In Ethiopia, we worked with the government to roll out governance reforms as part of its reform program for health service delivery. To make facilities responsive to local needs and mitigate administrative complexities, the government introduced boards, governing bodies and management committees for health centers.
Boards are now well established in most health facilities. They facilitate linkage with the community, and are used to advocate for increased resource mobilization. In addition, these governance structures serve as the major monitoring and decision-making bodies, and currently all reform efforts, including health care financing, depend on their functioning. The boards enable facilities to retain and reinvest client fees to improve quality services, including purchasing needed supplies. In just the first four years of the health care financing being enacted, the Meshualekia Health Center in Kirkos sub-city of Addis Ababa collected nearly 4.6 million Ethiopian Birr (US$ 231,795) and, under board oversight, used most of it to improve quality of care for its more than 52,000 clients.
We developed the hospital reform implementation guideline (EHRIG) with well-defined quality standards. The national average EHRIG attainment in 2015 was 84.5 percent, with demonstrable impacts in reduced waiting times and institutional mortality. Bed occupancy, average waiting time for surgery and patient satisfaction all showed improvements.