1. Assessment of the process and its effects on maternal and child health services Dr Nejoua BELKAAB Responsible for the Quality Unit Hospitals Direction and ambulatory cares-MH-Morocco Royaume du Maroc Ministère de la Santé The expert talk Eschborn 4th of December 2012

2. Processus de réalisation Processus support Processus de management Eléments d’entrée Elements of output How to assess the quality of health services? Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

3. INNOVATION AND LEARNING Leader-ship Staff Policy & Strategy Partnership and Resources Process F A C T O R S Results of Personnel Results of customers Community results Key Performan ce Results R E S U L T S Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

4. 1.Participants preparation 2.Self assessment 3. Analysis of self assessment 4.Audit +feedback 5. Participatif improvement plan 6.Result announcement and price rewards 7.Improvement support Hospital Health center Provincial health dept Maternity hospital

6.  Creation of a dynamic in the system.  Effect system,  Annual appointment of all professionals;  A step ahead in the process of governance: accountability, transparency and recognition of efforts;  It became a political instrument which can include the priorities of every strategy of the Ministry of Health;  Better performance after several editions. Better performance after several editions. Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

7. StrengthsChallenges  The responsible managers are informed on conduct of CQ, the evaluation criteria;  Awareness raising to reach highest numbers of different structures to join the process and to plan and implement changes according to the criteria of CQ;  Concrete actions to improve ;  Development of partnerships: Supporting representatives of the communities  No predetermined schedule that is shared with all structures / lots of hazards, unstable financing.....> difficulty of planning;  No circulation of information following the meetings;  No technical support, to execute changes "If we know or can do it, we had done! Without CQ “  Non harmonized actions Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

8. StrengthsChallenges  Open questioning of some processes;  Time for change and search recommendations for it.  Small team that fills the guidebook;  Teams do not have the same level of understanding;  No visibility on the horizons of expectation;  Lack of support during this phase;  Feels as a burden instead of being an opportunity for change. Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

9. StrengthsChallenges  Results that reflect the effort of the structure and level of involvement in the process.  Scoring very subjective, answers and horizons of expectation not detailed;  Questionable since all structures shall be subject to audit. Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

10. StrengthsChallenges  External evaluation;  Preparing the structure for this visit;  Structured diagnostic;  Confirmed areas for improvement in the majority of cases by the team;  Results more credible.  Time: 1 day, not sufficient for some structures;  Warned structures / situation not real;  Assessment according to one process description;  Results remain audit- dependent. Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

11. StrengthsChallenges  Improvement Plan is the subject of a specific assessment for the next edition;  Improvement actions oriented at the processes;  Realization of training by the central level, following the analysis of Improvement Plan in several domains.  Improvement Plan is not always included in the Annual Action Plan of the structure;  Sometimes implemented to meet the requirements of CQ; Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

12. StrengthsChallenges  Diagnostic of the entire system in real time and based on only one tool;  Official ceremony;  Recognition and distinction in presence of the Minister of Health;  Mediatization.  Double classification: ◦ Better performance in CQ ◦ Better productivity performance  Transverse data bank not available ;  No substantial prices;  When they exist (study trip or training ) for managers only;  Teams are not valued sufficiently. Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

13. StrengthsChallenges  Duplication of efforts: Lack of coordination with other structures in the province (delegation, hospital and health centers);  Lack of support in the implementation of Improvement Plan;  The resources are not oriented at implementing corrective actions.  Responsibility of the team to develop its own Improvement Plan;  Research partnership to concretize the Improvement Plan; Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

14. Key factors of successChallenges  Enlists in line with the strategy of the Ministry of Health for the reduction of maternal and infant mortality;  Conditionality in the program program of EU support (2011- 2014);  To date provided funding for the organization of CQ: ◦ 2006-2010: GTZ- global fund-OMS-MH ◦ 2011-2012: MH  Two evaluations stressed improtance of continuity ;  Debate on CQ for the first time in Moroccan parliament  Viability fragile, non- institutionalized approach;  Monotony felt by professionals;  Difficulties of measuring the contribution to the impact;  Implementation of other approaches more fashionable (accreditation) or current tools (RAMED) Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12

15. 1.Linking prices of CQ to technical support and / or financial:(Contracts, Assuring tutoring…); 2.CQ-SQI better synchronize with other approaches to quality management; 3.Develop a legal and administrative framework; 4.Promote an overall development framework with interfaces between health, education, economy and environment based on the same tool; 5.Maximize the values ​​of SQI by maintaining a long-term vision. SQI an instrument of creation of value Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12