Southern Ethiopia - Gwent Health Link

 Next steps

The visit to the three project Health Centres in March 2008 enabled collection of some evidence which shows the extent to which training, equipment and resources have been used to date and to a lesser extent, with what effect. Review of this evidence will enable objectives to be set for future work, building on the positive aspects and addressing issues that need further work. For example, the teaching logs are not being used to record teaching/training of staff and the computer logs are completed infrequently at best. However, the Health Centres are cleaner since the project began, equipment is being used and there is some evidence for an improvement in knowledge and skills after skills training in the Health Centres and/or the workshops. The findings from the evaluation will be shared with Ethiopian partners and followed up at the next visit so that a cycle of ‘objectives/action – evaluation- review and reflection- objectives/action’ is established.

Observations and reflections of Gwent team members have identified possible new areas of work in the Health Centres, particularly relating to leadership and organisation. These will be discussed with Ethiopian partners to identify and agree a way to address these issues.

Work undertaken during the visit in March 2008 established some simple baselines for assessment of progress/change at subsequent visits. The baselines are individual to each Health Centre and focus on the teaching and advice given at the March visit. For example, in Health Centre 3, the examination couch in the ‘Emergency’ room was positioned in a way that limited access to both sides of the patient and the head. Advice and rationale was given regarding changing the position of the couch. Implementation of the suggested change can be assessed at the next visit to the Health Centre. Similarly in Health Centre 2, the leg stirrups in the ‘gynaecology/post abortion’ room were not clean and in Health Centre 1 the ‘minor injuries’ room did not have IV fluids and a giving set readily available for immediate use. Again, advice and rationale was given in spontaneous teaching during the ‘formal’ tour of the Health Centre with staff. A comprehensive list, appropriate to individual Health Centres has been compiled and will be used as a ‘check list’ for the next visit/evaluation work. A similar exercise of ‘formal’ review of the Health Centre with staff and documentation of change against the checklist criteria, followed by drawing up a new baseline for the subsequent visit, will be undertaken.

A healthcare worker in each Health Centre has begun to collect evaluation data on a regular (weekly) basis and reports to a co-ordinator monthly. This information is then shared with the Gwent team via e-mail. Initial feedback on the exercise from Ethiopian colleagues collecting the data is positive. The Gwent team have advised Ethiopian team members of the value of meeting each other on a regular basis to exchange experiences and the results of the audits in their Health Centre. They have also been advised to rotate the venue of the meetings between each of the three Health Centres to facilitate sharing of practice ideas, difficulties and solutions and to provide staff with a perspective different to the one in their Health Centre. The Link will fund the travel costs for exchange visits/meetings. The next visit to Ethiopia will enable Gwent and Ethiopian partners to meet and review the exercise at a six month period and to agree any changes to the process and/or information collected.

The Exemplar Health Centre project began with a scoping exercise and assessment of needs, followed by provision of essential/baseline training, equipment and resources. To develop each Health Centre into an ‘exemplar Health Centre/centre of excellence’, agreement on what constitutes an exemplar in this context, the criteria that could be used to define ‘exemplar’ and the scales of assessment, needs to be made. It is important that definitions and criteria are relevant to the settings in which they apply and are ones to which Ethiopian colleagues can relate. For example, ‘clean’ may be one descriptor but what constitutes ‘clean’ and how should it be assessed and by whom? It may be a desirable feature of an exemplar Health Centre that staff training takes place – but what and by whom and to what standard? How will this be evidenced? How will the impact on patient care be incorporated into the descriptor and measurement tool? This work will therefore be done in conjunction with Ethiopian partners, once they have had an opportunity to review and reflect the practice in their own and other Health Centres after the initial exercise of monitoring and collection of evaluation data. Work with them on defining an ‘exemplar’ Health Centre will begin at the next visit to Ethiopia in October/November 2008.

Evaluating the work of the Link has so far focused on evaluating discreet aspects of the work, for example, the individual workshops have been evaluated through questionnaires and pre and post workshop tests and more recently, the extent to which initial provision of training, equipment and resources to the Health Centres has been effective, has been assessed. This work is ongoing. Future evaluation measures should also encompass feedback from UK employers of the Gwent team to identify the benefits and/or difficulties to the employer of supporting employees to undertake overseas development work.

Gwent team members reflect on individual benefits of participation in their post visit reports. A common template for post visit reports was piloted for the March visit. There are sections inviting comment on ‘personal benefits, employer benefits and influences on life’. Most cite benefits such as ‘it is a real privilege to be part of the team and to see where scarce resources are being spent’ or ‘I developed personally by working with a diverse group of skilled professionals… working with staff in the Health Centres and seeing the conditions they work in is a truly humbling experience’. The template for post visit reports will be reviewed at a Link meeting before the next visit to Ethiopia. Work will also be undertaken with Ethiopian colleagues to formally document their feedback on the benefits and difficulties of participating in the Link and its work.

An outcome of the March visit has been the drawing up of a comprehensive list of ‘needs and wants’ for each Health Centre. Each list was compiled following observation in the relevant Health Centre, meetings and discussion with Health Centre staff and also the local community. The needs of each Health Centre will be addressed individually as priorities dictate and funding allows. Common to all however is the urgent need for an ambulance to transfer patients requiring services that the Health Centre is unable to provide. Community representatives cited examples of patients who had died because transportation was unavailable, too difficult and/or too expensive. An ambulance is also needed to transfer patients to the Health Centre, particularly labouring women. The Gwent team witnessed relatives carrying patients for long distances on home made stretchers and chairs to reach the Health Centre. A priority for fund raising for the Link is now focussed on raising enough funds to purchase a motorbike ambulance for each Health Centre.