The Ethiopia healthcare quality initiative: design and initial lessons learned

Objective To describe the development, implementation and initial outcomes of a national quality improvement (QI) intervention in Ethiopia. Design Retrospective descriptive study of initial prototype phase implementation outcomes. Setting All public facilities in one selected prototype district in each of four agrarian regions. Participants Facility QI teams composed of managers, healthcare workers and health extension workers. Interventions The Ethiopian Federal Ministry of Health (FMoH) and the Institute for Healthcare Improvement co-designed a three-pronged approach to accelerate health system improvement nationally, which included developing a national healthcare quality strategy (NHQS); building QI capability at all health system levels and introducing scalable district MNH QI collaboratives across four regions, involving healthcare providers and managers. Outcome measures Implementation outcomes including fidelity, acceptability, adoption and program effectiveness. Results The NHQS was launched in 2016 and governance structures were established at the federal, regional and sub-regional levels to oversee implementation. A total of 212 federal, regional and woreda managers have been trained in context-specific QI methods, and a national FMoH-owned in-service curriculum has been developed. Four prototype improvement collaboratives have been completed with high fidelity and acceptability. About 102 MNH change ideas were tested and a change package was developed with 83 successfully tested ideas. Conclusion The initial successes observed are attributable to the FMoH’s commitment in implementing the initiative, the active engagement of all stakeholders and the district-wide approach utilized. Challenges included weak data systems and security concerns. The second phase—in 26 district-level collaboratives—is now underway.