JEPHTHAH INTERNATIONAL

THEOLOGICAL COLLEGE
THE IMPACT OF EXAMINING SCOPE AND
LIMITATIONS IN SOCIAL WORK PRACTICE TO
HEALTH CARE SETUP. THE CASE OF RAS DESTA
DAMTEW MEMORIAL HOSPITAL, ADDIS ABABA,
ETHIOPIA
BY BIRTUKAN DUFERA
ADVISOR: DR. TAMRIE H/GIORGIS (phd)

December 2024
 Presentation out line
• Introduction
• Objectives of the study
• Significance of the study
• basic research questions
• Delimitation and limitations the of study
• Research methodology
• Result
• Discussion
• Recommendation and conclusion
• References
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 Introduction
• Medical social work is one of the branches of
social work practice that involves working with
disease prevention and patient care
• It provide holistic support to patients and families
addressing the full range of bio psychosocial–
spiritual aspects that affect their health
• Its role is to improve social and emotional
functioning of patient
• Social work delivers service that promote quality
health care practicing in all health care settings
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(AASW, 2016) 3
 Con…
• In Ethiopia like many other developing countries
social work practice is not well developed
• Many of problems faced by patients and their
families are multi-factorial
• not simply health problem and treatment in
healthcare settings
• requires putting in place a holistic approach to
address both the health problem and the
psychosocial needs of the client
(Bolton & Gillett. 2019)
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 Con…
• To provide holistic health care that encompasses
the psychosocial dimension of individual illness
social work is the most relevant profession
• It is viewing patients illness in a way that deals
with the biological, psychological, social and
spiritual dimensions
( Beder 2006)
• Medical social work practice is not well
developed in Ethiopia
• Social work unit is established in all public
hospitals of Addis Ababa
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 Con…
• providing service limited to provision of welfare
service
• such as facilitating free medical service for those
who cannot afford and facilitating discharge for
those who do not have a place to stay
( Hiwot, 2016)
• The success of social work in promoting the
desirable health outcomes depends on
• how well the social work role is understood and
integrated within the health care facility
04/14/2025 (Ashcroft, 2018) 6
 Con…
• There is limited number of social workers, and thus
psychosocial services offered are inadequate to meet
client’s needs
(Sandra, et al, 2018)
• The case in Ethiopia is not that different as well
• Little literature is available regarding medical social
work practice in health care setting in Ethiopia
• This research aims to investigate the current medical
social work practice to build on what is known of the
practice and challenges
• in a way that it shows the gaps and limitations related
to the anticipated scope of service
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 Objective of the research
• General Objective
 To investigate the existing scope of medical social
work practice and related challenges in Ras Desta
Damtew Memorial Hospital, Addis Ababa,
Ethiopia, 2024.

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 Con…
• Specific objectives
 To examine the current social work intervention
practices of Ras Desta Damtew Memorial Hospital.
 To explore the role and scope of the current social work
practice being implemented in Ras Desta Damtew
Memorial Hospital.
 To identify service gaps in the delivery of medical social
work service.
 To explore barriers in implementation of social work
practice to the full scope
 To understand the perceptions of medical professionals
regarding the role of social work practice in health care.
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 Significance of the study
• This study aims to examine the current scope of
practice and related challenges
• which hinder to provide the intended service in
RDDMH
• The findings will be used as an input for relevant
management body
• will call for medical social workers to advocate for
their legal recognition as a profession
• will create awareness among higher level of
authorities who are responsible in developing
policies, guidelines and regulations
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 Basic Research Questions/hypotheses
1. How is social work practiced in Ras Desta
Damtew Memorial Hospital?
2. What are the roles and functions of social
workers?
3. How do medical professionals and the hospital
community at large perceive the role and necessity
of medical social work practice?
4. What are the challenges that social workers face
in their professional practice at Ras Desta Damtew
Memorial Hospital?
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 Delimitation and Limitation of the Study

• Delimitation of the study

 The research is assess the up-to-date health
service in bio psycho social view
 tried to show the gaps which need to be fill up
 the study is qualitative method
• Limitation of the study
 time constraint
 lack of sufficient budget
 it is not an end by itself and conducted on a
single hospital
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 RESEARCH METHODOLOGY
• Research design
 Qualitative method was employed
• Sampling method
 Among non-probability sampling strategies
purposive sampling was chosen
 Participants are social workers, physicians and
nurses
• Sample size
 15 participant were interviewed

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 Con…
• Method and process of data collection
 in-depth interviews, observation and document
review were used for data collection
 Most of interviews were recorded on an
audiotape upon obtaining the consent of
participants
 Information was gathered through face to face
interview

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 Con…

 Observation was used to understand the existing

procedures of social work practice and examine
the overall social work unit setup
 Job description, SOP, reports, patient assessment
formats and registers were reviewed
• Data Analysis and Interpretation
 Data were categorized in to broader themes
 Then major issues under each theme was further
reduced in to smaller set of themes

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 Con…

• Ethical Consideration
 Letter of support was obtained from the JIC
 And submitted to the hospital training and
research directorate to get permission
 Research purpose and process were explained
 They were asked to give verbal consent
 They were informed participating is voluntary

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 RESULT
Description of research participants
Participant category Male female Total

Social work 1 2 3

Nurse 2 6 8

Medical doctor 1 2 3

Supervisor 0 1 1

Total 4 11 15

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 Con…
• Majority of participants has acquired a degree
level of education in the fields of Nursing, Social
work and Medicine
• Two of the social workers are graduates of
masters in social work, and one of them has
attained Bachelor of Social Work
• Social workers participated in the study have
academic background in the field of nursing and
public health

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 Con…
• Data analysis and presentation
 Awareness on social work practice
 All respondents of the health care professionals have
the awareness on the existence of social workers in
the hospital
 Many of them perceive social workers role only as an
agent to authorize free medical care and treatment
for the poor
 Only one female nurse participant mentioned social
workers role as dealing with psychosocial problems of
the patients through counseling, social and financial
support
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 Con…
 A female nurse participant “ I never met any of the
social workers but I have heard of their existence
and they are the ones who authorize free
medication and care for the poor and homeless.”
(MP5) Male physician “I made few referrals for the
social work unit who need authorization of free
medication and they give solution to the poor, assist
those who do not have care giver.” (MP11)
 A Female nurse participant “They link patients who
are on waiting list for admission to a shelter, where
they can stay until they get bed for admission.”
(MP2)
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 Con…
 The perspectives of health care professionals
towards social workers functions
 is recognized as screening and approval of free
medical treatment
 and provision of care for the poor, mobilizing
resource and facilitating referral and linkage to
shelters and community resources
 main function of social workers in health care
setting is conducting assessment
 to identify psychosocial factors of individuals illness
 and to provide coordinated care accordingly
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 Con…
 health care professionals perceive that social
workers are not supposed to perform clinical
related activities
 Major functions of social workers as described by
social workers
 Screening and authorizing free medication and care
 case management: admitted poor patients who
cannot afford
 Pre - admission and discharge planning
 Resource mobilization and facilitating referrals and
linkage to resources
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 Con…
• Barriers to practice social work to full scope
 Absence of proper standard of practice
 Lack of awareness about social work practice in
health care
 Resource scarcity
 Work load
 Inappropriate service delivery unit

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 Discussion
• Social work is not well understood and valued in
the health care system
• Social works limiting to services like assessing and
authorizing free medical service only
• But while in actual sense their profession
encompasses social and emotional situations
• Identified absence of updated standard of
practice

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 Con…
• Practice of RDDMH is limited to individual with
minimum engagement with family's
• And no engagement at all in areas of practice such
as, management, leadership and administration,
policy practice, education and training
• Globally, social work is practiced at a wider scope
in every settings and units of health care delivery
(Browne 2012)

• Practice in developing countries like ours is not

well developed and is practiced in limited scope
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 Con…

• Barriers to practice to the full scope are similar to

other studies done in Africa
• they are related to lack of well defined scope and
role
• devoid of resources, lack of awareness among
other health care staff
(Muhandiki, 2016, Sandra, et al, 2018, Hiwot , 2016)

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 Con…
• bio psychosocial model is the most relevant
approach to deal with individual illness
• It views diseases /illness in the aspect of
biological, psychological and social pacts
• In the current medical practice various
assessment and evaluation are done to
investigate the causes of diseases by clinicians
(M. Havelka et al.2009)
• This can possibly leads to the missing of other
important factors of the psychosocial causes of
disease
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 Recommendation

Advanced research to better understand the

prevalence of psycho social factors presented
• as a cause or consequences of individual illness
• how they are being addressed in the current
health care practice
Prepare standard of practice, code of ethics,
defined scope of practice, supportive supervision
system and tool
• there has to be registration, certification and
licensing
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 Con…
Hospital management needs to be aware of the
need for integration of social work practice
• social workers engaged in the provision of
psychosocial support, help patients understand
their illness
• enable them to be emotionally stable and be able
to comply with physicians treatment
• provide other social support related to family
situation, financial and spiritual matters
• preparing suitable office and store for practicing
social work service
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 Conclusion
• Social workers are not practicing as per the
intended scope and standard of practice
• Barriers are less awareness about the role of
social workers and absence of clear standard of
practice and insufficient resource
• The existing practice is limited to certain social
services and excludes important elements of
practices and this has prevented the provision of
holistic patient care for patients

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 References
• Australian Association of Social Work , (2016) Scope of Practice – Hosipital Social Work
• Australian Association of Social Work , (2017) Code of Ethics,
• Australian Association of Social Workers. (2013). Practice Standard. Canberra:
• Beder, J. (2006). Hospital Social Work: The Interface of Medicine and Caring. Routledge, New
York .
• Bolton, D., & Gillett, G. (2019). The Biopsychosocial Model of Health and Disease: New
Philosophical and Scie ntific Developments. Springer.
• British Colombia Collage Of Social Work (2009) , Code of Ethics and Standard of Practice,
Browne, T. (2012). Hand book of Health Social Work. T. A.
• Browne, & S. Gehlert (Eds.). Wiley.
• Cowels(2012) Social Work in the Health Care Field: A Care Perspective, Second Edition,
Routledge
• Creswell, J. W (2007). Qualitative Inquiry and Research Design: Choosing Among Five
Approaches. Sage Publications
• National Association of Social Work (2017) , Code of Ethics,
• National Association of Social Workers. (2016). Standards for Social Work Practice in Health Care
Settings.
• National Council of State Boards of Nursing. (2009). Changes in Healthcare Professions‟ Scope of
Practice: Legislative Considerations.
• Rahel Abate (2014). "The Practices of Health Professionals In Medical Social Work In Minlik II31
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Hospital.", Addis Ababa University, Unpublished MSW Thesis
 .

THAN KYOU

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