Private Wing Policy Formulation Process, Its Effective Implementation and Associated Factors among Health Workforces in Public Hospitals of Addis Ababa, Ethiopia: Convergent Study Design

Abstract Background: The private wing health policy implementation has unintended policy effects like increasing medication error, absence of medical doctors in working hours, the presence of policy support to unfair revenue share among health workforces and inconsistent revenue-generating for the public ward. However, nothing is known about the policy formulation process and its effective implementation and associated factors. The purpose of this study was to describe the policy formulation process and estimate its effective implementation and associated factors among health workforces in public hospitals of Addis Ababa City Administration, Ethiopia. Methods: Convergent study design was used from June 18/2020 –Aug 8, 2020 among randomly selected 436 health workforces and purposively selected 6 Health Workforces who were Policymakers in Public Hospitals. Data were entered onto Epi Data software version 3.1 and exported to SPSS version 20 for further analysis. Data were cleaned by running simple frequency. Simple and multiple binary logistic regression analysis were done to identify associated factors with the outcome variable. Odds ratio along with 95% Confidence interval (CI) were estimated to measure the strength of the association. Then, thematic analysis was done based on codes conceptual relationship using Atlas Ti 8 Software for qualitative part. Results: Among 436 Health Workforces 409 were participated with a response rate of 93.8%. The overall effective policy implementation was 42.41%. In multiple binary logistic regression analysis, lack of effective coordination among various units (AOR=.293; 95% CI (.170, .505) was significantly associated with effective policy implementation. There were no any other alternative policy options seen during policy formulation by the actors involved. The formulation process was affected by actors involved and the context in which the policy was formulated. Conclusion: The overall implementation of the private wing policy is not effective and the policy formulation process doesn’t pass-through necessary policy formulation processes. That is why the unnecessary policy effects will remain challenging to the Government. Therefore, the coordination among various units which were designed to implement the private wing health policy should be strengthened, and also policymakers should follow sound policy formulation process.