<p>Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design</p>

Abstract

Background: Tuberculosis (TB) remains a foremost global public health threat. Active TB control needs geographically accessible health facilities that have quality diagnostics, equipment, supplies, medicines, and staff. Objective: This study aimed at assessing the geographic distribution, physical accessibility, readiness and barriers of health facilities for TB services in East Gojjam zone, Ethiopia. Methods: A convergent parallel design was applied using health facility and geographic data. Data on facility attributes, service availability and readiness were collected by inteviewing TB officers, laboratory heads and onsite facility visits. Coordinates of health facilities and kebele centroids were collected by GPS. We used ArcGIS 10.6 to measure Euclidean distance from each kebele centroids to the nearest health facility. Descriptive statistics were computed by using SPSS version 25. Barriers to TB service readiness were explored by in-depth interviews. NVivo12 was used to thematically analyze the qualitative data. Results: The overall TB health service coverage (THSC) was 23% (ranging: 10-85%). The mean distance from the nearest health facility was 8km (ranging: 0.5-16km). About 132 (32%) kebeles had poor geographic accessibility to TB services (over 10km distance from the nearest health facility) and had poor facility readiness. Although 114 (95%) health facilities offered at least one TB service, 44 (38.6%) of them had no sputum smear microscopy. The overall TB readiness index was 63.5%: first-line anti-TB drugs (97%), diagnostics (63%), trained staffs, diagnostic and treatment guidelines (53%) and laboratory supplies (41%). Lack of health workers (laboratory personnel), inadequate budget, poor management practice and TB program support, inadequate TB commodity suppliers, and less accessible geographic locations of health facilities were identified as barriers to TB service readiness distribution. Conclusion: Considerable proportion of the population in the study area have poor access to quality TB diagnostic services due to low THSC and poor facility readiness. Barriers to TB service availability and readiness were health system related. Regular refresher training of health workers on TB, creating mechanisms to attract laboratory personnel to work in the study area and scaling up of sputum smear microscopy services, establishing an efficient mechanism for procurement, distribution, utilization and reporting of TB commodity supplies, and good management practices are crucial to enhance TB service readiness in the study zone.

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“…This is a critical issue that needs special attention from the concerned offices because prevention might be in place if HWs knew well the transmission routes. The low scores might be due to including more HWs from rural health facilities that had limited access to information sources and preventive devices [ 13 , 38 , 39 ].…”

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“…Distance from each kebele to the nearest health facility (elucidation distance) on the other hand was measured using GIS 10.6. The detailed procedures of measuring facility readiness and their distance from each kebele were stated by our former paper conducted in the study area [ 21 ].…”

“…Similarly, a 10km distance, a reference standard used by the Ethiopian ministry of health to measure access to health facilities, was used as a cut-off value to measure the distance of each kebele to the nearest health facility. Accordingly, areas within 10km distance from the nearest health facilities were categorized as had good access to health facilities (coded by 1), and those areas located beyond a 10km radius were categorized as had poor access to health facilities (coded by 2) [ 21 , 26 ]. Moreover, the population density of each kebele was grouped into two categories: areas with a population density less than the national population density/115/km2/(coded by 1) and areas greater than the national average population density (coded by 2).…”

“…2) The high TB burdens and the least TB CNR (46%) from all zones in the region [ 12 , 20 ]. 3) Many people have poor access to TB diagnostic and treatment services mainly due to a lack of laboratory staff, TB diagnostic equipment, reagents, and supplies [ 21 , 22 ]. 4) Based on our search, there is no former study on the spatial-temporal distribution of TB cases in East Gojjam Zone.…”

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“…First, the use of existing national standards as the basis for the analysis of the offer of services is new. Other studies 22,36 on the same topic have rather used standards that were set by a group of practitioners or were international standards. We have also used tools that have been developed to assess the implementation of international standards 9,11,18,37 and were contextualized to Senegal.…”