Enhancing Leadership, Management and Governance Competencies for Performance Improvements at Primary Health Care Entities in Ethiopia: A Quasi-Experimental Study Design

Leadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing work climate, and creating responsive health systems. The Federal Ministry of Health with the support of USAID Transform: Primary Health Care project, cascaded its basic LMG trainings and interventions to primary health care staff. The purpose of this evaluation was to measure the changes observed on performance improvement at primary health care entities after implementing the interventions for one year. The results of this research will help policy makers, program managers, and implementers to make informed decisions in the area of performance improvement. The study used a quasi-experimental pre-post survey design to assess the changes observed as a result of LMG in performance management at primary health care entities. It was conducted from August 28, 2017 to September 30, 2018 in Amhara, Oromia, Tigray, and Southern Nations, Nationalities and Peoples Regions. The data was collected through document review and interviewer and self-administered questionnaires across 136 health facilities, in which there are 293 health workers who attended the LMG training; and 333 health workers who did not attend the training. In addition, training records were reviewed to capture change in knowledge and skill through pre-post training and, baseline and end-line performance improvement project achievements, respectively. The data were analyzed using SSPS IBM V 20.


Abstract
Background Leadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing work climate, and creating responsive health systems. The Federal Ministry of Health with the support of USAID Transform: Primary Health Care project, cascaded its basic LMG trainings and interventions to primary health care staff. The purpose of this evaluation was to measure the changes observed on performance improvement at primary health care entities after implementing the interventions for one year. The results of this research will help policy makers, program managers, and implementers to make informed decisions in the area of performance improvement.

Methods
The study used a quasi-experimental pre-post survey design to assess the changes observed as a result of LMG in performance management at primary health care entities. It was conducted from August 28, 2017 to September 30, 2018 in Amhara, Oromia, Tigray, and Southern Nations, Nationalities and Peoples Regions. The data was collected through document review and interviewer and self-administered questionnaires across 136 health facilities, in which there are 293 health workers who attended the LMG training; and 333 health workers who did not attend the training. In addition, training records were reviewed to capture change in knowledge and skill through pre-post training and, baseline and end-line performance improvement project achievements, respectively.
The data were analyzed using SSPS IBM V 20.

Results
The response rates were 100% for staff who attended the training; and 87% for staff who did not attend the training. Of those who attended the training, 235 (80.9%) and 252 (86%) trainees scored above 70% on post-test, and 80% or more achieved the desired measurable results of their performance improvement projects. Using the above-mentioned criteria, composite scores were compiled from post-test and performance improvement project results. The result showed that 70% (205/293) of basic LMG trainees completed the course. As a result of the LMG trainings, management systems, work climate, and responsiveness of the health system to challenges significantly improved (p<0.001). Because of the leadership projects, an additional 2,290.3 units of health service coverage were gained.

Conclusions
The performance of the primary health care entities was significantly improved as a result of enhanced knowledge and skills through LMG trainings, and leadership projects implemented at primary health care entities. We recommend providing LMG trainings for more health workers and managers working at primary health care entities to accelerate implementation of prioritized health sector interventions helpful to achieving the Sustainable Development Goals as a global target.
Evaluation of effectiveness and efficiency of the basic LMG training package is recommended.

Full-text
Due to technical limitations, full-text HTML conversion of this manuscript could not be completed.
However, the manuscript can be downloaded and accessed as a PDF.    In this office supervisors delegate challenging assignments to assistants, which helps them to develop their skills and expertise.

WC14
In this office when giving special assignments, supervisors clearly communicates expectations at the beginning and checks in on progress, without `micromanaging.' 5.60± SD 2.19 7.74± SD

WC15
In this office supervisors or unit leader regularly monitor progress and holds every staff accountable for following through on assigned tasks related to work plans.       Certification of Trainees after evaluation using posttest scores (Theory) and end-line leadership project performance assessment, September 2018.