The Medical Service Directorate of Federal Ministry of Health
The Federal Ministry of Heath has been leading a sector wide reform effort aimed at significantly improving the quality and accessibility of services at all levels of the health system. Through the Medical Service Directorate and as part of this reform, public hospitals in all regions have been implementing The Ethiopian Reform Implementation Guidelines since May 2010. Significant achievements have been registered in terms of effectiveness, efficiency of the hospital processes as well as patient satisfaction as measured by the hospital key performance indicators.
The Medical Services Directorate (MSD) of the FMOH in collaboration with RHBs and partners has established a performance monitoring and improvement framework for hospitals in which there are 4 main elements:
The recording and reporting of a core set of hospital key performance indicators (KPIs)
Supportive supervision site visits to hospitals
Regional review meetings between the RHB and all hospital in the Region
National review meetings between the MSD and all RHBs
To support implementation of the hospital performance monitoring and improvement framework the directorate has also developed and implemented:
- A Hospital Performance Monitoring and Improvement Manual for the regions
Hospital database tools for the recording, analysis and reporting of KPIs by each hospital
Regional level database tools for the collation and analysis of hospital KPI reports
Currently, there are 128 functional public hospitals which have been showing steady improvement in delivery of quality of healthcare service for community.
In response to variation in the implementation of reform initiatives and with the importance of creating a collaboration forum for hospitals, the MSD/FMOH has also initiated EHAQ project. Hospital developmental army has been consolidating achievements registered in hospital reform implementation and ensures sustainability; currently hospitals are implementing the EHRIG with the perspective of health developmental army.
The Ethiopian hospital alliance for quality initiative (EHAQ)
Although individual hospitals have achieved improvements in quality, inadequate performance persists in key areas even among higher-performing hospitals and many hospitals were unable to achieve the expected improvements in service delivery. To solve this challenge, the directorate has designed and implemented "Ethiopian hospital alliance for quality initiative "across all regions. This initiative involves a new model of organizational learning in Ethiopia, in which the hospital industry learns from its own successes through facilitated peer networks. The objective of the EHAQ is to improve the quality of hospitals in Ethiopia by achieving stretch targets in selected key performance indicators (KPIs) in all hospitals by March 2013.
Quality improvement in delivery service
1. Mother friendly delivery service initiative
One of the challenges in all facilities is low institutional delivery; to improve the problem the directorate has been developing national mother friendly delivery service guideline which will address issues related to birth companionship, mother privacy, cultural sensitivity, professional ethics, and neatness of delivery room.
2. Clinical auditing initiative
Clinical audit provides a method for systematically reflecting on and reviewing practice, Changes can be implemented at an individual, team, or service level. The reason why the directorate has developed the clinical audit guideline is to improve the quality of the service being offered to users, supporting health facilities to evaluate and improve the provision of effective health care services..
Masters of hospital and health care administration initiative
The establishment of health management as a profession is of paramount importance to improving the healthcare system in Ethiopia. Management is particularly important as resources are scarce and the health needs of the citizens are substantial.
The MHA program, which was started in collaboration with Yale University, is an executive development program that aims at producing capable and qualified hospital and other health service managers who can effectively run and provide decisive leadership to hospitals and related health service institutions. Since 2008, there is a post graduate degree program to train hospital and healthcare managers at Jimma University and Addis Ababa University. So far, nearly 100 trained hospital CEOs graduated and were deployed to their respective facilities. The program is currently under evaluation.
Pediatrics quality improvement project
FMOH/MSD in collaboration with WHO/CAH and EPS has been working on improving the quality of pediatric hospital care through introducing standard pediatric triage and emergency care, standard case management protocols and reorganization of the service delivery points. As of July 2012, pediatrics quality referral care has been implemented in 10 hospitals and substantial improvement was documented in 6 of the 10 hospitals through implementation of quality pediatrics emergency service based on combined national and WHO standards. As of march 2013, this initiative has been expanded to 13 public hospitals (including 6 university hospitals). Under this initiative, capacity building support was given to 23 hospitals, standard text book and emergency equipments were distributed to all public hospitals, panel discussion was conducted for pediatricians throughout the country and National Emergency triage assessment and treatment manual is under publication. Currently FMOH/MSD is working to scale up the pediatrics QOC to 50 public hospitals.