Discussion Papers

Exclusion of Traditional Birth Attendants from Formal Health Systems in Ethiopia

Traditional birth attendants have been a subject of discussion in the provision of maternal and newborn health care, especially in developing countries where there is a lack of infrastructure and trained health personnel. The objective of this study was to assess the role of trained traditional birth attendants in maternal and newborn health care in Afar Regional State. A qualitative cross-sectional study was conducted and 22 in-depth interviews and 6 focus group discussions conducted with health service providers, trained traditional birth attendants, mothers, men, kebele leaders and district health personnel.

Findings: This study indicates that trained traditional birth attendants are the backbone of the maternal and child health development in pastoralist communities. However, the current numbers are inadequate and cannot meet the needs of the pastoralist communities including antenatal care, delivery, postnatal care and family planning.

Without deploying adequate number of trained health workers for delivery service, trained traditional birth attendants remain vital for the rural community in need of maternal and child health care service, especially in areas with poor infrastructure. With close supportive supervision and evaluation of the trainings, the TTBAs can greatly contribute to decreasing maternal and newborn mortality rates. Both the government and non-governmental organisations should provide the necessary recognition and supportive supervision since TTBAs enjoy community goodwill and will continue to provide services to rural communities in Ethiopia for a long time.

Download:  Exclusion of Tradtional Birth Attendants from Formal Health Systems in Ethiopia [PDF]

Assesing 50 Years of AMREFs Intervention in Kajiado District

AMREF has been implementing health interventions in the largely semi-arid Kajiado District of Kenya, since the early 1960s. The initial rationale was to provide badly needed curative and promotive health services to marginalised nomadic pastoral communities. Over the years, AMREF interventions have evolved in response to dynamic demographic and socio-economic transformations resulting in reduced overall significance of nomadism and increased marginalisation of pastoralists. This paper set out to assess the impact of AMREF’s long interventions on improvements in health status and well-being of the beneficiary communities.

The study employs a combination of different methodologies to present descriptive information and analysis to develop initial stylised observations on AMREF’s long experience in Kajiado district and its influence on local communities, as well as public policy. The study relies heavily on review of existing project documentation within AMREF’s archives, embracing specific project and programme designs, progress reports and evaluations.

Findings: While the findings of these reviews are initially discussed separately, a synthesis of the three categories of findings is provided in a final section of the review which is followed by recommendations for future project and programme design in order to facilitate objective impact assessment.

Downloand: Assesing 50 Years of AMREFs Intervention in Kajiado District [PDF]

Prevention of HIVAIDS Infections Among Female Commercial Sex Workers Uganda

The Kawempe Community Health Development Project (KCHDP) located in a poor informal urban setting of Kampala aimed to improve sexual and reproductive health (SRH) services available to female commercial sex workers (CSWs) and equip them with employable skills for behavioural change. Project strategies included provision of user-friendly services at a community health facility, building critical community capacity for promotion of service utilisation and safe sex behaviour change, and providing vocational skills training to CSWs. The review was conducted to assess project impact on increasing SRH services uptake among the CSWs and document changes in their demand for adopting safe sex behavioural change.

This retrospective and cross-sectional study was conducted in July 2009 and reviewed project information from 2001 to 2008. The combined study design was intended to facilitate a more in-depth analysis of issues, taking into consideration the perspective of project key stakeholders. Both quantitative and qualitative data was generated with descriptive analysis methods and thematic analysis being used, respectively.

Findings: The project contributed to increased service uptake for SRH services and demand for safe sex behaviour change among CSWs in an urban poor community. There is need for the programme to strengthen its institutional and financial sustainability to match the increasing demand for SRH services and vocational skills training for CSWs. This may be through formation of partnerships and mainstreaming project activities into ongoing health and development programmes.

Download: Prevention of HIVAIDS Infections Among Female Commercial Sex Workers Uganda [PDF]

Efficacy of Community-Based Health Care in Kenya: An Evaluation of AMREF’s 30 Years in Kibwezi

AMREF has been involved in health development in Kibwezi, Eastern Kenya, since 1978. Its interventions have evolved in tandem with changes in community health needs and changes in government priorities. They have also greatly deepened and expanded in coverage in the 30 years of working in, for and with this hard-to-reach community. The paper is an evaluative research aimed at establishing the achievements of this long-term engagement. It presents the historical evolution of interventions, assesses AMREF’s programmes in relation to national health policy, analyses success of the various interventions in terms of project objectives, implementation processes, expected outputs and outcomes, achievement of partnerships and sustainability and identifies programme challenges and lessons learnt.

Using both secondary and primary data, the paper utilises a combination of methods to assess the efficacy, effectiveness and sustainability of AMREF’s interventions. The paper concludes that, although it is difficult to precisely measure the proportion of AMREF’s contribution, successful achievement of intended outputs and measurable or imputed health outcomes confirm a definite positive contribution to the improvement in the health status of the community.

Findings: The paper presents projects-specific achievements, identifies and demonstrates that the approach adopted has produced useful lessons for improving the health status of communities through strengthening of health systems.

Download: Efficacy of Community-Based Health Care in Kenya: An Evaluation of AMREF’s 30 Years in Kibwezi [PDF]

More than Facts & Figures: Effectiveness of AMREF’s HIV and AIDS Interventions

Over the years, AMREF has accumulated a rich repository of knowledge products from its HIV/AIDS interventions. To assess the organisation’s contribution to HIV/AIDS responses in Africa requires that we move beyond the accumulation of data, figures and facts found in the numerous monitoring and evaluation reports from independent projects to evidence based on systematic analysis across projects and countries. This paper documents the relevance of these interventions to AMREF’s corporate strategy, their impact on beneficiaries, as well as best practices.

Heterogeneity of HIV and AIDS interventions from Ethiopia, Kenya, South Africa, Tanzania and Uganda informed a three-part methodology: (1) a general global review of evidence on effectiveness of interventions; (2) a summary of evidence from published and unpublished sources of data and information sources using the logical framework format; and finally (3) a synthesis of findings at project-level within and across countries using a comparative framework.

AMREF should improve its quality of documentation and data management to move beyond project outputs to assessment of outcomes and impact as measures of effectiveness.

Download: More than Facts & Figures: Effectiveness of AMREF’s HIV and AIDS Interventions [PDF]