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Research article
Mesele Damte Argaw
JSI Research and Training Institute Inc
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9558-6619
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background The twinning partnership is a formal and substantive collaboration between two districts to improve their performance in providing primary healthcare services. The ‘win-win’ twinning partnership pairs relatively high and low performing districts. The purpose of this formative evaluation is to use the empirically derived systems model as an analytical framework to systematically document the inputs, throughputs and outputs of the twinning partnership strategy.
Methods This evaluation employed a case study research design and was conducted from October 2018 to September 2019, in Amhara, Oromia, Southern, Nations, Nationalities and Peoples’ (SNNP) and Tigray Regions. Qualitative data was collected using interviewer-guided semi-structured interview tools. The data were transcribed verbatim, translated into English and analyzed through the theoretical framework called Bergen Model of Collaborative Functioning (BMCF). Quantitative data were extracted from Routine Health Management Information System.
Results were presented using average, percentages and graphs. Result The result of this case study revealed that scanning the mission of the twinning partnership and focusing on a shared vision coupled with mobilizing internal and external resources were the fundamental input element for successful twinning partnership at the district level. In addition, the context of pursuing Universal Health Coverage (UHC) through achieving transformed districts can be enhanced through deploying skilled and knowledgeable leadership, defining clear roles and responsibilities for all stakeholders, forming agreed detailed action plans and effective communication that leads to additive results and synergy. The twinning partnership implementing districts benefit from the formal relationship and accelerate their performances towards meeting criteria of transformed districts in Ethiopia. At the baseline measurement stage, only two out of eight districts achieved a medium performance status; at mid-term, two districts achieved high performance status and during the end-line results out of eight twinning targeted districts, three districts fulfilled the transformation criteria, three districts were categorized as medium performers and the remaining two districts fell into the low performing districts category.
Conclusions The implemented twinning partnership helped to accelerate the health system’s performance in achieving the district transformation criteria. Therefore, scaling up the implementation of the twinning partnership strategy is recommended.
Keywords
Twinning Partnership,Universal Health Coverage, Transformation, Ethiopia
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- 1DistrictManagementStandardschecklist.xlsx
Additional file 1: District (Woreda) management standards self-assessment & validation checklist. The District management standards is a set of 26 management minimum standards with 81 verification criteria. The self-assessment and validation checklist is used to identify strengths and gaps useful for performance improvements. The tool is used by both partner districts for performance management on monthly basis. In addition, the zone health department organizes validation measurements on a semi-annual basis. The overall scoring is rated from 0.0% to 100.0%.
- 2Modelvillagechecklist.xlsx
Additional file 2: Model village checklist The overall scores on model villages will be converted out of 30.0%, which is assessed through model households, model schools improved latrine coverage, and skilled delivery coverage. The results will also contribute for district transformation criteria scores.
- 3CommunityBasedHealthInsurancechecklist.xlsx
Additional file 3: Community-Based Health Insurance checklist. Community-Based Health Insurance household membership is calculated on an annual basis. Hence, the tool helps to organize memberships into new enrollments and renewals. Net active household membership scoring is rated from 0.0% to 100.0%. The results will be converted out of 30.0% and contributed into district transformation criteria.
- 4KeyPerfromanceIndicators.xlsx
Additional file 4: Key Performance Indicators checklist The Key Performance Indicators are 18 in number. Each indicator is scored out of 100.0% but based on their importance, the Ministry set weights for each one. The overall score will be converted to 35.0% and will contribute scores to categorizing primary health care units.. The results will also contribute for high performing PHCU scores.
- 5EHCRIGsAssessmentChecklist1.xlsx
Additional file 5: Ethiopian Health Center Reform Implementation Guidelines (EHCRIGs) checklist. EHCRIGs are a set of 81 standards with 209 composite validation criteria. EHCRIGs assessment checklist is developed to perform self-assessment on a quarterly basis after which the district health office facilitates validation measurements on a semiannual basis. The performance management team and quality improvement committee use the information for performance and quality improvement initiatives. The overall scoring is rated out from 0.0% to 100.0% and translated into 35.0%.
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View the published article at BMC Health Services Research.
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Editorial decision: Accept
On 16 Sep, 2020
Version 2
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Editorial decision: Minor revision
On 09 Sep, 2020
Review #2 received
Received 06 Sep, 2020
Review #1 received
Received 25 Aug, 2020
Reviewer #2 agreed
On 17 Aug, 2020
Editor assigned
On 17 Aug, 2020
Reviewers invited
Invitations sent on 17 Aug, 2020
Reviewer #1 agreed
On 17 Aug, 2020
Submission checks complete
On 16 Aug, 2020
Editor invited
On 16 Aug, 2020
No comments provided
Editorial decision: Major revision
On 17 Jul, 2020
Review #2 received
Received 01 May, 2020
Review #1 received
Received 01 May, 2020
Reviewer #2 agreed
On 13 Apr, 2020
Reviewer #1 agreed
On 08 Apr, 2020
Editor assigned
On 30 Mar, 2020
Reviewers invited
Invitations sent on 30 Mar, 2020
Submission checks complete
On 29 Mar, 2020
Editor invited
On 29 Mar, 2020
First submitted
On 11 Mar, 2020
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Mesele Damte Argaw
JSI Research and Training Institute Inc
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9558-6619
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
No community comments so far
Submission checks complete
On 17 Sep, 2020
Editorial decision: Accept
On 16 Sep, 2020
Version 2
Posted 20 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 09 Sep, 2020
Review #2 received
Received 06 Sep, 2020
Review #1 received
Received 25 Aug, 2020
Reviewer #2 agreed
On 17 Aug, 2020
Editor assigned
On 17 Aug, 2020
Reviewers invited
Invitations sent on 17 Aug, 2020
Reviewer #1 agreed
On 17 Aug, 2020
Submission checks complete
On 16 Aug, 2020
Editor invited
On 16 Aug, 2020
No comments provided
Editorial decision: Major revision
On 17 Jul, 2020
Review #2 received
Received 01 May, 2020
Review #1 received
Received 01 May, 2020
Reviewer #2 agreed
On 13 Apr, 2020
Reviewer #1 agreed
On 08 Apr, 2020
Editor assigned
On 30 Mar, 2020
Reviewers invited
Invitations sent on 30 Mar, 2020
Submission checks complete
On 29 Mar, 2020
Editor invited
On 29 Mar, 2020
First submitted
On 11 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background The twinning partnership is a formal and substantive collaboration between two districts to improve their performance in providing primary healthcare services. The ‘win-win’ twinning partnership pairs relatively high and low performing districts. The purpose of this formative evaluation is to use the empirically derived systems model as an analytical framework to systematically document the inputs, throughputs and outputs of the twinning partnership strategy.
Methods This evaluation employed a case study research design and was conducted from October 2018 to September 2019, in Amhara, Oromia, Southern, Nations, Nationalities and Peoples’ (SNNP) and Tigray Regions. Qualitative data was collected using interviewer-guided semi-structured interview tools. The data were transcribed verbatim, translated into English and analyzed through the theoretical framework called Bergen Model of Collaborative Functioning (BMCF). Quantitative data were extracted from Routine Health Management Information System.
Results were presented using average, percentages and graphs. Result The result of this case study revealed that scanning the mission of the twinning partnership and focusing on a shared vision coupled with mobilizing internal and external resources were the fundamental input element for successful twinning partnership at the district level. In addition, the context of pursuing Universal Health Coverage (UHC) through achieving transformed districts can be enhanced through deploying skilled and knowledgeable leadership, defining clear roles and responsibilities for all stakeholders, forming agreed detailed action plans and effective communication that leads to additive results and synergy. The twinning partnership implementing districts benefit from the formal relationship and accelerate their performances towards meeting criteria of transformed districts in Ethiopia. At the baseline measurement stage, only two out of eight districts achieved a medium performance status; at mid-term, two districts achieved high performance status and during the end-line results out of eight twinning targeted districts, three districts fulfilled the transformation criteria, three districts were categorized as medium performers and the remaining two districts fell into the low performing districts category.
Conclusions The implemented twinning partnership helped to accelerate the health system’s performance in achieving the district transformation criteria. Therefore, scaling up the implementation of the twinning partnership strategy is recommended.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- 1DistrictManagementStandardschecklist.xlsx
Additional file 1: District (Woreda) management standards self-assessment & validation checklist. The District management standards is a set of 26 management minimum standards with 81 verification criteria. The self-assessment and validation checklist is used to identify strengths and gaps useful for performance improvements. The tool is used by both partner districts for performance management on monthly basis. In addition, the zone health department organizes validation measurements on a semi-annual basis. The overall scoring is rated from 0.0% to 100.0%.
- 2Modelvillagechecklist.xlsx
Additional file 2: Model village checklist The overall scores on model villages will be converted out of 30.0%, which is assessed through model households, model schools improved latrine coverage, and skilled delivery coverage. The results will also contribute for district transformation criteria scores.
- 3CommunityBasedHealthInsurancechecklist.xlsx
Additional file 3: Community-Based Health Insurance checklist. Community-Based Health Insurance household membership is calculated on an annual basis. Hence, the tool helps to organize memberships into new enrollments and renewals. Net active household membership scoring is rated from 0.0% to 100.0%. The results will be converted out of 30.0% and contributed into district transformation criteria.
- 4KeyPerfromanceIndicators.xlsx
Additional file 4: Key Performance Indicators checklist The Key Performance Indicators are 18 in number. Each indicator is scored out of 100.0% but based on their importance, the Ministry set weights for each one. The overall score will be converted to 35.0% and will contribute scores to categorizing primary health care units.. The results will also contribute for high performing PHCU scores.
- 5EHCRIGsAssessmentChecklist1.xlsx
Additional file 5: Ethiopian Health Center Reform Implementation Guidelines (EHCRIGs) checklist. EHCRIGs are a set of 81 standards with 209 composite validation criteria. EHCRIGs assessment checklist is developed to perform self-assessment on a quarterly basis after which the district health office facilitates validation measurements on a semiannual basis. The performance management team and quality improvement committee use the information for performance and quality improvement initiatives. The overall scoring is rated out from 0.0% to 100.0% and translated into 35.0%.
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