Identification of relevant performance indicators for district healthcare systems in Ethiopia: a systematic review and expert opinion.

To identify potential performance indicators relevant for district healthcare systems of Ethiopia. Public Library of Medicine and Agency for Healthcare Research and Quality of the United States of America, Organization for Economic Cooperation and Development Library and Google Scholar were searched. Expert opinions, policy documents, literature reviews, process evaluations and observational studies published between 1990 and 2015 were considered for inclusion. Participants were national- and local-healthcare systems. The phenomenon of interest was the performance of healthcare systems. The Joanna Briggs Institute tools were adapted and used for critical appraisal of records. Indicators of performance were extracted from included records and summarized in a narrative form. Then, experts rated the relevance of the indicators. Relevance of an indicator is its agreement with priority health objectives at the national and district level in Ethiopia. A total of 11 206 titles were identified. Finally, 22 full text records were qualitatively synthesized. Experts rated 39 out of 152 (25.7%) performance indicators identified from the literature to be relevant for district healthcare systems in Ethiopia. For example, access to primary healthcare, tuberculosis (TB) treatment rate and infant mortality rate were found to be relevant. Decision-makers in Ethiopia and potentially in other low-income countries can use multiple relevant indicators to measure the performance of district healthcare systems. Further research is needed to test the validity of the indicators.

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