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Strengthening government primary reproductive
healthcare services through social franchising in
rural Viet Nam: the “tinh ...
Content


Country context: Vietnam



Government Social Franchise (GSF) Model



Effectiveness



Conclusions



Less...
Viet Nam


Population: 90 million people, 50% <
25 years old



Women of reproductive age:
55.6%~25 million; approx 1.8 ...
Vietnam health system:
key issues


Health Insurance Coverage: 68%



Private sector providing 60% outpatient visits; ou...
SRH service delivery system in
Viet Nam
National/central
Gyn/Obs hospitals
Provincial general or
Gyn/Obs hospitals

Provin...
Commune Health Stations (CHS)


Key point of primary care for
rural/remote communities



Limited investment - perceived...
Government Social Franchise
(GSF) Model

Franchisor:

Franchisees:

Department
of Health

Commune Health
Stations

Technic...
Implementation:
1.

Mapping/recruitment of CHS

2.

Needs assessment

3.

Brand and guideline development

4.

Training of...
Phases and scale-up
Phase

Provinces

Donor
Funded

DOH Funded
Scale Up

Total GSF
Established

Phase I Pilot

Khanh Hoa
D...
Service utilisation

Franchise membership associated with increased utilisation:


453% increase in total use, 393% incre...
Service quality improvement

Strengthening government primary reproductive healthcare services through social franchising ...
Provider and client satisfaction


Providers reported feeling “more confident in our abilities
to provide accurate diagno...
Sustainability


“The „tinh chi em‟ model has developed solutions to improving
the quality of services in the context of ...
Conclusions


Harnessing existing public health system infrastructure to
increase SRH service delivery is highly effectiv...
Lessons learnt & implications


Project monitoring and evaluation play an important role



Strong collaboration and loc...
Thank you!

To find out more about how we are addressing unmet need by reaching
the most underserved, please visit www.mar...
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Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam

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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

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Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam

  1. 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 SLIDE 1
  2. 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 SLIDE 2
  3. 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 SLIDE 3
  4. 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 SLIDE 4
  5. 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 SLIDE 5
  6. 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 SLIDE 6
  7. 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 SLIDE 7
  8. 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 SLIDE 8
  9. 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 SLIDE 9
  10. 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 SLIDE 10
  11. 11. Service quality improvement Strengthening government primary reproductive healthcare services through social franchising in rural Viet Nam: the “tinh chi em” (Sisterhood) model SLIDE 11
  12. 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 SLIDE 12
  13. 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 SLIDE 13
  14. 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 SLIDE 14
  15. 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 SLIDE 15
  16. 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 SLIDE 16

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