joint-aus-us-gov-review-hamlin-fistula-ethiopia-final-report.doc

Typical government hospital clean light well

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typical government hospital: clean, light, well organised, well equipped and in beautifully landscaped surroundings. As discussed under Limitations, it was not possible to provide a ten year retrospective review of achievement against performance targets owing to lack of available plans and data. HFE’s current strategic plan is to repair a total of 4,000 patients per year at ‘full capacity’, with a critical assumption that patients are identified and transported in sufficient numbers to fistula centres. Reviewing the data across plans and reports is somewhat confusing: the Strategic Plan is based on the calendar year while donor reports use the GoE fiscal year (8 July-7 July); the presentation of data in the 2011/12 report to AusAID mixes numbers and proportions, thus creating a false picture of performance against targets. What is apparent, however, (Figure 2) is the overall decline in performance across centres from 2,395 in 2008 to 1,939 in 2012, with the exception of Bahir Dar which had a small increase in cases between 2011 and 2012. Otherwise there was wide variation in total numbers operated across regions, with Harar having 59 cases and AAFH having 773 in 2012 (See Annex 2 for further data). Figure 2: Annual number of fistula repairs carried out by AAFH and five satellite fistula centres Source: USAID. 2013 The generally downward trend is due to both supply and demand issues: On the supply side: Low performance in two regions is thought to be the result of having part time contract surgeons, limiting the surgeons’ ability to develop credibility and links with the community. (Relationships with the Regional Health Bureau (RHB) in the respective areas are reported to be handled with care since HFE has been criticised for stealing staff). 29 The Women and Health Alliance (WAHA) is an international non-profit NGO based in France and working in 18 countries. WAHA started OF surgery in Ethiopia in 2010, within three university hospitals. Both the CEO (Mulu Muleta) and another senior surgeon were previously surgeons in HFE. AusAID Health Resource Facility 8 Managed by HLSP in association with IDSS
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AID and USAID Review of Support to Hamlin Fistula Ethiopia (Ethiopia) 31/05/2018 Services Order 230 Draft report Coverage of services: remains inadequate especially in worst affected areas. In Mekelle, most patients come from the western part which is very far from the centre. For patients requiring referral to Addis Ababa, the distance is arguably a disincentive. On the demand side: Case detection: women with fistula are often hidden away and stigmatised, and families are ashamed to declare their presence. The team were told by women that they had suffered in this way for as long as 20 years and never knew they could receive help. This is why it is important for cured patients, community based workers (HEWs, HDA etc.) and community leaders to help with case detection and encourage women to come forward for assessment.
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