70 First, ask participants to brainstorm about how to answer the questions Is the health center doing a good job And How do you know List the answers on flip chart. Appreciate their answers and compare with the following Ask the participants to divide into groups of 5 persons and review the quarterly data given below. Distribute graph paper and ask each group to draw a line graph of ANC visits and skilled birth attendant (SBA) deliveries by quarter. Ask each group to select one program area (e.g. ANC or Measles vaccination) and comment on the Health Center’s performance during year 2000. Ask them to list down possible causes of such performance for that particular program area. Ask them to group those factors that could have influenced the quarterly performance that are beyond the control of health facility staff climate (i.e.,
rainy season, seasonal work and migration, possibly drugs and other resources, etc. Methods to answer the question Is the health center doing a good job
Time- trend
Comparison with baseline
Comparison with other health centers
Comparison with expected / target service coverage Family health services in 2000: Ina woreda, a Health Center provides family health services to a population of 26,584. Data on family health services for 2000 areas follows Q Q
Q Q Family planning acceptors 738 624 191 596
ANC
118 37 82 62 Skilled Birth Attendant at Delivery
6 2
1 3
PNC
4 3
0 2 DPT 3 9
6 16 5 Measles
8 6
15 5
71 Ask the participants regroup and review the annual data given below. Ask the participants to comment on the performance of the Health Center based on the annual data of the past 3 years. Ask what more information they need in order to assess the performance of the Health Center.
Possible answers -
data on associated indicators -
calculation of population coverage for making comparisons Emphasize on calculating relevant indicators (e.g. population coverage) using the raw data. Ask what the limitations of comparison with raw numbers are. Reiterate that we may know whether things are improving with raw numbers, but we don’t know whether we are reaching the population who need those services and, therefore, cannot decide on what we could (or should) be doing. Family health services 1998-2000: In the same Health Center the following family health services were provided over the past 3 years
1998 1999 2000 Family planning acceptors
2001 2042 2149
ANC
220 284 299 Skilled Birth Attendant at Delivery
7 11 12
PNC
2 8
9 DPT 3 37 34 36 Measles
28 31 34
72 Ask the participants to review the annual data given below. Ask, what types of calculations and comparisons have been done in this case.
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