Yale Bulletin and Calendar

December 15, 2006|Volume 35, Number 13|Four-Week Issue

Yale researchers share expertise with Ethiopian health care professionals to improve medical treatment

Researchers at Yale recently traveled to Ethiopia to introduce a program to provide health care managers and workers with extensive training and practice in various areas of hospital and health care management.

The Professional Development Program is a component of the Ethiopian Hospital Management Initiative (EHMI) conceived by the Ethiopian Ministry of Health and led by the joined forces of Yale and the William J. Clinton Foundation HIV/AIDS Initiative.

The program is an integral piece of EHMI, which began at the request of Tedros Adhanom Ghebeysus, the Ethiopian minister of health, as part of efforts by the Clinton Foundation HIV/AIDS Initiative to expand and improve treatment for people living with HIV/AIDS.

Over 80 Ethiopian health care professionals from 14 public hospitals, regional health bureaus and the nation's Ministry of Health attended training, which was led by Yale professors. Participants were taught management skills and techniques designed to help them improve both access to and delivery of health care services to Ethiopia's 76 million people.

After completing the training, the Ethiopian health care professionals returned to their respective hospitals where they are working side-by-side with fellows from the EHMI program to implement quality-improvement projects in their hospitals. The managers will receive ongoing training from Yale until they complete their projects and will receive a certificate from Yale.

During the opening session of training, Elizabeth H. Bradley, professor of public health in the Department of Epidemiology and Public Health (EPH) at Yale and director of the University's EHMI project, said: "We are extremely pleased to be able to provide this training to the health care workers of Ethiopia. We are certain it will greatly augment their management skills and make great strides toward improving the hospital system."

When Bradley and her team arrived in Ethiopia, they were able to identify key ways to improve the efficiency of hospitals, beginning with an emphasis on human resources management. Hospitals were staffed with few physicians, but an abundance of nursing staff. Misallocation and incentives for staff motivation and evaluation are wholly lacking, according to Bradley. For example, the program has found that only 21.4% of hospitals maintain any standard for nursing practice.

Setting up a performance-based human resources management program is essential, said Bradley. This begins with establishing a human resources department or hiring a specialist to reorganize how the hospitals are staffed. Bradley noted that these first steps will go a long way towards advancing the EHMI goals.

In addition to human resources, the group has been discussing ways to implement changes to improve methods for medical record keeping, a critical component to providing ongoing quality care, said Bradley. After observing in numerous hospitals a lack of crucial data in medical records and often lost or misplaced records, the team began designing a laptop-based, electronic medical record system. This system is expected to help clinicians maintain and update patient information, and care and treatment information.

The EHMI program is also addressing key hospital management issues including infection control and cleanliness practices, organization and management of hospital pharmacies and drug inventory, financial and budgetary controls, and quality-of-care management.

In a country that spends only 5.9% of its Gross National Product on health care annually and has extensive acute care needs, hospitals are often the place of last resort for many and ensuring that they are as productive and efficient as possible is critical, said Bradley.

"Nowhere is management as essential as in a resource-poor area," she noted. "We want to ensure that we are getting the most in terms of quality and efficiency for the scarce resources that are available."

After the training, Bradley and the team received a positive response from participants. "The method of problem-solving was particularly well received," said Bradley. "They found it helpful as an approach to solving some of the issues in their individual organizations. The program has bolstered the management team's ideas and they now know quite a bit more about hospital management."

Minister Ghebeysus expressed his vision for the fellows and medical directors. "This is the year to experiment, study and move forward," he said. "Think outside the box, be creative, innovative and try new things. Then we will evaluate them and see what can be integrated into the longer-term sustainable system of health care Ethiopia is building."

Kari Hartwig, assistant professor of public health in the global health division of EPH, said, "The Professional Development Program permits Yale to offer its skills beyond the classroom to health care practitioners in Ethiopia who are both in need and, more importantly, enthusiastic to learn. It's a dynamic challenge and a natural fit for Yale as we expand our work in global health."

Bradley said the professional development program may lead to larger efforts to develop a master's of hospital administration degree in Ethiopia and create a new profession that can sustain the management capacity in health care that the country will need in the decades to come.

The initial training by Yale took place this fall at Ghion Hotel in Addis Ababa. Trainers included Bradley, Hartwig, lecturer Marguerite Callaway and program manager Josh Pashman. Yale will provide a follow-up training to Ethiopian health care managers Jan. 22-25.

-- By Karen Peart

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