Quality of care in Ethiopia
Building on the existing quality management structures in the Health Service Quality Directorate and political will to improve the quality of maternal and newborn health services, Ethiopia joined the Quality of Care Network in 2017. At that time, Ethiopia was among the few countries that had already developed National Quality Strategy (2016- 2020). A revised National Quality Strategy (2021-2025) was finalized in 2021.
With political commitment for quality care in maternal and newborn health (MNH QoC), a specific MNH Quality of Care Technical Working Group was established to lead the implementation of the National Maternal and Newborn Quality Care Roadmap (2017-2020) and partners were mobilized to support operationalization of the Roadmap. The Federal Ministry of Health and supporting implementing partners have allocated specific funds toward MNH QoC in 48 learning facilities within 14 Learning Districts. Beginning in 2021, preparatory work for the end-term review of the Roadmap has been initiated to guide the scale-up to more districts and facilities. The Federal Ministry of Health had communicated plans to scale-up the MNH QOC initiative to 38 additional Learning Districts and 171 facilities for expansion of the initiative beginning in 2022. This represent a significant expansion from the 14 Learning Districts and 48 facilities that were in progress at the start of 2021. However, service delivery and scale-up plans have been greatly impacted by the current humanitarian crisis in Ethiopia, and the associated repurposing of resources for other priorities. Family Planning including postpartum family planning quality care has been agreed as flagship program of the Federal Ministry of Health for 2021-2022.
In Ethiopia, the capacity and readiness of learning facilities and districts to institutionalize a culture of quality has been supported by the establishment of strong learning structures. Firstly, Learning Facilities have established structures for quality improvement (QI) through assigning QI teams and focal persons to implement MNH QOC in facilities. The QI teams are equipped with the requisite knowledge and skills in quality improvement through regular basic training in QI. Facility QI teams are supported through onsite QI coaching and clinical mentoring by a pool of district QI coaches and through the RMNCAH catchment based clinical mentorship program. The QI teams use standard MNH audit tools adapted from the WHO standards for improving quality of maternal and newborn care to identify gaps in MNH care; design and implement changes, and then continuously monitor outcomes, refine and institute further changes to improve MNH services. The Network monitoring framework and tools have been adapted, and facilities are collecting and reporting on MNH QOC indicators. In 2021, 10 months of core MNH QOC indicator data has been collected from 13 Learning Districts and 40 facilities and reported to the Federal Ministry of Health.
Secondly, a district and national based learning system structure has been established whereby facilities within each Learning District come together for peer-to-peer learning. Learning is disseminated among facilities within a Learning District through learning collaborative sessions at district level every quarter. In addition, all Learning Districts convene at national level for broad-scale learning and sharing twice per year. The most recent national Learning District collaborative session was held in May 2021 hosted by the Federal Ministry of Health, with QI teams from 12 Learning Districts and 40 facilities.
The establishment of these functioning district learning networks has supported the documentation of several MNH QI projects and best practices from learning facilities. This learning structure has enabled health facilities to learn and test change in their own facilities and beyond. Tested change ideas synthesized from the Learning Districts are compiled in a National Change Package. This Change Package signifies a synthesis of the most robust and effective changes successfully tested and implemented in the learning districts where the MNH QoC initiative is operationalized to improve quality of MNCH services in Ethiopia. The Change Package can support scale up to further districts.
To ensure accountability and community engagement for quality care, Community Score Cards have been implemented in all Public Health Care facilities in all regions. In 2021, a desk review was conducted to explore existing community engagement platforms, approaches, and techniques in Ethiopia aiming to support and strengthen ongoing community engagement initiatives for QI.
Following the COVID 19 pandemic and the current humanitarian crisis, partnership and coordination mechanisms at sub-national levels for quality of care have been affected. The number and extent of partner engagements has been declining. Partner mapping and alignment of resources and projects with national priorities in support of the National Quality and Patient Safety Strategy (2021-2025) is crucial for continued commitment and support to quality care for maternal, newborn and child health.
Photo: Kanu Fanta nurses her 3-weeks-old Netsanet Adane at home in Amari Yewebesh Kebele, in the Amhara Region of Ethiopia, in July 2013. ©UNICEF/Ose