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The AHME Evaluation:Quality Assessment and Improvement

Dominic Montagu, Maia Sieverding, Christina Briegleb

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Objectives of the AHME Qualitative Evaluation

(1) To assess the drivers of provider and client attitudes towards quality of care, options for care, and health seeking behavior in Ghana and Kenya, and how AHME impacts these. (2) To document and describe the AHME operation processes in Ghana and Kenya, and their positive and negative impacts on the overall markets and institutional environments in which they function.

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Findings from the Ghana and Kenya qualitative fieldwork

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Sample

Providers

Ghana

Kenya

Maternity homes 11 1

Health clinics 10 17

Health centers - 2

Hospitals - 4

Pharmacies/chemists

2 -Clients

Ghana

Kenya

Maternal health 3 2

FP 3 9

Child health 15 15

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Provider perspectiveson benefits of franchising

• Training most valued component of franchise package• “Updates” on existing skills; learn long-term methods• Client relations and counseling

• Access to commodity supply, especially in Ghana

• Community benefit (Ghana)Being part of a support network (Kenya)

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Provider perspectiveson challenges & financial impact of franchising

• Challenges varied by network, include• monitoring/reporting requirements• low demand for FP

• Client flows for FP increased after franchising• Did not always see this as leading to improved finances for the

facility

• Branding• Client flows not attributed to branding• Client flows seen as the result of expanded services

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Client experience at the franchise clinic

• How learned of the franchise• Most heard of facility through referrals

• Brand Recognition• Very low brand recognition even among clients exiting network

facilities

• Overwhelming reason for returning to the franchise facility was positive client-provider relationship• No harsh treatment by staff (especially Ghana)• Prompt attention (especially Kenya)• Feeling able to ask questions

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Perspectives on NHIA in Ghana

• Providers: NHIA has had a substantial impact on healthcare market

• Felt they had to join NHIA to retain clients

• Generally low satisfaction with NHIA functioning• delayed payments • Low profit margins, particularly under capitation

• Clients/community members confused about which services covered and where

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Perspectives on NHIF in Kenya

• Providers: NHIF not very important• Some were experiencing delays in accreditation • Perception that not many clients are enrolled• Many facilities only offer outpatient services, which they

understood to be not covered under NHIF

• Clients/community members had low awareness of benefits, where to register

• Perception that NHIF is only for civil servants

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Conclusions

Quality Matters

• To patients – a lot• What patients perceive as quality is how they are treated rather than

clinical competence

• To providers – a fair amount• A major benefit of franchise membership is the opportunity to update

skills

• Branding doesn’t matter that much• Providers unconvinced increased client load due to brand• Patients don’t refer to brand when explaining why they selected

provider