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Success in Primary Health: A Multi-sectorial Collaboration. Preliminary Presentation - Quality Care Evaluation March 2006 Zoe Kopp MPH Director, Pfizer Global Health Fellow Teresa Narvaez Country Director, Project HOPE.

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success in primary health a multi sectorial collaboration

Success in Primary Health:A Multi-sectorial Collaboration

Preliminary Presentation -

Quality Care Evaluation

March 2006

Zoe Kopp MPH

Director, Pfizer Global Health Fellow

Teresa Narvaez

Country Director, Project HOPE

evaluation objectives
Evaluation Objectives
  • Evaluate the quality of care of services offered in the Herrera and Monte Plata clinics through a quantification of the actual level, according to the international standards, with the objective of improving the quality.
  • Provide the base of a strategy that assures the quality of the clinics program supported by Project HOPE in the Dominican Republic.
  • Conduct a profound financial analysis of both clinics to identify the key factors and conditions to achieve financial sustainability.
quality care evaluation team
Quality Care Evaluation Team
  • Zoe Kopp MPH – Pfizer, International Public Health Evaluator
  • Teresa Narvaez – Country Director, Project HOPE
  • Dr. Karen Cuevas – Director, Herrera Clinic
  • Angela Alban – Coordinator, Monte Plata Clinic
  • Dr. Ramon Alcequiez – Medical Evaluator
  • Dr. Anyinet Belen – Medical Evaluator
  • Lcda. Arelis Gil – Statistician, SESPAS
  • Lcdo. Luis Gonzalez – Statistician, SESPAS
what is quality care
What is Quality Care?

The right of clients to:

  • information
  • access
  • choose
  • security
  • privacy and confidentiality
  • dignity and comfort
  • form their own opinion
  • continued care
evaluation quality care
Evaluation:Quality Care
  • User Perspective:
    • Exit interviews at the clinic (160)
    • Interviews in the community (20)
  • Managerial Perspective
    • Interviews with managers at HOPE and ADOM (3)
    • Audit of medical files (60)
    • Observation of medical consultations (4)
  • Perspective of Clinic Personnel
    • Interviews with receptionists, janitors, nurses, doctors, and lab workers (10)
what did they like the best or the least




The environment

Good prices

Initial information, discussions


It seems to have everything that one needs


Here they find the best services


Wait time

That they discourage use of baby bottles

Bring in more pediatricians

Need a cafeteria

Wait for the lab workers

Don’t permit food in the waiting room

Don’t understand the shift system

What did they like the best or the least?
recommendations from patients
Recommendations from patients
  • More pediatric specialists
  • Put in a cafeteria
  • More seats in the waiting room
  • More comfortable seats by the lab
  • Quicker laboratory services
  • Open on weekends
  • Attend births and emergencies
  • Psychological and rehabilitation consultations
  • A specific doctor per patient
results audit of medical files
Results: Audit of Medical Files
  • All of the information noted in the medical files:


interviews key persons
Interviews: Key Persons
  • Dr. Schiffino - Sub-Secretary of State of Primary Care and Collective Health
  • Dr Héctor Eusebio –Dept. Director, Maternal Infantile
  • Dr. Marta Nina - Coordinator National Breastfeeding Program, SESPAS
  • Dr. Sonia Aquino – Program Coordinator, Maternal Infantile SESPAS
  • Dr. Josefina Cohen -Coordinator of the National Commission of Maternal Breastfeeding
  • Dr. Oscar Suriel – OPS
  • Dr. David Losk - USAID
  • Mrs. Zoraida Heredia Vda. Suncar –Evaluator, Brugal Award
  • Marcos Dionicio –President, Seminsa
results key interviews
Results: Key Interviews
  • Good reputation
  • Good spirit/empowering environment
  • Good organization
  • Good management – Teresa, Karen, Angela
  • Teresa is dynamic
  • Warm atmosphere
  • Efficient
  • Quality of Care Model
  • They are integrated in the country’s plan for vaccines and maternal/child health; “work as partners” of SESPAS
  • Collaborate really well with SESPAS. Integrate and coordinate with SESPAS in their health areas
  • Very impressed by the environment of the clinics; the cleanliness and the organization
  • Teresa and HOPE/ADOM have greatly assisted with the AIEPI campaign
notable achievements 1
Notable Achievements (1)
  • Herrera Clinic - Self-sustainable (model of care, management, and finances)
  • Positioning and recognition of organization and high quality services
  • Automated system of statistics, services and finances
  • The clinic personnel feel proud and empowered by the program; they feel that the success and self-sufficiency of the clinics is their responsibility
notable achievements 2
Notable Achievements (2)
  • Awards/Recognition
    • National Committee of AEIPI 2005
    • Brugal 2004: Social Assistance
    • OPS 2002: Sustainability
    • National Immunization Program: 2002
    • National Commission of Maternal Breastfeeding: 2001
  • Collaboration network - powerful
    • ADOM and their members
    • HOPE and their international contacts
    • SESPAS
    • Cooperating Agencies: Japan, USA, Italy
    • Private Businesses
    • National NGOs: Ora de Dios
    • Institutions and people
recommendations 1
Recommendations (1)

Determine how these clinic models can have the maximum impact in the national and international field. HOPE/ADOM through involvement with others with experience in the field of health (SESPAS, PAHO and other groups) should consider options like:

1) Creating a quality center of management training of primary health care services.

2) Expanding the number of clinics to at least have one clinic in each region to have more influence throughout the country

3) Using and design the future clinics with the ability to offer practical training to medical personnel from the DR and other countries

recommendations 2
Recommendations (2)

Define the Mission of the Clinics Project and develop a strategic plan for the next five years. Project HOPE and ADOM together need to define their vision, mission, and establish strategic objectives for their achievement (including measurable indicators).

Then develop a 5-year strategic plan to reach the set objectives and expansion plans for the clinics program. That should involve representation from both organizations, HOPE and ADOM, and representation from their employees.

recommendations 3
Recommendations (3)

Name a management sub-committee for the clinics programwith representation from ADOM, HOPE and clinic personnel. This committee will be in charge of providing leadership and follow-up to the strategic plan. In addition it will guarantee the quality of services in the clinics, supervise the appropriate handling of funds, manage the growth of the endowment fund and secure the future and the expansion of the impact of the clinics project.

recommendations 4
Recommendations (4)
  • Establish a Director of the Clinics Project position, within ADOM, to supervise and provide coordinated management for both clinics to obtain a higher level of efficiency in the handling and operation of the clinics and the implementation of the activities of the strategic plan.
final consideration
Final Consideration

The collaboration clinics of ADOM and HOPE in the DR are excellent examples of primary and maternal/child health clinics with a high level of quality care. These clinics could serve as quality care models for HOPE and ADOM and other organizations in the Dominican Republic and other countries.

“There are two ways of spreading light: to be the candle or the mirror that reflects it.”

-Edith Warton