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UNIVERSITY OF GONDAR

UNIVERSITY OF GONDAR

Practical Attachment

on

Client satisfaction

of

College of Medicine and Health Science

Prepared by: - Tewodros Mammo Ayele

January 2014

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Table of Content

Page

Table of content----------------------------------------------------------------------------------- I

Acknowledgement--------------------------------------------------------------------------------- II

1. Introduction----------------------------------------------------------------------------------- 1

2. Objectives-------------------------------------------------------------------------------------- 5

3. SWOT------------------------------------------------------------------------------------------ 5

3.1 Strength----------------------------------------------------------------------------------- 8

3.2 Weakness---------------------------------------------------------------------------------- 10

3.3 Opportunity------------------------------------------------------------------------------- 12

3.4 Threat--------------------------------------------------------------------------------------- 14

4. Discussion--------------------------------------------------------------------------------------- 16

5. Conclusion-------------------------------------------------------------------------------------- 17

6. Recommendation------------------------------------------------------------------------------ 18

7. References--------------------------------------------------------------------------------------- 19

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I.

ACKNOWLEGEMENT

I am enthusiastic to thank University of Gondar Ophthalmology Department for the

amiable assent given me to undertake the practical attachment.

I am appreciative to Ato Haimanot Guadie who gave me the opening to practice on

my profession.

II.

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I. Introduction

1.1 Background

It has been widely accepted that student attachment forms part of an important ingredient for

learning in tertiary and higher education institutions as it relates to those who are pursuing

careers in commerce. It has increasingly become an important element of training as employers

continue to demand for fully trained students. Attachments are a platform for students to

assimilate theory into practice. This is the whole essence of learning anyway, to apply the

learned theories (www.aabri.com).

In today’s increasingly competitive business environment, service quality is essential for the

success of any organization. Service quality is important aspect that affects the competitiveness

of business. Health institutions should increase the quality of service constantly since there is no

assurance that the current outstanding service is also suitable for future. Consequently,

organizations should “develop new strategy” to satisfy their customer and should provide quality

service to distinguish themselves from rivalries (Siddiqi; 2011). The challenge in defining

quality is that it is a subjective concept, like beauty.

Everyone has a different definition based on their personal experiences. Crosby (1979) defined

quality as “Conformance to requirements”.

This definition implies that organizations must establish requirements and specifications. Once

these specifications are established, the quality goal of the various functions of an organization is

to comply strictly with them. Juran (1982) defined quality as “Fitness for use”. As indicated on

www.qualitygurus.com quality also defined from different point of views: - From customer

point, from process point of view, from product point of view and from the cost point of view.

From customer point of view: “quality means fitness for use and meeting customer satisfaction.”

From process point of view: “quality means conformance with the process design, standards and

specifications.” From product point of view: “quality means the degree of excellence at an

acceptable price.” From the cost point of view: “quality means best combination between costs

and features.”

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1.2 Brief History of the University and the Ophthalmology Department

The University of Gondar (UoG) was officially established with its current status and

autonomy in 2004. It is located in the historical town of Gondar which is located 750 km

way from the capital to the Northwest. Its origin goes back to 1954 when the then Public

Health and Training Centre (PHC&TC); currently named College of Medicine and Health

Sciences was established. The establishment of the PHC&TC was dictated by the pressing

and enormous health problems that existed in the 1940’s and early 1950’s. The aim of the

Public Health and Training Centre was training of teams of middle-level health personnel.

Until 1960, the Ministry of Health was responsible for the college. In 1961, the college

joined the then Haile-selassie I University, now known as Addis Ababa University, by the

act of internal decree known as "Charter of Haile-sellassie I University”. In 1978,

announcements were made for the establishment of a Medical Faculty in the Gondar

College of Public Health and Training Centre by bilateral agreement reached between Karl

Marx’s University in Germany and Addis Ababa University. In the academic year 1980/81,

the name Gondar College of Medical Sciences was given to the GPHC&TC. The college was

given autonomy to stand by itself (separated from Addis Ababa University) in 1992.

It was in 2001 that the full-fledged expansion of the university get started with the addition

of one new faculty named Faculty of Management Sciences and Economics (recently

renamed as Faculty of Business and Economics). In the spring of 2003, the name of the

college was changed into Gondar University College. It was also at this time that two new

faculties, i.e. the then Faculty of Applied Natural Sciences(recently renamed as Faculty of

Natural and Computational Sciences) and the Faculty of Social Sciences and Humanities,

were added. Faculty of Veterinary Medicine and the then faculty of Law (recently renamed

School of Law) were opened by 2003 and 2005 respectively. Furthermore, one new faculty

namely Faculty of Agriculture and Natural Resources Management and two schools namely

School of Technology and School of Education are opened 2009.

Indeed it was during these expansion years that the department of ophthalmology was

incepted to start a full-fledged ophthalmology education under the college of Medicine and

Health Sciences. The College is the oldest health professionals training institute in Ethiopia.

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It is the only units of the university with college status. The college currently, comprises of

30 Departments offering training in 12 undergraduate programmes ( which include human

medicine, public health officer training, nursing, midwifery, medical laboratory technology,

environmental health, occupational health, anesthesiology, pharmacy, ophthalmology,

optometry, and physiotherapy) and 7 post graduate programs ( which include General

Surgery, Human Anatomy, Health Informatics, Epidemiology and Biostatistics, Public health

nutrition, Applied Human Nutrition, Health service management, Reproductive and child

health, Environmental Health, health promotion and communication and diseases

prevention and control).

Under the management of CMHS there is University teaching and referral hospital

consisting of surgical, medical, pediatric, orthopedic, ophthalmology and gynecology and

obstetrics wards with 350 beds, and an out-patient department (which also includes

ophthalmology and dentistry clinics). It is the only tertiary level referral center for over 4

million inhabitants in northwest Ethiopia.

1.2.1 Ophthalmology and Optometry Department

Established in 1982 as an academic unit, its startup can be traced back to the startup of the

university hospital. Till 2005 the unit has been providing courses for medicine and other

health students and provides eye care hospital services. It is during 2006 that the current

department of ophthalmology started training in ophthalmic officer, cataract surgeons and

optometry. Currently it is providing educational, eye-care services and research. The

department is offering or providing these services with 13 academic staffs and 12 hospital

staffs. Its current student population is 3 Ophthalmology residents and 130 Optometry

students.

The department, through appropriate channel, has been working with different partners

and donors. One of the most celebrated partnerships exists with ORBIS international.

Under the bilateral agreement signed in 2004 between Gondar University and ORBIS

international the department has achieved many breakthroughs that includes; capacity

building; equipping the unit with essential materials and supplies; assisting in outreach

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ophthalmic activities; establishing spectacle workshop and training different level eye care

health professionals.

The other enduring partner of the department is Light for the World, an international NGO

with similar objective of ORBIS international. Light for the World international on the other

hand contributed to the development of the department by constructing an independent

eye hospital with a capacity of 30 beds.

2.1. Purpose

The purpose of Ophthalmology department of University of Gondar is to eliminate

avoidable blindness in Ethiopia through provision of standard ophthalmic education,

quality and affordable eye care services and undertaking relevant researches.

2.2. Vision

Our vision

The vision of Ophthalmology department of University of Gondar is to be a center of

excellence in ophthalmic services, education and researches by 2020.

2.3. Values

The core values of Ophthalmology department of University of Gondar are:

Client first: The department is here for nothing but to serve and satisfy the clients

to treat them with compassion as we would like to be treated.

Commitment: No matter what challenges we face and discomforts we feel, we

stand firm, be patient and exert our utmost and sustained effort to achieve our

vision.

Commitment to ethics: Compliance to legal, social and professional ethics and

norms is crucial for our development and goodwill.

Collaboration: We work together with interested partners in sprit of mutual

support and understanding to achieve our collective goals.

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Excellence: We believe that excellence is the standard for all we do. We must strive

for excellence in everything we do: in our products and services, in their ability and

quality, in our human relations, our competitiveness and our growth.

Solidarity and Teamwork: Enhancing unity and forming cohesive teams

determines our future success. Thus, we value solidarity and encourage team work

in our process.

2.4 Objectives of Customer Care

To render quality and expedite service at affordable price to clients

To create better quality of work life to employees

To stretch long lasting partnership with suppliers

To produce high caliber and quality graduates

To offer health services both at hospital and community level

To deliver transparent and fast response to partners request

To provide quality service ,training and research to ophthalmological society of

Ethiopia

2.5 Importance of Client Satisfaction at Ophthalmology Department

Appropriate way of client service practice in health institutions help in appealing

and retaining various types of stakeholders that the health service will need in the

future.

3. Baseline Information and Situational (SWOT) Analysis of

3.1 Baseline Information i. Education

The ophthalmology department has started training of optometrists and cataract surgeons in

Bachelor degree since 2006 and trained ophthalmic officers in Bachelor degree from 2006 to

2010. Recently specialty training on ophthalmology has been launched as of October 2010.

Based on the information of the department, an overview of the programmes and their enrolment

for 2002 E.C. is given in Annex I.

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ii. Research

The department conducts four researches annually on average and mostly the researches

conducted is on the area of eye problems, their causes, prevalence, community awareness etc.

Research is conducted both by students as a requirement for partial fulfillment of their training as

well as by the academic staff members.

In carrying out the research the department via appropriate channel is collaborating with

different national and international institutes, such as ORBIS international and Light for the

world. Besides these research funds obtained from those partners, the staff do have an

opportunity to submit and contest for the available research fund available at the college level

allotted by the MoE budget of the University.

Results of the research undertakings are presented annually at the annual Staff and Students

Research Conference and published in various reputable journals.

iii. Eye Care Community services

The most important services delivered by the department to the community are health services

for patients seeking medical support at hospital level and out reaches activities to the rural area.

The department provides both inpatient and outpatient eye care services. It performs on average

40 major surgeries per week for inpatient health service seekers. Besides it provides diagnosis 60

and 10 minor surgery services for outpatient service seekers per day.

iv. Management and Resources

Organization

The department is accountable to the vice dean for college of medicine and health sciences. The

department is led by head usually elected among the staff. The head is responsible for the overall

activities and resources of the department. The department basically has three units namely an

academic unit, hospital service unit and administrative service unit. All these units have got their

own coordinators.

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Human Resources:

The department has 18 staffs (5 Ophthalmologists, 1 doctor of Optometry, 6 optometrists, 5

ophthalmic officers and 1 cataract surgeons) other than supporting staff.

The department has staffs that had got training on anterior segment, retina and vitreous abroad. ‘

Other resources

The department has its own building where different activities are being done. The building

contains Outpatient department (OPD), inpatient department with 32 beds, very modern

operation theater room with a state of art equipment, well equipped optometry unit, class rooms,

and offices for staffs.

Partnerships

The department works in collaboration with national and international organisations for

educational and/or research purposes/and/or eye care services. An overview of the most

important partner organisations and their involvement and achievement with the department is

given in table 1.

Table 1: Some selected partners of ophthalmology and the nature of their partnership activities

Partner Theme of

collaboration

Achievement

ORBIS Capacity building

and infrastructure

development

Trained 16 optometrists , 14 cataract surgeons, 40 ophthalmic

officers

Fellowship training for 3 ophthalmologist

Funded cataract surgery outreach campaigns, established

optical workshop in the hospital, equipped with different

ophthalmic equipments & instruments

LFTW Infrastructure

development

Short term training of IECWs

Construction of the new hospital

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Soliel

D`Afrique

Out-reach

activities

Supports cataract outreach activities

1.1 Situational (SWOT) Analysis

SWOT(which stands for Strengths, Weaknesses, Opportunities and Threats) analysis also called

an environmental scan is important for discovering and documenting facts and trends in the

operating environment of an organization that are likely to affect its future performance. It helps

to identify factors or conditions to which the organization can build strategic responses. Thus,

findings of SWOT analysis are basis for identification of strategic issues, and setting of goals and

objectives of an organization which assist to realize its mission and vision.

The following section describes the strengths and weaknesses of department of ophthalmology as

identified from the internal environmental analysis, and opportunities and threats as posed by the

external environment.

I. Internal Environment Analysis-Strengths and Weaknesses

Strengths are internal characteristics, qualities, and capacities that are doing well and are part of

the reason the organization’s accomplishments. However, weaknesses are internal limitations

that need to be improved.

In order to pinpoint the strengths and weaknesses of the department, the assessment was made

from four different viewpoints.

3.2. Strengths

3.2.1. Education and Trainings Services

Good attention to improve quality of education: In line with the university’s effort, the

department is committed and has good beginning in conducting practice oriented

education in providing field trips, off-campus educations, practical attachments and

exercising of external evaluation system to produce competent and disciplined graduates.

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Readiness for expansion and diversification of Educational Programs- there is an

encouraging effort and preparation to diversify and expand undergraduate, specialty and

subspecialty educational programs. The department has developed curriculum for

residency in ophthalmology.

3.2.2. Researching

Good relationship with the university’s research and community service

directorate: The department has created good relationship with the university’s research

and community services directorate that can further encourage the staff in researching

endeavors.

Research output dissemination: The existence of annual staff-student research

conference and an established journal (Journal of Ethiopian Health and Biomedical

Sciences) encourages our staff to carryout researches.

3.2.3. Eye care services

Number, variety and quality of surgeries done increased: The department has an

encouraging record and experience of providing a number of varied surgeries at premier

quality standards.

Encouraging community outreaches-The department is supporting the community in

TTP community diagnosis services by students, and in collaboration with national,

international NGOs and other development partners to promote the health status of the

community.

3.2.4. Management and resources

Encouraging growth in physical infrastructure: - New eye care center is constructed

in the premises of Gondar University Hospital.

Dedicated staffs to strengthen and expand activities in the department: all staff of

the unit is highly dedicated, and self responsible to their job and to strengthen and expand

the activities of the department.

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Good start of human resource development: currently there are four ophthalmologists

working in the department and one is on the verge of resume work at the department after

a study leave. Though much is left to be done with that regards, the department has

gained good experience of human resource development management.

Good experience of working with international and national partners and donors:

The department in particular and the university in general have sufficient experience in

attracting, treating and retaining partners.

3.3 Weaknesses

3.3.1 Education and Training

Shortage of academic staff-The number of academic staff of the department is not

enough. Besides the staff profile of the department is not adequate.

Lack of pedagogical skills- Some instructors of the department lack pedagogical skills

that might have contributed to poor delivery of education.

Inadequate educational facilities and supplies-There is no enough facilities and

supplies for teaching-learning process. The department does not have its own library.

College library is inadequate to accommodate sufficient seats, do not have required

reference materials, text books, journals, etc in quantity and diversity. Laboratories are

not adequate and well equipped with materials and supplied with consumables

sufficiently.

3.3.2 Researching

Poor research culture: Research works and culture are not well developed. Scientific

and/or ethical review process of the research proposals is slow and lengthy. Staffs are not

encouraged to engage in research.

Shortage of research funds and facilities: There is shortage of research funds and

facilities like reference materials, internet facilities, laboratory facilities, transportation

services. Research fund is released only annually, which inhibits research works to be

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continuously done and the fund ceil for one research project is limited to Birr 20,000.00

irrespective of the nature and complexity of the research.

Lack of advanced research laboratories: The department has no research laboratory to

carryout advanced researches.

Lack of journals: So far the university has only one journal. Hence there is stiff

competition to publish research outputs. The department has no journal of its own.

3.3.3 Eye care services

Poor quality of patient admission and care services-Patients’ admission process

has limitations and customer care services of the unit is low in quality.

Inadequate ophthalmic instruments and equipments: the unit has limited modern

technologies to provide better health services.

Undiversified Community Services-Community services are limited in diversity and

outreach.

3.3.4. Management and Resources

Severe employee attrition: The department has faced high number of staff turnover

for different reasons.

Inappropriate organizational structure: The organization of the department is

confusing. It is less empowered. There is confusion about the accountability too.

Limited administrative skills and overburdened managers: - Administrative skills

of managers of the unit related to leadership, communication, and interpersonal are

limited. Moreover, they are overburdened with routine works; hence less attention is

given to strategic issues which may jeopardize the efforts of the unit.

Donor dependency to run most of the activities: the department has no income

generating enterprises or sources hence it is usually dependent on donors to fulfill

necessary materials and equipments.

Poor incentive mechanism and less-conducive working environment: - there are

poor incentive mechanisms for staff of the unit. For instance low rate of payment of

clinical allowances and absence of other allowances like hardship, and distance

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allowances. There is shortage of facilities such as toilets, recreation centers, internet,

transport services, offices etc. at the premises of the unit. And the solid and liquid

waste management system of the university is poor leading to unpleasant and

unattractive working environment to the staff of the unit.

Weak staff Reward-Punishment culture:-There is no tradition of rewarding and

acknowledging good performers and still there is no tradition of demoting/reinforcing

poor performers at the department. There is no reward for project initiators and

innovative researchers as well.

Lack of maintenance and repair skill:- Maintenance and repair services are not

well organized, and it is not as fast as supposed to be. Particularly, maintenance and

repair services for medical equipments are so disappointing.

External Environment (PESTEL) Analysis-Opportunities and Threats

Opportunities refer to external activities or trends that the organization may benefit from,

connect with or take advantage of to grow or enhance its performance. Whereas threats are

external activities or trends that threaten the current and future success of the organization. Both

opportunities and threats are related to the external environment and described from the six

components of the external environment (namely political, economical, social, Technological,

environmental and legal factors) as presented below.

3.4. Opportunities

3.4.1 Political factors:

Favorable national policies: The national health policy of Ethiopia is so supportive for

the expansion and diversification efforts of the department. Conducive national foreign

policy that can facilitate creating international links and partnership that can create

opportunities for students’ exchange, scholarship for further education and obtain funds.

Besides, the educational policy of the country and the keen interest of the government to

support the expansion of undergraduate and post graduate programs and other facilities

help the department in expanding and diversifying its educational programs.

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3.4.2 Economical factors:

Fast economic growth: The fast economic growth achieved in the country has created

demand to the education and high job opportunities for graduates of the department that

let the department diversify its educational programs. It also alleviates the resource

scarcity at the department.

3.4.3 Social factors

Keen interest of stakeholders to cooperate: Stakeholders of the department has high

interest to work with our department.

Vision 2020 the right to sight: The presence of an international plan to eliminate

avoidable blindness from the world by 2020 set by WHO (World Health Organization)

that supports the vision of the department. It can be a benchmark for the departmental

achievements too.

3.4.4 Environmental factors:

Favorable climatic condition. The presence of favorable climatic condition enables the

department to attract professionals and students. Furthermore, the teaching and learning

process can be run smoothly.

3.4.5 Legal factors:

The newly enacted HEI proclamation No 650/2001: The proclamation has granted

right and autonomy to any unit of the university to be engaged in income generating

activities as independent legal person.

3.4.6 Other opportunities

Established research centre: There exist an established a research centre at Dabat

district to serve as research site for the department of ophthalmology jointly with other

units of college of medicine and health sciences.

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Easy access to share experiences from the hospital:-The University provides hospital

services at acceptable standards under all the constraints without interruption for over 4

million citizens. Furthermore it provides emergency health services at full-fledged level

and with utmost speed. It is a place from where large numbers of researches are

undertaken and distributed, good international linkages are observed; consequently

international students are using it as place for their practical education. It performs high

number of surgical operation as compared to other national hospital that amounts to more

than 4000 surgical operations per annum. These achievement and experience can easily

be gained from the hospital.

Commitment of the university management team: the top management of the

University is committed to expand and support our unit.

BPR Implementation- BPR is being implemented in the university as well as in the

college. Hence efficient, effective, and economic service to internal and external

customers can be delivered.

3.5. Threats

3.5.1 Economic factors:

Low scale of staff remuneration. Insufficiency of basic salaries, allowances and

perdiem payments (for both students and staffs) for field trips and off-site educational

programs and other off-office duties leading to high turnover of staffs and less

motivation for off-campus and clinical duties.

Unstable local and global economy: Frequent fluctuations of prices of input and

supplies that pose high challenge to the department in providing necessary inputs and

supplies.

Unavailability of quality ophthalmic equipments and instruments in the local

market: As Ethiopia is a less developed country, there is shortage of quality ophthalmic

equipments and instruments in the local market.

Shortage of budget: The department has low budget allocated from the government

through the university.

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Referral system is not yet implemented. Despite the presence of high interest to

upgrade the hospital to the referral system by the university it is not yet realized. This has

posed high work load to the department as it should deal with minor eye cases too.

3.5.2 Social factors:

Shortage of qualified professionals on market.- The shortage of trained academic staff

(mainly local academic staff) and health professionals to conduct both the undergraduate

and graduate programs in a successful manner is a challenge of the department.

Irresponsible and corrupted Suppliers. Suppliers of material inputs to the department

are less responsible, unethical and corrupted. Provision of substandard materials is

common.

Poor awareness of the society: The society has weak knowledge about the department

and its activities.

3.5.3 Environmental factors:

Distance from the capital-The department encounters a problem of attracting and

retaining of employees due to its distance from the capital city of Ethiopia. Furthermore,

the department has faced a problem of ease, economic and fast procurement of required

materials for the same reasons.

3.5.4 Other threats

Highly complained hospital administration -There is low effort on image building by

the hospital. It lacks policy with respect to free health service users plus to which it has

no strategic plan consequently the hospital is unable to generate and use its own income

by itself so that it could compensate the professionals fairly and minimize staff turnover.

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3. Discussion of Gaps Identified

In the previous section of the report the situational analysis of the Ophthalmology department was

identified and described. As it is demonstrated the basic tenets that the Ophthalmology department of

University of Gondar encountered with respect to its flaws are manifested below.

The first one is related to shortage of academic staff in terms of quantity as well as quality. That is staffs

are inadequate in number as well as there is a pedagogical skill gap in some of the instructors. Besides,

there is inadequacy of educational facilities and supplies. Pedagogical skill is the basic skill that is

required to be entailed by instructors of Ophthalmology department of University of Gondar because it is

one of the critical skills that they should possess in transferring their know-how to their recipients.

Moreover, shortage of employees in terms of number will have its own adverse influence in realising the

overall mission of the department.

In the sphere of research there is poor research culture, shortage of research funds and facilities,

lack of advanced research laboratories and lack of journals. The unavailability of favorable

research culture, lack of funds and laboratories and journals is the other determinant that will

hinder the undertakings of the department.

In the arena of eye care services there is poor quality of patient admission and care services,

inadequate ophthalmic instruments and equipments, undiversified Community Services. All

these conditions will have their own undesirable influence on the satisfaction level of

stakeholders of the department.

With respect to management and resources there is severe employee attrition, inappropriate

organizational structure, limited administrative skills and overburdened managers, donor

dependency to run most of the activities, poor incentive mechanism and less-conducive working

environment, weak staff reward-punishment culture, lack of maintenance and repair skill.

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4. Conclusion

Client satisfaction is the principal purpose that organizations are expected to strive because the

success of any entity will be determined to the extent that needs and wants of customers are

satisfied. Though the department has good attention to improve quality of education in terms of

expansion and diversification, good relationship with the university’s directorate about research and

community development, encouraging growth in physical infrastructure, dedicated staffs to strengthen

and expand activities, good start of human resource development and good experience of working with

international and national partners and donors staffs are inadequate in number as well as there is a

pedagogical skill gap in some of the instructors. There is also inadequacy of educational facilities and

supplies,severe employee attrition, inappropriate organizational structure, limited administrative

skills and overburdened managers, donor dependency to run most of the activities, poor incentive

mechanism and less-conducive working environment, weak staff reward-punishment culture,

lack of maintenance and repair skill.

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5. Recommendations

It would be advisable for the department to develop job profiles and identify critical skills

needed for the job role and conduct an inventory of current skills so as to identify

employees’ competencies and skill levels.

Trainings that will enhance critical skills that are needed to be able to realize the mission

and meet the goals of the department should be delivered to some of the instructors.

It would be advisable for the department to design appealing working environment and

incentive scheme so as to reduce employees’ turnover.

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Referrences

1. Academic Journal of Management: www.aabri.com

2. University of Gondar College of Medicine and Health Science Ophthalmology

department Strategic Plan (2005).