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Building the Capacity of Subnational Health Managers as a Critical Component of Decentralized Health Systems: Emerging Findings from Ethiopia

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In Ethiopia, immunization coverage (DTP3 vaccination) ranges from 26% to 93% across regions, with most regions falling short of the national target (90%). In decentralized health systems, such as Ethiopia, successful outcomes rely on strong subnational capacity to manage basic services such as immunization. The Ministry of Health (MOH) has prioritized the role of Regional Health Bureaus (RHBs) in providing technical oversight to districts for immunization. JSI adapted the “Standard Competencies Framework for the Immunization Workforce” (WHO 2018) for the Ethiopian context to identify skill gaps of RHB staff and develop targeted plans of technical assistance to address them.

Presented at 6th Global Symposium on Health Systems Research (HSR2020), November 8-12, 2020.

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Building the Capacity of Subnational Health Managers as a Critical Component of Decentralized Health Systems: Emerging Findings from Ethiopia

  1. 1. Building the Capacity of Subnational Health Managers as a Critical Component of Decentralized Health Systems: Emerging Findings from Ethiopia Lisa Oot, Rebecca Fields, Adriana Almiñana, Belayneh Dagnew, Daniel Girma, Elena Herrera, Natasha Kanagat Corresponding author: Lisa Oot, lisa_oot@jsi.com Presented at 6th Global Symposium on Health Systems Research, November 8-12, 2020 Photo: Bill & Melinda Gates Foundation
  2. 2. Introduction • In Ethiopia, immunization coverage (DTP3 vaccination) ranges from 26% to 93% across regions, with most regions falling short of the national target (90%). • In decentralized health systems, such as Ethiopia, successful outcomes rely on strong subnational capacity to manage basic services such as immunization. • The Ministry of Health (MOH) has prioritized the role of Regional Health Bureaus (RHBs) in providing technical oversight to districts for immunization. • JSI adapted the “Standard Competencies Framework for the Immunization Workforce” (WHO 2018) for the Ethiopian context to identify skill gaps of RHB staff and develop targeted plans of technical assistance to address them.
  3. 3. Methods • JSI developed a self-assessment questionnaire based on the competency framework to gauge RHB staff capacity on 14 competencies for immunization. • RHB staff in four regions self-administered the assessment at baseline (N=58) and midline 9- 10 months later (N=61), rating their competency on a Likert-style scale (Figure 1). • JSI analyzed baseline data in Excel and provided tailored technical support to each RHB based on baseline findings. • RHB staff in all regions had multiple opportunities to gain competency in skills critical to RI programming and receive on-job training from JSI staff during joint supervision visits to health facilities. Figure 1: Scale for self-assessing competency for each immunization program management competency area
  4. 4. Results • Midline self-assessments indicated an increase from 27% to 49% in the number of “fully competent” or “expert” responses.1 • Table 1: Across each competency area, respondents reported improvements in competency Develop technical presentation using appropriate data ↑ 27% Capacity building to lower level staff ↑ 34% Manage funds and determine the allocation of resources for immunization ↑ 22% Develop multi-year and annual plans ↑ 28% Coordinate with non-governmental organizations on planning/funding of services ↑ 30% Identify gaps in HR needs ↑ 12% Provide high quality supportive supervision ↑ 32% Data analysis, interpretation, and use ↑ 16% Conduct data quality self-assessments ↑ 8% Create an EPI microplan ↑ 30% Conduct EPI performance review ↑ 26% Supply and vaccine management ↑ 10% Use of Quality Improvement tools ↑ 29% Immunization safety measures and policies ↑ 13% Table 1: Percent point change baseline to midline of responses denoting "competent" or "expert“ for 14 competency areas 1 Note: endline not yet conducted
  5. 5. Conclusions • The use of self-assessments to estimate competency indicate early gains in capacity building of subnational health management teams. • Although self-assessments are subject to respondents’ perceptions of their skills, they nonetheless represent a practical and nimble way to begin to gauge the capacity of the immunization workforce during the course of a project or in lieu of large costly evaluations. • Application of the competency framework and self-assessments is an approach that could be integrated into the MOH in Ethiopia as a standard, low-tech/effort process to identify capacity building needs of its staff and provide targeted technical assistance. • Given limited time and resources for capacity building, this process can help to identify the competencies needed within teams at each level of the health system and then efficiently target resource allocation or technical assistance to build skills in specific areas. In addition, the approach can be used to gauge how well the MOH’s own capacity building initiatives are working.

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