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Base de datos de evaluación

Evaluation report

BHG 2000/006: External Evaluation of the Project "Psychosocial Care in Paediatric Wards" of Hospitals in Bosnia and Herzegovina July 1998-September 2000



Author: Belson, P.; Kovar,I.; Marolt-Meden, B.

Executive summary

Background

This ongoing project commenced in late 1997 with the aim of “improving the quality of care for paediatric patients in hospitals in both entities of Bosnia and Herzegovina.”  The project is supported financially and technically by UNICEF and implemented by HealthNet international, a Netherlands Non Governmental Organization. Additional technical support has been from the staff of Wilhelmina Hospital in Utrecht.  The project is being carried out in six paediatric wards in Banja Luka, Doboj, Mostar, Sarajevo, Travnik and Tuzla. The total funds expended so far have been 159,000 USD and have been provided by UNICEF. HealthNet has also donated some staff time and other resources in kind.

Purpose / Objective

The activities were evaluated as to whether these activities achieved the aims and objectives of the project:

i) To improve professional networking among paediatric wards
ii) To organize capacity building of paediatric staff
iii) To create a child-friendly environment i.e. by establishing functional playrooms
iv) To provide basic psychological instruments/literature and training materials for the paediatric wards

Methodology

Meetings with staff members of UNICEF and of HealthNet International. Meetings with the Deputy Minister of Health for Federation of Bosnia and Herzegovina and with the Deputy Minister of Health for Republika Srpska. Meetings with the Presidents of the two Paediatric Associations.

In Mostar, there was a detailed discussion with four parents - two from Doboj and two from Mostar - each the parent of a chronically ill or disabled child, who were attending a project seminar being held that day.

Visits to the paediatric wards in all six project sites and one non-project site. Observation of the activities of the staff, the children and the parents in the wards and in the playrooms.

Review of all project literature, reports, and information about children's health services in Bosnia and Herzegovina.

Key Findings and Conclusions

Our main conclusion is that this project is meeting its objectives as stated and has brought about benefit for staff, children and parents under very difficult post-war circumstances.

i) To improve professional networking among paediatric wards

Despite the extremely difficult working conditions of staff involved (salaries small and often delayed, lack of basic medicines and supplies, and even heating in winter). The networking process has been established and includes, as planned, the four person teams set up in the paediatric wards to implement the project. Team members visit and meet on a regular basis and are currently planning a newsletter proposed for end-2001 and this should enhance networking. A very important outcome of the project has been the networking between professionals and parents from both entities of Bosnia and Herzegovina, and a clear wish by all to work together for the benefit of children.

ii) To organize capacity building of paediatric staff

Seminars and meetings were held on a regular basis, and planned by asking the network members what topics they wished to discuss next, thus developing a strong sense of ownership of the project. Large seminars for teams from all project sites were held five times and, in each case, Prof. Wim Wolters, a psychologist from Utrecht in the Netherlands and various professional colleagues gave interactive professional seminars on a wide range of topics including separation issues, child development, recognition of and approach to child abuse, management of bed wetting etc. The most recent seminar also included parents, the first time that parents and paediatric professional staff have jointly participated in a state-wide meeting. Methods used in all of the meetings have included group discussion, presentation of cases and critique by visiting experts, and interactive question and answer sessions, thus exposing attendees to their first opportunity for active professional learning.

Baseline data on knowledge and attitudes were not established but anecdotal evidence from discussions with some of the staff, review of seminar reports and evaluation questionnaire indicates that professional capacity has been increased.

iii) To create a child friendly environment i.e. by establishing functional playrooms

The six playrooms have been refurbished, equipped and organized as planned. Each makes a valuable contribution to creating a child friendly environment in that hospital. All equipment donated appears to be present and also used. We are, however, concerned at the limited opening hours of most of the playrooms and the lack of access in some sites to toddlers, the group who would probably benefit most from the playroom.

There have been some additional effects of the project. The reception areas in some cases were decorated and had a "child friendly" appearance; however, in the wards themselves, few changes have been made to achieve this desirable outcome.

iv) To provide psychological instruments/literature and training materials for the paediatric ward

A considerable amount of professional literature was available and translated as described, and relevant to staff needs in the area of psychology, child development and psychological approaches to children in hospitals. The range of literature could have been broader and could have promoted family-centred care and play, particularly for the nursing and play staff.

The nurses taking on the play leader role have attended the seminars and other meetings, which have tended to focus on problems rather than play. They would benefit from more specific training in the value of play for the sick child and the types of play that can be provided diversional, developmental, preparation/post-procedural and therapeutic. They need to know about the behaviour of children under stress and enduring separation from family, familiar environment and normal activities, to understand the specific techniques for establishing relationships with children of all ages, from small babies to teenagers, and be able to undertake preparation programmes geared to all the interventions children are likely to experience, to see the wellness of the children rather than their illness.

Recommendations

We recommend that, in order to achieve the originally stated objective, the project considers broadening its activities and build on the already successful playrooms and psychosocial approach to have a more general "child rights" approach. This view was expressed by the majority of those interviewed. In our opinion, the existing network requires further support but could also form the nucleus of a bigger and more extensive project.

Extension within existing paediatric units. The programme needs to be extended out of the playroom into the paediatric wards, so that these can also become child and family friendly.
Baseline studies. In order to be able satisfactorily to measure any changes that the program might bring about for families in hospital, it would be useful to have established a baseline from which to measure those changes.

Parent and child satisfaction surveys. These might be considered as a way both to involve families and children in change and in gaining insight into what they see as important to them about a stay in a hospital.

Advice leaflet. The leaflet for parents giving guidelines about hospital should not be generic, but should have a degree of local specificity and reflect the intended actuality of provision. It should be available to parents before the child comes to a hospital, in out-patient units and from other community venues.

Playroom use. If possible, the playroom should be open throughout the day and at weekends, with a staff member present. Consideration should be given to having younger children in the playroom. Records should be kept of child's attendance in the playroom and the activities undertaken.



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Report information

Date:
2001

Region:
CEE/CIS

Country:
Bosnia-Herzegovina

Type:
Evaluation

Theme:
Health - Mental Health

Partners:
HealthNet International

PIDB:

Follow Up:

Language:
English

Sequence Number:
2000/006

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