PUBH 8475 Walden University Belize Public Health Program Discussion

?Challenges to Evaluation and Reporting?
Program Transcript
ANNA SILVA: At the end of most of our projects or programs we do a survey. So
we do a pre- and post-test that going into that project or program, we get what
people know. And then at the end of that program, then we also do that post-test
again to see what you have learned or how effective the projects have been.
So at the beginning you need to find out, what is their knowledge of that
particular project that we’re doing? For example, domestic violence. OK, what do
you know about domestic violence? Do you know people who have been
affected? If you haven’t, do you know people who have been affected by
domestic violence? And what resources are you aware of that is there? And so
we do that at the beginning and then at the end after giving them all the
information. You definitely see a difference if they have gained the knowledge
that we are trying to pass on to them.
JENNIFER HARSTA: What we like to do is also keep a photographic record, or
even a video record of some of the things that are taking place in the community.
We like to let our parent company, Water Missions International, and a team here
with us now– and that’s Cedar Creek Church– we like to let them feel like they’re
a part of it if they can’t actually come and be with us.
We do like to report the positive effects. And certainly we do have negative things
that happen as well. There are some communities that really do reject that
chlorine taste. So we might spend six months trying to get it regulated, so that
they will actually drink the water and not be– well, I guess, it’s offensive to their
taste buds. So we just to really do a lot of troubleshooting on that.
ROEL HARSTA: Actually, this chlorinator is somewhat of an issue with some of
these communities because what we’re doing is we’re introducing chlorine, which
has the taste of chlorine, which a lot of the locals are not used to. And so they
don’t like it. And so now what we’re doing in some of the later installations, we
put a carbon filter after the chlorinator, which actually, in essence, takes the
chlorine taste out of it again.
JORGE POLANCO: I use malaria as an example because that has been of
priority for the Ministry of Health. And actually, that has been one of the programs
with great success over the recent years.
In 1994, we had a little over 10,400 cases of malaria. 96% of it being via bugs.
Last year we reported less than 74 cases. And over the last 7 years, we have
maintained it less than 150 cases. So we have managed to keep it as a very low
level countrywide. There are only two districts right now reporting most of the
malaria cases– the Stann Creek District. But within the Stann Creek District is
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only 4 or 5 localities that are reporting 85% of those cases. So we have already
begun zooming into those 5 localities. Right now we brought in a person who will
be working. He’s on a contract. He’s retired. He was a former chief of operations.
And he was tasked to do treatings. And one of those treatings will be to zoom in
those five localities to see how we could improve the overall environment and
sanitation of those villages.
In other words, treating the cases will be done as a routine basis. But we want to
sensitize the community that they really need to get to the roots, which is nothing
but the environmental sanitation, controlling the breeding sites, teaching them,
providing them with information as to how to get rid of breeding sites.
Most of the times, 100% of the times, to get rid of a breeding site around your
house is the easiest thing to do. But if they are not informed, or they are not
sensitive, or they are not motivated, they won’t do it. Taking care of a breeding
site costs absolutely nothing. It will take you 5 minutes versus having the
[INAUDIBLE] breathing the air and transmitting malaria.
So we have our reporting manual, this booklet that outlines the frequency and the
format for the reporting of every activity at national level. We have what we call
programmatic areas. First, these used to be the vertical programs when all the
ministries and all the world had vertical programs– AIDS, malaria, MC. Now we
have integrated them so they are within the region or at the regional level, so we
call them programmatic areas. But they are the same names. Environmental
health, I think, include vector control, public health, trials, et cetera. maternal and
child health, HIV and AIDS, STIs, laboratory service, we just have support
service. Dental health, mental health, et cetera. So all those functions are carried
out at the local level. And they have persons who are responsible for the
implementation of those activities.
And then we have standardized formats for reporting. They use the basic
variables– age, sex, locality, activity done. For example, recently at the level of
community health workers, which are not really our staff, they are volunteers but
they work with the Ministry of Health, they recently had a revision of their existing
reporting forms. A previous legal, just a standard, open format that they used to
report their activities. Recently it was developed in such a way that we will know
exactly how many people are sick in that community, how many house visits they
did, the type of them, how many persons they referred, what were the reasons
for referral, et cetera, et cetera.
Reporting traditionally has not been an easy issue. But it has existed. It was
much, much better when we had vertical programs. Perhaps they liked to be
treated like in the military. You need to do it and you do it. When they were
integrated into the regions, the overall reporting practice declined a little. It’s
picking up again because we realized it was a problem.
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Reporting has taken an effort. Some persons, very, very few will do it
automatically. But they are so involved. And this goes back– there’s a series of
reasons. They are extremely busy in their day-to-day activities that they will see
reporting as not important for them. Even though for the management team and
for us reporting is fundamental because that’s the only way we know where we
are in regards to our targets.
So yes, some persons have needed much more effort to do the reporting. But it’s
coming along. The use of this manual, the use of a chart, we’ve used all different
means to really motivate and to improve our reporting. But I think it does come a
long way.
For the last three years we have consecutively reported annual reports in a very
comprehensive manner. Previous to that we had individual reports. Everybody
would report individually and it was not integrated.
I could count the number of surveys that we have done over the last 25 years.
They’re extremely limited. It’s not something systematic. We have done two
surveys on [INAUDIBLE], one in 2001 and one, the current one. We’ve done a
national survey to determine the prevalence of obesity and chronic diseases
which was in 2006. We do assessments or surveys, but mostly operational
surveys for the purposes of controlling outbreaks for certain diseases like malaria
or dengue. But for us to see something systematic that we will have surveys
every 5 years or every 10 years to pick up health problems in general, we don’t
do that.
JENNIFER HARSTA: We test the water, we assess the village and community,
we go in and we do community development. And part of that is– it is teaching
and enabling the community with advice, suggestions. And then, walking them
beside an implementation process. And then we do follow-up. And that is huge to
us. It is huge. It is not always easy because once you’ve got a project in and
you’ve labored it, and then you’ve kind of walked away to let them carry it,
coming back to it is not– you want to come back, but you’ve also started other
projects that need your immediate attention. But coming back to it is probably the
most important part of it. Because just like today, we find that things slip through
the cracks and not being run as efficiently as it could be. So we do have to do
follow-up, continual follow-up.
You need to have integrity for what you do. And if you say you’re going to try
something, you need to give it the absolute best to your ability. And we are not
perfect people. And we don’t always have perfect solutions. But if we don’t have
it, admitting that we don’t have it complete. But seeking out what it is to complete
that and to make it right, it just speaks for recognizing that it’s not always about
us and what we can do. It’s about that we find a way to help somebody, but it
might not be just through ourselves.
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FEMALE SPEAKER: What is a success story for you?
ANNA SILVA: Somebody leaving the shelter and maybe a few months on their
own, coming back to say, I am still OK. Coming back to ask for advice. That
person just comes back to say me, say, I thank you. Thank you– to you and
Mary Open Doors. There’s been a change, a big change in my life. That’s a
success story for us.
[MUSIC PLAYING]
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