TY - JOUR
T1 - Exploring complementary and competitive relations between non-communicable disease services and other health extension programme services in Ethiopia
T2 - a multilevel analysis
AU - Tesema, Azeb Gebresilassie
AU - Peiris, David
AU - Joshi, Rohina
AU - Abimbola, Seye
AU - Fentaye, Fasil Walelign
AU - Teklu, Alula M.
AU - Kinfu, Yohannes
N1 - Funding Information:
AGT would like to acknowledge the financial support received from UNSW through the Scientia PhD Scholarship program. All authors would also like to thank MERQ consultancy group and Ministry of Health, Ethiopia for providing the national assessment Survey data, which was funded by the Bill & Melinda Gates Foundation grant.
Funding Information:
The UNSW Scientia Scholarship program supports AGT. SA was supported by the Australian National Health and Medical Research Council (NHMRC) through an Overseas Early Career Fellowship (APP1139631). RJ is supported by the Australian National Heart Foundation (APP 102059) and a UNSW Scientia Fellowship. DP is supported by NHMRC career Development Fellowship, Level 2 and Australia National Heart Foundation Future Leader Fellow. AT and FWF are employed by MERQ Consultancy PLC.
Publisher Copyright:
©
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background Ethiopia has recently revitalised its health extension programme (HEP) to address the rising burden of non-communicable diseases (NCDs). We examined the effects of existing essential HEP services on the uptake of NCD preventive services. Methods We applied a mixed-effect non-linear model with a logit link function to identify factors associated with a community resident's probability of receiving NCD prevention services through the HEP. The data were drawn from the Ethiopian HEP assessment Survey conducted in all regions. The analysis included 9680 community residents, 261 health extension workers (HEWs), 153 health posts, 119 health centres, 55 districts and 9 regions, which we combined hierarchically into a single database. Results In the 12 months before the survey, 22% of the sample population reported receiving NCD preventive service at least once. The probability of receiving NCD prevention service increased by up to 25% (OR=1.25, CI 1.01 to 1.53) if health centres routinely gathered NCD data from health posts and by up to 48% (OR=.48, CI 1.24 to 1.78) if they provided general (ie, non-NCD specific) training to HEWs. NCD preventive service uptake also increased if the HEW held level IV qualification (OR=1.32, CI 1.06 to 1.65) and lived in the community (OR=1.24, CI 1.03 to 1.49). Conversely, if facilities delayed general performance reviews of HEWs by a month, uptake of NCD prevention services decreased by 6% (OR=0.94, CI 0.91 to 0.97). We observed that better HIV/AIDS programme performance was associated with a lower uptake of NCD preventive services (OR=0.15, CI 0.03 to 0.85). Conclusion Despite efforts to improve NCD services through the HEP, the coverage remains limited. A strong HEP is good for the uptake of NCD preventive services. However, integration requires a careful balance, so that the success already recorded for some existing programmes is not lost.
AB - Background Ethiopia has recently revitalised its health extension programme (HEP) to address the rising burden of non-communicable diseases (NCDs). We examined the effects of existing essential HEP services on the uptake of NCD preventive services. Methods We applied a mixed-effect non-linear model with a logit link function to identify factors associated with a community resident's probability of receiving NCD prevention services through the HEP. The data were drawn from the Ethiopian HEP assessment Survey conducted in all regions. The analysis included 9680 community residents, 261 health extension workers (HEWs), 153 health posts, 119 health centres, 55 districts and 9 regions, which we combined hierarchically into a single database. Results In the 12 months before the survey, 22% of the sample population reported receiving NCD preventive service at least once. The probability of receiving NCD prevention service increased by up to 25% (OR=1.25, CI 1.01 to 1.53) if health centres routinely gathered NCD data from health posts and by up to 48% (OR=.48, CI 1.24 to 1.78) if they provided general (ie, non-NCD specific) training to HEWs. NCD preventive service uptake also increased if the HEW held level IV qualification (OR=1.32, CI 1.06 to 1.65) and lived in the community (OR=1.24, CI 1.03 to 1.49). Conversely, if facilities delayed general performance reviews of HEWs by a month, uptake of NCD prevention services decreased by 6% (OR=0.94, CI 0.91 to 0.97). We observed that better HIV/AIDS programme performance was associated with a lower uptake of NCD preventive services (OR=0.15, CI 0.03 to 0.85). Conclusion Despite efforts to improve NCD services through the HEP, the coverage remains limited. A strong HEP is good for the uptake of NCD preventive services. However, integration requires a careful balance, so that the success already recorded for some existing programmes is not lost.
KW - Community-based survey
KW - Health policies and all other topics
KW - Health services research
KW - Health systems
KW - Health systems evaluation
UR - http://www.scopus.com/inward/record.url?scp=85134826349&partnerID=8YFLogxK
U2 - 10.1136/bmjgh-2022-009025
DO - 10.1136/bmjgh-2022-009025
M3 - Article
AN - SCOPUS:85134826349
SN - 2059-7908
VL - 7
SP - 1
EP - 10
JO - BMJ Global Health
JF - BMJ Global Health
IS - 6
M1 - e009025
ER -
