Yale global health researchers evaluate Ethiopia Primary Healthcare Transformation Initiative

Researchers at the Yale School of Public Health published a paper describing how the Ethiopia Primary Healthcare Transformation Initiative is improving primary healthcare system performance.


Shandra Ahsan

11:07 pm, Mar 09, 2022

Contributing Reporter



Courtesy of Mayur Desai and Erika Linnader

Researchers at the Yale School of Public Health recently evaluated a multi-year health policy and management initiative they launched in Ethiopia, identifying novel ways to enhance global primary care systems. 

Erika Linnander, director of Yale’s Global Health Leadership Initiative, currently leads the Primary Healthcare Transformation Initiative, which is a multi-year effort to create a culture of performance management and accountability in Ethiopia’s district health offices. In a recent paper published in the International Journal of Health Policy and Management, Linnander and her team of researchers examined the effects of zonal-level management practices in the Ethiopian healthcare systems. The paper, a product of ten years of collaboration with the administrative health systems in Ethiopia, demonstrated that investment in zonal-level management practices is associated with significant improvements in lower-level management and performance in primary care systems. 

“The type of management we are focusing on is community and patient-centered,” Linnander said. “Do you meet regularly with your staff to evaluate performance based on data? Do you ask your community what is and isn’t working? Do you coordinate with other sectors that play a role in health determinants?”

The paper’s focus demonstrated the effects that prioritization of management and the strengthening of systems can have on the Ethiopian healthcare system. The Primary Healthcare Transformation Initiative provided professionals with a master’s level education on health management, created the position of hospital CEO and shifted health management responsibilities from clinicians to professional managers. According to Linnander, this came at a time when Ethiopia had rapidly built its primary care program, so it was critical that proper management systems were put in place.

“I wouldn’t say that clinicians aren’t the best people to step into managerial roles,” Mayur Desai SPH ‘94 GRD ‘97, associate professor of epidemiology and author of the paper, wrote to the News. “Healthcare management and leadership are not taught in medical and nursing schools, so why would we just expect a doctor or a nurse to automatically be an excellent manager?”

Taking clinicians out of these managerial roles proved to not only improve primary care management but also ensured that clinicians could continue their main roles as care providers. 

“When you’re in a context where your healthcare resources are so limited, you don’t want to take your clinicians out of [providing care] and put them in these [managerial] roles,” Linnander explained.

Efforts by the Primary Healthcare Transformation Initiative resulted in improved standards of management practices across three levels –– zonal, district and health facility. For care providers, improving management led to “numerous benefits” such as “increased job satisfaction, greater commitment to the organization and better stewardship of limited resources,” Desai said. For patients, improved healthcare system management resulted in better clinical outcomes. 

“When [management] works well, it’s invisible,” Linnander explained. “If you’re a patient and you’re walking into a health center that’s well managed, it just feels good. It’s clean, they have the supplies that are needed, the clinical teams work together, there’s a medical record that they can access and use. It just makes clinical care better for the patient.”

The Yale School of Public Health is located on 60 College St.


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