Service availability and readiness for diabetes and hypertension care among health facilities in Lagos State, Nigeria

Abstract Background More than 80% of the global premature mortality from noncommunicable diseases (NCDs) occurs in low- and middle-income countries (LMICs). Nigeria, like most LMICs, has limited capacity to respond to diabetes and hypertension. As the Lagos State government accelerates the rollout of its mandatory health insurance, Lagos State Health Scheme (LSHS), the number of individuals with diabetes and hypertension seeking care will increase. This study aimed to determine service availability and service readiness for diabetes and hypertension among health facilities providing primary care for these conditions in Lagos State, and to explore the facility characteristics associated with service readiness. Methods We conducted a cross-sectional survey of 84 facilities enrolled in the baseline study of an impact evaluation of the Lagos State Health Scheme. We collected data using relevant modules of the World Health Organization’s Harmonized Health Facility Assessment tool. Service availability was defined as providing diagnosis or treatment for either condition, and service readiness scores were calculated as the proportion of tracer items available and functional at the facility on the survey day. Further, we used a multiple linear regression model to estimate associations between facility characteristics and service readiness. Results Service availability for both conditions was high. The mean diabetes and hypertension service readiness scores were 69% and 66%, respectively. The percentage of fully ready healthcare facilities was very low (2.6% for diabetes and 2.5% for hypertension). The staff and guidelines domain received the lowest score for both conditions. There was no association between service readiness and LSHS empanelment status. Providing only outpatient services had a negative association with service readiness for both conditions. Participation in a quality improvement program had a positive association with hypertension service readiness score. Conclusion While the mean service readiness scores for diabetes and hypertension were moderately high among sampled health facilities, only a very small percentage were fully service ready. There were critical deficits in service readiness domains that must be addressed to ensure the required inputs for high-quality diabetes and hypertension care is available in the State.