Improving neglected tropical disease services and integration into primary healthcare in Southern Nations, Nationalities and People’s Region, Ethiopia: Results from a mixed methods evaluation of feasibility, acceptability and cost effectiveness

Background: Ethiopia is one of the countries with the highest burden of neglected tropical diseases (NTDs), with 16 of 20 recognised NTDs considered a public health problem, twelve of which have been identified as public health priorities by the Ethiopian Federal Ministry of Health. However, until recently NTDs have not received adequate attention at national and subnational levels in the country. This study assessed feasibility, acceptability, and cost-effectiveness of an NTD intervention when integrated into the primary health care system in Ethiopia. Methods: This study was conducted in Damot Gale district, Wolaita Zone, Southern Ethiopia and used a mixed methods approach to evaluate an intervention integrating four common NTDs (trachoma, lymphatic filariasis, schistosomiasis and podoconiosis) into Ethiopia’s primary healthcare system. The intervention consisted of adapted job aids, supportive supervision, and improved supplies of medical tools to improve diagnosis, management and reporting. Results: The study found that the intervention was feasible and successful at improving the detection, management and reporting across the four common NTD’s included and had a high level of acceptance from health workers. The intervention demonstrated cost-effectiveness. Conclusion: The findings highlight the need for further investment and consideration of integrating and scaling up NTD interventions at the primary healthcare level in Ethiopia, demonstrating that providing a package of interventions to support integration can be a cost-effective method. Author summary: Building on the findings of a previous small-scale operational study and formative phase, this study involved implementing an intervention to integrate the prevention, diagnosis, management and reporting of four common NTDs — trachoma, lymphatic filariasis, schistosomiasis and podoconiosis — into Ethiopia’s primary healthcare system. The intervention consisted of providing health workers with adapted job aids, supportive supervision and improved diagnostic and medical supplies to facilitate NTD diagnosis, management, and reporting. It was implemented for six months in one hospital, one health centre and five health posts in Damot Gale district, Ethiopia and the feasibility, acceptability and cost-effectiveness were evaluated. Results indicate feasibility, as the capacity of all enrolled health facilities for detecting, managing, and recording target NTDs improved over time. Furthermore, the use of intervention materials by health workers also increased over time. The intervention tools proved to be highly acceptable to health workers who viewed them as helpful, relevant, and easy to use. The findings further highlight that providing a package of interventions to support integration can be a cost-effective method and that the integration and scale of NTD interventions at the primary healthcare level in Ethiopia should be considered.