Integrating promotive, preventive, and curative health care services at hospitals and health centers in Addis Ababa, Ethiopia

Abstract

Background

The current trend in patients’ disease management is mostly aimed at addressing their present health complaints; the focus is thus purely curative. As the limits of curative medicine become apparent and the cost of medical care escalates, disease prevention is gaining prominence. Factors that contribute to unreliable delivery of an integrated health care service are worth investigation. This study explores the extent to which health promotion and disease prevention services are integrated to curative health care and identifies the factors associated with not reliably providing the services.

Methods

A cross-sectional quantitative study using an exploratory and descriptive design was used to explore and describe the extent of health promotion, preventive, and curative health care services provision, and investigated factors related to low performance. Phase I of the study examined the degree of promotive and preventive health care provision at hospitals and health centers while investigating the staffing and equipment and supply status of the facilities. Phase II, using the Delphi consensus-seeking process, focused on the validation of the findings from Phase I.

Results

Of all patients who attended health facilities, only 2.4% (n=20) received optimal health promotion services. Disease prevention services were optimally provided to only 3.6% (n=30) patients. Integrated health promotion and disease prevention services were provided to only 0.8% (n=7) patients. The main reasons for not providing an integrated health care service were shortage of skilled health staff, equipment, medication, protocols, and guidelines, and high service cost, poor patient awareness, and health professionals’ focus on curative health care.

Conclusion

Health service providers were not routinely conducting patient-specific health promotion, disease prevention, and integrated health care services, losing the opportunities of patient’s presence for health promotion and diseases prevention purposes. Addressing barriers can help with integrating health promotion and disease prevention services to the curative health care services.

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Keywords:

• integrated health service
• disease prevention
• health promotion
• curative care
• non-communicable diseases

Acknowledgments

Our sincere gratitude is to the University of South Africa, for permission to conduct the study and for the Higher Degrees Committee of the Department of Health Studies, University of South Africa (UNISA), for ethical clearance and permission. We are grateful to the Addis Ababa Regional Health Bureau, subcity administration health departments and the respective health facilities, for providing permission to conduct the study in their facilities. The study would have not been possible had it not been for the patients, the health facility managers, and health professionals, generously sharing their expertise, patience, and time. We are thankful to Rina Coetzer, for her patient and professional finalizing of the manuscript, and to Iauma Cooper, for critically and professionally editing the language and content of the manuscript. The study was not funded by any grant.

Author contributions

Both authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work. NFW, designed the study concept note, developed proposal and thesis, and conducted data collection analysis, interpretation and write-up. MCB closely advised and supported NFW in the development of study concept note, developing the proposal and thesis, and data analysis, interpretation and write-up.

Disclosure

The authors report no conflicts of interest in this work.