Partnership Defined Quality_Beth Outterson_10.16.13

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  • PDA
  • This is a repeat of previous slide right column.PDQ is more than just conducting a client survey. The community is a participant and contributor in change.If you are trying to improve the quality of a certain population that the providers really do not want to serve then your first obstacle is getting the providers on board. They have no motivation to change their services to meet the needs of a population they do not wish to serve.PDQ let’s the providers and community create the action plans. You have to be willing to let them work on what they find important and not be too rigid with your predefined notion about what must change or be addressed first. You can focus on a particular type of service but often the issues are overriding and apply to many types of services.
  • Social Accountability operationalizes and affirms relationship between citizens and the state.-marginalized members address duty bearers. Empowering and inclusive.community takes ownership to improve health using existing resources. Solutions are sustainable. Client satisfaction and provider performance increase along with overall health status. Creates mechanism for rapid mobilization around health priorities
  • When we analyzed the existing approach for community involvement/community mobilization we found that community is not involved functionally in improving health services (action plans were mainly developed by health services implementing NGOs for community health counsels)
  • You can see here where are the parallels in perceptions of concern between community and providers.
  • The QITs had to be formed separately by gender which was a challenge
  • SC has used PDQ in over 15 countries but we have always used it as an add on to increase quality. But what we have seen is that the empowerment that takes place lasts well beyond the project. In Armenia, we went back 3 years after the project had ended and the QITs were still operating and solving new problems in their communities.We have just started using a PDQ M and E toolkit that monitors not only the accomplishments of the QIT teams and how many health improvements there are, but also looks at the functioning of the QIT itself in terms of specific indicators of community capacity including gender equity, participation of marginalized groups, community cohesion, using internal resources and
  • Partnership Defined Quality_Beth Outterson_10.16.13

    1. 1. Partnership Defined Quality: A Methodology to build Social Accountability Beth Outterson Reproductive Health Advisor October 16, 2013 PDQ: A Methodology to Build Social Accountability
    2. 2. Partnership Defined Quality (PDQ) • Improves quality and accessibility of services with greater involvement of the community in defining, implementing and monitoring the QI process. • Providers and community members (both users and non-users) work together to identify and address priority problems. • Recognition that quality may be defined from different perspectives (client/ provider) • Recognition that providers and clients can work together as allies to address problems – overcomes blame • Process for identifying problems separately, bringing providers and community members together, and establishing QI teams of providers and community members to address problems and continue to identify new ones in cyclical review. PDQ: A Methodology to Build Social Accountability
    3. 3. When to Use PDQ? • When action is needed -- not just information sharing • When stakeholders - both providers and community want change • When there is a willingness to listen and change how things are done locally PDQ: A Methodology to Build Social Accountability
    4. 4. How PDQ builds Social Accountability • Marginalized members address duty bearers • Community takes ownership to improve health using existing resources • Client satisfaction and provider performance increase along with overall health status • Creates mechanism for rapid mobilization around health priorities PDQ: A Methodology to Build Social Accountability
    5. 5. PDQ Process PDQ: A Methodology to Build Social Accountability
    6. 6. Country example – Afghanistan ACCESS /HSSP Project Context: • Low coverage for safe motherhood services: • ANC coverage (45%) • Deliveries by skilled birth attendant (19%) • Postnatal care (29%) Program goal • Increase access to safe motherhood services • Enhance quality of safe motherhood services Expected outcomes: • Increased coverage of ANC, SBA and PNC PDQ: A Methodology to Build Social Accountability
    7. 7. Preparation and Planning • Orientation sessions with provincial and district MoPH and NGO staff • Involved MoPH and NGO staff in the preparation and planning process • Community Mapping (identifying areas with low coverage) • Data analysis (HMIS) and discussions • Prepared agenda for community shuras (male and females) • Feedback on health indicators • Orientation on PDQ process and role of community shuras • Time/date for PDQ inquiry PDQ: A Methodology to Build Social Accountability
    8. 8. Phase 1 – Building Support • Two day workshop with community shuras (religious leaders, teachers, communityrepresentatives): • Feedback on health indicators • Community Mapping (re-confirming areas with low coverage) • Discussions – access problems • Orientation on PDQ process – role of community shuras • Developing PDQ inquiry checklist • Setting time and dates for PDQ inquiry PDQ: A Methodology to Build Social Accountability
    9. 9. Phase 2 – Exploring Quality Exploring quality (Community) • Checklist developed in consultation with community shura (male and female) • Women using health services • Women not using health services • Caregivers • Family members Exploring quality (Health workers) • FFSDP conducted • Staff interviews • FGDs (PDQ inquiry) PDQ: A Methodology to Build Social Accountability
    10. 10. Phase 3 – Bridging the Gap • Involved MoPH and NGO staff in the preparation and planning of bridging the gap workshop • One day in advance notification (male and female sessions separate; same agenda) • Participants: • Community shuras (male and female) • Health facility staff • Selected caregivers or clients • Both health facility staff and community presented their point of view to each other (categorized information) • Developed shared vision by using Venn diagram • Problems are identified and prioritized • Root causes identified (problem tree analysis) PDQ: A Methodology to Build Social Accountability
    11. 11. PDQ: A Methodology to Build Social Accountability
    12. 12. Phase 4 – Working in Partnership • Quality Improvement Team developed • Members from existing community shura • Health Facility staff • Selected caregivers/clients • Village administrators • 6-8 members PDQ: A Methodology to Build Social Accountability
    13. 13. Example of action plan PDQ: A Methodology to Build Social Accountability
    14. 14. Accomplishments • ANC coverage increased • 45% in 2004 to 62% in 2006 • Deliveries by SBA increased • 19% in 2004 to 25% in 2006 • PNC increased • 29% in 2004 to 41% in 2006 • DPT3 vaccination coverage increased • 43% in 2005 to 77% 2006 • Community participation – meaningful; sustainable • PDQ recognized as national quality assurance standard • ACCESS/HSSP project • Scaled up to 13 provinces PDQ: A Methodology to Build Social Accountability
    15. 15. Measuring community capacity • Measurement tools: • Exit interviews: client satisfaction • Supervisory checklist for QIT Function (rotational leadership, gender equity, inclusion, joint decision making) • Findings: • PDQ communities vs non PDQ communities: > improved provider performance (Pakistan, Nepal, Armenia) • Empowerment: sustainability, QITs (return visits) • Sense of pride, ownership of health center was expanded to other aspects of community life PDQ: A Methodology to Build Social Accountability
    16. 16. Challenges • Working with the least advantaged—the poor • Frequent postings and transfers of health center staff • Time consuming process PDQ: A Methodology to Build Social Accountability
    17. 17. Resources PDQ Manual PDQ for Youth Manual PDQ Facilitator's Guide PDQ M&E Toolkit 11 PDQ Monographs Please contact Beth Outterson at boutterson@savechildren.org PDQ: A Methodology to Build Social Accountability

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