COMMUNICATION
STRATEGY
for the
QUALITY OF CARE
INITIATIVE
Prepared April 2001
DISH II PROJECT
TABLE OF CONTENTS
Background……………………………………………………………………...3
Strategy Overview………………………………………………………………3
Phase 1: Sensitisation………………………………………………………….4
Phase II: Provider Campaign…………………………………………………7
Phase III: Community Campaign - Part 1 & 2………………………….…..8
Workplan…………………………………………………………………………10
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Background
In July 2000, representatives from the Ministry of Health, District Health Services, DISH II,
and Population Council developed a strategy to improve and maintain basic standards of care
at health facilities. The rationale behind this strategy development was the general consensus
that quality of health services needed improvement in the DISH II districts. Health services in
the districts were under-utilised and DISH HMIS sentinel reports showed that utilisation for
reproductive health services had been declining for the past year. Typically, low utilisation
occurs when service quality is poor. In addition, studies and supervision visits to health
facilities have found need to improve services in a number of key areas.
Based on successful interventions in Egypt and Brazil, the developed quality of care strategy
is designed to: 1) enhance service provider self confidence and performance; 2) institute a
team approach to support better quality services; 3) involve communities in quality
improvements; and 4) maintain quality through a system of certification and reward.
Since that time, the basic standards for health care have been drafted, as well as a
standardised, objective assessment tool to use when evaluating a facility based on these
measurements. In late January 2001, the assessment tool was validated in seven different
districts: Hoima, Mpigi, Luwero, Mbarara, Ssembabule, Kamuli and Mbale. The validation
exercise took place at 4 facilities in each district - a Health Centre II, III, IV and a Hospital.
The validation evaluated not only the operational feasibility of the tool, but collected feedback
from the community, providers and district health officials on standards, the tool and the
quality of services in their district. The results were summarised and presented to the working
group for further examination. At that point, additional changes were made to the standards,
incorporating discoveries from the exercise. Currently, the Ministry of Health is considering
the Quality of Care strategy for nation-wide implementation.
The next stage of the quality of care program is the dissemination and implementation of the
basic standards in 12 DISH districts. For this phase to take place successfully, a carefully
crafted communication strategy must be implemented simultaneously.
Strategy Overview
The communication strategy for the quality of care initiative involves three aspects.
Phase 1: Sensitisation
It is important to sensitise the community leaders and health workers about the quality of care
strategy as they are key to the overall implementation of the program. With the support of
these main audiences, the program has a higher likelihood of success. Sensitisation will
involve a clear description of the program, what role the audience can play and projected
outcomes. Elements of the sensitisation campaign include not only developing the quality
"symbol" for the program, but also producing materials that describe the program and identify
channels for disseminating these materials.
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Phase 2: Provider Campaign
This phase of the communication strategy is aimed solely at health providers. The purpose
behind the campaign is to encourage health providers to change some of their negative
attitudes and poor practices that directly impact the quality of services for clients.
Phase III: Community Campaign - Part 1 & Part 2
The community campaign, targeted to the general population, is twofold. The first aspect
involves sensitisation and education of community members about the quality of care strategy
and encourages their participation in quality improvement activities. The second portion of
the campaign educates the public on what it means when a health facility is recognised and
encourages the utilisation of such health units.
PHASE I: SENSITISATION
A. DESIGNING THE QUALITY SYMBOL
Before developing the sensitisation program, it was necessary to outline the parameters for the
quality symbol. It is important to identify what the symbol should mean to the public, as well
outline some general descriptive measures. This information will be forwarded to the ad
agency that will create sample symbols for review.
The symbol should represent/evoke:
1. Good quality
2. Caring, friendly service providers
3. Appropriate, competent treatment
4. Partnership between service providers, clients and community.
The symbol should be:
 Unique
 Recognisable by low literates
 Easily reproduced (can be printed in black & white and is still legible; minimal
colours)
 Not language dependent
 Appealing to all cultures
 Easily described in words
 Simple
B. SENSITIZATION PROGRAM
The first integral part of the Communication Strategy is the sensitisation of various audiences
about the Quality of Care Strategy. In order to improve services and increase the utilisation of
health facilities, the people must first understand what quality mean and how they are directly
impacted by such a program. There are two main audiences to consider and each will require
a separate line of sensitisation.
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GROUP 1: Leaders
Primary Audience
Leaders -- men and women of the community who represent and guide political, civic,
opinion and religious sectors.
Leaders play an important role in the flow of information within a community and thus, used
appropriately, can greatly impact the overall success of an initiative. In particular, leaders
influence the public, help pass the message/advocate to others, control funds, have the
power/authority to change things, have followers and enemies, are knowledgeable, can
encourage "ownership" of initiative throughout the community. These same people want o
remain informed, maintain their status and increase recognition, receive credit for positive
achievements, demonstrate to communities their exemplary behaviour and minimise risks to
their position.
Objective
To get leaders to understand, endorse and actively support the initiative.
Key Promise/Benefit Statement
You will be recognised/known for bringing improved health services to your community if
you endorse and support the quality of care initiative.
Message Points
 Why there is a need to improve quality? (Because services are currently under-utilised)
 Efforts to improve quality of health services are already underway
 Describe what is meant by basic health care standards
Support Points
 Describe what activities will be done to help facilities meet the basic standards, monitor
standards and recognise/reward facilities that maintain the standards
 The QOC initiative is a government program through the Ministry of Health (include
quotation concerning quality from the National Health Policy)
 Show examples of successful initiatives in Egypt, West Africa and Brazil
 Encourage leaders to: 1) help educate the communities about what they can expect; 2)
endorse the initiative in your speeches and communications; 3) help disseminate
information about the initiative to all levels of political system; 4) contribute to quality
improvement activities so facilities meet standards; 5) participate in awards ceremonies
and monitoring of health facilities in your area; 6) assist the district to mobilise resources
as required for facilities to meet basic standards (e.g. renovations, construction,
equipment, timely salaries)
Channels/Media Used to Communicate this Information to the Audience
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1. The QOC Working Group with MOH representation orients the District Health
Committee, District Health Management Team and the Secretary for Health during a 1day workshop that results in a District Sensitisation Plan to sensitise the following groups:
District Local Council, District Executive, LC III Executive/Sub-County Chiefs, SubCounty Health Committee, and Health Unit Management Committees.
2. Post assessment meetings with Sub-County Health Committee.
3. 1-2 page colour flyer describing the strategy and showing the symbol for use during
sensitisation meetings.
4. Updated flyer to be distributed after 6 months showing leaders' active involvement and
recognition with the program.
5. Copies of basic standards for distribution to leaders.
6. Lapel pins for leaders to wear with the symbol.
GROUP 2: Health Professionals
Primary Audience
Central Ministry of Health, District Health Representatives, Health Sub-District
Representatives and Providers
Objective: Educate the audience about the QOC initiative and gain their commitment to
achieve and maintain the basic standards of quality.
Key Promise/Benefit Statement
If you are committed to achieving and maintaining the basic standards of quality you will
improve your working conditions, improve the services provided and thus be recognised as a
good health professional.
Support Points:
 Describe the initiative with background/history of development and give examples of
where this type of program has worked
 Why should we improve quality? Poor client perception discourages timely care and
causes a poor provider image and status in the community. Not meeting the client's needs
and expectations will cause the client's health status to be poor.
 Describe the standards
 Describe the monitoring and evaluation process - emphasise the whole supervision
system.
 The standards are part of the National Supervision Guidelines (NSG) - it's a government
program. Quote from National Policy.
 Describe the role of leaders, clients and community members in improving quality of care.
 Testimonials from health professionals working in similar programs that have been
successful
 Identify how people at all levels of the system can work as a team to help facilities meet
the standards.
 Give examples of how the initiative will improve their working conditions and services.
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Channels/Media Used to Communicate this Information to the Audience
1. District and HSD - sensitised through DHMT meetings
2. Central MOH - quality assurance committee meetings, formal communications from top
management
3. Production of a booklet on the Quality of Care Initiative including Standards
4. Guidelines for process of assessing the standards and monitoring (Technical instruction)
5. Sensitise HSD supervisory teams who will sensitise the health workers during supervision
visits
6. DHMT sensitises the in-charges at the monthly meeting of the HSD.
7. Sensitisation could also take place during in-service training.
8. Flyer/brochure describing program for distribution during training/meetings.
9. "Ask me about" buttons/badges for providers to wear
10. Activation Kits including poster(s) for health facilities which list the standards, stickers
emphasising good services, Health provider charter/Provider's pledge, list of ways to
involve your community to improve health facility
PHASE II: PROVIDER CAMPAIGN
Audience
Any service provider at all levels and types of health facilities
Objective
To improve the quality of relationships between providers and clients in order to contribute to
improved quality of services.
Key Promise
You will be recognised and appreciated for the services you provide.
Key Messages
1) Show your clients that you respect them by:
- Explaining procedures, treatments, reasons for delays or what is going on
- Not making them wait a long time
- Listening attentively
- Encouraging them to discuss problems
- Giving clear instructions on procedures/treatment
- Spending more time with them
- Providing a welcoming environment
- Putting yourself in their shoes
2) The way you treat your clients and your attitude is just as important as technical
competence. Providers who have both earn the respect of the community, and are seen as
important assets.
Support Points
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Demonstrate how it feels to be a client not treated respectfully and show the contrast to
treating clients with respect
Role Models
Client and community leaders testimonials/Votes of thanks
Supervisors praise and recognise good IP skills of providers/positive criticism
Channels/Media to Communicate These Messages to the Audience:
1. Provider Brochure/Newsletter (recognise good providers, recognise quality facilities,
brand it with quality symbol)
2. HSD Award by HSD Supervisors
- Supervisor Kit with instructions and guidelines
- 2 Certificates (provider and facility)
- Post photos in newsletters/Post photos at DDHS
- Tie award name to name of newsletter
- Some point of service gift (mug)
3. TV Series Episode demonstrates key messages/Videos
4. Activation Kits: Add items for these messages (stickers, danglers); provider charter
5. Radio Program - work in messages for providers into current programs
6. Radio spots focus on what clients want from providers
7. Briefing packets to professional associations (encourage member participation on local
radio talk shows)
PHASE III: COMMUNITY CAMPAIGN - PART 1 & 2
A. COMMUNITY CAMPAIGN - PART I
This campaign will take place as health facilities begin the quality of care process and are
striving to meet the standards.
Audience
Community members who are clients of the health facilities and potential clients.
Objective
To convince the audience that the health providers are concerned about the quality of services
at their facility and need their active participation to improve the process.
Key Promise/Benefit Statement
If you participate in the quality improvement process, you will receive better quality services.
Support Points
 We are aware that services need improvement and we are taking steps to improve them.
 Government has initiated a new program to improve services but we need your
involvement.
 Ask your providers/HUMC about the QOC initiative and what you can do to help.
 Show appreciation for service providers who provide good quality care
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Channels/Media to Communicate These Messages to the Audience
1. Localised radio spots
2. Posters
3. Health Matters about Quality of Care
4. Encourage providers to hold village meetings to create awareness - include suggestions in
Activation Kit.
B. COMMUNITY CAMPAIGN - PART II (Recognition/Reward)
This campaign will begin once health facilities meet the standards.
Primary Audience
Men and women 15+ older living within the catchment area of a health facility.
Secondary Audience
Service providers, leaders
Objective
To recognise and increase utilisation of health facilities providing good quality services.
Key Promise
If you utilise a recognised health facility, you will get services you can trust from competent
and caring providers.
Support Points
 Describe initiative - setting and monitoring standards, working to improve services
 Government (MOH) initiative
 Explain what the symbol represents. Meaning of the symbol:
1. Meets MOH's standards for good quality which includes client concerns
2. Describe standards as:
*Clean service environment
*Basic equipment
*Drugs available
*Shorter waiting time
*Competent trained providers who will address your concerns and answer your
questions
 Come to the facility, tell us what you think of it, and tell your friends about it.
 Thank community for support and encourage continued support to maintain good quality
of care.
Channels/Media to Communicate These Messages to the Audience:
Activities occurring at the beginning of the campaign:
1. Symbol plaque for facility
2. Facility certificate with dates
3. Award Ceremony: high profile with press coverage
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4. Packet of materials/guidelines for community ceremony: press kit, Health Matters to
educate community, flyer to advertise that facility has received symbol; T-shirts and caps
for providers
5. District Counting Display Board
6. Include messages in current radio program
Activities occurring after critical mass of health facilities receive symbol:
1) Jingle and radio spots
2) Posters
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