Southern Ethiopia - Gwent Health Link

Health Centre ongoing self-evaluations

Health Centre staff began their ongoing self evaluations in April 2008 and to date, have provided written reports for two months (April and May). Self monitoring is focused on similar measures to those used by the Gwent team, i.e. use of computers and equipment, cleanliness of the Health Centre, training of staff and use of skills, statistical information relating to births as well as patient and staff satisfaction (see appendix 6 for pro forma guidance).

It is early in the process of self monitoring and therefore data is limited. There is however evidence that the Health Centres are using various items of the equipment provided, to some extent at least. There is active monitoring of the cleanliness of each Health Centre on a regular basis and perhaps for the first time, users are being asked for their impressions and opinions on the service provided. This activity seems to be valued highly by both staff and patients, for example one health officer reported ‘it is really wonderful to talk to the client about their feelings and to accept comments from them’ and cited a patient who told her that he ‘was very much happy to talk to the head of the health centre’ (Health Centre 3, April report). There is evidence from the patient interviews that users of the Health Centres perceive an improvement, for example: ‘the cleanness of the health centre better than the previous time’ (Health Centre 1, April report) and ‘it is good, I choose this Health Centre that is why I came here’ (Health Centre 2, May report), but there is also more work to be done, for example ‘at the beginning the health workers didn’t start on time so I have waited a lot’ (Health Centre 3, May report). Computer logs have been completed in Health Centres 1 and 3 but the recorded numbers for use of the computer are relatively small. There was no record in the computer log for Health Centre 2 although the April report states ‘the staff members were not able to use one computer due to technical problems but some of them have been using the other. None of the staff members were recording their activities in the log book so it is not possible to trace who used the computer and when’. There is evidence of a change in practice in Health Centre 3 following the midwifery skills workshop in October 2007 and the teaching and advice given at the visit in March 2008. The Health Centre staff member monitoring data in Health Centre 3 reports: ‘almost all staffs are now not doing episiotomy this is a great change in our health centre’ (May report). There are also areas where change may take longer to achieve, for example delivery in positions other than lithotomy. Only Health Centre 1 reports that lithotomy position is seldom used.

In the past three months, staff in the Health Centres have had to cope with limited (at best) resources, poor estate maintenance, fluctuations in electricity supply (Health Centre 1), difficulties with water supply (Health Centre 2) and tribal conflict (Health Centre 3). The self evaluation exercise in itself is a new concept to most but it is reported to help staff as ‘it makes everybody to be motivated’ (Health Centre 3, April report). Overall, the initiation of this activity has been very positive.