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Impact Evaluation of the Sun Quality Health Franchise in Myanmar Principle Investigators:

Impact Evaluation of the Sun Quality Health Franchise in Myanmar Principle Investigators: Dr. Kathryn O’Connell Dr. Tin Aung Population Services International Dr. Dale Huntington Multi-Site Franchise Study Meeting Center for Global Development November 20, 2008.

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Impact Evaluation of the Sun Quality Health Franchise in Myanmar Principle Investigators:

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  1. Impact Evaluation of the Sun Quality Health Franchise in Myanmar Principle Investigators: Dr. Kathryn O’Connell Dr. Tin Aung Population Services International Dr. Dale Huntington Multi-Site Franchise Study Meeting Center for Global Development November 20, 2008 05_XXX_MM1

  2. Sun Quality Health Franchise • SQH launched in 2001, now active in 145 townships across 13 states of Myanmar • Recruits approximately 120 providers per year in batches of about 20 who participate in a three-day induction training. • A total of 914 providers have participated in the induction training and 828 remain active in 2008. • GPs who provide an entire range of primary care services; in addition, some provide maternity care, minor surgery and other specialized services, depending upon their qualifications 05_XXX_MM2

  3. Sun Quality Health Franchise 05_XXX_MM3

  4. SQH Impact Evaluation Study Research Questions Client: • How has the Sun Quality Health franchise affected health care seeking behaviours of clients (bringing new clients in or shifting sources of care)? • How responsive is the Sun Quality Health franchise to client expectations? • Does the Sun Quality Health franchise reach poor and vulnerable populations (address PSI/Myanmar mission)? Provider: • What are the subjective incentives for providers to join and remain members of Sun Quality Health franchise? • How does joining the Sun Quality Health franchise affect the volume, composition of services and revenue of the members’ medical practice? 05_XXX_MM4

  5. SQH Impact Evaluation Study Design Three main elements: • Formative research • Uncontrolled observational study of clients and providers • Prospective cohort study of the SQH providers' practice characteristics. 05_XXX_MM5

  6. Formative Research • Attitudinal determinants of the behaviours of interest are elicited from the target populations using qualitative research methods • Focus Group Discussions, In-depth interviews with SQH clients and provider members • Collect expressions from: • Clients: service delivery responsiveness and patient satisfaction • Providers: non-monetary incentives to join and remain members of SQH • Results will be used to generate multi-items scale scores using psychometric measurement techniques 05_XXX_MM6

  7. Facility Based Uncontrolled Observational study • Two subjects / sources of data: • Clients who are using SQH supported services and any other RH related services (e.g., maternal care, gynecology, SRH related counseling, post-abortion) • Providers who are members of the SQH franchise. • Total of 220 SQH facilities will be randomly selected using probability proportionate to size (PPS) of average monthly reproductive health case load. • Exit interviews with 5 RH clients per clinic, and one or more providers per clinic (total 1,100 RH clients, approximately 240 providers) • Service statistics from the sampled clinics for trends in the RH service case load 05_XXX_MM7

  8. Prospective Cohort Study of Practice Characteristics Three different cohorts of providers followed for 2 years: • All newly enrolled SQH providers in the year of the study launch • 134 providers who have been SQH members for 2 years and are still actively providing RH services (random selection) • 130 SQH providers who have been members for 4 years and are still active (random selection) • Each provider will be requested to complete a specially adapted MIS form at the time of their induction training: • Monthly case load by reason for visit • Monthly revenue generated / gross income 05_XXX_MM8

  9. SQH Impact Evaluation Study: Implementation Update • Multiple scientific and ethical reviews February - July 2008 • Local IRB created by PSI / Myanmar • Study launched September 2008 • 3 year study duration: • Year 1: Launch prospective cohort study of providers, conduct formative research (early 2009), develop study instruments including pretesting, organize for survey field work • Year 2: Conduct facility based study, report on results • Year 3: Conclude prospective cohort, report on results 05_XXX_MM9

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