Lingrui Liu - Global Health Leadership Initiative, Yale University, New Haven, CT, USA
Mayur M. Desai - Global Health Leadership Initiative, Yale University, New Haven, CT, USA
Netsanet Fetene - Global Health Leadership Initiative, Yale University, New Haven, CT, USA
Temsgen Ayehu - Federal Ministry of Health, Government of Ethiopia, Addis Ababa, Ethiopia
Kidest Nadew - Global Health Leadership Initiative, Yale University, New Haven, CT, USA
Erika Linnander - Global Health Leadership Initiative, Yale University, New Haven, CT, USA

BackgroundDespite a wide range of interventions to improve district health management capacity in low-income settings, evidence of the impact of these investments on system-wide management capacity and primary healthcare systems performance is limited. To address this gap, we conducted a longitudinal study of the ۳۶ rural districts (woredas), including ۲۲۹ health centers, participating in the Primary Healthcare Transformation Initiative (PTI) in Ethiopia. MethodsBetween ۲۰۱۵ and ۲۰۱۷, we collected quantitative measures of management capacity at the district and health center levels and a primary healthcare key performance indicator (KPI) summary score based on antenatal care (ANC) coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We conducted repeated measures analysis of variance (ANOVA) to assess (۱) changes in management capacities at the district health office level and health center level, (۲) changes in health systems performance, and (۳) the differential effects of more vs less intensive intervention models. ResultsAdherence to management standards at both district and health center levels improved during the intervention, and the most prominent improvement was achieved during district managers’ exposure to intensive mentorship and education. We did not observe similar patterns of change in KPI summary score. ConclusionThe district health office is a valuable entry point for primary healthcare reform, and district- and facility-level management capacity can be measured and improved in a relatively short period of time. A combination of intensive mentorship and structured team-based education can serve as boh an accelerator for change and a mechanism to inform broader reform efforts.

Management Capacity Intervention, Performance Management, Primary Care, Longitudinal Assessment, Ethiopia, Sub-Saharan Africa