Poster Reference Number : PO1302

1. Phuong H. Nguyen1, Sunny S. Kim2, Sarah C. Keithly3, Nemat Hajeebhoy4, Lan M. Tran5,Marie T. Ruel6, Rahul Rawat7, Purnima Menon81International Food Policy Research Institute (IFPRI), Hanoi, Vietnam; 2IFPRI, New Delhi, India; 3Institute of Social and Medical Studies, Hanoi, Vietnam; 4IFPRI, Washington, DC, USA;,5FHI 360, Hanoi, Vietnam Methods Background and Objectives Data from a process evaluation were used. A&T-supported facilities (A&T-F, n=20) were compared to standard facilities (SF, n=12). Program impact pathways (PIPs) were mapped to describe a detailed pathway from the various program inputs to the intended program impacts on IYCF practices and nutrition. Data collection included: facility assessments (n=32), provider surveys (n=96), counseling observations (n=137), client exit interviews (n=137), in-depth interviews with mothers (n=48). Donadedian’s conceptual framework was applied to assess 3 components of service quality: structure, process, and outcome. Evidence indicates that social franchising improves the quality of health services in developing countries, but this approach has not been tested for nutrition services. Under the Alive & Thrive (A&T) initiative, elements of social franchising, particularly standardized and branded services for infant and young child feeding (IYCF) counseling, were introduced in 800 government-owned health centers as the first step towards establishing a social franchise service. This study assessed the role of the A&T interventions in shaping the quality of the counseling facilities and services. Incorporating elements of social franchising in government health services improves the quality of infant and young child feeding counseling services at commune health centers in Vietnam Results Table 2: Process attributes of A&T facilities and standard facilities Figure 1: Conceptual framework for assessing quality of care *p<0.05, **p<0.01, ***p<0.001 Compared to SF, the quality of service provision was higher in A&T-F where providers were slightly more knowledgeable about optimal IYCF practices, demonstrated superior communication skills, and conducted more comprehensive counseling sessions. Figure 2. Interpersonal communication skills of providers in A&T facilities and standard facilities Table 1: Structural attributes of A&T-supported facilities and standard facilities Compared to providers in SF, considerably larger proportions of those in A&T-F displayed strong communication skills for all indicators. Compared to providers in SF, considerably larger proportions of those in A&T-F displayed strong communication skills for all indicators. Table 3: Technical content of counseling sessions in A&T-supported facilities and standard facilities p<0.05, **p<0.01, ***p<0.001, A&T-F were more likely than SF to have an unshared, well-equipped room for nutrition counseling (65.0% vs. 10.0%). The availability of services and providers was comparable between A&T-F and SF. More A&T-F providers were trained in IYCF than SF providers (86.7% vs. 13.9%). The content of training was also more comprehensive (13.2 topics in A&T-F vs. 5.8 in SF). p<0.05, **p<0.01, ***p<0.001, Figure 3: Percentage of target populations in the commune that utilized services by duration of A&T-supported facility operation Compared to SF, BF counseling services delivered by A&T-F providers were significantly more informative and broader in scope. However, the difference in CF counseling was minimal and not significant. Table 4: Client satisfaction when receiving counseling from A&T-supported facilities and standard facilities Given the early stage of implementation, utilization was low overall, dropping from a satisfactory 48.9% among pregnant women in the commune to only 1.4% among mothers with infants 6-24 months. While client satisfaction did not differ by facility type, A&T-F was valued by users as a resource for information and problem solving on feeding issues. Conclusions: Incorporating elements of social franchising significantly enhances the quality of nutrition counseling services within government primary health facilities. This model has the potential to improve IYCF practices provided utilization of services increases substantially. Keywords: Social franchise, counseling, infant and young child feeding practices, quality of care, Vietnam Poster ReferenceNumber: PO1302