Recording and materials from the webinar on Cleaner hospitals for better quality of care: the example of Ethiopia’s Clean & Safe Health Facility Initiative

As part of CASH, St Paul's hospital in Addis Ababa ensured women in labour had access to latrines.

13.02.2018

On 9 February, the Quality of Care Network hosted a webinar on 'Cleaner hospitals for better quality of care: the example of Ethiopia’s Clean & Safe Health Facility Initiative'

Molla Godif Fisehatsion from the Ministry of Health in Ethiopia and Tewodros Fantahun from St Paul’s Hospital Millennium Medical College in Addis Ababa presented the Clean and Safe Health Facility initiative (CASH), a programme of the Ethiopian Federal Ministry of Health to make healthcare facilities clean, safe and comfortable to patients, visitors and staff.  They explained how the CASH initiative supports the overall national proirity of improving quality of care, and what specific impact it had in the case of St Paul's hospital staff motivation, infrastructure improvement, and patients' experience of care.

With CASH in its 4th year of implementation, and now active in all public hospitals in the country, the webinar provided an opportunity to look at the successes, challenges and requirements of a long standing, ambitious programme targeting simulteaneously health workers and managers, hospital cleaning staff and  patients and their families.

Listen to the recording of the webinar

Dowload Tewodros Fantahun's presentation

See the questions and answers below, and join the conversation by posting a comment/question 

 

 

Comments

How did you do the compétition between the hospitals in order to déterminante a winner?

ANSWER

Based on the   national CASH audit tool, hospitals all over the country are assessed and evalauated by health proffessionals who  are oriented on the audit tool. Those hospitals which performed well based on the assessment/evaluation get recognition.

Which monitoring tools did you use?

ANSWER

The national CASH audit tool is used mostly but when we need to assess specific service areas we use more specific and appropriate audit tools for that specific  area(Eg. MCH services). Currently the CASH audit tool is updated and some important indicators/elements of the WASH-Fit are incorporated.

Can the CASH implementation assessment tool or checklist be shared?

ANSWER

Yes, we can share with you.

How did you do the competition between the hospitals in order to determinate a winner.

ANSWER

See answer to the first question

Fantastic initiative! Really interesting to hear how it has been implemented. My question is around cleaning staff who often represent a marginalised group despite their role in IPC - to what degree has the CASH initiative been directed towards cleaning staff, their training, and their role in infection prevention in terms of environmental hygiene? And what has been the striking findings from their involvement, if any? If their involvement was not a specific element of the initiative, was there particular reasoning around this?

ANSWER

Fortunately when the initiative was implemented we did get trainers from a Swedish organization called Human Bridge to train cleaners. Thus more than 300 cleaners invited from 11 hospitals, mostly from St. Paul hospital and Black Lion hospitals (the two biggest hospitals in the country) participated. This shows  how important  the cleaners are for CASH and that is why we started to train the cleaners. In addition to that we do have infection prevention and control training material specific to supportive staff with a focus on cleaners and they have regularly have had 4 day trainings. One of the priniciples of CASH is «CASH is the responsibility of everybody ».

Thank you for the interesting presentation. Can you expand on the challenge of 'attitudes of health workers'? Do you mean they do not practice things like handwashing with soap as much as they should?

ANSWER

Regarding attitude one of the good success we have brought through implementing CASH is behaviour change among people at the hospital. Previously this area was one of the neglected areas which was not considered as component of health service delivery. But due to the advocacy and mobilization we did I can say that change is encouraging. It remains a challenge to some extent.

The 'CASH implementation score' appeared to be largely based on measures of infrastructure/hardware. To what extent are you systematically monitoring behaviour change among health workers?

ANSWER

The goal of CASH is to create  cleaner and safer health care environment and to contribute quality of care and then able to reduce maternal and child mortality. So based on our outcome we focus on measuring whether we are creating a cleaner and safer health care environment or not. Yes of course we conduct also a qualitative survey by asking questions related to behaviour change. Additionally we observe whether the recommended practices are implemented or not.

Thank you for the presentation on CASH.  Is it possible to share some of the costs related to the initiative?

ANSWER

There is no CASH specific budget mobilized.

Was there other rewards other than the trophy?

Are there any other incentives for staff than the competition and receiving the trophy, any payments?

ANSWER

No incentive specific to individuals/staffs

What are the plans for replicating and rolling out these successes to other hospitals, health centres, and health posts? Is the project financially sustainable? It must be an expensive initiative – where does the funding come from? Do you think the investments have in the end saved money?

ANSWER

Yes, we have been scaling it up to other hospitals and health centers. But there is no CASH specific budget and this is one of the big challenges. But hospitals mobilize from their internal revenue and in some cases they get some support from the community (not direct money).

Were you able to see a link with outcomes for patients/clients?

Can you share a powerful story from a health worker on how they were positively affected by CASH (from the hospital)?

Thanks for your willingness to share the assessment tools. How could we get them?

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