious, rigid,
puncture-resistant containers immediately after use.
Indicator: Bio-hazardous materials are properly managed according to the guidelines.
SDS 7: The SQH provider maintains accurate records.
A medical record documents a client’s medical treatment, and current health status, and is an
integral component in the delivery of quality health care.
SQH providersare responsible forensuringthatmedical records, as required by PSI/M, are accurate
and up to date at all times.
Indicator: SQH providers maintain accurate records according to PSI/Mrequirements.
SDS 8: The SQH provider follows the policies of PSI/M pricing and incentive schemes.
Pricingpolicyand incentive schemes are important to change desired behavior of target groups by
increasingaccesstodefinedproductsandservices delivery. In order to ensure the incentives reach
only to the needy, SQHproviderneedstofollow the policiesof all PSI/Mincentives schemes. PSI/M
is responsible to provide updated summarized incentive policies to SQH providers.
Indicator: SQH provider has the updated copy of summary incentives tables.
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B. Standards of SQH network services
I. Key information for clients
SDS 9: The SQH provider communicates key information of health services or products
before the client receives it.
Indicator: The client understands key information of health services he/she has been provided.
RH
(i) Birth Spacing
After consultation with SQH provider, all BS clients are able to describe the following:
General
a. The variety of available BS methods at SQH clinic by mode of use
b. The main advantages and disadvantages of these methods
Specifically; the client is able to explain
a. What their chosen method is
b. Common side effects of their chosen method
c. Possible complications (if any)
d. Follow up schedule
(ii) Cervical cancer prevention
After consultation with SQH provider, all CCP clients are able to describe the following:
a. What cervical cancer is
b. What VIA is
c. What cryotherapy is
d. Common side effects of cryotherapy
e. Follow up schedule
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STI
AfterconsultationwithSQHprovider,all STIclientsare able to explainthe following:
a. howto take the drugstheyhave beenprescribed
b. whytheyshouldavoidsex withoutcondom
c. why theyshouldrefertheirsexual partnerstoSQH clinic
d. whytheyshouldseekHIV counselingandtesting
HIV
(i) PITC
Afterconsultationwith SQH provider, all PITC clients are able to explain or describe the following:
a. HIV is a fatal infection commonly associated with TB and STIs
b. PITC is a routine test for defined target groups
c. PITC is voluntary and the client has a right to decline it
d. The benefits of knowing HIV result
e. Declining an HIV test doesn’t affect the client’s access to other services like TB treatment
f. The client’s information is confidential
(ii) ART
After consultation with SQH provider, all ART clients are able to explain or describe the following:
a. ART is life-long treatment (HIV is treatable but not curable disease) with inherent cost
b. It is required to take same drugs at the same time every day
c. ART has short term and long term side effects
d. It is still important to protect him/herself from re-infection and others from transmission
e. It is important to come back to see the doctor immediately if any new symptoms occur
f. Follow up schedule
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TB
After consultation with SQH provider, all TB patients are able to explain or describe the following:
a. TB is infectious and curable
b. Anti-TB drugs are free of charge
c. Anti-TB treatment duration, form of drugs and dosage
d. Drugs must be taken daily at regular interval
e. Drugs taking must be supervised by an observer and who his/her chosen DOTS observer is
f. How to prevent transmission of infection
g. It is important to come back to see the doctor if any new symptoms occur
h. Follow up schedule
Malaria
After consultation with SQH provider, all malaria patients are able to explain or describe the
following:
a. How to take the drugs
b. It is important to come back to see the doctor if the symptoms persist
c. 3 ways to prevent malaria infection
Pneumonia
AfterconsultationwithSQHprovider,all caregiversof under 5 children with pneumonia are able to
explain or describe the following:
a. How to take the drugs
b. Chest indrawing and 3 common danger signs of pneumonia
c. Follow up schedule
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II. Respect for clients’ rights
SDS 10: The SQH provider respects a client’s right to make informed decisions in health
services.
Behavior is critically important to maintaining good health. The more clients are involved in
choosingtheirhealthservices,the longerthey are likelyto sustaintheirhealthybehavior. Therefore
informed decision-making is an essential part of quality health care services.
All SQH providers must explain about health products and services before they are received and
clients should understand the services and get involved in decision-making.
SQH providers explain about the health products and services
SQH providers should encourage clients to clarify any queries during the discussion
SQH providers should be non-judgmental
SQH providers should guide clients to get right decision
Indicator: The client gives informed consent to receive health services he/she needs.
SDS 11: The SQH provider respects a client’s right for privacy and dignity.
Privacy and dignity is a priority for rapport and trust building between SQH providers and
clients.“Privacyisfreedom from intrusion; this refers to all information and practice that is personal
or sensitive to the individual. Dignity is being worthy of respect.”
Thisappliestoall clientsirrespectiveof age,ethnicity,andgender,social,cultural,psychological and
physical needs.
All SQH providersensure thattheirclientsare treatedwithprivacyanddignityall the time.All clients
have the right to remain autonomous and independent whenever possible.
Indicator: The client is treated with privacy and dignity for health services he/she receives.
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SDS 12: The SQH provider respects a client’s right to receive health services which meet
PSI/M minimum clinical standards.
Indicator:SQH providerprovideshealthservices to the clients according to PSI/Mminimum clinical
standards.
RH
(i) Clinical standards of birth spacing
Standard 1: Performgeneral BScounselingincluding HTSP and method specific counseling to all BS
clients (see SDS 9: RH – birth spacing)
Standard 2: Performrelevanthistorytakingandphysical examinationtoassessmedical eligibility of
the client for a chosen method
Standard 3: Provide appropriate BSmethodin accordance with the client’s eligibility and informed
choice
Standard 4: Perform infection prevention procedure according to the method provided
Standard 5: Make schedule with a BS client for follow up visits
Standard 6: Manage common side effects of BS methods properly during follow up visits
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(ii) Clinical standards of cervical cancer prevention
Standard 1: Offer cervical cancer screening to women aged between 25 and 45 years
Standard 2: Explain risk of cervical cancer, screening procedure (VIA) and management
(cryotherapy) to the clients (see SDS 9: RH – CCP) – Counseling 1
Standard 3: Perform relevant history taking and physical examination
Standard 4: Perform VIA according to PSI/M’s service delivery protocol
Standard 5: Interpret VIA results correctly and explain VIA results to the client
Standard 6: Offer cryotherapy to VIA + clients according to the eligibility criteria for cryotherapy
Standard 7: Explain cryotherapy procedure and common side effects of cryotherapy –Counseling 2
Standard 8: Obtain and Record the client’s consent to perform cryotherapy
Standard 9: Perform infection prevention procedure including instrument processing according to
PSI/M’s service delivery protocol
Standard 10: Perform cryotherapy according to PSI/M’s service delivery protocol
Standard 11: Schedule follow-up visits for all clients according to VIA result
Standard 12: Manage common side effects of post cryotherapy clients during follow up visits
Standard 13: Refersuspectedcervical cancercases,VIA +clientswhoare not eligible forcryotherapy
and those with post cryotherapy side effects beyond the providers’ ability to manage using PSI/M
referral directory
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STI
Clinical standards of STI
Standard 1: Perform relevant history taking including sexual history
Standard 2: Perform physical examination based on presenting symptoms after taking the client’s
consent
Standard 3: Use PSI/Mstandard flowchart for the management of common STD syndromes
Standard 4: Prescribe appropriate drugs including Cure U kits according to the syndrome
Standard 5: Explain how to take the drugs
Standard 6: Explain why the client should avoid sex without condom and how to use correctly and
consistently
Standard 7: Explain why STI client should receive HIV counseling and testing, and where it is
available.
Standard 8: Explainimportance of partnerreferral andgive partnerreferral cardtorefer all partners
to the clinic
Standard 9: Agree a schedule for follow-up visits
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HIV
(i) Clinical standards of PITC
Standard 1: Offer HIV testing to all defined eligible clients
Standard 2: Give pre test information (see SDS 9: HIV – PITC)
Standard 3: Obtain the client’s consent after giving pre test information
Standard 4: Perform serial HIV testing according to PSI/M’s testing flow chart
Standard 5: Conduct post test counseling according to HIV test result
(ii) Clinical standards of ART
Standard 1: Confirm HIV status
Standard 2: Perform staging of an HIV infected client according to WHO guidelines
Standard 3: Decide when to start according to WHO guidelines
Standard 4: Provide appropriate treatment of opportunistic infections before starting ART
Standard 5: Conduct adherence counseling before starting ART
Standard 6: Provide correct regimen according to PSI/M’s ART protocol
Standard 7: Monitor ART client closely for acute side effects and IRS during first 3 months and
manage according to the protocol
Standard 8: Give adherence counseling during follow up visits as required
Standard 9: Schedule follow-up visits
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TB
Clinical standards of TB
Standard 1: Performrelevantlaboratoryinvestigationtoconfirmdiagnosisforall suspectedTBcases
Standard 2: Categorize correctly for the treatment after confirmation
Standard 3: Conduct adherence counselingtothe patientandDOT observertogetherbefore starting
treatment
Standard 4: Provide correct treatment regimen according to the category
Standard 5: Weighthe patientinitiallyandduringfollow upfordosage and monitoring of treatment
response
Standard 6: Perform recheck sputum for all patients according to NTP guidelines
Standard 7: Take action for all treatment interrupted cases and report timely
Standard 8: In case of treatment failure, make sure by sputum results of defined month of each
category according to NTP guidelines
Standard 9: Fill treatment record card correctly and timely
Standard 10: Provide co-trimoxazole prophylaxis to all TB-HIV co-infected cases
Standard 11: Give contact tracing card to all TB patients for referral
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Malaria
Clinical standards of Malaria
Standard 1: Take relevanthistoryincluding previous anti malaria drug history and conduct relevant
physical examination.
Standard 2: Perform rapid diagnostic test kits to all suspected malaria cases
Standard 3: Refer highly suspicious of malaria cases with RDT negative result to higher health
facilities for additional diagnostic procedure (Blood for MP)
Standard 4: Look for and examine servere signs of malaria for life saving management and urgent
referral
Standard 5: Weigh the patient if necessary
Standard 6: Exclude pregnancybefore givingtreatmentif the patientisawomanof reproductive age
Standard 7: Provide treatment according to the guidelines
Standard 8: Explain how to take the drugs to the patient or caretaker
Standard 9: Explainhowto preventmalaria(sleepunderITN,use repellants,and wear long sleeves,
trousers)
Standard 10: Schedule follow-up visit
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Pneumonia
Clinical standards of pneumonia for under 5 children
Standard 1: Take relevant history considering other differential diagnosis
Standard 2: Perform physical examination for diagnosis according to the guidelines
Standard 3: Use service guideline chart and dosage chart for diagnosis and management including
referral of childhood pneumonia
Standard 4: Look for and examine chest indrawing and danger signs of pneumonia for life saving
management and referral
Standard 5: Take respiratory rate for one minute using timer
Standard 6: Provide correct treatment according to the guidelines
Standard 7: Give instruction for the treatment (how to prepare the drugs, interval and duration of
the treatment) and home care to the care taker
Standard 8: Schedule follow-up visit
