Readiness of Ugandan health services for the management of outpatients with chronic diseases

Objective Traditionally, health systems in sub‐Saharan Africa have focused on acute conditions. Few data exist on the readiness of African health facilities ( HF s) to address the growing burden of chronic diseases ( CD s), specifically chronic, non‐communicable diseases ( NCD s). Methods A stratified random sample of 28 urban and rural Ugandan HF s was surveyed to document the burden of selected CD s 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 CD s of 222 health workers were assessed through a self‐completed questionnaire. Results Among adult outpatient visits at hospitals, 33% were for CD s including HIV vs . 14% and 4% at medium‐sized and small health centres, respectively. Many HF s lacked guidelines, diagnostic equipment and essential medicines for the primary management of CD s; 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 HF s. Non‐doctor clinicians and nurses lacked knowledge and experience in NCD care. Conclusion Compared with higher level HF s, lower‐level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower ‐ level HF s, urgently need improvement in managing common NCD s 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.