Evaluation Studies

The Government of Ghana has adopted the WHO focused antenatal care (ANC) package in a move to improve access, quality and continuity of ANC services to pregnant women. As part of these efforts, the Government has exempted fees for ANC clients. The main objective of this study, undertaken by Noguchi Memorial Institute for Medical Research in collaboration with the Ghana Health Service (GHS), FRONTIERS, and with USAID funding, was to examine the extent to which adaptation of the package influenced quality of care received by pregnant women and its acceptability to both providers and clients. The study used a policy analysis and a situation analysis in ten intervention clinics in which the package had been introduced and four comparison clinics.

To promote the health and survival of mothers and babies, Kenya has adapted the WHO goal-oriented Antenatal Care (ANC) package, popularly known as focused ANC (FANC). The Ministry of Health (MOH) has designed new guidelines for ANC services, placing emphasis on refocusing antenatal care, birth planning and emergency preparedness, and the identification, prevention and management of life threatening complications during pregnancy and childbirth. ANC visits are now used as an entry point for a range of other services, thus promoting comprehensive integrated service delivery. A major challenge, however, is whether the Kenyan health care system can cope with the implementation of this package.

Poverty and limited health services in rural Africa present barriers to adherence to antiretroviral therapy that necessitate innovative options other than facility-based methods for delivery and monitoring of such therapy. We assessed adherence to antiretroviral therapy in a cohort of HIV-infected people in a home-based AIDS care programme that provides the therapy and other AIDS care, prevention, and support services in rural Uganda. [author’s description]

This paper describes the application of activity-based costing (ABC) to calculate unit costs for a healthcare organization in a developing country. It also describes the ways in which these calcualtions can provide information for improving the efficiency and quality of healthcare services. [from abstract]

This research sheds light on the nature, design and provision of institutional services for providing training to the premier community health service providers in the public sector in Bangladesh. Virtually no major study exists on the training of the FWVs in the country. The methodology of the research mainly consists of a personal interview and questionnaire survey, covering the concerned trainers and officials of the major public health administration and training institutions of the country, including the National Institute of Population Research and Training, the Family Planning Directorate and the Family Welfare Visitors’ Training Institute.

The Quality Assurance Project investigated how job aids could increase compliance with guidelines for the Integrated Management of Childhood Illness (IMCI) in cooperation with the Zambia Central Board of Health beginning in 1999. One of the first countries to introduce IMCI, Zambia had a large number of IMCI-trained providers, and several IMCI job aids were already in use: a chartbook, recording form, poster, and mother card. The study proceeded in three stages: an initial assessment of job aid usage in 1999, the design and introduction of a new IMCI job aid (called “new outpatient department book” or “NOPD book”) that also served as the patient record, and a second assessment of job aid usage in 2000 after introduction of the NOPD book.

The study was carried out to evaluate short term effects of one to one educational intervention approach, conducted with 40 drug sellers in order to improve the private sector’s practices, compliance and performance in using the national treatment guidelines for malaria and other common childhood (diarrhoea, acute respiratory tract infection-ARI) illnesses in Kibaha district-Tanzania. [from abstract]

This assessment establishes the link between service quality and initial training by examining the skill retention of 2 cohorts of service providers who participated in a family planning (FP) training program in Kenya during 1994–1995. The following two questions were considered: 1) Do providers use the skills in which they were trained? 2) Is the length of time after the course concludes related to whether trained providers retain their new skills? [publisher’s description]

This retrospective study assessed the effects of pre- and post-training programme for healthcare professionals about breastfeeding. [from abstract]

This report describes highlights from the Doctors We Trust Project in St. Petersburg and the Together We Are Stronger Project in Kaliningrad. Both projects focused onthe limitations of health care for vulnerable groups in St. Petersburg and Kaliningrad. The key strategy was to build cooperative links between government agencies and NGOs, uniting those who control public medical facilities and those who work most closely with vulnerable populations. The goal was to strengthen the NGOs’ capacity to provide care, while helping the governmental sector and medical personnel better understand and respond to the needs of people living with HIV and AIDS (PLHA) and other vulnerable groups.

The shortage of trained health professionals is among the main obstacles to strengthening low-income countries health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. [author’s description]

The overall objective of this study is to evaluate the capacity as well as the performance of the health facilities (HF) and community associations (community health workers associations (CHW), traditional birth attendant associations (TBA) and associations of people living with HIV (PLWHA), operating in the Gisagara (formerly Kibilizi) District. [from summary]

This Praxis Note provides an overview of the impact of HIV/AIDS on the Malawi health care system and on the organisational capacity of Mulanje Mission Hospital. It describes the experiences and lessons learnt from a capacity building program designed to address capacity deficits and erosion caused by HIV/AIDS attrition. Less emphasis was placed on external training courses and increasing attention given to short-course inputs and distance learning. [from introduction]

There has been little research on HIV incidence or prevalence among hospital staff worldwide, and even less on modes of transmission among those infected. Recent evidence from South Africa suggests that HIV prevalence among health care personnel may not differ greatly from the general population. This evaluation study describes the significant effect of HIV morbidity and mortality among the workers in Zambia’s health care system. [adapted from introduction]

In 1996, the REWARD Project identified a need for effective interventions to increase women’s communication about reproductive health among themselves and with their husbands. Project staff formed women’s groups, called Communication Action Groups (CAGs), in three rural districts. The project provides group leaders with training on communication, leadership, group dynamics, condom use, condom negotiating skills, and HIV/AIDS and sexually transmitted infections (STIs). This study was designed to evaluate the effectiveness of the CAG program so that achievements and problems could be identified and program activities strengthened.

The overall objective of community-based medical education (CBME) is to produce highly qualified doctors in sufficient numbers to meet the health needs of the nation at community and hospital levels. In the current program, medical students undertake an eight-week residential posting in their final year. The objective of this study was to assess the communities’ awareness, perception and participation in the CBME program. [adapted from introduction]

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities. [from abstract]

This document presents estimates of the number and proportion of children who will lose one or both parents in 23 countries heavily affected by HIV/AIDS. The report also presents the view that solutions can be found only through coordinated efforts to support, strengthen, and multiply coping strategies among the families and communities on the front lines of the pandemic. The COPE (Community-based Options for Protection and Empowerment) program is a promising example of how this can be done. Human resources challenges are also addressed. [adapted from author]

In much of sub-Saharan Africa, a significant portion of the population lives in rural areas, leaving many women with limited access to clinic-based family planning services. Thus CBD of contraceptives remains an important service delivery mechanism in this region. The primary aim of this study was to assess the safety, quality, and feasibility of Depo-Provera provision by community reproductive health workers.

The emphasis of the COPHIA program is the provision of home-based care and support services by multi-purpose community-based health workers to vulnerable households in the geographic focus areas that are coping with the burden of caring for seriously ill family members or caring for orphans and vulnerable children. The COPHIA community-based health workers, with the support of clinical and non-clinical supervisors, provide the direct physical and emotional care and support services to PLWHA and orphans and vulnerable children in the project catchment area with the support of trained primary caregivers.

The MCH clinic workers in Somalia receive formal and in-service training to perform their professional duties. Their competence in the field was never examined. This study assessed their competencies in detecting malnourished children 5 years and below in Beledweyne. [from abstract]

Partners for Health Reformplus conducted a comprehensive assessment of the public health sector in Côte d’Ivoire to quantify HR available and what is needed to maintain basic health services while scaling up HIV/AIDS services to reach targets at the national level and at the global level through initiatives such as the President’s Emergency Plan for AIDS Relief, the World Health Organization’s 3 by 5 Initiative, and the Millennium Development Goals. [from abstract]

Nepal’s National Health Training Center (NHTC), the Family Health Division (FHD), USAID/Nepal, and JHPIEGO developed a Comprehensive Family Planning (COFP) course to provide comprehensive and effective training for family planning (FP) service providers in Nepal. Designed to increase training efficiency—by consolidating isolated courses into one complete, standardized course and by introducing competency-based, humanistic training approaches—the COFP course was intended to provide health workers with a complete range of essential FP information and skills necessary to provide quality services to clients. A number of agencies and individuals collaborated to adapt and develop these standardized training materials, and trainers were then specially prepared to deliver this course. [publisher’s description]

The African Heads of State meeting in Abuja, Nigeria on Roll Back Malaria adopted effective treatment of malaria nearer the home as one of the strategies for malaria control in Africa. A potentially effective strategy for bringing early, appropriate and low cost treatment of malaria closer to the home is through the use of community health workers (CHWs). There is paucity of information about people’s actual preferences for CHWs and how stated preferences relates to revealed preferences for both the CHW strategy and other strategies for improving the timeliness of malaria treatment in not only Nigeria but in many malaria endemic countries.

This document evaluates the Continuum of Care service delivery model established to address the problem of proving care and ART treatment to those suffering with HIV. The study documents the elements of the service delivery model including the focus on linkages between clinicians and the community and details the district-based success of the program.

The objective of this document is to implement and evaluate a public–private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. [author’s description]

This report presents the results of a longitudinal, quasi-experimental study evaluating the introduction and use of COPE and the resulting changes in service quality in two countries, Kenya and Guinea. At the end of a 15-month period, providers’ attitudes, providers’ ability to solve problems, service quality, and client satisfaction were assessed at eight intervention sites and at eight matched control sites, using both qualitative and quantitative methods. [author’s description]

Presbyterian Church of East Africa (PCEA) Chogoria Hospital is a faith based non-governmental organization providing a wide range of healthcare services. The organization faces a number of challenges related to sustainability: declining donor support (especially for reproductive health services), low cost recovery levels, and increasing poverty levels among its clientele. In response to these concerns, a team from Chogoria Hospital attended a one-week workshop held in Ghana on financial sustainability and developed a small scale operations research project to determine the cost of providing a selected number of reproductive health (RH) services and to evaluate their cost recovery levels.

Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. [author’s description]

There is a growing conviction among policy-makers that the availability of adequate numbers of well-trained and motivated human resources is a key determinant of health system’s capacity to achieve their health, responsiveness and fairness-improving goals. The objective of this study was to estimate the cost, effectiveness and incremental cost effectiveness ratios of various distance-education strategies for the health sector in Swaziland; and recommend the most cost-effective option. [abstract]