Evaluation of Hypertension Care Services in 93 Ethiopian Public Healthcare Facilities From 2019 to 2023: A Quasi-Experimental Study

Abstract

Background and aims: Hypertension is becoming a major public health issue in Ethiopia. However, there is limited comprehensive evidence on hypertension care, including service availability, utilization, and care quality. This study aimed to determine the effect of the NORAD-WHO-NCD intervention in improving the availability, utilization, and quality of hypertension care in public healthcare facilities.

Methods: A multicenter, quasi-experimental study comprising 31 interventions and 62 control public healthcare facilities was conducted across Ethiopia's six regions and one city administration between November 12 and December 31, 2023. A data abstraction form was used to collect relevant data spanning 54 months from various departments. To determine the independent effects of the intervention, a differences-in-difference regression model was used and p < 0.05 was used to indicate statistical significance.

Results: From 2019 to 2023, the percentage of healthcare facilities treating hypertension increased to 93.6% for intervention facilities and 90.3% for control facilities. The average monthly number of screenings performed in 2023 was 682 (95% CI 592, 772) among intervention and 278 (95% CI 238, 318) among control health facilities. In 2023, the average monthly number of newly diagnosed patients was 6 (95% CI 5, 7) by intervention and 4 (95% CI 3, 5) by control health facilities. Similarly, the average monthly number of patients receiving pharmacologic treatment was 138 (95% CI 103, 173) in intervention and 49 (95% CI 41, 57) in control facilities. In the intervention and control facilities, the average monthly number of patients with controlled blood pressure was 121 (95% CI 89, 154) and 49 (95% CI 40, 58), respectively. The intervention led to a monthly average increase of 425 hypertension screenings across all age groups (95% CI 131, 719, p = 0.04).

Conclusions: While intervention facilities showed notable improvements, hypertension care services remain limited nationwide, underscoring the need for scalable interventions to address regional disparities.

Keywords: Ethiopia; difference in difference model; hypertension care; noncommunicable diseases; primary healthcare; quasi‐experimental study.

Figure 1

Graphical diagnostic for the parallel trends and average number of clients screened for hypertension (A), newly diagnosed hypertensive patients (B), hypertensive patients on pharmacologic treatment (C), and hypertensive patients with controlled blood pressure (D) per month (n = 93 health facilities).