title: Evaluation of care access and hypertension control in a community health worker driven non-communicable disease programme in rural Uganda: the chronic disease in the community project.
abstract: The burden of non-communicable diseases continues to grow throughout the developing world. Health systems in low- and middle-income regions face significant human resource shortages, which limit the ability to meet the growing need for non-communicable disease care. Specially trained community health workers may be useful in filling that provider gap. This study aimed to evaluate consistency of access to care and quality of hypertension control in a community health worker led, decentralized non-communicable disease programme operating in rural Uganda. Days between clinical evaluations and average systolic blood pressure were described for programme patients; these markers were also compared with patients seen in a central, hospital-based clinic. In 2013, community health worker programme patients were seen every 35.6 days and significantly more often than clinic patients (50.8 days, P < 0.001). From October to December 2013, hypertensive patients in the community health worker programme had a mean systolic blood pressure of 147.8 mmHg. This was lower than the average systolic pressure of clinic patients (156.7 mmHg, P < 0.001). Programme patients' blood pressures were also more frequently measured at below goal than clinic patients (71.2 vs 59.8%, P = 0.048). Decentralizing care and shifting significant clinical management responsibilities to community health workers improved consistency of access to care and did not come with a demonstrable cost in quality of hypertension control. Community health workers may have the potential to bridge the provider gap in low-income nations, providing expanded non-communicable disease care.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA, Doctors for Global Health, Kisoro, Uganda.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: O'Neil
authors.affiliation: Doctors for Global Health, Kisoro, Uganda, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Wanda C
authors.initials: WC
authors.lastname: Lam
authors.affiliation: Doctors for Global Health, Kisoro, Uganda, Kisoro District Hospital, PO Box 247, Kisoro, Uganda.
authors.forename: Patience
authors.initials: P
authors.lastname: Nyirangirimana
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA, and.
authors.forename: William B
authors.initials: WB
authors.lastname: Burton
authors.affiliation: Doctors for Global Health, Kisoro, Uganda, Kisoro District Hospital, PO Box 247, Kisoro, Uganda.
authors.forename: Michael
authors.initials: M
authors.lastname: Baganizi
authors.affiliation: Doctors for Global Health, Kisoro, Uganda, Kisoro District Hospital, PO Box 247, Kisoro, Uganda.
authors.forename: Sam
authors.initials: S
authors.lastname: Musominali
authors.affiliation: Doctors for Global Health, Kisoro, Uganda, Kisoro District Hospital, PO Box 247, Kisoro, Uganda.
authors.forename: Deus
authors.initials: D
authors.lastname: Bareke
authors.affiliation: Doctors for Global Health, Kisoro, Uganda, Department of Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA, and.
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Paccione
keywords: Access; community health workers; hypertension; non-communicable disease; task shifting