Public-on-private dual practice among physicians in public hospitals of Tigray National Regional State, North Ethiopia: perspectives of physicians, patients and managers

Abstract Background Physicians who work in the private sector while also holding a salaried job in a public hospital, known as “dual practice,” is one of the main retention strategies adopted by the government of Ethiopia. Dual practice was legally endorsed in Tigray National Regional State, Ethiopia in 2010. Therefore, the aim of this study was to explore the extent of dual practice, reasons why physicians engage in it, and its effects on public hospital services in this state in northern Ethiopia. Methods A cross-sectional study using mixed methods was conducted from February to March 2011 in six geographically representative public hospitals of Tigray National Regional State. A semi-structured, self-administered questionnaire was distributed to all physicians working in the study hospitals, and an interviewer-administered, structured questionnaire was used to collect data from admitted patients. Focus group discussions were conducted with hospital governing boards. Quantitative and qualitative data were used in the analysis. Results Data were collected from 31 physicians and 449 patients in the six study hospitals. Six focus group discussions were conducted. Twenty-eight (90.3%) of the physicians were engaged in dual practice to some extent: 16 (51.6%) owned private clinics outside the public hospital, 5 (16.1%) worked part-time in outside private clinics, and 7 (22.6%) worked in the private wing of public hospitals. Income supplementation was the primary reason for engaging in dual practice, as reported by 100% of the physicians. The positive effects of dual practice from both managers’ and physicians’ perspectives were physician retention in the public sector. Ninety-one patients (20.3%) had been referred from a private clinic immediately prior to their current admission-a circular diversion pattern. Eighteen (19.8%) of the diverted patients reported that health workers in the public hospitals diverted them. Conclusions Circular diversion pattern of referral system is the key negative consequence of dual practice. Physicians and hospital managers agreed that health worker retention was the main positive consequence of dual practice upon the public sector, and banning dual practice would result in a major loss of senior physicians. The motive behind the circular diversion pattern described by patients should be studied further

Correction to: Public-on-private dual practice among physicians in public hospitals of Tigray National Regional State, North Ethiopia: perspectives of physicians, patients and managers

Correction After the publication of this article [1] it has come to our attention that the author Jeph Herrin was incorrectly included as Jeph Henry. The correct spelling is included in this erratum and the original article has been updated

Coverage, social mobilization and challenges of mass Zithromax administration campaign in South and South East zones of Tigray, Northern Ethiopia: A cross sectional study

<div><p>Background</p><p>The antibiotic treatment of people with trachoma helps to prevent transmission the disease in a community. Currently, Zithromax is the drug recommended for mass drug administration (MDA). MDA should be carried out annually for three to five years in trachoma endemic areas. Coverage survey is essential to track progress towards program goals and to identify communities with poor coverage in order to permit timely and appropriate actions. We assessed mass Zithromax administration coverage, social mobilization and campaign challenges in south and southeast zones of Tigray, Ethiopia.</p><p>Method</p><p>We conducted a survey in community in Southern and South East zones of Tigray region from August 15 to August 31, 2016. The survey included nine Woredas. It was supported by qualitative methods. A total of 3741 individuals were enrolled from 933 households using multistage sampling. We used structured questionnaire. In-depth interview and focus group discussion were also applied. Descriptive statistics was performed using SPSS version 20.We thematically analyzed the qualitative data using Atlas 7.</p><p>Result</p><p>The overall coverage of Zithromax MDA was 93.3%. It ranges from 90.0% in Seharti Samre to 97.9% in Endamokoni. The coverage was 93.4% for males and 93.1% for females. A higher proportion (98.3%) of children aged 5 to 15 years and 409 (87.8%) under five children took Zithromax. The coverage was 94% in rural and 91.2% in urban. Women development army (43.3%) and health extension workers (32.5%) were the main source of information. Frequent occurrence of drug side effects, rumors, lack of community and leaders’ engagement in the campaign, fasting, shortage of human power and short term unavailability of supplies were barriers during the campaign.</p><p>Conclusion</p><p>The Zithromax MDA coverage in the study zones was higher than the minimum WHO set criteria of 80%. There was a wide difference in coverage among Woredas and Kebeles. The MDA coverage was lower in urban than rural. Misconceptions and poor mobilization were common challenges. Thus, proper planning, community mobilization and uniform training will need to be done ahead of the campaign in the future.</p></div

Type and source of information about Zithromax mass administration in Southern and Southeast zones of Tigray, 2016.

<p>Type and source of information about Zithromax mass administration in Southern and Southeast zones of Tigray, 2016.</p

Zithromax MDA coverage by district, Southern and Southeast Zones of Tigray, 2016.

<p>Zithromax MDA coverage by district, Southern and Southeast Zones of Tigray, 2016.</p

Zithromax coverage stratified by age and residence in South and Southeastern zones of Tigray region, 2016.

<p>Zithromax coverage stratified by age and residence in South and Southeastern zones of Tigray region, 2016.</p

Reasons for non-participants on Zithromax MDA in Southern and Southeast zones of Tigray, 2016.

<p>Reasons for non-participants on Zithromax MDA in Southern and Southeast zones of Tigray, 2016.</p

Zithromax coverage stratified by sex and residence in South and Southeastern zones of Tigray region, 2016.

<p>Zithromax coverage stratified by sex and residence in South and Southeastern zones of Tigray region, 2016.</p

Mass drug administration coverage by selected variables in South and Southeastern zones of Tigray, 2016 (N = 3741).

<p>Mass drug administration coverage by selected variables in South and Southeastern zones of Tigray, 2016 (N = 3741).</p