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Hema Magge, Abiyou Kiflie, Kojo Nimako, Kathryn Brooks, Sodzi Sodzi-Tettey, Nneka Mobisson-Etuk, Zewdie Mulissa, Befikadu Bitewulign, Mehiret Abate, Abera Biadgo, Haregweni Alemu, Yakob Seman, Munir Kassa, Pierre Barker, Daniel Gebremichael Burrsa, The Ethiopia healthcare quality initiative: design and initial lessons learned, International Journal for Quality in Health Care, Volume 31, Issue 10, December 2019, Pages G180–G186, https://doi.org/10.1093/intqhc/mzz127
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Abstract
To describe the development, implementation and initial outcomes of a national quality improvement (QI) intervention in Ethiopia.
Retrospective descriptive study of initial prototype phase implementation outcomes.
All public facilities in one selected prototype district in each of four agrarian regions.
Facility QI teams composed of managers, healthcare workers and health extension workers.
The Ethiopian Federal Ministry of Health (FMoH) and the Institute for Healthcare Improvement co-designed a three-pronged approach to accelerate health system improvement nationally, which included developing a national healthcare quality strategy (NHQS); building QI capability at all health system levels and introducing scalable district MNH QI collaboratives across four regions, involving healthcare providers and managers.
Implementation outcomes including fidelity, acceptability, adoption and program effectiveness.
The NHQS was launched in 2016 and governance structures were established at the federal, regional and sub-regional levels to oversee implementation. A total of 212 federal, regional and woreda managers have been trained in context-specific QI methods, and a national FMoH-owned in-service curriculum has been developed. Four prototype improvement collaboratives have been completed with high fidelity and acceptability. About 102 MNH change ideas were tested and a change package was developed with 83 successfully tested ideas.
The initial successes observed are attributable to the FMoH’s commitment in implementing the initiative, the active engagement of all stakeholders and the district-wide approach utilized. Challenges included weak data systems and security concerns. The second phase—in 26 district-level collaboratives—is now underway.
