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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