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

Abstract

Background In low-income nations such as Ethiopia, noncommunicable diseases (NCDs) are becoming more common. The Ethiopian Ministry of Health has prioritized NCD prevention, early diagnosis, and management. However, research on the readiness of public health facilities to address NCDs, particularly hypertension and type II diabetes mellitus, is limited. Methods The study used a multistage cluster sampling method and a health facility-based cross-sectional study design. A total of 83 health facilities were evaluated based on WHO’s Service Availability and Readiness Assessment (SARA) tool to investigate the availability of services and the readiness of the primary health care unit (PHCU) to manage type II diabetes and Hypertension. Trained data collectors interviewed with PHCU head or NCD focal persons. The study tried to investigate (1) the availability of basic amenities and the four domains: staff and guidelines, basic equipment, diagnostic materials, and essential medicines used to manage DM and HPN, (2) the readiness of the PHCU to manage DM and HPN. The data were processed by using SPSS version 24. Descriptive statistics, including frequency and percentage, inferential statistics like the chi-square test, and logistic regression models were used to analyze the data. Results Of the 82 health facilities, only 29% and 28% of the PHCU identified as ready to manage HPN and DM. Facility type, facility location, presence of guidelines, trained staff, groups of antihypertensive and antidiabetic medicines had a significant impact (P < 0.05) on the readiness of the PHCU to manage HPN and DM at a 0.05 level of significance. Facilities located in urban were 8.2 times more likely to be ready to manage HPN cases than facilities located in rural (AOR = 8.2, 95% CI [2.4–28.5]) and P < 0.05. Conclusion and recommendation The results identified comparatively poor and deprived readiness to offer HPN and DM services at lower-level health facilities(health centers). Equipping the lower-level health facilities with screening and diagnostic materials, essential medicines, and provision of basic training for the health care providers and NCD guidelines should be available, especially in the lower health care facilities.

Lived experiences of people living with HIV and hypertension or diabetes access to care in Ethiopia: a phenomenological study

“…Our finding was consistent with a study conducted in southern Ethiopia, where shortages in the supply of diabetes care made it challenging to access diabetes care 32. The implementation of PHC level NCD services in Ethiopia is hampered by a lack of medical supplies and medication distribution 11 18. A qualitative study revealed a critical shortage of equipment and apparatus such as BP cuffs, glucometers, strips and NCD drugs at the PHC level in Ethiopia 11 19 21.…”

“…Prior studies revealed patient misconceptions, low awareness,14 lack of knowledge,15 shortage of trained HCPs, inadequate knowledge and skills of HCPs in NCD case management,16–18 lack of diagnostic materials, medicines and medical commodities to manage hypertension and diabetes18 19 and dissatisfaction with HCPs 19. A lack of regular screening and treatment, insufficient diagnostic and treatment facilities14 and stigma are the main barriers to accessing diabetes and hypertension services in Ethiopia 20 21.…”

Assessment of availability, readiness, and challenges for scaling-up hypertension management services at primary healthcare facilities, Central Highland region, Vietnam, 2020

“…A study from Uganda demonstrated a higher level of service readiness for hypertension management (86%), but with weaknesses in capacity of health staffs and lack of functional equipment [ 19 ]. While another study from Ethiopia reported lower levels of service readiness for Hypertension management at primary health care units (29%), influenced by insufficient equipment for screening and diagnostic, insufficient essential medicines, and lack of basic training and guideline for non-communicable diseases [ 20 ]. However, results should be interpreted with caution as the discrepancies between studies could be due to study location, sample size or instruments used.…”

Managing hypertension in rural Gambia and Kenya: Protocol for a qualitative study exploring the experiences of patients, health care workers, and decision-makers

“…Such barriers are compounded by misconceptions about aetiology and the potential benefits of pharmacotherapy 13 , which, along with an inability to afford medication, can lead to poor treatment adherence. At the health care worker level, poor communication, lack of skills and competencies, limited number of trained health workers, and inadequate referral systems complicate optimal treatment [15][16][17][18][19][20] . System-level barriers include poor access to health facilities, particularly in rural areas, unreliable supply of antihypertensive medications, poor coverage of national health insurance schemes, and underinvestment in health service infrastructure 16,19,[21][22][23] .…”