Academic journal article Bulletin of the World Health Organization

A National System for Monitoring the Performance of Hospitals in Ethiopia/ Systeme National Permettant De Controler Les Performances Des Hopitaux En Ethiopie/ Un Sistema Nacional Para Monitorizar El Rendimiento De Los Hospitales En Etiopia

Academic journal article Bulletin of the World Health Organization

A National System for Monitoring the Performance of Hospitals in Ethiopia/ Systeme National Permettant De Controler Les Performances Des Hopitaux En Ethiopie/ Un Sistema Nacional Para Monitorizar El Rendimiento De Los Hospitales En Etiopia

Article excerpt

Introduction

Improvement in the quality of hospital care is a fundamental aspect of health system strengthening (1-4) that is directly linked to the service delivery dimension of the World Health Organization (WHO) building blocks of a health system." While the monitoring of hospital performance is a key ingredient to such improvement, (1,3,4) many countries struggle to develop and implement feasible strategies to monitor hospitals nationally. The challenge is particularly acute in low-income countries where resources for measurement and reporting are scarce.

In the field of global health, research on performance monitoring often focuses broadly on health systems (6-9) rather than on hospitals. The literature on the development and implementation of systems for monitoring hospital performance is largely dominated by case studies and reports from high-income countries with national health systems--e.g. Canada (10) and Denmark, (11) the United Kingdom of Great Britain and Northern Ireland (12) and other countries in western Europe. (13-15) Although there has also been some relevant research in the United States of America, (10) it has tended to focus on a narrow set of quality measures in specific populations. (16,17) The WHO performance assessment tool for quality improvement in hospitals is a donor-led, externally designed measurement project rather than a country-led, internally developed initiative. (14,15) This tool has been applied in only one middle-income country (South Africa). (14,15) Most attempts to monitor hospital performance in low-income settings have involved small numbers of facilities and narrowly defined clinical measures of performance. (18-24) When creating their accreditation systems for hospitals, both Liberia and Zambia monitored hospital performance for just a year, to collect baseline data. (25,26)

We could find no peer-reviewed studies done in low-income countries that described the development and sustained implementation of a national system for monitoring hospital performance, based upon a comprehensive set of key performance indicators. We therefore sought to describe the creation and implementation of such a national system in a low-income country. We considered Ethiopia to be a good setting in which to conduct our case study because of recent hospital reform in the country. The reform led to the creation of: (i) the role of hospital chief executive officer--qualified through a masters degree programme in hospital and health-care administration; (27,28) (ii) private wings in hospitals that allowed revenue generation and (iii) hospital governing boards. (28,29)

The many new government hospitals that were built during the ongoing reform process led to improved hospital access in both rural and urban settings. We describe the development of key performance indicators, the process of monitoring hospital performance relative to these indicators and the trend in performance since 2010, which marked the implementation of Ethiopia's national system of hospital monitoring. Findings from this case study may be helpful to other low-income countries seeking to elevate the quality of facility-based health care through performance monitoring and accountability.

Key performance indicators

Development

We developed performance indicators that were relevant for hospitals and consistent throughout the country. The first indicator developed was the most fundamental--adherence to national guidelines on hospital management. In 2009, Ethiopia partnered with the Clinton Health Access Initiative and the Yale Global Health Leadership Institute to develop national guidelines for the management of hospitals: the Ethiopian Hospital Reform Implementation Guidelines. (30,31) These guidelines included 124 hospital management standards, each of which was a statement --e.g. "the hospital conducts a physical inventory of all pharmaceuticals in the store and each dispensing unit at a minimum of once per year. …

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