1. Using Supervision to Sustain Quality Reproductive Health Interventions in Viet Nam: The Reproductive Health Projects (RHPs) Experience Dang Van Tuyen, MD, MPH Pathfinder International American Public Health Association 132 nd Annual Meeting Washington, D.C. November 7-11, 2004

2. Using Supervision to Sustain Quality Reproductive Health Interventions in Viet Nam  Introduction  Integrated Supervision for Quality of Care (IS/QoC)  Achievements  Clients  Providers  Services  Management  System  Challenges/Lesson learned  Conclusion

3. Introduction  Reproductive Health Projects overview  Pathfinder/Ipas/EngenderHealth-Viet Nam Ministry of Health  Mission  History/Partnership  Objectives/Strategy  Sustainability  History of conventional supervision in Viet Nam  Limited guidance on monitoring/supervision  Emphasized the problems rather than solutions  Conducted quickly and superficially  Integrated Supervision for Quality of Care (IS/QoC)

4. Principles of IS/QoC  Improves quality of care from client’s and provider’s perspectives  Involves staff from the bottom up  Includes a comprehensive service assessment  Based on individual responsibility, empowerment and teamwork  Relies on the supportive attitude of supervisors  Emphasizes solutions over problems

5. IS/QoC Methodology  Based on concepts of quality of care, participatory learning, and change management  Allows continuous room for improvement  Utilizes five evaluation tools based on indicators and checklists  Sources of data:  Client exit interviews  Facility review  Observation of services  Self-assessment  Service statistics  Problem identification and action plan  Encourages constructive coaching and feedback

6. Achievements from a client perspective  IS/QoC involved clients in the quality improvement process through routine client interviews  IS/QoC increased client satisfaction with quality of care

7. Achievements from a provider perspective IS/QoC  Generated greater understanding of clients’ perspective  Emphasized self-learning, individual responsibility, and teamwork  Improved staff motivation  Improved clinical and personal skills through coaching and feedback  Generated a more positive attitude towards supervision  Improved overall working conditions

8. Achievements from a service perspective IS/QoC  Increased accessibility of services and facilities  Increased client flow  Increased service utilization, such as post abortion contraceptive use

9. Achievements from a management perspective IS/QoC precipitated  Use of data for decision Making  Staff involvement in problem identification and solution development  Staff motivation and openness to supervision  Better communication between staff and senior management  Effective direction of resources

10. Achievements from a systems perspective IS/QoC achieved  MoH approval for nationwide implementation and curriculum  Provincial decisions to institutionalize IS/QoC  Provincial willingness to use local funds to extend training in IS/QoC on a wider scale

11. Challenges/Lessons Learned  IS/QoC requires a labor-intensive introduction. Staff and management orientation is critical.  Active involvement and support from management is fundamental.  Availability of some resource allocation for solution implementation is recommended.  A clear supervision framework is necessary for the health system on a national level

12. Challenges/Lessons Learned, cont’d.  Supervisors become problem solvers and centers of change management.  Supervisors' credibility lies in ability to implement suggested improvements.  Rushed supervision visits lead to neglect of clinical coaching and feedback and to superficial problem solving.

13. Conclusion  Improved supervision practices have enhanced quality and sustainability of reproductive health services and management systems in Vietnam

14. Thank You! Pathfinder International Room 205 B4b Gaing Vo Building 269 Kim Ma Street Ha Noi, Vietnam www.pathfind.org