Maternal and Child Health Service Provision Assessment in Tikur Anbessa General Specialized Hospital
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Date
2005-03
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Addis Ababa University
Abstract
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.
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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
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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.
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Keywords
Maternal, Child Health Service