SQH Service Delivery Standards v5

Service Delivery Standards

For

Sun Quality Health

PSI Myanmar, 2012

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Introduction

PSI Myanmar works in partnership with the Ministry of Health to improve the health of poor people in Myanmar. The Sun Quality Health (SQH) network of private General Practitioners has played a major part in this effort since 2001. PSI provides support to SQH doctors to help them improve Quality, Equity, and Access to the services they provide.

PSI has developed these Service Delivery Standards (SDS) to support further improvement in the Quality of care provided through SQH. SDS will provide a common benchmark for PSI and for all SQH doctors; by clearly defining what Standards are expected, we can begin to effectively measure service Quality. Once service Quality is defined and measured, SQH will be able to identify weaknesses and track progress towards improved Quality, with the goal of meeting all Standards.

The Service Delivery Standards defined here are minimum standards. They are not intended to provide a comprehensive set of rules, guidelines, or protocols. They in no way replace national standards, as set out by the Ministry of Health. They do not replace comprehensive training provided by PSI or others, and following these SDS alone is not sufficient to provide high quality care.

As minimum Standards, these SDS should be attainable by all SQH providers. PSI is committed to providing the support necessary to help providers achieve them. SQH providers are encouraged to consider their own performance relative to SDS, and if areas for improvement are identified, to request the engagement and support of PSI. At the same time PSI is developing tools for monitoring performance against SDS, and will offer feedback to SQH as appropriate.

The Standards set our below have been developed based on National Guidelines and international best practice. Nevertheless, that are a first attempt, and they are intended to provide a starting point for a process of development and refinement. SQH providers will be the key partners in this development, and we will work together to ensure that each Standard is specific, measurable, achievable, and relevant.

PSI would like to acknowledge the ongoing support of the Ministry of Health, donors and international partners, and, most importantly, the continued dedication and commitment of our Sun Quality Health doctors. Together, we will continue to improve the quality of health services available to Myanmar’s poor.

Dr Min Zaw

Director, Health Services, PSI Myanmar

Yangon 2012

SQH SDS Version 5, May 2012

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SQH Service Delivery Standards

Summary

A. Standards of SQH network members

SDS 1: The SQH clinic clearly displays an SQH signboard.

SDS 2: The SQH clinic clearly displays a current PSI/M pricing wall sheet.

SDS 3: The SQH clinic clearly displays IEC materials at easily accessible area for the clients.

SDS 4: The SQH clinic is registered at local health authority and the SQH provider has a medical license.

SDS 5: The SQH provider ensures that quality PSI health products are always available for the clients.

SDS 6: The SQH provider ensures that bio hazardous materials are properly handled, stored and disposed of.

SDS 7: The SQH provider maintains accurate records.

SDS 8: The SQH provider follows the policies of PSI/M pricing and incentive schemes.

B. Standards of SQH network services

I. Key information for clients

SDS 9: The SQH provider provides key information of health services or products before the client receives it.

II. Respect for clients’ rights

SDS 10: The SQH provider respects a client’s right to make informed decision of health services.

SDS 11: The SQH provider respects a client’s right for privacy and dignity.

SDS 12: The SQH provider respects a client’s right to receive health services which meet PSI/M minimum clinical standards.


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A. Standards of SQH network members

SDS 1: The SQH clinic clearly displays an SQH signboard.

The SQH brand is a valuable asset of the SQH franchise. Clients decide whether to utilize health care services at a particular location based on what they know, or think they know, about the brand. The SQH brand must have the ability to sway clients to use the SQH clinic by reminding them of the perceived quality expected from the service.

Indicator: SQH signboard clearly displayed outside the clinic.

SDS 2: The SQH clinic clearly displays a current PSI pricing wall sheet

Display of PSI’s current pricing wall sheet helps poor clients to confidently utilize SQH services. It helps to keep SQH providers accountable to follow PSI/M’s pricing structure.

Indicator: Current PSI pricing wall sheet is posted either in the waiting room or consultation room of SQH clinic.

SDS 3: The SQH clinic clearly displays IEC materials at easily accessible area for the clients.

IEC is a cost-effective approach to mobilize communities into making life-saving behavioral changes in their daily health practices. IEC materials are an essential component in facilitating the health knowledge, attitude and practices about common illnesses and their causes.

Indicator: All current, appropriate IEC materials relating to SQH services and products are easily accessible to clients visiting to the clinic.

SDS 4: The SQH clinic is registered at local health authority and the SQH provider has a medical license.

According to law in relation to medical services in Myanmar, each medical doctor must have a medical license from Myanmar Medical Council and a clinic registration document issued from local health authority. These are evidence of qualified medical doctors for general practice in community.

PSI/M is an INGO and has MoU with DoH. Therefore in order to run its health related activities without any interruption, medical license and clinic registration must be available at all affiliated SQH providers.

Indicator: SQH provider has medical license and clinic registration. PSI/M keeps SQH provider’s number of medical license in provider profile.


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SDS 5: The SQH provider ensures that quality PSI/M health products are always available for the clients.

An SQH provider is responsible for ordering adequate stocks of PSI/M health products and PSI/M staff is responsible to deliver the ordered stocks timely making ensure no stock-out or expiry. Health products need to be stored in a cool, dry place, out of direct sunlight, in order to keep their optimal efficacy until the end of their shelf-life. Some may need refrigeration.

Indicator: PSI/M health products are properly stored. Stock levels are adequate to prevent stock out. No expired, damaged or otherwise defective products are found.

SDS 6: The SQH provider ensures that bio-hazardous materials are properly handled, stored and disposed of.

Being SQH clinics as health care facilities, they generate infectious as well as non-infectious waste materials. It is likely to transmit infection and endanger human health, and the environment. Infectious medical waste is also known as biohazard waste.

During storage, handling, and transport, infectious medical waste (except for sharps) must be contained in disposable containers or bags that are moisture resistant and strong enough to prevent leakage or expulsion of solid or liquid waste. Sharps must be disposed of in impervious, rigid, puncture-resistant containers immediately after use.

Indicator: Bio-hazardous materials are properly managed according to the guidelines.

SDS 7: The SQH provider maintains accurate records.

A medical record documents a client’s medical treatment, and current health status, and is an integral component in the delivery of quality health care.

SQH providers are responsible for ensuring that medical records, as required by PSI/M, are accurate and up to date at all times.

Indicator: SQH providers maintain accurate records according to PSI/M requirements.

SDS 8: The SQH provider follows the policies of PSI/M pricing and incentive schemes.

Pricing policy and incentive schemes are important to change desired behavior of target groups by increasing access to defined products and services delivery. In order to ensure the incentives reach only to the needy, SQH provider needs to follow the policies of all PSI/M incentives schemes. PSI/M is responsible to provide updated summarized incentive policies to SQH providers.

Indicator: SQH provider has the updated copy of summary incentives tables.


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B. Standards of SQH network services

I. Key information for clients

SDS 9: The SQH provider communicates key information of health services or products before the client receives it.

Indicator: The client understands key information of health services he/she has been provided.

RH

(i) Birth Spacing

After consultation with SQH provider, all BS clients are able to describe the following:

General

a. The variety of available BS methods at SQH clinic by mode of use

b. The main advantages and disadvantages of these methods

Specifically; the client is able to explain

a. What their chosen method is

b. Common side effects of their chosen method

c. Possible complications (if any)

d. Follow up schedule

(ii) Cervical cancer prevention

After consultation with SQH provider, all CCP clients are able to describe the following:

a. What cervical cancer is

b. What VIA is

c. What cryotherapy is

d. Common side effects of cryotherapy

e. Follow up schedule


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STI

After consultation with SQH provider, all STI clients are able to explain the following:

a. how to take the drugs they have been prescribed

b. why they should avoid sex without condom

c. why they should refer their sexual partners to SQH clinic

d. why they should seek HIV counseling and testing

HIV

(i) PITC

After consultation with SQH provider, all PITC clients are able to explain or describe the following:

a. HIV is a fatal infection commonly associated with TB and STIs

b. PITC is a routine test for defined target groups

c. PITC is voluntary and the client has a right to decline it

d. The benefits of knowing HIV result

e. Declining an HIV test doesn’t affect the client’s access to other services like TB treatment

f. The client’s information is confidential

(ii) ART

After consultation with SQH provider, all ART clients are able to explain or describe the following:

a. ART is life-long treatment (HIV is treatable but not curable disease) with inherent cost

b. It is required to take same drugs at the same time every day

c. ART has short term and long term side effects

d. It is still important to protect him/herself from re-infection and others from transmission

e. It is important to come back to see the doctor immediately if any new symptoms occur

f. Follow up schedule


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TB

After consultation with SQH provider, all TB patients are able to explain or describe the following:

a. TB is infectious and curable

b. Anti-TB drugs are free of charge

c. Anti-TB treatment duration, form of drugs and dosage

d. Drugs must be taken daily at regular interval

e. Drugs taking must be supervised by an observer and who his/her chosen DOTS observer is

f. How to prevent transmission of infection

g. It is important to come back to see the doctor if any new symptoms occur

h. Follow up schedule

Malaria

After consultation with SQH provider, all malaria patients are able to explain or describe the following:

a. How to take the drugs

b. It is important to come back to see the doctor if the symptoms persist

c. 3 ways to prevent malaria infection

Pneumonia

After consultation with SQH provider, all caregivers of under 5 children with pneumonia are able to explain or describe the following:

a. How to take the drugs

b. Chest indrawing and 3 common danger signs of pneumonia

c. Follow up schedule


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II. Respect for clients’ rights

SDS 10: The SQH provider respects a client’s right to make informed decisions in health services.

Behavior is critically important to maintaining good health. The more clients are involved in

choosing their health services, the longer they are likely to sustain their healthy behavior. Therefore

informed decision-making is an essential part of quality health care services.

All SQH providers must explain about health products and services before they are received and

clients should understand the services and get involved in decision-making.

SQH providers explain about the health products and services

SQH providers should encourage clients to clarify any queries during the discussion

SQH providers should be non-judgmental

SQH providers should guide clients to get right decision

Indicator: The client gives informed consent to receive health services he/she needs.

SDS 11: The SQH provider respects a client’s right for privacy and dignity.

Privacy and dignity is a priority for rapport and trust building between SQH providers and

clients.“Privacy is freedom from intrusion; this refers to all information and practice that is personal

or sensitive to the individual. Dignity is being worthy of respect.”

This applies to all clients irrespective of age, ethnicity, and gender, social, cultural, psychological and

physical needs.

All SQH providers ensure that their clients are treated with privacy and dignity all the time. All clients

have the right to remain autonomous and independent whenever possible.

Indicator: The client is treated with privacy and dignity for health services he/she receives.


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SDS 12: The SQH provider respects a client’s right to receive health services which meet PSI/M minimum clinical standards.

Indicator: SQH provider provides health services to the clients according to PSI/M minimum clinical standards.

RH

(i) Clinical standards of birth spacing

Standard 1: Perform general BS counseling including HTSP and method specific counseling to all BS clients (see SDS 9: RH – birth spacing)

Standard 2: Perform relevant history taking and physical examination to assess medical eligibility of the client for a chosen method

Standard 3: Provide appropriate BS method in accordance with the client’s eligibility and informed choice

Standard 4: Perform infection prevention procedure according to the method provided

Standard 5: Make schedule with a BS client for follow up visits

Standard 6: Manage common side effects of BS methods properly during follow up visits


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(ii) Clinical standards of cervical cancer prevention

Standard 1: Offer cervical cancer screening to women aged between 25 and 45 years

Standard 2: Explain risk of cervical cancer, screening procedure (VIA) and management (cryotherapy) to the clients (see SDS 9: RH – CCP) – Counseling 1

Standard 3: Perform relevant history taking and physical examination

Standard 4: Perform VIA according to PSI/M’s service delivery protocol

Standard 5: Interpret VIA results correctly and explain VIA results to the client

Standard 6: Offer cryotherapy to VIA + clients according to the eligibility criteria for cryotherapy

Standard 7: Explain cryotherapy procedure and common side effects of cryotherapy –Counseling 2

Standard 8: Obtain and Record the client’s consent to perform cryotherapy

Standard 9: Perform infection prevention procedure including instrument processing according to PSI/M’s service delivery protocol

Standard 10: Perform cryotherapy according to PSI/M’s service delivery protocol

Standard 11: Schedule follow-up visits for all clients according to VIA result

Standard 12: Manage common side effects of post cryotherapy clients during follow up visits

Standard 13: Refer suspected cervical cancer cases, VIA + clients who are not eligible for cryotherapy and those with post cryotherapy side effects beyond the providers’ ability to manage using PSI/M referral directory


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STI

Clinical standards of STI

Standard 1: Perform relevant history taking including sexual history

Standard 2: Perform physical examination based on presenting symptoms after taking the client’s consent

Standard 3: Use PSI/M standard flowchart for the management of common STD syndromes

Standard 4: Prescribe appropriate drugs including Cure U kits according to the syndrome

Standard 5: Explain how to take the drugs

Standard 6: Explain why the client should avoid sex without condom and how to use correctly and consistently

Standard 7: Explain why STI client should receive HIV counseling and testing, and where it is available.

Standard 8: Explain importance of partner referral and give partner referral card to refer all partners to the clinic

Standard 9: Agree a schedule for follow-up visits


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HIV

(i) Clinical standards of PITC

Standard 1: Offer HIV testing to all defined eligible clients

Standard 2: Give pre test information (see SDS 9: HIV – PITC)

Standard 3: Obtain the client’s consent after giving pre test information

Standard 4: Perform serial HIV testing according to PSI/M’s testing flow chart

Standard 5: Conduct post test counseling according to HIV test result

(ii) Clinical standards of ART

Standard 1: Confirm HIV status

Standard 2: Perform staging of an HIV infected client according to WHO guidelines

Standard 3: Decide when to start according to WHO guidelines

Standard 4: Provide appropriate treatment of opportunistic infections before starting ART

Standard 5: Conduct adherence counseling before starting ART

Standard 6: Provide correct regimen according to PSI/M’s ART protocol

Standard 7: Monitor ART client closely for acute side effects and IRS during first 3 months and manage according to the protocol

Standard 8: Give adherence counseling during follow up visits as required

Standard 9: Schedule follow-up visits


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TB

Clinical standards of TB

Standard 1: Perform relevant laboratory investigation to confirm diagnosis for all suspected TB cases

Standard 2: Categorize correctly for the treatment after confirmation

Standard 3: Conduct adherence counseling to the patient and DOT observer together before starting treatment

Standard 4: Provide correct treatment regimen according to the category

Standard 5: Weigh the patient initially and during follow up for dosage and monitoring of treatment response

Standard 6: Perform recheck sputum for all patients according to NTP guidelines

Standard 7: Take action for all treatment interrupted cases and report timely

Standard 8: In case of treatment failure, make sure by sputum results of defined month of each category according to NTP guidelines

Standard 9: Fill treatment record card correctly and timely

Standard 10: Provide co-trimoxazole prophylaxis to all TB-HIV co-infected cases

Standard 11: Give contact tracing card to all TB patients for referral


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Malaria

Clinical standards of Malaria

Standard 1: Take relevant history including previous anti malaria drug history and conduct relevant physical examination.

Standard 2: Perform rapid diagnostic test kits to all suspected malaria cases

Standard 3: Refer highly suspicious of malaria cases with RDT negative result to higher health facilities for additional diagnostic procedure (Blood for MP)

Standard 4: Look for and examine servere signs of malaria for life saving management and urgent referral

Standard 5: Weigh the patient if necessary

Standard 6: Exclude pregnancy before giving treatment if the patient is a woman of reproductive age

Standard 7: Provide treatment according to the guidelines

Standard 8: Explain how to take the drugs to the patient or caretaker

Standard 9: Explain how to prevent malaria (sleep under ITN, use repellants, and wear long sleeves, trousers)

Standard 10: Schedule follow-up visit


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Pneumonia

Clinical standards of pneumonia for under 5 children

Standard 1: Take relevant history considering other differential diagnosis

Standard 2: Perform physical examination for diagnosis according to the guidelines

Standard 3: Use service guideline chart and dosage chart for diagnosis and management including referral of childhood pneumonia

Standard 4: Look for and examine chest indrawing and danger signs of pneumonia for life saving management and referral

Standard 5: Take respiratory rate for one minute using timer

Standard 6: Provide correct treatment according to the guidelines

Standard 7: Give instruction for the treatment (how to prepare the drugs, interval and duration of the treatment) and home care to the care taker

Standard 8: Schedule follow-up visit


SQH Service Delivery Standards v5

Documents

Transcript of SQH Service Delivery Standards v5