AVAILABILITY AND READINESS OF HEALTH FACILITIES FOR CHRONIC KIDNEY DISEASE, DIABETES, AND CARDIOVASCULAR DISEASE IN ETHIOPIA: EVIDENCE FROM SERVICE PROVISION ASSESSMENT DATA

 

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AVAILABILITY AND READINESS OF HEALTH FACILITIES FOR CHRONIC KIDNEY DISEASE, DIABETES, AND CARDIOVASCULAR DISEASE IN ETHIOPIA: EVIDENCE FROM SERVICE PROVISION ASSESSMENT DATA

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Daniel
Ketema
Daniel Ketema DKetema@georgeinstitute.org.au The George Institute for Global Health, Sydney Renal and Metabolic program Sydney Australia * UNSW Sydney Faculty of Medicine and Health Sydney Australia
Rohina Joshi rohina.joshi@unsw.edu.au Faculty of Medicine and Health, UNSW Sydney School of Population Health Sydney Australia - Walter Sisulu University South Africa
Workagegnehu Hailu workhailu@yahoo.com College of Medicine and Health Sciences, University of Gondar Department of Internal Medicine Gondar Ethiopia -
Martin Gallagher martin.gallagher@unsw.edu.au The George Institute for Global Health, UNSW Sydney Renal and Metabolic program Sydney Australia - UNSW Sydney Liverpool Clinical School Liverpool Clinical School Australia
Sradha Kotwal skotwal@georgeinstitute.org.au The George Institute for Global Health Renal and Metabolic program Sydney Australia - Prince of Wales Hospital UNSW, Sydney Randwick Australia
Min Jun mjun@georgeinstitute.org.au The George Institute for Global Health Renal and Metabolic program Sydney Australia - Faculty of Medicine and Health Faculty of Medicine and Health Sydney Australia
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Chronic kidney disease (CKD), diabetes, and cardiovascular disease (CVD) are major, interlinked public health challenges in Ethiopia. Sharing common risk factors, each condition heightens the risk of the others, compounding the disease burden and straining the healthcare system. However, little is known about the readiness of Ethiopian health facilities to manage these conditions. This study aimed to assess the readiness of health facilities to provide CKD, diabetes, and CVD care. 

This study used data from the Ethiopian Service Provision Assessment Survey (2021–22). Facility readiness for CKD, diabetes, and CVD services was determined based on the availability of four domains: staff and guidelines, basic equipment, diagnostic capacity, and essential medicines. Readiness score was calculated for each domain as the mean score of items and, the overall service readiness score was the mean score of all domains. Differences by facility characteristics were estimated with 95% confidence interval(CI). Facilities with an overall mean readiness score of 70% and above were classified as having "high readiness," while those scoring below 70% were classified as "low readiness. A survey-weighted multivariable logistic regression model was conducted to assess associated factors with the level of health facilities readiness. 

Among 901 surveyed facilities in Ethiopia (338 facilities based on weighted sampling)), 57% offered CKD, 93% diabetes, and 93% CVD diagnosis and/or management services. Mean readiness scores were 42.9% (95% CI: 40–46%) for CKD, 47.8% (95% CI: 45–50%) for diabetes, and 44.0% (95% CI: 41.8–45.9%) for CVD. In adjusted analyses, private/faith-based facilities had lower readiness for CKD care (adjusted odd ration [aOR 0.24, 95%CI:0.07–0.88]), while rural facilities had 74% lower readiness for CKD (aOR: 0.26; 95% CI: 0.08–0.83) and diabetes (aOR: 0.34; 95% CI: 0.16–0.72). Facilities with higher availability of basic amenities were more likely to be ready for CKD (aOR: 4.92; 95% CI: 1.71–14.10), diabetes (aOR: 3.56; 95% CI: 1.43–8.83), and CVD (aOR: 2.83; 95% CI: 1.05–7.59). Facilities receiving supervisory visits and holding staff meetings were also positively associated with the readiness level of health facilities.

Our findings suggest notable gaps in the healthcare system’s readiness to manage CKD, diabetes, and CVD, with disparities more pronounced in rural and non-public facilities. Addressing these gaps may require supportive supervision, staff engagement, expanded workforce training, reliable supply chains, and improved diagnostic capacity.

Kewords