Ethiopian Journal of laboratory Medicine Volume 2 Number 2 December 2015
www.emlaeth.org
Original Artide Diagnostic laboratory sa-viceavailability Theodros GetacheN", Am:nu\ TereteGelibo\
in Ethiopia: Health Facility Assessment
Abebe Bekele', Atkure Detar',
Mekonnen
Tadesse', Habtarru
Teklie',
Kassahun
Yibeital fl.s:Sa', Antla Kebede'
I Abstract
Background: The SJrvey is designed to gerl€rate a set of indicators on key inputs and outputs of the health &)'StEm, which can be used to I'TS3SJre progress in hE9lth system sralgthooing. The aim of the SJrYey was to ~ the availability and preparedness of health facilities in Ethiopia to provide quality laboratory services. Method: The ag:essIBlt was part of the 2014 Ethiopia ~vice Provision ~IBIt Plus (E9'A+ 2014) SJrvey. A total of 1,327 health facilities (hospitals, ~EdEd health centers, private dinies, and health posts) wereassessej. Of tl1e93, 1165 (88%) fadlitieswere inducted in this sudy. ReSJlts: Fifty seven perCEnt of thefacilitiesexduding health posts in Ethiopia had laboratory diagno&ic services, HIV diagnostic tESt (59 %) is the rros comronly providEd basic laboratory sevices Liver or reoal function tess were the leas (7 %) provided laboratory 93rvices in Ethiopia. Twenty three perCEnt of facilitiesexduding health poss providEd haerroglobin tESts. Facilities managed by non-governrrental organisations (40 %) offered i1aa'n:)globin test. Facilities in urban areas (37 %) offered gra:rter proportion of the savices corrpered to facilities located in rural areas (13%). Com'ronly providej laboratory 93rvia::s in Ethiopian facilities (hospitals, higher dinies, and rrajium dinics) were CS=/body fluid analysis (45 %), and sool rncroscopy (42 %). Majority of referral ~tals and gerl€ral hospitals (94%), and most of higher clinics (88 %) offered Gram's stain test). The least available advanca:i diagno&ic services in Ethiopian facilities exduding health poss indude 93rum elEdrolyte tESt (10 %), full blood oount with differerltial (10 %). blood typing and cross matching (3 %), CD4 oount (3 %), ~ilis oorology (3 %), TB culture (1 %), and TB rapid tests « 1%).CD4 oount was paforrred in less than 10 % of the facilities in all regions. ~um electrolyte and full blood oount tess were done one in four facilities found in Addis Ababa, Harari, and Dire Dawa. Fifty three perCEnt of the health poss provide malaria diagnostic tess and fourteen perCEnt of the bealth poss offer HIV diagno&ic tes in Ethiopia. Conduson: TheassessrBlt indicated gaps in rros of the laboratory oorvia::swhich oould considerably irrpact quality and acc.El$ibility of diagno&ic sevices This suggests that there isurgerrt need to irrprove the capacity of diagnostic laboratories to offer quality servia::s across health facilities in theoountry. Keywords:
~viceprovison,
laboratory,
-Corresponding author: Thaxtros addresses:
[email protected]
Ethiopia
Getachew, Ethiopian Public Health Institute, Addis Ababa,
Background Ethiopia's Growth and Transformation Plan (GTP) has been designed to mantan rapid and broedbased economic growth and everltualy to erld
Ethiopia, Email
poverty (1). The Heath Sedor Developmerlt A-ogram (HSOP) is a key COf'1l)Of1eI1tof the GTP. Its primary objEdive is to il11Xove the heath of the populaion through promotion of preverltive, cerarve and rehabilitaive heath oorvices by
Ethiopian Medical Laboratory Association (EMLA): Leading the Fields of Laboratory Medicine in Ethiopia
Page 31
Ethiopian Journal of Laboratory Medicine Volume 2 Number 2 December 2015
irT1Xoving an:ss to ctfordci>le hEHth savices; CIld.improving thequaity of I1eath savices(2). Ethlopta has a three-tiS" hooIth rae defiva-y ~stan: leveJ one is a Woreda'Distrid hEHth ~stan corTl>risa:t of a pril'Tla'Y hospita (saves 60,000 -100.000 populaion), I1eath centres (one hEHth ceotre saves15, 000-25.000 populaion) CIld their scieJlite Heath Posts (1/3,000-5,000 populaion) coorected to ea::h other by a rserra ~stan. The primay hospita, heSth centre CIld hEHth posts form a A-il'Tla'Y Heath Cere Unit (PHCU). Leva two is a Genera Hospita saving 1.0-1.5 million populaion a1d leveJ three is a Speciai~ Hospita saving a populaion of 3.S5.0 million (2). The dEm1traizaion of pawS" to regional gov.a:nmetlts .has resulted in IergeJy shifti ng the dEriSion ~Ing for public savice defiva-y from the. ceotre to bang unda' the aJthority of the regIons CIld down to the district leveJ. Offices a different leveJs from the FedS"a Ministry of Heslth to Regiona Heslth BurE9Js (RHBs) and Woreda Heslth Offices shere in dErision ~ing processes,powers, duti es CIld responsibiIities. The Ministry a1d the RHBs focus more on policy maters a1d tedlnica 9.Jpport while Woreda Heslth Offices nm~ CIld coordinae the operaion of the district hEHth ~stan unda' thar jurisjidion (2). ~d erciory tests ita ita ita er c c c public profit it) Urba1 Rura
na
Basic tests Hernoglobi n Blood glucose Maaria dicgnostic test Urine protein Urine gl ucose HIV di~nostictest DBS colla::tion TB rricroocopy Syphilis~id di~nostic test GEnera microocopy Urine prEgnarlCy test Liver or rE:lla function test (AL T or Creetinine) Advanced level diagncSic tests Serum ele:::trolytes (chemistry cnayzer) Full blood count with dlfferentias Blood typing end cross mcichi ng CD4count Syphi lis S9'oIogy Gram stain Stool mi croocopy CSFI body fluid counts TB culture TB rapid dicgnostic test Number of frolities
100 84
85 90
67 75
24 20
65 82
51 77
0 3
27 22
9 75
17 25
40
37
46
44
78 97 97 100 47 81
85 95 95
88 98 96 96
82 59 51
82 89
71 81
82 61
80
78 75 75
56 58 56
55 79
40
17 52
72 10 70
45 0
53
3 11
25 29 29 19 2 16
50
89
6 4 6 6 0 0
5 29
81 84 100
76 82 95
69
91
98
77
94
46
53 94 19
94
34
33 58
13 11
56
44
37 32 63 8 30
54 15
23 24
56 46 42
59 11 36
34 62
86
58
1
85
85
69 28 78
20 23 29
34 57 50
29 45
89
36 63 61
21 41
59
2 3
41 51
94
72 89
58
38
46
70
44
2
71
17
0
4
6
11
11
17
1
7
97
72
63
8
43
23
0
11
6
10
20
18
5
10
97
72
63
8
43
23
0
11
6
10
20
18
5
10
19 78 31
12 47 28
6
5 0 1
88
62
5 5 4 18
81
71
0 0 0 1 2
0 6 3 6 28
2 0 2 23 23
0 10 4 18 57
3 6 6
94 80
29 69 85
7 4 14
94
5 2 3 15 57
39 48
4 1 1 7 37
3 3 3 20 42
97 3
98
96
57 0
90 0
3 0
0
78 0
29 0
61 0
63 0
33
0
97 0
58
1
0
45 0
6
6
0
1
6
0
0
1
0
1
0
1
1
1
2
7
3
182
13
37
119
190
2
163
8
149
214
363
84
44
58
Note: The basic test indicators presEJltErl in this table cororlse the diagnostic capacity dormin for ~ng general S9'vice rwdiness within the hwlth facility assessrr lei It f'T'lihodoiogy proposed by WiO and USAJD (WiO 2012). Note: DBS dried blood spot; cg= cerEbrospi nal fl uid; CT CXlI1'l>UlErltorrography
=
I Page 36 I
=
=
Ethiopian Medical Laboratory Association (EMLA): Leading the Fields or Laboratory Medicine in Ethiopia
Ethiopian Journal of laboratory Medicine Volume 2 Number 2 December 2015
www.emlaeth.org
Table 4: Arrong all facilities, epy 70 Uri ne pregncr.cy tes 80 Liva- or rena function tes (ALT or CrESinine) 11 Advancej lENa dl~ostie tess Sen.rn a Edrolytes (dlE'ITiruy anayzer) Full blood count with diffa-entias Blood typi ng and cross ".-am ng CD4 COIXIt SyJ:iliIIs SEJ'oI ogy Grarnstan Stool micrmx>py CS=I body fluid counts TB culture TB~d di~letest Nt.mb9"of fa::i Iities
46
17 17
22 15
20 32
16 30
16 18
2 2
51 49
54 73
52 64
23 24
92 52 52
51 41 40
53 44 36
79 48 47
49 45 37
50 32 28
46 9 9
71 89 89
75 81 82
66 72 72
46 42
78 5 41
58 14 36
63 15 32
72 6 32
44 0 24
55 3 30
22 2 8
49 14 60
45 10 55
72 12 58
59 11 36
40
22
28
33
17
21
12
34
62
44
29
53
35
40
56
40
45
17
66
72
68
45
50
40
38
44
47
42
12
89
84
76
46
5
5
2
6
3
4
0
43
41
38
7
22
14
4
9
14
9
5
37
38
38
10
22
14
4
9
14
9
5
1
37
38
38
10
11 5 8 37 68
5 5 4 11 51
2 3 3 14 32
4 3 1 12 37
2 3 2 26 46
5 3 5 20 36
0 2 1 17 42
0 0 0 5 15
6 9 11 63
6 3 13 68 70
10 8 16 34 62
3 3 3 20 42
71 0
43 0
30 0
44 0
54 0
57 0
40 0
15 0
86 0
84 0
76 0
45 0
0
3
0
0
0
1
0
0
4
2
1
22
5
87
8
4
80
6
2
31
3
363
25
116
60
56
Note: The basic test Indicators presentE(!In this table COIlllfi sa the diagnoslJc capacity dorrai n for as3eSSi ng gena-al seNce rE9Ci ness "';thin thehEBlth facility as.
