Explore the practice and barriers of collaborative health policy and system research-priority setting exercise in Ethiopia.

INTRODUCTION: Collaboration is gaining prominence in the priority setting of Health Policy And System Research (HPSR). However, its practice and challenges are not well explored in Ethiopia. Understanding the practice and barriers of collaborative Health Policy and System Research will help design approaches and platforms for setting inclusive and participatory policy and system-level health research topics. This paper explores the practice and barriers of collaborative HPSR-priority setting exercise in Ethiopia. METHODS: This study investigates the practice and barriers of collaborative health policy and system research priority-setting exercises in Ethiopia. Utilizing a mixed-methods approach, we conducted Key Informant Interviews (KIIs) and an online self-administered survey with open-ended questionnaires to capture diverse perspectives from stakeholders involved in the research priority-setting process. Through conventional content analysis, we identified key contents related to current practices, challenges, and opportunities for enhancing collaboration in health policy and system research prioritization. RESULTS: Our findings reveal a complex landscape characterized by varying levels of stakeholder engagement, institutional capacity constraints, and competing priorities within the health research ecosystem. Despite notable efforts to foster collaboration, stakeholders identified persistent challenges such as limited resources, institutional fragmentation, and inadequate coordination mechanisms as barriers to effective priority-setting processes. The implications of our research extend beyond academic discourse, with direct relevance to health policy and system research practice in Ethiopia. By shedding light on the dynamics of collaborative priority-setting exercises, our findings offer valuable insights for policymakers, researchers, and practitioners seeking to enhance the effectiveness and inclusivity of health research prioritization processes. Addressing the identified barriers and leveraging existing strengths in the research ecosystem can contribute to more evidence-informed health policies and programs, ultimately improving health outcomes for Ethiopian populations. CONCLUSIONS: Most institutions do not apply health policy and system research-priority setting to conduct informed decision-making. The barriers explored were weak integration, lack of knowledge, system, and platforms for the priority setting of Health Policy and System Resreach. So, it is recommended to build skills of different actors in the Health Policy and System Research-priority setting exercise and design a system and platform to integrate different stakeholders for collaborative research topics priority setting.

Health policy and systems research priority-setting exercise in Ethiopia: a collaborative approach.

INTRODUCTION: Health policy and systems research (HPSR) is a multi-disciplinary approach of generating health system and policy-level evidence. Setting HPSR agendas is considered as an efficient strategy to map and identify policy and cost-effective research topics, but its practice in developing countries is limited. This paper aimed to conduct a collaborative health policy and system research priority-setting exercise in Ethiopia. METHOD: The WHO's plan, implement, publish, and evaluate (PIPE) framework and the Delphi technique were used to conduct the priority-setting exercise. The PIPE model was used to lead the priority-setting process from planning to evaluation, while the Delphi technique was used to run the rating and ranking exercise with the aim of reaching a consensus. Two rounds of expert panel workshops supplemented with an online survey were used for the HPSR agenda setting, rating and ranking purposes. Groups were formed using the WHO health system building blocks as a base framework to identify and prioritize the HPSR topics. RESULT: Under 8 themes, 32 sub-themes and 182 HPSR topics were identified. The identified research themes include leadership management and governance, health policy, health information system, healthcare financing, human resource for health, medical products and supply, service delivery and cross-cutting issues. CONCLUSIONS: Priority HPSR topics focussing on national health priority issues were identified. The identified topics were shared with policymakers and academic and research institutions. Evidence generation on the identified priority topics will guide future research endeavours and improve evidence-informed decision-making practice, health system performance and national health goals and targets.

Medical documentation practice and associated factors among health workers at private hospitals in the Amhara region, Ethiopia 2021.

INTRODUCTION: Medical documentation is an important part of the medical process as it is an essential way of communication within the health care system. However, medical documentation practice in the private sector is not well studied in Ethiopian context. The aim of this study was to assess the practice of medical documentation and its associated factors among health workers at private hospitals in the Amhara region, Ethiopia. METHOD: An institution-based cross-sectional quantitative study supplemented with a qualitative design was conducted among 419 health workers at the private hospitals in the Amhara Region, Ethiopia from March 29 to April 29 /2021. Data were collected using both a self-administered questionnaire and interview guide for quantitative and qualitative respectively. Data were entered using Epi data version 3.1 and analyzed using SPSS version 20. Descriptive statistics, Bi-variable, and multivariable logistic regression analysis were performed. In-depth interviews were conducted using semi-structured questionnaires with eight respondents to explore the challenges related to the practice of medical documentation. Respondent's response were analyzed using OpenCode version 4.03 thematically. RESULTS: Four hundred seven study participants returned the questionnaire. Nearly 50 % (47.2%) health workers had of good medical documentation practice. Health workers who received in-service training on medical documentation AOR = 2.77(95% CI: [1.49,5.14]), good knowledge AOR = 2.28 (95% CI: [1.34,3.89]), favorable attitude AOR = 1.78 (95%CI: [1.06,2.97]), strong motivation AOR = 3.49 (95% CI: [2.10,5.80]), available guide line formats AOR = 3.12 (95% CI: [1.41,6.84]), eHealth literacy AOR = 1.73(95% CI: [1.02,2.96]), younger age AOR = 2.64 (95% CI:[1.27,5.46]) were statistically associated with medical documentation. CONCLUSION: More than half of the medical services provided were not registered. Therefore, it is important to put extra efforts to improve documentation practice by providing planed trainings on standards of documentation to all health workers, creating positive attitudes and enhancing their knowledge by motivating them to develop a culture of information.

Outcome evaluation of capacity building and mentorship partnership (CBMP) program on data quality in the public health facilities of Amhara National Regional State, Ethiopia: a quasi-experimental evaluation.

BACKGROUND: Capacity Building and Mentorship Partnership (CBMP) is a flagship program designed by the Ethiopian Ministry of Health in collaboration with six local universities to strengthen the national health information system and facilitate evidence-informed decision making through various initiatives. The program was initiated in 2018. This evaluation was aimed to assess the outcome of CBMP on health data quality in the public health facilities of Amhara National Regional State, Ethiopia. METHODS: A matched comparison group evaluation design with a sequential explanatory mixed-method was used to evaluate the outcome of CBMP on data quality. A total of 23 health facilities from the intervention group and 17 comparison health facilities from a randomly selected district were used for this evaluation. The Organization for Economic Cooperation and Development (OECD) evaluation framework with relevance, effectiveness, and impact dimensions was used to measure the program's outcome using the judgment parameter. The program's average treatment effect on data quality was estimated using propensity score matching (PSM). RESULTS: The overall outcome of CBMP was found to be 90.75 %. The mean data quality in the intervention health facility was 89.06 % [95 %CI: 84.23, 93.88], which has a significant mean difference with the comparison health facilities (66.5 % [95 % CI: 57.9-75]). In addition, the CBMP increases the data quality of pilot facilities by 27.75 % points [95 %CI: 17.94, 37.58] on the nearest neighboring matching. The qualitative data also noted that there was a data quality problem in the health facility and CBMP improved the data quality gap among the intervention health facilities. CONCLUSIONS: The outcome of the CBMP was highly satisfactory. The program effectively increased the data quality in the health facilities. Therefore, the finding of this evaluation can be used by policymakers, program implementers, and funding organizations to scale the program at large to improve the overall health data quality for health outcome improvement.

Level and contributing factors of health data quality and information use in two districts in Northwest Ethiopia: social-ecological perspective.

BACKGROUND: The health management information system has been implemented at all levels of healthcare delivery to ensure quality data production and information use in Ethiopia. Including the capacity-building activities and provision of infrastructure, various efforts have been made to improve the production and use of quality health data though the result is still unsatisfactory. This study aimed to examine the quality of health data and use in Wogera and Tach-Armacheho districts and understand its barriers and facilitators. METHODS: The study utilized a mixed-method; for the quantitative approach, institution-based cross-sectional study was conducted to determine the quality of health data and use by 95 departments in the two districts. The qualitative approach involved 16 in-depth interviewees from Wogera district. A descriptive Phenomenological design was used to explore factors influencing the quality and use of health data. The quantitative data were expressed descriptively with tables, graphs, and percent whereas the qualitative data were analyzed with content analysis guided by the social-ecological model framework. RESULT: The average levels of information use for Wogera and Tach-Armacheho districts were estimated at 29 and 35.9, respectively. The overall average level of accuracy of reports for six different health services in the HCs of Wogera and Tach Armacheho districts were 0.95 and 0.86, respectively. The qualitatively identified factors that influence the production and use of quality health data include valuing data, getting staff training, being a patriotic staff, and getting supportive supervision, were identified from individual-level characteristics; similarly, coaching, supportive supervision, and peer-to-peer learning from relational/interpersonal level characteristics, and organizational culture, incentive, infrastructure establishing accountability, and staff turnover, were identified from organizational level characteristics. CONCLUSION: The quality of data and routine information utilization was low and were influenced by a number of actors presented in and around the health system including individual, interpersonal, and organizational characteristics. Incentive affects data quality and information use directly or indirectly after modifying factors at all levels of the social-ecological model. Therefore, interventions should gear towards addressing multiple social-ecological factors of the health system concomitantly or intervene on incentive which has a multifaceted effect on the outcome.

Healthcare providers' digital competency: a cross-sectional survey in a low-income country setting.

BACKGROUND: Healthcare providers across all clinical practice settings are progressively relying and adapting information communication technologies to perform their professional activities. In this era of technology, healthcare providers especially in lower income countries should have at least basic digital competency if a successful application of technology is to be achieved. The aim of this study was to assess digital competency of healthcare providers among seven public health centers in North-West Ethiopia. METHODS: A cross-sectional study design was applied to assess the basic digital competency of healthcare providers working in seven public health centers in North-west Amhara regional state, Ethiopia. Self-administered questionnaire adopted from the European commission's digital competency framework for assessing digital competency were used. A multivariable logistic regression was performed to identify factors associated with basic digital competency with p-value< 0.05 as a rule out for statistical significance. The strength of association was explained in terms of coefficient estimate, adjusted odds ratio and a 95% confidence interval (CI). RESULT: From the total of 193 healthcare providers included in the study, 167 of them responded which is a response rate of 86.5%. The majority of respondents 88 (52.7%) were males and the mean age was 28.2 years with a standard deviation of 5.5 years. The result indicated that all items demonstrated an adequate level of internal consistency with Cronbach alpha > 0 .7. Healthcare providers in those public health centers reported that problem solving, safety and communication are the most common challenges encountered. The multivariable logistic regression model indicated that factors such as sex, educational status, profession type, monthly income and years of experience are statistically significant predictors. CONCLUSION: Basic digital competency level of healthcare providers working in public health centers in this setting is relatively low. The results highlight the need to improve digital competency among healthcare providers focusing on the identified skill gaps.

E-health literacy and associated factors among chronic patients in a low-income country: a cross-sectional survey.

BACKGROUND: Chronic patients persistently seek for health information on the internet for medication information seeking, nutrition, disease management, information regarding disease preventive actions and so on. Consumers ability to search, find, appraise and use health information from the internet is known as eHealth literacy skill. eHealth literacy is a congregate set of six basic skills (traditional literacy, health literacy, information literacy, scientific literacy, media literacy and computer literacy). The aim of this study was to assess eHealth literacy level and associated factors among internet user chronic patients in North-west Ethiopia. METHODS: Institutional based cross-sectional study design was conducted. Stratified sampling technique was used to select 423 study participants among chronic patients. The eHealth literacy scale (eHEALS) was used for data collection. The eHEALS is a validated eight-item Likert scaled questionnaire used to asses self-reported capability of eHealth consumers to find, appraise, and use health related information from the internet to solve health problems. Statistical Package for Social science version 20 was used for data entry and further analysis. Multivariable logistic regression was used to examine the association between the eHealth literacy skill and associated factors. Significance was obtained at 95% CI and p < 0.05. RESULT: In total, 423 study subjects were approached and included in the study from February to May, 2019. The response rate to the survey was 95.3%. The majority of respondents 268 (66.3%) were males and mean age was 35.58 ± 14.8 years. The multivariable logistic regression model indicated that participants with higher education (at least having the diploma) are more likely to possess high eHealth literacy skill with Adjusted Odds Ratio (AOR): 3.48, 95% CI (1.54, 7.87). similarly, being government employee AOR: 1.71, 95% CI (1.11, 2.68), being urban resident AOR: 1.37, 95% CI (0.54, 3.49), perceived good health status AOR: 3.97, 95% CI (1.38, 11.38), having higher income AOR: 4.44, 95% CI (1.32, 14.86), Daily internet use AOR: 2.96, 95% CI (1.08, 6.76), having good knowledge about the availability and importance of online resources AOR: 3.12, 95% CI (1.61, 5.3), having positive attitude toward online resources AOR: 2.94, 95% CI (1.07, 3.52) and higher level of computer literacy AOR: 3.81, 95% CI (2.19, 6.61) were the predictors positively associated with higher eHealth literacy level. CONCLUSION: Besides the mounting indication of efficacy, the present data confirm that internet use and eHealth literacy level of chronic patients in this setting is relatively low which clearly implicate that there is a need to fill the skill gap in eHealth literacy among chronic patients which might help them in finding and evaluating relevant online sources for their health-related decisions.

Intention to use electronic medical record and its predictors among health care providers at referral hospitals, north-West Ethiopia, 2019: using unified theory of acceptance and use technology 2(UTAUT2) model.

BACKGROUND: Electronic Medical Records (EMRs) are systems to store patient information like medical histories, test results, and medications electronically. It helps to give quality service by improving data handling and communication in healthcare setting. EMR implementation in developing countries is increasing exponentially. But, only few of them are successfully implemented. Intention to use EMRs by health care provider is crucial for successful implementation and adoption of EMRs. However, intention of health care providers to use EMR in Ethiopia is unknown. OBJECTIVE: The aim of this study was to assess health care provider's intention to use and its predictors towards Electronic Medical Record systems at three referral hospitals in north-west, Ethiopia, 2019. METHODS: Institutional based cross-sectional explanatory study design was conducted from March to September among 420 health care providers working at three referral hospitals in north-west Ethiopia. Data were analyzed using structural equation model (SEM). Simple and multiple SEM were used to assess the determinants of health care providers intention to use EMRs. Critical ratio and standardized coefficients were used to measure the association of dependent and independent variables, 95% confidence intervals and P-value were calculated to evaluate statistical significance. Qualitative data was analyzed using thematic analysis. RESULT: The mean age of the study subjects was 32.4 years ±8.3 SD. More than two-third 293(69.8%) of the participants were male. Among 420 health care providers, only 167 (39.8%) were scored above the mean of intention to use EMRs. Factors positively associated with intention to use EMRs were performance expectancy (ß = 0.39, p < 0.001), effort expectancy (ß = 0.24,p < 0.001),social influence (ß = 0.18,p < 0.001),facilitating condition (ß = 0.23,p < 0.001), and computer literacy (ß = 0.08,p < 0.001). Performance expectancy was highly associated with intention to use EMRs. CONCLUSION: Generally, about 40 % of health care providers were scored above the mean of intention to use EMRs. Performance expectancy played a major role in determining health care providers' intention to use EMRs. The intention of health care providers to use EMRs was attributed by social influence, facilitating condition in the organization, effort expectancy, performance expectancy and computer literacy. Therefore, identifying necessary prerequisites before the actual implementation of EMRs will help to improve the implementation status.

Mapping the Role of Digital Health Interventions to Enhance Effective Coverage of Antenatal Care: A Scoping Review.

Background: Antenatal care (ANC) is a core component of maternal health services. However, only half of the pregnant women in LMICs obtain WHO recommended minimum of four antenatal contacts. In addition, ANC 4+ is a commonly used indicator in monitoring ANC utilization. However, contact coverage alone provides no indications of service quality. In recent years, digital health interventions bring opportunities to provide quality maternal health care. Yet, there are few reviews on how digital health interventions contribute to improving effective coverage of antenatal care. A rigorous review that examines the role of digital health interventions in improving effective coverage of antenatal care is needed to examine how digital health solutions were rapidly deployed to support quality antenatal care service delivery. Objective: This review aimed to map evidence on the role of digital health solutions on quality of antenatal care service to enhance effective ANC coverage. Methods: A scoping review approach was used and four Databases (PubMed, Cochrane Library, Scopus and Embase) as well as search engines like Advanced Google Search and Google Scholar were searched from September 1 to 8, 2022. Thematic content analysis was used to present the findings. Results: A total of 1701 articles were searched. A total of 27 full-text studies were included in the final analysis. The most reported use of digital health was for client education and behavior change communication. Most studies showed that digital health interventions have proven effective in improving antenatal care. However, most of the studies did not address to assess the quality of ANC services. Conclusion: In this review, we found out that digital health solutions targeted at pregnant women can improve antenatal care services. There is body of evidence showing the effectiveness of digital health interventions on a range of maternal health outcomes. Few pieces of literature exist on the use of digital health interventions on the quality of antenatal care services. There is a need for more trial and program evaluation studies that examine the role of digital health interventions on the quality of ANC.

Maturity Assessment of District Health Information System Version 2 Implementation in Ethiopia: Current Status and Improvement Pathways.

BACKGROUND: Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. OBJECTIVE: This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. METHODS: A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. RESULTS: The national DHIS2 implementation's maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. CONCLUSIONS: On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed.

Poisoning cases and their management in Amhara National Regional State, Ethiopia: Hospital-based prospective study.

BACKGROUND: Poisoning is a significant public health problem globally. Ethiopia is a low-income country undergoing technological and social change that may increase access to drugs and chemicals, potentially increasing the incidence of poisoning. This study describes the epidemiology of hospital admissions due to poisoning in a region of Ethiopia. METHODS: An institution based prospective observational study was employed, as a study design, in selected hospitals of the region from January to December 2018. RESULTS: Of 442 poisoning cases, 78 (17.6%) died. Almost all poisoning cases were intentional self-poisonings. The most frequent poisonings were organophosphate compounds, 145 (32.8%), and metal phosphides (majorly aluminum phosphide), 115 (26.0%). The ingested poison was most frequently accessed from the patients' homes, 243 (55.0%), followed by purchases from local shops, 159 (36%). The median duration of admission was 24 hours. Of all the cases, 23 (5.2%) were admitted to intensive care units (ICU) requiring mechanical ventilation. Most of the cases admitted to the ICU were aluminum phosphide-poisoned patients. The majority of deaths (43 of 78) were due to metal phosphides. From the multivariate logistic regression analysis, altered level of consciousness on hospital arrival, metal phosphide poisoning, and no laboratory result as a part of the diagnosis process or investigation of the extent of toxicity were found to be significantly associated with the likelihood of poor treatment outcome. CONCLUSION: The majority of the poisoning cases were females. The most common reasons for the intent of self-poisoning were dispute-related, mainly family disharmonies, followed by psychiatric conditions. The poisoning agents were mostly obtained from households. Organophosphate compounds and metal phosphides were the first and the second most frequently encountered poisoning agents, respectively, and it was noted that the later ones were responsible for most of the fatal cases. Of the pharmacologic interventions, atropine was the only agent regarded as an antidote. The most commonly employed agent for supportive treatment was cimetidine followed by maintenance fluids, while gastric lavage was the only GI decontamination method used among others. The fatality rate of poisoning in this study was found to be much higher than in other similar studies. Impaired consciousness upon hospital arrival, metal phosphide poisoning, and no involvement of laboratory investigation were found to significantly associate with the likelihood of death. Generally, the results dictate the need for the design and implementation of strategies to create awareness, prevent, and manage poisoning incidences in the community.

Communicable and Non-communicable Diseases Diagnosis and Treatment Service Availability at Primary Health Care Units During COVID-19 Outbreak in Ethiopia.

Background: Non-communicable diseases (NCDs) pose a substantial global health challenge, resulting in an annual death toll of over 15 million individuals aged 30 to 69. Ethiopia, categorized as COVID-19 vulnerable, grapples with NCD treatment challenges. This study aims to assess disease service availability at primary health units in Ethiopia during the pandemic. Methods: A facility-based cross-sectional study was conducted from October to December 2021 across regions, encompassing 452 facilities: 92 health centers, 16 primary hospitals, 344 health posts, and 43 districts. Facility selection, based on consultation with regional health bureaus, included high, medium, and low performing establishments. The study employed the WHO tool for COVID-19 capacity assessment and evaluated services for various diseases using descriptive analysis. Results: Results reveal service disruptions in the past year: hospitals (55.6%), health centers (21.7%), districts (30.2%), and health posts (17.4%). Main reasons were equipment shortages (42%), lack of skilled personnel (24%), and insufficient infection prevention supplies (18.8%). While tuberculosis treatment was fully available in 23% of health posts and malaria services in 65.7%, some health centers lacked HIV/AIDS, cardiovascular, mental health, and cervical cancer services. Most communicable and non-communicable disease diagnoses and treatments were fully accessible at primary hospitals, except for cervical cancer (56.3%) and mental health (62.5%) services. Conclusion: Significant gaps exist in expected services at primary health units. Improving disease care accessibility necessitates strengthening the supply chain, resource management, capacity building, and monitoring systems.

Barriers Towards Obstetric Care Service Utilization in Ethiopia: An Explorative Qualitative Study.

Background: Obstetric care has been at the center of both global and national agendas. More than 50% of pregnant mothers are still preferring to give birth at home with some even after having full antenatal care. However, a few literatures looked at contributing factors for this problem but they are not conclusive and do not consider different sociocultural context of Ethiopia and different health service related barriers. Hence, the aim of this study was to explore barriers to obstetric care service utilization in Ethiopia using the socio-ecological model. Methods: Explorative qualitative study was employed involving key-informant interviews, in-depth interviews, and focus group discussions between October and December 2021; Individual, community, health system, and contextual barriers were explored. Atlas ti. Version 9 was used for analysis. Result: Lack of awareness, unfavorable perception, lack of partner involvement, cultural barrier, shortage of supplies, poor infrastructure, provider-related factors, poor monitoring, and evaluation system, challenging topography, and conflict were the major barriers that hinder mothers from receiving obstetrics service in Ethiopia. Conclusion: Lack of awareness, unfavorable perception, conflict, problems with health system structure and process, and cultural and geographical conditions were major barriers in Ethiopia. Therefore, packages of intervention is important to avail essential equipment, strengthening follow up system, create awareness, and increase access to health facilities is very important for service improvement by the government and non-governmental organizations. Additionally, implementing conflict resolution mechanism is important for addressing better obstetric service.

Essential Health Services Delivery Status During COVID-19 Pandemic in Ethiopia: A National Mixed-Methods Survey of Primary Healthcare Units.

Background: Essential health services are a package of services critical to improve health outcomes. COVID-19 pandemic disrupts essential health services. However, the level of essential health service disruption due to COVID-19 in Ethiopia is not clear. This study aimed at measuring the status of delivery of essential health services in Ethiopia during COVID-19. Methods: A national mixed-methods cross-sectional survey was conducted. It was undertaken in Amhara (10 districts), Oromia (eight districts), Sidama (six districts), Southern Nations, Nationalities, and People's Region (16 districts), and Dire Dawa City Administration. A total of 452 health facilities were surveyed. Data were collected using face-to-face interview. Descriptive analysis was undertaken. Qualitative data was analyzed thematically. Results: The woredas (districts) and health facilities which adopted essential health services before the COVID-19 pandemic were 81.4% and 51.2%, respectively. Nearly all health centers provided antenatal care services. Blood pressure measuring apparatus and delivery set were available in all health centers. However, only 50% of health centers had radiant warmer. Malnutrition services were provided by 47% of rural health centers. Moreover, a functional incinerator was available in only 41% of health centers. The provision of cardiovascular disease management was at 27.2%. Furthermore, HIV/AIDS treatment was provided by 43.5% of health facilities. Conclusion: The adoption of lists of essential health services was optimal. The status of delivery of essential health services was high for maternal healthcare. Neonatal care at birth, malnutrition treatment, and cardiovascular disease management were low. The district health system should strive more to maintain essential health services.

Barriers to Family Planning Service Utilization in Ethiopia: A Qualitative Study.

Background: The unmet need for family planning (FP) is a major impediment to achieving the sustainable development goal The COVID-19 pandemic and other contextual, individual, and hospital-related problems are major barriers that reduce FP service uptake. However, most of the studies are quantitative and give due focus to individual and community-level barriers. Therefore, this study tends to explore barriers to the utilization of FP in Ethiopia including health care and contextual barriers. Methods: A multiple explorative case study design was employed from October to December 2021 and a total of 41 Key-informant interviews, 32 in-depth interviews, and 13 focus group discussions were performed by using the purposive sampling technique. The data were analyzed with a thematic content analysis approach using NVivo software. Result: This study explored barriers to FP in four major teams; individual, community-related, health system, and contextual barriers. It reviled that the community's misconception, fear of side effects, lack of women's decision-making autonomy, existing socio-cultural norms, religious conditions, topography, covid 19 pandemic, and conflict were the major barriers to FP service utilization. Conclusion: Using the four teams mentioned above, this study identified different poor health professional skills, misconceptions, pandemics, functional, and structurally related barriers. As a result, it is recommended that health education for the community and training for health professionals are important. Collaboration between government and non-government organizations is also mandatory for strengthening mentorship and supervision systems and establishing resilient health care that can avoid future pandemics.

Availability of Maternal, Newborn care and Child Health Services at Primary Health Care Unit during COVID-19 Outbreak in Ethiopia.

Background: The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak. Methods: A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection. Result: During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale. Conclusion: Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.

Assessment of Availability of Tracer Drugs and Basic Diagnostics at Public Primary Health Care Facilities in Ethiopia During COVID-19 Pandemic.

Background: The emergence of COVID-19 pandemic has disrupted the supply chain and stock of medicines and drugs across the globe. Tracer drugs are essential medicines that address the population's priority health problems. Thus, this study aimed to assess availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia. Methods: Facility based cross-sectional study was employed in four regions and one city administration. The primary health care units (PHCUs) were purposively selected in consultation with respective regional health bureaus. Finally, 16 hospitals, 92 health centers and 344 health posts were included. This study adopted WHO's tool that was being used to rapidly assess the capacity of health facilities to maintain the provision of essential health services during the COVID-19. Descriptive analysis was done using frequency and percentage, and results were presented. Results: The overall mean availability of tracer drugs in PHCUs was 77.6%. Only 2.8% of PHCUs have all tracer drugs. The mean availability of basic diagnostic at national level was 86.6% in PHUs except health posts where it was less. Health facilities with all basic diagnostic services was 53.7%. Of the total 344 health posts assessed, 71% were providing diagnostic testing for malaria using either laboratory equipment or rapid diagnostic test (RDT) while 43% provide urine test for the pregnancy. Conclusion: This study shows availability of all tracer drugs in PHCUs in Ethiopia was extremely low. There was regional variation in availability of tracer drugs and basic diagnostics. It is very crucial to increase availability of tracer drugs and diagnostics. Drugs and diagnostic materials should be supplied according to the capacity and location of health facilities.

COVID-19 Infection Prevention Preparedness, Practices and Case Management in the Primary Health Care Units in Ethiopia.

Background: COVID-19 as pandemic declared by WHO on March 11, 2020 and first case detected in Ethiopia on March 13/2020. The COVID-19 caused a global crisis, including millions of lives lost, public health systems in shock and economic and social disruption. Strategies depend on how an existing health system is organized. Even though public health emergency operation centers of the Ethiopia switched to emergency response, there is no national evidence about infection prevention and control. Therefore, this project aimed to assess the level of infection prevention and control and management of COVID- 19 in Ethiopia, 2021. Methods: The cross-sectional study conducted at four regions and one city (Amhara, Oromia, SNNPR, Sidama Region, and Dire Dawa). Being with zonal health departments and woredas health offices, primary health care units were selected. The data were collected electronically through Kobocollect software from November 08-28/2021. Descriptive analysis like frequency and percentage was conducted by SPSS software version 25 and the results were presented by tables, figures and narration. Results: Data were collected from 16 hospitals, 92 health centers, and 344 health posts. All hospitals have designated COVID-19 focal person. There were significant number of woredas and PHCUs who didn't have IPC guidelines and protocols. About 11 woredas had no any type of diagnostic tests for COVID-19. Conclusions: The study revealed that there were significant gaps on Infection prevention and control practice, shortage of personal protective equipment, isolation and specimen transportation problem, lack of call centers. We recommend concerned bodies to fill the identified gaps.

Geographical weighted regression analysis of delayed antenatal care initiation and its factors among all reproductive-aged women in Ethiopia, 2016.

BACKGROUND: Delayed antenatal care is when the first visit is carried out after 12 gestational weeks. Despite the fact that many studies have been conducted on antenatal care initiation, little attention has been paid to its spatial pattern. Therefore, this study examine geographical weighted regression analysis of delayed antenatal care initiation and its factors among all reproductive-aged women in Ethiopia. OBJECTIVE: To assess geographical weighted regression analysis of delayed antenatal care initiation and its factors among all reproductive-aged women in Ethiopia, 2016. METHODS: This study was grounded on the 2016 Ethiopian Demographic Health Survey. It incorporated extracted sample size of 4740 (weighted) reproductive-aged women. ArcGIS version 10.8 and SaTScan™ version 9.7 software were employed to investigate geographic information. To distinguish factors associated with hotspot areas, local and global models were fitted. RESULT: the geographic pattern of Delayed antenatal care initiation was clustered (Moran's I = 0.38, p < 0.001). Kuldorff's spatial scan statistics discovered three significant clusters. The most likely cluster (LLR = 66.13, p < 0.001) was situated at the zones of SNNP and Oromia regions. In the local model, being uneducated, being poor wealth, having an unwanted pregnancy, and having higher birth order were factors associated with spatial variation of delayed antenatal care. CONCLUSION: The spatial pattern of delayed antenatal care in Ethiopia is clustered. Maternal education, wealth status, pregnancy desirability, and birth order were predictor variables of spatial variation of delayed antenatal care. Therefore, designing a hotspot area-based interventional plan could help to improve early ANC initiation.

Health Professionals' Attitude Toward the Use of Social Media for COVID-19 Related Information in Northwest Ethiopia: A Cross-Sectional Study.

Background: Social media platform is one way to share online information regarding pandemic prevention. However, there is no study regarding the attitude of health professionals toward social media use for the COVID-19-related information. This study aimed to assess health professionals' attitudes toward using social media for COVID-19-related information. Methods: An institution-based cross-sectional study was conducted among 355 health professionals in Bahir Dar city public health centers, Northwest Ethiopia. A pretested self-administered questionnaire was used to collect the data. The data were entered by EPI-data version 4.6 and analyzed using SPSS version 23 software. Descriptive statistics, bivariable, and multivariable logistic regression analysis were used to describe respondents' attitudes toward using social media for COVID-19 information and identify associated factors. An adjusted odds ratio (OR) and a p-value with a 95% CI were calculated to measure the strength of the association and assess statistical significance. Result: Out of 341 participants, about 73% of the participants had a good attitude toward the use of social media for COVID-19 information. Age < 24 [adjusted odds ratio (AOR) = 3.74, 95% CI: (1.53-9.13)] and age group 25-34 years [AOR = 2.25, 95% CI: (1.04-4.86)], computer training [AOR = 2.03, 95% CI: (1.03-4.00)], usefulness of social media [AOR = 3.25, 95% CI: (1.58-6.67)], and trustworthiness [AOR = 3.57, 95% CI: (1.93-6.60)] were enabling factors for attitude toward the use of social media for COVID-19 related information. Conclusion: Health professionals had a moderate attitude toward using social media for accessing COVID-19-related information. This implies that after considering positive attitude predictors, such as providing basic computer training, emphasizing the usefulness of social media, and building trusted social media pages, social media platforms can be used as a source of COVID-19-related information for health professionals.