ArticleBMC primary care2024
Barriers and enablers to improving integrated primary healthcare for non-communicable diseases and mental health conditions in Ethiopia: a mixed methods study.
Article in BMC primary care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Implementation strategies for evidence-based management of type 2 diabetes at primary healthcare facilities in low- and middle-income countries and related barriers and facilitators: a scoping review.Implementation science communications · 2026Pooled it
- Barriers and facilitators to integrating non-communicable disease care within primary healthcare systems in low-resource countries: a systematic review.BMC health services research · 2026Pooled it
- Bridging policy and practice: a scoping review of health system implementation research practice in Ethiopia.Implementation science communications · 2026Review
- Barriers and enablers in implementing integrated primary health care: A qualitative assessment in West Sumbawa District, Indonesia.PLOS global public health · 2026Article
- Implementation strategies for integrating non-communicable disease care into primary healthcare settings in sub-Saharan Africa: A systematic review.PLOS global public health · 2026Article
- Spatial Distribution of COVID-19 Diagnostic Services in Mopani District, Limpopo Province, South Africa.Public health challenges · 2025Article
- From separate streams to confluence: A framework for meaningful mixed methods integration in African primary care research.African journal of primary health care & family medicine · 2025Article
- Implementation science promotes clinical practice of guidelines: a scoping review.BMC health services research · 2025Article
- Associations between integrated family planning, maternal and newborn health, and immunization services and adoption of postpartum family planning and immunization services in Ethiopia.BMC public health · 2025Article
- Strengthening primary health care in Ethiopia: A scoping review of successes, challenges, and pathways towards universal health coverage using the WHO monitoring framework.PLOS global public health · 2025Article
- Ethiopian primary healthcare clinical guidelines 5 years on-processes and lessons learnt from scaling up a primary healthcare initiative.BMJ global health · 2024Article
- Article
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Authors and funding
13 authors.
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Abstract
backgroundThe Ethiopian Primary Healthcare Clinical Guidelines (EPHCG) seek to improve quality of primary health care, while also expanding access to care for people with Non-Communicable Diseases and Mental Health Conditions (NCDs/MHCs). The aim of this study was to identify barriers and enablers to implementation of the EPHCG with a particular focus on NCDs/MHCs.
methodsA mixed-methods convergent-parallel design was employed after EPHCG implementation in 18 health facilities in southern Ethiopia. Semi-structured interviews were conducted with 10 primary healthcare clinicians and one healthcare administrator. Organisational Readiness for Implementing Change (ORIC) questionnaire was self-completed by 124 health workers and analysed using Kruskal Wallis ranked test to investigate median score differences. Qualitative data were mapped to the Consolidated Framework for Implementation Science (CFIR) and the Theoretical Domains Framework (TDF). Expert Recommendations for Implementing Change (ERIC) were employed to select implementation strategies to address barriers.
resultsFour domains were identified: EPHCG training and implementation, awareness and meeting patient needs (demand side), resource constraints/barriers (supply side) and care pathway bottlenecks. The innovative facility-based training to implement EPHCG had a mixed response, especially in busy facilities where teams reported struggling to find protected time to meet. Key barriers to implementation of EPHCG were non-availability of resources (CFIR inner setting), such as laboratory reagents and medications that undermined efforts to follow guideline-based care, the way care was structured and lack of familiarity with providing care for people with NCDs-MHCs. Substantial barriers arose because of socio-economic problems that were interlinked with health but not addressable within the health system (CFIR outer setting). Other factors influencing effective implementation of EPHCG (TDF) included low population awareness about NCDs/MHCs and unaffordable diagnostic and treatment services (TDF). Implementation strategies were identified. ORIC findings indicated high scores of organisational readiness to implement the desired change with likely social desirability bias.
conclusionAlthough perceived as necessary, practical implementation of EPHCG was constrained by challenges across domains of internal/external determinants. This was especially marked in relation to expansion of care responsibilities to include NCDs/MHCs. Attention to social determinants of health outcomes, community engagement and awareness-raising are needed to maximize population impact.
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