Focus: Health systems research and implementation

Affiliation: Addis Ababa University, School of Public Health; Yale University, School of Public Health

Contacts: Getnet Mitike, MD,; Elizabeth H. Bradley, PhD,
Projects: Yale has extensive involvement in improving both hospital-based and primary care in Ethiopia.

Improving Hospital Quality
The Ethiopian Federal Ministry of Health (FMOH), the Clinton Health Access Initiative, and the Global Health Leadership Institute (GHLI) at Yale University have been working together for more than 6 years on the Ethiopian Hospital Management Initiative (EHMI), a program aimed at improving the quality of care in hospitals by focusing on health systems research, teaching and practice.  Several EHMI projects provide an opportunity to conduct implementation science research related to improving health systems.

Ethiopian Hospital Alliance for Quality (EHAQ):  EHAQ is the continents first national quality improvement collaborative, recognizing the local leadership that is spread across Ethiopia’s hospitals. EHAQ’s aim is to create measurable improvement in patient experiences in hospitals nationally and encourage hospitals to develop and share best practices. Evaluation studies could examine best practices at the hospital level for improving patient experience and the role of collaboratives to improve practices could be conducted. Several key performance indicators (KPIs) used regularly by hospitals and could be augmented and analyzed to understand the magnitude and determinants of variation in hospital performance.

Improving Adherence to Clinical Guidelines:  The EHMI team is conducting a baseline assessment to understand the quality of hospital care in labor and delivery, and is developing tools and supporting resources to improve adherence to clinical guidelines in these areas.  Opportunities exist to measure changes in quality of care related with various tools and resources, and to understand the implementation successes and challenges behind the development and roll-out of the tools. 

Master of Hospital and Healthcare Administration:  Yale, Addis Ababa University (AAU) and Jimma University have developed 2 masters programs, with more than 90 hospital CEOs and senior managers either enrolled or graduated and currently working within the Ethiopian health system.  Studies could include evaluations of this educational approach on management systems at hospitals and examination of leadership effectiveness in hospitals and health bureaus that support the hospital.

Governing Board Study:  A recent EHMI study on the functionality of hospital governing boards in Ethiopia and their impact on hospital performance will guide the Ethiopian government and other countries in developing methods for improving board functionality.  Opportunities exist for advanced measurement of board functionality and hospital performance after the implementation of an intervention informed by the initial study results. Additional evaluations of developing governance structures on a variety of outcomes could be designed.

Satisfaction of Employees in Healthcare (SEHC):  A national staff satisfaction survey has been validated and distributed for use in all healthcare facilities.  Opportunities exist to explore satisfaction as it relates to the management of human resources for health and to further investigate issues of retention.

Strengthening Primary Care

Yale joins the FMOH, Harvard School of Public Health, and the Bill & Melinda Gates Foundation in an effort to develop a primary care system that will be responsive to the population needs over the next 20 years.  We have supported the FMOH in the development of a 20-year vision and strategic plan, and are preparing to implement and test key components of that strategic plan.  Key activities include:

Time Motion Study:  A mixed methods study that includes both non-participant observations of Health Extension Workers (HEWs) (time-motion) and in-depth interviews of diverse key informants in the primary care system will serve the following objectives: (1) Understand how health extension workers (HEWs) spend their time, (2) Understand how HEWs and health posts interact with the health centers and hospital in their Primary PHCU, and (3) Describe that range factors leading to HEW motivation, demotivation, and performance.  Opportunities exist for full participation in this study.

Demonstration Projects to Strengthen the Primary Health Care Unit: We will develop, implement, and evaluate a series of demonstration projects in support of the FMOH’s strategy to strengthen primary health care units (PHCU). Drawing on the experiences and lessons learned during the time motion study, we will identify PHCUs (urban and agrarian) to serve as learning centers for PHCU development.  We will convene the key leadership staff in the PHCU to implement several systems improvements, likely in the following areas: governance and leadership, management capacity, referral guidelines, service package, and performance management.   One could design any number of studies to examine the degree to which the health extension worker program and the PHCU demonstration projects accomplish their goals and improve public health outcomes.