Abstract
BackgroundStandards 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).MethodsA 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.ResultFor 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).ConclusionsThe 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.
Highlights
Standards represent benchmarks against which improvements can be measured
This chapter deals with evidence of establishment & functionality of how boards will be scored: i.e. minutes, official assignment; guidelines; term of references; regular board meetings; strategic and annual plans; established functional management committees; review performance of health center directors; post services costs; agreements signed to provide credit services; financial reports using balance sheets; approved purchase plans; financial guidelines; & audit reports. (12 standards and 35 validation criteria)
As the results show in the table below (Table 6), one-way Analysis of Variance (ANOVA) was employed to test mean differences of Ethiopian Health Center Reform Implementation Guidelines (EHCRIGs) scores and district performance tiers
Summary
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). The life expectancy of its citizens improved from 45 years in 1990 to 64 years in 2014; maternal mortality ratio has declined from 1400 deaths per 100,000 live births to 351 in 2016 and under-five mortality rate has declined by 67%, to 68 deaths per 1000 births [4] These results were achieved as a result of strong commitment from the Ethiopian government as well as technical and other resource support from development partners. The Ministry is in a favorable position to create demand and to expand access to effective interventions to improve maternal, newborn and child health outcomes Despite these gains, the government recognizes the need to maintain progress and tackle the high maternal and neonatal mortality rates. As providing quality health services in an equitable manner is a major goal, developing clinical and administrative standards are a key element of health reform interventions
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