Health facility readiness for nutrition and mental health services and their utilization in Ethiopia

Abstract Background: Ethiopia still has major public health issues regarding mental disorders and malnutrition. The relationship of nutrition and mental health is now well recognized, but there is limited evidence with regard to the capacity of the health system to deliver integrated services. This study aimed to assess the readiness of Ethiopian health facilities to provide nutrition and mental health services and to investigate the association between the health facility's readiness and utilization of services. Methods: The data for this analysis is from the Ethiopia Service Provision Assessment (ESPA) 2021–2022. A composite readiness score was developed for four domains: Trained staff, Guidelines and protocols, Equipment and diagnostics, and Essential medicines. Facilities with scores ≥70% were considered to be ready. The number of nutrition-related and mental health-related patient visits in the preceding month was used as a measure of service utilization. Weighted descriptive statistics and multilevel logistic regression models were done. Results: Nutrition services were provided by approximately 68.2% of facilities and mental health services were provided by 28.1% of facilities. Very few facilities were ready for nutrition and mental health services (4.1%). For nutrition services, the same pattern was found (no exception, as mentioned above) as for mental health services, with factors related to utilization higher for facilities that had readiness than for those that did not. Conclusions: The level of preparedness to provide nutrition and mental health services in Ethiopia is low. The higher the service use scores the more prepared the facilities were. It is possible to increase the capacity of services to improve the provision of services, particularly in areas with lower demand or in rural settings.