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Table 2 Emergent themes and key findings

From: Experiences of managerial accountability in Ethiopia’s primary healthcare system: a qualitative study

Themes

Key Findings

Development of a shared understanding of system-wide accountability

• Degrees of understanding about the link between accountability and performance are varied

• Focus is on accountability for individual performance as opposed to system-wide constructs of accountability

• Preserve the connection between rights and accountability; consider constraints on the ability of the worker or the organization to perform well

Streamlining of managerial accountability lines for healthcare managers

• Multiple, unsynchronized lines of accountability for healthcare managers exist

• Politically-driven appointments for technical roles at all levels, from the woreda to the Federal Ministry of Health, are common

• Poor merit-based appointment system creates lack of incentives for high performance

Strengthening of medico-legal knowledge and systems

• Patients lack knowledge of their legal rights in the case of a medical error

• Providers and institutions are unaware of what constitutes a medical mistake from a legal perspective

• Medico-legal capacity at both the individual and institutional levels needs strengthening

Development of mechanisms for bottom-up accountability

• Overall lack of responsiveness from higher levels in the health system

• Current systems for routine oversight are limited and are not designed to be responsive to complaints or other early signals

• Community and lower-level stakeholders should regularly evaluate higher-level health system entities