Decentralizing care for cutaneous leishmaniasis and other skin diseases to primary health facilities in Southern Ethiopia: What are the needs?

Abstract

Background Cutaneous leishmaniasis (CL) and other skin diseases impose a high disease burden in Ethiopia, yet access to care is poor due to limited and centralized diagnostics and treatment. Decentralizing care could improve this but may necessitate substantial changes to the healthcare system. This study aimed to assess the available resources and the knowledge and skills of healthcare professionals for decentralizing the diagnosis and care of CL and common skin diseases to lower healthcare facilities. Methods A cross-sectional study was conducted in South Ethiopia, from May to July 2023, involving 11 health centers, four primary hospitals, and one general hospital. Infrastructure was assessed on-site. Resources, knowledge, and skills of staff members regarding the treatment of CL and other skin diseases were collected using a newly developed questionnaire, comprising 25 knowledge-based and 14 skill-based questions. Skills were assessed via lesion and pathogen images. Descriptive statistics for the different variables studied and inferential statistics based on (confidence) interval estimation were reported. Results Most facilities had equipment for diagnosis and localized treatment. Adequate hospitalization space and necessary equipment for systemic treatment of CL were found in 3 out of 4 primary hospitals, but none of the health centers. Consumable and drug shortages were common across all facilities. The median score of BSc laboratory technologists was significantly higher than that of diploma technicians (i.e. 29 vs. 15 out of a maximum of 39, p < 0.001). Clinical staff scores varied significantly across education levels (p = 0.007), with physicians scoring the highest (median 33, IQR 31–36), followed by health officers (median 29, IQR 27–32), BSc nurses (median 28, IQR 16–36), and diploma nurses (median 25, IQR 19–29). Notably, no significant differences in median scores were observed between primary hospitals and health centers for clinical and laboratory staff. Conclusions Decentralizing the diagnosis and treatment of common skin diseases and localized CL treatment to health centers appears feasible with facility adjustments, continuous training, and reliable supply chains, while referring CL cases requiring systemic treatment to primary hospitals. Strong strategic efforts to maintain staff knowledge and skills and tackle supply shortages are crucial for successful decentralization.