Some (actual) field notes

So far, I've been posting about my travels. But this blog is called field notes, so I think it's time that I actually shared some of them.

My main project here has evolved somewhat. I have been working with an organization called Jhpiego, an affiliate of Johns Hopkins, and one of the USAID NGO partners. When I started, I was planning to assist one of the Jhpiego staff on documenting promising practices in maternal, newborn and child health. This is a lengthy process, and involves input from the ministry of health, USAID, UN organizations, and other NGO partners. Coordinating with all of these organizations has shown to be valuable, as representatives from each organization that have been involved thus far all have great insight. However, it has also proved to be difficult to coordinate all of these partners in a timely manner. So almost a month into the summer, I realized this project was not going to get done while I was here, and although I have continued to assist, I was assigned a new project.

I've been working to document successes and challenges of the implementation of a new management strategy, developed by Jhpiego, called Standards-Based Management and Recognition (SBM-R), which has been piloted in the Regional Health Centers. These health centers act as primary health care units (almost like big clinics, or very small and basic hospitals) for catchment populations of about 25,000-50,000. The purpose of the SBM-R is to help health centers to identify their gaps in performance and quality, create an action plan, and implement changes to improve their services. The SBM-R tool is basically a simple checklist that staff can go over regularly and check off their progress. The intervention has mainly been tailored to improving maternal health care, but also covers improving infection prevention, the pharmacies and laboratories, and management in general. So far, I have had a chance to visit 9 of the 11 health centers where this intervention has been implemented. Here are some photos of my visits:

Entryway to one health center.

Welcome sign at one health center. Unfortunately, I don't understand Oromifa, the language that this sign is in. [As a side note, Oromifa is the language spoken by the people of the Oromia region. It is the largest region in the country, population-wise, however, the official language in Ethiopia is Amharic, the language spoken by the second largest ethnic group. Just some food for thought...]

One of the health center staff with PPE donated to them by the Integrated Family Health Program (a Jhpiego partner). The health center was able to greatly improve their infection prevention measures through SBM-R and these types of donations.

Some health center clients. Mothers with their healthy babies.

Saw these types of stickers all over. USAID has quite a large presence in Ethiopia.

Delivery beds in one of the health centers. They really needed new ones, as you might be able to tell from the rust covering the tables. The blue curtains give privacy if there are two women giving birth at the same time. Completely different from the experience in America.

This is one of the health centers in the northern part of the country, the Tigray region. The health center had a room full of beds, but no funding to buy mattresses for them. This was one typical problem at the health centers - a lack of resources.

One health center was particularly grateful for Jhpiego's assistance and showed it. They posted posters like this all over their health center prior to our arrival. Hannah Gibson is our program director.

All in all I've felt that my visits to these health centers have been a great learning experience. I have also seen how a simple management tool (the SBM-R) can really help to improve the quality of services and patient satisfaction. Although I was not able to see the health centers before the intervention, I was able to infer by the data collected on their performance before and after SBM-R that the intervention really helped the health centers make significant progress. I also got the sense from health center staff that they all felt more motivated and invigorated by their work than before. Staff burnout is still a problem across the country. There is a huge diaspora of health professionals, mainly due to poor salaries, long and arduous hours, and a lack of resources and training that lead to poor service and low patient satisfaction. But I was really impressed by the dedication of most of the staff I talked to. I only hope I can convey the successes of SBM-R in my report and that it will help Jhpiego continue and scale up this type of technical assistance to more health centers.