Process evaluation of Operational Triple Zero program at Amhara National Regional state Public Hospital, Northwest Ethiopia, 2024

Abstract

Background One customized adolescent-focused service delivery model introduced by Ethiopia is Operation Triple Zero (OTZ), which stands for “Zero viral loads, Zero missed appointments, and Zero missed drugs.” The program also promotes other “zeros,” including zero stigma, zero deaths, zero sex for those abstaining, zero unprotected sex for the sexually active, and zero mother-to-child HIV transmission for pregnant and breastfeeding adolescents and young people, among others. OTZ enrolls adolescents’ ages 10-19 years old in peer support groups. Evaluation Objective: To evaluate the process of the OTZ program in the University of Gondar Comprehensive Specialized Hospital and Felegehiwot Comprehensive Specialized Hospital, Northwest Ethiopia, 2024. Methods: Facility-based single case study design with concurrent mixed method approach was used to evaluate the process of OTZ program. The focus of the evaluation was formative assessment of the process of OTZ program. The evaluation included availability, compliance and patient satisfaction dimensions. A total of 26 indicators, including availability (7), patient satisfaction (10) and compliance (9) indicators was used to measure the overall implementation of the program. A total of 500 clients were interviewed to assess the implementation status of the operational triple zero program. Multiple data collection approaches, such as exit interview, observation, and key informant interview were done. Quantitative data were gathered using Kobo and was exported to STATA version 14 for analysis. Binary logistic regression model was fitted to see the association of independent and dependent variable. In the multivariable logistic regression analysis adjusted odds ratio with 95%CI and P-value < 0.05 was used to determine the factors associated with patient satisfaction. The qualitative data was gathered by using in-depth interview with the key informants and transcribed in text format of Amharic and translated in to English language. Then was analyzed using thematic analysis manually. Results: The overall program implementation in the ANRS of Northwest Ethiopia revealed an overall process evaluation score of 80%. With availability of resources 75%, compliance to the standard was 89.32% and level of satisfaction of the clients was 80%. There was a problem of availability of trained staffs and shortage of supplementary foods like plumpinut for the malnourished clients. Not being comfortable with the waiting area was 67% less likely to be v satisfied (AOR = 0.33; 95% CI: 0.18, 0.58) compared to those who comfortable with the waiting area. Not thought of that the HCW did not had knowledge was 97.6% less likely to be satisfied (AOR = 0.0242; 95% CI: 0.0027, 0.2176) compared to those who thought the HCW had knowledge. Being satisfied with the OTZ program among participants who began the service less than a year ago were 90.58% times less likely to be satisfied (AOR = 0.45; 95% CI: 0.0017, 0.2176) compared to those who started the program since its inception and participating for one year. Conclusion and recommendations: The overall implementation of the program was very good. However, availability of trained health care workers were very low. There is a need to improve the status of HCW related to training. There were also inadequate funds to support and motivate children's participation, including only a small amount of pocket money provided. Additionally, some children, who lived far from the hospitals, needed transportation money, which led to missed appointments. Therefore, the hospitals should create more opportunities to train the HCW. Increase funds to support the implementation of the program.