This article describes the United States Agency for International Development Transform: Primary Health Care Activity supported a twinning partnership strategy, which was implemented between districts (woredas) in the different performance categories. This study presents the details of the partnership and the result observed in health systems strengthening in Ethiopia. The twinning partnership strategy was implemented with six steps. The established relationship helps the health systems to build the skill and capacities of the health workforce at primary healthcare entities. Both partner woredas improved their performances through the established win-win relationship and institutionalized the characteristics of a learning organization.

Background: Gender equity involves fairness in all aspects of life for women and men and is usually determined by social, political, economic, and cultural contexts. The proportion of female leaders in healthcare within the health sector is low. The aim of this study was to explore and describe the experiences, opportunities, and challenges faced by women in their path towards becoming leaders within the health sector.Methods: This study was conducted using the phenomenological method of qualitative inquiry. A purposive sampling technique was used to identify six women leaders. Semi-structured interviews were conducted through telephone by the investigators. The qualitative data analysis was conducted parallel with data collection using steps of thematic analysis.Results: This study identified individual, societal, and organizational level opportunities and challenges that had an influence on the career paths of female health leaders in Ethiopia. The leadership positions were an opportunity in the career development of women who had long-term goals, were known for their empathy, and exercised wise use of resources. In addition, women who had the support of close family members and their peers are more likely to compete and rise to leadership positions. Furthermore, women who received organizational support in the form of affirmative action, training, development, and recognition also tended to rise to leadership positions. However, women who assumed leadership positions but whose day-to-day decision-making was influenced by their supervisors, those who had experienced sexual harassment, and those under the influence of societal norms were less likely to attain leadership positions.Conclusion: This study explored the opportunities and challenges of women leaders in the health sector in a low-income country. The findings highlight individual, social, organizational, and societal factors influencing the career development of women leaders. Therefore, enhancing the leadership capacity of women, and improving social and organizational support is recommended. In addition, addressing the low level of self-image among women and patriarchal societal norms at the community level is recommended.

Background Gender equity involves fairness in all aspects of life for women and men and is usually determined by social, political, economic, and cultural contexts. The proportion of female leaders in healthcare within the health sector is low. The aim of this study was to explore and describe the experiences, opportunities, and challenges faced by women in their path towards becoming leaders within the health sector. Methods This study was conducted using the phenomenological method of qualitative inquiry. The approach was chosen for its merits to narratively explore and describe the lived stories and shared experiences of women leaders in the healthcare system. A purposive sampling technique was used to identify six women leaders. Semi-structured interviews were conducted through telephone by the investigators. The qualitative data analysis was conducted parallel with data collection, using steps of thematic analysis. Results This study identified individual, societal, and organizational level opportunities and challenges that had an influence on the career paths of female health leaders in Ethiopia. The leadership positions were an opportunity in the career development of women who had long-term goals, were known for their empathy, and exercised wise use of resources. In addition, women who had the support of close family members and their peers are more likely to compete and rise to leadership positions. Furthermore, women who received organizational support in the form of affirmative action, training, development, and recognition also tended to rise to leadership positions. However, women who assumed leadership positions but whose day-to-day decision-making was influenced by their supervisors, those who had experienced sexual harassment, and those under the influence of societal norms were less likely to attain leadership positions. Conclusion The opinions and experiences of female health leaders revealed that individual behaiour whileassumming a leadership positon, empathy, and wise resource management positivey influence their career development. In addition, female health workers who had support form close family members and peers strived for growth to leadership positions. Furthermore, the presence of organizational support, in the form of affirmative actions, and succession planning were another opportunity for females in their career paths. Conversely, some social norms were found to deter female health workers from advanicing to leadership positions. Therefore, enhancing the leadership capacity of women and improving social and organizational support is recommended. In addition, addressing the low level of self-image among women and patriarchal societal norms at the community level is recommended.

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.

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.