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

48 fistula foundation letter to givewell team 9

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48 Fistula Foundation letter to GiveWell team, 9 February 2012 49 S. Ahmed, S.A. Holtz. Social and economic consequences of obstetric fistula: Social and economic consequences of obstetric fistula -Life changed forever? International Journal of Gynecology and Obstetrics (2007) 99, 510-515 50 (4,000 in the Strategic Plan, 3,000 in 2011/12 report and 2,530 Annual Performance report). 51 Ethiopia Midwives Association. State of Ethiopia Midwifery 2012. AusAID Health Resource Facility 31 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 with HR directorate in FMOH suggested that there would be a glut of midwives in a few years. Attrition is high because of poor conditions and inadequate training which the FMOH is only too aware of. In this scenario, it is important for HFE to define its role and added value. (See Annex 4b for further detail on midwives). The cost of training a BSc midwife in HMC is US$16,000 over the four year period. FMOH indicated that the cost of training each Diploma midwife is US$630 and US$42,000 for each Health Officer doing the Accelerated Training in obstetric care owing to the cost of contracting consultants for supervision. Table 10 below provides some comparative costs of midwife training across countries. HCM costs look reasonable and efficient by comparison, except when compared with Government costs in Ethiopia (though these costs do not include living costs). Table 10: Unit costs of BSc midwife training in different countries Country Duration of training Scope of costing Student cost per year: US$ Afghanistan 2 years All expenses including housing, food, training materials etc. 8,000 -9,000 Burundi 4 years Tuition, transportation, accommodation and living fees, registration fee, internet fees, library charges 3,250 Ethiopia (GoE) 4 years School fees (class room learning and clinical experience in the field ) 1,630 HCM (Ethiopia) 52 4 years Training, housing and expenses (Source: HCM website) 4,000 Southern Sudan 3 years Scholarship, full board, books , and transportation fee 11,800 Tanzania - Recurrent expenditure 3,236 Source: Friedman H et.al back ground paper for The State of the world’s Midwifery report. April 2011. Considering the “value” aspect of VfM, the quality in HCM is undoubtedly much higher and so it is difficult to make strict comparisons with Government training. It is widely acknowledged (e.g. by FMOH, UNFPA) that the quality of the training in HCM is significantly better than training provided in government institutions in terms of staff to student ratios and numbers of deliveries that are performed by students. The HCM midwives are providing good services in their respective health centres though the costs of sustaining them in situ, which include salary top-ups of ETB500 per midwife each year incrementally, accommodation, equipment and supervision costs cannot be taken on by government. The 34 midwives to have graduated to date are, however, a “drop in the ocean” compared to the needs in Ethiopia, suggesting that the objectives of preventing fistula may not be achievable. This stream of work would benefit from clearer
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