title: The health system burden of chronic disease care: an estimation of provider costs of selected chronic diseases in Uganda.
abstract: OBJECTIVE
  To explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit.
  
  
  METHODS
  Full 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.
  
  
  RESULTS
  Provision 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.
  
  
  CONCLUSIONS
  Most 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.
authors.affiliation: Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Stella Nalukwago
authors.initials: SN
authors.lastname: Settumba
authors.forename: Sedona
authors.initials: S
authors.lastname: Sweeney
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.forename: Samuel
authors.initials: S
authors.lastname: Biraro
authors.forename: Gerald
authors.initials: G
authors.lastname: Mutungi
authors.forename: Paula
authors.initials: P
authors.lastname: Munderi
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology; D003365:Costs and Cost Analysis; D003625:Data Collection / Q000379:methods; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology; D004827:Epilepsy / Q000191:economics* / Q000453:epidemiology; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000453:epidemiology; D018803:Models, Economic; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000453:epidemiology; D012189:Retrospective Studies; D014454:Uganda / Q000453:epidemiology
keywords: Costes; Enfermedades No Infecciosas; Maladies non transmissibles; Ouganda; Países con ingresos bajos y medios; Uganda; VIH; cost; coût; health systems; human immunodeficiency virus; low- and middle-income countries; non-communicable diseases; pays à revenus faibles et intermédiaires; sistemas sanitarios; systèmes de santé