Southern Ethiopia - Gwent Health Link

Background

The Southern Ethiopia - Gwent Healthcare Link started in 2000 when the Tropical Health and Education Trust (THET), UK facilitated contacts and co-operation between a few professionals from Nevill Hall Hospital  Dilla College of Teachers Education and Health Sciences and Dilla Hospital in SNNPR, Ethiopia. Initially entitled Nevill Hall - Dilla link this brought together institutions and professional staff working thousands of miles apart. In the past eight years the link has developed and changed in recognition of the experience, capacity and needs of both partners although it retains as its core to help front line health workers to provide better healthcare today and support teaching of healthcare workers for tomorrow in order to save lives.

This report covers the period April 2006 to April 2008.  It provides a summary of all the activities undertaken by the link and sets out broad plans for future involvement.  Further information about all the links work can be found at our website http://www.ethiopiagwentlink.org

Some people reading this report may be interested to know more about Ethiopia, its peoples and the environment in which health care is provided.  A small number of statistics are provided at Annex 1.

Training programmes

In Ethiopia 77 million people have only 2000 doctors and 139 hospitals. 85% live in rural areas, with no real access to a doctor or a hospital, and depend for their health care upon one of the 700 health centres which are often over 100km from any hospital. Health centres have no doctors and are run by the health officers and nurses. The clinical outcome of  patients, especially those requiring emergency interventions, such as following trauma, with acute life or limb threatening emergencies or with complications of pregnancy, depend on the level of skills training of the non doctor frontline health workers, health officers, nurses and midwives.

From the onset the link has made skills training of the non doctor frontline health workers and supporting rural health care facilities as its priority.

CME for health officers

The link has continued to support skills training for final year health officer students and CME for graduate health officers in the SNNP region.  Through donations of teaching equipment, training mannequins and instruments the link have now helped to set up a skills laboratory in Hawassa College for skills training in surgery, resuscitation, obstetrics and paediatrics.  In November 2007, 28 health officers attended a workshop designed to strengthen skills in the management of trauma, acute surgical and obstetric emergency problems in resource poor and remote settings.  Participants were trained through hands on practice on mannequins in case scenario-based simulation and were also given challenges to devise essential items in trauma care such as splints and neck collars from common everyday materials.  So far the link has trained over 300 student health officers and 200 health officers working in health centres in emergency skills.

Midwifery skills workshops

A pilot programme designed to improve midwifery skills in local hospital and health centres was initially organised in March 2006.  Based on its success and a needs assessment a further event, for a larger group, took place in October 2006 focusing on hands-on skills in emergency obstetrics.  An even larger group - this time comprising 48 midwives/nurses - attended a four-day course in November 2007 with aims to update emergency obstetric drills, common obstetric problems, provide participants with the knowledge and skills to teach others and provide a support mechanism for those working in isolated rural areas.  All these courses were run jointly by members of the link and staff from Hawassa College. So far the link has trained over 120 midwives in emergency obstetric care.

Laboratory skills training

In 2006 the link organised a skills training programme for final year medical laboratory science students in Hawassa College.  In March 2007 a larger group of link members with expertise in microbiology, haematology, blood banking, bio-chemistry and infection control visited Hawassa Hospital and four teaching health centres in SNNP.  The team explored problems related to infection control in Hawassa Hospital and the health centres and made recommendations for improvement.  In March 2008 the link organised a five day workshop for graduate laboratory technicians working in remote facilities in SNNPR.  The programme was attended by 28 technicians and the feedback was extremely positive. So far the link has trained over 120 medical laboratory technicians working in remote health centres and hospitals.

‘Training the Trainers’ workshops

To achieve sustainability of the training programmes, following a pilot in 2005, in October 2006 the link initiated and organised a  ‘Training the Trainers’ programme for the specialists working in Hawassa and other local hospitals in conjunction with the Regional Health Bureau of SNNPR and Hawassa University. The World Health Organization (WHO) had already recognized link’s training programmes for the non doctor health professional as one of the best example in Africa and collaborated with the link in this ‘Training of the trainers’ programme.

Leadership skills

In October 2006 a pilot programme of leadership skills was held for key staff including departmental heads in the new Hawassa University.

Supporting exemplar Health Centres

Following discussions between the link, Hawassa training college and the SNNPR regional health bureau we agreed to support a small number of local teaching health centres with material resources, focused training and a dialogue with local community leaders in improving health care delivered to the local population.  It is planned that by developing these health centres as exemplar institutions it will be possible to improve the health care for the rural populations served and indirectly to assist other health centres to follow best practice and self-improvement.

In November 2007 the link donated large quantities of surgical and obstetric instruments and equipment, laboratory equipment and disposable items to the Yirga Cheffie, Wondo-Genet, Alaba and Yirgalem Health Centres.  In addition the first three were also provided with oxygen concentrators and computers pre-installed with textbooks and teaching materials on essential medical topics.  Staff were trained, on site, to use the medical equipment as well as the computers.  A short skills workshop on the management of trauma and emergency surgical and obstetric problems was also conducted on site.

In March 2008 the first three health centres were revisited when further emergency, midwifery and computer training was provided, additional materials donated and equipment and cleanliness audits undertaken.  Additionally, joint meetings between health centre staff, local Woreda council members and local community leaders took place and an agreed Memorandum of Understanding outlining joint aims and responsibilities was signed.

Evaluation

The link recognizes the need to provide evidence that its activities are effective.  The link was successful in obtaining funding to develop an evaluation framework and in March 2008 this became a core piece of joint work at each of the exemplar health centres.  Evaluation criteria were agreed with the health centre staff and financial support provided to ensure that routine data would be collected and collated locally over a six-month period.

Supporting hospitals and Hawassa University

In 2007 the link donated 14 oxygen concentrators to hospitals in the SNNPR region as well as Burr hole/craniotomy instruments requested by Butajira Hospital.  A large number of surgical, obstetrics and anaesthetic instruments and disposable materials have been donated to Hawassa Hospital and the link has also helped to establish a computer library at the University and provided them with many textbooks and CD-ROM books.

In 2007 the link sponsored Dr Aberra, the founder of the link and link coordinator in Ethiopia, to undertake specialist training in urology in India for 12 months.  Dr Aberra’s training is expected to benefit a population of nearly 15 million people in SNNPR region of Ethiopia where there is not a single trained urologist.

University links

The link initiated, following many years of discussion and sponsored personal visits, a formal institutional link between Cardiff University and Hawassa University from 2006.  The link worked to jointly negotiate a British Council grant for this purpose for three years.  In March 2007 staff from Cardiff University visited Hawassa with a reciprocal visit taking place in May 2007.  A further visit was undertaken in early 2008 and Dr Yifru Berhan, Dean of medical facilities at Hawassa Hospital was a keynote speaker at their conference ‘Global Health Event: Cardiff for Africa’ in March 2008.

Wales for Africa

In October 2006 the first Minister of the Welsh Assembly Government, Rhodri Morgan, launched the Wales for Africa programme.  In this programme urgent need to actively support sub-Saharan African countries in reaching millennium development goals are stressed and the Southern Ethiopia - Gwent Healthcare Link is cited as a model of a successful link and the way forward.  In June 2007, working closely with other health links in Wales, the link assisted in the organisation of the first Wales for Africa health links conference where link members organised seminars, presented lectures and posters. Since then the link has collaborated with other health links between Wales and Africa to form Wales for Africa health Links Group to share experience and make better impact through working together.  In recognition of his unique contribution and significant experience in health link work Biku Ghosh was elected the inaugural chair of Wales for Africa Health Links Group.

Working with other international charities

From the beginning the link has worked closely with THET and this continues.  In 2007 we started a collaboration with Safe Hands for Mothers a charity designed to improve health education amongst women in the area of the Wondo-Genet Health Centre.  In November 2007 two members from the Mothers of Africa charity visited with the link and participated in training workshops and we are planning a CME workshop for nurse anaesthetists with them to be run in late 2008.

Links with Bryn-y-Cwm community

In 2007 the Bryn-y-Cwm area of north Gwent became a potential Gold Star community pilot project of the United Nations when it linked with Yirga Chefie, a town in the coffee growing area of SNPPR where one of our exemplar health centres is based and the health link has been working since 2000. An initial visit from the Bryn-Y- Cwm community to meet members of the Yirga Chefie community took place in October 2007 alongside health link staff and we have continuing close relations with the group as well as some shared membership.

Planning for the future

Amazingly, given the range of activities mentioned above, the link remains a relatively small group and extremely dependent on the commitment of a dedicated group of individuals both in Gwent and Ethiopia.  Our activities are shaped in discussion with colleagues in Ethiopia and reflect their assessment of need as well as the skills and resources available from link members in Gwent.

Subject to the availability of resources we plan to continue undertaking two visits per year, in March and October, and in the short term these will continue to focus on our work within the three health centres.  This will involve a focus on improvements in clinical practice, facilities and hygiene and a developing relationship with local community leaders, politicians and Woreda officials. In our discussions, so far, health centre and community representatives have identified current problems as the absence of any facilities for transferring seriously ill patients from the health centres to the hospitals and inconsistent power supplies.  If resources can be secured the link hopes to assist with the provision of motorcycle ambulances and generators for each of the health centres at some stage in the future.

Resources

Mention has already been made of the commitment and skill of the small number of link members both in Gwent and Ethiopia who keep the wheels turning.  Without them the link’s work would quickly come to a close.  Relationships between link members in Gwent and Ethiopia are personal and professional with individuals visiting time and again. The infrastructure that has now been established in Ethiopia is more robust than at any time in the past and allows regular updates and communication to occur between visits allowing time when link members are present in Ethiopia to be as productive as possible.

The majority of individuals associated with the link are employed by the trust which usually recognizes their contribution and time spent in Ethiopia as part of their ongoing professional development.  Individuals reflect that they gain much at both a personal and professional level by their involvement in the link and believe they return chastened, uplifted and more skilled to undertake their ongoing employment. The link is extremely grateful for all the support that has been offered by the Trust and looks forward to its continuation.

Financially the link is only able to plan as far ahead as its resources permit.  We have been fortunate in gaining a number of small grants in recent years but clearly need to expand a regular source of income as this provides a more sustainable base than reliance on grants.  The link requires a minimum of £20,000 per annum to sustain its current workload and the trust board is invited to consider what action it could take in order to achieve a more secure footing for the link especially through the existing payroll giving facility available to trust employees.

Conclusion

The Trust Board is invited to receive this report on the activities of the Southern Ethiopia – Gwent Healthcare Link during the past two years and endorse its continuing support for the future.

ANNEX 1

A few statistics to help understand Ethiopia better.

• Population of Ethiopia 77,431,000 of whom 84% live in rural communities
• There are approximately 1971 doctors in Ethiopia approximately 1 for every 37,000 people. In the UK there is one doctor for every 434 people
• 22% of the overall population have access to water supply [defined as  the availability of atleast 20 litres of safe water per person per day from a source within 1 kilometre of their dwelling] but only 11% of the rural population have this and 0% are ‘house connected’
• 13% of the overall population have access to improved sanitation [i.e. access to public sewers, septic systems or pit latrines] but only7% of the rural population have such access and 0% are ‘house connected’
• The annual budget of Ethiopia on health matters is £100 million, the budget for Gwent Healthcare Trust more than 4x this amount.