Integrated Primary Health Care in Ethiopia

Setting

Meskan, Mareko and Sodo districts of the Gurage Zone, Southern Nations, Nationalities and Peoples’ Region of Ethiopia, 100 to 130km south of the capital city, Addis Ababa. The Butajira Health and Demographic Surveillance Site (HDSS) is nested within the Meskan and Mareko districts. One general hospital (Butajira hospital), one primary hospital (Buee hospital), 18 health centres (8 in Sodo, 7 in Meskan, 3 in Mareko) and 125 health posts (58 in Sodo, 41 in Meskan and 26 in Mareko).

Disease Prevalence

Diabetes prevalence in adults is around 5% in urban2 and 2% in rural settings,2,3,4 and in urban settings  hypertension prevalence is around 25-30%.5,6,7 Most cases are undetected, or if detected uncontrolled. Capacity to diagnose and manage hypertension and diabetes is largely lacking at primary healthcare clinic level, and limited at primary hospital level.8 

Policy Landscape

Policy documents on mental health and non-communicable diseases stress integration of care within primary care to expand access, but the two strategies have been implemented vertically.  The Federal Ministry of Health is now scaling up the Ethiopian PHCG guideline nationally, bringing care for common non-communicable diseases (e.g. diabetes, hypertension, mental and substance use disorders), for the first time, into primary care. Scale up will include facility-based learning for primary care providers, mentoring from dedicated trainers and health system strengthening to support sustainability.  

Previous Research

Previous research in the same study districts on integrated PHC services for people with mental disorders have shown high levels of initial engagement but high levels of drop-out and intermittent follow-up. Patients and providers have an inadequate understanding of the need for ongoing care, and patients are not empowered for self-care management. The health system does not support care planning and co-ordination with health extension workers for community outreach.9 Low quality care and a failure to ‘treat-to-target’ adapting care according to response, are also significant concerns.

References

  1. All Party Parliamentary Groups on Global Health; HIV/AIDs; Population, Development and Reproductive Health; Global Tuberculosis; and Patient and Public Involvement in Health and Social Care. Patient empowerment: for better quality, more sustainable health services globally. London, UK: : APPG on Global Health 2014. http://www.appg-globalhealth.org.uk/reports/4556656050
  2. Abebe SM, Berhane Y, Worku A, et al. Diabetes mellitus in North West Ethiopia: a community based study. BMC Public Health 2014;14:97. doi:10.1186/1471-2458-14-97
  3. Worede A, Alemu S, Gelaw YA, et al. The prevalence of impaired fasting glucose and undiagnosed diabetes mellitus and  associated risk factors among adults living in a rural Koladiba town, northwest Ethiopia. BMC Res Notes 2017;10:251. doi:10.1186/s13104-017-2571-3
  4. Zekewos A, Loha E, Egeno T, et al. Prevalence of Diabetes Mellitus and Associated Factors in Southern Ethiopia: A Community Based Study. Ethiop J Health Sci 2018;28:451–60. doi:10.4314/ejhs.v28i4.11
  5. Tesfaye F, Byass P, Wall S. Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a silent epidemic. BMC Cardiovasc Disord 2009;9:39. doi:10.1186/1471-2261-9-39
  6. Asresahegn H, Tadesse F, Beyene E. Prevalence and associated factors of hypertension among adults in Ethiopia: a community based cross-sectional study. BMC Res Notes 2017;10:629. doi:10.1186/s13104-017-2966-1
  7. Awoke A, Awoke T, Alemu S, et al. Prevalence and associated factors of hypertension among adults in Gondar, Northwest Ethiopia: a community based cross-sectional study. BMC Cardiovasc Disord 2012;12:113. doi:10.1186/1471-2261-12-113
  8. Getachew T, Bekele A, Amenu K, et al. Service availability and readiness for major non-communicable diseases at health facilities in Ethiopia Atkure Defar, Habtamu Teklie, Girum Taye, Tefera Taddele, Geremew Gonfa, Misrak Getnet, Terefe Gelibo, Yibeltal Assefa, Amha Kebede, Sofonias Getachew. Ethiop J Health Dev 2017;31:384–90.
  9. Hailemariam M, Fekadu A, Prince M, et al. Engaging and staying engaged: a phenomenological study of barriers to equitable access to mental healthcare for people with severe mental disorders in a rural African setting. Int J Equity Health 2017;16:156. doi:10.1186/s12939-017-0657-0