A Systems Approach to Improving Rural Care in Ethiopia 英文参考文献.docVIP

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A Systems Approach to Improving Rural Care in Ethiopia 英文参考文献.doc

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A Systems Approach to Improving Rural Care in Ethiopia 英文参考文献

ASystemsApproachtoImprovingRuralCareinEthiopia ElizabethH.Bradley1*,PatrickByam1,RachelleAlpern1,JenniferW.Thompson1,AbrahamZerihun2, YigeremuAbeb2,LeslieA.Curry1 1YaleSchoolofPublicHealth,GlobalHealthLeadershipInstitute(GHLI),YaleUniversity,NewHaven,Connecticut,UnitedStatesofAmerica,2EthiopianMillenniumRural Initiative(EMRI),ClintonHealthAccessInitiative(CHAI),AddisAbaba,Ethiopia Abstract Background:Multipleinterventionshavebeenlaunchedtoimprovethequality,access,andutilizationofprimaryhealth careinrural,low-incomesettings;however,thesuccessoftheseinterventionsvariessubstantially,evenwithinsinglestudies wherethemeasuredimpactofinterventionsdiffersacrosssites,centers,andregions.Accordingly,wesoughttoexamine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variationinimpactacrossprimaryhealthcareunits. Methodology/PrincipalFindings:Weconductedamixedmethodspositivedeviancestudyof20PrimaryHealthCareUnits (PHCUs)inruralEthiopia.UsinglongitudinaldatafromtheEthiopiaMillenniumRuralInitiative(EMRI),weidentifiedPHCUs withconsistentlyhigherperformance(n=2),mostimprovedperformance(n=3),orconsistentlylowerperformance(n=2) intheprovisionofantenatalcare,HIVtestinginantenatalcare,andskilledbirthattendancerates.Usingdatafromsitevisits andin-depthinterviews(n=51),weappliedtheconstantcomparativemethodofqualitativedataanalysistoidentifykey themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerialproblemsolvingcapacity,2)relationshipwiththeworeda(district)healthoffice,and3)communityengagement. InhigherperformingPHCUsandthosewiththegreatestimprovementaftertheEMRIintervention,healthcenterandhealth poststaffweremoreabletosolveday-to-dayproblems,staffhadbetterrelationshipswiththeworedahealthofficial,and PHCUcommunities’leadership,particularlyreligiousleadership,werestronglyengagedwiththehealthimprovementeffort. Distancefromthenearestcity,qualityofroadsa