Background Leadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing the work climate, and creating responsive health systems. Hence, the Ethiopian Ministry of Health with the support of the USAID Transform: Primary Health Care project has been implementing LMG interventions to improve performances of primary healthcare entities. The purpose of this evaluation was to compare maternal and child health service performances and overall health system strengthening measurement results of primary health care entities by LMG intervention exposed groups. Methods The study used a cross-sectional study design with a propensity matched score analysis, and was conducted from August 28, 2017, to September 30, 2018, in Amhara, Oromia, Tigray, and Southern Nations, Nationalities, and Peoples’ (SNNP) regions. Data collection took place through interviewer and self-administered questionnaires among 227 LMG intervention exposed and 227 non-exposed health workers. Propensity score matched analysis was used to balance comparison groups with respect to measured covariates. Results The mean overall maternal and child health key performance indicator score with standard deviation (± SD) for the LMG intervention exposed group was 63.86 ± 13.16 and 57.02 ± 13.71 for the non-exposed group. The overall health system strengthening score for the LMG intervention exposed group (mean rank = 269.31) and non-exposed group (mean rank = 158.69) had statistically significant differences (U = 10.145, z = − 11.175, p = 0.001). In comparison with its counterpart, the LMG exposed group had higher average performances in 3.54, 3.51, 2.64, 3.00, 1.07, and 3.34 percentage-points for contraceptive acceptance rate, antenatal care, skilled birth attendance, postnatal care, full immunization, and growth monitoring services, respectively. Conclusion There were evidences on the positive effects of the LMG intervention on increased maternal and child health services performances at primary healthcare entities. Moreover, health facilities with LMG intervention exposed health workers had higher and statistically significant differences in management systems, work climates, and readiness to face new challenges. Therefore, this study generated evidence for integrating LMG interventions to improve the performance of primary healthcare entities and maternal and child service uptake of community members, which contributes to the reduction of maternal and child deaths.

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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.

ObjectivesLeadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing work climate, and creating responsive health systems. This study aimed to determine the change that occur in the performance of primary healthcare entities and compare the outputs of block and segmented LMG trainings and the intervention as a whole after implementation for one full year.ResultsTwo hundred and ninety-three LMG trained and 333 non-trained health workers participated with a response rate of 100 percent and 87 percent, respectively. Of those who attended the didactics sessions, 235 (80.9%) scored 70% or more on post-test exams. In addition, the assessment on the practical exercises after implementing the leadership projects revealed that the majority, 252 (86%) scored 80% or more on their desired measurable results. As a result of the LMG trainings, management systems, work climate, and responsiveness of the health system to new challenges were significantly improved (p<0.001). Owing to the leadership projects, within the 136 health facilities, an additional 2,290.3 units of health service coverage was gained. A comparison of the trainees revealed that more block (79.1%), than segmented I (65.02%) and segmented II (62.0%) LMG trainings were successfully completed. Therefore, providing block LMG trainings for more health workers and managers working at primary healthcare entities is 53 recommended as it willaccelera te the implementation of prioritized health sector interventions.

Objectives Leadership, management, and governance (LMG) trainings are implemented to capacitate managers and clinical healthcare providers in several countries. However, there is no evidence gathered on effectiveness and efficiency of LMG trainings in low-income countries. Hence, this study aims to determine the effectiveness and efficiency of basic LMG trainings implemented in Ethiopia. Results In the study, the results training evaluations of 293 health workers with a 100.0% response rate is presented. In addition, data on 136 leadership project achievements and financial documents are reviewed. The mean pretest score with SD was 44.97% ± 15.50%, and the post-test score was 78.11% ± 14.22%, which showed a significant gains in knowledge at post-test with t=-35.99, df = 292, p < 0.001. The average net health service coverage gain by each entity was 16.55% (95% CI: 12.26%, 20.84%). The majority of LMG trainings were found to be effective in imparting knowledge and skills for staff to lead, manage and govern primary health entities. Moreover, the trainings were efficient in regards to time, communication, and resources utilized during the sessions. The trainings had a synergetic effect in strengthening health system components in the low-income country of Ethiopia.