Abstract
In 2018, the World Health Assembly mandated Member States to take action on rheumatic heart disease (RHD), which persists in countries with weak health systems. We conducted an assessment of the current state of RHD-related healthcare in Uganda. This was a mixed-methods, deductive simultaneous design study conducted in four districts of Uganda. Using census sampling, we surveyed health facilities in each district using an RHD survey instrument that was modeled after the WHO SARA tool. We interviewed health workers with experience managing RHD, purposively sampling to ensure a range of qualification and geographic variation. Our final sample included 402 facilities and 36 health workers. We found major gaps in knowledge of clinical guidelines and availability of diagnostic tests. Antibiotics used in RHD prevention were widely available, but cardiovascular medications were scarce. Higher levels of service readiness were found among facilities in the western region (Mbarara district) and private facilities. Level III health centers were the most prepared for delivering secondary prevention. Health worker interviews revealed that limited awareness of RHD at the district level, lack of diagnostic tests and case management registries, and absence of clearly articulated RHD policies and budget prioritization were the main barriers to providing RHD-related healthcare. Uganda's readiness to implement the World Health Assembly RHD Resolution is low. The forthcoming national RHD strategy must focus on decentralizing RHD diagnosis and prevention to the district level, emphasizing specialized training of the primary healthcare workforce and strengthening supply chains of diagnostics and essential medicines.
Highlights
Rheumatic heart disease (RHD) has nearly been eradicated in wealthy nations but remains a significant public health concern in low-resource countries like Uganda.[1]
We used quantitative and qualitative methods to find out, firstly, what percentage of health facilities are currently providing rheumatic heart disease services and, secondly, what things need to be fixed in order to improve service availability
We found that only 1–2% of health facilities are currently fully equipped to provide rheumatic heart disease prevention and treatment
Summary
Rheumatic heart disease (RHD) has nearly been eradicated in wealthy nations but remains a significant public health concern in low-resource countries like Uganda.[1]. Experts generally agree that RHD persists in part because of weak primary healthcare systems that are failing to deliver evidence-based care to those in need, most of whom come from marginalized populations like rural communities and urban informal settlements.[6] Low availability of RHD preventive interventions and treatments can be remediated by health system reforms including the decentralization of preventive care, formation of national control programs, and focused expansion of tertiary services.[7] These measures have not occurred in most low-resource countries: until recently, RHD has not been part of national health agendas or strategies, despite its intersection with priorities such as child and adolescent health, maternal health, and non-communicable diseases. We conducted an assessment of the current state of RHD-related healthcare in Uganda
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