Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

Schwartz, Jeremy I.; Dunkle, Ashley; Akiteng, Ann R.; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles; Mutungi, Gerald; Rabin, Tracy L.; Skonieczny, Michael; Sykes, Jamila; Mayanja‐Kizza, Harriet

doi:10.3402/gha.v8.26537

Cited by 30 publications

(25 citation statements)

References 18 publications

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“…This has implications for the nationwide scale up of the ICDM model in South Africa and planning of integrated chronic care of communicable and non-communicable conditions in Swaziland and Ethiopia (Rabkin et al 2012) and Uganda (Schwartz et al 2015). …”

Section: Discussionmentioning

confidence: 99%

Quality of integrated chronic disease care in rural South Africa: user and provider perspectives

Ameh

Klipstein‐Grobusch

D’Ambruoso

et al. 2016

Health Policy Plan.

109

189

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The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model.In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients ≥18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian’s structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis.The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while managers reported treatment of chronic diseases by traditional healers and reduced facility-related HIV stigma because HIV and NCD patients attended the same clinic.Leveraging elements of HIV programmes for NCDs, specifically hypertension management, is yet to be achieved in the study setting in part because of malfunctioning blood pressure machines and anti-hypertension drug stock-outs. This has implications for the nationwide scale up of the ICDM model in South Africa and planning of an integrated chronic disease care in other low- and middle-income countries.

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Section: Discussionmentioning

confidence: 99%

Quality of integrated chronic disease care in rural South Africa: user and provider perspectives

Ameh

Klipstein‐Grobusch

D’Ambruoso

et al. 2016

Health Policy Plan.

109

189

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“…Uganda like other developing countries is experiencing an epidemiological transition characterised by an increasing burden of NCDs and population ageing ( 7 – 10 ). The rise in the prevalence of NCDs has resulted in a double burden of diseases – both communicable and NCDs – in developing countries including Uganda ( 11 , 12 ). The population of older persons is steadily increasing ( 9 ).…”

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confidence: 99%

Prevalence and risk factors for self-reported non-communicable diseases among older Ugandans: a cross-sectional study

Wandera¹,

Kwagala²,

Ntozi

2015

Global Health Action

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BackgroundThere is limited evidence about the prevalence and risk factors for non-communicable diseases (NCDs) among older Ugandans. Therefore, this article is aimed at investigating the prevalence of self-reported NCDs and their associated risk factors using a nationally representative sample.DesignWe conducted a secondary analysis of the 2010 Uganda National Household Survey (UNHS) using a weighted sample of 2,382 older people. Frequency distributions for descriptive statistics and Pearson chi-square tests to identify the association between self-reported NCDs and selected explanatory variables were done. Finally, multivariable complementary log–log regressions to estimate the risk factors for self-reported NCDs among older people in Uganda were done.ResultsAbout 2 in 10 (23%) older persons reported at least one NCD [including hypertension (16%), diabetes (3%), and heart disease (9%)]. Among all older people, reporting NCDs was higher among those aged 60–69 and 70–79; Muslims; and Pentecostals and Seventh Day Adventists (SDAs). In addition, the likelihood of reporting NCDs was higher among older persons who depended on remittances and earned wages; owned a bicycle; were sick in the last 30 days; were disabled; and were women. Conversely, the odds of reporting NCDs were lower for those who were relatives of household heads and were poor.ConclusionsIn Uganda, self-reported NCDs were associated with advanced age, being a woman, having a disability, ill health in the past 30 days, being rich, depended on remittances and earning wages, being Muslim, Pentecostal and SDAs, and household headship. The Ministry of Health should prevent and manage NCDs by creating awareness in the public and improving the supply of essential drugs for these health conditions. Finally, there is a need for specialised surveillance studies of older people to monitor the trends and patterns of NCDs over time.

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“…Our findings support previous work that demonstrates that Ugandan health facilities are poorly prepared to address the growing burden of NCD. [12,16,18] We extend this previous work by identifying and quantifying clear within-country disparities in preparedness. We found significant associations between EM-NCD availability and geographic region, managing authority, health facility type, and the range of HIV services.…”

Section: Discussionmentioning

confidence: 63%

Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: a Poisson analysis using the Service Availability and Readiness Assessment

Armstrong-Hough

Kishore²,

Byakika

et al. 2017

Preprint

Self Cite

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1Objective Although the WHO-developed Service Availability and Readiness Assessment 2 (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, 3 SARA data have not previously been used to model predictors of readiness. We sought to 4 demonstrate that SARA data can be used to model availability of essential medicines for treating 5 non-communicable diseases (EM-NCD). 6Methods We fit a Poisson regression model using 2013 SARA data from 196 Ugandan health 7 facilities. The outcome was total number of different EM-NCD available. Basic amenities, 8 equipment, region, health facility type, managing authority, NCD diagnostic capacity, and range 9 of HIV services were tested as predictor variables. 10Findings In multivariate models, we found significant associations between EM-NCD 11 availability and region, managing authority, facility type, and range of HIV services. For-profit 12 facilities' EM-NCD counts were 98% higher than public facilities (p<.001). General hospitals 13 and referral health centers had 98% (p=.004) and 105% (p=.002) higher counts compared to 14 primary health centers. Facilities in the North and East had significantly lower counts than those 15 in the capital region (p=0.015; p=0.003). Offering HIV care was associated with 35% lower EM-16 NCD counts (p=0.006). Offering HIV counseling and testing was associated with 57% higher 17 counts (p=0.048). 18 Conclusion We identified multiple within-country disparities in availability of EM-NCD in 19Uganda. Our findings can be used to identify gaps and guide distribution of limited resources. 20While the primary purpose of SARA is to assess and monitor health services readiness, we show 21 that it can also be an important resource for answering complex research and policy questions 22 requiring multivariate analysis. 23PeerJ Preprints | https://doi.org/10.7287/peerj.preprints.3197v1 | CC BY 4.0 Open Access |

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Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

Cited by 30 publications

References 18 publications

Quality of integrated chronic disease care in rural South Africa: user and provider perspectives

Quality of integrated chronic disease care in rural South Africa: user and provider perspectives

Prevalence and risk factors for self-reported non-communicable diseases among older Ugandans: a cross-sectional study

Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: a Poisson analysis using the Service Availability and Readiness Assessment

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