Geographical variations of health facilities management teams’ functionality in Ethiopia: Spatial analysis of Ethiopian Service Provision Assessment (SPA) 2021-2022

Objectives The study aimed to assess the spatial distribution of Health Facility Management Teams (HFMTs) functionality and identify geographic hotspots of non-functionality among Ethiopian health facilities. Methods This cross-sectional study utilized data from the Ethiopian Service Provision Assessment (ESPA) 2021-2022, conducted by the Ethiopian Public Health Institute (EPHI) in collaboration with the Ministry of Health (MoH) and ICF. A total of 1,407 health facilities were included, excluding facilities from the Tigray region. HFMT functionality was assessed using four indicators, and facilities meeting all indicators were classified as functional. Descriptive analyses were performed using STATA version 17. Spatial analyses, including Global Moran’s I, Getis-Ord Gi* hotspot analysis, ordinary Kriging interpolation, and SaTScan cluster detection, were conducted using ArcGIS 10.7.1 and SaTScan software. Results Most health facilities had functional HFMTs. However, significant spatial clustering of non-functional HFMTs was observed (Moran’s I = 0.098, p = 0.000024), indicating a non-random geographic distribution. Hotspot analysis identified western, central, and southern Benishangul Gumuz as the primary hotspot areas, with additional hotspots in parts of Afar, Harari, Somali, and Oromia regions. Kriging interpolation predicted a high probability of HFMT non-functionality in central Benishangul Gumuz and surrounding areas. SaTScan analysis confirmed a significant primary cluster centered in Benishangul Gumuz (RR =17.63, LLR = 12.16, p = 0.0042). Conclusion HFMT functionality in Ethiopia exhibits significant geographic variation. Benishangul Gumuz emerged as the principal hotspot of HFMT non-functionality, highlighting the need for targeted management strengthening interventions in high-risk areas.