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Top Réseau

Summary

Top Reseau aims to improve access to reproductive health services among vulnerable groups, particularly youth.

Key program components

Top Reseau provides youth friendly education and outreach through a mix of television and radio advertisements, mobile video units, and peer educators to promote safe sexual behavior, including prompt STI treatment, abstinence, partner reduction, and condom use. The clinics deliver an integrated intervention of interpersonal activities, mass media communication, and youth-friendly clinical service to motivate youth to adopt safer behaviors and improve their sexual and reproductive health.

Each clinic is a fractional franchise and offers a variety of services in addition to reproductive health and family planning (FP/RH) services; however, services are uniformly priced within each region. By joining the network and agreeing to the standards of care and youth-friendly services (rigorously enforced through supervision and inspections),these private clinics benefit from free training and peer education. Ten percent of all private physicians are now affiliated with Top Réseau.

By working through the existing private sector rather than creating a new government system, Madagascar has been able to quickly and effectively implement a national infrastructure of clinics providing consistent, high-quality and nonjudgmental education, treatment and care.

To help finance the cost of care, patients receive vouchers which can be used to cover half of doctor's fees. The franchise implements a voucher scheme that targets youth and high risk groups and subsidizes FP/RH counseling and STI treatment. Services also include voluntary counseling and testing for HIV, rapid diagnosis of malaria and provision of ART combination therapies. The scheme was launched in 2005, and to date, 282,552 vouchers have been disbursed. The voucher is free to the client.

Quality assurance (QA) and performance monitoring methods include:

  • Site visits (4/year)

  • Internal clinical audits (1/year)

  • External clinical audits (1/2 years)

  • Qualitative reviews with clients (1/year)

  • Provider surveys (1/year).

The program reports that their annual evaluation procedure is most useful in terms of gauging the quality of outlets and providers. Routine QA data (specifically from supervision visits) is used for developing action plans at the outlet level and to tailor the content for provider-specific coaching visits.