Improving Health Centers’ Outreach Activities Kampot Province Applied Health Research by the Kampot PHD

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

Kampot PHD 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.

Kampot PHD Rationale 1997 MOH Guidelines for Operational Districts 2001 MOH Guidelines for Outreach Services from Health Centers Health Sector Strategic Plan

Kampot PHD 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

Kampot PHD 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

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

Kampot PHD Problem Diagram Supplies, Material and Drugs Outreach Activities not performed properly according to MOH Guidelines Financial Factors Human Resource Factors Environmental conditions/ locations/ situations of villages Coordination between HC staff and local authorities Community involvement is low Low level of participation of community intermediaries – FBCs, VHW Per Diem Transportation Ice Not on time Inadequate No standard* Difficult to reimburse Low capacity Inadequate number Wrong staff doing OA COMMUNITY RELATED FACTORSPROVIDER RELATED FACTORS Budget not on time

Kampot PHD 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

Kampot PHD 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?

Kampot PHD 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?

Kampot PHD 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?

Kampot PHD 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)

Kampot PHD 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

Kampot PHD Methodolo gy COMMUNITY RELATED FACTORS PROVIDER RELATED FACTORS Supplies, Material and Drugs Human Resource Factors Environmental conditions/locations / situations of villages Coordination between HC staff and local authorities Community involvement is low Low level of participation of community intermediaries – FBCs, VHW Low capacity Inadequate number Wrong staff doing OA Outreach Activities not performed properly according to MOH Guidelines Financial Factors Per Diem Transportation Ice Not on time Inadequate No standard* Difficult to reimburse Budget not on time

Kampot PHD Methodolo gy COMMUNITY RELATED FACTORS PROVIDER RELATED FACTORS Outreach Activities not performed properly according to MOH Guidelines Financial Factors Per Diem Transportation Ice Not on time Inadequate No standard* Difficult to reimburse Budget not on time

Kampot PHD Methodolo gy COMMUNITY RELATED FACTORS PROVIDER RELATED FACTORS Supplies, Material and Drugs Human Resource Factors Environmental conditions/locations / situations of villages Coordination between HC staff and local authorities Community involvement is low Low level of participation of community intermediaries – FBCs, VHW Low capacity Inadequate number Wrong staff doing OA Outreach Activities not performed properly according to MOH Guidelines Financial Factors Per Diem Transportation Ice Not on time Inadequate No standard* Difficult to reimburse Budget not on time

Kampot PHD Methodology Sampling and Study Population  nine health centers selection is based on: Categorization used in the Reward and Sanction Mechanism for Health Centers Kampong TrachKampotChhouk AAA B2B1 CB2C Note that HCs in Angkorchey OD are excluded.

Kampot PHD 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

Kampot PHD Methodology HCs excluded in the study N = 14 HCs as sample population N = 9 Angkor Chey HCs N = HCs 10 HCs 33 HCs as study units 4

Kampot PHD 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

Kampot PHD Limitation of the Study PHD/OD staff new to research internal researchers OD supervisor – HC staff relationship other unforeseen changes/improvement in other factors

Kampot PHD 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

Kampot PHD Ethical Issues are results to reflect the real situation?

Kampot PHD Proposed Budget DescriptionEstimated Cost OA Per Diem $ 8, Research Proper $ 3, Research Materials $ Training for Researchers $ SC Meetings $ 1, Contingency Costs (10%) $ Total $ 14,401.55

Kampot PHD Thank you for your kind attention! OA Steering Committee