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M1

Impact Evaluation of the Sun Quality Health Franchise in Myanmar

Principle Investigators:Dr. Kathryn O’Connell

Dr. Tin Aung Population Services International

Dr. Dale HuntingtonMulti-Site Franchise Study Meeting

Center for Global DevelopmentNovember 20, 2008

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M2

Sun Quality Health FranchiseSun Quality Health Franchise

SQH launched in 2001, now active in 145 townships across 13 states of Myanmar

Recruits approximately 120 providers per year in batches of about 20 who participate in a three-day induction training.

A total of 914 providers have participated in the induction training and 828 remain active in 2008.

GPs who provide an entire range of primary care services; in addition, some provide maternity care, minor surgery and other specialized services, depending upon their qualifications 73

124

331

468

561

710

804 828

FP

MalariaSTITB

Pneumonia

-

200

400

600

800

1,000

01 02 03 04 05 06 07 08thruOct

Total RH Malaria STI TB Pneumonia

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M3

Sun Quality Health FranchiseSun Quality Health Franchise

Family Planning Consultations & CYP 2001 - 2008 (projected)

385,424577,917

748,522896,088931,504199,323

43,5412,726

-

200,000

400,000

600,000

800,000

1,000,000

01 02 03 04 05 06 07 08

FP Consultations-

50,000

100,000

150,000

200,000

250,000

CYP

Yearly FP ConsultationsCYP

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M4

SQH Impact Evaluation Study SQH Impact Evaluation Study

Research Questions

Client:How has the Sun Quality Health franchise affected health care seeking behaviours of clients (bringing new clients in or shifting sources of care)?How responsive is the Sun Quality Health franchise to client expectations?Does the Sun Quality Health franchise reach poor and vulnerable populations (address PSI/Myanmar mission)?

Provider:What are the subjective incentives for providers to join and remain members of Sun Quality Health franchise?How does joining the Sun Quality Health franchise affect the volume, composition of services and revenue of the members’ medical practice?

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M5

SQH Impact Evaluation Study DesignSQH Impact Evaluation Study Design

Three main elements: 1. Formative research

2. Uncontrolled observational study of clients and providers

3. Prospective cohort study of the SQH providers' practice characteristics.

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M6

Formative ResearchFormative Research

Attitudinal determinants of the behaviours of interest are elicited from the target populations using qualitative research methods

Focus Group Discussions, In-depth interviews with SQH clients and provider members

Collect expressions from:

– Clients: service delivery responsiveness and patient satisfaction– Providers: non-monetary incentives to join and remain members

of SQH

Results will be used to generate multi-items scale scores using psychometric measurement techniques

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M7

FFacility Based Uncontrolled Observational studyacility Based Uncontrolled Observational study

Two subjects / sources of data:

– Clients who are using SQH supported services and any other RH related services (e.g., maternal care, gynecology, SRH related counseling, post-abortion)

– Providers who are members of the SQH franchise.

Total of 220 SQH facilities will be randomly selected using probability proportionate to size (PPS) of average monthly reproductive health case load.

Exit interviews with 5 RH clients per clinic, and one or more providers per clinic (total 1,100 RH clients, approximately 240 providers)

Service statistics from the sampled clinics for trends in the RH service case load

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M8

Prospective Cohort Study of Practice Prospective Cohort Study of Practice CharacteristicsCharacteristics

Three different cohorts of providers followed for 2 years:

1. All newly enrolled SQH providers in the year of the study launch

2. 134 providers who have been SQH members for 2 years and are still actively providing RH services (random selection)

3. 130 SQH providers who have been members for 4 years and are still active (random selection)

Each provider will be requested to complete a specially adapted MIS form at the time of their induction training:

– Monthly case load by reason for visit – Monthly revenue generated / gross income

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M9

SQH Impact Evaluation Study: Implementation UpdateSQH Impact Evaluation Study: Implementation Update

Multiple scientific and ethical reviews February - July 2008

– Local IRB created by PSI / Myanmar

Study launched September 2008

3 year study duration:

– Year 1: Launch prospective cohort study of providers, conduct formative research (early 2009), develop study instruments including pretesting, organize for survey field work

– Year 2: Conduct facility based study, report on results

– Year 3: Conclude prospective cohort, report on results