Operationalising effective coverage measurement in Ethiopia: a qualitative study

Efforts to improve the quality of maternal, neonatal and child health services have intensified in Ethiopia. Consistent with global recommendations, measuring only coverage of these health services is no longer sufficient to assess their impact on population health. As a result, interest has grown in effective coverage measures that combine service access and service quality into one metric. However, operationalising effective coverage measurement in settings like Ethiopia requires understanding the context and feasibility with available data and resources. Thus, this study aimed to explore the demand for effective coverage measurement among Ethiopian key stakeholders and identify the actions needed to enhance its implementation in Ethiopia’s healthcare system. An explorative, qualitative study design was employed, and data was collected through semi-structured interviews. Nineteen key informants from national level, three regions (Amhara, Oromia and Gambela), and one administrative city (Addis Ababa) in Ethiopia, participated in the study from March to April 2023. Key informants were identified using a snowballing approach. This study received ethical approval from the London School of Hygiene and Tropical Medicine and the Ethiopian Public Health Institute ethical review boards. There is a strong demand for effective coverage measurement for decision making on health care quality in the Ethiopian health sector. The demand is characterised either for individual patient care or for tracking health system performance; currently, there is limited clarity on the distinction between these two needs. A strong sentiment exists for the use of routine health information system data for this purpose, although stakeholders acknowledge the limitations of this data source. To advance the effective coverage measurement agenda in Ethiopia, respondents recommend building confidence in the quality of data sources, the need for more guidance on how to generate effective coverage measures, and the need for government leadership to coordinate these efforts. The strong demand for effective coverage measures and the positive policy environment encourages further testing of effective coverage measurement in Ethiopia.