Are Ethiopian schools of medicine producing competent medical graduates for providing quality health care in the era of COVID-19 pandemic?

BACKGROUND

Competent health workforce, including medical doctors, is the heart of health systems. Cognizant of this, Ethiopia is implementing licensure exam as a strategy to produce competent health workforce, including medical doctors and beyond, for the provision of high quality health care, among others. However, there is a dearth of evidence on medical graduates' competence in Ethiopia in the era of Covid-19 pandemic. Hence, this study aimed to assess the competence of medical graduates-based on licensure exam results in Ethiopia.

METHODS

A multi -center institution-based cross-sectional study was conducted among 1051 medical graduates (selected through cluster sampling method) from May - July 2022 in Medical Schools found in Amhara region, Northwest Ethiopia. Data were collected from secondary sources at the Ministry of Health and Medical Schools using a structured checklist. Data analysis was performed using SPSS Version 23 software. A binary logistic regression analysis was performed to identify factors associated with graduates' competence.

RESULTS

Nine hundred sixty-one (91.4%) medical graduates were competent. The study revealed that those graduates with older age (AOR: 0.63; 95% CI: 0.52, 0.76), being female graduates (AOR: 0.39; 95% CI: 0.22, 0.69), graduated in 2021 (AOR: 0.31; 95%; CI: 0.17, 0.60) and attending education in junior medical schools (AOR: 0.06; 95% CI : 0.01, 0.40) have lower competence as compared with that of their counterparts. Whereas, graduates with no repeating internship attachment (AOR: 2.41; 95% CI: 1.40, 4.17) and graduates with repeating academic year (AOR: 2.01; 95% CI: 1.14, 3.56) have better competence than that of their counterparts.

CONCLUSION

The proportion of competent medical graduates was relatively low as per the national strategic plan which aspires that all medical graduates to be competent. Medical graduate's competence was affected by age, gender, curriculum being implemented, and having academic as well as internship repeats. As result, policymakers should scale up competency based education in Medical Schools.

Leaving no one behind in health: Financial hardship to access health care in Ethiopia

BACKGROUND

Financial hardship (of health care) is a global and a national priority area. All people should be protected from financial hardship to ensure inclusive better health outcome. However, financial hardship of healthcare has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the incidence of financial hardship of healthcare and associated factors among households in Debre Tabor town.

METHODS

Community based cross sectional study was conducted, from May 24/2022 to June 17/2022, on 423 (selected through simple random sampling) households. Financial hardship was measured through catastrophic (using 10% threshold level) and impoverishing (using $1.90 poverty line) health expenditures. Patient perspective bottom up and prevalence based costing approach were used. Indirect cost was estimated through human capital approach. Bi-variable and multiple logistic regressions were used.

RESULTS

The response rate was 95%. The mean household annual healthcare expenditure was Ethiopian birr 12050.64 ($227.37). About 37.1% (95%CI: 32, 42%) of the households spend catastrophic health expenditure with a 10% threshold level and 10.4% of households were impoverished with $1.90 per day poverty line. Being old, with age above 60, (AOR: 4.21, CI: 1.23, 14.45), being non-insured (AOR: 2.19, CI: 1.04, 4.62), chronically ill (AOR: 7.20, CI: 3.64, 14.26), seeking traditional healthcare (AOR: 2.63, CI: 1.37. 5.05) and being socially unsupported (AOR: 2.77, CI: 1.25, 6.17) were statistically significant factors for catastrophic health expenditure.

CONCLUSION

The study showed that significant number of households was not yet protected from financial hardship of healthcare. The financial hardship of health care is stronger among the less privileged populations: non-insured, the chronically diseased, the elder and socially unsupported. Therefore, financial risk protection strategies should be strengthened by the concerned bodies.

Are Ethiopian diabetic patients protected from financial hardship?

Background

Globally, diabetes mellitus exerts an economic burden on patients and their families. However, the economic burden of diabetes mellitus and its associated factors were not well studied in Ethiopia. Therefore, the aim of this study is to assess the economic burden of diabetes mellitus and its associated factors among diabetic patients in public hospitals of Bahir Dar city administration, Ethiopia.

Methods

Across sectional study was conducted on 422 diabetic patients. The patients were selected by simple random sampling method. The prevalence-based model was used to estimate the costs on patients’ perspective. Bottom up and human capital approaches were used to estimate the direct and indirect costs of the patients respectively. Wealth index was constructed using principal component analysis by SPSS. Forty percent of nonfood threshold level was used to measure catastrophic diabetic care expenditure of diabetic patients. Whereas, the World Bank poverty line (the $1.90-a-day poverty line) was used to measure impoverishment of patients due to expenses of diabetes mellitus care. Data were entered by Epi data version 3.1and exported to SPSS version 23 for analysis. Simple and multiple logistic regressions were used.

Results

Four hundred one respondents were interviewed with response rate of 95%. We found that 239 (59.6%) diabetic patients incurred catastrophic diabetic care expenditure at 40% nonfood threshold level. Whereas, 20 (5%) diabetic patients were impoverished by diabetic care spending at the $1.90-a-day poverty line. Educational status of respondent, educational status of the head of household, occupation and wealth status were statistically associated with the catastrophic diabetic care expenditure.

Conclusions

The study revealed that the economic burden of diabetic care is very disastrous among the less privileged populations: the less educated, the poorest and unemployed. Therefore, all concerned stakeholders should design ways that can reduce the financial hardship of diabetic care among diabetic patients.