Improving Health Centers

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Improving Health Centers Outreach Activities

• Kampot Province
• Applied Health Research by the Kampot PHD

2
Context

• Capacity building support to Kampot PHD
• Training
• Coaching
• Skills development
• Particular interest on improving problem
  identification and developing innovative solutions

3
Context

• Create a pool of researchers within the Kampot
  PHD to conduct applied health research when needs
  arise.
• GTZ-Kampot PHD-Racha-NIPH discussion came up with
  a research topic
• Look into the performance of outreach activities
  provided by the HC staff in Kampot.

4
Rationale

• 1997 MOH Guidelines for Operational Districts
• 2001 MOH Guidelines for Outreach Services from
  Health Centers
• Health Sector Strategic Plan 2003-2007

5
Rationale

• Per diems and transport allowance given
• 3 6 months after the actual conduct
• More often reduced amount
• Leaves the HC staff to
• shoulder expenses
• or not to conduct it but reporting anyway

6
Rationale

• Poor performance of outreach services recognized
• Triggers discussion between PHD and NGOs whether
  this is due to non-timeliness of per diem
• Proposal from Racha and later GTZ to support
  initial funding of OA to most HCs

7
?

• is it really the timeliness of per diem?
• what other factors contribute to OA performance?

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Problem Diagram
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Research Objectives

• to assess the performance of the OA in selected
  health centers
• to identify constraints and other contextual
  factors affecting OA performance
• to provide feedback and recommendations to the
  PHD/OD to improve performance of OA
• To build capacity of the PHD team in conducting
  qualitative research
• To establish and promote links between NIPH and
  the provinces

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Research Questions

• How do the HC staff perceive outreach
  activities? How does a properly performed
  outreach activity look like?
• What are the constraints/barriers faced by the
  HC staff providing outreach activities?
• What are the environmental factors affecting the
  provision of outreach activities in the village?

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Research Questions

• How does the community perceive the provision of
  health services in the village?
• What are the existing community-based mechanisms
  supporting health outreach activities?
• How far are the poor reached by outreach
  activities of the HC staff?

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Research Questions

• What measures or remedies should be undertaken
  to improve the quality and quantity of outreach
  activities?
• Does payment of per diem on time lead to better
  quality or more outreach activities?

13
Methodology

• Study design
• descriptive to provide a clear picture of the
  functioning of outreach activities,
• comparative and quasi-experimental intervention
  between HCs receiving per diem on time (cases)
  and HCs receiving delayed per diems (control)

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Methodology

• Phases of the Research
• baseline captures present situation
• intervention timely per diem will be given to
  the HCs except the control HCs
• evaluation assess outcome of the intervention
  and identify/measure changes

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Methodology
COMMUNITY RELATED FACTORS
PROVIDER RELATED FACTORS
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Methodology
COMMUNITY RELATED FACTORS
PROVIDER RELATED FACTORS
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Methodology
COMMUNITY RELATED FACTORS
PROVIDER RELATED FACTORS
18
Methodology

• Sampling and Study Population
• nine health centers
• selection is based on
• Categorization used in the Reward and Sanction
  Mechanism for Health Centers

Note that HCs in Angkorchey OD are excluded.
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Methodology

• Sampling and Study Population
• 3 villages in each HCs
• selection is based on
• Identification of the participating researchers
  and OD chief
• With criteria to be developed and generally
  agreed by all

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Methodology
21
Research Team

• Steering Committee 3 PHDs, PHD EPI Chief, PHA,
  1 NIPH consultant, Racha Provincial
  Coordinator (tent.)
• Researchers 2 in each OD (M/F), 2 PHD (M/F), 2
  GTZ staff
• Research Groups 2-3 Kampot researchers and 1
  NIPH researcher per OD

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Limitation of the Study

• PHD/OD staff new to research
• internal researchers
• OD supervisor HC staff relationship
• other unforeseen changes/improvement in other
  factors

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How to minimize limitation?

• Training will be conducted on how to do research
• OD researchers will not work in their own OD
  e.g., Researchers from Kampot will work in Chhouk
  OD.
• Will only choose researchers who are willing to
  participate and learn new ideas

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Ethical Issues

• are results to reflect the real situation?

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Proposed Budget
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Thank you for your kind attention!
OA Steering Committee