Health Center Contest in Kampong Trach Operational District,
For two years now, Kampong Trach Operational District has been conducting
annual awarding of the best health centers in its district. This was an idea that was
developed by the OD Vice-Chief when he realized that he could make good use of
the Monthly Health Center Supervision (ICS). The indicators were mostly health
service indicators and some aspects on HIS quality, staff discipline and working
hours. The awards include bicycles, cash awards from then PHD, bags from OD and
felicitation certificate signed by the PHD of Kampot. From the interview conducted
with the OD VC it was known that the hospital assisted in financing the ceremony
during the time when the income from the hospital health financing scheme was on
its peak. The bicycles came from the EPI program (10) and were distributed to top
ten health centers. For the awarding in 2001, the GTZ assisted in providing bicycles
(5) and assistance to the awarding ceremony.
Process in the Health Center Contest
The indicators that were used are listed in Annex 1 (Checklist for Health
Center Evaluation). It includes health services results e.g., ANC2, BS, EPI, OPD
among others. Other indicators include HIS quality, staff discipline and working
hours. The HC Chief and the OD Supervision Team agreed on these indicators. The
scoring system is done by assigning the highest score to the target for the year, e.g.,
target for ANC2 is 40% which is plotted against the highest score which is 6. For HIS
quality, the scores were taken from the Peer Evaluation System/HC Spot Check as
discussed in another paper (see Annex 2 – Excerpt of Comprehensive HIS in
Kampot). Equal weights are given to all the ten indicators.
There are several steps involved in collecting the data and ensuring reliability:
a. During OD supervision at the Health Center, the OD team fills up the ICS
form, checks HC1 and Health Center Register of the previous month. During
this time, the team also sees whether important schedules for outreach
activities, staff working hours, among others were pasted on the wall.
Supervision is not scheduled hence the HC staff does not know when the
team is coming.
b. During Discocom (meeting of HC Chief at the OD), HC1 were submitted to the
OD. It is also during this time that HIS quality is being checked through Peer
Evaluation System (see Annex 2). The results of last month's evaluation are
presented to the HC Chief. The HC Chief are then informed of their monthly
ranking. The OD VC also provides them a copy of the previous month's
c. The data for twelve months were collated and summarized and the best
health centers (number depends on available resources) are given awards.
Perception of Health Center Staff on the HC Contest
Interviews conducted to three health centers (Numbers 1, 5, 11 from 2000
contest) revealed the following:
a. Knowledge about the Health Center Contest
The Health Center Chief and some of its staff are aware of the contest and
link their score with the supervision results conducted by the OD Supervision
Team and the Discocom meeting. Most of them know some of the indicators
used and how they achieve such ranking. There was no opposition on the part of
the Health Center staff interviewed regarding their ranking. Most of the indicators
are quantifiable and sources are their own reports (e.g., HC1). All of them agree
that the contest is fairly treated.
The HC staff would like the contest to continue even without big awards
because it gives life to their work. During Discocom meeting there was a lot of
discussion because that is the time when they see that what they have
accomplished (or not accomplished) at the Health Center are discussed, given
attention and summarized. Question on what else motivates staff to be in a
competitive mood is still not answered fully.
c. Ways to improve
The Health Center Contest also allows the HC staff to be more aware of their
problems. The staff of the poor performing health center expressed that they
need the support of the OD/PHD on promotion of their EPI activities because of
its low acceptance by the population.
All the HC staff points to the following in achieving their targets:
- good community participation as the key in achieving the best results (with
and without NGO support),
- good planning of outreach activities,
- support from OD/PHD in terms of erring staff, health promotion activities
The best performing health center identified internal supervision and internal
conflict resolution as important aspects in achieving their results.
The health center contest in Kampong Trach is an innovative initiative by the
OD VC. It provides practical use of the supervision checklist and HC1. It also
maximizes supervision visits and Discocom meeting as venues to monitor activities
and compare one health center achievement with others. In that sense the HC chief
sees perspective beyond their health centers. A feeling of pride of being the best and
feeling of getting there motivates health center staff to work. It is interesting to note
that this initiative did not fall too much on the trap of motivating staff for financial
remuneration. It tries to capitalize on a human being's drive to do well and to
Listed below are some observations on what is good and what needs
improvement in the Health Center Contest in Kampong Trach District based on three
aspects: process, tools (indicators/criteria) and resource mobilization.
What is good What needs improvement/ still to be
- the evaluation of HC is done on a - need to set clear objectives of the HC
regular (monthly) basis contest
- results of the evaluation are known and - there is a need to continuously
discussed among the HC Chief improve HIS validity since this is the
most important basis for scoring.
- it makes use of the existing activity - there is a need to follow up and make
(supervision to HC, Discocom Meeting, use of Social Capital as a sustainable
etc) motivating factor for HC staff.
- participatory – the contest and
indicators used are all agreed by the
HC Chief and OD
- effort on integration – tried to put
together NP and support programs like
- capitalizes on advantages of
competition and HC staff's drive to be
- indicators are verifiable i.e., results - need to consider putting weight on
from HC1 is the primary source of data some inputs e.g., HC with or without
qualified staff, HC with or without NGO
support, the number of staff in HC, etc.
- Grading or Scaling of scores are - Can gradually start on putting other
objective i.e., target ranges are plotted quantitative indicators on HC
against the score management e.g., no of FBC meetings
and minutes, % of exempted patients
from HFS, income from HFS, etc.
Nevertheless, additional indicators will
only be useful once the objective for
the HC contest has been clearly
- Scoring aims toward achievement of - Can gradually start also on qualitative
target ie., target for the year has the indicators phrased quantitatively e.g.,
highest score on patient interaction, proportion of
patient greeted and patient
- indicators are mostly on health service - Can make use of other data collection
results (process indicators – utilization, method, e.g., direct observation, exit
coverage) interviews, community interviews other
than document review (HC1, HC
Register) which can be tampered
- - consider putting different weights on
criteria/indicators, more important ones,
- Resourcefulness and maximizing - Proper judgment is necessary when
resources e.g., making use of bicycles making use of resources that deviates
given by EPI program as award from original purpose. The initial
purpose of the resources should be
addressed first e.g., distribution of
bicycle to areas where it is needed then
the rest for the contest.
- The financial assistance from the HFS - There is also a possibility that HFS in
of the Kampong Trach District Hospital the HC can play a role in the
when it was functioning well played an sustainability of the Contest.
important role in assisting OD finance
It is premature to look into the impact of the health center contest to the
functioning and overall performance of the health centers in Kampong Trach.
Nevertheless, the initiative is quite promising. The fact that the OD VC tried to make
use of the supervision results and the health staff agreed to it is a good indicator that
there are still aspects in motivation (other than monetary) left untapped. This needs
further observation and attention.
Annex 2 Selection from the Paper on Comprehensive Health Information
System for Kampot PHD
Health Information System in Kampot
Improvement in Data Documentation
For three years now, PHD-HIS in Kampot with the support of the Reproductive and
Health Alliance (Racha) has been improving the quality of Kampot health data. In
1999, the first problem encountered was the irregular documentation of HIS data.
Often, these data were just written in small pieces of paper, which would later on
disappear. The PHD has not had yet the capacity to print forms for this. In the interim
the HC staff were taught to write down data in journal/book. Most health centers did
except that the forms were not uniform. The PHD-HIS and Racha then provided a
standard tabulation based on the MOH format. Then the PHD also made available
print forms for distribution to Health Centers.
After improvement in the documentation of HIS data, the next problem they realized
was that in most Health Centers, there were discrepancies between the data in the
HC1 and the Health Center Register. They then introduced the so-called Peer
Evaluation System. During monthly Discocom meeting at the ODs, the Health
Center Chiefs bring their respective HC1 and Health Center Registers. Two Health
Centers exchange their documents and check consistency of these two documents
(HC1 and HC Register) using the criteria (evolving) in form of a checklist (Annex A).
The results are then summarized in percentage and each HC sees their performance
(called quality validation) in relation to others in form of a bar graph (see example in
Evaluation on HIS Quality in Kampong Trach HCs
After the Peer Evaluation, the PHD-HIS, PHD-MCH and OD-HIS conducts HC spot
checking, choosing the best or the worst performing Health Center to conduct the
spot check monthly. They use the same checklist as the ones used in Peer
Evaluation at OD and compare it with the grading it has received at the OD.
Efforts on Data Visualization/Utilization
Racha, through the PHD-MCH, also introduced visualization of health data with
emphasis on MCH indicators i.e., ANC, BS, and EPI. Previously, the PHD/OD HIS,
EPI, MCH staff on how to make graphs from the health data collected, plot them
against the program's yearly target. The graph is then updated monthly. The OD HIS
staffs are the ones doing the graphs for HC. Recently, Racha conducted training to
Health Center staff on data visualization for them to do their own graphs.
The Malaria Unit of the Technical Bureau also assisted the Operational Districts to
make the data on Malaria useful for both the Health Centers and the Operational
Districts. The Head of the Unit (Mr. Saroth) provides graphs to the OD and from
there, analyses which HC has increasing incidence of the disease. Nevertheless,
visualization is done at the PHD level and distributed to the priority ODs (particularly
Chum Kiri in Chhouk).
Present HIS in Kampot
The result of regular peer evaluation on HIS limited if not eliminated the
inconsistencies between HC1 and HC Register (along with other problems) as can
be observed in the evaluation summary from 1999 – 2001 (see examples in Fig 2
and Fig 3). The visualization at PHD/OD also provided the staff clear signal on which
program in what OD/health center needs assistance.
Fig. 2 Evaluation of HIS Quality in Kampong Trach (1999 - 2001)
Svay Tong Tnot Boeng Sala Russey Srok Sre Chea Touk Meas Banteay Meas Damnak Kantourt Prek Kroes Sdach Kong Kanthor Kampong Trach
Fig. 3 Evaluation on HIS Quality in Kampot Province
(1999 - 2001)
Angkorchey Chhouk Kampong Trach Kampot
1999 87.85 69.62 84.02 71.53
2000 97.62 90.99 91.62 96.26
2001 99.14 95.5 96.25 99.02