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Comparative Study
. 2019 Feb 19;19(1):127.
doi: 10.1186/s12913-019-3939-y.

Improved performance of district health systems through implementing health center clinical and administrative standards in the Amhara region of Ethiopia

Mesele Damte Argaw  1 , Binyam Fekadu Desta  2 , Temesgen Ayehu Bele  3 , Abebe Dagnew Ayne  4
Affiliations
Comparative Study

Improved performance of district health systems through implementing health center clinical and administrative standards in the Amhara region of Ethiopia

Mesele Damte Argaw et al. BMC Health Serv Res. .

Abstract

Background: Standards represent benchmarks against which improvements can be measured. In 2016, the Federal Ministry of Health developed and endorsed a set of standards entitled the Ethiopian Health Center Reform Implementation Guidelines (EHCRIGs). This study aims to assess the effects of planned interventions on performance and quality of services in primary health care units (PHCUs).

Methods: A quasi-experimental pre-post study design was used to compare the performance of PHCUs against the ECHRIG standards before and after its implementation in 76 woredas of the Amhara region from July - December 2017. Pre and post-intervention validation measurements of performance improvement in 76 woredas were conducted. The data were entered and analyzed using Statistical Package for Social Sciences.

Result: For this study, ten sessions of two-day trainings were conducted for 1306 staff. Additionally, on-site mentoring and coaching was conducted for a period of three months. The average EHCRIG standards met before and after intervention totaled 59 and 66%, respectively. The scores showed a positive correlation coefficient (r = 0.74) with statistical significant paired sample t-test with t = - 7.15, df = 75, P < 0.000. In addition, the mean scores among performance tiers were 74, 66 and 65% for high, medium and low performing woredas respectively. The One-way Analysis of Variance (ANOVA) showed a borderline significant difference between groups with (F = 2.4, P < 0.09).

Conclusions: The implementation of the standards has garnered significant improvements in performance at the primary health care level. Therefore, continuing the initiated strengthening of health system performance against the standards and evaluation of the quality of primary health services is recommended.

Keywords: EHCRIGs; Health center reform; Performance improvement; Primary health care; Standards.

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Conflict of interest statement

Authors’ information

MDA: MPH, Senior Health Systems Strengthening Adviser at USAID Transform: Primary Health Care, JSI Research and Training Institute Inc., Addis Ababa, Ethiopia. BFD: MPH, Deputy Chief of Party at USAID Transform: Primary Health Care, JSI Research and Training Institute, Inc. TAB: MPH, Health Extension and Primary Health Care Directorate, Federal Ministry of Health, Addis Ababa, and Ethiopia. ADA: MPH, Amhara Regional State Health Bureau, Disease Prevention and Health Promotion Core Process, Bahir Dar, Ethiopia.

Ethics approval and consent to participate

The research protocol of this quasi-experimental pre-post-intervention study was reviewed and granted (Certification reference number: HRTT02/137/2018) from the Amhara National Regional State Health Bureau Research and Ethics Review Committee. In addition, permission to conduct the study was obtained from USAID Transform: Primary Health Care project, JSI Research & Training Institute, Inc. [8]. Written informed consent was obtained from all study participants after providing brief explanations about the purpose and procedure of the study. To maintain the confidentiality of collected data, anonymity was maintained throughout the research process.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
A diagrammatic presentation of the causal pathways [4]. The figure illustrates the theory of change with, Long term outcome, Long term outcomes, preconditions, and assumptions
Fig. 2
Fig. 2
Map of the Study Area. Depicted map of the study area. The map clearly presented location of Amhara Region in Ethiopia and label performance tier of selected woredas
Fig. 3
Fig. 3
Ethiopian Health Tier System [12]. Depicted the Ethiopian Health Tier System, Where Health Centres are located at the primary level health care category
Fig. 4
Fig. 4
Pre and Post-intervention average score by ten chapters, December 2017. The figure showed that the pre and post intervention average score of 76 districts on each chapter
See this image and copyright information in PMC

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