School of Population Health, University of New South Wales, Sydney, Australia.
The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Sydney, Australia.
BMC Health Serv Res. 2024 Sep 4;24(1):1021. doi: 10.1186/s12913-024-11455-5.
Ethiopia's health system is overwhelmed by the growing burden of non-communicable diseases (NCDs). In this study, we assessed the availability of and readiness for NCD services and the interaction of NCD services with other essential and non-NCD services.
The analysis focused on four main NCD services: diabetes mellitus, cardiovascular diseases, chronic respiratory diseases, and cancer screening. We used data from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. As defined by the World Health Organization, readiness, both general and service-specific, was measured based on the mean percentage availability of the tracer indicators, such as trained staff and guidelines, equipment, diagnostic capacity, and essential medicines and commodities needed for delivering essential health services and NCD-specific services, respectively. The survey comprised 632 nationally representative healthcare facilities, and we applied mixed-effects linear and ordered logit models to identify factors affecting NCD service availability and readiness.
Only 8% of facilities provided all four NCD services. Availability varied for specific services, with cervical cancer screening being the least available service in the country: less than 10% of facilities, primarily higher-level hospitals, provided cervical cancer screening. General service readiness was a strong predictor of NCD service availability. Differences in NCD service availability and readiness between regions and facility types were significant. Increased readiness for specific NCD services was significantly associated with increased readiness for communicable disease services and interacted with the readiness for other NCD services.
NCD service availability has considerable regional variation and is positively associated with general and communicable disease services readiness. Readiness for specific NCD services interacted with one another. The findings suggest an integrated approach to service delivery, focussing holistically on all disease services, is needed. There also needs to be increased attention to reducing resource allocation variation between facility types and locations.
埃塞俄比亚的卫生系统不堪重负，面临着日益增长的非传染性疾病（NCD）负担。在这项研究中，我们评估了 NCD 服务的可及性和准备情况，以及 NCD 服务与其他基本服务和非 NCD 服务的相互作用。
该分析侧重于四项主要的 NCD 服务：糖尿病、心血管疾病、慢性呼吸道疾病和癌症筛查。我们使用了 2018 年埃塞俄比亚服务可用性和准备情况评估（SARA）调查的数据。按照世界卫生组织的定义，基于培训人员和指南、设备、诊断能力以及提供基本卫生服务和 NCD 特定服务所需的基本药物和商品的 tracer 指标的平均可得性百分比，衡量了一般和特定服务的准备情况。该调查包括 632 个具有代表性的国家医疗保健设施，我们应用混合效应线性和有序逻辑回归模型来确定影响 NCD 服务可及性和准备情况的因素。
仅有 8%的设施提供了所有四项 NCD 服务。特定服务的可及性存在差异，宫颈癌筛查是该国最不可用的服务：不到 10%的设施，主要是较高级别的医院，提供宫颈癌筛查。一般服务准备情况是 NCD 服务可及性的有力预测因素。区域和设施类型之间的 NCD 服务可及性和准备情况存在显著差异。特定 NCD 服务准备情况的提高与传染病服务准备情况的提高显著相关，并与其他 NCD 服务的准备情况相互作用。
NCD 服务的可及性存在相当大的区域差异，与一般和传染病服务的准备情况呈正相关。特定 NCD 服务的准备情况相互作用。这些发现表明，需要采取综合服务提供方法，全面关注所有疾病服务。还需要更加关注减少设施类型和地点之间资源分配的差异。
