PEPFAR-supported partnership linking Debre Berhan Referral Hospital with Elmhurst Hospital Center helped rural hospital emerge as national benchmark

A team from Debre Berhan Referral Hospital traveled to Addis Ababa on April 4 to accept accolades and monetary awards for once again earning a place as one of the country’s top-performing hospitals from the Federal Ministry of Health. From left to right, Hospital CEO Ato. Police Abebe, Medical Director Dr. Fiseha Tadesse Mogessie, former Hospital CEO Ato. Getachew Werku, and Psychiatric Department Head Dr. Dessalegn Asmare.

AIHA’s partnership linking Debre Berhan Referral Hospital in Ethiopia with Elmhurst Hospital Center in New York City may have graduated from our HIV/AIDS Twinning Center Program’s technical assistance nearly two years ago, but the strong foundation for positive change that resulted from the alliance continues to pay dividends.

For the third year in a row, Ethiopia’s Federal Ministry of Health recognized Debre Berhan as one of the country’s top-five hospitals, presenting the institution with a 5 million Birr award (equivalent to USD 277,000) for the best performance in providing support to its cluster hospitals in the rural Amhara Region.

At a gala ceremony hosted by the Ministry at the African Union Auditorium in Addis Ababa on Monday, April 4, Deputy Prime Minister Demeke Mekonnen lauded the accomplishments of Debre Berhan, along with the four other top-performing hospitals in Bisidimo, Lemlemcarl, Burmeda, and Hidar Asreand — the latter two being former cluster hospitals supported by Debre Berhan. Two of the cluster hospitals that Debre Berhan currently supports — Alem Ketema and Woldiya — were also honored by the Ministry of Health for their achievements and awarded 3 million Birr each. As lead cluster hospital, their success resulted in the Ministry awarding Debre Berhan an additional 1 million Birr.

“The high-level performance of these hospitals has demonstrated to us all that it is possible to improve and to achieve great things,” the Deputy Prime Minister said, noting that each institution had worked hard for their success over the course of several years. “These hospitals are not like a shooting stars, rather they have sustained this high standard of service over the years,” he stressed.

“Our partnership with Elmhurst was not superficial. It brought practical changes in attitudes and operations to our hospital, which has been the basis for our success,” explains Dr. Fiseha Tadesse Mogessie, Debre Berhan’s Medical Director, stressing that this peer-to-peer institutional approach to technical assistance had real depth, with a strong focus on making sustainable and holistic improvements.

“I am so proud of the continued growth and success of our Debre Berhan partners as demonstrated by national recognition from the Ethiopian Government for the past three years in a row,” says AIHA Country Director for Ethiopia Kidest Hailu.

“I witnessed first-hand on many occasions the strong professional and personal bonds forged between the Debre Berhan team and their counterparts at Elmhurst. Moreover, I also have seen the remarkable improvements in quality of care, staff skills and morale, and patient satisfaction that are a direct result of this partnership, which received support from the US President’s Plan for AIDS Relief (PEPFAR), the US Centers for Disease Control and Prevention (CDC) in Ethiopia, and the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) for seven years. Truly, the technical assistance they received, coupled with Dr. Fiseha’s visionary leadership, has helped them emerge as a benchmark hospital for the whole country,” she continues.

Dr. Fiseha agrees. “When our twinning partnership launched in 2007 and I visited Elmhurst for the first time, I realized there were two possible scenarios for the future. Scenario one was for us to witness the high level of care provided at Elmhurst and believe that anything similar would simply be unattainable for Debre Berhan, which would lead to frustration and helplessness,” he recalls. “Under scenario two, we would be inspired by Elmhurst’s success and use that inspiration to redirect our resources and change our approaches to better serve our community. We chose scenario two.”

When Dr. Fiseha describes with pride the many positive changes that have taken place at Debre Berhan as a result of their partnership with Elmhurst, he’s quick to point out the high level of coordination, hard work, and dedication it took for his staff — and from the Elmhurst team, who provided technical assistance and support — to transform Debre Berhan into a benchmark hospital for all of Ethiopia.

Debre Berhan and Elmhurst partners during a professional exchange to Ethiopia. From 2007-2014, partners conducted a number of these exchanges, which are a two-way transfer of knowledge, skills, and technologies. During this time frame, US Government funding for the partnership was $1.2 million, which AIHA leveraged with an additional $2.1 million in in-kind contributions of professional time and material resources as a result of our voluntary, peer-to-peer, institutional twinning model.

“We may not be able to replicate all of the latest technologies and procedures utilized at Elmhurst just yet,” Dr. Fiseha says, “but we have been able to improve so many things that make a real difference for our patients and their families, as well as for our staff and theirs.”

If you ask staff from Debre Berhan or Elmhurst what they think about twinning, they might say that it helps them to understand the context and environment in which people work by direct observation and discussion; identify mutual goals based on real-life, on-the-ground analysis; and develop sustained interpersonal and professional relationships, breaking down barriers and defenses that often serve as barriers to achieving these goals. They might also explain that twinning is an extremely cost-effective and sustainable model of technical assistance — one that the Debre Berhan team has already successfully replicated in their efforts to train staff at nearby rural hospitals in what has become a geometric progression of learning.

Elmhurst Hospital Center’s Medical Director, Dr. Joseph Masci, says, “The nature of the twinning model … working so closely with our exact counterparts over several years and developing these long-term professional and personal relationships is something that is just not possible with any other form of technical assistance. There is a special value to this process where colleagues can work and grow together. When we got to go over as a team, we were able to see each other in a different light as we all responded to the challenges of working in the Ethiopian setting. It fostered a genuine camaraderie among the Elmhurst team and got us to look at our own work processes more critically.”

Like the successful and ongoing transformations that have taken place at Debre Berhan, the personal and professional relationships forged with their Elmhurst colleagues have been sustained well beyond the graduation of the partnership in September 2014.

“Following the partnership graduation, we have continued to communicate and work together with Elmhurst Hospital. HIV/AIDS Nurse Neil Landreville, who retired from Elmhurst soon after the graduation, spent more than a year since then dedicating his personal time and money to support our hospital,” Dr. Fiseha says. “Other Elmhurst nurses have also continued to support us and, spearheaded by Neil and Dr. Masci, secured a private donation of viral load tests to support our ART program. Currently we have to send the tests to a laboratory in Addis Ababa, but we are in the process of building a lab at Debre Berhan that will enable us to process the tests here,” he reports.

AIHA’s institutional twinning model is a unique approach to health systems strengthening. It fosters long-term personal and professional relationships that often last well beyond the funding period. Here at Elmhurst Hospital Center in Queens, the US partners commemorated this bond by installing an engraved brick in the entry way to the New York hospital. In Debre Berhan, the Ethiopian partners have renamed a street on the hospital campus Elmhurst Road.

According to Dr. Keseteberhan Admasu, Ethiopia’s Minister of Health, hospitals were evaluated on four performance indicators: maternal and child health; clean and safe hospital environment; Ethiopian Hospital Reform implementation; and, for referral hospitals, support provided to their cluster hospitals. In total, 31 hospitals were selected by the Ministry for various awards.

Another AIHA partnership institution, St. Paul Hospital Millennium Medical College in Addis Ababa, was one of just two university hospitals awarded 3 million Birr. Speaking at the April 4 ceremony, he explained that a new criterion for the coming year will focus on patient satisfaction and the provision of compassionate, respectful, and caring service.