The health system burden of chronic disease care: an estimation of provider costs of selected chronic diseases in Uganda. Issue 6 (6th March 2015)

• Record Type: Journal Article
• Authors: Settumba, Stella Nalukwago; Sweeney, Sedona; Seeley, Janet; Biraro, Samuel; Mutungi, Gerald; Munderi, Paula; Grosskurth, Heiner; Vassall, Anna
• Is Part Of: Tropical medicine & international health. Volume 20:Issue 6(2015:Jun.)
• Page Start: 781
• Page End: 790
• Publication Date: 2015-03-06
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12487
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" id="tmi12487-abs-0001"> <title>Abstract</title> <sec id="tmi12487-sec-0001" sec-type="section"> <title>Objective</title> <p>To explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit.</p> </sec> <sec id="tmi12487-sec-0002" sec-type="section"> <title>Methods</title> <p>Full financial and economic cost data were collected from 12 facilities in two districts, from the provider's perspective. A combination of ingredients‐based and step‐down allocation costing approaches was used. The diseases under study were diabetes, hypertension, chronic obstructive pulmonary disease (COPD), epilepsy and HIV infection. Data were collected through a review of facility records, direct observation and structured interviews with health workers.</p> </sec> <sec id="tmi12487-sec-0003" sec-type="section"> <title>Results</title> <p>Provision of chronic care services was concentrated at higher‐level facilities. Excluding drugs, the total costs for NCD care fell below 2% of total facility costs. Unit costs per visit varied widely, both across different levels of the health system, and between facilities of the same level. This variability was driven by differences in clinical and drug prescribing practices.</p> </sec> <sec id="tmi12487-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Most patients reported directly to higher‐level facilities, bypassing nearby peripheral facilities. NCD services in Uganda are underfunded particularly at peripheral facilities. There is a need to estimate the budget impact of improving NCD care and to standardise treatment guidelines.</p> </sec> </abstract>