The purpose of this study was to explore the level of integration of health promotion and disease... more The purpose of this study was to explore the level of integration of health promotion and disease prevention services with the curative care provided at hospitals and health centres in Addis Ababa, and to propose recommendations that could improve such an integrated health service. A quantitative approach, using an exploratory and descriptive design was applied at 22 public health facilities in Addis Ababa followed by the Delphi technique to reach consensus on ways to improve the integration of health promotion, preventive and curative care. An integrated health service (IHS) framework was used as the conceptual framework upon which the study was based. Multistage sampling involving stratified simple random sampling was applied to select hospitals and health centres while a systematic sampling technique was used to sample patients from the outpatient and inpatient medical departments. Data was collected by means of two questionnaires from patients and health service managers, respec...
<p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors a... more <p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors associated with being referred from prior source of care.</p
<p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors A... more <p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors Associated with Seeking Prior Care of Patients at Hospital and Health Center.</p
MSExcel file showing data on management and health systems performance collected by the project t... more MSExcel file showing data on management and health systems performance collected by the project team working in each of the 36 intervention districts, based on existing administrative records at the health center and district level
Strengthening district-level management may be an important lever for improving key public health... more Strengthening district-level management may be an important lever for improving key public health outcomes in low-income settings; however, previous studies have not established the statistical associations between better management and primary healthcare system performance in such settings. To explore this gap, we conducted a cross-sectional study of 36 rural districts and 226 health centers in Ethiopia, a country which has made ambitious investment in expanding access to primary care over the last decade. We employed quantitative measure of management capacity at both the district health office and health center levels and used multiple regression models, accounting for clustering of health centers within districts, to estimate the statistical association between management capacity and a key performance indicator (KPI) summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. In districts with above median management capacity, health center management capacity was strongly associated (p < 0.05) with KPI performance whereas in districts with below median management capacity, health center management capacity was not associated with KPI performance. Having more staff at the district health office was also associated with better KPI performance (p < 0.05) but only in districts with above median management capacity. The results suggest that district-level management may provide an opportunity for improving health system performance in low-income country settings
<p><sup>1</sup> 43 people did not report their age.</p><p><sup&g... more <p><sup>1</sup> 43 people did not report their age.</p><p><sup>2</sup> 164 people did not know the distance</p><p><sup>3</sup> P-Values calculated using chi-squared test for categorical variables and Student’s t-test for continuous variable age.</p><p>Descriptive statistics by type of facility.</p
Primary health care services are fundamental to improving health and health equity, particularly ... more Primary health care services are fundamental to improving health and health equity, particularly in the context of low and middle-income settings where resources are scarce. During the past decade, Ethiopia undertook an ambitious investment in primary health care known as the Ethiopian Health Extension Program that recorded impressive gains in several health outcomes. Despite this progress, substantial disparities in health outcomes persist across the country. The objective of this study was to understand how variation in the implementation of the primary health care efforts may explain differences in key health outcomes. We conducted a qualitative study of higher-performing and lower-performing woredas using site visits and in-depth interviews undertaken in 7 woredas. We classified woredas as higher-performing or lower-performing based on data on 5 indicators. We conducted a total of 94 open-ended interviews; 12-15 from each woreda. The data were analyzed using the constant compara...
<p><sup>1</sup> HEW: Health extension worker</p><p><sup>2<... more <p><sup>1</sup> HEW: Health extension worker</p><p><sup>2</sup> PHCU: Primary health care unit</p><p><sup>3</sup> Other includes follow up, non-governmental organizations, Emmanuel Mental Health hospital, care abroad, and traditional medicine.</p><p><sup>4</sup> N = 13 people seeking care at a hospital had sought care at more than 1 prior facility, and N = 3 people seeking care at a health center had sought care at more than 1 prior facility.</p><p>Sources of prior care and sources of referrals.</p
The purpose of this study was to explore the level of integration of health promotion and disease... more The purpose of this study was to explore the level of integration of health promotion and disease prevention services with the curative care provided at hospitals and health centres in Addis Ababa, and to propose recommendations that could improve such an integrated health service. A quantitative approach, using an exploratory and descriptive design was applied at 22 public health facilities in Addis Ababa followed by the Delphi technique to reach consensus on ways to improve the integration of health promotion, preventive and curative care. An integrated health service (IHS) framework was used as the conceptual framework upon which the study was based. Multistage sampling involving stratified simple random sampling was applied to select hospitals and health centres while a systematic sampling technique was used to sample patients from the outpatient and inpatient medical departments. Data was collected by means of two questionnaires from patients and health service managers, respec...
<p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors a... more <p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors associated with being referred from prior source of care.</p
<p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors A... more <p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors Associated with Seeking Prior Care of Patients at Hospital and Health Center.</p
MSExcel file showing data on management and health systems performance collected by the project t... more MSExcel file showing data on management and health systems performance collected by the project team working in each of the 36 intervention districts, based on existing administrative records at the health center and district level
Strengthening district-level management may be an important lever for improving key public health... more Strengthening district-level management may be an important lever for improving key public health outcomes in low-income settings; however, previous studies have not established the statistical associations between better management and primary healthcare system performance in such settings. To explore this gap, we conducted a cross-sectional study of 36 rural districts and 226 health centers in Ethiopia, a country which has made ambitious investment in expanding access to primary care over the last decade. We employed quantitative measure of management capacity at both the district health office and health center levels and used multiple regression models, accounting for clustering of health centers within districts, to estimate the statistical association between management capacity and a key performance indicator (KPI) summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. In districts with above median management capacity, health center management capacity was strongly associated (p < 0.05) with KPI performance whereas in districts with below median management capacity, health center management capacity was not associated with KPI performance. Having more staff at the district health office was also associated with better KPI performance (p < 0.05) but only in districts with above median management capacity. The results suggest that district-level management may provide an opportunity for improving health system performance in low-income country settings
<p><sup>1</sup> 43 people did not report their age.</p><p><sup&g... more <p><sup>1</sup> 43 people did not report their age.</p><p><sup>2</sup> 164 people did not know the distance</p><p><sup>3</sup> P-Values calculated using chi-squared test for categorical variables and Student’s t-test for continuous variable age.</p><p>Descriptive statistics by type of facility.</p
Primary health care services are fundamental to improving health and health equity, particularly ... more Primary health care services are fundamental to improving health and health equity, particularly in the context of low and middle-income settings where resources are scarce. During the past decade, Ethiopia undertook an ambitious investment in primary health care known as the Ethiopian Health Extension Program that recorded impressive gains in several health outcomes. Despite this progress, substantial disparities in health outcomes persist across the country. The objective of this study was to understand how variation in the implementation of the primary health care efforts may explain differences in key health outcomes. We conducted a qualitative study of higher-performing and lower-performing woredas using site visits and in-depth interviews undertaken in 7 woredas. We classified woredas as higher-performing or lower-performing based on data on 5 indicators. We conducted a total of 94 open-ended interviews; 12-15 from each woreda. The data were analyzed using the constant compara...
<p><sup>1</sup> HEW: Health extension worker</p><p><sup>2<... more <p><sup>1</sup> HEW: Health extension worker</p><p><sup>2</sup> PHCU: Primary health care unit</p><p><sup>3</sup> Other includes follow up, non-governmental organizations, Emmanuel Mental Health hospital, care abroad, and traditional medicine.</p><p><sup>4</sup> N = 13 people seeking care at a hospital had sought care at more than 1 prior facility, and N = 3 people seeking care at a health center had sought care at more than 1 prior facility.</p><p>Sources of prior care and sources of referrals.</p
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