Publications

---

Communication Impact! 4

Egypt's Gold Star Quality Program Wins Clients and Communities (November 1998)

The Egyptian Ministry of Health and Population (MOHP) and Ministry of Information (MOI) are showing the world how to put quality of care at the top of the national health care agenda. The Gold Star Quality Program is the largest public sector family planning quality improvement program in the world. It aims to upgrade the quality of Egypt's family planning services while creating among the public and service providers an expectation that services will meet the new standard of higher quality. It stimulates the supply of quality services through better training and supervision of health care providers and it stimulates demand by promoting these higher quality services to the public.

This USAID-supported Quality Improvement Program (QIP) helped increase the public sector's role in providing family planning services from 30% in 1992 to 40% in 1997. Between 1995 and 1997 the country's overall contraceptive prevalence rate increased from 47.9% to 54.5%. (Figure 1)

The Gold Star Quality Program

The Gold Star Program Applies the PRO Approach (Promoting Professional Providers) to position, publicize, promote, and recognize individuals and work teams that provide higher-quality services and to encourage all service providers to make higher-quality services the norm. The three-step Gold Star strategy entails:

1. Promoting quality family planning service providers as a means of enhancing their self-image and job performance
2. Promoting certified clinics as sits for high-quality services
3. Associating these high-quality sites and services with an easily recognized symbol

Linking two important ministries, the innovative Gold Star Program partnership combines the extensive FP service delivery capacity of the MOHP with the strong communication skills of the MOI's State Information Service (SIS). The MOHP offers a national network of over 3800 outpatient service units, ranging from one-room rural units to multiple-room compexes in large urban hospitals. The MOHP system provides service access to the least well served, the poorest of the poor.

Providers include nurses as well as physicians who range from general practitioners to gynecology specialists. The MOI's SIS is recognized as a leader in family planning IEC. It conducts various campaigns using an effective mix of communications, ranging from counseling support materials at the clinic level, to spot advertising and entertainment formats in the mass media, to community outreach programs conducted through its national network of 62 local information centers.

The Gold Star

Focus groups and pilot testing revealed that the Gold Star was an appropriate symbol for a high-quality health program. This a Gold Star now appears on accredited clinics and all promotional materials as a mark of quality.

Clinics are supervised and rated each quarter according to a comprehensive checklist of 101 quality indicators. A clinic earns a Gold Star by attaining a 100% quality standards certification score for two consecutive quarters and retains its Gold Star by maintaining that score at successive quarterly evaluations. An MOHP clinic that earns and displays a Gold Star is considered among the best of the best.

Gold Star Communication Campaign

In the multimedia communication campaigns, catchy television and radio spots call attention to the Gold Star clinic sites and providers. Family health weeks, clinic openings and other community events highlight the services available. Signs and displays show clients exactly where to go. Within the clinics, Gold Star posters, desk plates, and lapel pins, reinforce the Gold Star image. And for individual counseling sessions, flip charts and method-specific procedures help clients make informed choices.

The initial campaign unfolded in two phases. A first wave of messages, aired when qualifying Gold Star sites were few, invited consumers to try the service. To encourage communities to place their trust in these services, the MOHP developed the slogan "Behind every door are friends and family who care about you and your family."

The second wave was launched after a critical mass of Gold Star clinics had begun to operate nationwide. It highlighted the Gold Star mark-of-quality and invited clients to use the nearest Gold Star clinics regularly. Communication workers from the SIS conducted Family Health Weeks, intensive week-long community mobilization and advocacy activities designed to build a sense of community partnership with the improved clinics.

Impact

The success in the MOHP quality initiative to date can be measured in at least six different ways:

• By the number of certified Gold Star clinics - 1,450 by early 1998 (Figure 2)
• By the increase in the proportion of users of MOHP FP services from 30% of all FP users in 1992 up to 40% in 1997
• By contributing to the increase in contraceptive prevalence from 47.9% to 54.5% over a two year period, for the first time exceeding half of the eligible population
• By the high levels of client satsfaction, especially with regard to waiting time, staff courtesy, and the amount of FP information provided (El Zanaty & Associates, in press)
• By the high levels of exposure to the campaign after eight months, as reported by 87% of women ages 15-49 and by recognition of the Gold Star logo by 45% (Central Agency for Public Mobilization and Statistics - CAPMAS, Egypt, 1998)
• And by the high levels of understanding among women (70%) and men (90%) that the Gold Star represents high-quality services and well-trained providers.

In addition to these quantitative measures, the success of the Gold Star approach is anectotally confirmed at the political and community levels. State governors increasingly want to be involved as keynote speakers at the high profile Gold Star certifications and ceremonies. They too want to participate in the media coverage, movie star appearances, and performing arts celebrations that have made Gold Star clinics a source of community pride. And, in the few cases where clinics have lost their Gold Star status, village elders demanded explanation from local health officials and clinic personnel for this decertification and insisted that their clinics be brought back to the high-quality levels of a Gold Star clinic.

From every point of view - clients, communities, health care providers, and policy-makers - the MOHP Gold Star program is a win-win story for quality of care.

To learn more about the Gold Star Project, contact:

© 2005 The Johns Hopkins University. All rights reserved.
Security and Privacy Policy, 111 Market Place, Suite 310, Baltimore, MD 21202, webmaster@jhuccp.org

Photos courtesy of Photoshare, a service of The INFO Project.