title: Readiness of Ugandan health services for the management of outpatients with chronic diseases.
abstract: OBJECTIVE
  Traditionally, health systems in sub-Saharan Africa have focused on acute conditions. Few data exist on the readiness of African health facilities (HFs) to address the growing burden of chronic diseases (CDs), specifically chronic, non-communicable diseases (NCDs).
  
  
  METHODS
  A stratified random sample of 28 urban and rural Ugandan HFs was surveyed to document the burden of selected CDs by analysing the service statistics, service availability and service readiness using a modified WHO Service Availability and Readiness Assessment questionnaire. Knowledge, skills and practice in the management of CDs of 222 health workers were assessed through a self-completed questionnaire.
  
  
  RESULTS
  Among adult outpatient visits at hospitals, 33% were for CDs including HIV vs. 14% and 4% at medium-sized and small health centres, respectively. Many HFs lacked guidelines, diagnostic equipment and essential medicines for the primary management of CDs; training and reporting systems were weak. Lower-level facilities routinely referred patients with hypertension and diabetes. HIV services accounted for most CD visits and were stronger than NCD services. Systems were weaker in lower-level HFs. Non-doctor clinicians and nurses lacked knowledge and experience in NCD care.
  
  
  CONCLUSIONS
  Compared with higher level HFs, lower-level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower-level HFs, urgently need improvement in managing common NCDs to cope with the growing burden. This should include the provision of standard guidelines, essential diagnostic equipment and drugs, training of health workers, supportive supervision and improved referral systems. Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible.
authors.affiliation: Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Katende
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Gerald
authors.initials: G
authors.lastname: Mutungi
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.affiliation: Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Samuel
authors.initials: S
authors.lastname: Biraro
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Eric
authors.initials: E
authors.lastname: Ikoona
authors.affiliation: Mwanza Intervention Trials Unit and Weill Bugando School of Medicine, Mwanza, Tanzania.
authors.forename: Robert
authors.initials: R
authors.lastname: Peck
authors.affiliation: Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Hayes
authors.affiliation: Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Paula
authors.initials: P
authors.lastname: Munderi
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
mesh_terms: D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000628:therapy; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D004827:Epilepsy / Q000175:diagnosis / Q000628:therapy; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006296:Health Services / Q000592:standards; D006801:Humans; D010045:Outpatients; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000628:therapy; D012423:Rural Health; D011795:Surveys and Questionnaires; D014454:Uganda; D014504:Urban Health
keywords: Afrique subsaharienne; Ouganda; Uganda; chronic diseases; enfermedades crónicas; health services; healthcare systems; maladies chroniques; outpatients; pacientes externos; patients ambulatoires; services de santé; servicios sanitarios; sistemas sanitarios; sub-Saharan Africa; systèmes de santé; África subsahariana