PT - JOURNAL ARTICLE AU - Azeb Gebresilassie Tesema AU - David Peiris AU - Rohina Joshi AU - Seye Abimbola AU - Fasil Walelign Fentaye AU - Alula M Teklu AU - Yohannes Kinfu TI - Exploring complementary and competitive relations between non-communicable disease services and other health extension programme services in Ethiopia: a multilevel analysis AID - 10.1136/bmjgh-2022-009025 DP - 2022 Jun 01 TA - BMJ Global Health PG - e009025 VI - 7 IP - 6 4099 - http://gh.bmj.com/content/7/6/e009025.short 4100 - http://gh.bmj.com/content/7/6/e009025.full SO - BMJ Global Health2022 Jun 01; 7 AB - Background Ethiopia has recently revitalised its health extension programme (HEP) to address the rising burden of non-communicable diseases (NCDs). We examined the effects of existing essential HEP services on the uptake of NCD preventive services.Methods We applied a mixed-effect non-linear model with a logit link function to identify factors associated with a community resident’s probability of receiving NCD prevention services through the HEP. The data were drawn from the Ethiopian HEP assessment Survey conducted in all regions. The analysis included 9680 community residents, 261 health extension workers (HEWs), 153 health posts, 119 health centres, 55 districts and 9 regions, which we combined hierarchically into a single database.Results In the 12 months before the survey, 22% of the sample population reported receiving NCD preventive service at least once. The probability of receiving NCD prevention service increased by up to 25% (OR=1.25, CI 1.01 to 1.53) if health centres routinely gathered NCD data from health posts and by up to 48% (OR=.48, CI 1.24 to 1.78) if they provided general (ie, non-NCD specific) training to HEWs. NCD preventive service uptake also increased if the HEW held level IV qualification (OR=1.32, CI 1.06 to 1.65) and lived in the community (OR=1.24, CI 1.03 to 1.49). Conversely, if facilities delayed general performance reviews of HEWs by a month, uptake of NCD prevention services decreased by 6% (OR=0.94, CI 0.91 to 0.97). We observed that better HIV/AIDS programme performance was associated with a lower uptake of NCD preventive services (OR=0.15, CI 0.03 to 0.85).Conclusion Despite efforts to improve NCD services through the HEP, the coverage remains limited. A strong HEP is good for the uptake of NCD preventive services. However, integration requires a careful balance, so that the success already recorded for some existing programmes is not lost.Data may be obtained from a third party and are not publicly available. All relevant data contributing to the findings are within the paper and in Supplementary table 1. As secondary data users, we are restricted by data sharing policy and ethical clearance to share additional data. All request for the original data should be directed to the data custodian, the MERQ Consultancy.