Medical Students as Health and Environmental Promoters

by Salma Galal, M.D.

Evaluation of the health & environment education activities

The health & environment education activities were evaluated as along the lines of or as process, impact and outcome. Some indicators were quantitative others qualitative.

1. process evaluation

Animated by Rifkin's et al (2) qualitative indicator of community participation, a qualitative indicator measuring process connected with the health education activities was tested. The scale began from 0 - 20 for a confined period of time, which was set for measuring the following:
 
a) did the student find other person in the community taking over the health education activity? How many persons? (0-5)
 
b) did she manage the administrative problems she faced (e.g. convincing the administrator of her activities and the importance of their support)? (0-5)
 
c) did she get over the strict health education activity to other domains (like to social groups or to other connected groups)? (0-5)
 
d) did she approach the health education in a holistic sense (e.g. did she address the problems the target group faced and try to solve them)? (0-5)

The following example show the 'snow-ball' effect of the activity:
A student in a village in Upper Egypt started health education in a 4th grade class in primary school. Having educated the children in basics personal hygiene she asked them to appear the next day with combed hairs, cut fingernails, clean clothes, washed up etc. However, the coming day only half of the pupils came following her instructions. On her way back she met one of the absent boys, asking him about the reason for his absence, he stated that he had to work and earn money for the family. Realizing the entanglement of poverty, illiteracy and diseases, the medical student had to approach the social affair office in the village to ask for support for some pupils.

Mothers of the boys of 4th year class, when they heared about the health education of their children, the medical check up and the support some received from the social affairs, they were very eager to sit with the medical student and to be instructed in health and environmental matters. They sensed her honest voluntarism and interest in improving conditions...

In addition, students had to write reports and present the results of the laboratory tests and the knowledge evaluation of the pupils.

For monitoring attendance and participation of class was also assessed.

2. impact evaluation

• knowledge indicators
  

  For each session a pre- and post-test' were done for the target groups.

  Knowledge indicators were easier to be performed with literates. With illiterate women and still not writing children, they were performed orally.

  Pre- and post-test on knowledge of the diverse topics e.g. adequate nutrition, prevention of bilharzia were done with different target groups.

• health indicators related to the topics of education (e.g. communicable diseases, nutrition ...etc)
  

  It was not always possible to apply health indicators during the activity.

  Medical students had to look for tangeable health indicators which could be achieved within a short time in order to improve credibility.

  As one of the repeated topics was personal hygiene, children were examined as regards to the presence of skin parasites at the beginning of the health education intervention and after one month. The ailments were curable within a short period of time if compliance to therapy instruction was held.

  However, for some of the students, like those working with nursery children, it was almost impossible to apply the test. They would have needed other persons to do it with them. Only observations - qualitative indicators - during the process were registered, like how many of the children applied a healthful behavior of which they were instructed in the previous session ..etc.

3.outcome evaluation

It was possible to undertake general examination and laboratory investigations for the pupils (at that time most of these schools lacked the Health Insurance scheme). For some primary classes, analyse of urin and stool as well as haemoglobin level was as undertaken at the beginning of the health education and a year after . The following measures were used:

• haemoglobin levels of pupils at the beginning and after one year
• parasitic infestation in urine at the beginning and after one year
• parasitic infestation in stool at the beginning and after one year

Sometimes it was not possible to test the haemoglobin level at the health unit. The pupils were taken to the nearby hospital. However, some school children could not afford paying transport to join and get the analysis done.

One of the qualitative indicators envisaged and to be considered in near future plans is whether the school or village can initiate a 'community health insurance system' either through an NGO or community leaders?

For comments, suggestions, and feedback please email: heea_egypt@yahoo.com.