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Partnership Defined Quality: an Overview

Partnership Defined Quality: an Overview November 18, 2009 Beth Outterson, Director, Adolescent Health Save the Children. By The End of this session, participants will be able to:. Describe the PDQ methodology Know when and how PDQ can be used to strengthen quality and access to services

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Partnership Defined Quality: an Overview

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  1. Partnership Defined Quality: an Overview November 18, 2009Beth Outterson, Director, Adolescent Health Save the Children

  2. By The End of this session, participants will be able to: • Describe the PDQ methodology • Know when and how PDQ can be used to strengthen quality and access to services • Know how to plan and design a program that incorporates the PDQ methodology • Be familiar with lessons learned from PDQ projects • Know how to evaluate the PDQ process and its outcomes

  3. Partnership Defined Quality Partnership Defined Quality

  4. Ancient Chinese Proverb “Go in search of Your People Love them, learn from them Plan with them, serve them; Begin with what they have; Build on what they know. But of the best leaders, When their task is accomplished, Their work is done, The People all remark: ‘We have done it ourselves’” Lao Tzu

  5. What is PDQ? A methodology to improve quality and accessibility of services with greater involvement of the community in defining, implementing and monitoring the quality improvement process.

  6. How is it different from other quality improvement methods? • There is an actual partnership between users and nonusers of the community AND health care providers. • This collaboration promotes improved communication and empowerment for problem solving using locally available resources

  7. When use PDQ? When use PDQ? • When action is needed not just information. • When both providers and community want change. • When there is a willingness to be flexible.

  8. When? When Use PDQ? • When there is support from key stakeholders. • When there is enough time to properly implement process.

  9. Features of PDQ Features of PDQ • PDQ can be a complementary strategy to other QI. Usually embedded within larger projects • Creation of Quality Improvement Teams (QITs) • Emphasis on mutual responsibility for problem identification and problem solving

  10. Value Added of PDQ Value Added of PDQ Beyond Quality Improvement… • Helps eliminate social and cultural barriers to better health • Strengthens community’s capacity to improve health • Creates mechanism for rapid mobilization around health priorities

  11. PDQ Process BUILDING SUPPORT COMMUNITY DEFINED QUALITY HEALTH WORKER DEFINED QUALITY BRIDGING THE GAP WORKING IN PARTNERSHIP FOR QUALITY IMPROVEMENT Increase communities’ sense of ownership of health facility Increase community capacity for social change Improve provider job satisfaction Shared rights and responsibilities for better health outcomes Improve client satisfaction Better Health

  12. Pre-program: Planning and Design Pre-phase: Planning and Design • Make sure you have willingness of stakeholders • Need adequate dedicated staff and volunteers • Need people with skills in facilitation, community mobilization, PRA techniques, focus group methodology, monitoring and evaluation

  13. Phase 1: Building Support Phase 1: Building Support Develop the support necessary to implement the PDQ process from the health system and the communities involved. • Meet with stakeholders and influentials • Need willingness by providers to make changes • Need management support of changes

  14. Phase 2: Exploring Quality • FGDs to explore perceptions of quality from service providers, those that use health services, and those that never or no longer use them (FGD for each subgroup) • Use market analogy to help define health “quality”

  15. CDQ –Community Defined Quality CDQ –Community Defined Quality • The “community” may vary • Explores quality from previous experience • Initiates rights discussion

  16. HDQ- Health Worker Defined Quality HDQ- Health Worker Defined Quality • Explores “what is in it for me” • Allows all levels of providers to have a voice

  17. Phase 3: Bridging the Gap Phase 3: Bridging the Gap Provides and understanding of the varying perspectives of quality and integrates those perspectives into a shared vision of quality. • Together groups hear each others views • Can validate what was presented • Establishes a QI Team

  18. Phase 4: Working in Partnership A quality improvement team comprised of providers and community determine causes, solutions and create a joint plan of action.

  19. PDQ in Peru: Puentes Examples: • PUENTES - Peru • PDQ – Nepal • PDQ – West Bank and Gaza

  20. PDQ in Action HDQ- Health Worker Defined Quality • Explores “what is in it for me” • Allows all levels of providers to have a voice 20

  21. The Problem Despite having a “quality” facility, community members were not utilizing services

  22. Innovating PDQ Innovating PDQ • Videos produced and shared among community members and health center personnel • Developed action plans together for improving quality • Jointly implemented & evaluated project activities

  23. Results Results • MOH and community members report increasing utilization of health services • Joint committees coordinate, monitor and document activities • Tangible results include: • expanded hours of service • additional resources (human and physical) • community participation in improving health centers

  24. Why PDQ for Nepal? Why PDQ for Nepal? • Centralized QI effort based on national standards had not reached peripheral facilities • Low utilization rates even after 6 years of health service strengthening • Need to reach the minority groups and other non-users of the Health Facilities • Despite training and QI efforts, improvements were not sustained at the local health posts

  25. Significant Results Significant Results • Increase in sick children seeking treatment • Increase in service utilization by adults • Increase in FP utilization • Increase in appropriate infection prevention • Increase in health worker presence • Increase in service utilization from lower caste children

  26. PDQ in West Bank and Gaza PDQ in West Bank and Gaza THE PROBLEM: Facilities were over service capacity, there was wasted resources and antibiotics were over prescribed.

  27. Results Results • Decrease in waiting time. • Greater client satisfaction with services • Lower use of antibiotics

  28. Challenges PDQ: Challenges • Time commitment from the participants • Maintaining political will • Gaining true community representation and participation at all levels • Keeping the process flexible to meet local needs • Replication and scaling up

  29. Lessons Learned PDQ: Lessons Learned • Does not require huge investment of additional resources when built into existing system improvement efforts • PDQ can be a catalyst for other initiatives • Dialogue often yields solutions – e.g. allows misconceptions to be clarified • Skilled and impartial facilitators are essential

  30. Partnership Defined Quality for Youth: a process manual for improving RH services through youth-provider collaboration

  31. How is PDQ-Y Different? Differences in PDQ-Y manual • Socio dramas and mapping instead of FGDs • PRA and Games • Stronger M and E components • More country level examples • Youth-Adult Partnership skill-building sessions included

  32. Next Steps for SC Next Steps for SC • Seeking funds for case-control studies to measure impact of PDQ and PDQ for youth • Measure community capacity with CC indicators now in M and E toolkit • Improve and populate documentation database • Build regional PDQ expertise

  33. How can PC and SC work together on PDQ and PDQ (Y)? • Ideas for discussion: • PC can link with existing SC PDQ implementation efforts; and consider new ones • PCVs can co-facilitate PDQ process, especially by monitoring QIT meetings, train QIT for improved function, and completion of action plans • PCVs can document, evaluate and disseminate

  34. Resources Resources • 11 PDQ Monographs • PDQ M and E Toolkit - December 2009 • PDQ Technical Advisory Group includes trainers and PDQ experts • Recent PDQ/PDQ-Y experience includes: • Bolivia (Y), Pakistan (MNCH), Kenya (AMREF), Indonesia, Philippines (SHN), Burkina Faso (Nutrition 2010), Guatemala (FP), Vietnam (MNCH), Armenia (MCH), Nepal (Y), Ethiopia (Y), Republic of Georgia (Y)

  35. Resources (cont’d) Resources (cont’d) • PDQ Manual: http://www.savethechildren.org/publications/programs/health/PDQ-Manual-Updated-Nigeria.pdf • PDQ for Youth Manual: http://www.savethechildren.org/publications/programs/health/PDQ-Y-Manual.pdf • PDQ Facilitator's Guide http://www.coregroup.org/diffusion/Save_PDQ_Facil_Guide.pdf

  36. THANK YOU!!

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