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Pre- and Post-Intervention Assessment Index



Study population

(Commune Health Center)

Quang Ninh Province

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Pre- and Post-Intervention Assessment Index

Intervention activities

- Solution group with medical facilities:

+ Supplement and ensure medical staff for commune health stations.

+ Investment in facilities and equipment.

+ Training, retraining, and improving professional qualifications for medical staff providing reproductive health services.

- Solution group for women aged 15-49: Increase awareness of reproductive health care through health education communication

COMPARE

Select 21 communes in 3 districts for research (Descriptive study)

Current status of providing CSSKSS services.

Select 21 communes in 3 research districts (Post-intervention survey)

Effectiveness of some intervention solutions

- Infrastructure index group

- Medical equipment index group

- Index group on types of reproductive health services provided at commune health stations

- Index group on affordability and service prices at commune health stations (opinions of

Medical staff)

- Index group on affordability and satisfaction when using services

Women's health care


Figure 2.4. Research diagram


2.6. Research variables and indicators

2.6.1. Some basic concepts

* Medical staff

Quantity: Implemented according to Joint Circular No. 08/2007/TTLT-BYT-BNV dated June 5, 2007 of the Ministry of Health - Ministry of Home Affairs. The minimum staff of a commune health station is 5 staff.

The human resource structure has 5 groups of professional titles: doctor; physician (general practitioner/medical/obstetrics and pediatrics); secondary midwife; secondary nurse; secondary pharmacist (for mountainous areas, it can be a primary pharmacist, can be full-time or part-time). The human resource coefficient is adjusted according to geographical area: Plains and midlands: coefficient 1; mountainous areas, remote areas of the Red River Delta and Mekong Delta: coefficient 1.2; highlands and islands: coefficient 1.3;

* Infrastructure

According to criterion 3 (infrastructure) in the National Standards on Commune Health for the period 2011-2020, each commune health station must have at least 10 functional rooms with sufficient area to perform assigned functions and tasks:

- Clinic

- Traditional medicine

- Pharmacy, warehouse

- Laboratory (paraclinical)

- Sterilization

- First aid room, emergency room

- Save patients and pregnant women

- Gynecology and family planning clinic

- Delivery room

- Injection room

- Counseling room, TT-GDSK, DS-KHHGĐ


- Administration department

- Duty room

In particular, to provide reproductive health services, at least 4 rooms are needed: (1) Pregnancy examination and consultation room; (2) Delivery room + procedure, (3) Gynecological examination room; (4) Obstetrics and gynecology room and if possible, 2 more rooms should be arranged: (1) obstetrics and gynecology room and (2) Communication and consultation room/corner [7].

* Domestic water source, toilet, waste treatment

Basic hygienic domestic water sources are based on the National Technical Regulation on domestic water quality issued under Circular No. 05/2009/TT-BYT dated June 17, 2009 of the Ministry of Health.

Medical waste mainly consists of solid waste and liquid waste, divided into hazardous waste and normal waste. Normal waste is treated according to local regulations. Hazardous medical waste is collected and treated according to industry regulations under Decision No. 43/2007/QD-BYT on promulgating the Regulation on medical waste.

* Medical equipment

The list of equipment for commune health stations issued by the Ministry of Health is currently in accordance with Decision No. 437/QD-BYT dated February 20, 2002 of the Minister of Health. The list has a total of 176 types. The types of equipment must be suitable for the health care needs of the people in the commune and the professional capacity of medical staff at the commune health station.

According to the National Guidelines on Reproductive Health Services (Issued with Decision No. 4620/QD-BYT dated November 25, 2009 of the Minister of Health), essential equipment for Reproductive Health Services for a health facility includes [7]:

- 1 pregnancy test kit

- 3 sets of birthing kits

- 1 set of episiotomy sutures


- 1 cervical screening kit

- 1 neonatal resuscitation kit

- 1 set of intrauterine device placement and removal

- 3 gynecological examination kits

- 1 set of manual vacuum aspiration pump with 1 valve

- Other tools

* Types of reproductive health services provided at commune health stations

According to Decision No. 385/2001/QD-BYT of the Minister of Health dated February 13, 2001, [16] Commune health stations are responsible for providing health care services including 11 obstetric techniques, 3 gynecological techniques, 5 family planning techniques, and 7 child health care techniques. In particular, the basic essential obstetric emergency service at the commune level includes 5 techniques:

- Antibiotic infusion;

- Oxytocin injection and infusion;

- Use of anticonvulsants in the treatment of preeclampsia and eclampsia;

- Peel vegetables by hand and

- Take placenta, remaining fetus

* Essential drugs

The list of main medicines applied to commune health stations is currently according to Decision No. 05/2008/QD-BYT dated February 1, 2008 of the Ministry of Health. The number of medicines selected is according to the regulations of the Department of Health to meet the basic medical examination and treatment needs of local people.

Essential drugs for reproductive health care at commune health stations are implemented according to Decision No. 17/2005/QD-BYT of the Minister of Health, including:

- Pain reliever, anesthetic

- Antibiotics

- Antihypertensive drugs


- Antiseptic and disinfectant

- Antispasmodic

- Uterine contraction drugs

- Sedatives

- Vitamin and mineral group

- Contraceptive group

- Other drug groups

* The ratio of women having abortions to the number of births : is the number of women having abortions over the number of women giving birth in the year.

* Percentage of women giving birth who receive prenatal check-ups 3 or more times during 3 pregnancies (calculated on the total number of women giving birth in the commune during the same period). 3 pregnancies are the first 3 months, the middle 3 months and the last 3 months. Calculated until the woman has finished giving birth; not counting the check-up when she is in labor.

* Rate of women receiving postnatal care : is the number of mothers and newborns examined and cared for by medical staff from birth to 42 days after birth, calculated on average per 100 live births in the commune in a specified period. In case of only caring for mothers or newborns, it is also counted.


Percentage of women receiving postpartum care (%)

Total number of mothers giving birth in the commune receiving postnatal care (care for both mother and child, or mother or child) in the year


Total number of live births in that commune during the same period

= X 100


* Proportion of couples of childbearing age using modern contraception : This is the percentage of women of childbearing age (15 to 49 years old) whose husbands are using or whose husbands are using one of the contraceptive methods such as IUD, sterilization, birth control pills, condoms,


Cervical diaphragm, spermicide cream among total married women aged 15 - 49 in the commune (actual population).

2.6.2. Main research variables

- General information about the service provider

+ Medical staff: age, gender, seniority, professional qualifications, training time.

+ Facilities, essential medical equipment, and reproductive health services provided at the commune health station

+ People's reproductive health care needs and the ability of commune health stations to respond.

- Information on the users of reproductive health services: age, number of people in the family, family economic situation, status of reproductive health services use, opinions on the quality of reproductive health services at the commune health station, ability and viewpoints on paying for reproductive health services

2.6.3. Evaluation index before and after intervention

* Infrastructure index group:

Percentage of commune health stations with maternity clinics

Percentage of commune health stations with gynecological clinics Percentage of commune health stations with family planning technical rooms Percentage of commune health stations with delivery rooms

Percentage of commune health stations with maternity rooms

Percentage of commune health stations with communication and counseling rooms/corners

Percentage of commune health stations with regular clean drinking water Percentage of commune health stations with clean water for hand washing

Percentage of commune health stations with hygienic toilets

Percentage of commune health stations with clean and hygienic service rooms

Percentage of commune health stations with clean environment around the station

Percentage of commune health stations with garbage containers


Percentage of commune health stations with regulations on customer rights Percentage of commune health stations with service price lists

Percentage of commune health stations with waiting chairs for customers

Percentage of commune health stations with communication materials on reproductive health care

* Index group on medical equipment and essential drugs serving reproductive health care

Percentage of commune health stations with delivery kits

Percentage of commune health stations with episiotomy suture kit

Percentage of commune health stations with cervical screening kits

Percentage of commune health stations with neonatal resuscitation kits

Percentage of commune health stations with intrauterine device insertion and removal kits

Percentage of commune health stations with gynecological examination kits

Percentage of commune health stations with 1-valve Karman suction pump

Percentage of commune health stations with a complete list of essential drugs for reproductive health care

* Index group on basic reproductive health services provided at commune health stations

Percentage of commune health stations providing antibiotic infusion services Percentage of commune health stations providing uterotonic injection services Percentage of commune health stations providing anticonvulsant injection services

Rate of commune health stations providing artificial placental removal and uterine control services

Rate of commune health stations providing uterine curettage services

Rate of commune health stations providing vaginal delivery support services

Rate of commune health stations providing emergency services for newborn asphyxia

* Index group on affordability and service prices at commune health stations (opinions of

Medical staff):

Percentage of commune health workers who answered correctly and fully about the service prices to be collected

Percentage of commune health workers who answered that service prices can cover actual costs

Percentage of commune health workers answering the impact of fee collection on service use


* Group of indicators on women's ability to pay for reproductive health services:

Types of payment for CSSKSS services

Women's ability to pay for reproductive health services

Percentage of women satisfied with using reproductive health services

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