Health system responsiveness and its associated factors among patients with mental illness receiving outpatient care in public hospitals, Addis Ababa, Ethiopia, 2025: a facility-based cross-sectional study

BACKGROUND: Health system responsiveness encompasses the non-clinical aspects of healthcare, such as dignity, confidentiality, and communication that meet patients' expectations. It is a core component of the World Health Organization's framework for people-cantered care. Although responsiveness has been widely studied in general healthcare settings, evidence from mental health services remains limited, particularly in low- and middle-income countries such as Ethiopia. OBJECTIVE: To assess health system responsiveness and its associated factors among patients with mental illness receiving outpatient care in public hospitals in Addis Ababa, Ethiopia, 2025. METHODS: A facility-based cross-sectional study was conducted from March 1 to April 30, 2025, among 509 patients attending outpatient mental health services in selected public hospitals. Participants were selected using a multistage approach, with hospitals randomly chosen and participants within each hospital selected by systematic random sampling. Data were collected using a pretested questionnaire based on the WHO's seven-domain responsiveness framework. Bivariate and multivariable logistic regression analyses were performed, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Statistical significance was set at p < 0.05. RESULT: Among the 509 participants, 276 (54.22%) reported good health system responsiveness. The dignity domain had the highest mean score, whereas the choice domain had the lowest. Higher odds of good responsiveness were observed among patients with health insurance (AOR = 1.89; 95% CI: 1.27-2.82), those who experienced shorter waiting times (< 30 mins: AOR = 3.36, 95% CI: 1.81-6.24; 30-60 mins: AOR = 2.00, 95% CI: 1.03-3.92), those who reported consistent availability of prescribed medications (AOR = 1.77; 95% CI: 1.12-2.83), and those attended by providers who introduced themselves (AOR = 1.71; 95% CI: 1.13-2.59). Conversely, rare (AOR = 0.40; 95% CI: 0.24-0.68) and absent (AOR = 0.18; 95% CI: 0.04-0.87) availability of medications were associated with significantly lower responsiveness. CONCLUSION AND RECOMMENDATION: Responsiveness of outpatient mental health services was suboptimal. Health insurance coverage, shorter waiting times, consistent availability of prescribed medications, and provider self-introduction during consultations were statistically significant factors associated with good responsiveness. To improve responsiveness, efforts should focus on expanding health insurance coverage, minimizing patient waiting times, ensuring reliable medication availability, and encouraging respectful provider introductions.