Abstract:
Background: Decentralization through the establishment of hospital governing boards has been touted as an
effective way to improve the quality and efficiency of hospitals in low-income countries. Although several studies
have examined the process of decentralization, few have quantitatively assessed the implementation of hospital
governing boards and their impact on hospital performance. Therefore, we sought to describe the functioning of
governing boards and to determine the association between governing board functioning and hospital performance.
Methods: We conducted a cross-sectional study with governing board chairpersons to assess board (1) structure,
(2) roles and responsibilities and (3) training and orientation practices. Using bivariate analysis and multivariable
regression, we examined the association between governing board functioning and hospital performance. Hospital
performance indicators: 1) percent of hospital management standards met, measured with the Ethiopian Hospital
Reform Implementation Guidelines and 2) patient experience, measured with the Inpatient and Outpatient Assessment
of Healthcare surveys.
Results: A total of 92 boards responded to the survey (96% response rate). The average percentage of EHRIG standards
met was 58.1% (standard deviation (SD) 21.7 percentage points), and the mean overall patient experience score was
7.2 (SD 2.2). Hospitals with greater hospital management standards met had governing boards that paid
members, reviewed performance in several domains quarterly or more frequently, developed new revenue
sources, determined services to be outsourced, reviewed patient complaints, and had members with knowledge
in business and financial management (all P-values < 0.05). Hospitals with more positive patient experience had
governing boards that developed new revenue sources, determined services to be outsourced, and reviewed
patient complaints (all P-values < 0.05).
Conclusions: These cross-sectional data suggest that strengthening governing boards to perform essential
responsibilities may result in improved hospital performance.
