Comparison of maternal and child health service performances following a leadership, management, and governance intervention in Ethiopia: a propensity score matched analysis

Abstract

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.

Exploring the opportunities and challenges of female health leaders in three regional states of Ethiopia: a phenomenological study

“…Leadership training and mentoring sessions, facilitated with the support of partners build the leadership capacity and competencies of women, and prepare them to be competent for leadership dispensation. This finding aligns with that of Desta et al (2020) and , where facilitating leadership training and coaching activities were found to be effective in building the desired competencies [38][39][40].…”

The Role of Leadership in Sub-Saharan Africa in Promoting Maternal and Child Health

“…This chapter builds on a modified framework from policy interventions facilitating demographic dividend (see Figure 5) [59]. There have been several attempts to address the linkages between leadership and MCH; however, they have mainly focused on "lower levels" targeting professionals and cadres in health workforce [60][61][62][63][64]. Most studies have focused on capacity-building, development of skills to better serve more deprived segments of the population, and accountability.…”

Magnitude of optimal access to ANC and its predictors in Ethiopia: Multilevel mixed effect analysis of nationally representative cross-sectional survey

“…Interventions to reduce maternal mortality such as Universal access to reproductive health services (ANC and others) [15], family planning 2020 [16,17], the Ethiopian government considerations of maternal health care services through giving priority as a political agenda to reduce the maternal mortality below 267 deaths per 100,000 live births [18] had been executed. However, the maternal [19][20][21], and neonatal mortality rates continue to rise in developing nations. Undoubtedly needs an improved optimal access to ANC services with an attention for the timing of first ANC, frequencies of ANC and skilled ANC attendant [11,12].…”