Data from: District-level health management and health system performance

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. 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. 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. In
districts with above median management capacity, health center management
capacity was strongly associated (p < 0.05) with KPI performance
whereas in districts with below median management capacity, health center
management capacity was not associated with KPI performance. 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. The results suggest that district-level management
may provide an opportunity for improving health system performance in
low-income country settings.

强化区级管理，或是改善低收入地区核心公共卫生结局的重要抓手；然而，过往研究尚未明确此类场景下，精细化管理与基层医疗体系绩效间的统计关联。为填补这一研究空白，我们针对埃塞俄比亚的36个农村区县与226家医疗中心开展了一项横断面研究——该国在过去十年间，已为扩大基层医疗可及性投入了大量雄心勃勃的资源。我们分别对区县卫生办公室与医疗中心的管理能力采用量化评估手段，并纳入区县内医疗中心的聚类效应，使用多元回归模型估算管理能力与核心绩效指标（Key Performance Indicator，KPI）综合得分间的统计关联；该综合得分基于产前检查覆盖率、避孕措施使用率、熟练助产接生率、婴儿疫苗接种率以及基本药物可及性五项指标构建。在管理能力高于中位数的区县中，医疗中心的管理能力与KPI绩效呈显著关联（p<0.05）；而在管理能力低于中位数的区县中，医疗中心管理能力则与KPI绩效无显著关联。区县卫生办公室的人员配置充足，同样与更优的KPI绩效呈显著关联（p<0.05），但这一关联仅存在于管理能力高于中位数的区县中。本研究结果表明，区级管理或可为低收入国家改善医疗体系绩效提供可行路径。