Background: More than half of diabetics’ in Ethiopia live undiagnosed, and the majority of those who already knew their status also struggle to manage their diseases. However, the underlying challenges are less understood in the study area. Therefore, this study aimed to assess diabetes screening and management capabilities, barriers, and opportunities in southern Ethiopia. Methods: We applied a mixed methods study. To assess the healthcare systems’ capabilities, we collected quantitative data from randomly selected ten hierarchically organized healthcare facilities, and purposive maximum variation sampling was applied to recruit twenty-nine individuals for face-to-face in-depth interviewing. The interviews were audio recorded, transcribed verbatim, thematically analyzed, and presented accordingly. Results: Our study findings indicated that there were good opportunities and encouraging capabilities like government commit-ment and expansion of services to improve diabetes screening and management in southern Ethiopia. Nevertheless, poor governance, the system’s structural problems, skilled professionals’ inaccessibility and lack of teamwork, poor service integration, poor planning, and lack of monitoring and evaluation mechanisms have been hampering the service delivery at the system level. While service unaffordability, low awareness level, and lifestyle modification problems were the main challenges at the patient level. Furthermore, outdated paper-based medical record documentation, frequent essential drug stock-outing, essential laboratory service interruptions, and none-use of some available services like HbA1c have been contributing to the barriers. Conclusion: Despite favorable capabilities available, diabetes management in southern Ethiopia has been struggling with solvable structural defects, poor service delivery and inaccessibility, and patients’ poor lifestyle modification. Therefore, public health system restructuring, optimum financing, computerization of medical records documentation, and health system and patient capacity building are strongly recommended interventions to tackle the problem at the grass-root level.
