Performance of Ethiopia's health system in delivering integrated community-based case management
Ethiopian Medical Journal
Save the ChildrenCT, United States; Save the Children, Awassa, Ethiopia; UNICEF, Addis Ababa, Ethiopia; Federal Ministry of Health, Addis Ababa, Ethiopia; Integrated Family Health Project, Addis Ababa, Ethiopia; John Snow Incorporated, Addis Ababa, Ethiopia
Background. Analyzing complex health programs by their components and sub-components serves design, documentation, evaluation, research, and gap identification and prioritization. In 2012, we developed a rapid methodology to characterize integrated community case management (iCCM) programs by assessing benchmarks for eight health system components in three program phases. Objective. To assess iCCM benchmarks in Ethiopia three years after scale-up commenced, and to compare the benchmarks across the geographical region. Methods. Six national iCCM experts scored each of 70 benchmarks (no, partial, or yes) and then were facilitated to reach consensus. Results. Overall, iCCM benchmark achievement in Ethiopia was high (87.3%), highest for pre-introduction (93.0%), followed by introduction (87.9%) and scale-up (78.1%) phases. Achievement by system component was highest for coordination and policy (94.2%) and lowest for costing and finance (70.3%). Six regional countries' benchmark assessments, including two from Ethiopia 14 months apart, were highly correlated with program duration at scale (correlation coefficient: +0.88). Conclusion. Ethiopia has a mature, broad-based iCCM program. Despite limitations, the method described here rapidly, systematically, and validly characterized a complex program and highlighted areas for attention through government or partners.
case management; community care; Ethiopia; health care quality; human; integrated health care system; quality control; standards; Benchmarking; Case Management; Community Health Services; Delivery of Health Care, Integrated; Ethiopia; Humans; Process Assessment (Health Care)