Readiness of Zanzibar's public health facilities to deliver NCD services: a cross-sectional survey toward UHC

Non-communicable diseases (NCDs) represent an escalating public health crisis, particularly in low- and middle-income countries where health systems often struggle to provide consistent, effective care. As global health initiatives push toward Universal Health Coverage (UHC), the focus has shifted to whether local facilities possess the necessary infrastructure and resources to manage these long-term conditions.

Did You Know? A comprehensive assessment of all 52 public and parastatal health facilities in Zanzibar revealed an average readiness score of only 54% for delivering essential NCD services.

Assessing Facility Preparedness

A recent cross-sectional survey evaluated health facilities in Zanzibar using an adapted version of the WHO Service Availability and Readiness Assessment (SARA) tool, alongside elements from the Pen Plus and Access Bottlenecks, Costs, and Equity (ABCE) surveys. The findings highlight a significant disparity in service capacity across the region.

While the referral hospital demonstrated a readiness score of 73%, primary health care centres lagged significantly behind at 29%. Data indicates that while the healthcare workforce (73%) and basic infrastructure (69%) are relatively well-supported, the systems required for sustained patient care are lacking.

Expert Insight: The data suggests that aggregate readiness scores can be deceptive. By averaging high-performing referral hospitals with under-equipped primary care centres, we may overlook the critical gaps in diagnostic services and financial protection that prevent patients from accessing care at the local level.

The Path to Equitable Care

The study identified specific bottlenecks that hinder effective NCD management, most notably in diagnostic and treatment services (40%) and financing and payment mechanisms (31%). Essential medicines also remain a challenge, with a readiness score of 53%.

Moving forward, the results suggest that health systems could improve readiness by prioritizing targeted investments. Enhancing diagnostic capacity, stabilizing supply chains for essential medicines, and formalizing financial risk protection measures are likely necessary steps to achieve more equitable outcomes. Future efforts to reach Universal Health Coverage may depend on whether primary care facilities—the front line of patient interaction—receive the specific resources required to close these identified gaps.

Frequently Asked Questions

What were the lowest performing areas of readiness?

The study found that the lowest readiness scores were in financing and payment mechanisms (31%), diagnostic and treatment services (40%), and the availability of essential medicines (53%).

How does facility type impact readiness?

There is a significant disparity based on facility level. Referral hospitals showed higher readiness (73%) compared to primary health care centres, which had the lowest average readiness score at 29%.

What factors are associated with higher readiness?

Facilities that provided both inpatient and outpatient care demonstrated significantly higher readiness scores compared to those that did not.

How can health systems better prioritize resources to ensure that primary care facilities are as prepared as referral hospitals to manage chronic health conditions?

Readiness of Zanzibar’s public health facilities to deliver NCD services: a cross-sectional survey toward UHC