Strengthening Health Care Leadership in Ethiopia

Strong health systems need strong leaders. USAID Transform: Primary Health Care is strengthening Ethiopia’s health management leadership so that it can reduce preventable child and maternal death through simple cost-effective and proven interventions such as increased immunization and deliveries in health facilities, and improved perinatal access, attendance, and care.

In the short-term, Transform is helping the Ethiopian government transform (thus the name!) woredas (districts) into well-managed networks of appropriately staffed and equipped primary health care facilities. In a transformed woreda, skilled health workers report accurate data to competent woreda and regional managers, who use the data to make budgetary and programmatic decisions that strengthen health services and ultimately lead to a healthier population.

With that in mind, the Transform team assessed the performance of 300 woredas against government and global health standards, such as management practices and service coverage. The project then worked with regional health leaders to categorize woredas as high-, medium-, or low-performing. Regional health leaders in turn worked with woreda and health facility leaders to prioritize areas needing improvement (e.g., nutrition tracking, stronger referrals to higher levels of care, emergency transport).

Woreda leaders had six months to collaborate with regional leaders and project staff to improve their prioritized areas. Low-performing woredas, of course, needed and receive more support than medium- and high-performing woredas. To ensure sustainability, USAID Transform: Primary Health Care helped regional managers and local universities improve how they coach and mentor woreda and facility managers to identify health challenges and develop solutions beyond the six-month period.

“[The process] engages managers at various levels of the system, and helps them explore the local context, think out of the box, and find solutions for local problems. We are hopeful that this initiative will transform the primary health care system,” said Dr. Abreham Alano, head of the regional health bureau in Ethiopia’s Southern Nations, Nationalities, and People’s region.

The approach reinforces the leadership continuum from regional to woreda to health facility to community. Nearly a year later, regional and woreda managers are more involved and are working to improve health outcomes in their communities, and measuring success through health indicators and client experience. Together they are experiencing the satisfaction of success and the frustration of failure, and learning from both. USAID Transform: Primary Health Care will continue to support this process to strengthen the leadership continuum for a sustainable health system.

USAID: Transform Primary Health Care is a five-year, flagship health systems strengthening project aimed at ending preventable maternal and child deaths in Ethiopia. The project is supported by USAID and implemented by Pathfinder International and JSI Research & Training Institute, Inc.