Southern Ethiopia - Gwent Health Link

Scoping the Health Centres, March 2007

Initial work in each of the three Health Centres focussed on undertaking a basic scoping exercise and needs assessment regarding supplies, equipment, resources and training. Assessment of needs was based on observation and then discussion and agreement with Ethiopian partners during preliminary visits to the Health Centres in 2007 and earlier.

A ‘formal’ scoping exercise of the three Health Centres was undertaken by two members of the Gwent team in March 2007. This identified some important generic issues which were then shared and discussed with Ethiopian partners. Estate facilities, infection control risks, the condition of inpatient areas and maternity services and a general lack of basic, essential equipment and resources were of particular concern. At the time, Health Centres were reported to have little, if any, maintenance programme. Although all had access to water, poor plumbing created difficulties and electricity supply was erratic. Inpatient areas lacked any degree of comfort in the form of bed linen and curtains for privacy. There was limited, if any, transport to bring labouring women to the Health Centre from rural areas, similarly for the transfer of those women experiencing complications that Health Centre staff were unable to manage. Other patients who required more specialised services and care within a hospital environment faced the same difficulties. Equipment and resources for patient care in all Health Centres were minimal and of poor quality. Health Centre waste was disposed of by incineration in a large pit. Common diseases treated included malaria, diarrhoea, intestinal parasites, upper respiratory tract infection, tuberculosis, urinary tract infection and HIV.

The scoping exercise identified that none of the Health Centres had the following: oxygen concentrator; suction apparatus; autoclave; adequate sinks for decontamination of surgical instruments; adult and neonatal resuscitation equipment; drugs for resuscitation; incubators; bed linen of any kind; functioning scales for weighing adults; functioning scales for weighing neonates; resuscitation mannequins for training, nor books/learning resources; goggles; curtains and screens for privacy; much essential equipment for adequate treatment of patients, particularly surgical instruments. There were minimal amounts of sterile and non sterile gloves and aprons. Equipment that was available was in various states of (generally poor) repair. It was therefore difficult for staff to provide the care required.

The scoping exercise also identified staffing levels in each Health Centre and some specifics relating to services and identified needs, for example:

Health Centre 1 employed three health officers, nine clinical nurses, one midwife, three laboratory technicians; and three cleaners. There was no pharmacist or administrative assistant. Health Centre 1 had no surgical instruments and only minimal equipment for delivery. There were no library or reference books and no guidelines/protocols for good practice. Staff reported that they needed basic equipment to be able to improve the care given to patients. The numbers of patients seen at Health Centre 1 in the previous year were reported as follows: medical and surgical outpatients 10,800; paediatric outpatients 6000; deliveries 456.

Health Centre 2 employed one health officer, five nurses, two midwives, three laboratory technicians, two pharmacists, two health assistants, twelve administrative assistants including guards and three cleaners. There was no surgical equipment or books and minimal delivery equipment. The numbers of patients attended to in the previous year were reported as follows: medical and surgical outpatients 30,000; paediatric outpatients 10,800; deliveries 360.

Health Centre 3 employed one health officer, nine clinical nurses, one midwife, two laboratory technicians, one pharmacist, one public health nurse, four health assistants and twelve administrative assistants, including a gardener/guard, plus five cleaners. Estate facilities were reported to be in a reasonable condition but there was no surgical equipment and only minimal amounts of equipment for delivery. There were no books or learning resources. Staff identified that they needed basic equipment in order to improve care for patients. They also stated that they would like access to a computer and to implement some in-service training. In the previous year Health Centre 3 attended to 24,000 medical and surgical outpatients and 360 women had given birth there. No figures were given for paediatric outpatients.

Ministry of Health guidelines for staffing Health Centres stipulate ten health care professionals and twelve administrative support staff per Health Centre (Federal Democratic Government of Ethiopia, 2005). The breakdown of type of professional however varies in different policy documents, for example, the specification of midwives per Health Centre ranges from one to three (Girma et al 2007). The target population of a Primary Care Unit (one Health Centre and three Health Posts) is 25,000 (Federal Democratic Government of Ethiopia, 2005). Each of the project Health Centres has a catchment population of 100,000.

Overview of activities undertaken with the three Health Centres

Based on the scoping exercise and needs assessments, the purpose of the visits in November 2007 and March 2008 was for the Gwent team to begin the process of working with each Health Centre and its wider community. In each Health Centre, equipment, surgical instruments, teaching and learning materials and other resources to meet requested/observed needs were provided. A comprehensive record of what was given was made. One to one and small group skills training took place during both visits. In November, two computers were installed in each Health Centre with a range of relevant software to set up e-learning opportunities. Meetings were held with staff to listen to their views and involve them in the process of change. During the March visit the Gwent team facilitated a joint meeting in each area with Gwent team members, Ethiopian Link colleagues, Health Centre staff and representatives of the local community, plus Woreda Health Council members. A ‘memorandum of understanding’ was signed by all parties to formally acknowledge the partnership arrangements and the responsibilities of each partner.