Published in PLOS One on 2025-12-05, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Andualem Yalew Aschalew, Jenberu Mekurianew Kelkay, Getachew Teshale, Kaleb Assegid Demissie, Nebebe Demis Baykemagn, Azmeraw Tadele, Misganaw Guadie Tiruneh, Tesfahun Zemene Tafere, Asebe Hagos, Melak Jejaw
Source: PLOS One • DOI 10.1371/journal.pone.0336675
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
In response to the escalating non-communicable disease (NCD) challenge, effective management of NCDs requires sustained investments in infrastructure, trained health workforce, and the consistent availability of guidelines. Therefore, this study assessed both the availability and readiness of health facilities (HFs) to provide NCD-related services, while also examining how facility characteristics and health system factors are associated with service readiness.
We analysed data from the nationally representative Ethiopia Service Provision Assessment (ESPA) survey 2021−22 to determine the availability and readiness of HFs for cardiovascular diseases (CVDs), diabetes, chronic respiratory diseases (CRDs) and mental, neurological and substance (MNS) use disorders-related services using the WHO Service Availability and Readiness Assessment manual. Readiness score was measured as the average availability of tracer items in percent, and HFs were considered ‘ready’ for NCDs management if they scored ≥70 (out of 100). We performed weighted multivariable logistic regression to identify factors affecting NCD service readiness.
Approximately 93% reported offering services for diabetes, CVDs, and CRDs, while only 26% provided MH services. Overall service readiness remains critically low when applying the 70% readiness threshold. Only 15.68% of facilities were deemed ready for diabetes, 10.64% for CVDs, 3.14% for CRDs, and 11.52% for MNS use disorders-related services. Public facilities demonstrated significantly higher preparedness than private facilities. A number of factors have been associated with better service readiness, including the location of the facility, the level of the facility, having a quality control unit, conducting regular administrative meetings and receiving external supervision.
This study reveals that overall service readiness for NCDs remains significantly low across HFs in Ethiopia. Public facilities and facilities located in urban settings demonstrated significantly higher levels of service readiness, highlighting substantial disparities in resource availability, integration with national health programs, and access to support systems. These findings underscore the need for Ethiopia’s health system to move beyond service availability and focus on enhancing the preparedness of care delivery, with particular emphasis on equity and integration.
Introduction
Noncommunicable diseases (NCDs) killed at least 43 million people in 2021. Of all NCD deaths, 73% were in low- and middle-income countries (LMICs). The four major NCDs: Cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs) and diabetes, account for 80% of all premature NCD deaths [1].
In 2019, Ethiopia’s estimated number of NCD deaths was 219,284, making a death rate of 204 per 100,000. CVDs, cancers, CRDs, and diabetes were found to be among the leading causes of death rates. In addition, mental, neurological and substance (MNS) use disorders become prevalent [2]. Despite NCDs accounting for about 48% of mortality, the Ethiopian government’s efforts have primarily targeted infectious diseases and maternal health, leaving NCDs underfinanced [2]. The National Health Accounts report indicates that 68% of NCD services were financed by out-of-pocket expenditures from households, with only about 1% covered by development assistance [3,4].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Andualem Yalew Aschalew, Jenberu Mekurianew Kelkay, Getachew Teshale, Kaleb Assegid Demissie, Nebebe Demis Baykemagn, Azmeraw Tadele, Misganaw Guadie Tiruneh, Tesfahun Zemene Tafere, Asebe Hagos, Melak Jejaw. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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