Readiness of Ugandan health services for the management of outpatients with chronic diseases. Issue 10 (8th July 2015)

• Record Type: Journal Article
• Authors: Katende, David; Mutungi, Gerald; Baisley, Kathy; Biraro, Samuel; Ikoona, Eric; Peck, Robert; Smeeth, Liam; Hayes, Richard; Munderi, Paula; Grosskurth, Heiner
• Is Part Of: Tropical medicine & international health. Volume 20:Issue 10(2015:Oct.)
• Page Start: 1385
• Page End: 1395
• Publication Date: 2015-07-08
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12560
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" id="tmi12560-abs-0001"> <title>Abstract</title> <sec id="tmi12560-sec-0001" sec-type="section"> <title>Objective</title> <p>Traditionally, health systems in sub‐Saharan Africa have focused on acute conditions. Few data exist on the readiness of African health facilities (HFs) to address the growing burden of chronic diseases (CDs), specifically chronic, non‐communicable diseases (NCDs).</p> </sec> <sec id="tmi12560-sec-0002" sec-type="section"> <title>Methods</title> <p>A stratified random sample of 28 urban and rural Ugandan HFs was surveyed to document the burden of selected CDs by analysing the service statistics, service availability and service readiness using a modified WHO Service Availability and Readiness Assessment questionnaire. Knowledge, skills and practice in the management of CDs of 222 health workers were assessed through a self‐completed questionnaire.</p> </sec> <sec id="tmi12560-sec-0003" sec-type="section"> <title>Results</title> <p>Among adult outpatient visits at hospitals, 33% were for CDs including HIV <italic>vs</italic>. 14% and 4% at medium‐sized and small health centres, respectively. Many HFs lacked guidelines, diagnostic equipment and essential medicines for the primary management of CDs; training and reporting systems were weak. Lower‐level facilities routinely referred patients with hypertension and diabetes. HIV services accounted for most CD visits and were stronger than NCD services. Systems were weaker in lower<italic>‐</italic>level HFs. Non‐doctor clinicians and nurses lacked knowledge and experience in NCD care.</p> </sec> <sec id="tmi12560-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Compared with higher level HFs, lower‐level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower<italic>‐</italic>level HFs, urgently need improvement in managing common NCDs to cope with the growing burden. This should include the provision of standard guidelines, essential diagnostic equipment and drugs, training of health workers, supportive supervision and improved referral systems. Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible.</p> </sec> </abstract>