Abstract
Background: The maternal, neonatal and child mortality rates in Ethiopia are among the reported highest in Africa. Despite the reported alarming mortality rates, there are proven public health interventions in place to avoid preventable maternal and child deaths. Leadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing the work climate, and creating responsive health systems. Hence, the Ethiopian Ministry of Health with the support of the USAID Transform: Primary Health Care Activity has been implementing LMG interventions to improve performance of primary health care entities. The LMG interventions include a six-day classroom training with an additional six to nine months of leadership project implementation, supplemented with three to four onsite coaching sessions. The purpose of this evaluation was to measure the effects of LMG interventions on maternal and child health service performances and on the overall health system strengthening measurement results of primary health care entities. Methods: The study used a cross-sectional study design with propensity matched score analysis and was conducted from August 28, 2017, to September 30, 2018, in Amhara, Oromia, Tigray, and Southern Nations, Nationalities, and Peoples’ (SNNP) regions. Data collection took place through interviewer and self-administered questionnaires among 227 LMG intervention exposed and 227 non-exposed health workers. Propensity score matched analysis was used to estimate the average treatment effects of LMG interventions on contraceptive acceptance rates, antenatal care, skilled birth attendance, postnatal care, full immunization services, growth monitoring services, management system, work climate and capacity to respond to new challenges. Results: The mean overall maternal and child health key performance indicator score with standard deviation (SD) for the LMG intervention exposed group was 63.86 ± 13.16 (SD) and 57.02 ± 13.71 (SD) for the non-exposed group. The overall health system strengthening score for the LMG intervention exposed group (mean rank =269.31) and non-exposed group (mean rank = 158.69) had statistically significant differences (U=10.145, z= -11.175, p=0.001). The average treatment effects of 3.54, 3.51, 2.64, 3.00, 1.073.34 percentage-points were observed for contraceptive acceptance rate, antenatal care, skilled birth attendance, postnatal care, full immunization, and growth monitoring services, respectively. In addition, with regards to health system strengthening measurements, we found an average treatment effect (ATE) of 12.46, 4.79 and 4.88 percentage points for strengthening management system, enhancing work climate and capacity to respond to new challenges, respectively. Conclusion: We found positive evidence of effects of the LMG intervention on increased maternal and child health services performances at primary healthcare entities. Moreover, health facilities with LMG intervention exposed health workers had a higher and statistically significant difference in management systems, work climate and readiness to face new challenges. Therefore, this study generates evidence for integrating LMG interventions to improve the performance of primary healthcare entities and maternal and child service uptake of community members, which contributes to the reduction maternal and child deaths.
Inequalities in utilization of maternal and child health services in Ethiopia: the role of primary health care
