Medium-to-long term sustainability of a health systems intervention to improve service readiness and quality of non-communicable disease (NCD) patient care and experience at primary care settings in Uganda

BMC Health Services Research

Research

Kathy Baisley¹  Heiner Grosskurth¹  David Katende²  Isaac Sekitoleko²  Moffat Nyirenda²  Michael Charles Mubiru³  Kevin Nakuya³  Ivan Kasamba³  Caleb Kusilika³  Allan Buyinza³  Gerald Mutungi⁴ 

[1] London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK;London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK;MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda;MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda;Ministry of Health Uganda, Kampala, Uganda;

关键词: Sustainability;    Evaluation;    Chronic diseases;    NCDS;    Health systems;    Primary care;    Sub-Saharan Africa;    Uganda;    Intervention trial;    Long term;    Medium term;    Patient clubs;    Adherence clubs;   

DOI  :  10.1186/s12913-023-09983-7

 received in 2023-02-04, accepted in 2023-08-29,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundWith the double burden of rising chronic non-communicable diseases (NCDs) and persistent infectious diseases facing sub-Saharan Africa, integrated health service delivery strategies among resource-poor countries are needed.Our study explored the post-trial sustainability of a health system intervention to improve NCD care, introduced during a cluster randomised trial between 2013 and 2016 in Uganda, focusing on hypertension (HT) and type-2 diabetes mellitus (DM) services.In 2020, 19 of 38 primary care health facilities (HFs) that constituted the trial’s original intervention arm until 2016 and 3 of 6 referral HFs that also received the intervention then, were evaluated on i) their facility performance (FPS) through health worker knowledge, and service availability and readiness (SAR), and ii) the quality-of-patient-care-and-experience (QoCE) received.MethodsCross-sectional data from the original trial (2016) and our study (2020) were compared. FPS included a clinical knowledge test with 222 health workers: 131 (2016) and 91 (2020) and a five-element SAR assessment of all 22 HFs. QoCE assessment was performed among 420 patients: 88 (2016) and 332 (2020). Using a pair-matched approach, FPS and QoCE summary scores were compared. Linear and random effects Tobit regression models were also analysed.ResultsThe mean aggregate facility performance (FPS) in 2020 was lower than in 2016: 70.2 (95%CI = 66.0–74.5) vs. 74.8 (95%CI = 71.3–78.3) respectively, with no significant difference (p = 0.18). Mean scores declined in 4 of 5 SAR elements.Overall FPS was negatively affected by rural or urban HF location relative to peri-urban HFs (p < 0.01). FPS was not independently predicted but patient club functionality showed weak association (p = 0.09).QoCE declined slightly to 8.7 (95%CI = 8.4–91) in 2020 vs 9.5 (95%CI = 9.1–9.9) in 2016 (p = 0.02) while the proportion of patients receiving adequate quality care also declined slightly to 88.2% from 98.5% respectively, with no statistical difference (p = 0.20). Only the parent district weakly predicted QoCE (p = 0.05).ConclusionsFour years after the end of research-related support, overall facility performance had declined as expected because of the interrupted supplies and a decline in regular supervision. However, both service availability and readiness and quality of HT/DM care were surprisingly well preserved.Sustainability of an NCD intervention in similar settings may remain achievable despite the funding instability following a trial’s end but organisational measures to prepare for the post-trial phase should be taken early on in the intervention process.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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