Maternal and Child Health Service Provision Assessment in Tikur Anbessa General Specialized Hospital
Creators: name: Endrias, Tesfaye
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2005

description: Service provision assessment (SPA) is a survey of health facilities formulated to provide information on the general functioning of outpatient services related to basic maternal, child, and reproductive health. It measures the presence and functioning of components that are considered essential for the provision and maintenance of good quality health services. Quality of health care is a useful reference in the formulation of practical approaches to quality assessment and improvement. The study was conducted in Tikur Anbess General Specialized Hospital on Maternal and Child health care, in child health care, family planning and antenatal care clinics. Objective of the study was to describe strengths and weaknesses, adherence to standards, and client-provider satisfaction in child health, family planning, and antenatal care health services. This study was a descriptive cross-sectional study undertaken using quantitative method. The study used four different data collection instruments, such as: Exit Interview, Provider Interview, and Observation, and Inventory. A total of 450 clients and 130 service providers were involved in the study. One of the most important components to assess the quality of MCH Service Provision was Client exit interview conducted among sick child caretakers, family planning, and antenatal care clients. Through the exit interview it is revealed that elements of quality of care such as important procedures during the hospital visit were made. Majority of the clients, through exit interview believed that the providers perform most of the tasks and procedures during their visit. The client's response was also proved to be similar with the findings of performance observation. viii Important procedure such as reviewing record before starting the session and check about previous history measuring pulse rate, blood pressure and temperature. More than 75% of the clients in all the three clinics rate the service they got in the hospital as very satisfactory and this showed their positive opinion on the usefulness of information given by providers, and degree of satisfaction the way both health workers treated them. However, the interview indicated gaps in the provision of health education to clients such as providing materials and take home messages. The caretaker's interviews supported the observation findings that provision of education materials to the clients is not common practice. The four most common suggestions made by clients to improve quality of services accounted for more than 50% of total suggestions. In all the three-study area and the suggestions were directed towards increasing space, regularly available doctors, increasing motivation of providers and increasing number of providers. The other areas, which were given or strongly addressed by most clients, were improvements to the physical environment of the hospital, which are hygiene/cleanliness increasing number of hours, improve supply of drugs. In all the three clinics only very few providers were observed thanking caretakers for cooperation or thanks ANC or FP client for coming to the hospital and for her time. The other weakness observed and needs due consideration by the management of the hospital is the extreme shortage of washing facilities. Thus none of the health providers in the sick child and ANC clinics were observed washing hands and dries them. This elementary and basic hygienic practice must be dully addressed. Unlike the contemporary and increasingly accepted practice such as in IMCI service only 4.8%, were observed giving the first dose of ix the oral treatment they prescribed and less than 20% discussed the child's growth chart with caretakers. Despite the strength of carrying out procedures such as telling the caretakers what illnesses the child has and ask about normal feeding when the child is not ill and check for pallor, in more than 90% of the observations the providers were not observed discussing and giving advice on the child's health. Thus there is a need for also for communication skill. A very important practice which should be taken as a strength and that has to be encouraged is procedures such as checking BP, weight, tempreture are well carried out. All observations revealed that in the sick child clinic the weight of all children were taken and above all the measurement was plotted on the growth chart and recorded on the child chart. The observation showed that the FP and ANC clinics adequately ensured visual and auditory privacy. Despite the strengths important elements of a family planning clinic need considerations. Important procedures such as discussing partner attitude toward family planning and discussing using condoms as dual method for preventing STI and pregnancy are carried out by few. The study also identified the lack of clear job description, standards and guidelines and also the presence of a lot of resentment about the lack of Motivation and Incentives such as training opportunity and promotion. Despite the strengths of the OPD services it is clear from the study results that providers were not performing the range of tasks in a comprehensive health service care. In particular provision of health education, pertinent advises on family planning pregnancy care and growth monitoring. On the basis of this study recommendations are forwarded to Improve or enhance the technical supervision of the health service delivery system, clarify job expectations of the health service providers through creating and disseminating job descriptions, seeking mechanisms and strategies that enhance community's positive influence on health workers and designing mechanisms for increasing provider motivation through monetary and nonmonetary incentives.