Strengthening Primary Healthcare in Ethiopia

Primary Healthcare (PHC) is an important part of any healthcare system. It aims to make sure everyone can access quality medical services, especially in their own communities. This approach is crucial for reaching health goals that make healthcare available for all by 2030 and beyond.

The Astana Declaration of 2018 also highlighted how important PHC is for achieving universal health coverage (UHC). It’s a promise that the international community made to strengthen healthcare systems worldwide. However, in low- and middle-income countries, PHC often struggles to deliver.

#The Importance of PHC in Ethiopia

In Ethiopia, the PHC system focuses on making healthcare services as accessible as possible. This means providing services near people’s homes and communities. To tackle the challenges in basic healthcare, Ethiopia has taken various steps to create community-based PHC services.

Despite efforts to improve PHC, there's still not enough information about how well these systems work across the country. To address this, the Primary Health Care Performance Initiative (PHCPI) was developed to measure and evaluate PHC systems. To help with the lack of data, a tool called the PHC Progression Model was created to assess healthcare capacity in various regions.

#The Study Area

In this study, we looked at the PHC capacity in the Central Gondar zone of Northwest Ethiopia between March and June 2023. This zone contains a comprehensive specialized hospital, one general hospital, nine primary hospitals, 76 health centers, and 154 health posts. For our evaluation, we randomly selected three public primary hospitals and five health centers.

#Assessing PHC Capacity

To evaluate the capacity of PHC, we used the PHC Progression Model. This model guides how we assess PHC capabilities, especially in areas with limited resources. The assessment focuses on three main components: Governance, Inputs, and management of population health and facilities.

For our evaluation, we identified 33 specific measures from the model to assess the PHC capacity.

#Data Collection Methods

We used various data collection methods, including interviews with key informants, document reviews, and facility observations. Our document review included patient charts, registration documents, and strategic plans. We adapted tools from previous assessments to gather relevant information.

The evaluation process started with an internal review by facility staff, followed by external assessments by different teams. The scores were combined into nine sub-scores, and these were further summarized into three main areas: Governance, Inputs, and Population Health and Facility Management.

#Results of the Capacity Assessment

The assessment revealed that the PHC capacity in Central Gondar was below the expected standards. In the governance area, the average score was 1.5 out of 4. The input area scored a bit better at 2.2 out of 4. However, the capacity for managing population health and facilities was particularly low at only 1.3 out of 4.

When breaking down the governance area, we saw that the primary healthcare policy scored fairly well (3/4), but most of the other measures scored quite poorly (1/4). The input area had a mixed result, with funding being the least favorable aspect (1.7/4), while other areas like information systems fared better (2.7/4).

#Population Health Management

The population health and facility management aspect of PHC was assessed too, and it scored a disappointing 1.3 out of 4. This part included evaluating Community Engagement, local health planning, and how well facilities managed their services. Here, we found significant gaps in health priorities and community involvement, which could negatively impact overall health outcomes.

#Comparing Results Across Facilities

Among the 33 measures evaluated, only the health information management score from certain facilities reached an acceptable score. The social accountability, innovation, and learning measures were among the lowest across the board.

When comparing facility scores, Wogera Primary Hospital performed best in governance, while Sanja and Wogera performed better in inputs. Qoladba Health Center excelled in managing population health and facility management.

#Budget Constraints Affecting Healthcare

A key issue affecting PHC in Central Gondar is funding. The input scores showed that budget-related challenges were common for health centers and hospitals. Unpredictable economic issues, changes in reimbursement models, and rising costs led to difficulties in maintaining quality services.

The study highlighted that funding challenges could hinder healthcare delivery, especially when adapting to new patient needs and technologies. A strong budget is essential for healthcare leaders to prioritize care effectively.

#Equipment and Supplies Situation

The availability of essential medicines and equipment was also assessed. Most facilities scored fairly well, but some showed low availability of basic equipment. The findings indicated that stock-outs of medical supplies could negatively impact patients and discourage them from seeking care.

On the brighter side, some health centers received excellent scores for civil registration and vital statistics, indicating better performance in these areas compared to others.

#Community Engagement in Healthcare

Community engagement is crucial in primary healthcare. It allows residents to take part in health decisions and feel more connected to services. However, our study showed that community engagement was lacking. There were no significant activities to build trust between the community and health system.

Without active community involvement, health priorities may not align well with actual needs. This could lead to poor health outcomes because decisions are influenced more by historical factors than by current health needs.

#Conclusion and Need for Improvement

The evaluation pointed to areas requiring significant improvement in Ethiopia's PHC system. While some areas performed adequately, governance and population health management stood out as needing urgent attention.

The overall performance highlights the need for effective strategies to strengthen leadership, community engagement, and sustainable funding. Without timely action, critical health services may continue to struggle, ultimately affecting the health of the population.

In summary, while Ethiopia has made strides in developing PHC, the assessment uncovered gaps that call for immediate and targeted actions. Community involvement, better funding, and leadership training are essential for creating a stronger healthcare system that meets the needs of all citizens. After all, a healthy population is a happy population, and who doesn't want a little more happiness around?