USAID Transform: Primary Health Care Project, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2022 Apr 8;22(1):460. doi: 10.1186/s12913-022-07885-8.
The Ethiopian Ministry of Health strives to achieve universal health coverage (UHC) through increasing the number of its high-performing primary healthcare units. Although the Ethiopian health system is managed within a decentralized political system, the Ministry of Health works towards institutionalizing performance management innovations and organizational cultures that increase the excellence of primary healthcare entities. To date, there has been little evidence gathered on the factors influencing the excellence of primary healthcare units in Ethiopia. Therefore, the aim of this study was to assess and compare how the introduction of performance management and organizational culture innovations through project support affect the excellence of primary healthcare units in Ethiopia.
A facility-based comparative study was conducted in USAID Transform: Primary Health Care project supported and non-supported primary healthcare units located in the Oromia and Southern Nations Nationalities and Peoples' (SNNP) regions of Ethiopia. Quantitative data were collected from randomly selected health workers using interviewer-administered questionnaires. In addition, primary healthcare unit excellence measurements were extracted from routine health information databases over eight quarters. The data were analyzed using the Statistical Package for Social Science (SPSS IBM v 20) research software package. Results were presented in frequency tables and graphs. After checking the data for homogeneous distribution, a paired sample t-test for equal variances, otherwise known as the Mann-Whitney U test was analyzed to claim statistically significant difference at P < 0.05.
Out of 368 invited health workers, 364 participated in this study, (a response rate of 98.9%). Slightly higher than two-thirds of participants were enrolled from the Jimma Zone of Oromia Region. Orientations on performance management standards were provided to 101 (68.2%) and 45 (48.3%) health workers from project-supported and non-supported facilities, respectively. The mean perceived organizational culture score with [± Standard Deviation (SD)] was 3.72 ± 0.75 among project-supported health workers and 3.385 ± 0.75 among non-supported health workers, respectively. An independent sample t-test showed statistically significant differences, where project-supported health workers had higher mean scores on perceived organizational culture than their non-supported counterparts, with t = 433, df = 362, P = 0.001. The mean baseline primary healthcare unit excellence score was 63.2% and 50.5% for project-supported and non-supported health facilities, respectively. The end line excellence scores increased to 93.3% for project-supported and 79.1% for non-supported facilities. The end line overall primary healthcare units' mean rank excellence scores were 257.67 for the project supported and 105.66 for non-project supported facilities. This result of a non-parametric test, i.e. the Mann-Whitney U test revealed that project-supported facilities were higher and had a positive statistically significant difference (U = 2,728, z = -13.78, P = 0.001).
The findings of this study underscore a direct relationship between implementing performance management innovations and enhancing organizational cultures for excellence at primary healthcare units. Project-supported primary healthcare units had higher organizational culture and excellence scores than their counterpart non-supported facilities. Therefore, achieving UHC through excellence in primary healthcare facilities requires scaling up of performance management innovation interventions.
埃塞俄比亚卫生部致力于通过增加其高绩效初级医疗保健单位的数量来实现全民健康覆盖（UHC）。尽管埃塞俄比亚卫生系统在权力下放的政治制度下管理，但卫生部正在努力使绩效管理创新和组织文化制度化，以提高初级医疗保健实体的卓越水平。迄今为止，关于影响埃塞俄比亚初级医疗保健单位卓越水平的因素几乎没有证据。因此，本研究的目的是评估和比较通过项目支持引入绩效管理和组织文化创新如何影响埃塞俄比亚初级医疗保健单位的卓越水平。
在 USAID Transform：初级医疗保健项目支持和非支持的初级医疗保健单位中进行了基于设施的比较研究，这些单位位于埃塞俄比亚的奥罗米亚和南部地区。使用访谈员管理的问卷从随机选择的卫生工作者那里收集定量数据。此外，从八个季度的常规卫生信息数据库中提取了初级医疗保健单位卓越测量值。使用 SPSS IBM v 20 统计软件包分析数据。结果以频率表和图形呈现。在检查数据是否具有均匀分布后，使用具有相等方差的配对样本 t 检验（也称为曼-惠特尼 U 检验）来分析在 P < 0.05 时具有统计学意义的差异。
在 368 名受邀的卫生工作者中，有 364 人参加了这项研究（响应率为 98.9%）。来自奥罗米亚地区吉马区的参与者略多于三分之二。101 名（68.2%）和 45 名（48.3%）项目支持和非支持设施的卫生工作者分别接受了绩效管理标准的培训。具有[±标准偏差（SD）]的感知组织文化得分的平均值分别为 3.72 ± 0.75 支持的卫生工作者和 3.385 ± 0.75 非支持的卫生工作者。独立样本 t 检验显示出统计学上的显著差异，其中支持的卫生工作者的感知组织文化得分高于非支持的卫生工作者，t = 433，df = 362，P = 0.001。基线初级医疗保健单位卓越得分的平均值分别为项目支持设施的 63.2%和非支持设施的 50.5%。卓越得分的终点线增加到项目支持的 93.3%和非支持的 79.1%。项目支持设施的最终整体初级医疗保健单位卓越排名得分为 257.67，非项目支持设施的得分为 105.66。这是一个非参数检验的结果，即曼-惠特尼 U 检验表明，项目支持的设施更高，具有统计学意义的积极差异（U = 2,728，z = -13.78，P = 0.001）。
这项研究的结果强调了在初级医疗保健单位实施绩效管理创新和增强卓越的组织文化之间的直接关系。项目支持的初级医疗保健单位的组织文化和卓越分数高于其非支持设施的对应分数。因此，通过提高初级医疗保健设施的卓越水平实现全民健康覆盖需要扩大绩效管理创新干预措施的规模。
