Transforming primary health care unit service delivery through leadership, management and governance (LMG) training: A field action report from Ethiopia

Abstract

Background: In order to achieve global and national health targets in Ethiopia, it is crucial that cadres of leaders have the skills, knowledge and tools to manage and govern the primary health care reform initiative currently underway. To support this, John Snow, Inc. (Strengthening Ethiopia’s Urban Health Program (JSI/SEUHP),the implementing partner, collaborated with the Federal Ministry of Health (FMOH), regional health bureaus (RHBs), and town and sub-city health offices to provide leadership, management and governance (LMG) training between November 2016 and August 2017. The training of trainers (ToT) was undertaken by professionals from the FMOH, RHB and universities, who cascaded it to health care workers in 12 health centers (HCs), one sub-city health office and one town health office, in phases, followed by workplace implementation. This field action report documents the results and lessons learned from the implementation of this LMG training.

Methods: A mixed methods approach was used to assess the impact of LMG training. Changes in leadership competencies were assessed through pre- and post-test evaluations, and the impact of LMG training on primary healthcare service delivery was assessed through facility records. The implementation process and impact on providers’ perceptions were documented through a combination of coaching discussions, group work and quarterly activity implementation reports.

Results and Discussion: Health facilities implementing the LMG project improved institutional delivery from 40% to 80% in Sodo town, and the ANC follow-up retention rate increased from 40% to 78% in Addis Ababa Woreda10 HC. As a result of the LMG training, providers working in supported facilities noted improvements in the workplace atmosphere, provider motivation, team work and resource management.

Conclusions: The LMG training resulted in improved manager and provider motivation, and competency to carry out LMG practices. The training catalyzed positive competition between health facility teams to achieve facility-level service delivery goals. Findings suggest that scaling LMG training is a promising mechanism to support health sector transformation in Ethiopia. [Ethiop.J. Health Dev. 2020; 34(Special issue 2):33-41]

Key words: Leadership, management, governance, Ethiopia