Improved performance of district health systems through implementing health center clinical and administrative standards in the Amhara region of Ethiopia

BMC Health Serv Res. 2019 Feb 19;19(1):127. doi: 10.1186/s12913-019-3939-y.


Background: Standards represent benchmarks against which improvements can be measured. In 2016, the Federal Ministry of Health developed and endorsed a set of standards entitled the Ethiopian Health Center Reform Implementation Guidelines (EHCRIGs). This study aims to assess the effects of planned interventions on performance and quality of services in primary health care units (PHCUs).

Methods: A quasi-experimental pre-post study design was used to compare the performance of PHCUs against the ECHRIG standards before and after its implementation in 76 woredas of the Amhara region from July - December 2017. Pre and post-intervention validation measurements of performance improvement in 76 woredas were conducted. The data were entered and analyzed using Statistical Package for Social Sciences.

Result: For this study, ten sessions of two-day trainings were conducted for 1306 staff. Additionally, on-site mentoring and coaching was conducted for a period of three months. The average EHCRIG standards met before and after intervention totaled 59 and 66%, respectively. The scores showed a positive correlation coefficient (r = 0.74) with statistical significant paired sample t-test with t = - 7.15, df = 75, P < 0.000. In addition, the mean scores among performance tiers were 74, 66 and 65% for high, medium and low performing woredas respectively. The One-way Analysis of Variance (ANOVA) showed a borderline significant difference between groups with (F = 2.4, P < 0.09).

Conclusions: The implementation of the standards has garnered significant improvements in performance at the primary health care level. Therefore, continuing the initiated strengthening of health system performance against the standards and evaluation of the quality of primary health services is recommended.

Keywords: EHCRIGs; Health center reform; Performance improvement; Primary health care; Standards.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Ambulatory Care / standards
  • Ambulatory Care Facilities / standards
  • Analysis of Variance
  • Clinical Competence / standards
  • Delivery of Health Care / standards*
  • Educational Status
  • Ethiopia
  • Female
  • Government Programs
  • Health Personnel / standards
  • Health Personnel / statistics & numerical data
  • Humans
  • Male
  • Primary Health Care / standards*
  • Quality Improvement / standards*
  • Quality Improvement / trends