Effective management is particularly critical in low-income settings where scarce resources must be carefully stewarded and efficiently deployed to meet the substantial health needs of the population. Competencies of health management include strategic thinking and problem solving, human resource management, financial management, operations management, performance management and accountability, governance and leadership, political analysis and dialogue, and customer and community assessment and engagement. The results suggest that district-level management may provide an opportunity for improving health system performance in low-income country settings.ĭeveloping management and problem-solving capacity at all levels is fundamental to health systems strengthening. Having more staff at the district health office was also associated with better KPI performance (p < 0.05) but only in districts with above median management capacity. In districts with below median management capacity, health center management capacity was not associated with KPI performance. In districts with above median district management capacity, health center management capacity was strongly associated (p < 0.05) with KPI performance. We employed quantitative measure of management capacity at both the district health office and health center levels and used multiple regression models, accounting for clustering of health centers within districts, to estimate the statistical association between management capacity and a key performance indicator (KPI) summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. To explore this gap, we conducted a cross-sectional study of 36 rural districts and 226 health centers in Ethiopia, a country which has made ambitious investment in expanding access to primary care over the last decade. Strengthening district-level management may be an important lever for improving key public health outcomes in low-income settings however, previous studies have not established the statistical associations between better management and primary healthcare system performance in such settings.
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