Readiness of Ugandan health services for the management of outpatients with chronic diseases

Abstract

ObjectiveTraditionally, 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).MethodsA 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.ResultsAmong adult outpatient visits at hospitals, 33% were for CDs including HIV vs. 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‐level HFs. Non‐doctor clinicians and nurses lacked knowledge and experience in NCD care.ConclusionCompared with higher level HFs, lower‐level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower‐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.

Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study

“…Most of our results come from a single hospital. This hospital, though, is similar to other government hospitals in East Africa, 10,11 and our results at a second public hospital in Tanzania confirm similar mortality rates. In addition, our study design should be relatively simple to replicate since our study demonstrated that 99% of hospitalized adults had access to mobile phones, and we successfully contacted >90% of participants (or their proxies) 12 months after discharge.…”

“…The resources of BMC are similar to those available in other government hospitals in East Africa. 10,11 …”

“…Studies from the US have demonstrated that early linkage to primary care is one important predictor of post-hospital survival. 7–9 Primary care systems in sub-Saharan Africa are weak, 10,11 and this cause lower linkage to primary care and higher post-hospital mortality.…”

Heart failure, post-hospital mortality and renal function in Tanzania: A prospective cohort study

“…6,18 The delay in diagnosis in HF until the time of the index hospital admission is likely related to the limitations in resources for diagnoses of HF at lower level health facilities. 7,8 Therefore, as supported by evidence from the U.S., 19,20 we have identified the post-hospital period as a critical window of interventional opportunity for improving HF outcomes in Africa.…”

“…5 At our own hospital, HF represents 10% of hospital admissions and 10% of in-hospital deaths. 6 In addition, primary healthcare resources for managing chronic diseases such as HF are severely limited in sub-Saharan Africa, 7,8 with most service provided at hospitals instead of community health facilities.…”