Effect of training on the use of long-lasting insecticide-treated bed nets on the burden of malaria among vulnerable groups, south-west Ethiopia: baseline results of a cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, the utilization of long-lasting insecticide-treated bed nets (LLITN) is hampered by behavioural factors such as low awareness and negative attitude of the community. The aim of this study was to present the design and baseline results of a cluster randomized trial on the effect of training of household heads on the use of LLITN.</p> <p>Methods</p> <p>This baseline survey was undertaken from February to March, 2009 as part of a randomized cluster trial. A total of 11 intervention and 11 control <it>Gots </it>(villages) were included in the Gilgel Gibe Field Research Centre, south-west Ethiopia. House to house visit was done in 4135 households to collect information about the use of LLITN and socio-demographic variables. For the diagnosis of malaria and anaemia, blood samples were collected from 2410 under-five children and 242 pregnant women.</p> <p>Results</p> <p>One fourth of the households in the intervention and control <it>Gots </it>had functional LLITN. Only 30% of the observed LLITN in the intervention and 28% in the control <it>Gots </it>were hanged properly. Adults were more likely to utilize LLITN than under-five children in the control and intervention <it>Gots</it>. The prevalence of malaria in under-five children in the intervention and control <it>Gots </it>was 10.5% and 8.3% respectively. The intervention and control <it>Gots </it>had no significant difference concerning the prevalence of malaria in under-five children, [OR = 1.28, (95%CI: 0.97, 1.69)]. Eight (6.1%) pregnant women in the intervention and eight (7.2%) in the control <it>Gots </it>were positive for malaria (P = 0.9). Children in the intervention <it>Gots </it>were less likely to have anaemia than children in the control <it>Gots</it>, [OR = 0.75, (95%CI: 0.62, 0.85)].</p> <p>Conclusion</p> <p>The availability and utilization of LLITN was low in the study area. The prevalence of malaria and anaemia was high. Intervention strategies of malaria should focus on high risk population and vulnerable groups.</p

Determinant factors of knowledge management practice: the case of ministry of health, Ethiopia

This study aims at assessing knowledge management maturity level and the effect of the determinant factors of knowledge management in Ethiopia’s federal ministry of health. Explanatory survey design involving both the quantitative and qualitative methods was employed. General knowledge management maturity model based on people, process and technology key process areas was used to measure knowledge management maturity level in the organization. The qualitative data was analyzed using thematic analysis and summarized under pre identified and emerging themes. The quantitative and qualitative data were triangulated to enrich the findings. The study determined that the ministry’s overall knowledge management maturity level was close to maturity level-2 (Aware), which is generally to mean that the organization was aware of and has the intention to manage its organizational knowledge, but it might not know how to do so. Organizational culture, human resource, information technology and knowledge management process were identified as having significant and positive linear relationship with the knowledge management practice in the organization. It is essential for the ministry to reestablish knowledge management or define improvement plans using model such as the general knowledge management maturity model. The improvement should address the identified determinant factors as well as criterion set for each of the people, process and technology key process areas

Change Management and Organization Performance: Pre- Post Case Study at Federal Ministry of Health, Ethiopia

The purpose of this study is to investigate the pre and post implementation of change management (BSC and strategic planning) on performance of Ethiopian Federal Ministry of Health. Both qualitative and quantitative approaches are employed. The data are gathered from employees of the Ministry through survey questionnaires, and from directorate heads through interviews and focus group discussions. The researcher identified that the major bottleneck for implementation of strategic planning and BSC are lack of adequate resources for training and software, extent of staff participation and lack of adequate resources The research established that the balanced scorecard is a useful tool. It helps organizations to turn visions into reality with accuracy and efficiency. Strategy and BSC implementation therefore require that all business units, support units and employees be aligned and linked to the strategy and scorecard. The study concludes that the main objective of the Balanced ScoreCard is to bring the different perspectives (finance, internal business processes, learning, growth and clients) together in a uniform system. The study recommends organizations to adopt balanced scorecard and strategic planning for measuring performance and for better progress. But it should make deep investigation in implementing any management tools. Taking one or more countries as reference is not enough rather it is better to see or analyse the environment in which the organization is working. Finally the paper provides information and suggestions that are helpful for companies that are interested in developing strategic planning and balanced scorecard. Keywords Balanced Scorecard, Strategic planning and organizational performanc

The performance of health workers in Ethiopia - results from qualitative research

Insufficient attention has been paid to understanding what determines the performance of health workers and how they make labor market choices. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia, a country with some of the poorest health outcomes in the world. It describes performance problems identified by both health, users and health workers participating in the focus group discussions, including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption. The second part of the paper presents four structural reasons why these problems arise: (1) the ongoing transition from a health sector dominated by the public sector, toward a more mixed model; (2) the failure of government policies to keep pace with the transition toward a mixed model of service delivery; (3) weak accountability mechanisms and the erosion of professional norms in the health sector; and (4) the impact of HIV/AIDS. The discussions underline the need to base policies on a micro-analysis of how health workers make constrained choices, both in their career and in their day to day professional activities.Health Monitoring&Evaluation,Health Systems Development&Reform,Agricultural Knowledge&Information Systems,Housing&Human Habitats,Health Economics&Finance

The Performance of Health Workers in Ethiopia Results from Qualitative Research

Insufficient attention has been paid to understanding what determines the performance of health workers and how they make labor market choices. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia, a country with some of the poorest health outcomes in the world. We describe performance problems identified by both health users and health workers participating in the focus group discussions, including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption. In the second part of the paper we present four structural reasons why these problems arise: (i) the ongoing transition from health sector dominated by the public sector, towards a more mixed model; (ii) the failure of government policies to keep pace with the transition towards a mixed model of service delivery; (iii) weak accountability mechanisms and the erosion of professional norms in the health sector; and (iv) the impact of HIV/AIDS. The discussions underline the need to base policies on a micro-analysis of how health workers make constrained choices, both in their career and in their day to day professional activities.health worker performance, human resources for health, corruption

Evidence Advisory System Briefing Notes: Ethiopia

There has been a growing global concern for improving the use of evidence to inform health policy in recent years. Increasingly there is recognition that individual projects or programmes building evidence synthesis skills, may be limited in their effect without a broader consideration of the systems in place which ‘embed’ or ‘institutionalise’ evidence informed policy making practices (Alliance for Health Policy and Systems Research and WHO 2007). The GRIP-Health programme is a five year project supported by the European Research Council which studies the political nature of health policy to understand how to best improve the use of evidence. This explicitly political lens enables us to focus on the contested nature of health issues as well as the institutions that shape the use of evidence in health policy making. We understand institutions as including both formal structures and rules, as well as informal norms and practices (Lowndes and Roberts 2013). The GRIP-Health programme follows the World Health Organization’s view that Ministries of Health remain the ultimate stewards of a nation’s health, and further play a key role in providing information to guide health decisions (World Health Organization 2000, Alvarez-Rosette, Hawkins, and Parkhurst 2013). As such, GRIP-Health is particularly concerned with the structures and rules created by government to gather, synthesise, or otherwise provide evidence to inform policy making. This working paper is one of a series of six briefs covering a set of countries in which the GRIP-Health programme is undertaking research. This brief presents an overview of what is termed the ‘Evidence Advisory System’ (EAS) for health policy making within the country of interest, which is taken to encompass the key entry points through which research evidence can make its way into relevant health policy decisions. This can include both formal (government mandated) and informal structures, rules, and norms in place. Individual reports in this series can be useful for those considering how to improve evidence use in specific country settings, while taken together the reports identify the differences that can be seen across contexts, permitting reflection or comparison across countries about how evidence advisory systems are structured – including which responsibilities are given to different types of bodies, and how well evidence advice aligns with decision making authority structures

Gender differences regarding barriers and motivators of HIV status disclosure among HIV-positive service users.

There are inconsistent findings about the relation between gender and HIV status disclosure. We conducted a facility-based crosssectional study, using qualitative and quantitative data collection methods, to explore gender differences in HIV-positive status disclosure among service users in south-west Ethiopia. Among 705 participants, an equal number of men and women (94.6% men v. 94.3%, women) indicated that they had disclosed their result to someone, and the majority (90.9% men v. 90.7% women) to their current main partner. 'It is customary to tell my partner everything' was the most frequently cited reason for disclosing (62.5% men v. 68.5% women). Reasons for non-disclosure varied by gender: men were concerned about their partner's worry and exposure of their own unfaithfulness. Women feared physical violence, and social and economic pressure in raising their children. Factors that influenced disclosure also indicated gender variation. For men, disclosure of HIV results to a sexual partner was positively associated with knowing the partner's HIV status and discussion about HIV testing prior to seeking services, while for women it was associated with knowing the partner's HIV status, advanced disease stage, having no more than primary education, being married, and perceiving the current relationship as long-lasting

Determinants of delay in malaria treatment-seeking behaviour for under-five children in south-west Ethiopia: a case control study

<p>Abstract</p> <p>Background</p> <p>Prompt diagnosis and timely treatment of malaria within 24 hours after onset of first symptoms can reduce illness progression to severe stages and therefore, decrease mortality. The reason why mothers/caretakers delay in malaria diagnosis and treatment for under-five children is not well studied in Ethiopia. The objective of this study was to assess determinants of malaria treatment delay in under-five children in three districts of south-west Ethiopia.</p> <p>Methods</p> <p>A case control study was conducted from March 15 to April 20, 2010. Cases were under-five children who had clinical malaria and sought treatment after 24 hours of developing sign and symptom, and controls were under-five children who had clinical malaria and sought treatment within 24 hours of developing sign and symptom of malaria. Data were collected by trained enumerators using structured questionnaire. Data were entered in to Epi Info version 6.04 and analyzed using SPSS version 16.0. To identify determinants, multiple logistic regression was done.</p> <p>Results</p> <p>A total of 155 mothers of cases and 155 mothers of controls were interviewed. Mothers of children who were in a monogamous marriage (OR = 3.41, 95% CI: 1.39, 8.34), who complained about the side effects of anti-malarial drugs (OR = 4.96, 95% CI: 1.21, 20.36), who had no history of child death (OR = 3.50, 95% CI: 1.82, 6.42) and who complained about the higher cost of transportation to reach the health institutions (OR = 2.01, 95% CI: 1.17, 3.45) were more likely to be late for the treatment of malaria in under-five children.</p> <p>Conclusion</p> <p>Effective malaria control programmes should address reducing delayed presentation of children for treatment. Efforts to reduce delay should address transport cost, decentralization of services and increasing awareness of the community on early diagnosis and treatment.</p

Country contextualisation of cost-effectiveness studies: lessons from Ethiopia

Emerging demographic, epidemiological and health system changes in low-income countries require revisions of national essential health services packages in accordance with standard healthcare priority setting methods. Policy makers are in need of explicit and user-friendly methods to compare impact of multiple interventions. We provide experiences of country contextualisation of WHO-CHOICE methods and models to a country level. Results from three contextualised cost-effectiveness analyses (CEAs) are presented, and we discuss how this evidence can inform priority setting in Ethiopia. Existing models for a range of interventions in obstetric and neonatal care, psychiatric and neurological treatment and prevention and treatment of cardiovascular diseases are contextualised to the Ethiopian setting. CEAs are defined as contextualised if they include national analysts and use country-specific input for either costs, epidemiology, demography, baseline coverage or effects. Interventions (n=61) are ranked according to incremental cost-effectiveness rates (ICERs), and expected health outcomes (Disability Adjusted Life Years (DALYs) averted) and budget impacts are presented for each intervention. Dominated interventions (n=30) were excluded. A USD2.8 increase per capita in the annual health budget is needed in Ethiopia (currently at USD28 per capita) for increasing coverage by 20%–75% for all the 22 interventions with positive net health benefits. This investment is expected to give a net benefit at around 0.5 million DALYs averted in return in total, with a willingness to pay threshold at USD2000 per DALY averted. In particular, three interventions, neonatal resuscitation, kangaroo mother care and antibiotics for newborn sepsis, stand out as best buys in an Ethiopian setting. Our method of contextualised CEAs provides important information for policy makers. Rank ordering of interventions by ICERs, together with presentations of expected budget impact and net health benefits, is a clear and policy friendly illustration of possible efficient stepwise pathways towards universal health coverage.publishedVersio

Developing and validating a multi-dimensional instrument for measuring the performance of district health systems in a national region in Ethiopia

Background: Despite being the main vehicles of primary healthcare provision in Ethiopia, district health systems lack comprehensive set of valid performance indicators that are both process and outcome oriented. Therefore, we aimed to develop and validate a set of performance indicators for district health systems of Oromia Region, Ethiopia. Methods: We used a sequential mixed-methods design. During development stage, we employed a qualitative interview study in Oromia Region, Ethiopia. We transcribed, did in vivo coding and inductive analysis of the interviews. Moreover, we conducted a narrative systematic review. Records on performance of health systems were appraised and synthesized. Then, during the validation stage, we supplied the indicators generated from the previous two studies to experts in the field of health systems as part of a Delphi study. In the Delphi study, experts voted on the inclusion- or exclusion-of indicators in three stages. Results: Eleven functions of district health systems emerged from the interviews including: creating capacity of health centers for the provision of health care; and provision of comprehensive health care for communicable diseases and maternal health conditions, among others. Furthermore, 59 out of 238 indicators generated by the interviews and the systematic review were found to be valid by experts. Among these, 40 were found to be able to be drawn from the information systems in the districts. The indicators addressed multiple dimensions of performance of district health systems, such as capacity, quality, and outcomes. Among valid and feasible indicators were rate of utilization of family planning methods, and tuberculosis cases per 1000 people. Conclusion: Policy makers can use the valid indicators to monitor national policy priority areas like the expansion of family planning services. Moreover, the indicators can be used in the districts for local decision making, for example, to identify poorly performing functions and take corrective action