Health system capacity and readiness for delivery of integrated non-communicable disease services in primary health care: A qualitative analysis of the Ethiopian experience

Abstract

Background Non-communicable diseases (NCDs) now account for about 71% and 32% of all the deaths globally and in Ethiopia. Primary health care (PHC) is a vital instrument to address the ever-increasing burden of NCDs and is the best strategy for delivering integrated and equitable NCD care. We explored the capacity and readiness of Ethiopia’s PHC system to deliver integrated, people-centred NCD services. Methods A qualitative study was conducted in two regions and Federal Ministry of Health, Addis Ababa, Ethiopia. We carried out twenty-two key informant interviews with national and regional policymakers, officials from a partner organisation, woreda/district health office managers and coordinators, and PHC workers. Data were coded and thematically analysed using the World Health Organization (WHO) Operational Framework for PHC. Results Although the rising NCD burden is well recognised in Ethiopia, and the country has NCD-specific strategies and some interventions in place, we identified critical gaps in several levers of the WHO Operational Framework. Many compared the under-investment in NCDs contrasted with Ethiopia’s successful PHC models established for maternal and child health and communicable disease programs. Insufficient political commitment and leadership required to integrate NCD services at the PHC level and weaknesses in governance structures, inter-sectoral coordination, and funding for NCDs were identified as significant barriers to strengthening PHC capacity to address NCDs. Among the operational-focussed levers, fragmented information management systems and inadequate equipment and medicines were identified as critical bottlenecks. The PHC workforce was also considered insufficiently skilled and supported to provide NCD services in PHC facilities. Conclusion Strengthening NCD prevention and control through PHC in Ethiopia requires greater political commitment and investment at all health system levels. Prior success strategies with other PHC programs could be adapted and applied to NCD policies and practice, giving due consideration for the unique nature of the NCD program.

Readiness of the primary health care units and associated factors for the management of hypertension and type II diabetes mellitus in Sidama, Ethiopia

“…This outcome is consistent with findings from earlier Tanzanian ( Adinan et al, 2019 ), Zambian, and Malawian investigations ( Shiroya et al, 2021 ). The good reason for not providing DM and HPN at the rural health facilities could be improper supportive supervision from the nearby health offices, a little concern for NCDs, and a lack of political commitment ( Tesema et al, 2021 ; Bausch et al, 2021 ; Agunga, 2018 ).…”

Exploring complementary and competitive relations between non-communicable disease services and other health extension programme services in Ethiopia: a multilevel analysis

“…Our result showed a strong link between HEW performance evaluation practices and NCD prevention services, with delays in conducting assessments having a significant adverse effect on NCD uptake. While a qualitative study in Ethiopia suggests that PHC services receiving greater attention are more likely to be implemented,23 our findings demonstrate complementary effects, as none of the health system factors—such as overall HEW training, supportive supervision, and performance appraisal—captured in our study was explicitly aimed at NCDs.…”

“…Previous research BMJ Global Health on Ethiopia's NCD programme at the PHC level indicated that supervisors had minimal knowledge of NCDs while the supervision system itself lacked NCD focus. 23 Such a lack of a deeper understanding of NCD knowledge among supervisors is likely to lead to a greater emphasis on supporting programmes, they were familiar with and trained on; hence the insignificant association with NCD observed in the present study.…”

“…assessments having a significant adverse effect on NCD uptake. While a qualitative study in Ethiopia suggests that PHC services receiving greater attention are more likely to be implemented, 23 our findings demonstrate complementary effects, as none of the health system factorssuch as overall HEW training, supportive supervision, and performance appraisal-captured in our study was explicitly aimed at NCDs. However, the finding on training, which showed attendance by HEP coordinators as having a negative impact on NCD uptake, is contrary to conventional beliefs.…”

“…Kebele is the country’s lowest administrative unit and provides administrative support to the health post. A detailed description of Ethiopia’s health system has been reported elsewhere 23…”