1. Partnership Defined Quality:
A Methodology to build Social Accountability
Beth Outterson
Reproductive Health Advisor
October 16, 2013
PDQ: A Methodology to Build Social Accountability

2. Partnership Defined Quality (PDQ)
•
Improves quality and accessibility of services with greater involvement of the
community in defining, implementing and monitoring the QI process.
•
Providers and community members (both users and non-users) work together to
identify and address priority problems.
•
Recognition that quality may be defined from different perspectives (client/
provider)
•
Recognition that providers and clients can work together as allies to address
problems – overcomes blame
•
Process for identifying problems separately, bringing providers and community
members together, and establishing QI teams of providers and community
members to address problems and continue to identify new ones in cyclical review.
PDQ: A Methodology to Build Social Accountability

3. When to Use PDQ?
• When action is needed -- not just information sharing
• When stakeholders - both providers and community
want change
• When there is a willingness to listen and change how
things are done locally
PDQ: A Methodology to Build Social Accountability

4. How PDQ builds Social Accountability
• Marginalized members address duty bearers
• Community takes ownership to improve health using
existing resources
• Client satisfaction and provider performance increase
along with overall health status
• Creates mechanism for rapid mobilization around
health priorities
PDQ: A Methodology to Build Social Accountability

5. PDQ Process
PDQ: A Methodology to Build Social Accountability

6. Country example – Afghanistan
ACCESS /HSSP Project
Context:
• Low coverage for safe motherhood services:
• ANC coverage (45%)
• Deliveries by skilled birth attendant (19%)
• Postnatal care (29%)
Program goal
• Increase access to safe motherhood services
• Enhance quality of safe motherhood services
Expected outcomes:
• Increased coverage of ANC, SBA and PNC
PDQ: A Methodology to Build Social Accountability

7. Preparation and Planning
• Orientation sessions with provincial and district MoPH and NGO
staff
• Involved MoPH and NGO staff in the preparation and planning
process
• Community Mapping (identifying areas with low coverage)
• Data analysis (HMIS) and discussions
• Prepared agenda for community shuras (male and females)
• Feedback on health indicators
• Orientation on PDQ process and role of community shuras
• Time/date for PDQ inquiry
PDQ: A Methodology to Build Social Accountability

8. Phase 1 – Building Support
• Two day workshop with community shuras (religious leaders,
teachers, communityrepresentatives):
• Feedback on health indicators
• Community Mapping (re-confirming areas with low
coverage)
• Discussions – access problems
• Orientation on PDQ process – role of community shuras
• Developing PDQ inquiry checklist
• Setting time and dates for PDQ inquiry
PDQ: A Methodology to Build Social Accountability

9. Phase 2 – Exploring Quality
Exploring quality (Community)
• Checklist developed in consultation with community shura
(male and female)
• Women using health services
• Women not using health services
• Caregivers
• Family members
Exploring quality (Health workers)
• FFSDP conducted
• Staff interviews
• FGDs (PDQ inquiry)
PDQ: A Methodology to Build Social Accountability

10. Phase 3 – Bridging the Gap
• Involved MoPH and NGO staff in the preparation and planning of
bridging the gap workshop
• One day in advance notification (male and female sessions separate;
same agenda)
• Participants:
• Community shuras (male and female)
• Health facility staff
• Selected caregivers or clients
• Both health facility staff and community presented their point of
view to each other (categorized information)
• Developed shared vision by using Venn diagram
• Problems are identified and prioritized
• Root causes identified (problem tree analysis)
PDQ: A Methodology to Build Social Accountability

11. PDQ: A Methodology to Build Social Accountability

12. Phase 4 – Working in Partnership
• Quality Improvement Team developed
• Members from existing community shura
• Health Facility staff
• Selected caregivers/clients
• Village administrators
• 6-8 members
PDQ: A Methodology to Build Social Accountability

13. Example of action plan
PDQ: A Methodology to Build Social Accountability

14. Accomplishments
• ANC coverage increased
• 45% in 2004 to 62% in 2006
• Deliveries by SBA increased
• 19% in 2004 to 25% in 2006
• PNC increased
• 29% in 2004 to 41% in 2006
• DPT3 vaccination coverage increased
• 43% in 2005 to 77% 2006
• Community participation – meaningful; sustainable
• PDQ recognized as national quality assurance standard
• ACCESS/HSSP project
• Scaled up to 13 provinces
PDQ: A Methodology to Build Social Accountability

15. Measuring community capacity
• Measurement tools:
• Exit interviews: client satisfaction
• Supervisory checklist for QIT Function (rotational
leadership, gender equity, inclusion, joint decision making)
• Findings:
• PDQ communities vs non PDQ communities: > improved
provider performance (Pakistan, Nepal, Armenia)
• Empowerment: sustainability, QITs (return visits)
• Sense of pride, ownership of health center was expanded
to other aspects of community life
PDQ: A Methodology to Build Social Accountability

16. Challenges
• Working with the least advantaged—the poor
• Frequent postings and transfers of health center staff
• Time consuming process
PDQ: A Methodology to Build Social Accountability

17. Resources
PDQ Manual
PDQ for Youth Manual
PDQ Facilitator's Guide
PDQ M&E Toolkit
11 PDQ Monographs
Please contact Beth Outterson at
boutterson@savechildren.org
PDQ: A Methodology to Build Social Accountability