Assessment of Priority Non-Communicable Diseases and Injuries (NCDI) Interventions and Human Resourcing at Selected Health Facilities in Four Regions of Ethiopia

Abstract

Background and Rationale: Non-communicable diseases and injuries (NCDIs) are now major causes of mortality and morbidity globally. The Ethiopian NCDI Commission launched in 2018, estimated the burden of NCDIs as the causes of 52% of the total mortality and 46% of the DALYs lost. It also selected 218 health interventions for implementation, which will pave the way for Universal Health Coverage. The objective of the study includes to: assess the current delivery of the high-priority interventions for NCDIs at health facilities in Ethiopia to achieve Universal Health Coverage; assess the current staffing and organization of these services at various levels of the health system; identify major barriers to the delivery of recommended interventions; identify additional priority interventions that could be delivered or strengthened; determine what human resources are needed to deliver the additional interventions at First Level hospitals. Materials and Methods: A cross-sectional institution-based quantitative study was conducted at 39 purposively selected public health facilities from December 2020 to February 2021 using a structured quantitative survey. The study populations were facility managers and department coordinators. Data were analyzed manually for means, proportions, and we made comparisons between the health facilities. Results: A total of 39 health facilities were included in the survey from four Regional States in Ethiopia. It included 6 Referral Hospitals, 11 First Level Hospitals, and 22 Health centers. The proportion of priority Universal Health Coverage (UHC) interventions for Ethiopia offered by Referral Hospitals (RH), First Level Hospitals (FLH), and Health centers (HC) was 76%,71%, and 64%, respectively. The proportion of priority NCD and Injury interventions offered were in RH 65% and 81%, FLH 61% and 57%, and health centers 41% and 29%, respectively. The proportion of CMNN interventions offered by RH, FLH, and HCs was 91%,89%, and 89%, respectively. The proportion of NCDI interventions that were determined to be feasible were 73%, 62%, and 63%, respectively, for RH, FLH, and HCs. The major barriers in delivering NCDI services in Referral Hospitals were the shortage of medicines, equipment, and diagnostics; for FLH, however, the reasons were a shortage of human resources and medications followed by limited diagnostics; in Health Centers, lack of training of HCWs, lack of drugs and diagnostics were the major bottlenecks. For FLH, a detailed analysis showed that 27 priority NCDI interventions were of medium availability, and 30 priority interventions were of low availability. From these, for medium availability 22 of 27, and for low availability 10 of 30 interventions were highly feasible for implementation. Service integration platforms were deduced by logically rearranging the units and their required inputs. Discussion and recommendations: The delivery of priority NCDI interventions is less than priority CMNN Interventions, and this effect is exacerbated as you move from RH to FLH and HC levels. The major barriers in delivering NCDI services in Referral Hospitals were the shortage of medicines, equipment, and diagnostics; for FLH, however, the reasons were a shortage of human resources and medications followed by limited diagnostics; in Health Centers, lack of training of HCWs, lack of drugs and diagnostics were the major bottlenecks. In FLH, there were a group of medium and low availability services which were determined to be highly feasible for implementation by HF management. These high feasibility interventions can be introduced by integrating services through shared units, human resources, and other resources in the FLH. The establishment of NCD clinics in Health centers by training available staff on NCDs, Mental Health, and palliative care will help expand NCDI services.