Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care

Abstract

Objective: This study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia.

Design: Secondary data analysis of institution-based cross-sectional national survey data.

Setting: Data were obtained from the 2021-2022 Ethiopian Service Provision Assessment (ESPA) survey which includes all active health facilities in Ethiopia.

Participants: This study included all health facilities that provide DM services (both diagnosis and treatment) and recently collected DM data during the 2021-2022 ESPA survey.

Outcome measures: The service availability was computed as the percentage of facilities offering DM services to provide TB management. The preparedness of these facilities for managing TB was measured using three service tracer indicators (staff training and guidelines, diagnostics and essential medicines used in TB management) defined by the WHO Service Availability and Readiness Assessment Manual. The extent of preparedness was categorised as low level (<50%), moderate level (≥50% to 75%) and high level (≥75%). A descriptive statistic was employed to present the study findings.

Results: Only 170 out of 338 facilities were reported to provide DM services across the country, with 136 (70%) also offering TB management services. Among these facilities, the majority were health centres (n=82; 60.1%), publicly owned (n=98; 72.0%), rural (n=83; 60.7%) and located in the Oromia region (n=53; 39.0%). Regarding preparedness, facilities offering DM services had an overall moderate to high preparedness for managing TB, with 47 (27.5%), 53 (31.1%) and 70 (41.3%) facilities classified as low-level, moderate-level and high-level preparedness, respectively. Specifically, these facilities were less prepared in the domains of 'trained staff and guidelines' and 'diagnostics', but had better preparedness in providing first-line TB drugs, with an overall score of 79.7%.

Conclusions: Although the percentage availability of TB services in facilities offering DM services and their preparedness was unsatisfactory compared with WHO standards, Ethiopia has a greater capacity to implement WHO strategies to reduce the burden of TB-DM comorbidity. However, given the high epidemiological risk and the high burden of both diseases in the country, our findings emphasise the urgent necessity to establish and implement a collaborative TB-DM care plan to integrate TB services within facilities providing DM care.

Keywords: general diabetes; health policy; tuberculosis.

Figure 1. Selection of healthcare facilities (HFs) included in this study. DM, diabetes mellitus; ESPA, Ethiopian Service Provision Assessment.

Figure 2. Availability of basic service components that support the provision of TB management (n=136). MDR-TB, multidrug resistant-tuberculosis.

Figure 3. The percentage distribution of health facility preparedness for treatment of TB by facility characteristics. DM, diabetes mellitus; SNNP, South Nation Nationalities and People; TB, tuberculosis.