https://ir.unisa.ac.za/handle/10500/14520 2026-08-03T19:50:12Z https://ir.unisa.ac.za/handle/10500/32747 Development of strategies to strengthen tuberculosis diagnostic system in Oromia Region, Ethiopia Bizuneh Alemu Fetenesa Background: Tuberculosis (TB) remains a significant public health challenge in Ethiopia, particularly in the Oromia Region, where diagnostic system gaps contribute to missed cases and delayed treatment. The diagnostic policy emphasizes prompt identification, yet implementation barriers persist. Objective: This study aimed to evaluate physical access to TB diagnostics, assess utilisation patterns and determinants, examine diagnostic information use for decision-making, and develop evidence-based strategies to strengthen the TB diagnostic system in Oromia Region, Ethiopia. Methods: A quantitative, cross-sectional descriptive design was employed across the Oromia Region of Ethiopia, encompassing a study population of 171 health facilities and 222 professionals. Using stratified random sampling, a total of 112 health facilities (comprising 31 hospitals, 42 health centres, and 39 public-private mix facilities) alongside 59 managing health organisations were selected. Data collection took place from December 2023 to August 2024, utilizing 2 instruments: (1) structured checklists for retrospective review of tuberculosis diagnostic records (2018–2023); (2) questionnaires administered to 222 health professionals (78% male, 22% female), including laboratory technicians, TB focal persons, and program managers; and geospatial analysis based on the Global Moran’s I statistic to evaluate physical accessibility within radii of <5 km, 5–10 km, and >10 km. Data were analyzed using SPSS version 29 (descriptive statistics and multivariate logistic regression) and Microsoft Excel. To validate and refine strategic priorities, a modified three-round Delphi technique was conducted with 11 national and regional TB experts (radiologists, Histopathologists, national TB program officers, and reference laboratory managers), with a consensus threshold of >70% for item inclusion. Results: Basic laboratory amenities averaged only 58% availability. Only 18.5% of health professionals demonstrated knowledge of national TB guidelines. Conventional microscopy was available in 84% of facilities, but WHO-recommended rapid diagnostics (GeneXpert) reached only 24.1%, with significant urban-rural disparities. Geospatial analysis revealed that 41-50% of populations lacked access within 10km of AFB microscopy, Xpert MTB, and X-ray services. Test utilisation remained below 11% among symptomatic patients, associated with supply shortages (71% of respondents), equipment failures (68%), and inadequate screening practices (OR=0.358, p=0.216). Pulmonary TB case detection averaged 64%, and 27.6% of facilities lacked diagnostic service plans. The Delphi process yielded consensus on five strategic objectives with 30 specific strategies, including: establishing district-level molecular diagnostic centres (90.9% consensus), implementing multi-tiered buffer stock systems (100% consensus), mandating healthcare worker competency training (100% consensus), developing unified diagnostic M&E frameworks with digital dashboards (90.9% consensus), and establishing dedicated coordination bodies from ministry to district level (81.8-100% consensus). Conclusion: The TB diagnostic system in Oromia Region faces critical gaps in infrastructure, health worker knowledge, diagnostic utilisation, and monitoring systems. The developed 30-strategy framework provides an evidence-based, expert-validated roadmap to strengthen confirmatory and supportive TB diagnostics through tiered service delivery, supply chain resilience, workforce capacity building, and data-driven governance. 2025-12-01T00:00:00Z https://ir.unisa.ac.za/handle/10500/32746 A strategy to enhance utilisation of adolescents' sexual and reproductive health services in South-East Ethiopia Derese Teshome Demissie Adolescent sexual and reproductive health (SRH) remains a critical health challenge in low-resource settings, including Ethiopia. This study investigated service provision with respect to SRH for adolescents in south-east Ethiopia, focusing on barriers to access and strategies to enhance utilisation in the Arsi Zone. The findings informed the development of a strategy to enhance uptake of adolescent SRH services. A sequential explanatory mixed-methods design was employed in two phases: a quantitative phase comprising surveys with adolescents and a qualitative phase comprising focus group discussions with adolescents, key informant interviews with healthcare workers, teachers, and community leaders to explore perceptions and experiences of SRH services. The research team analysed quantitative data in Statistical Package for Social Sciences (SPSS) version 30 using descriptive and multivariate statistics, while qualitative data analysed thematically. Results showed that only 23.5% of adolescents accessed SRH services. Major barriers included lack of awareness (33.6%), financial constraints (28.9%), distance to facilities (18.3%), fear of parental reaction (17.7%), and religious or cultural taboos (13.2%). Factors that increase utilisation included discussion of SRH between adolescents and trusted adults (AOR=2.12) or did not feel fear when seeking care (AOR=2.07) were more likely to use services. Adolescents with SRH problems, such as STIs, were nearly five times more likely to seek services (AOR=4.88), while those who found service hours convenient were over three times more likely to use adolescent-friendly services (AFS) (AOR=3.19). Adolescents perceived SRH services as essential; however, they reported significant difficulties in accessing them. The need for comprehensive SRH education, open family discussions, and supportive community involvement emerged as a key. Socio-cultural barriers such as stigma and taboos were consistently reported as limiting service use. Trusted adults were identified as critical in reducing fear and encouraging utilisation. The findings informed the development of an alternative strategy which should improve adolescent sexual and reproductive health outcomes. Such a strategy should embrace target interventions that address key barriers to improve awareness, access, and acceptability of adolescent SRH services in Arsi Zone. The proposed strategy prioritises community participation, culturally sensitive education, expansion of AFS and multisectoral collaboration. Implementing this strategy has the potential to significantly improve SRH outcomes among adolescents in Arsi Zone. 2026-01-01T00:00:00Z https://ir.unisa.ac.za/handle/10500/32642 Loss to follow-up on antiretroviral therapy amongst HIV patients on CCMDD program at Makhado Municipality, Limpopo Province, South Africa Moradi, Rofhiwa Faith Background: Loss to Follow-Up among HIV patients receiving Antiretroviral Therapy (ART) remains a significant barrier to achieving optimal HIV care outcomes in South Africa. The Central Chronic Medicine Dispensing and Distribution (CCMDD) Programme was introduced to improve access to treatment; however, retention challenges persist. Purpose: The study aimed to explore factors contributing to high rates of LTFU among HIV patients enrolled in the CCMDD Programme in the Makhado Local Municipality in the Limpopo Province, South Africa. Study setting: The study was conducted in three purposively selected clinics that implemented the CCMDD Programme in the Makhado Local Municipality, in the Limpopo Province. Method: An exploratory, descriptive qualitative research design was employed. A purpose sample of 34 HIV positive patients, aged 18 years and older, who had defaulted ART within the past twelve months but subsequently returned to care, participated in semi-structured, in-depth interviews. Data were analyzed using Braun and Clarke’s six-step thematic analysis. Trustworthiness was ensured through researcher-led data collection and strategies to enhance credibility and dependability. Results: Five major themes emerged from the data: (1) positive factors of the CCMDD Programme; (2) individual factors; (3) interpersonal factors; (4) community factors; and (5) health system-related factors. The positive aspects of the CCMDD Programme included improved patient adherence to treatment and reduced facility congestion. Contributing barriers included a shortage of medication, long waiting periods, poor data recording, communication breakdowns,Limited understanding of the Programme, distance and travel time, challenges with script renewal, side effects, stigma, nondisclosure, and a lack of social support. Conclusion: The findings of the study highlighted that the key drivers contributing to LTFU include stigma, non-disclosure of HIV status, long travel distances to collection points, lack of social support, and limited knowledge of the CCMDD Programme. Strengthening patient education, improving communication systems, and implementing early tracing strategies may enhance retention and adherence among patients enrolled in the CCMDD Programme. 2026-02-01T00:00:00Z https://ir.unisa.ac.za/handle/10500/32581 Community based health insurance uptake and utilisation of healthcare in Ethiopia Adane Kebede Gutema Background: Community-Based Health Insurance (CBHI) is widely recognized as a key strategy for improving healthcare access and financial protection among lowincome populations. In Ethiopia, despite sustained efforts to expand CBHI coverage, enrolment remains below the national target of 80%. By 2020, only 49% of eligible households enrolled in Shaggar City, Oromia Region, Ethiopia. This limited coverage continues to expose many households to out-of-pocket healthcare costs, delays in seeking care, and poor health outcomes, thereby constraining broader socioeconomic development. Purpose: This study aimed to investigate the factors influencing CBHI uptake and healthcare utilization and to develop sustainable, evidence-based intervention strategies to enhance enrolment, renewal, and effective service use. Methods: A convergent mixed-methods design, guided by the Socio-Ecological Model (SEM), was employed across six sub-cities of Shaggar City, Oromia Region. The quantitative component involved a cross-sectional survey of 406 households, analyzed using SPSS (version 26) through descriptive statistics and multivariable logistic regression. The qualitative component comprised in-depth interviews with health leaders, CBHI officials, experts, healthcare providers, and community representatives, and was analyzed thematically. Findings from both strands were integrated and further refined using the APEASE framework (Affordability, Practicability, Effectiveness, Acceptability, Safety, and Equity). Results: CBHI enrolment showed a substantial improvement over time. While national and earlier evidence indicated that only 49% of eligible households were enrolled by 2020, the findings of this study revealed that enrolment had increased to 98% among eligible households in the study area by 2025. Despite this significant progress in coverage, both CBHI uptake and healthcare utilization were influenced by interconnected factors operating at multiple levels. Key determinants included individual awareness, perceived quality of healthcare services, household economic status, community trust, and institutional capacity. Qualitative insights further enriched these findings by highlighting persistent challenges related to service quality, limited access to reliable information, and gaps in system responsiveness. Drawing on the integrated evidence, the study developed the Comprehensive Integrated CBHI Uptake and Utilization (CICU) strategy, which focuses on strengthening awareness, improving service delivery, and enhancing sustained community engagement. Conclusion: This study makes a meaningful contribution to the field of health financing by offering an empirically grounded and theoretically informed framework for strengthening the implementation of Community-Based Health Insurance. The proposed Comprehensive Integrated CBHI Uptake and Utilization (CICU) strategy provides practical and context-sensitive guidance for policymakers and practitioners to enhance enrolment, improve service utilization, and address system-level challenges. By promoting more equitable and sustained access to quality healthcare, the study also supports Ethiopia’s ongoing efforts toward achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3 (SDG 3). Keywords: Community-Based Health Insurance, CBHI uptake, healthcare utilization, socio-ecological model, health financing, Shaggar City, Oromia Region, Ethiopia 2026-01-09T00:00:00Z