背景:权力下放最终涉及在卫生系统的较低级别的地方执行大多数医疗保健活动。然而,当执行不力时,权力下放会造成角色和责任的混乱。因此,这项研究的目的是评估立法指南的存在和使用,这些指南描述了在Jimma区卫生系统中决策的分散权力的分配,埃塞俄比亚西南部。
方法:2007年1月16日至3月15日在JimmaZone进行了采用定性和定量方法的横断面研究。联邦卫生部相关部门的卫生经理,奥罗米亚地区卫生局(RHB),JimmaZonal卫生部,这项研究包括了Jimma区的13家Woreda卫生局以及这些地区的卫生中心和卫生站。使用采访指南和为卫生系统每个级别准备的自我管理的结构化问卷收集数据。磁带记录的定性数据使用主题框架方法进行转录和分析,而Windows12.0.1版的SPSS用于分析获得的定量数据。
结果:根据区域指南,确保实现区域卫生服务目标是RHB的责任。这项研究中包括的97名健康管理人员(97.9%)很明显。然而,几乎相当比例的受访者,95人(95.9%)同意FMOH应该对此负责。同样,71(73.9%)的卫生管理人员知道,批准卫生预算和为当地资源生成所做的努力是Woreda行政委员会的责任,而其余27.1%的人不确定或不同意这一区域方向。几乎在每个功能区都观察到这种混乱。此外,大多数地区卫生办公室和卫生机构都没有立法准则。
结论:在国家和区域两级制定了描述卫生系统决策中分散权力分配的立法指南。然而,这项研究的结果表明,JimmaZone卫生系统中的卫生管理人员似乎对各个级别的角色和责任没有正确的认识。是的,因此,非常重要的是要澄清这种混淆以及能力建设努力,以匹配每个级别不断变化的角色。
BACKGROUND: Decentralization ultimately involves the execution of most health care activities at lower levels of the health system. However, when poorly implemented, decentralization can create confusion about roles and responsibilities. Therefore, the objective of this study was to assess the presence and use of legislative
guidelines depicting the distribution of decentralized authority for decision making in the Jimma Zone health system, Southwest Ethiopia.
METHODS: A cross sectional study employing both qualitative and quantitative methods was undertaken from 16(th) January to 15(th) March 2007 in Jimma Zone. Health managers at relevant departments of the Federal Ministry of Health, Oromia Regional Health Bureau (RHB), Jimma Zonal Health Department, 13 Woreda Health Offices of Jimma Zone and the health centers and health posts in these districts were included in the study. Data was collected using interview guides and self administered structured questionnaires prepared for each level of the health system. Tape-recorded qualitative data was transcribed and analyzed using thematic framework approach while SPSS for windows version 12.0.1 was used to analyze the quantitative data obtained.
RESULTS: According to the regional guidelines, ensuring achievement of regional health service targets is the
responsibility of the RHB. This was clear to 97 (97.9%) of the health managers included in this study. However, almost equivalent proportion of the respondents, 95 (95.9%) agreed that the FMOH should be responsible for this. Similarly, 71 (73.9%) of the health managers knew that approval of health budgets and efforts for local resource generation is the
responsibility of the Woreda Administrative Council while the remaining 27.1% were uncertain or disagreed about this regional direction. Such confusions were observed in almost every functional area. Moreover, legislative
guidelines were not available in most of the district health offices and health facilities.
CONCLUSIONS: Legislative
guidelines depicting the distribution of decentralized authority in decision making in the health system were prepared at national and regional levels. However, the findings of this study suggested that health managers in the Jimma Zone health system did not appear to have the right perceptions about roles and responsibilities of the various levels. It is, therefore, very important to clarify such confusions along with capacity building efforts to match the changing roles of each level.