District-level health management and health system performance

Abstract

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 district management capacity, health center management capacity was strongly associated (p < 0.05) with KPI performance. 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.

Leadership, governance and management for improving district capacity and performance: the case of USAID Transform: Primary Health Care

“…The improvements may be related to the practice of effective management which has direct implications in in uencing availability input and redesigning of processes (14). A study in Ethiopia also showed that improving competencies at the district level can improve service availability and quality by improving capacity of management at the facility level, coordination, resource availability and accountability (4).…”

Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana

“…state, regional, district, sub-district), is frequently perceived as a way to improve health system performance as local authorities are better able to make informed decisions regarding local conditions [1][2][3]. However, in order to improve performance, individual capacity among local health managers are needed [1,[4][5][6]. Moreover institutional capacities, such as functional support systems and enabling work environments, including an appropriate level of autonomy for the managers', must be in place [7].…”

“…planning, supervising, monitoring quality and coverage), resources (i.e. staff, budgets, drugs, equipment, buildings and information), and stakeholders (external relations, partners, community members, service users and intersectoral stakeholders) [4,16,17]. Literature suggests weak management and leadership capacities among local health managers globally [7,[18][19][20][21][22].…”

“…Several studies suggest a positive association between district-level management capacity and health system performance [4,[24][25][26][27][28][29][30]. However, the study of Fetene et al in Ethiopia (2019) is to our knowledge the only in a lower income setting that has applied a quantifiable and precise measurement of management capacity at district level.…”

Modeling a reliable and valid framework for building and measuring the health system workforce’s competence to lead, manage and govern in Ethiopia: Factor analysis approach

“…The workforce who are competent to lead, manage and govern improve the health system performance and health outcomes. (1)(2)(3)(4)(5) Because, it supports them to balance people's needs, workloads and organizations' requirements simultaneously. (6) Thus, a continuous deal in this area is important due to knowledge development and technological innovations.…”