Healthcare space management

Healthcare space management in Ethiopia involves addressing various challenges related to the
organization, utilization, and quality of healthcare facilities.It includes Different documents and
standards and supported by researchs.

Healthcare space management in Ethiopia involves planning, designing, and optimizing physical spaces
within healthcare facilities to ensure efficient and effective service delivery. It encompasses aspects such
as layout, infrastructure, equipment placement, and safety protocols.

Here are some relevant standards and guidelines related to healthcare space management in Ethiopia:

1. Essential health service package (EHSP)

2. Estimated costs and ficical space analysis for EHSP

3. The Ethiopian Hospital Service Transformation Guidelines (EHSTG)

4. Patient volume and primary quality of care

5.National minimum standards for health care facilities

1.Essential health service package (EHSP)

Ethiopia’s investment in health over the last two decades has led to significant improvements in
population health, including increased life expectancy. The EHSP aims to provide essential health
services to the population.

Components of the EHSP:

The EHSP covers a wide range of health interventions, including:Reproductive, maternal, newborn, child
health, and nutrition services.Major communicable diseases.Non-communicable diseases.Surgical and
injury care.Emergency and critical care.Neglected tropical diseases.Hygiene and environmental health
services.Health education and behavioral change communication.Multi-sectoral nutrition interventions.

Development Process:
The EHSP development process involves defining the scope, selecting interventions, estimating costs,
and engaging in deliberation3.Explicit criteria are used to prioritize interventions based on factors such
as disease burden, cost-effectiveness, equity, and public acceptability4.

The Essential Health Service Package, launched in November 2019, aims to provide access to
quality health services without any financial challenges regardless of age, ability to pay and
economic status, and geographic location for the population in Ethiopia.

The EHSP was developed through a participatory approach, with frequent appraisal and

feedback before decision-making. A roadmap document that guided and informed the overall

process and each step of the revision process was prepared, presented to the management of
the Federal Ministry of Health (FMOH) and approved. Several consultative
technical workshops were convened to define the scope of the revision, develop a complete list
of health interventions, develop prioritisation criteria, gather evidence and compare and rank
health interventions according to a range of criteria.
Seven prioritisation criteria were selected, mostly based on the review of the national health
policy

1. Size of the disease burden

2. Cost-effectiveness

3. Budget impact

4. Equity

5. FRP

6. Public acceptability

7. Political acceptability
The major components of the EHSP of Ethiopia are classified based on the BoD of Ethiopia.
:

1. Reproductive, maternal, neonatal, child and adolescent health

2. Major communicable diseases

3. Non-communicable diseases

4. Surgical and injury care

5. Emergency and critical care

6. Neglected tropical diseases

7. Hygiene and environmental health services

8. Health education and behaviour change communication services

9. Multi-sectoral nutrition interventions

Values and guiding principles for Ethiopia’s EHSP

The following are the values and guiding
principles:

 Value for money

 Priority to the worse-off

 Enhance equity

 Reduce poverty

 Creation of a resilient health system

 Achievement of UHC

 Cost-effectiveness

 Affordability

 Improve quality

 Building institutional capacity

 Sustainability of health interventions

Objectives of the EHSP

The main objectives of the EHSP are as follows:

 To reduce high BoD in Ethiopia by availing affordable high-priority interventions
 To protect the population against catastrophic health expenditures and provide FRP
 To increase equitable access to health services and interventions
 To increase the efficiency of the health system
 To increase public participation and transparency in decision-making in the health
sector

The main objectives of the EHSP are as follows:

 To reduce high BoD in Ethiopia by availing affordable high-priority interventions
 To protect the population against catastrophic health expenditures and provide FRP
 To increase equitable access to health services and interventions
 To increase the efficiency of the health system
 To increase public participation and transparency in decision-making in the health
2. Estimated costs and ficical space analysis for EHSP

Estimating the required resources for implementing an essential health services package (EHSP) is vital
to examine its feasibility and affordability.

As it is explained on the study of “Is Universal Health Coverage Affordable? Estimated Costs and Fiscal
Space Analysis for the Ethiopian Essential Health Services Package” in 2021, the financial resources
required to implement the Ethiopian EHSP from 2020 to 2030. To implement the EHSP, 13.0 billion USD
(per capita: 94 USD) would be required in 2030. The largest (50–70%) share of estimated costs was for
medicines, commodities, and supplies, followed by human resources costs (10–17%). However, the
expected available resources based on a business-as-usual fiscal space estimate would be 63 USD for
the same year. Therefore, the gap as a percentage of the required resources would be 33% in 2030. The
resources needed to implement the EHSP would increase steadily over the projection period due mainly
to increases in service coverage targets over time. Allocating gains from economic growth to increase
the total government health expenditure could partly address the gap.

3. The Ethiopian Hospital Service Transformation Guidelines (EHSTG)

The Ethiopian Hospital Service Transformation Guidelines (EHSTG) provide a common set of guidelines
to help hospital leaders, managers, and clinicians in Ethiopia steer the consistent implementation of
transformational systems and processes within hospitals. These guidelines focus on improving health
care quality and aligning standards with implementation practices. The EHSTG covers various aspects of
hospital management, including leadership, governance, and service delivery12. One of its key concerns
is ensuring effective, efficient, and quality hospital services while promoting good governance for health.

Ethiopian Hospital Services Transformation Guidelines (EHSTG) build

on and expand the Ethiopian Hospital Reform Implementation Guidelines

(EHRIG) and are consistent with the Health Sector Transformation

Plan (HSTP). The EHSTG, which is consistent with the national focus on

quality improvement in health care, contains a common set of guidelines

to help hospital Chief Executive Officers(CEOs), managers, and clinicians

(care providers) in steering the consistent implementation of these

transformational systems and processes in hospitals throughout the country.

The EHSTG focused on selected management and clinical functions, including

new individual service specific chapters for Emergency Medical, Outpatient

and Inpatient Services, Nursing and Midwifery, Maternal, Neonatal and

Child Health and Teaching Hospitals’ Management. These guidelines also

incorporate recent lessons from the operationalization of the EHRIG, as well

as, new national initiatives such as the Guidelines for the Management of

Federal Hospitals in Ethiopia, Hospital Development Army (HDA), Clean

and Safe Hospital (CASH), and Auditable Pharmaceutical Transaction and

Service (APTS).

It is expected that the guidelines will continuously evolve as new evidence

emerges regarding improved hospital care and practices that are better

tailored to needs and circumstances of different tiers of public hospitals.

We are grateful to all partners that have participated in the production of

these guidelines. Special thanks go to our colleagues at the Clinton Health

Access Initiative for their substantial contributions and support throughout

the development of these guidelines as well as their dedicated efforts in

support of our health reform efforts in so many other capacities.

4. Patient volume and primary quality of care

Several studies have reported inadequate levels of quality of care in the Ethiopian health system.
Facility characteristics associated with better quality remain unclear. Understanding associations
between patient volumes and quality of care could help organize service delivery and potentially
improve patient outcomes.

Based on the study Patient volume and quality of primary care in Ethiopia: findings from the routine
health information system and the 2014 Service Provision Assessment survey,

The study included 424 facilities including 270 health centers, 45 primary hospitals and 109 general
hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score
of 38%. Outpatient volume varied from less than one patient per day to 581. Among facilities seeing
90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar
association between volume and quality of antenatal care visits.

5. National minimum standards for health care facilities

The National Minimum Standards for Healthcare Facilities in Ethiopia is a regulatory document that
mandates both practitioners and health institutions to comply with a minimum set of requirements.
These standards ensure quality and safety in healthcare provision, and their regular update helps sustain
best practices. The Ethiopian Food, Medicine, and Healthcare Administration and Control Authority
(EFMHACA) oversees the implementation of these standards.

The national minimum standards constitute licensure requirements, good governance practice
standards, human resource management standards, service providers’ and clients’ rights and

responsibilities, health service practice standards, premises standards, professionals’

standards, product standards, and cross-cutting service standards for different types and levels
of health facilities. All standards incorporated proven best practices in healthcare, including
pharmaceutical services that should be instituted within all health facilities, whether operating
in the public or private sector.
In Ethiopia, government and development partners are investing a huge amount of resources
to improve the quality of health services and ensure their sustainability. However, there

remain the serious challenges of accountability, ownership, and sustainability. Accordingly,

governance is recognized as one of the key strategic interventions in the Health Sector
Development Programme (HSDP) IV. It is also recognized by international development
partners as a building block for health system strengthening. The development of these
Standards can be taken as a good governance intervention within the health system. These
regulatory tools mandate that both practitioners and health institutions comply with a
minimum set of requirements and update their licenses regularly to continue operating as a
healthcare-providing institution. This way, best practices (adapted to the country’s context)
will easily be owned and sustained.

Objectives

 Ensure quality and safety of healthcare services

 Provide guidance on healthcare regulation
 Provide a standardized tool for licensing and inspection of health facilities
 Standardize requirements for provision of health services across the public and private
sectors Establish transparent processes and ensure accountability in regulating the health
sector

Conclusion

Healthcare space management in Ethiopia involves optimizing resources, improving quality, and
ensuring effective service delivery.

Remember that these standards and guidelines are essential for maintaining safe, efficient, and patient-
centered healthcare spaces in Ethiopia
Reference

- Development of the National Minimum Standards for Healthcare Facilities in Ethiopia: A Milestone for
Country Ownership and Sustainability of Best Practices, Edmealem Ejigu Hailu Tadeg, June 2014.

- Essential health service package (EHSP) document

- "Is Universal Health Coverage Affordable? Estimated Costs and Fiscal Space Analysis for the Ethiopian
Essential Health Services Package

Alemayehu Hailu,Getachew Teshome Eregata, Karin Stenberg &Ole Frithjof Norheim

Article: e1870061 | Received 03 Sep 2020, Accepted 24 Dec 2020, Published online: 19 Mar 2021

-The Ethiopian Hospital Service Transformation Guidelines (EHSTG) document, 2017

-Woldie M, Kassa M, Berman P, Kruk ME. Patient volume and quality of primary care in Ethiopia: findings
from the routine health information system and the 2014 Service Provision Assessment survey. BMC
Health Serv Res. 2021 May 22;21(1):485. doi: 10.1186/s12913-021-06524-y. PMID: 34022856; PMCID:
PMC8140434.