Tinh chi em (Sisterhood)
Country of Operation
- Provincial Health DepartmentGovernment
- Marie Stopes International VietnamNot-for-profit
Summary'Tinh chi em' (Sisterhood) is an innovative partial franchise model that applies private sector franchise approaches to improve performance of public sector service delivery. The program works in reproductive health and family planning
The ultimate goal of the project is to improve the quality and utilization of reproductive health and family planning services at the level of Communal Health Station (CHS) through the application of the Government Social Franchise (GSF) model, and contribute to the successful fulfillment of the National Reproductive Strategy of Viet Nam.
Key program components
The Tinh Chi Em model provides an example of successful collaboration between provincial level health departments and an international NGO (MSI). This partnership allows local health departments to take ownership of the program and act as franchisors, while utilizing the expertise and resources available through MSI-Vietnam’s extensive network. The program was piloted in 38 commune health stations (10 in Da Nang and 28 in Khanh Hoa) located in rural and semi-urban areas with the aim to improve service quality and client satisfaction, and to increase utilization. As a result, a total of 669 public health workers attended 31 training courses in 2007. An additional 249 staff received refresher training in 2008, and 767 from a further 38 CHSs were trained during the expansion phase to 38 additional CHSs in 2009.
Clients can get reproductive health and family planning (RHFP) services at Commune Health Stations either for free (those covered by health insurance), or at a cost regulated by the Department of Health (e.g. 0.2$ for STI examination, 4-5$ for normal birth delivery).
The program has significantly improved clinic infrastructure, service quality and client satisfaction. Service utilization at franchised public health stations has increased by more than four-fold in the first year, and the number of RHFP consultations increased by five-fold. The GSF model allows lower income segments to access affordable high quality RHFP services at the local level, thereby reducing the burden on provincial and central public hospitals.
Between 2010 and 2011, a new donor (the European Union) has provided funds for the implementation of this model and the piloting of a health voucher within the public sector. In 2012, the Provincial Departments of Health decided to replicate the model with an additional 33 health facilities.
Quality assurance (QA) and performance monitoring methods include:
- Internal clinical audits (4/year)
- External clinical audits (1/year)
- Vignettes (1/year)
- Client exit interviews (4/year)
- Qualitative reviews with clients, providers and the community (4 each/year) and many more
Managers use a dashboard to visualize data and track performance. The program reports that a QA checklist created with the Ministry of Health is the performance measurement tool that is most useful in assessing quality of services. The program reports that a lack of approval mechanisms for health staff to collect service fees or process vouchers was a challenge in 2012. There were also delays in re-construction of facilities. A reward system for staff in the CHSs was created that consisted of both tangible and intangible items. It was revised in order to encourage staff to perform higher quality services in the clinics.
This program received 335,597 FP client visits and 551,815 SRH client visits (in 2011). There have been 2,388,602 total visits (Recorded in 2012).
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