PRIME II

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PRIME II

• Consumer Driven Quality in the Dominican Republic

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10 Steps of DRCDQ Strategy

• Step 1 Stakeholder meetings held with ADOPLAFAM
  (NGO) definition of priorities and consumer
  target groups (consumers who can pay for
  services)
• Step 2 Meetings with community leaders in 5
  target areas
  

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10 Steps of DRCDQ (cont.)

• Step 3 Participatory Group Activities using COPE
  methodologies
  
• Community Representatives elected
• Step 4 Results of community activities presented
  to clinic
  
• Step 5 Clinic Action Plan (CAP) defined and
  presented to community reps
  

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10 Steps of DRCDQ (cont.)

• Step 6 Continued Meetings between clinic staff
  and Community to follow up on clinic action plan
  
• Decision to organize community talks with
  clinic doctors in target areas.
  
• Decision to train community representatives and
  promoters on how to document consumer opinion in
  tools designed by PRIME and ADOPLAFAM

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10 Steps of DRCDQ (cont.)

• Step 7 Community talks field testing tool to
  document consumer opinion
  
• Step 8 Community representatives trained to use
  quality of care interviews during home visits
  
• Step 9 Doctors and promoters share learned
  information with staff
  
• Step 10 IMPROVED QUALITY OF CARE!!

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WHO, WHAT, WHERE, AND WHEN OF THE EVALUATION
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WHO IS INVOLVED IN THE EVALUATION?

• Clinic staff
• Clinic community promoters
• Consumers

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How are we evaluating?

• Client exit interviews
• Clinical observations
• Promoter Observations
• Provider Interviews
• Focus Groups (February 2003)

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What are our process indicators?

• Number and type of services used by clients with
  coupons
  
• Number and type of services used by clients
  without coupons
  
• Number, sex, and age of clients seeking services
  at clinic
  
• Number of problems identified and solved by the
  clinic quality team
  
• Number of meetings held between community members
  and clinic staff

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BASELINE RESULTS

• In 32 client exit surveys
• 72 of clients interviewed were satisfied with
  the services they received
  
• 50 felt that the clinic offered the services
  they needed
  
• 97 felt they were able to talk without
  interruptions
  

• In 11 provider observations
• 40 of providers explained what would happen in
  the medical exam
  
• 20 of providers allowed the patient to talk
  without interrupting her
  
• 20 of providers asked what the motive of the
  patients visit was
  
• 12.5 of providers asked if the patient had any
  questions and to express her opinions

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BASELINE RESULTS

• In 49 promoter observations
• 2 registered their visit, the results of the
  visit, and made a follow-up plan
  
• 35 asked if the woman had been to the clinic
• 10 asked those who had been to the clinic what
  they thought of the clinic services
  

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Process Indicator Results to Date

• Clinic Action Plan Completed
• 8 meetings between clinic and community members
  at clinic to discuss importance of community
  input, discuss how community members want to give
  input to clinic, and review action plan
• 6 talks given on community requested topics by 4
  different clinic providers in community
  
• 27 Community promoters and representatives
  trained on needs and quality assessment
  interview
  

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Summary of CDQ/quality improvement action plan

• Need more privacy
• Television with education videos in waiting room
• More awareness building on clinic services
• Child immunization

• Clear signs identifying clinic
• Need for place to give birth/stay overnight
• Good treatment by staff
• Clean and hygienic environment

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Some preliminary Output indicators

• Increase in number of paying clients
• Income from paid services in the clinic have
  increased from 22,646 in January to 43,209 in
  August.
  
• In December of 2001, the ratio of paying clients
  to non-paying clients was 28/72 In August of
  2002, the ratio was 83/13.
  
• Increase in number of clients
• Between October-December 2001, 956 clients
  attended the clinic. By October-December 2002,
  this number increased to 1925.
  

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Output Indicators (cont.)

• Increase in number of services
• 2 more gynecologists (one female) added
• Addition of 3 full days of gynecology (at the
  baseline, the one gynecologist only worked two
  days a week)
  
• Addition of 3 hours of pediatric attention
• Addition of a cardiologist
• Addition of a 2 psychologists
• Addition of 6 hours of sonograms
• Addition of Radiology 5 days a week

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Next steps (project ends June 2003.)

• Continued field monitoring of the model for
  increasing community input, revise tool according
  to findings.
  
• Continue community talks by providers
• Continue meetings between community
  representatives and clinic staff.
  
• Promoters and representatives to continue testing
  tool
  
• Document changes in quality of care
• Video document process
• Final Evaluation-April 2003