Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
Department of Pediatrics, Yekatit 12 Hospital and Medical College, Addis Ababa, Ethiopia.
Health Policy Plan. 2023 Apr 11;38(4):474-485. doi: 10.1093/heapol/czad013.
Comprehensive and globally comparable evidence about primary health care (PHC) capacity is needed to inform policies and decisions. We carried out a study to assess the Ethiopian PHC capacity in terms of governance, inputs, and population health and facility management domains. The PHC capacity of all the regions, city administrations and the Ministry of Health was assessed using the PHC progression model. The model has 33 measures categorized into three domains. Data were collected and synthesized from all relevant national and regional documents, datasets and key informants. A team of trained evaluation experts conducted external assessments at national and regional levels followed by an internal assessment and a validation workshop. All 33 measures were scored from 1 (lowest) to 4 (highest). The inter-rater reliability test indicated that the overall agreement between internal and external scores was 65%. We found the highest consistency in the internal assessment with a score of 0.84. The findings of this study indicated that the governance domain score was 2.8 out of 4, showing varying scores in quality management, priority setting as well as innovation and learning. The inputs domain score was 2.3 for drugs, supplies and facility infrastructure. The score for the population health and facility management domain was 2. A comparison of federal and national average scores for all measures indicated no significant difference between the two (P-value = 0.69). There are relevant PHC policies and leadership structures at the federal and regional levels. However, the capacity to effectively implement these policies and strategies at sub-national levels is sub-optimal. The challenges related to major inputs coupled with data-quality problems reduced the capacity of the PHC system at the local level. Periodic assessment of the PHC system and closely working with subnational units will potentially improve the capacity of PHC in Ethiopia.
需要全面和具有全球可比性的初级卫生保健（PHC）能力证据，为政策和决策提供信息。我们进行了一项研究，以评估埃塞俄比亚在治理、投入以及人口健康和设施管理领域的 PHC 能力。使用 PHC 进展模型评估了所有地区、城市管理局和卫生部的 PHC 能力。该模型有 33 项措施，分为三个领域。从所有相关的国家和地区文件、数据集和主要信息来源收集和综合数据。一组经过培训的评估专家在国家和地区两级进行外部评估，然后进行内部评估和验证研讨会。所有 33 项措施的得分从 1（最低）到 4（最高）。组内和组间评分的一致性检验表明，内部和外部评分之间的总体一致性为 65%。我们发现内部评估的一致性最高，得分为 0.84。这项研究的结果表明，治理领域的得分为 4 分中的 2.8 分，表明在质量管理、优先事项设定以及创新和学习方面的得分各不相同。药物、用品和设施基础设施的投入领域得分为 2.3。人口健康和设施管理领域的得分为 2. 所有措施的联邦和国家平均得分比较表明，两者之间没有显著差异（P 值=0.69）。联邦和地区一级都有相关的 PHC 政策和领导结构。然而，在国家以下各级有效实施这些政策和战略的能力不足。与主要投入相关的挑战加上数据质量问题，降低了地方一级 PHC 系统的能力。定期评估 PHC 系统并与国家以下各级密切合作，有可能提高埃塞俄比亚 PHC 的能力。
