ArticleScientific reports2026
Readiness of Zanzibar's public health facilities to deliver NCD services: a cross-sectional survey toward UHC.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Non-communicable diseases (NCDs) are a growing public health challenge, particularly in low- and middle-income countries (LMICs), where weak health systems limit access to effective care. Achieving Universal Health Coverage (UHC) requires health facilities that are equipped and ready to deliver NCD services. However, evidence on the readiness of health facilities to provide these services in various contexts is limited. This study contributes to filling this gap by assessing the availability and readiness of health facilities to provide essential NCD services in the context of Zanzibar. We employed a facility cross-sectional survey and collected data across all 52 public and parastatal health facilities in Zanzibar using an adapted WHO Service Availability and Readiness Assessment (SARA) tool, incorporating elements from the Pen Plus survey and the Access Bottlenecks, Costs, and Equity (ABCE) survey tools. We generated readiness scores across various strata and used multiple regression analysis to examine factors associated with readiness. Readiness was assessed in terms of availability of trained workforce, essential medicines, diagnostic capacity, financial risk protection mechanisms, and patient registration and follow-up systems. We found an average readiness score of 54% across all facilities, with primary health care centers having the lowest readiness score (29%) compared to the referral hospital (73%). Readiness was particularly low in diagnostic and treatment services (40%), financing and payment mechanisms (31%), and essential medicines (53%), but comparatively higher in healthcare workforce (73%) and infrastructure readiness (69%). Lower-level facilities were associated with lower readiness scores after adjusting for key confounders in the multiple regression analysis. Availability of both inpatient and outpatient care was associated with significantly higher readiness (β = 10.50, p = 0.029). Primary health care facilities remain underprepared to deliver essential NCD services and overall readiness scores mask substantial variation by service type and facility. Strengthening service readiness will require targeted investments in workforce training, diagnostic capacity, supply chain systems, and financial protection measures to advance equitable NCD care as part of UHC efforts.
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