Quality of Care Workshop| India| June 30-July 1, 2015 Alive & Thrive: Strategic use of data to ensure provision of good quality IYCF counseling services

2 Quality, quality, quality….

Framework for scaling up nutrition Alive & Thrive is funded by the Bill & Melinda Gates Foundation and the governments of Canada and Ireland and managed by FHI 360.

A&T Viet Nam Franchise Model In Viet Nam, 1 out of 3 children under five is stunted * Key contributor is poor infant and young child feeding practices (IYCF) Functional health system in place with capacity to deliver Question  Can large scale behavior change for improved IYCF be delivered by institutionalizing good quality standardized counseling services into the public health system using social franchising principles? * Data Source: Nutrition Surveillance 2010, National Institute of Nutrition

Good Quality IYCF Counseling Services? = Leads to behavior change – Addresses key issues / concerns of clients – Timely and relevant to context of each mother-child pair – Clearly defined standard of practice – becomes the ‘norm’ 5

Strategic Use of Data 6

Test & improve delivery platform Identify priority behaviors, define standard package User friendly timely data used for decision making Define performance metrics, measure outcome & impact Good Quality IYCF Counseling Services Strategic use of data

A&T Viet Nam Franchise Model From , ~800 social franchises were established through the public health system across 15 of 63 provinces (all levels of facilities – province, district & commune) 9-15 timed and targeted counseling contacts per mother child pair over a 27 month period (3 rd trimester of pregnancy to 24 months of age) Performance Objectives – – Double exclusive breastfeeding – Improve quality and quantity of complementary feeding – Reduce stunting by 2 per cent points each year

Quality Data (Facility, Counseling Service, Data Management) through Supportive Supervision Coverage – Proportion of children 0-24 months availing franchise services Volume – Total number of counseling contacts per month Service Utilization – average number of contacts per mother-child pair Performance Metrics 4 Rounds of process evaluation and impact evaluation: Training, Franchise Management, Service delivery, service utilization and Infant & Young Child Feeding Practices

Franchise Review Launched 4 plans: -Target setting -Performance-based incentive -Demand generation -Supportive supervision Performance Metrics: Quantitative

11 Performance Metrics: Qualitative

Priority: Reward & Encourage Priority: Demand Generation Priority: Quality Priority: Quality & Demand Generation 2 HIGH Quality LOW Volume 4 LOW Quality HIGH Volume 3 LOW Quality LOW Volume 1 HIGH Quality HIGH Volume Performance Metrics: Qualitative and Quantitative

Client satisfaction Service utilization Capacity of providers IYCF knowledge Interpersonal Communication skills Technical content Duration of consultation Infrastructure Space Equipment, Materials Availability of services Staff Services offered Time Process Evaluation

Issues for consideration Pre-service curriculum and continuing medical education Regulation, health facility certification & re- certification Financial mechanisms – performance based incentives, health insurance, fee for service 14

Key Messages Data (both qualitative and quantitative) should drive all aspects of programming – design, implementation, monitoring and evaluation – and ensure quality Data collected should be relevant  linked to desired outcome. “Measure what matters” (Ashish Jha) Data collected should be packaged (e.g. user friendly formats) with feedback loops for timely decision making and action 15

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