*August 15, 2011
Sareeta Apa and I had the first part of the day off. It was spent beautifully. We followed our old routine and took a rickshaw ride around Gaibandha. It was an adventure, at the surface, to shop for fruit, but our true unspoken motive was to take in the hidden parts of this bustling little town. We visited the train station, walked rock paths lined with old trees, next to quiet green ponds.
We even visited a small Hindu village inside Gaibandha, which boasted architecture starkly different from the colonial-style buildings we kept spotting. In the center of the village, we entered a Hindu temple where a group of men, sitting on pillows, were debating in a circle. Sareeta Apa asked if it was okay if we could go in, and they smiled welcomingly. What a serene place – so much of what we saw was handmade. We hesitatingly exited the temple to finally head back to the field office for our meeting later in the afternoon.
Back at the field office, the director of community-based programming started the meeting off with an overview of what monitoring would entail at the field level and the expected outcomes. As he talked, I noticed there was a lot of nodding (my translator was studying for exams today!) among the five field officers and paramedics, four of which had been at our first meeting in Gaibandha in July.
As we talked, some voiced concern that monitoring and focusing on quality might make Friendship compromise on the quantity, or vast access, of health services the organization offers. As in, giving more time to each patient might mean more patients turned away. This is a significant concern and one that cannot be dismissed without discussion, but if Friendship operates with the goal of improving community health, there are things we can do through monitoring to maximize our potential without having to compromise on the number of patients we see. The good part of the meeting is that it allowed us to lay down some additional concrete benefits of starting a monitoring culture within Friendship, per request of the meeting attendees.
i) Creating a monitoring network within Friendship, where different tiers of field workers monitor and provide feedback to each other allows us to learn from each other, improve our services, and recognize/celebrate good performance. One of the most eye-catching results from the situational analysis showed a lack of feedback loops, or unidirectional feedback. A network allows us to have “loops of feedback” that gives as much information back into the loop as it takes.
ii) We can present these tools not only as accountability mechanisms for the quality of our services in addition to the quantity, but also to prove our liability to donors and interested parties alike. And honestly, no matter where you are, quality cost$ le$$ (don’t let the dollar signs fool you – costs include time, precious human capital, suffering, and losses to the organization when patients aren’t treated to the best of our capacity).
iii) Monitoring and supervision allows us to create a paper-base, built-in documentation within our health system, which Friendship can use as a basis for future evaluations and impact assessments of our satellite clinic services.
What I particularly liked about the meeting was that we received a lot of questions and concerns from the field staff, which indicates that they’re actively thinking about all of this. A weakness of the meeting was that as we talked about our monitoring tools, the actual tools sat in the middle of the table, mostly untouched. I had envisioned a meeting where we would get feedback from the group for each of the tools, but alas, we spent most of the meeting actually convincing the field staff that monitoring is a good, worthwhile, and valuable thing. I would have liked to be a bit farther at this point, but at the same time, to have the director give the meeting, voicing some of the very points he had contested weeks ago, was a small victory for me. We attained ownership today, which I hope will be the foundation for Friendship to build upon the outcome of my internship and my time here.