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Introducing an accountability framework for polio eradication in Ethiopia: results from the first year of implementation 2014-2015.
Pan African Medical Journal. 2017; 27(Suppl 2):12.INTRODUCTION: the World Health Organization (WHO), Ethiopia country office, introduced an accountability framework into its Polio Eradication Program in 2014 with the aim of improving the program's performance. Our study aims to evaluate staff performance and key program indicators following the introduction of the accountability framework. METHODS: the impact of the WHO accountability framework was reviewed after its first year of implementation from June 2014 to June 2015. We analyzed selected program and staff performance indicators associated with acute flaccid paralysis (AFP) surveillance from a database available at WHO. Data on managerial actions taken were also reviewed. Performance of a total of 38 staff was evaluated during our review. RESULTS: our review of results for the first four quarters of implementation of the polio eradication accountability framework showed improvement both at the program and individual level when compared with the previous year. Managerial actions taken during the study period based on the results from the monitoring tool included eleven written acknowledgments, six discussions regarding performance improvement, six rotations of staff, four written first-warning letters and nine non-renewal of contracts. CONCLUSION: the introduction of the accountability framework resulted in improvement in staff performance and overall program indicators for AFP surveillance.
Completion of the modified World Health Organization (WHO) partograph during labour in public health institutions of Addis Ababa, Ethiopia.
Reproductive Health. 2013; 10:23.BACKGROUND: The World Health Organization (WHO) recommends using the partograph to follow labour and delivery, with the objective to improve health care and reduce maternal and foetal morbidity and death. The partograph consists of a graphic representation of labour and is an excellent visual resource to analyze cervix, uterine contraction and foetal presentation in relation to time. However, poor utilization of the partograph was found in the public health institutions which reflect poor monitoring of mothers in labour and/or poor pregnancy outcome. METHODS: A retrospective document review was undertaken to assess the completion of the modified WHO partograph during labour in public health institutions of Addis Ababa, Ethiopia. A total of 420 of the modified WHO partographs used to monitor mothers in labour from five public health institutions that provide maternity care were reviewed. A structured checklist was used to gather the required data. The collected data were analyzed using SPSS version 16.0. Frequency distributions, cross-tabulations and a graph were used to describe the results of the study. RESULTS: All facilities were using the modified WHO partograph. The correct completion of the partograph was very low. From 420 partographs reviewed across all the five health facilities, foetal heart rate was recorded into the recommended standard in 129(30.7%) of the partographs, while 138 (32.9%) of cervical dilatation and 87 (20.70%) of uterine contractions were recorded to the recommended standard. The study did not document descent of the presenting part in 353 (84%). Moulding in 364 (86.7%) of the partographs reviewed was not recorded. Documentation of state of the liquor was 113(26.9%), while the maternal blood pressure was recorded to standard only in 78(18.6%) of the partographs reviewed. CONCLUSIONS: This study showed a poor completion of the modified WHO partographs during labour in public health institutions of Addis Ababa, Ethiopia. The findings may reflect poor management of labour or simply inappropriate completion of the instrument and indicate the need for pre-service and periodic on-job training of health workers on the proper completion of the partograph. Regular supportive supervision, provision of guidelines and mandatory health facility policy are also needed in support of a collaborative effort to reduce maternal and perinatal deaths.
Belize City, Belize, Ministry of Health, 1984. , 54 p. (EPI/84/003)An evaluation of the Expanded Program on Immunization (EPI) in Belize was conducted by the Pan American Health Organization/World Health Organization at the request of the country's Ministry of Health. The evaluation was undertaken to identify obstacles to program implementation, and subsequently provide national managers and decision makers with viable potential solutions. General background information is provided on Belize, with specific mention made of demographic, ethnic, and linguistic characteristics, the health system, and the EPI program in the country. EPI evaluation methodology and vaccination coverage are presented, followed by detailed examination of study findings and recommendations. Achievements, problems, and recommendations are listed for the areas of planning and organizations, management and administration, training, supervision, resources, logistics and the cold chain, delivery strategies, the information and surveillance system, and promotion and community participation. A 23-page chronogram of recommended activities follows, with the report concluding in acknowledgements and annexes.
Paper presented at the Nineteenth Session of the UNICEF/WHO Joint Committee on Health Policy, Geneva, February 1-2, 1972. 40 pFamily planning is an integral part of the health care of the family and has a striking impact of the health of the mother and children. Many aspects of family planning care require the personnel, skills, techniques, and facilities of health services and is thus of concern to UNICEF and WHO. Once individual governments have determined basic matters of family planning policy and methods, UNICEF and WHO can respond to requests for assistance on a wide range of activities, with the primary goal being the promotion of health care of the family. Emphasis will be placed on achieving this by strengthening the basic health services that already have a solid foundation in the community. The past experience of UNICEF and WHO should provide valuable guidance for assistance to the health aspects of family planning, particularly as they relate to the planning and evaluation of programs; organization and administration; public education; the education and training of all medical personnel; and the coordination of family health activities both inside and outside the health sector. The review recommends that UNICEF and WHO first regard the capacity of the host country to absorb aid and maintain projects, and that specific family planning activities, such as the provision of supplies, equipment, and transport, be introduced only when the infrastructure is actually being expanded. Capital investment should be viewed in relation to the government's ability to meet budgetary and staff requirements the new facilities demand.
COMMUNITY DEVELOPMENT JOURNAL. 1988 Jan; 23(1):55-7.The local associations of Maisons Familiales (MF) in Senegal periodically conduct participatory evaluations of community projects. 2 evaluations often used include internal exercises by and for the staff, such as a written questionnaire, and an assisted self evaluation. An assisted self evaluation often involves participant subgroups discussing problems and possible solutions with each subgroup later sharing items with a national and/or a foreign evaluation facilitator. The facilitator(s) meets with all the subgroups and brings out important issues in the subgroups, then all the subgroups discuss the issues and form a consensus on what actions should be taken. The training staff at an MF center thought the program was fine based on what a few people said, but, after looking at statistics on the number of trainees over a couple of years, the staff learned that the numbers have declined. The staff then discussed the situation and learned that a barrier had developed between the training staff and villagers. As in any evaluation, one must distinguish between the subjective view (what people say) and objective reality (the actual situation using data). In another type of self evaluation, a group discussed dynamism in a village and came up with 4 different points of view. After visiting a "dynamic" and a "nondynamic" village using the 4 points as measurements, the group learned that its previous impressions of the 2 villages were not completely borne out. This evaluation helped the staff to see villagers' priorities and to listen better. Despite wanting to conduct a real impact evaluation, workers have not yet done so because they do not have time to schedule evaluations, do not have enough base line data, and do not know how to account for influences on changes in the villages other than the MF training programs.
In: Management information systems and microcomputers in primary health care, edited by Ronald G. Wilson, Barbara E. Echols, John H. Bryant, and Alexandre Abrantes. Geneva, Switzerland, Aga Khan Foundation, 1988. 17-20.A wide array of issues must be addressed if the development and use of management information system (MIS) and microcomputers are to improve management of primary health care (PHC) programs and increase the equity and cost-effectiveness of PHC. These issues include: specification of the purpose and objectives of MIS at community and district levels; distinquishing types of information required; the understanding of organizational issues that must be resolved as a result of introducing MIS; the practical definition of the most useful indicators of program effectiveness and efficiency; the specification and monitoring of data collection, compilation, and analysis requirements and procedures; procedures for generating and using processed MIS data and management information; the PHC program's capacity to absorb technological innovations; and personnel requirements. The need for improved data systems must be recognized. Data quality and systematic flow of information must be ensured from the field level upwards, and minimum information requirements need to be defined. The success of any MIS is heavily dependent on feedback of the data collected. Unless staff at all levels of a PHC program understand the importance of the data they are collecting, the value and use of the information system will be negligible. Examples of the Egyptian government's National Health Information System and the role of the World Bank are used to show how MIS and microcomputer can be introduced and used in PHC.
Report on the evaluation of UNFPA assistance to the Sudan population and housing census of 1983: project SUD/79/P01.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1985 Mar. xi, 40 p.Since the evaluation report of the 1973 Census of Sudan made recommendations on how to improve census implementation for the 1980 round, UNFPA felt it to be important to see if the 1983 census took them into account and if it achieved better results. The project document included 3 objectives concerning data collection and analysis: the availability of accurate and up-to-date information on the total population of Sudan, on the components of population growth, and on demographic, social and economic characteristics; and 2 objectives concerning institution building: the availability of trained statistical personnel and the strengthening of data processing facilities. 2 of the 5 objectives have been achieved--up-to-date information on the total population of Sudan and for all recognized civil sub-divisions is available and a new computer facility with adequate capacity and configuration has been installed and is in operation. The caliber of staff in the census office is high, and the training program overall was adequate. The census communication campaign emphasized the use of mass media. Overall, the publicity for the census was considered by the Mission to have been good. Although the enumeration took longer than scheduled in some areas, the observance of the enumeration timetable can be considered satisfactory. Data preparation and electronic processing have been severely delayed due to the low productivity of the computer staff. The strong points of the project were the high priority given to the census by the government; the better planning for the 1983 census as compared with the 1973 census; and the high quality of technical assistance provided by UN advisors. Weak points have been the lack of long-term resident advisors in general census organization, cartography and data analysis; the delay in the provision of government and UNFPA inputs; and the loss of trained personnel from the Department of Statistics, particularly in data processing.
Report on the evaluation of UNFPA assistance to the civil registration demonstration project in Kenya: project KEN/79/P04.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. xi, 36 p.Kenya established a compulsory vital statistics and civil registration system in 1963 and it was extended nationwide in phases until it covered the whole country by 1971. Serious under-registration of births and deaths however, has persisted. In order to improve registration coverage, the government submitted a proposal to UNFPA to support experimentation with ways to promote registration in some model areas. The original project document included 4 immediate objectives: the strengthening of the civil registration system in the model areas including the creation of a new organizational structure, the training of project personnel and the decentralization of registration activities; the improvement of methods and procedures of registration through experimentation; the collection of reliable vital statistics in the model areas; and, the establishment of a public awareness program on the need for civil registration to ensure the continuation and extension of the new system. Of the 4 objectives of the project, 2 have been achieved--the strengthening of civil registration in the model areas and the improvement of methods and procedures of registration. The major deficiency during the project period was the lack of required staff in the field. The primary feature which distinguishes the project is that traditional birth attendants and village elders become key persons at the village level and act as registration informants after receiving training. The strong points of the project are the high quality of technical assistance provided by the executing agency, the close collaboration among various government departments, and the choice of project strategy and model area. Recommendations have been made to correct the problems of a lack of key personnel at the head office and in the field, and the expansion of registration to new areas before consolidation was completed in the old areas.
Report on the evaluation of UNFPA assistance to the family health programme of Zambia: project ZAM/74/PO2 (February - March 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. x, 38,  p.The objective of the Family Health Program of Zambia is to enhance the health and welfare of Zambians, particularly mothers and children, through an increase in coverage of the population served through under-5s clinics, pre- and post-natal services and child spacing activities. The Mission found that the strong points of the project are the increasing commitment of the Government to incorporate family planning activities as an essential component of its family health and primary health care programs; the training and health education components of the program; and the enthusiasm and ability of the Zambian Enrolled Nurse/Midwives in organizing maternal child health/family planning services at service delivery points. Factors which appear to have hindered a more effective project performance have been the restriction on prescribing contraceptives by anyone but physicians; the imbalance in implementation among the project components; the failure to appoint international and national staff to key positions and with a timing that would have enabled staff members to support each other as members of a coordinated team; weak supervision; no research and evaluation activities; transport problems; the lack of use of, and updating of, the project plans; and the absence of a tripartite review early in the project's life to address implementation problems.
[Unpublished] 1984. v, 37,  p.This is an evaluation of the Rural Health Systems Project funded in 1979 through a contract between AID, the Rural Health Development Staff of the University of Hawaii and the government of Guyana. The goal of the project is to improve and expand primary care services to rural areas of Guyana through training community health workers and medexes, and utilizing them in an interlocking, tiered, supervisory and referral structure. The evaluation team was to assess the adequacy and relevancy of medex training; the performance of graduates, the adequacy of support and management systems for medexes, and the ability and commitment to continue the training by the government of Guyana. The evluation team visited a large number of health facilities staffed by medexes, interviewed key persons in the Ministry of Health, AID, and the Health Manpower Developement Staff of the University of Hawaii. The team's findings show that the Medex Training Program is of high quality. Medex are working effectively in medically underserved areas; progress is being made in financial information, 2-way radio and supply systems, this despite severe economic difficulties. The development of transportation systems has been extremely slow and difficult and contracts for building housing have not been completed. The team offers a number of recommendations which include the continuation of the Medex Training Program in order to maintain a steady supply of trained personnel; the need to develop a comprehensive career structure and professional incentive program; the regionalization of the expanded 2-way radio system as a continuing education medium; the immediate implementation and careful monitoring of the new financial managements information system; and the necessity for further action to improve the transportation systems. Furthermore, the team's recommendations emphasize that AID expedite its approval of documents necessary for housing contracts to be negotiated; that responsibility for supervisory medexes in rural health centers be gradually transferred to the regional health teams and that Medex headquarters and training staff be more closely integrated. The report includes various appendices: a map of the country, a list of persons interviewed by the team; training and education manuals for diabetes; samples of the system for teaching essentials to medex (e.g., clinical practice, history taking and physical examination) and the declaration of Alma Ata on primary health care.
Evaluation of the regional advisory services in population education and communication in Sub-Saharan Africa of FAO, the ILO and UNESCO, 1978-1982.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Jun. iv, 64 p.This evaluation was conducted to assess alternative modes of providing regional population education and communication (PEC) advisory services in the African Region in the future, in addition to assessing past performance of existing projects. In the absence of specific and measurable project objectives, as well as uniform, reliable and comparative data for the different projects included in this evaluation, it was not possible to determine exactly the quantity and quality of the achievements of the regional advisory projects over the period under review. Nevertheless, it is concluded that the achivements had been relatively limited, partially because of inherent difficulties associated with the provision of advisory services in the region (e.g., distances, inter-and intra-country communication problems) but more so because of weaknesses in the formulation and implementation of the regional advisory projects. These weaknesses include: 1) differing views on the part of the Executing Agencies and the United Nations Fund for Population Activities (UNFPA) about the functions of the regional advisors which underlie the rather vaguely defined functions presented in the project documents; 2) insufficient planning of the regional advisory teams' activities; and 3) recruitment difficulties which led to vacancies and high turnover as well as to the hiring of partially qualified advisors. Furthermore, the present arrangement for the delivery of regional PEC advisory services, e.g., separate agency teams and advisors located in different countries, impedes the effective delivery of services because the advisors under this arrangement cannot function as 1 team. It is recommended that the functions of the regional PEC advisors in Africa be concentrated on assistance to country project formulation, advice on country project management and systemenatic particiaption in country project monitoring and evaluation. Recommended regional PEC advisory services are 1 team for PEC in the non-formal sector and another team for population education in the formal sector. Other recommendations deal with the role of Headquarters vis a vis regional follow-up and monitoring/supervision of regional advisors, other in-country activites and need for resident country advisors.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1982 Dec. xi, 44,  p. (Project SWA/75/P01)The long range objective of this project (1976-1981) was to improve and enhance the health and welfare of mothers and children, especially in rural areas. In assessing Project achievements and the degree to which progress toward the long term objective has been accomplished, the Evaluation Mission found that the immediate objectives had, to a large degree, been met within the general framework of the Ministry of Health's (MOH) development program. Service delivery points in governmental, mission private and industrial/plantation health facilities are now widely distributed throughout Swaziland. The integration of preventive and curative is clearly in place in the rural health clinics and health centers. Analysis of service statistics data indicates that a large % of pregnant women attend antenatal clinics. Family planning services are now offered in 86 clinics with 27,094 clinic attendances recorded for 1981. The pill is the most popular method, followed by condoms, injectables and IUDs. An adequate though incipient health education program is functioning. The MOH strengthened the health infrastructure for, and has in place a program of, maternal child health (MCH) and family planning (FP). The strong points of the program are the government's commitment to MCH/FP, the general strategy, the training component, the number and quality of staff involved in service delivery, the number of service delivery points and the system of recruitment and the employment of Rural Health Motivators (RHM). Weak points, which appear to have hindered a more effective program performance, are planning and management, the lack of solid socio-anthropological knowledge to base, the lack of a focal point for FP, supervision at all levels and the lack of monitoring and evaluation which, if properly undertaken, could have led to changes and adjustments in the program. Future activities supported by the United Nations Fund for Population in the organization and management of family planning activities within the MCH program and within other government and voluntary organizations. UNFPA should help the government prepare a new proposal for UNFPA assistance to family planning activities in the country and should consider supporting supervision and training activities.