Academic journal article Bulletin of the World Health Organization

Improving Health Services to Displaced Persons in Aceh, Indonesia: A Balanced scorecard/Ameliorer Les Soins De Sante Destines Aux Personnes Deplacees a Aceh, Indonesie : Un Tableau De Bord prospectif/Mejora De Los Servicios Sanitarios Para Las Personas Desplazadas En Aceh, Indonesia: Metodo De Evaluacion Integral

Academic journal article Bulletin of the World Health Organization

Improving Health Services to Displaced Persons in Aceh, Indonesia: A Balanced scorecard/Ameliorer Les Soins De Sante Destines Aux Personnes Deplacees a Aceh, Indonesie : Un Tableau De Bord prospectif/Mejora De Los Servicios Sanitarios Para Las Personas Desplazadas En Aceh, Indonesia: Metodo De Evaluacion Integral

Article excerpt

Background

After the Indian Ocean tsunami in December 2004, there were 530 000 internally displaced persons in Aceh province, Indonesia. Local health care was often unavailable, since health workers were missing and facilities destroyed. The International Organization for Migration (IOM) worked with the Ministry of Health and local district health offices (DHOs) to construct temporary clinics for displaced populations.

Problem

As of November 2006, 34 000 persons still lived in temporary accommodation centres in the Aceh Barat and Nagan Raya districts of Aceh. (1) Local DHOs were occupied rebuilding a permanent health infrastructure, so temporary clinics had little support.

DHOs asked IOM to assist in monitoring temporary clinic operations. Through site visits, we learnt that the clinics lacked health promotion activities and maintained inconsistent stocks of supplies. Often health workers were newly trained, isolated and unsupervised. Unreliable financial arrangements between DHOs and the government agency for tsunami rehabilitation and reconstruction disrupted planning and contributed to high turnover of clinic staff. The absence of a health information system made it difficult to monitor service delivery and outcomes.

IOM proposed a balanced scorecard to document quality issues for each clinic and to serve as a management tool for DHOs and the Ministry of Health in this setting. A balanced scorecard is a set of simple measures used to describe and improve overall performance. (2) Afghanistan and the Netherlands recently adopted balanced scorecards to improve their national health systems, largely because of the tool's ability to quickly identify problems and guide action. In these countries, measures for the scorecard were derived from large national databases. (3,4) Such large-scale databases do not exist in Aceh. Instead, we conducted regular onsite surveys to generate information for the balanced scorecard, which then guided rapid cycle improvement efforts. (5)

Balanced scorecard

Development

In September 2006, IOM staff conducted initial assessments of temporary health clinics, concentrating on four domains: (i) health worker training; (ii) facility resources; (iii) community satisfaction and outreach and; (iv) service provision. In each area, we developed simple measures. Through discussions with district health officials and clinic staff, each measure was selected based on its significance, potential for improvement and ease of data collection (Fig. 1). We hoped to develop a sustainable model to be used by DHOs and local staff.

TWO local IOM staff members, a nurse and a public health specialist, collected data through interviews, observations and basic assessments such as counting supplies and determining water availability. In the accommodation centres, the team sampled every fourth household. Data were combined to create composite measures using STATA, version 9 (StataCorp, College Station, United States of America).

The scorecard was presented in an easy-to-read table with each measure in a row and each clinic in a column. Measures were highlighted on the scorecard by colour to signify whether target levels were met: green (met target), yellow (partially met target) and red (below target). For example, the "drug" measure was green for clinics with more than 90% of essential drugs in stock, yellow for 90-50% and red for < 50% (Fig. 1). Target levels were developed from focus group meetings with provincial and district health officials using national standards.

Implementation

The balanced scorecard was piloted in February 2007. Beginning in March 2007, it was implemented every 1-2 months in seven clinics and their nine associated temporary accommodation centres. The project was completed in December 2007, coinciding with the relocation of displaced residents to permanent housing and the closure of centres and clinics. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.