a systems approach to improving rural care in ethiopia一个系统的方法来改善农村医疗在埃塞俄比亚.pdfVIP

A Systems Approach to Improving Rural Care in Ethiopia 1 1 1 1 2 Elizabeth H. Bradley *, Patrick Byam , Rachelle Alpern , Jennifer W. Thompson , Abraham Zerihun , Yigeremu Abeb2, Leslie A. Curry1 1 Yale School of Public Health, Global Health Leadership Institute (GHLI), Yale University, New Haven, Connecticut, United States of America, 2 Ethiopian Millennium Rural Initiative (EMRI), Clinton Health Access Initiative (CHAI), Addis Ababa, Ethiopia Abstract Background: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. Methodology/Principal Findings: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1)