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Implementation outcomes of national decentralization of integrated outpatient services for severe non-communicable diseases to district hospitals in Rwanda
- Source :
- Tropical Medicine & International Health
- Publication Year :
- 2021
-
Abstract
- Objectives Effective coverage of non‐communicable disease (NCD) care in sub‐Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first‐level hospitals. This study describes the facility‐level implementation outcomes of this strategy. Methods In 2014, the Ministry of Health trained two nurses in each of the country’s 42 first‐level hospitals to implement and deliver nurse‐led, integrated, outpatient NCD clinics, which focused on severe NCDs. Post‐intervention evaluation occurred via repeated cross‐sectional surveys, informal interviews and routinely collected clinical data over two rounds of visits in 2015 and 2017. Implementation outcomes included fidelity, feasibility and penetration. Results By 2017, all NCD clinics were staffed by at least one NCD‐trained nurse. Among the approximately 27 000 nationally enrolled patients, hypertension was the most common diagnosis (70%), followed by type 2 diabetes (19%), chronic respiratory disease (5%), type 1 diabetes (4%) and heart failure (2%). With the exception of warfarin and beta‐blockers, national essential medicines were available at more than 70% of facilities. Clinicians adhered to clinical protocols at approximately 70% agreement with evaluators. Conclusion The government of Rwanda was able to scale a nurse‐led outpatient NCD programme to all first‐level hospitals with good fidelity, feasibility and penetration as to expand access to care for severe NCDs.
- Subjects :
- medicine.medical_specialty
Referral
type 1 diabetes
030231 tropical medicine
Type 2 diabetes
Disease
Essential medicines
Health Services Accessibility
03 medical and health sciences
0302 clinical medicine
Ambulatory care
medicine
Ambulatory Care
Humans
first‐level hospital
Noncommunicable Diseases
national scale‐up
Retrospective Studies
Heart Failure
Type 1 diabetes
Government
non‐communicable disease
business.industry
Delivery of Health Care, Integrated
Politics
Public Health, Environmental and Occupational Health
Rwanda
Non-communicable disease
rheumatic heart disease
medicine.disease
Infectious Diseases
Diabetes Mellitus, Type 1
Outcome and Process Assessment, Health Care
Family medicine
Hypertension
Africa
Parasitology
Original Article
Rural Health Services
rural
business
Original Research Papers
Subjects
Details
- ISSN :
- 13653156
- Volume :
- 26
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Tropical medicineinternational health : TMIH
- Accession number :
- edsair.doi.dedup.....3ca64765aecb08b8139c95d90db1d339