article · International Journal of Mental Health Systems
Access to mental health services in Ethiopia remains restricted and geographically uneven across the country. An analysis of national survey data from 1,158 health facilities reveals significant spatial clustering of mental healthcare. High availability is concentrated in Addis Ababa, central and south-western Oromia, and north-western Amhara. Conversely, underserved coldspots persist across several regions, including Afar, Benishangul-Gumuz, Gambella, Harari, Dire Dawa, northern Somali, and northern Southern Nations, Nationalities, and Peoples' Region. The likelihood of a facility providing mental health services is negatively influenced by rural location, primary-level facility status, serving a small catchment population below 10,000, and the practice of charging user fees. Addressing these geographic and structural inequities requires expanding coverage into primary care units, revising workforce task-shifting strategies, and introducing alternative service delivery approaches such as telemedicine and community-led initiatives.
Mental health disorders represent a substantial health burden, yet essential care is frequently out of reach for those in rural and lower-income communities. Identifying exact geographic gaps and administrative barriers allows healthcare authorities and funders to direct resources, staff, and targeted interventions to the regions and facility tiers where mental health services are most severely lacking.
The findings highlight clear operational gaps that could inform health logistics planning, public health software, and digital health delivery. Specifically, the identified shortages support the need for telemedicine platforms and community-based digital tools tailored to underserved and rural primary healthcare providers. Because the work is an observational health facility survey, commercial applications remain at an early concept stage, requiring technological development and clinical validation before deployment in local health networks.
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Despite the substantial burden of mental health disorders in Ethiopia, access to mental health services remains limited and unevenly distributed. This study aimed to examine the spatial distribution of mental health services in Ethiopian health facilities and identify factors contributing to their availability. Data were drawn from the 2021–2022 Ethiopian Service Provision Assessment-Plus (ESPA+) survey, which included a census of hospitals and a representative sample of health centres, posts, and clinics. Spatial patterns were assessed using the Global Moran’s Index (Moran’s I) to evaluate spatial autocorrelation, while hotspot analysis employing Getis-Ord Gi* statistics identified areas with high and low service availability. A Poisson regression was conducted to assess factors associated with mental health service availability. Analysis of 1,158 health facilities revealed a significant clustering of mental health services in Ethiopia, with a Global Moran’s I value of 0.09 ( P < 0.01). Hotspot analysis identified areas of high mental health service availability in Addis Ababa, central and south-western Oromia, and north-western Amhara, while areas with low availability were found in Afar, Benishangul-Gumuz, Gambella, Harari, Dire Dawa, northern Somali, and northern SNNPR. Factors negatively associated with mental health service availability included rural location, primary facility status, a small catchment population (< 10,000), and facilities charging service fees. This study highlights significant disparities in the availability of mental health services in Ethiopia, particularly in rural and underserved regions. Expanding mental health services within primary healthcare units, and revisiting task-shifting strategies to mitigate shortages in the mental health workforce may help to improve access to mental health care. Integrating innovative delivery models,such as telemedicine and community-based initiatives,will be helpful in fostering equitable mental healthcare nationwide.
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DOI: 10.1186/s13033-026-00729-6
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