Monitoring & Evaluation

Developing a Competence Framework and Evaluation Tool for Primary Care Nursing in South Africa

Nurses provide the bulk of primary care services in South Africa. Post-apartheid health legislation envisions the provision of comprehensive primary services at all public clinics, which implies the need for a cadre of primary care nurses able to render such services. The objective of this study was to identify core competencies of clinic nurses and develop an evaluation tool for primary care nursing in South Africa. [from abstract]

Improving Health Worker Performance: in Search of Promising Practices

This report was commissioned to describe experiences and to provide lessons learnt with respect to interventions to retain staff and improve their productivity, competence and responsiveness. [from summary]

Competence of Maternal and Child Health Clinic Workers in Detecting Malnutrition in Somalia

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]

Assessing Clinical Skills: Standard Setting in the Objective Structured Clinical Exam (OSCE)

Family Medicine training and assessment is becoming more formalized and developed in South Africa. Assessment of competency in relation to clinical skills can involve observation in the clinical setting, but is more usually assessed in an examination. Summative assessment of family physician’s clinical skills now usually includes an Objective Structured Clinical Examination (OSCE). Standardisation of the OSCE is required to define the pass mark above which a candidate performs at the level expected of a family physician. [from abstract]

Midwives' Competence: Is It Affected by Working in a Rural Location?

Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to competencies identified as being those which all professionals should have in order to provide effective and safe care for low-risk women.

Excessive Work Hours of Physicians in Training in El Salvador: Putting Patients at Risk

Recent studies involving physicians in training have shown that excessive work hours are associated with an increased rate of medical errors and adverse events. The problem of excessive work hours of physicians in training in El Salvador has political and economic roots that need to be addressed by politicians and public health policy makers. [adapted from author]

Getting Clinicians to Do Their Best: Ability, Altruism and Incentives

By measuring the ability and actual practice of a sample of clinicians in Tanzania and examining the terms of employment for these clinicians, we show that both ability and motivation are important to quality.

Guidelines for Evaluating Basic Nursing and Midwifery Education and Training Programmes in the African Region

The aims of these guidelines are to provide information about the concepts and processes essential for quality assurance of basic nursing and midwifery education in the African Region; propose a process and content for evaluating existing basic nursing and midwifery education programs; stimulate ideas for establishing a quality assurance system for basic nursing and midwifery education; guide allocation of human and financial resources in current and future programmes and services; provide well-defined international and regional standards of education. [from introduction]

Quality of Communication about Older Patients between Hospital Physicians and General Practitioners: a Panel Study Assessment

The main objectives of this study were to assess the quality of the written communication between physicians and to estimate the number of patients that could have been treated at primary care level instead of at a general hospital. [from abstract]

What Can Be Done about the Private Health Sector in Low-Income Countries?

In recent years there has been a considerable growth of interest in the activities of providers in the private health sector in low income countries, and in how policy-makers might best capitalize on the accessibility and popularity of this sector. However, the evidence is limited as to which approaches work best. The aim of the present paper is to consider how the activities of the private health sector in low-income countries can be influenced so that they help to meet national health objectives. [from introduction]

Using HMIS for Monitoring and Planning: the Experience of Uganda Catholic Medical Bureau

Uganda has been successful in implementing the national “Health Management Information System” (HMIS). Disease surveillance reports and monitoring of key output indicators within the health sector seem to be the areas with the most remarkable advance. But little mention has been made on the importance of the use of information for monitoring performance indicators and for management/decision making purposes. The existing HMIS makes this possible.

Adequacy and Efficiency of Nursing Staff in a Child-Welfare Clinic at Umtata General Hospital, South Africa

South Africa has a serious shortage of human and financial resources to provide primary healthcare services especially in the historically under-served areas. It is a tedious task to carry out healthcare delivery for the masses without rationalizing human resources in the form of re-allocation and re-deployment of healthcare personnel. This study aimed to establish the level of adequacy and efficiency of nursing staff in the former Transkei region. The study was carried out in the child and family welfare clinic of the Umtata General Hospital. [from abstract]

Health Providers' Counselling of Caregivers in the Integrated Mangement of Childhood Illness (IMCI) Programme in Uganda

IMCI was launched in Uganda in June 1995 and has so far been implemented in most districts. However, reports indicate that counselling is poorly performed and that health providers find IMCI counselling the most difficult component to implement. The study was carried out to assess IMCI-trained health providers’ counselling of caregivers and to determine factors that facilitate or constrain counselling. [from abstract]

Recognition of High Risk Pregnancies and Referral Practices Among Traditional Birth Attendants in Mkuranga District, Coast Region, Tanzania

A cross-sectional study was carried out in Mkuranga District of Tanzania with the aim of comparing the ability of trained and untrained traditional birth attendants (TBAs) in identifying women with danger signs for developing complications during pregnancy and childbirth as well as their referral practices. Study findings revealed that majority of the TBAs (86.5%) had not received any training. Trained TBAs were more knowledgeable on danger signs during pregnancy and childbirth and were more likely to refer women with complications to a health facility, compared to untrained TBAs. The authors recommend that in resource constrained countries like Tanzania and especially in remote rural areas, TBAs should be trained on early identification of mothers with obstetrical complications and on their prompt referral to health facilities that can provide emergency obstetric care.

Assessing the Level of Preparedness of Private Health Providers for Clinical Management of HIV/AIDS Epidemic in Nassarawa State, Nigeria

Very little information is available on the extent to which the private health sector is involved in clinical management of HIV/AIDS in Nigeria. This study assessed the potentials and existing capacity of 15 private health facilities in Nassarawa state for clinical management of HIV/AIDS. [from abstract]

Improving the Use of Long-Term and Permanent Methods of Contraception in Guinea: a Performance Needs Assessment

This report describes a performance needs assessment of family planning and other health care providers in three regions of Guinea. Its purpose was to identify performance gaps or problems and determine the most appropriate interventions to improve providers’ performance and clients’ and communities’ access to and use of long-term and permanent methods of contraception (LTPMs)—specifically, male and female sterilization and the intrauterine device (IUD). [adapted from author]

Occupational Stress Experienced by Caregivers Working in the HIV/AIDS Field in South Africa

Occupational stress and burnout merit concern in South Africa as the severity and intensity of the HIV epidemic is often perceived as overwhelming, leaving many caregivers with intense feelings of hopelessness and despair. This study explores and describes the experiences, feelings and perceptions of South African caregivers working in various capacities (healthcare, counselling and teaching) in the HIV/AIDS field. [from abstract]

Evidence-Based Standards for Measuring Nurse Staffing and Performance

Policy makers and hospital administrators are seeking evidence to support nursing staffing decisions that includes both the volume and mix of nurses required to provide efficient and effective care. The principal objective of this study was to examine the interrelationships between variables thought to influence patient, nurse, and system outcomes. The results provide quality, evidence-based standards for adjusted ranges of nursing productivity/utilization and for staffing levels for patients receiving cardiac and cardiovascular nursing care. [from executive summary]

Improving the Performance of Primary Providers in Family Planning and Reproductive Health: Results and Lessons Learned from the PRIME II Project, 1999-2004

A foundation of collaborative partnership, strong technical staff and field presence, and practical monitoring and evaluation anchored the PRIME II Project’s successful efforts to improve the performance of primary providers of family planning and reproductive health (FP/RH) services. PRIME II’s global achievements and lessons learned are summarized in the first section; an overview of project results in each technical leadership and focus area is presented in Chapter 2. [author’s description]

TRACE: a New Way to Measure Quality of Maternal Health Care

To evaluate the quality of maternal clinical care, Immpact, a global research initiative, developed an innovative method, called TRACE, to trace adverse and favourable events in pregnancy care. It is based on the confidential enquiry technique, whereby expert panels of health care professionals assess the quality of health care provided to clients in an
adverse event, such as a maternal death. [author’s description]

Providing Health Care Under Adverse Conditions: Health Personnel Performance and Individual Coping Strategies

This resulted in a collection of papers with very different viewpoints and formats, reflecting the different professional and geographical backgrounds of the participants. First a set of papers describes the performance of health personnel in a number of countries and attempts to improve it. A second part looks more closely at the various coping strategies health care workers, medical and paramedical, clinical and managerial, actually apply to deal with difficult working and living conditions.

Impact of an In-Built Monitoring System on Family Planning Performance in Rural Bangladesh

This article assesses interventions aimed at improving family planning mechanisms and reviewing the problem-solving processes to build an effective monitoring system of the interventions at the local level of the overall system of the Ministry of Health and Family Welfare of the Government of Bangladesh. [adapted from author]

Guidelines for Introducing Human Resource Indicators to Monitor Health Service Performance

This manual describes the purpose and processes for developing and using a system of Human Resources for Health (HRH) performance indicators in order to monitor the activities of a public sector health service. It is particularly aimed at enhancing the management process in developing countries and draws on experiences of pilot work. [from purpose]

Mapping Capacity in the Health Sector: a Conceptual Framework

This paper aims to review current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries.

Africa's Health in 2010: Capacity Strengthening of African Institutions and Networks: a Strategy

The purpose of this document is to provide Africa 2010’s strategy for strengthening regional and local capacity for adopting effective policies and innovations to improve the health status of Africans. [from introduction]

Using Data to Improve Service Delivery: a Self-Evaluation Approach

This guide will help frontline health workers use the data collected at health facilities to solve common problems in service delivery and improve their response to community needs. It is intended for doctors, nurses, and midwives in community-based health centers. The overall aim of the guide is to promote greater use of existing service data to improve health services. It does not require health workers to collect any additional data. [introduction]

Challenges to Creating Primary Care Teams in a Public Sector Health Centre: a Cooperative Inquiry

Effective teamwork between doctors and clinical nurse practitioners (CNP) is essential to the provision of quality primary care in the South African context. The Worcester Community Health Centre (CHC) created dedicated practice teams offering continuity of care, family-orientated care, and the integration of acute and chronic patients. The teams depended on effective collaboration between the doctors and the CNPs. This inquiry focuses on the question of how more effective teams of doctors and clinical nurse practitioners offering clinical care could be created within a typical CHC. [adapted f

Effective Healthcare Teams Require Effective Team Members: Defining Teamwork Competencies

Although effective teamwork has been consistently identified as a requirement for enhanced clinical outcomes in the provision of healthcare, there is limited knowledge of what makes health professionals effective team members, and even less information on how to develop skills for teamwork. This study identified critical teamwork competencies for health service managers. [from abstract]

Guide to Monitoring and Evaluation of Capacity-Building Interventions in the Health Sector in Developing Countries

The focus of this guide is the measurement of capacity for the purpose of monitoring and evaluating capacity-building interventions. It responds to a demand among public health planners, evaluators, and practitioners for advice on assessing the many aspects of health programming that fall under the rubric of capacity building. [author’s description]

Training Curriculum in Interpersonal Communication, Referral and Follow-up Process, and Selected Practices in Infection Prevention and Control

This training curriculum is a guide to assist trainers in improving health care by training health professionals in: interpersonal communication in information, education, and counseling; referral and follow up processes; and infection prevention and control practices. Materials in this document are designed for training service providers who work at a variety of health facilities in Iraq. The curriculum can be used to train health professionals including physicians, nurses, midwives and other health workers in group training or, with adaptation, as a basis for individualized or self-directed learning. [author’s description]