title: Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia.
abstract: In 2004, Ethiopia introduced a community-based Health Extension Program to deliver basic and essential health services. We developed a comprehensive performance scoring methodology to assess the performance of the program. A balanced scorecard with six domains and 32 indicators was developed. Data collected from 1,014 service providers, 433 health facilities, and 10,068 community members sampled from 298 villages were used to generate weighted national, regional, and agroecological zone scores for each indicator. The national median indicator scores ranged from 37% to 98% with poor performance in commodity availability, workforce motivation, referral linkage, infection prevention, and quality of care. Indicator scores showed significant difference by region (P < 0.001). Regional performance varied across indicators suggesting that each region had specific areas of strength and deficiency, with Tigray and the Southern Nations, Nationalities and Peoples Region being the best performers while the mainly pastoral regions of Gambela, Afar, and Benishangul-Gumuz were the worst. The findings of this study suggest the need for strategies aimed at improving specific elements of the program and its performance in specific regions to achieve quality and equitable health services.
authors.affiliation: Center for National Health Development in Ethiopia, Columbia University, Addis Ababa, Ethiopia; The Earth Institute, Columbia University, New York, New York hailaycnhde@ethionet.et.
authors.forename: Hailay D
authors.initials: HD
authors.lastname: Teklehaimanot
authors.affiliation: Center for National Health Development in Ethiopia, Columbia University, Addis Ababa, Ethiopia; The Earth Institute, Columbia University, New York, New York.
authors.forename: Awash
authors.initials: A
authors.lastname: Teklehaimanot
authors.affiliation: Center for National Health Development in Ethiopia, Columbia University, Addis Ababa, Ethiopia; The Earth Institute, Columbia University, New York, New York.
authors.forename: Aregawi A
authors.initials: AA
authors.lastname: Tedella
authors.affiliation: Center for National Health Development in Ethiopia, Columbia University, Addis Ababa, Ethiopia; The Earth Institute, Columbia University, New York, New York.
authors.forename: Mustofa
authors.initials: M
authors.lastname: Abdella
mesh_terms: D018672:Community Health Planning; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005002:Ethiopia; D006268:Health Facilities; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration / Q000592:standards; D012041:Regional Medical Programs / Q000592:standards; D012424:Rural Population; D014838:Volunteers