SLIDE 1 Cambodia – Quality Impr
e ve l
Pr
hir Kr uy Se c r e tar y of State , Ministr y of He alth Royal Gove r nme nt of Cambodia
SLIDE 2 Cambodia – Countr y Pr
2014
Popula tion (million) 15.4 Rura l popula tion (% ) 80 Popula tion a g e d 15- 60 ye a rs (% ) 61 GDP ($ billion) 16.7 GDP g rowth (% ) 7.0 Infla tion (% ) 3.9
SLIDE 3
SLIDE 4 Cambodia – He alth Pr
L ife e xpe c ta nc y a t birth (ye a rs) 72 T
- ta l fe rtility ra te (pe r woma n)
2.9 Numbe r of live births (thousa nds) 388.8 Numbe r of de a ths (thousa nds) 86 Public He a lth F a c ility T ype He a lth Posts 106 He a lth Ce nte r 1105 Re fe rra l Hospita ls 97 Na tiona l Hospita l 8
SLIDE 5 He alth Outc ome s in Cambodia
472 206 170 95 66 45 28 124 83 54 35
20 40 60 80 100 120 140 50 100 150 200 250 300 350 400 450 500 2000 2005 2010 2014
pe r 1,000 live bir ths
de a ths pe r 100,000 live births
Ac hie ve me nts MDG 4 & 5
MMR IMR U5MR
SLIDE 6 He alth Se c tor Re for ms
He a lth Cove r a g e Pla n Ope r a tiona l g uide line s He a lth Str a te g ic Pla n 1 He a lth Str a te g ic Pla n 2 He a lth Str a te g ic Pla n 3
Soc io- E c onomic De ve lopme nt Pla n Na tiona l Stra te g ic De ve lopme nt Pla n
Re c tangular Str ate gy
1996 1997
2002 – 2007 2008 – 2015 2016 – 2020
SLIDE 7 Quality – A Str ate gic F
“F urthe r e nha nc ing the quality o f he alth se rvic e s thro ug h stre ng the ning c linic al te c hniq ue s and manag e me nt c apac ity o f physic ians, me dic al staff and he alth o ffic ials” “to pro vide ste wa rdship fo r the e ntire he alth se c to r and to e nsure suppo rtive e nviro nme nt fo r inc re ase d de mand and e q uitab le ac c e ss to quality he alth se rvic e s in o rde r that all the pe o ple o f Camb o dia are ab le to ac hie ve the hig he st le ve l o f he alth and we ll- b e ing .”
SLIDE 8 Quality Impr
National Quality Polic y 2005
Six Str ate gie s E mpo we r ing c usto me r s Clinic al Pr ac tic e Pr
- fe ssio nal de ve lo pme nt
Manage me nt de ve lo pme nt Institutio nalizatio n o f quality He alth F ac ility Asse ssme nts (L 1 & L 2) Patie nt Char te r Manage me nt Standar ds Natio nal E xit E xaminatio n QAO QIWG Clie nt Satisfac tio n Sur ve y CPA & MPA Guide line s Clinic al Pr ac tic e Guide line s He alth Pr ac titio ne r Re gulatio n E nabling le gislation
SLIDE 9 Quality of Car e - Polic y Re for ms
Qua lity Improve m e nt Roa d Ma p De ve lopme nt & use
e ve l 1 T
Clie nt’s Rig hts – Provide r’s Rig hts & Dutie s Ma ste r Pla n for Qua lity Improve me nt in He a lth Ong oing Ac c re dita tion Stra te g y De ve lopme n t of the L e ve l 2 T
Ong oing Use
e ve l 2 T
2006 2006- 2007 2007 2010 2012 2011- 2013 2014- 2015
SLIDE 10 Quality Impr
Supply- side inte r ve ntions
SLIDE 11
Institutionalization of quality
Struc ture Proc e ss Outc ome
L e ve l 1 Asse ssme nt L e ve l 2 Asse ssme nt HMIS Monitor ing
SLIDE 12 L e ve l 1 Asse ssme nt - Intr
SLIDE 13 30% 63% 67% 87%
60% 92% 72% 95%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46
Asse ssme nt Sc or e s
Hospitals
Sc or e of Re fe r r al Hospitals in L e ve l 1 asse ssme nts: 2007- pr e se nt
Ho spital Base line Ho spital Re -asse ssme nt (2nd) Ho spital Re -assessment (≥3rd)
SLIDE 14 ► Stro ng fo c us o n the pro c e ss o f c a re ► Sta nda rds c o me fro m CPGs a nd pa ne ls o f e xpe rts ► Da ta is c o lle c te d thro ug h:
► Dire c t Ob se rva tio n - Pa tie nt-Pro vide r inte ra c tio n/ b e ha vio r a nd
Wa rds a nd F a c ilitie s
► Re c o rds/ Do ssie r Re vie w ► Clinic a l vig ne tte s
L e ve l 2 Asse ssme nt - Intr
SLIDE 15
L e ve l 2 Asse ssme nts - Sc or e by Se r vic e for e ac h Hospital
SLIDE 16
L e ve l 2 Asse ssme nts - Sc or e by Se r vic e for e ac h He alth Ce nte r
SLIDE 17
L e ve l 1 & 2 Asse ssme nts
F e e dba c k
► De sig ne d to pro vide sc o re a t e nd o f a sse ssme nt fo r e a c h
he a lth fa c ility
► He a lth fa c ility suppo se d to de sig n q ua lity impro ve me nt
a c tivitie s o ve rse e n b y Ope ra tio na l Distric t a nd/ o r Qua lity Assura nc e Offic e
F uture Pla ns
► Co ntinue to mo nito r he a lth fa c ilitie s with lo w sc o re s ► Co mb ine the L
e ve l 1 & 2 a sse ssme nts to ha ve a c o mb ine d a sse ssme nt pro c e ss
SLIDE 18 Pr
- fe ssional de ve lopme nt
Na tiona l E xit E xa mina tion
Ob je c tive - to e nsure g ra dua te s ha ve re q uire d skills a nd c o mpe te nc e
to pra c tic e sa fe ly
Co nsists o f two c o mpo ne nts
Multiple Cho ic e Que stio ns (MCQs) Ob je c tive Struc ture d Clinic a l E
xa mina tio n (OSCE ) Curre ntly c o ve rs me dic a l do c to rs, de ntists, pha rma c ists a nd BSc
nurse s.
Pla ns to e xpa nd to o the r disc ipline s inc luding midwife ry a nd la b o ra to ry
sc ie nc e fro m ne xt ye a r
SLIDE 19 53 233 539 239 136 226 190 913 137 200 173
100 200 300 400 500 600 700 800 900
Me dic ine De ntistr y Phar mac y BSN
Numbe r of Gra dua te s
2013 2014 2015
National E xit E xamination
SLIDE 20 Quality Impr
De mand- side inte r ve ntions
SLIDE 21 E mpowe r ing Custome r s
Ca mbodia n Cha rte r on Clie nts’ Rig hts a nd Provide rs’ Rig hts- Dutie s
Clie nts’ Rights Pr
s’ Rights- Dutie s
Right to e quality, and to be fr e e fr
ms o f disc r iminatio n Right to info r matio n and he alth e duc atio n Right to he alth c ar e and tr e atme nt Right to c o nfide ntiality Right to pr ivac y Right to c ho ic e and info r me d c o nse nt Right to e xpr e ss o pinio n and to par tic ipatio n Right and dutie s to ask and r e c e ive in-fo r matio n ac c o r ding to me dic al te c hnique s Rights and dutie s to pr
e and tr e atme nt Rights and dutie s in c o nfide ntiality Rights and dutie s to de c ide o n inte r ve ntio n
SLIDE 22 E mpowe r ing Custome r s
Na tiona l Clie nt Sa tisfa c tion Surve y
Public Hospitals
Patie nts in past mo nth
Custo me r Car e F ac ilitie s Co mmunic atio n Co st
He alth Ce nte rs
Patie nts in past mo nth
Custo me r Car e F ac ilitie s Co mmunic atio n Co st
Pr ior ity Impr
Ac tion Plans
SLIDE 23 E mpowe r ing Custome r s
Compone nt De sc r iption Sc r e e ning & pr
Re spo nde nt c o rre spo nds to ta rg e t g ro up a nd de mo g ra phic
c ar e
Re spo nsive ne ss, pro c e ss o f c a re , re lia b ility
ac ilitie s
F a c ilitie s a nd a c c e ss
E xpla na tio n, dia g no sis a nd pre ve ntio n
Pa yme nt pro c e dure s a nd c o st
E xpe c tations
Ove ra ll sa tisfa c tio n a nd re c o mme nda tio ns
Issue s & sugge stions
Spo nta ne o us re a c tio ns
Na tiona l Clie nt Sa tisfa c tion Surve y
SLIDE 24 National Clie nt Satisfac tion Sur ve y - Re sults
Satisfac tio n inde x by type o f he alth pr
79 74 93 93 97
Custome r c ar e F ac ilitie s Communic ation Cost Ove r all
98 95 94 74 81 94 91 92 71 76
80 76 95 89 97
All Pr
s He alth Ce nte r s Re fe r r al Hospitals National Hospitals
SAT ISF ACT ION Inde x
T OT AL HC RH NH 86 87 82 85
SLIDE 25 Quality Impr
Challe nge s
SLIDE 26
Ac kno wle dg e me nt o f the pro b le m Unre g ula te d priva te se c to r L
a c k o f a lig nme nt – q ua lity impro ve me nt e ffo rts
Re so urc e de ma nds Susta ina b ility o f inte rve ntio ns I
nc e ntive s to c ha ng e b e ha vio r
Co nsume r a wa re ne ss
Challe nge s
SLIDE 27 Quality Impr
Oppor tunitie s
SLIDE 28
Po litic a l c o mmitme nt Ne w initia tive s I
nfo rma tio n – na tio n-wide a sse ssme nt
E
c o no mic g ro wth
ASE
AN I nte g ra tio n
Priva te Se c to r Do no r inte re st
Oppor tunitie s
SLIDE 29 Quality Impr
Ne xt Ste ps
SLIDE 30
Advo c a te fo r g re a te r re so urc e c o mmitme nt to wa rd
q ua lity impro ve me nt;
Stre ng the n e nfo rc e me nt o f re g ula to ry a nd le g isla tive
fra me wo rk;
I
nstitutio na lize q ua lity impro ve me nt me a sure s in pub lic pro g ra ms;
I
nc e ntivize q ua lity impro ve me nt;
Ne xt Ste ps
SLIDE 31
Ne xt Ste ps
I
de ntify c o re se ts o f q ua lity me a sure s fo r sta nda rdize d re po rting b y a ll se c to rs o f he a lth c a re ;
E
sta b lish a n a g e nda fo r re se a rc h a nd de ve lo pme nt ne e d e d to a dva nc e q ua lity me a sure me nt a nd re po rting ;
E
nsure info rma tio n o n he a lth c a re q ua lity is wide ly a va ila b le in the pub lic do ma in;
Ra ise c o mmunity a wa re ne ss a nd de ma nd fo r q ua lity se rvic e s.
SLIDE 32
T hank You
