Integrated holistic chronic wound care package for skin-NTDs and other conditions for the primary healthcare setting in Ethiopia

BACKGROUND: Globally, chronic wounds resulting from diverse etiologies impose a significant physical, psychosocial, and economic burden and have remained a highly neglected public health challenge. Yet, people in rural Ethiopia have limited access to quality and comprehensive wound care. There is a marked paucity for an integrated, holistic care model in the primary healthcare settings. Hence, this study aimed to develop a context-tailored, integrated, holistic, chronic wound care package in Ethiopia. METHODS: A multi-method approach was applied, including a scoping review, formative assessments, Theory of Change workshops and a qualitative validation study. Purposive sampling was employed to recruit participants. Collected data were transcribed, coded, and thematically analysed to generate insights for refining the intervention package. RESULTS: A total of 49 stakeholders participated in the Theory of Change (ToC) workshops, while 36 participants were included in the qualitative study. The intervention package is structured around six core thematic components: awareness-raising and stigma reduction, capacity-building, active case detection and follow-up, program and supply chain management, Institutional and community-based rehabilitation, monitoring, and evaluation. Implementation and scale-up of these components are designed to cascade across three levels of the existing primary healthcare system, specifically the health organization, the health facility level, and the community level. CONCLUSION: This study introduced a context-driven, integrated, and holistic wound care package aimed at managing chronic wounds alongside their associated mental health and psychosocial challenges. The package encompasses interventions that address the physical, psychological, and social impacts of chronic wounds in individuals affected by neglected tropical diseases of the skin and related conditions. It employs multilevel implementation strategies targeting individuals, communities, and the health system to reduce morbidity, disability, and the economic and psychosocial burdens linked to chronic wounds. This standardized, scalable, and sustainable care model provides a promising approach for Ethiopia and other low- and middle-income countries.