As a group, complete a profile of a health centre or the hospital within the first two weeks of the block. The goal is to give you an opportunity to fully understand the settings under which primary health care is provided. By the end of the assessment, you should be able to describe the basic facilities in the site, report on the access, quality of care, equipment and the infrastructure status of the facility, identify resource challenges faced by the facility as it fulfils its role in the delivery of primary health care, and list required resources to address any identified gaps. In addition, you should be able to critically discuss the strengths and weakness of primary health care and make recommendations for improving its delivery.
You should assess the following areas of your facility:
- Clinic location
- Structure and size of buildings
- Staff numbers by cadre
- Facility capacity and number of patients served
- Description of the catchment area (population, demographic, population, economic, activities, administrative area)
- Facility governance/leadership
- Services offered by the facility: Home based care, outpatient, in-patient
- Organisation of the clinic
- Equipment available
- Drug supply system
- Description of patient consulting rooms
- Privacy for patients
- Infection control status of the facility (ventilation, disposal of medical waste)
- Availability of water and electricity
- Communication systems (phones, road network)
- Referral networks (ambulance)
- Toilet facilities
For each category listed, there should be a thorough assessment including (if applicable) whether the item exists and is functional. Collect data through observation of the clinic environment and activities, interviews with key clinical personnel (facility manager/in-charge or other designee, nurses and other staff), and review of existing information (hospital reports, census data, and district office records). Appendix A contains a detailed checklist that outlines areas to be assessed. It is in the format of a questionnaire which may be adapted to suit the local facility conditions and may be used if you so desire.
The analysis should discuss the adequacy of resources at the facility. Although some of the measures are subjective, students should look at each category and decide if the situation is good, acceptable or poor. This is a subjective judgment and may need to be adapted to suit the clinic.
Good is a situation where all facilities are in good working order and in no way interfere with the delivery of services.
Acceptable is a situation in which the minimum requirements are available but existing conditions may interfere with the provision of services, hence adjustments need to be made so that services may be rendered unhindered.
Poor describes a situation where the facilities or equipment are such that services cannot be provided at an acceptable level.
For each category, generate a description of criteria that meet good, acceptable or poor levels. Comparisons may be made across categories and represented in tables and graphs in the group report.
In putting together the final oral report, the group should work through data collected in the different categories of the audit, identifying problems or issues in each category, the implications of these issues/problems for service delivery in the clinic and the possible solutions proposed. For example:
Categories |
Issues |
Implications |
Proposals or solutions |
Infrastructure |
Poor electricity supply |
– Low immunization coverage in the community
– Outbreaks of measles
|
– Advocacy directed at the local council or provincial government to link the clinic to the national power grid
-Alternate source of electricity (e.g. a generator) |
Equipment |
Non-functional refrigerator for cold-chain storage |
Access: Child health |
Poor immunization services |
Although the checklist serves as a guide to carrying out the health facility assessment, the main component of the presentation will be around the analysis and recommendations for addressing the identified gaps to service delivery. Each group will be expected to suggest at least 3 key proposals or recommendations for enhancing service delivery. One of the proposals may become a foundation for the Quality Improvement Project.
Present your findings in a group oral presentation. It should not exceed 15-20 minutes. Audio-visual aids, where available, may be used for the presentation. This is a group activity and group marks will be allocated. Students may divide the various aspects of the study among group members, but the final report must be integrated and will be assessed as such. Each group will receive a single mark. If you chose to audit to audit a health centre other than your primary site, the group should elect a group leader who will work with the preceptor to arrange the visit.
The health facility profile should be carried out within the first 2 weeks of your block and presented to an assessor (College of Medicine staff or local block supervisor) in an oral presentation. A representative of health facility management should be represented at this final oral presentation.