Abstract
ObjectiveTo explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit.MethodsFull financial and economic cost data were collected from 12 facilities in two districts, from the provider's perspective. A combination of ingredients‐based and step‐down allocation costing approaches was used. The diseases under study were diabetes, hypertension, chronic obstructive pulmonary disease (COPD), epilepsy and HIV infection. Data were collected through a review of facility records, direct observation and structured interviews with health workers.ResultsProvision of chronic care services was concentrated at higher‐level facilities. Excluding drugs, the total costs for NCD care fell below 2% of total facility costs. Unit costs per visit varied widely, both across different levels of the health system, and between facilities of the same level. This variability was driven by differences in clinical and drug prescribing practices.ConclusionMost patients reported directly to higher‐level facilities, bypassing nearby peripheral facilities. NCD services in Uganda are underfunded particularly at peripheral facilities. There is a need to estimate the budget impact of improving NCD care and to standardise treatment guidelines.
Highlights
The prevalence of non-communicable disease (NCD) has been rising in low- and middle-income countries (LMIC) over the past years and is likely to increase further [1, 2]
This lack of a programmatic approach exists despite the fact that NCDs and human immunodeficiency virus (HIV) infection require similar responses from the health system: a regular long-term follow-up of patients and an uninterrupted provision of medicines
While the hospital and health centre level IV (HC IV) had the minimum number of the staff required according to staffing norms, only 1 of 7 health centres level III (HCs III) and 1 of 3 health centres level II (HCs II) had all the staff allocated to them
Summary
The prevalence of non-communicable disease (NCD) has been rising in low- and middle-income countries (LMIC) over the past years and is likely to increase further [1, 2]. The WHO Kampala Declaration and Agenda for Global Action of 2008 (‘health workers for all and all for health workers’) [6] emphasises the dilemma of this double burden, and the pressure it places on health systems and the limited resources available to fund them[7] Despite this growing pressure, there remains little understanding about how chronic care services are and should be provided in LMIC, at the peripheral health system level. While there has been progress in disease-specific chronic care programs targeted at people with human immunodeficiency virus (HIV) infection, NCDs have not yet seen structured care programmes in LMIC [8]. Many countries are concerned about healthcare expenditures associated with NCDs and how best to provide services
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