Southern Ethiopia - Gwent Health Link

 Evaluation data/evidence from other sources

Feedback from a number of other sources relating to specific and/or general aspects of the work of the Link can be related to the Exemplar Health Centre project. This includes formal workshop evaluations and pre and post workshop tests. The full results of these are available on request. Workshops are held on an annual basis for health officers, for nurses and midwives and for laboratory technicians. The workshops are linked to the Exemplar Health Centre project as course participants are drawn from all Health Centres and small community hospitals across SNNPR, including from the three project Health Centres. Evaluations document that workshops are valued by participants who state that they meet their needs for updating knowledge and skills. Pre and post workshop tests show improved knowledge. Demonstrating that the workshops have an influence on knowledge and skills in practice is more difficult to measure however, but there can be small opportunities to do so through observation in the Health Centres. There are single examples of evidence from Health Centres 1 and 3 that the workshops have had a positive influence on practice. (See sections on’ Findings and Analysis of Evidence, March 2008’ and ‘Health Centres self- evaluation’)

At the joint Health Centre/Link/Woreda/community meeting held in each project Health Centre during the March visit, there was spontaneous public appreciation of the work of the Link thus far. Examples were cited where training, equipment and support has begun to improve the Health Centre. Following receipt of a new delivery couch and bed sheets at the end of the March visit, written letters of thanks were received from Health Centre 3, signed by all staff members including the cleaners and guard. A follow up letter states …‘you are the reason why our health centre is more clean and helpful for the patients. About the bed sheets, I can see the patients feeling now that they are happy we are also very much happy’…

The Ethiopian Link co-ordinator accompanied the Gwent team for much of the visit in March so it was possible to discuss with him his perceptions/observations. Familiar with the project Health Centres before the Link began working with them and also familiar with the training of health professionals in Ethiopia, his feedback testified to the value of the workshops for updating essential skills. He also observed a genuine interest in Health Centre staff and the communities, of working with the Link to effect change and improvements in the Health Centres.

The Link Adviser in Ethiopia during the March 2008 visit participated in a post visit ‘review and reflection’ session with the Gwent team. Feedback from the Link Adviser was that the Link is greatly valued, particularly the ‘on site’ skills training. He reported noticing a real difference in the skills of students and staff who have completed a workshop. Health Centres were said to be challenging places to work, particularly for young and inexperienced staff, so the ongoing support of the Gwent team is very much appreciated. The Link Adviser is of the view that the partnership approach is a particular strength of the Link, one which ensures that equipment provided is both useful and functioning and that members of staff are trained in its correct use. The Link Adviser stated that he firmly believes that everyone involved has real confidence in the Link.

The post visit reports of members of the Gwent team document valuable observations and insights into the work within the Health Centres and comment on factors that may influence the care environment. Analysis of these shows ‘leadership’ and ‘basic nursing care’ as common observations. These areas can be discussed with Ethiopian partners and form the basis of some further training sessions. The post visit reports also testify to the commitment to the Link of Ethiopian partners and hence perceived value to them, for example: ‘…it felt as if we were all greeted by ‘family’, this shows the commitment between the Link and its partners and the substantial progress that has been made’ (post visit report re Health Centre 1) and ‘all the staff were welcoming and gave their time freely. They seemed eager to talk about their situation, learn from others and work together’. (Post visit report, overall comment)

A group interview was held with forty three student midwives in their second year of training. No student had experienced a clinical placement in a Health Centre at this stage. The occasion was therefore used to discuss the midwifery course and experience of clinical practice to date and to undertake some spontaneous skills teaching. The group commented on the large numbers of students on placement at any one time which reflects the observations made in the Health Centres in November 2007. Interviewing students on placement in the project Health Centres is planned for future visits/evaluation work.

The Link is/has been involved in other activities to meet its aims and objectives on a wider basis, for example, a senior doctor was sponsored for twelve months to go to India to undertake a course in urology. Having recently qualified, he is now the only urologist for a population of fifteen million. Letters of appreciation from Ethiopian colleagues testify to the value of investment in his training. In the longer term it should be possible to quantify the extent to which this is of benefit to patients.

Equipment has been provided to other hospitals, for example, Dilla community hospital and Hwassa referral hospital and there is evidence through feedback from Ethiopian colleagues that much of it has been used. At an unscheduled visit to Dilla hospital in March 2008, an elderly gentleman was observed receiving oxygen via the oxygen concentrator provided by the Gwent team. Training materials were also provided to Hwassa College of Health Sciences and observation and discussion with teaching staff in November and March found that it was used to varying degrees. Some issues with access to the training materials were reported.