Health service delivery and disease management across Ethiopian health care facilities: An evidence-based analysis of tuberculosis program performance and system determinants.

چکیده اصلی

BACKGROUND: Ethiopia's health system faces a triple burden of infectious diseases, notably tuberculosis (TB), non-communicable diseases (NCDs), and injuries, challenging service delivery in resource-limited settings. METHODS: We conducted a mixed-methods analysis of TB program performance and health system determinants across 112 Ethiopian health care facilities using a historical baseline dataset (2010-2011). We integrated quantitative data (spatial analysis and mixed-effects logistic regression) with qualitative insights (policy analysis and stakeholder interviews), adhering to RECORD and COREQ guidelines. RESULT: Pediatric TB detection was critically low (2.1% vs. WHO's 12%), and treatment success varied significantly by facility type (hospitals: 88.2%; primary health care units [PHCUs]: 63.8%; chi^2 = 34.2, p < 0.001). Key system bottlenecks included low staff density (0.7/1000) and supply chain interruptions strongly correlated with treatment failure (r = 0.72). Qualitative triangulation revealed that diagnostic uncertainty and irregular supervision directly compounded these institutional gaps. INTERPRETATION: We propose a "Five-Pillar Framework" diagnostic strengthening, community systems, supply chain reform, digital health, and governance improvements to advance universal health coverage (UHC). While based on foundational baseline data, these findings offer a transferable model for low- and middle-income countries (LMICs).

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