Determinant of malaria service readiness at health facilities in Ethiopia: Evidence from 2018 service availability and readiness assessment: Cross-sectional study

Introduction: Globally, an estimated 3.3 billion people are at risk of getting malaria. The majority of cases have occurred in the African Region. This study aims to assess the determinant of malaria service readiness at the health facility level. Method: Data from the 2018 Service Availability and Readiness Assessment was used for this analysis. The study was a facility-based cross-sectional study and a stratified sampling technique was used. Data was collected from October - December 2017. Mean readiness score was used by computing six tracer items (Availability of at least one trained staff for malaria diagnosis & treatment, Availability of malaria diagnosis & treatment guideline, Malaria diagnostic capacity, First-line anti-malarial drug in-stock, Paracetamol cap/tab, and ITN). Linear regression was used to identify factors associated with the mean readiness score of health facility to provide malaria service. The proportion test was used to check any change between 2016 and 2018 malaria service readiness. Result: A total of 764 health facilities were included in the study, of these only 682(89.3%) provided malaria service. Eighty-nine percent of the facilities offered diagnosis or treatment service for malaria and 70% of the facilities diagnose malaria by clinical symptoms followed by microscopy (67%) and Rapid Diagnostic Tests (RDT) (46%). Only 3% of the facilities had all the six tracer items. Hospitals and health centers had the availability of tracer items above the average mean readiness score (52%). Facilities managed by other than public authorities had lower mean score readiness for malaria service compared with those managed by the public. Higher and Medium clinics, lower clinics as well as health posts had lower mean score readiness for malaria service compared with hospitals. A significant change not observed for malaria service readiness of tracer items between 2016 and 2018 (p-value=0.732). Conclusion: The current study revealed that higher and medium clinics, lower clinics, health posts, facilities managed by other authority and regions (Addis Ababa, Harrari, SNNP, Somali, Amhara, and Oromia) were the significant determinants of malaria service readiness and no significant change was observed on malaria service readiness score between 2016 and 2018 Service Availability and Readiness Assessment Survey.