II HOSPITAL ASSESSMENT REPORT FOR CLINICAL OUT REACH PROJECT ASSESSING TEAM. Drs.1. Abraham G/Egeziabeher, Plastic surgeon 2. Hagos Biluts, consultant surgeon 3. Tessema GASHAW, Medical officer 4. Yegeremu Kebede, Plastic surgeon Sr. Abeba Mekonen, out reach nurse December 10/2006 Addis Ababa Ethiopi Table of contents EXECUTIVE SUMMARY. 3 1. INTRODUCTION 4 2. METHODS AND INSTRUMENTS 5 3. RESULTS 9 4. DISCUSSION. 20 5. RECOMMENDATION. 22 Executive summary. The majority of Africa’s population lives in rural or remote areas while only a small percentage of healthcare facilities capable of specialized treatment are accessible to them there. Ethiopia shares the same in the way that a concentration of trained healthcare workers in the urban centers in overcrowded hospitals that not only have to treat their own patients but support the surrounding facilities. Even while the federal system in Ethiopia has provided referral hospitals in remote areas they are under-funded and constantly experiencing a shortage of trained staff. The objective of this project is to strengthen the capacities of ten university and regional hospitals, selected from a group of twenty referral hospitals in Ethiopia. The current specialized clinical out reach project in Ethiopia is just starting up as national programme. Therefore it has limited experience and resource in the Ethiopian context. Therefore it is assumed to be an area of lesson accumulation, start up for advocacy on the need of the population and indigenous system establishment. The specific criteria for assessment of hospitals were drafted based on the above the generalized scheme of strategies and they are listed as follows i.e. Hospitals should render public services, they have cadres of staff who are trainable to carry out some specialist care tasks both at the medical, nursing and paramedical levels, they receive an adequate number of patients requiring specialist treatment i.e. Catchment’s population of 200,000 and above and they have the required infrastructure to take advantage of specialist services or willingness to put in place such infrastructure Generally Hospitals lack most of the general specialty areas. Some of the relatively better available general specialty fields are Internal Medicine, Pediatrics, Gynae-Obs, and Surgery. Services like dentistry, ENT, Ophthalmology, Psychiatry and Orthopedics are seriously lacking in almost all Hospitals. The sub specialty areas such as plastic and reconstructive surgery, Maxillofacial surgery, orthopedics surgery and hand surgery are seriously needed by general surgeons. The maintenance and installation of medical equipments is a serious problem across all Hospitals. Based on the assessment results, consultation workshop discussion and the project concepts the following recommendations are made i.e. The hospitals such as Mekele, Gondar, ,Dessie, Adama ,Bahir dar, Awassa, Hossana, Karamara and Metu are worth selecting ,capacity buildings and out reach specialist services are better if they focus on general surgery, plastic and reconstructive surgery, orthopedics surgery, hand surgery and equipment installation and maintenance; Comprehensive team training is advisable approach and s subsequent project appraisal on un met needs of hospitals is valuable 1. Introduction Almost 80% of Africa’s population lives in rural or remote areas while only a small percentage of healthcare facilities capable of specialized treatment are accessible to them there. Ethiopia is no different with a concentration of trained healthcare workers in the urban centers in overcrowded hospitals that not only have to treat their own patients but support the surrounding facilities. Even while the federal system in Ethiopia has provided referral hospitals in remote areas they are under-funded and constantly experiencing a shortage of trained staff. The objective of this project is to strengthen the capacities of ten university and regional hospitals, selected from a group of twenty referral hospitals in Ethiopia. The decision will be made using predetermined criteria and will mean intervention with the aim to provide secondary health care services and efficient and effective tertiary care for those persons that require specialized medical services. Volunteer doctors, nurses and paramedics from more populated areas will visit the chosen hospitals and provide many desperately needed services in the areas of general and specialized surgery, obstetric and gynecological care, pediatrics, internal medical and surgical care, orthopedics and radiological and diagnostic services which are inaccessible to approximately 80% of the population. Sensitization and awareness programs in the urban centers, where there is already an expressed interest among doctors, nurses and specialists will encourage participation in the program. Visits by these healthcare professionals and the development of training material and specifically designed training workshops will work to strengthen the delivery of health services in the areas lacking both human and financial resources. The most obvious benefit of these actions will be the at least 10,000 patients treated by the doctors who without these visits would have to wait indefinitely for treatment, if they had access to it at all. The second and equally important outcome to these volunteer services is the educational value allowing the treatment of patients to continue after the expiration of the project. 500 health care professionals will benefit from direct training from the visiting specialists and another thousand will gain knowledge and insight from indirect on-the-job training in the hospitals. The beneficiaries of the workshops and the medical service visits will obviously be the children that receive reconstructive surgery, the women who receive obstetric and gynecological care (especially to repair obstetric fistula) and the people with preventable or correctable disorders receiving help that without this project they had no hope of receiving. On top of these, the healthcare professionals receiving the refresher and training courses and first hand observation experience will benefit from this project and be able to greatly help their own communities. The improved health of the population and increase capabilities of healthcare personnel will in turn benefit the regional healthcare centers and referral hospitals and further the aims of the Federal Ministry of Health. At the same time the project will create avenue for professionals to help their needy citizens. 2. Methods and instruments 2.1. GENERAL STRATEGIES OF SELECTION The current specialized clinical out reach project in Ethiopia is just starting up as a pure national programme. Therefore it has limited experience and resource in the Ethiopian context. This current project is assumed to be an area of lesson accumulation, start up for advocacy on the need of the population and indigenous system establishment. The selection of the hospitals and their need assessment takes the following general strategy into consideration. 2.1.1 Areas of lesson accumulation The projects Ethiopian experience as mentioned above is limited and the resource dedicated to it is limited. As we all know and anticipate will be the need of the population is high. The rationale behind this mismatch based on AMREF accumulated experience elsewhere is to use this limited resource as an area of lesson accumulation for overall health system improvement. Institutions which can exploit this limited resource and assumed to be productive in an area of direct enhancement of capacity and can make some kind of management, technology, and knowledge synergy and thereby produce their alike with minimum leverage are likely to be the first to get priority. 2.1.2. Start up for advocacy As mentioned else where it is just starting in Ethiopia .The experience of this project will play a key role in the future for improvement of the referral services. This is not a simple area of trial and error. Care should be taken at the beginning; otherwise we will fail in becoming responsible health professionals in general and citizens in particular. The concern we have, the result we produce with this minimum resource, the system we establish which shows our capacity and sincerity to answer the genuine needs of our society given the means to act are the image building acts which we shouldn’t miss at the beginning. There fore institutions which are responsible to carryout relatively good out comes with the available resources and can establish accountable systems speak loud to the project. The result of the project shouldn’t be diluted by over stretching these minimal resources and speak against the project. Targeted and fruitful results which will have a vibrant image should be the means for forward movement. 2.1.3 Indigenous system establishment. We should use this chance to establish an indigenous system. We have specialized health professionals who can share their experiences with minimal resource and at the same time we have junior health can be trained on the job to make the system really locally driven than solely dependent on the out side world. Therefore the project should work hand in hand with the ongoing indigenous capacity building activities so that it can share the available resources which are dedicated to the hospitals and thereby form synergy than establishing its own venue. At the same time it should be an instrumental means to bring substantial change in making specialized services accessible to the under served segment of the