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