Health care providers’ clinical knowledge on selected maternal and child health conditions and staff attendance in Ethiopia

Abstract

Introduction: Health systems and services depend critically on the size, skills, and commitment of the health workforce. The major objective of this study is to assess the health care provider’s clinical knowledge on selected disease conditions and staff attendance in Ethiopia to provide quality health services.

Methods: The assessment is part of the 2014 Ethiopia Service Provision Assessment Plus (ESPA+) Survey. From a total of 1,327 health facilities, 4,807 healthcare providers were assessed. All Hospitals, selected health centers, and private clinics were included. Health posts were not assessed. The approach, in general, follows the World Bank’s Service Delivery Indicators (SDI) methodology.

Results: Diagnostic accuracy of service providers based on the average of four disease conditions, namely malaria, pulmonary tuberculosis, postpartum hemorrhage, and birth asphyxia is 71 %. Overall, the adherence of providers to clinical guidelines concerning client history taking, physical examination, and investigation of pulmonary tuberculosis case is 47 %, 59 %, and 55 % respectively. There is no major variation of this adherence by facility type, region, and providers’ category. Overall, staff absenteeism was 33 % irrespective of the reason. Out of which unapproved was 9 %. This is maximum for the health posts (16 %). The approved reasons included that staff was absent due to: sickness or maternity leave (4 %), training or seminar (7 %), official mission (4 %), and other approved reasons (8 %). Health providers in Afar region (18 %) followed by South Nation Nationalities People (16 %), Dire Dawa and Benishangul Gumuz (14 % each), and Harari (13 %) regions were more likely to be absent. 

Conclusion: Overall diagnostic accuracy based on the average of four disease conditions was low. It varied by disease condition, professional category, and facility type. Adherence to clinical guidelines on client history taking, physical examination, investigations, and treatment and general management of the disease condition. There is a considerable practice gap in adhering to the required clinical guidelines. The staff attendance suggests that there is room to improve staff availability at the facility.