领导、治理和管理以提高地区能力和绩效：以美国国际开发署的“转型：初级卫生保健”为例。
Leadership, governance and management for improving district capacity and performance: the case of USAID transform: primary health care.
机构信息
USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia.
出版信息
BMC Fam Pract. 2020 Dec 4;21(1):252. doi: 10.1186/s12875-020-01337-0.
BACKGROUND
Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC - primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support.
METHODS
This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts.
RESULTS
Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8 ± 121.45 standard deviation (SD) compared to non-LMG districts 56.89 ± 110.39 SD, with t (282243) = - 3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts.
CONCLUSION
District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.
背景
初级卫生保健（PHC）在埃塞俄比亚是预防、促进和治疗保健服务的主要切入点。区卫生办公室负责规划、实施和评估所有区卫生活动。此外，区卫生办公室管理服务提供设施，提供初级卫生保健 - 初级医院、保健中心和保健站。作为医疗保健系统层级的领导者，区卫生管理必须确保团队和组织内的方向、协调和承诺，并确保成果与组织的愿景、价值观和战略保持一致。美国国际开发署的 Transform：初级卫生保健提供了多样化的支持，以提高区卫生管理人员的能力，包括在职培训，随后是绩效改进项目的规划和实施，以及在职指导和支持。
方法
本研究旨在比较领导、管理和治理（LMG）和非-LMG 区之间的区级能力和绩效。从 2019 年 1 月至 12 月，从 284 个区收集了项目成果监测数据，这些数据显示了区的绩效。该研究采用了比较性横断面研究设计，评估和比较了区卫生办公室一级的指标。区分为两类：LMG 和非-LMG 区。该研究比较了 94 个 LMG 区和 190 个非-LMG 区的数据。使用倾向评分匹配来控制 LMG 和非-LMG 区之间差异的影响。
结果
独立样本 t 检验的结果显示，LMG 区的平均绩效得分为 61.8±121.45 标准差（SD），而非-LMG 区为 56.89±110.39 SD，t（282243）=-3.407317，p<0.001，双侧。平均绩效的 4.9 个百分点的差异表明 LMG 和非-LMG 区之间存在统计学上的显著差异。
结论
区级领导力发展计划有助于提高区的能力、结构和管理实践以及护理质量。
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