Yemen Project. Read the Yemen case study and fill out this worksheet. Please answer using short responses. For aspects that are not clear from the Yemen project description, please state this, explain gaps in the information and write a question that you would like to ask the implementing team.
Project title: Yemen Project (This section required a specific project name which is missing in the document)
Country: Yemen
Critical information:
1. Technical areas
2. Location
3. Objectives
4. Levels of health system where implementation is focused
5. Target populations
6. Project implementation timeline
Worksheet 1: Period of time
Clarification needed/ other details
Start date
Project Period is five years with no exact date of when it started and ended
End date
Project Period is five years with no exact date of when it started and ended
Worksheet 2: Technical areas
· Possibilities include: Maternal, newborn, child, immunization, malaria, diarrhea, acute respiratory infection, family planning, nutrition, gender, HIV/AIDS
Technical areas
Clarification needed/ other details
Newborn
Need to clarify on why newborn infants with less than 2.5 kg have high chances of dying. Besides, the case study focuses on the causes of mortality rates in Yemen and other parts of the world. According to the study, the leading cause of newborn deaths include poor health services, and 13% of babies in Yemen are born preterm.
Maternal
The number of females suffering from obstetric fistula in not clear. In Yemen, there are numerous instances of obstetric fistula, more so affecting young women. For the sake of mothers’ health, the routine postpartum and newborn care should be improved.
Family planning
Cultural beliefs related to the use of family planning contraceptives are not explained. Furthermore, 62% of women claiming to avoid pregnancy do not use family planning. As a result, it is crucial to determine the main factors preventing them from using contraceptives in detail.
Diarrhea
The prevention measures to prevent children from death cause by diarrhea are not clear. Although Yemen introduced community-based program for treating pneumonia, the laid strategies for treating malaria are not outlined
Gender
Even though the percentage of girls involved in early marriage is clear, the number of boys marrying young women is not provided. An estimate of 16% of girls in Yemen are married at the age of 15 to 18 years. However, the main causes of early marriage are not outlined.
Nutrition
The case study does not specify nutrition requirements for babies and mothers. Besides, it focuses on acute and chronic malnutrition. It also provides effective ways for improving nutrition among babies.
Immunization
Authors of the research needs to clarify on the number of deaths caused by lack of immunization in Yemen. With a clear analysis on its distribution across the country, it will be easier to implement appropriate approach to deal with a high number of unvaccinated children.
Child health
There is a gap on how to access unvaccinated and ill children. Although the team aims at improving the environment to encourage healthcare providers to do their job, the way they are likely to access patients are not outlined. I would ask the implementation team to encourage all parents to attend their healthcare programs.
Worksheet 3.1: Location
· Possibilities include: Entire country, Provinces, Governorates, Districts, Sub-districts, Counties, Sub-counties, Parishes, Sub-parishes, Communities, Villages, Neighborhoods, Health facilities, Health facility catchment areas, (add some from Ethiopia context, Yemen, Uganda)
· Rank in order of largest administrative area to smallest, varies by country.
· Include in definition if administrative level is health specific or serves other governance needs. Health system administrative areas are not always the same as areas used for other functions.
· For Communities, villages, neighborhoods, health facility catchment areas, find out how geographic boundaries are determined, how different stakeholders define each, differences in population sizes. In some cases, these terms are not well defined even within a country. Sometimes activities are not carried out uniformly throughout a location. For example, iCCM activities often occur at => 5km from health canter and routine immunization services are provided through a combination of static (health facility) and outreach immunization sessions. Outreach sessions are planned for areas without easy access to health facilities.
Location
(start with largest administrative level)
Definition/ relationship to health system
Will project be implemented in entire location, if not explain.
Clarification needed/ other details
Entire country
Refers to an independent state with the ability to structure its own health care policies.
No. The first and second year will involve three governorates, which include Sana’a, Dhamar and Aden.
The considered factors that led to the selection of the three governorates are not included. Even though the other governorates will be awarded the promotion later, the criteria used for warding them should be clear. My main question to the project team is what is why did they consider the Sana’a, Dhamar and Aden first?
Governorate
This is an administrative division of a state, which ensures effective health policies for people living in a certain county.
No. Only two to three districts will be selected per governorate.
The main factors that will lead to selection of a district are not clear. The project team should describe the way the districts were selected.
District
A district refers to a local location managed by a local government, thus ensuring that health departments are operating smoothly.
No. Few sub-districts will be used while implementing the project.
The selection criteria are not clear. Therefore, the team should answer the question which selection criteria can be used to support more additional districts?
Sub-district
In health care systems, a subdistrict is a low-level administrative division of a district.
No. Some districts were not even selected for the project.
The project team should identify the name of sub-districts selected for the project.
Health center catchment area
Refers to an area that can be served by a healthcare facility or a dispensary.
Yes
No provided outreach sessions. the case study seems to avoid people who are not near health centers. How will people in remote areas receive health care services effectively?
Community
In health care, a community involves people accessing the same medical facility sharing similar geographical location.
Yes. A community covers a small area. Therefore, it is necessary to implement the project in the entire area.
Will all individuals in every society benefit from the implementation of the project?
Worksheet 4: Objectives
· If not SMART, note clarifying information needed
Objective
Clarification needed/ other details
Improve enabling environment for high-impact RMNCH/Nut services (national-level support).
No clear definition of policies required to ensure an effective environment for born children and infants in Yemen. Outlining rules that will be used at the provision of health care services for pregnant mothers is essential.
Enhance human resource planning and preparedness of the work force.
The available workforce and equipment are not clear. What is know is that Yemen has low workforce in the healthcare sector with inadequate equipment. For the team to address this gap, they should demonstrate the number of equipment and workers needed to ensure effective provision of services to sick children.
Support staff at the district level to effectively implement and monitor high-impact health and nutrition interventions.
No clear information on the coverage and quality of healthcare services. across the country, there is weak management information on health care facilities. The project team should answer the question, what strategies are required to ensure effective management of healthcare centers in all levels of governance?
Increase access to and the quality of service delivery points offering high-impact health and nutrition interventions.
The case study does not describe on the way it will lead to the improvement of delivery points. In most cases, the old health facilities might not be used to offer modern facilities. Therefore, it is essential to specify whether they will be advanced or new hospitals will be constructed in different parts of the country.
Improve health and nutrition practices by families, supported by community health workers and other community members.
No available information on the way Yemen communities are organized. Without adequate information concerning each society, it is difficult to offer the best services. therefore, the project team should answer the question, does community organization affect the provision of health care services?
Worksheet 5: Levels of health system where intervention is focused
· Possibilities include: National, Department, Governorate, Province, District, Sub-district, Community, Health Facility, Health Post, Referral Hospital,
Level
Clarification needed/ other details
National
Main activities conducted by national government towards the project are not included. Governments play an essential role in health care systems. Therefore, it is important to recognize their involvement in the project.
Governorate
The involvement of governorates in the project is not defined. The project team only claims to support governorates to develop and implement various health strategies. They should answer the question, what kind of resources are required by governorates to develop effective programs?
District
The existing materials in each district are not known. Furthermore, knowing available health care provision materials in each district might contribute to equal distribution of resources.
Community
There are no outlined policies on the way the project team will lead to influential diverse workforce. As a result, women might not be involved in the leadership and implementation processes. The project team should answer the question, who will be involved in the implementation of the project in the community level?
Yemen Project
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