Published in PLOS One on 2025-11-13, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. HealthSignal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Daniel Bekele Ketema, Min Jun, Sradha Kotwal, Workagegnehu Hailu, Martin Gallagher, Rohina Joshi
Source: PLOS One • DOI 10.1371/journal.pone.0336781
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Chronic kidney disease (CKD) is a growing public health problem in Ethiopia. However, evidence on the health system and contextual factors influencing CKD care remains limited. This study explored the barriers and facilitators to CKD care from the perspectives of healthcare providers and other stakeholders.
A descriptive qualitative study was conducted using purposive and maximum variation sampling to recruit healthcare providers (including general practitioners, nephrologists/internists, nurse) and non-communicable disease (NCD) officers and program coordinators. Interviews were audio recorded, transcribed, and thematically analysed, underpinned by the Theoretical Domains Framework version 2.
Fifteen participants (six general practitioners, five nephrologists/internists, one nurse, and three NCD program officers and coordinators) were included. About 40% of participants had over six years’ experience. Key barriers to CKD care included patient misconceptions, low patient and healthcare provider awareness, shortage of health workforce, knowledge gaps among junior healthcare providers, limited resources, high out-of-pocket costs, absence of registries for CKD, weak referral systems, inconsistent access to medicines and diagnostics, lack of structured training, and conflict-related disruptions. Facilitators included adherence to guidelines by senior staff, inclusion of CKD into national non-communicable disease strategies, and increased use of media for public health education.
Addressing key barriers and enhancing prioritisation of CKD by clinicians and policymakers is critical. Strengthening workforce capacity, awareness, referral systems, and integration into national strategies offers opportunities to improve CKD care.
Introduction
Chronic kidney disease (CKD) is a growing global public health concern, contributing significantly to morbidity, premature mortality [1–6], and healthcare costs [5–7]. Globally, an estimated 850 million people have CKD [8], accounting for 10% of the world’s population. CKD disproportionately affects low- and middle-income countries (LMICs), where access to preventive and curative care remains limited [11]. In Ethiopia, Emerging hospital-based observational studies indicate that CKD is a common health problem with diabetes, hypertension, and glomerular diseases being the most important causes [12–15].
Previous studies in Ethiopia have described various health system challenges related to the growing burden of chronic diseases, including but not specific to CKD [2,13,16–20]. These include limitations in healthcare infrastructure, access to services, resource constraints, and wider socioeconomic challenges [21,22]. Studies from other countries have identified several barriers and facilitators specific to CKD management, such as healthcare provider knowledge, patient awareness, health system organisation, and policy support [23–25]. However, differences in health system capacity, socioeconomic context, and cultural factors limit the generalisability of these findings to Ethiopia. To our knowledge, there is no existing evidence on the barriers and enabling factors for CKD management in Ethiopia. The objective of this qualitative study was to identify barriers and facilitators in CKD management in Ethiopia from the perspective of healthcare providers and key stakeholders who play a critical role in shaping CKD care.
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 financing & policy 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 Daniel Bekele Ketema, Min Jun, Sradha Kotwal, Workagegnehu Hailu, Martin Gallagher, Rohina Joshi. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by HealthSignal. The researchers are the authors of the source study, not members of HealthSignal’s staff.
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