ArticlePloS one2019
District-level health management and health system performance.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- What is the relationship between hospital management practices and quality of care? A systematic review of the global evidence.Health policy and planning · 2025Pooled it
- Factors That Influence Data Use to Improve Health Service Delivery in Low- and Middle-Income Countries.Global health, science and practice · 2020Pooled it
- Evaluation of an innovative model for leadership and management development among national immunization program teams.Public health in practice (Oxford, England) · 2026Article
- The Relevance, Delivery, and Effects of Health Management, Leadership, and Governance Training on Managers' Practices and Organizational Results: A Protocol for an Effectiveness-Implementation Hybrid Type 2 Study.Health science reports · 2026Article
- Practice of Leadership, Governance, and Management Related to Maternal Nutrition Intervention Research Embedded in Antenatal Care in Burkina Faso.The American journal of tropical medicine and hygiene · 2025Article
- Management capacity of primary healthcare facilities in low- and middle-income countries: A scoping review.PLOS global public health · 2025Article
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- Strengthening health management, leadership, and governance capacities: What are the actual training needs in Tanzania?Health science reports · 2023Article
- Universal health coverage in Pakistan: is the health system geared up to take on the challenge?Globalization and health · 2023Article
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- Emergency department performance assessment using administrative data: A managerial framework.PloS one · 2023Review
- What Factors Explain Low Adoption of Digital Technologies for Health Financing in an Insurance Setting? Novel Evidence From a Quantitative Panel Study on IMIS in Tanzania.International journal of health policy and management · 2023Article
- Measuring Organizational Culture in Ethiopia's Primary Care System: Validation of a Practical Survey Tool for Managers.International journal of health policy and management · 2022Article
- An Analysis of Zonal Health Management Capacity and Health System Performance: Ethiopia Primary Healthcare Transformation Initiative.International journal of health policy and management · 2022Article
- Primary Health Care Management Effectiveness as a Driver of Family Planning Service Readiness: A Cross-Sectional Analysis in Central Mozambique.Global health, science and practice · 2022Article
- Best and worst performing health facilities: A positive deviance analysis of perceived drivers of primary care performance in Nepal.Social science & medicine (1982) · 2022Article
- Conducting rapid research to aid the design of a health systems governance intervention in the Somali Region of Ethiopia.Frontiers in sociology · 2022Article
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- Improving access to health services through health reform in Lesotho: Progress made towards achieving Universal Health Coverage.PLOS global public health · 2022Article
- Establishing evidence-based decision-making mechanism in a health eco-system and its linkages with health service coverage in 25 high-priority districts of Uttar Pradesh, India.BMC health services research · 2021Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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 district management capacity, health center management capacity was strongly associated (p < 0.05) with KPI performance. 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.
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