Why are the implementation of and access to child developmental assessment within routine healthcare so difficult in Ethiopia? A descriptive qualitative study

Introduction: Developmental delays in early childhood present significant long–term challenges, making early developmental assessment crucial for effective intervention. Despite this, such assessments are not routinely implemented within routine healthcare services in Ethiopia. This study examines the barriers and facilitators affecting both the provision and accessibility of developmental assessments by exploring the experiences of health professionals and parents of under–five children. Methods: A descriptive qualitative study was conducted in the Gamo Zone, South Ethiopia, between August 2023 and January 2024. Twenty semi‑structured Key Informant Interviews (KII) were undertaken with purposively selected key informants, including one zonal maternal and child health (MCH) focal person, two MCH officers, two MCH coordinators, two pediatricians, three pediatric nurses, four general practitioners, and six parents of children under five years of age. All interviews were audio‑recorded, transcribed verbatim, and analyzed using ATLAS.ti 7. A thematic analysis approach was applied to identify barriers and facilitators influencing the provision and accessibility of child developmental assessments. Findings: Health professionals reported challenges that hindered the delivery of effective developmental assessments, including poor infrastructure, limited government commitment, funding shortages, and insufficient knowledge and technical skills regarding developmental delays and assessment procedures. Conversely, the structured layout of the existing health‑care system and an established referral pathway were reported as operational facilitators to support the provision of these services. Parents described barriers to accessing developmental assessments, including low socioeconomic status, prevailing community beliefs, societal attitudes, and stigma toward children with developmental delays. Encouragingly, broad community trust in and acceptance of routine child health programs emerged as an important facilitator that improved access to developmental assessment services. Conclusion: Improving the integration of developmental assessment into Ethiopia’s routine child health services requires addressing both system‑level shortcomings and the social realities that shape families’ access to care. A practical, implementation‑focused approach, one that strengthens frontline capacity, reinforces existing health‑system structures, and builds on community trust, offers the most promising path forward. With coordinated commitment, developmental assessment can shift from a neglected service to a reliable and sustainable part of pediatric care.