Dominican Republic performance improvement project evaluation.

In June of 1998 the Dominican Republic was selected as one of the sites in which PRIME would test its Performance Improvement Approach (PIA). PRIME’S PIA is a methodology newly adapted from successful use in business which can be used to identify gaps in primary care provider performance the root causes of those gaps and the interventions that can be applied to fix those problem causes. At the suggestion of the USAID mission in Santo Domingo PRIME opened preliminary discussions with the Dominican Social Security Institute (IDSS). IDSS agreed to become a pilot test site focusing on the performance of family planning/reproductive health (FP/RH) providers at hospitals clinics and consultorios (physician offices). With technical assistance from PRIME IDSS PIA team members defined and identified indicators for the desired performance of FP/RH providers. Baseline data were gathered to determine the actual level of performance using these same indicators. Root causes were uncovered for performance problems and the team designed an array of interventions to address the causes. After prioritizing interventions a controlled operations research (OR) design was chosen to determine the effects of alternate intervention combinations on quality of care (QOC) and provider performance and whether lower cost interventions could have adequate effects without higher cost interventions. Three provinces were selected for testing the array of interventions. San Cristobal received the full set of interventions which included RH training for providers expectation setting by IDSS headquarters client feedback and dissemination of educational materials. La Romana received only expectation setting client feedback and educational materials. La Vega served as a control area and did not receive any intervention. Early results indicate that provider performance has improved significantly over baseline levels where the full package of interventions was applied. In areas where simple interventions were applied performance has not increased significantly. The nature of these interventions (e.g. feedback systems) may require more time to note performance changes. The short intervention time allowed between baseline and follow-up make the results informative but inconclusive. Longer-term follow-up should provide more compelling results. During follow-up interviews local project participants found the PIA useful and praised the participatory and systematic nature of the approach. The IDSS management plans to expand the interventions used during this pilot to a nation-wide application. (excerpt)