Capacity of the Ethiopian primary health care system to achieve universal health coverage

A primary health care progression approach

Bibliographic Data

ID15127371
AuthorsKiddus Yitbarek (0000-0002-4935-6871, Jimma University), Absalat Serawit (0000-0003-1385-8105, Department of Pediatrics, Yekatit 12 Hospital and Medical College , Addis Ababa, Ethiopia), Girmay Medhin (0000-0003-2146-4261, Addis Ababa University), Girmaye Medhin (Addis Ababa University), Yibeltal Kiflie Alemayehu (0000-0002-1781-0777, Jimma University), Alula M Teklu (0000-0001-7321-2838, MERQ Consultancy PLC , Addis Ababa, Ethiopia), Yibeltal Assefa (0000-0003-2393-1492, The University of Queensland), Tilahun Haregu (0000-0002-8797-0469, The University of Melbourne), Tilahun Nigatu Haregu (The University of Melbourne)
Year2023
Volume38
Issue4
Pages474-485
Publication date2023-04-11
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czad013
PMID36760182
OpenAlexW4319826128
LanguageEN
Citations received5
References cited20

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

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