Academic literature on the topic 'Ethiopian health system'

In the last decade, the reach of New Public Management (NPM) has stretched well beyond its Western origins as modernising African governments and their global health partners have sought to import new approaches. Public health systems in Africa are entirely different to those of the West however, and this sort of application introduces a number of contextually-specific questions that are not considered by the majority of the NPM literature. The few studies that do investigate NPM in Africa are evaluative in content, seeking to understand whether reforms work and to identify barriers to success. Invariably, whether they find in favour of public management reform or not, the same issues are highlighted: lack of capacity, weak institutions, and improper implementation. This thesis will build a theory of NPM reform that is particular to the African context. I develop this theoretical extension through an intensive ethnographic case study of one of the most important on-going public health reform efforts in Africa—the transformation of the entire Ethiopian hospital system to an NPM-style administrative regime. I develop a constructionist theory of African NPM through thick description of the hospitals under reform. I detail the various ways in which the reforms are indigenised as they meet up with local understandings, institutions, and market contexts, and the inevitable unintended consequences as managers seek to ‘make do’ in environments radically different to those of NPM’s origins. I then conduct a detailed consumer analysis to describe the strategies employed by patients seeking care. Patients from different class positions use very different strategies to get health services and I demonstrate that the reform has very different consequences for Ethiopians across classes. Many patients are not recognisable as the ‘customers’ described in the reform documents, and so the hospitals do not organise their reform efforts to serve them.

For many years, the tight bureaucratic and task centered approaches of civil service institutions of Ethiopia led to fragmentation, overlap and duplications of efforts than being responsive, flexible and customer focus. To this end, Business Process Reengineering (BPR) has been considered as a government sector technique to help organizations fundamentally rethink how they do their work in order to dramatically improve customer service, cut operational costs, become responsive, flexible and customer focus. BPR has great potential for increasing productivity through reduced process time and cost, improved quality, and greater customer satisfaction, but it often requires a fundamental organizational change. Despite the numerous advantages of BPR in terms of responsiveness, flexibility and customer focus, its implementation is perceived to be a difficult task and also many unsuccessful experiences have been reported in the literature. In fact, there are very few survey researches that attempt to highlight the kinds of activities that the organizations should pursue to ensure a reasonable transition to the new process; manage the human and technical issues surrounding implementation of the new process; and assess the results of its reengineering efforts. But these researchers saw the issues from private cooperative organizational perspectives and contexts. Besides, most of the discussions and findings were stretched up to showing that successful BPR implementations process are mainly associated with the organizations capability in managing changes. The researches paid no attention to other factors, like the issues of enabler, tools and techniques which can be utilized to build momentum. Hence, the present research investigated the factors associated with successful implementations of BPR projects in the contexts of public institutions. Based on a case study conducted in Ethiopian Ministry of Health and Gambella Regional Health Bureau; this research attempted to provide guidelines and best practices in public service providing institutions that will help them to achieve dramatic performance gains while implementing BPR projects. A cross sectional, qualitative and quantitative study was conducted taking 90 respondents and 20 interviewees as study subjects. Data were collected from June 1 to July 31 2010. A structured questionnaire was filled by 90 respondents where 43.3 % of them from Gambella Peoples’ National Regional State Health Bureau and 56.7% of them were from Ethiopian Federal Ministry of Health. The questionnaire was employed to collect data on change management and factors associated with the attainment of performance goals whereas in-depth interviews were utilized to substantiate the findings of questionnaire and investigate the use of information technology as enabler. The in-depth interviews included planners, core process owners and directors. Cross tabulation results imply that there is significant associations between attainment of performance goals and availability of written comprehensive plan for pilot test, refinement and implementation of change management plan, availability of communication strategy, placement of performance measures, motivation to take new roles and responsibilities, Use of information technology as enabler and pilot testing to evaluate new process. Hence, the findings of this research suggest that reengineering project implementation is complex, involving many factors. To succeed, it is essential that change be managed and that balanced attention be paid to all identified factors, including those that are more contextual (e.g., management support and technological competence), performance management, availability of comprehensive implementation plan, communication strategies, refinement and implementation of change management plan, use of pilot testing to evaluate new process, motivation to take new roles and responsibilities and usage information technology as enabler.<br>+251911436197, Gambella, Ethiopia, P.o.box. 90

The 2015 global adoption of the United Nations 2030 Agenda for Sustainable Development places the achievement of health equity as a global priority for health and development. Due to the normative nature of the concept of health equity and the multi-level, multi-sectoral approaches required to advance it, interdisciplinary investigations are warranted to demonstrate how health equity as a policy objective is understood and operationalized. This dissertation is a case study of health equity in maternal, newborn and child health (MNCH) in Ethiopia, using qualitative methods to explore how health equity is conceptualized and pursued by stakeholders across levels of the health system. Ethiopia, a low-income country in East Africa, reported improvements in MNCH during the Millennium Development Goal period (1990-2015), largely attributed to the expansion of health services into rural areas; however, achievements were not realized across all geographies and population groups. Health equity is a stated policy objective for the country. Through a series of four articles, this dissertation addresses: community members’ perceptions and experiences related to health inequity and MNCH; barriers and enablers encountered by community-level health workers in implementing an equity-oriented MNCH intervention; subnational health managers’ understandings of health equity, and their roles in promoting it; and the characterization of health equity as a policy problem in national-level health discourses. This work deconstructs health equity into three components (health, distribution of health and characterization of the distribution of health) and compares how stakeholders across levels of the health system attribute meaning to each component and imply responsibility and accountability for health equity. The findings detail how diverse experiences related to health equity in MNCH across community, subnational and national contexts are driven by high-level technocratic framings of health equity, which tend to emphasize the delivery of a narrow package of health services to under-served geographical areas. Providing support and recognition for the role of subnational stakeholders in mediating the adaption of national health equity policies to local contexts, and making prominent the social justice underpinnings of health equity in the implementation of national policies are opportunities to strengthen the advancement of health equity in Ethiopia.

Many Low and Middle Income Countries (LAMICs) still lack sufficient health research capacity to build a local evidence-base with which to inform policy and improve population health. Recognising this, The 2013 World Health Report called for all nations to be producers of health research. To achieve this, new strategies that can develop sustainable locally-led capacity are required. Among the health research capacities needed, ability to conduct clinical trials is important. However, there is no evidence-informed guidance on the best ways to develop locally-led trial capacity. This thesis aims to fill this gap. Three cases-studies using qualitative methods to explore the barriers and enablers to locally-led trial conduct were conducted in Ethiopia, Cameroon and Sri Lanka. Current and potential local trial researchers and health research system stakeholders were recruited. A synthesis of the health research capacity development literature was conducted to compare the case-studies’ findings with wider published perspectives. These data permit an examination of the key issues facing the development of locally-led trial capacity in LAMICs. Barriers and enablers to locally-led trial conduct were found at macro, institutional and individual levels. Although different country research systems, and institutions and individuals within them, were variably successful at conducting trials, the key issues and mechanisms influencing successful trial undertaking were largely similar. Agreement among the case-studies and with the diverse literature suggests that many of the findings will be transferable to other LAMICs, and are also of relevance to other health research methods. A conceptual framework explaining the antecedents and consequences of locally-led trial undertaking in LAMICS is presented. This identifies the following factors as important for supporting locally-led trial undertaking: awareness and appreciation for health research and clinical trials; motivation to conduct clinical trials; availability of human resources with trial knowledge and technical skills; research leadership capabilities; ability to form collaborations, effective teams and acquire resources; trial management dedicated to sustainable capacity development and producing useful research; and system-wide prioritisation of health research. The theories of change presented within this framework are used to develop practical recommendations for development of locally-led trial capacity in LAMICs. These recommendations have four inter-related goals: fostering pro-research cultures in stakeholder institutions; developing trial leaders and staff; providing a facilitative operational environment for trials; and ensuring trial research has an impact. However, to create the will to enact change, advocacy from research champions and conducting trials in a way that benefits local institutions and population health is needed.

Research Doctorate - Doctor of Philosophy (PhD)<br>Being a female is difficult in Ethiopia where boys are privileged over girls, girls have less access to school and healthcare, and girls suffer from harmful practices such as early marriage, female genital mutilation, abduction and rape. For those who pass through childhood and reach womanhood, intimate partner relationships are not necessarily safe either—there is a high prevalence of violence against women by their intimate partners. Previous studies have suggested that intimate partner violence (IPV) could be affected by many factors and IPV, in turn, affects the overall health of affected women and their babies. At the time of commencing this thesis, only individual-level determinants of IPV had been investigated within small geographic areas in Ethiopia. There was no study that assessed the hierarchical multilevel predictors of IPV. National-level evidence regarding the adverse impacts of IPV on women’s reproductive health and the survival of their neonates was lacking, and the Ethiopian health system responses to IPV were largely unknown. Therefore, this study investigated the individual, relationship, community, and societal-level determinants of IPV directed against women; it examined the adverse reproductive outcomes (unintended pregnancy, pregnancy loss and neonatal mortality) of IPV in Ethiopia; and explored the perceptions of, and attitudes towards, IPV within the Ethiopian health system. The thesis used a multimethod approach incorporating retrospective analyses of nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS) and qualitative in-depth interviews. In analyses of EDHS data, the determinants and impacts of IPV were invesigated in a subsample of married women of reproductive age (15–49 years) who participated in the domestic violence sub-study of the survey. In addition, a qualitative study was conducted among thirteen purposively selected in-depth interview participants (nine healthcare providers and five health managers) to explore perceptions to IPV. Analyses of EDHS data showed that about one in every three women reported experiencing IPV (a composite measure of physical, sexual and emotional abuse) and three in every five women experienced partner controlling behaviours. Lifetime IPV experience was higher among women who were older, married before the age of 18 years, had witnessed inter-parental violence during their childhood, had a partner who drank alcohol, and lived in a community with high IPV accepting norms. Alternatively, experiences of IPV were lower among women who had decision-making autonomy in the household, who had the same or lower educational attainment as their partner, and lived in a community with low proportions of educated women. These findings reveal that although individual-level factors were significant determinants of IPV, higher level factors including female education and IPV acceptance in the community were also important influences on this major public health issue in Ethiopia. This thesis further revealed that women’s IPV experience, including partner controlling behaviours, were significantly associated with the risk of unintended pregnancy, pregnancy loss and neonatal mortality in Ethiopia, with the impact on unintended pregnancy being partly mediated by women’s autonomy. Qualitative interviews with healthcare providers and health managers in the Ethiopian health sector further suggest that the existing health system responses were insufficient, with several barriers and challenges identified as hindering the health system from providing consolidated IPV services. Taken together, these findings suggest combined interventions at different levels may reduce IPV in Ethiopia. Women’s health and neonatal survival strategies should focus beyond the direct causes and target IPV as an underlying factor in maternal and neonatal ill health and mortality. Reproductive health programs should be sensitive to the relational aspects of fertility control, and the need to improve women’s decision-making power to reduce the negative reproductive health effects of IPV. Overall, there is a clear need to incorporate IPV services into the Ethiopian healthcare setting and should be provided as a key component of maternal reproductive health service. This requires policy frameworks and clear guidelines, training of healthcare workers, community education and sensitization, and sectoral collaborations.

Health Management Information System (HMIS) in developing countries lags seriously behind as compared to the developed countries; and the existing HMIS in many countries is insufficient to support health management functions. The purpose of this study was to describe the implementation of Anti-retroviral Therapy (ART) pharmacy management information system in public health facilities. Quantitative, descriptive research was conducted at 38 public health facilities. The participants of the study were Pharmacists and Druggists those are working at ART Pharmacy. Data collection was done by using structure questionnaire. 76 respondents were recruited to participate in the study. The participants ages ranged from 26-50 years and all had more than 2 years’ work experience. The study indicated that even if there is a system at most health facilities their utilization of information technology (IT) for pharmacy practice were not appreciated. The findings indicated that the need for creating awareness among professionals in giving more skill oriented and also a formal in-service information technology related trainings for the professionals. To achieve better utilization of information technology at health care delivery system particularly pharmacy practice, government and stakeholder should consider capacity building activities through proper training and it should also viewed as a long term socio-cultural and technical development process.<br>Health Studies<br>M.A. (Public Health with specialization in Medical Informatics)

Background: Preconception care (PCC) is highly recommended evidence-based intervention to optimize women’s health in particular and in so doing reduce the incidences of adverse pregnancy outcomes (APO). PCC targets modification of risk factors to APO occurring before and just at early weeks of conception. Nevertheless, in Ethiopia, the need to implement PCC as part of the continuums of the comprehensive Maternal, Neonatal and Child Health Care services is not yet studied. Purpose/Aim of the study: This study aimed to develop a guideline to assist the incorporation of PCC in Ethiopian health system thereby reduce the highly incident APOs in the country, which is the purpose of the study. Methodology: This study applied the explanatory sequential mixed method to determine the determinants to the non-implementation PCC in Ethiopia. In addition, a policy document analysis was conducted to identify the existence of policy guiding the implementation of PCC in Ethiopia. Finally, the study applied a Delphi technique to increase the utility and acceptance of the guideline developed. The study was guided by a theory based framework called a Framework for Determinants of Innovation Processes (FDOIP). RESULT: Nearly all (84.7%) of the healthcare providers (HCPs) never ever practiced PCC. Even among those who ever practiced, the majority (74%), practiced it poorly. More than two third (68.6%) had poor PCC knowledge. HCP’s with good PCC knowledge had likely hood of practicing PCC by four times greater than those with poor PCC knowledge (AOR=4.4, 95% CI: 2.5-7.6). The policy document analysis identified the absence of policy guiding the practice of PCC in Ethiopia. The HCP’s curriculums also didn’t include PCC. The determinants to non-implementation of PCC, as perceived by the qualitative study participants include absence of national PCC policy , absence of PCC guideline, lack of institutional PCC plan, presence of other competing demand, lack of laboratory facilities and setup, lack of accountable body, absence of Individual or organization introduced PCC to the country, absence of trained manpower on PCC, absence of known expert in PCC, Poor public awareness about preconception health and PCC, Unplanned Pregnancy and poor health seeking behaviour. CONCLUSION The study revealed the absence of a standard and complete PCC practices by the HCPs. Nearly all HCPs never ever implement PCC. Even those very few practitioners were found practicing PCC poorly that is in a substandard, incidental, and in an inconsistent way. There is no formal policy document guiding the implementation of in Ethiopia. The HCPs training curriculum didn’t include PCC. The guideline developed base on the study findings of the study recommended to incorporating PCC in Ethiopia health system.<br>Health Studies<br>D. Litt. et Phil. (Health Studies)