Capacity of the Ethiopian primary health care system to achieve universal health coverage: a primary health care progression approach

Abstract

Comprehensive and globally comparable evidence about the 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 have 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 with 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 potentially improves the capacity of PHC in Ethiopia.

Assessment of the Global Fund-supported procurement and supply chain reforms at the Ethiopian Pharmaceuticals Supply Agency: a mixed-methods study

“…This is a fundamentally important consideration as various health systems, including those in low-income and middle-income countries, such as Ethiopia are striving towards UHC 31. The HSTP-I mid-term review (2018) documented relatively high availability of programme medicines in line with the set national targets 6 39. According to a WHO African Region report, Ethiopia had a health product score of 0.51, which was slightly higher than the regional average of 0.48 40…”