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March 2001, Vol. 7, No. 1Women's Health The Reproductive Health Working Group, a research team established at the Population Council’s Cairo office, recently conducted an intervention in collaboration with the Egyptian Ministry of Health and Population to address the medical needs of rural Egyptian women. The researchers created a framework for the integration of reproductive health and primary care and applied it at three primary care centers in Giza. They also assessed the influence of the intervention on quality of care and demand for services. Previous studies by the group showed that rural Egyptian women bear a heavy disease burden. The researchers found, for example, that the vast majority of women in two villages in Giza were experiencing at least one gynecological or related condition at the time of the study. The women in these villages indicated that they avoid consulting doctors in part because the quality and nature of available services are often inadequate. The reproductive health framework The identification of essential services was guided by the findings on women’s needs from the previous study. The framework allowed for provision of nutritional advice, and screening and treatment for reproductive tract infections, anemia, hypertension, urinary tract infections, uterine prolapse, and diabetes, among other services. Moreover, the researchers created a simple, yet comprehensive system for keeping patient medical records. Previously, maternal and child health and family planning records were kept separately from primary care records. While this system was sufficient for statistical reporting, it hampered the ability of clinicians to see the whole picture of a patient’s health. The new record-keeping system documented all patient visits in one file. The research team outlined standards of care to be followed, such as increasing the duration of interactions between providers and clients, improving sanitary practices, and enhancing client privacy in the clinic. They also trained doctors and nurses in technical and communication skills and launched a community health education program. “Health education, when conducted carefully, can enable women to make informed medical decisions. Our previous research showed that many women in Giza were unaware of the medical significance of their symptoms, so improving their knowledge about health is vital,” says Population Council researcher Karima Khalil, a member of the study team. In order to ensure an effective two-way referral system to higher treatment levels, the research team spent considerable time establishing links with local district hospitals. The team emphasized the importance of providing feedback to the primary clinician after the referral visit. Finally, the intervention entailed such basic infrastructure upgrades as painting clinic walls and replacing old microscope lenses. The team developed and tested tools to monitor and evaluate every component of the work. They found that the health education program quickly increased the demand for reproductive health services and that women had favorable responses to the clinic upgrades. The time women spent waiting for their appointments decreased, while the amount of time they spent with the provider doubled. Doctors became more sensitive to women’s privacy, and examination procedures and subsequent diagnoses improved greatly. Enhanced diagnostic procedures were also a result of training for laboratory technicians that was conducted as part of the intervention. Sterilization and hygienic conditions at the clinics improved markedly. Nurses became more enthusiastic about their jobs and began assisting doctors more than they had previously. Several management issues at the clinics remained troublesome even after the intervention, however. While the doctors were in effect managers of the clinics, they had never received any management training. As a result, job descriptions and the division of responsibilities, particularly among nurses, were not generally followed. Attendance and punctuality were erratic in some cases. Moreover, medications, microscope slides, and disposable gloves were supplied irregularly. The research team recommended that the physicians would benefit greatly from a short course in management skills. Another obstacle involved the two-way referral system. The arrangement did not function satisfactorily, perhaps as a result of bureaucratic obstacles within local district hospitals. “While some challenges remain, this study has shown that a simple framework of essential reproductive health services can be provided at the primary care level,” concludes Khalil. “Doctors, nurses, and lab technicians can learn new procedures, and clients very much need and appreciate the new services.” To confirm their findings and learn more about ways to improve integrated service delivery, the working group is currently testing the framework in 15 additional clinics in Giza. Sources | |||||||||||||||||||||||||||||||||||||||||||||||
