Quality of Primary Health Care during COVID-19 Pandemic in Addis Ababa Ethiopia: Patients-side and facility level assessment

Abstract Background: Quality is increasingly becoming an important aspect of health care that is given a priority nowadays. The assessment and assurance of quality depends on reliable evidence. It is evident that there is no comprehensive study related to quality of health care in public primary health care facilities during COVID-19 pandemic in Ethiopia. Even if the formulation and launching of health facility standards nationally has been made in 2013 and quality has been taken as one pillar for the past two decades, quality of health services has been poor. Unfortunately, the occurrence of COVID 19 pandemic poses another threat to the already existing poor quality of health service. Therefore, this assessment of selected quality dimensions of primary health care in Addis Ababa could be used for future monitoring and evaluation of quality improvement in the country as well as prepare the primary health facilities against possible future pandemics. Objective: The objective of the study is to assess the selected dimension of health care quality at the time of COVID 19 in the selected primary health care facilities in Addis Ababa, Ethiopia Methods: A facility-based cross-sectional study design was used. The study was done in six health facilities in Addis Ababa, Ethiopia. Patients, health service providers and health facilities were the study participants. An observation checklist and interviewer administered questionnaire were used to assess the routine service provision. Data cleaning, management and analysis was done using SPSS version 23 statistical software. Both descriptive and analytical results were used to present the findings. Result: The overall patient satisfaction was 77.9 %. From the quality dimension, the grand mean satisfaction score for health service accessibility, patient centeredness, equitability, and timeliness were54.7%, 67.9%, 72.1%, 63.4% respectively. From the facility level analysis only two facilities indicated employees receive ongoing Continuing Professional Development (CPD). All the facilities maintain employment record of each staff; however, with regard to the content only two facilities contain credential information, health examination record, in-service education /training and copies of annual evaluation. In half of the facilities lack of procedure room and hand washing room was observed. Toilets were not clean. Poor continuity of care was also identified and only two facilities indicated they had feedback providing mechanism in the referral system. Conclusion: Most of the respondents were satisfied with the quality of primary health care service. Gaps, however, were identified in the human resource management, infrastructure, referral system and continuity of care from the facilities’ perspective. Incomplete recording of most of the content of employee was identified as well. Thus, it is recommended to improve the identified challenges through provision of a system (guideline), continuous supervision, mentorship, and training. [Ethiop. J. Health Dev. 2021; 35(SI-1):98-107] Keyword: quality of service, patient satisfaction, continuing professional developmen

Improving the Quality of Clinical Coding through Mapping of National Classification of Diseases (NCoD) and International Classification of Disease (ICD-10).

AbstractIntroduction: Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. Utilization of international disease classification provides higher-quality information for measuring healthcare service quality, safety, and efficacy. The Ethiopian National classification of disease (NCoD) was developed as part of Health Management information System (HMIS) reform with consideration of accommodating code in International Classification of disease (ICD-10). There is limited resource about the utilization status and related determinants of NCoD by health care professionals at tertiary level hospitals. This study is designed to assess the utilization status of NCoD and improve the quality of clinical coding through mapping of NCoD and ICD-10. Methods: Quasi-experimental study considering “Mapping” as an intervention was employed in this study. Retrospective medical record reviews were carried out to assess the utilization of NCoD and its challenges at Tikur Anebsa Specialized Hospital (TASH) for a period of one year (2018/2019). Qualitative approach used to get expert insight on NCoD implementation challenges and design of mapping exercises as an intervention. Seven thousand five hundred forty-seven (20%) of the medical records from the total of 37,734 medical records were selected randomly for review. A data abstraction checklist was developed to collect relevant information on individual patient charts, patient electronic records specific on a confirmed diagnosis. The reference mapping approach was employed for the mapping output between ICD-10 and NCoD. Both ICD-10 and NCoD were mapped side by side using percentage comparison and absolute difference. Result: Data for document review was taken from the electronic medical record database. Out of the total, 3021 (40%) of records were miss-classified based on the national classification of disease. From the miss-coded record, 1749 (58%) of them used ICD code to classify the diagnosis. Reasons provided for poor utilization of NCoD among physicians include, perception of having a limited list of diagnosis in the NCoD, not being familiarized, inadequate capacity building about NCoD use, and absence of enforcing mechanism on the use of standard diagnostic coding among professionals. Utilization of disease classification coding provides higher-quality information for measuring healthcare service quality, safety, and efficacy. This will in turn provide better data for quality measurement and medical error reduction (patient safety), outcomes measurement, operational planning, and healthcare delivery systems design and reporting. Conclusion: Extended NCoD categories were mapped from ICD-10. Standard ways of coding disease diagnosis and coding of new cases into the existing category was established. This study recommends that due emphasis should be given in monitoring and evaluation of medical coding knowledge and adherence of health professionals, and it should be supported with appropriate technologies to improve the accessibility and quality of health information. [Ethiop. J. Health Dev. 2021; 35(SI-1):59-65] Keywords: Mapping, NCoD, ICD, Clinical Coding, Diagnosis, Health Information Syste

Degree of adherence of the urban health extension service delivery process to the standards set nationally

Background: The Urban Health Extension Program (UHEP) is an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at the household level. Even though the HEP was launched in Ethiopia in 2003 as the flagship program for the implementation of primary health care in the country, studies looking at its quality are limited. Adherence to set standards within a program is one of the parameters that indicate process quality. This paper, part of a larger survey to assess the quality of services provided by the UHEP in Ethiopia, looks at the degree of adherence to the service delivery process to the standards set nationally. Methodology: The study included an assessment of the degree of adherence of the urban health services delivery process to the national standards in selected urban health extension facilities within the catchment areas of sampled institutions. The assessment was made using observation checklists of the routine service provision of the health professionals. Data collection for the survey included the assessment of the service delivery practices of 330urban health extension professionals (UHE-ps) in five major regions. Results: When compared with the standards set in the national program implementation manual, environmental sanitation and counseling of mothers (99.4%), essential nutrition action (in terms of growth monitoring and provision of vitamin A and iron supplementation) (95.4%), HIV/AIDS and STI-related services (95.1%), antenatal care (87.6%), adolescent reproductive health(RH) services (82.1%), family planning services (81%) and facilitating immunization (63.7%) were reported to have good performance. On the other hand, childhood curative services (22%), curative care for pregnant mothers (24.2%), delivery care (25.4%), and follow-up of treatment for leprosy cases (25.5%) were reported to have comparatively low performance. Conclusions: Overall, the comparison of adherence to standards set by the UHE-ps implementation manual showed that the most preventive and health promotive services (including HIV/AIDS and STI) were regularly provided, while the low performance of UHEps was reported in delivery-related and curative services (including those given to pregnant women and children. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):62-69] Keywords: Adherence to standards; Urban Health Extension Program; Urban Health Extension Professionals

Preparedness of the Urban Health Extension Program to provide priority health services identified in its packages

Background: The Urban Health Extension Program (UHEP) – an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at a household level – is one of the three approaches of the national Health Extension Program (HEP).The UHEP is organized to deliver services within 16 packages. This study is aimed at assessing the preparedness of the program to provide priority health services identified in its packages. Methodology: The study covered sampled urban health extension facilities within five study regions, and included 26 facility assessments, and 330 urban health extension professionals’ (UHE-ps’) assessments. Results: According to the findings of the facility assessment, most items within the UHEP packages are available, even though very few facilities were found to stock delivery kits, dressing materials, and oxytocin. Adrenaline was also observed to be found in only a limited number of facilities. Regarding teaching aids and services guidelines, most of the facilities had health education materials, Health Management Information System (HMIS) recording and reporting formats, family health services guidelines, disease prevention guidelines, family planning guidelines, and environmental health guidelines. All of the facilities observed seemed to have most of the services that are prioritized within the UHEP packages. The items less available include HIV testing and counseling guidelines, first aid kits, and infant weighing scales. A knowledge assessment through a test of 327 UHE-ps using questions based on the guideline manual showed a mean score of 76.2% (32 out of 42), with a minimum of 33.3% (10 out of 42) and maximum of 90.5% (38 out of 42). Considering the mean score (76.2%) as the passing grade, only 43% of the UHE-ps scored above the average. Questions on controlling communicable diseases and postnatal care (PNC) were items on which the UHE-ps scored highest. Conclusions and Recommendations: The findings of the present survey show that there is an overall fair level of preparedness within the UHEP to provide the services identified within its various component packages. However, there are still a few services packages for which the UHE facilities do not seem to be well prepared. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):76-82] Keywords: Preparedness; Urban Health Extension Program; Urban Health Extension Professionals

Patterns of utilization, expectations, and satisfaction of the community to urban health extension services

Background: The Urban Health Extension Program (UHEP) – an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at the household level – is one of the three approaches of the national Health Extension Program (HEP). There are very few studies on the quality of health care provided by the UHEP in Ethiopia. This study is part of a comprehensive survey designed to assess the quality of health service delivered by the UHEP, and looks at the pattern of utilization, expectations, and satisfaction of the community in relation to services provided within the UHEP. Methodology: The study covered sampled households for a community-based cross-sectional survey using structured questionnaires among 589 households within five major regions (Amhara; Harari; Oromia; Southern Nations, Nationalities, and Peoples’ (SNNP); and Tigray), as well as the two city administrations of Addis Ababa and Dire Dawa. Results: According to the findings, about 88% of the respondents have heard about urban health extension services in general, and the majority (51.6%) of them have heard about the services from the urban health extension workers (UHEWs), while 28.4%, 10.6%, and 9.3% heard about it from mass media, health centers and neighbors, respectively. Service packages reported to have been used most include environmental health (75.7%), health education (56.5%), and immunization of children (39.2%). On the other hand, services such as first aid (2.2%), referral (3.1%), HIV/AIDS care and support (3.7%), postnatal care (7.8%) and nutritional screening of children (9.7%) seem to have very low rates of utilization. With regard to the overall satisfaction of respondents on their visits to UHE facilities, more than 40% of the survey households responded as being satisfied or very satisfied with most of the items, except for the availability of UHEPs for home visits, availability of medical supplies, and referrals for consultations. Conclusions: Beneficiary communities seem to have an overall positive impression of the services provided by the UHEP, even though knowledge about and utilization of some of the services seem to be minimal. There are tendencies among many community members of associating the program with kebele political activities. There are also instances where communities expect too much from the urban health extension professionals (UHE-ps), while some others tend to undermine the knowledge and skills of UHE-ps and do not consider them as health professionals. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):83-90] Keywords: Utilization of urban health extension; Urban Health Extension Program; Urban Health Extension Professionals

Expectations and satisfaction of urban health extension workers regarding their service delivery environment

Background: The Urban Health Extension Program (UHEP) – an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at a household level – is one of the three approaches of the national Health Extension Program (HEP). As health extension workers (HEWs) are the backbone of the program, the present study was designed to assess their expectations and satisfaction regarding their service delivery environment. Methodology: The study for this assessment involved in-depth interviews that included urban health extension professionals (UHE-ps), supervisors of UHE-ps, as well as village health committee members and health service managers and supervising health workers in 76 selected urban health extension facilities within the five major regions (Amhara; Harari; Oromia; Southern Nations, Nationalities, and Peoples’ (SNNP); and Tigray), as well as the two city administrations of Addis Ababa and Dire Dawa. Findings: Most UHE-ps seem to be less motivated in their jobs and consider it as only temporary. A lack of training opportunities and absence of a clear career structure, non-uniformity of payment and being engaged in administrative routines that are not directly related to health services are among the reasons mentioned for dissatisfaction by UHE-ps. On the other hand, there are also some who are satisfied with their work and who feel that they are making changes to the health status of their communities. Conclusions: The findings of the study show that there are UHE-ps who are satisfied in their professional activities and consider themselves as contributing to changes in the health status of their communities. However, most of the UHE-ps are said to be less motivated in the jobs and seem to consider their roles as temporary (until they get a better job). Many complain about the lack of training opportunities, the absence of a clear career structure, and having to engage in non-professional activities. To address UHE-ps’ lack of motivation, it is recommended that the government should propose a clear career structure for them and implement a uniform payment structure across the country. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):70-75] Keywords: Expectations & Satisfaction; Urban Health Extension Program; Urban Health Extension Professionals

Female Academic Career Development and Administrative Positions at Addis Ababa University: a Mixed-Method Study

AbstractBackground: In Ethiopia, the number of female in academia in general and in administrative positions and higher university ranks in specific is very small as compared to men. A slight change has been seen in recent years, where a few women have come to male-dominated administrative positions as university presidents, vice presidents, deans and directors with still insignificant increase in the number of full professors. Objective: This study assessed female faculty member's career development and involvement in administrative positions and explored challenges. Method: We used a sequential mixed-method study starting with a cross-sectional quantitative study among 888 faculty members. The quantitate data were analysed using descriptive statistics and regression models to identify independent predictors of administrative involvement using SPSS version 25 software. An exploratory qualitative study was done among eight purposively selected female faculty. NVivo10 data management software was used to code and categorize the transcripts. Result: We found that male faculty members were more likely to involve in administrative positions than their female counterparts [AOR (95%CI) 1.6(1.1, 2.4)]. Those who were provided housing facility by AAU [AOR (95%CI) 2.29 (1.61, 3.23)] and assistant professors and above [AOR (95%CI) 1.495 (1.01, 2.220)] were more likely to involve in an administrative position than their counterparts. The qualitative findings indicated that the low salary faculty earns, lack of networks and family responsibility have deterred females from taking administrative positions. Conclusion: Female faculty involvement in the university administrative position and career development is very low. Both structural and personal factors such as gender roles affected their professional enhancement in academic ranks and hence positions. Creating a conducive platform for female faculty development is recommended to increase their involvement in administrative positions. [Ethiop. J. Health Dev. 2021; 35(SI-2):30-39]Keywords: Addis Ababa University, administrative positions, career development, female academician, female facult

Gender Difference in Research Productivity and its Associated factors in Addis Ababa University: a Cross-Sectional study

AbstractBackground: Gender equity movements have increased the number of women going to higher institutions. However, the number of women participating in research is limited in creating a critical mass. Objective: To assess the gender gap in research and its associated factors determinants among faculty at Addis Ababa University. Method: We conducted a cross-sectional study from October 2018 to March 2019 using a structured self-administered questionnaire. University faculty who was lecturers and above level who served the University for more than a year were invited to participate in the study. Faculty were approached by data collection facilitators with graduate degrees and the secretory of the respective departments. We used descriptive and multivariate statistical methods to analyse the data. Result: Of the 888 study participants, 161 (18.1%) females faculty participated in the study. It was found that three hundred ninety-seven male academics (54.6%) and 50 female academics (31.1%) had ever published articles in peer-reviewed journals (p<0.001). Male faculty were more likely to publish in peer-reviewed journals than their female counterparts [AOR and (95% CI) [2.55 (1.68, 3.86)]. Faculty with a rank of assistant professors and above [AOR (95% CI) 3.47(2.31, 5.21)], those who have a Ph.D. as highest degree [AOR (95% CI) 2.98 (2.11, 4.19) and those who have affiliation with other institutions [AOR (95% CI) 2.59 (1.98, 3.56)], were more likely to publish in peer-reviewed journals than their counterparts. Conclusion: Female faculty were less likely to be involved in research than men counterparts. The University needs to narrow the gender gap in research by designing and implementing an appropriate intervention strategy. [Ethiop. J. Health Dev. 2021; 35(SI-2):15-21]Keywords: Addis Ababa University, female faculty, gender difference, publication, researc

Experience of Research Undertaking among Women Academia at Addis Ababa University: a Qualitative Study

AbstractBackground: As a pioneer University in the Country, Addis Ababa University engages itself in collaborative and local research undertakings along with teaching, community engagements and technology transfer. Despite its long engagement in research, the participation of women academia in research is limited as manifested by their low research productivity in terms of publication in peer-reviewed scientific journals. However, the reasons for their low research participation are less known and needs further exploration. Objective: To explore the experience of research undertakings among women academia at Addis Ababa University. Method: We conducted an exploratory qualitative study using a phenomenological approach among women academia. Eight women who have been working in the University with a rank of a lecturer having at least two years participated in in-depth interviews. We used NVivo10 software to code and categorize the transcripts. Result: Our study revealed that only a few senior informants with more than 10 years of stay at the University had a better experience in applying for national and international research grants. Although all the participants said they had ever undertaken research, their publication track in peer-reviewed journals is limited. Social and economic factors, lack of networking, low salary and family responsibility, limited internet and library access, and lack of research skill among young faculty were raised as impediments to undertake research. Conclusion: This study has indicated that women in academia had limited research engagement in terms of grant application and publication in peer reviewed scientific journals. Balancing work and family life, low salary, lack of access to common University facilities were some of the challenges. While structural change ensures gender equality at a long time, addressing the gender gap in research is the responsibility of AAU. [Ethiop. J. Health Dev. 2021; 35(SI-2):22-29]Keywords: Addis Ababa University, experience of research, women in academi

Antenatal care quality and detection of risk among pregnant women: An observational study in Ethiopia, India, Kenya, and South Africa

Background Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC. Methods and findings This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases. Conclusions In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester