Cambodia Quality Impr ove me nt at National L e ve l Pr of T - PowerPoint PPT Presentation

Cambodia – Quality Impr ove me nt at National L e ve l Pr of T hir Kr uy Se c r e tar y of State , Ministr y of He alth Royal Gove r nme nt of Cambodia

Cambodia – Countr y Pr ofile 2014 Popula tion (million) 15.4 Rura l popula tion (% ) 80 Popula tion a g e d 15- 61 60 ye a rs (% ) GDP ($ billion) 16.7 GDP g rowth (% ) 7.0 Infla tion (% ) 3.9

Cambodia – He alth Pr ofile 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 L ife e xpe c ta nc y a t birth (ye a rs) 72 T ota 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

He alth Outc ome s in Cambodia Ac hie ve me nts MDG 4 & 5 500 140 472 450 124 120 400 de a ths pe r 100,000 live births 100 350 95 ths 1,000 live bir 300 83 80 250 66 206 60 200 pe r 54 170 45 150 40 35 100 28 20 50 0 0 2000 2005 2010 2014 MMR IMR U5MR

He alth Se c tor Re for ms Re c tangular Str ate gy Soc io- E c onomic De ve lopme nt Pla n Na tiona l Stra te g ic De ve lopme nt Pla n He a lth He a lth He a lth Cove r a g e Str a te g ic Str a te g ic Pla n Pla n 1 Pla n 3 2002 – 2008 – 2016 – 1996 1997 2007 2015 2020 Ope r a tiona l He a lth g uide line s Str a te g ic Pla n 2

Quality – A Str ate gic F oc us “to pro vide ste wa rdship fo r the e ntire he alth se c to r “F urthe r e nha nc ing the quality o f he alth se rvic e s and to e nsure suppo rtive e nviro nme nt fo r inc re ase d thro ug h stre ng the ning c linic al te c hniq ue s and de mand and e q uitab le ac c e ss to quality he alth manag e me nt c apac ity o f physic ians, me dic al staff se rvic e s in o rde r that all the pe o ple o f Camb o dia are and he alth o ffic ials” ab le to ac hie ve the hig he st le ve l o f he alth and we ll- b e ing .”

Quality Impr ove me nt Roadmap National Quality Polic y 2005 QAO QIWG Six Str ate gie s Institutio nalizatio n o f quality He alth F ac ility Asse ssme nts (L 1 & L 2) CPA & MPA Guide line s Manage me nt Standar ds E nabling le gislation Clinic al Pr ac tic e Guide line s Clinic al Pr ac tic e Natio nal E xit E xaminatio n Pr o fe ssio nal de ve lo pme nt Manage me nt de ve lo pme nt He alth Pr ac titio ne r Re gulatio n Patie nt Char te r E mpo we r ing c usto me r s Clie nt Satisfac tio n Sur ve y

Quality of Car e - Polic y Re for ms Clie nt’s Qua lity Rig hts – Ong oing Improve m Provide r’s Ac c re dita Ong oing Use e nt Roa d Rig hts & tion of the L e ve l Ma p Dutie s Stra te g y 2 T ool 2011- 2014- 2006- 2010 2012 2007 2006 2007 2013 2015 De ve lopme Ma ste r Pla n De ve lopme n nt & use for Qua lity t of the L e ve l Improve me 2 T ool of L e ve l 1 nt in He a lth T ool

Quality Impr ove me nt – Supply- side inte r ve ntions

Institutionalization of quality L e ve l 1 Struc ture Asse ssme nt HMIS L e ve l 2 Outc ome Proc e ss Monitor ing Asse ssme nt

L e ve l 1 Asse ssme nt - Intr oduc tion

Sc or e of Re fe r r al Hospitals in L e ve l 1 asse ssme nts: 2007- pr e se nt 95% 100% 87% 92% 90% 72% e s 80% 67% Asse ssme nt Sc or 70% 63% 60% 60% 50% 40% 30% Ho spital Base line 30% 20% Ho spital Re -asse ssme nt (2nd) 10% Ho spital Re - assessment (≥3rd) 0% 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 Hospitals

L e ve l 2 Asse ssme nt - Intr oduc tion ► 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 nts - Sc or e by Se r vic e for e ac h Hospital

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

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

Pr ofe 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

National E xit E xamination 913 900 800 Numbe r of Gra dua te s 700 600 539 500 400 300 239 233 226 200 190 173 200 136 137 100 53 0 Me dic ine De ntistr y Phar mac y BSN 2013 2014 2015

Quality Impr ove me nt – De mand- side inte r ve ntions

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 ovide r s’ Rights- Dutie s Right to e quality, and to be fr e e fr o m all fo r ms o f Right and dutie s to ask and r e c e ive in-fo r matio n disc r iminatio n ac c o r ding to me dic al te c hnique s Right to info r matio n and he alth e duc atio n Rights and dutie s to pr o vide he alth c ar e and tr e atme nt Right to he alth c ar e and tr e atme nt Rights and dutie s in c o nfide ntiality Right to c o nfide ntiality Rights and dutie s to de c ide o n inte r ve ntio n Right to pr ivac y Right to c ho ic e and info r me d c o nse nt tic ipatio n Right to e xpr e ss o pinio n and to par

E mpowe r ing Custome r s Public Custo me r Car e Hospitals F ac ilitie s Co mmunic atio n Patie nts in past Pr ior ity Co st Na tiona l mo nth Impr ove me nts Clie nt Ac tion Plans Sa tisfa c tion Surve y Custo me r Car e He alth Ce nte rs F ac ilitie s Patie nts in past Co mmunic atio n mo nth Co st

E mpowe r ing Custome r s Na tiona l Clie nt Sa tisfa c tion Surve y Compone nt De sc r iption Re spo nde nt c o rre spo nds to ta rg e t g ro up Sc r e e ning & pr ofile a nd de mo g ra phic 1. Custome r c ar e Re spo nsive ne ss, pro c e ss o f c a re , re lia b ility 2. F ac ilitie s F a c ilitie s a nd a c c e ss 3. Communic ation E xpla na tio n, dia g no sis a nd pre ve ntio n 4. Cost 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

National Clie nt Satisfac tion Sur ve y - Re sults Satisfac tio n inde x by type o f he alth pr o vide r All Pr ovide r s He alth Ce nte r s Re fe r r al Hospitals National Hospitals Ove r all 97 81 76 97 Cost 93 71 74 89 Communic ation 93 92 94 95 F ac ilitie s 74 91 95 76 Custome r c ar e 79 94 98 80 T OT AL HC RH NH SAT ISF ACT ION Inde x 86 87 82 85

Quality Impr ove me nt – Challe nge s

Challe nge s  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

Quality Impr ove me nt – Oppor tunitie s

Oppor tunitie s  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

Quality Impr ove me nt – Ne xt Ste ps

Ne xt Ste ps  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  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.

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