Rachelle Alpern

The impact of the World Health Organization's Patient Safety Programme's 19-item Surgical Safety Checklist on surgical processes and outcomes was assessed in 2008-2009 at two hospitals in the resource-limited setting of Liberia. In the preintervention phase, data were prospectively collected on surgical processes and outcomes from 232 consecutively enrolled patients who were undergoing surgery. In the postintervention phase, data were collected on 249 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. Multivariable logistic regression was used to determine the adjusted association between the introduction of the checklist and surgical process and outcome measures. These analyses were conducted among the pooled data, as well as for data stratified by hospital. The introduction of the checklist was associated with significant (p < 0.05) improvements in terms of overall surgical processes and surgical outcomes. The stratified analysis pr...

Government-community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.

Background: Ethiopia is one of 57 countries identified by the World Health Report 2006 as having a severely limited number of health care professionals. In recognition of this shortage, the Ethiopian Federal Ministry of Health, through the Ethiopian Hospital Management Initiative, prioritized the need to improve retention of health care workers. Accordingly, we sought to develop the Satisfaction of Employees in Health Care (SEHC) survey for use in hospitals and health centers throughout Ethiopia.