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" Assessing Managerial Accountability in Ethiopia's Primary Healthcare System "
Patel, Akshar
Curry, Leslie
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Latin Dissertation
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| Language of Document
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English
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| Record Number
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1106008
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| Doc. No
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TLpq2356802408
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| Main Entry
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Curry, Leslie
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Patel, Akshar
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| Title & Author
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Assessing Managerial Accountability in Ethiopia's Primary Healthcare System\ Patel, AksharCurry, Leslie
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| College
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Yale University
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| Date
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2019
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| student score
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2019
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| Degree
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M.P.H.
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| Page No
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37
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| Abstract
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In Ethiopia, the primary healthcare system is organized into the hierarchy of Federal Ministry of the Health (FMOH) at the top, then Regional Health Bureaus (RHBs), Zonal Health Departments (ZHDs), Woreda (District) Health Offices (WHOs), Health Centers (HCs), and finally Primary Hospitals (PHs) at the bottom. Each region additionally has a Pharmaceutical Funds and Supply Agency (PFSA). Greater accountability through both top-down and bottom-up mechanisms have been shown to be positively associated with health systems performance in high-income settings, but little is known about how accountability for primary care performance is operationalized or experienced in low-and-middle income countries (LMIC) settings. This study set out to characterize stakeholder perceptions and experiences with accountability systems in primary care in a low-income setting. We conducted semi-structured key informant interviews with stakeholders from across Ethiopia’s primary healthcare system to explore perspectives on accountability and use of existing mechanisms. Purposive sampling based on the stakeholder’s role within their respective health system level was used to select informants. Stakeholders were selected from the FMOH, RHBs, ZHDs, WHOs, HCs, PHs, and PFSAs. We continued to enroll participants until we reached thematic saturation (n=41). We identified six opportunities and themes for strengthening the role of accountability within primary care. These include 1) a shared understanding of accountability and measuring for performance improvement is lacking, 2) accountability-related problems in healthcare are interdependent, 3) the culture of accountability reflected limited appreciation for existing practices, 4) there are many unsynchronized lines of accountability for healthcare managers, 5) empowering patients and providers through medico-legal enforcement needs emphasis, and 6) bottom-up accountability in the current primary healthcare system is inadequate. Findings from this study place current tools and systems into context and highlight areas for continued development. Many of these accountability practices and standards have not been entirely actualized throughout the primary healthcare sector. Through the discovery of these common themes and their practical implications, the Primary Healthcare Transformation Initiative (PTI), led by Yale Global Health Leadership Institute (GHLI) will better direct future programming and support networks to fill in the gaps in accountability.
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| Subject
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Health care management
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Public health
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Public policy
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