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Looking at approaches to quality improvement at the national level: the example of Ethiopia

How did the Ethiopian Ministry of Health approach quality improvement? This article provides the roadmap and policy they developed.
A male doctor holds a stethoscope up to the camera. The tip of the stethoscope is covered in the colours of the Ethiopian flag
© Shutterstock

So, after looking at the frameworks, the tools available for measuring quality and the processes involved in improving quality, let’s see how this is translated into national policy. In this step we want you to review Ethiopia’s national health care quality strategy, published in 2016.

Have a look at how the Ministry of Health in Ethiopia describe their approaches to quality improvement. This is a very good example of a quality of care policy. It’s worth having a look at the full document if this is an area of interest to you. The link to the full document is available in the ‘see also’ section at the end of this step.

We have summarised the key features of this document below.

The policy covers the whole health system, with a special emphasis on the main health priorities of the nation. For Ethiopia, these are:

  • Maternal and newborn mortality reduction
  • Malnutrition
  • Malaria, HIV and TB
  • Non-communicable diseases including diabetes, cancer, cardiovascular disease, mental illness and respiratory disease
  • Clinical and surgical care.

So the policy is focused on the health burden. The roadmap is replicated below, and illustrates a set of steps to improve quality: 1. Defining the context 2. Setting priorities for improvement, 3. Setting the scope, 4. Understanding the mechanisms that influence quality, 5. Developing appropriate strategies and 6. Implementing and evaluating strategies.

Roadmap to achieving improved national quality

roadmap showing steps needed to improve national quality Source: Ethiopian National Health Care Quality Strategy 2016 – 2020 (pg. 3).

So, having determined their health priorities, and the steps to achieve improved quality, the next task was to define the ‘ideal’ situation, a combination of quality planning, quality improvement and quality control. We like the way they have brought these three aspects together – quality planning, quality improvement and quality control, as it is usually more common to see these acting as separate activities, and the approach in this document is more systematic. The graphic below also illustrated the importance of developing quality throughout the health system, from the community through to the national level. Look at the full document for a more detailed description of what actions are required at each level.

Ideal state of quality in the Ethiopian health care system

Ideal state of quality in the Ethiopian health care system Source: Ethiopian National Health Care Quality Strategy 2016 – 2020 (pg. 15).

Finally, the last piece of this policy that is worth reviewing is the strategic focus areas, defined as:

  • Develop an integrated approach
  • Activate key constituencies
  • Drive improvement by linking quality to other development goals
  • Support responsive feedback mechanisms

Or ‘DADS’ (perhaps someone was thinking about male involvement when they put this approach together!).

Strategic focus areas

Develop an integrated approach to planning, improving, and controlling quality Activate key constituencies to advance quality Drive improvement in quality by explicitly linking UHC strategy with quality Source: Ethiopian National Health Care Quality Strategy 2016 – 2020 (pg. 18).

Of course, we have all seen very beautiful policies, such as this one, sit on a shelf somewhere and never be put into practice (perhaps there is a quality indicator on policy action waiting to be developed!). It will be interesting over the next few years to see how Ethiopia implements this policy.

Does your country have a national quality of health care strategy? If it does, comment below on whether you think it is being implemented. If your country does not have a national quality of health care strategy, comment on where else national quality standards and quality improvement processes are proposed (e.g. are they included in other policies?)

Federal Democratic Republic of Ethiopia, Ministry of Health, 2016, Ethiopian national health care quality strategy 2016-2020: Transforming the quality of health care in Ethiopia.
© Nossal Institute for Global Health at the University of Melbourne
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