A patient walks into a general hospital on Monday for his/her hypertension review, spends close to an hour in the waiting area, has his file retrieved, is seen by a triage nurse and then proceeds to see a doctor  after waiting for about an hour in the queue. After the consultation by a clinician/physician, proceeds to have his/her refills of anti-hypertensive medicines and is ready to walk back home after spending almost half the day at a hospital. Meanwhile he/she is also diabetic and is due for a review on Wednesday at the same general hospital. On Wednesday the process is very similar only that this time he/she has to come after an overnight fast so that they can take his fasting blood sugar before proceeding to see the clinician/physician.  A few of the diabetic patients have had their kidneys affected in the process and because of this they may have to attend the renal clinic on Thursday for review and treatment.  This kind of cycle may happen every month or every two or three months. This is in no way an exaggeration but an attempt to reflect the dilemma of the many Ugandans that have NCD comorbidities (two or more coexisting medical conditions/diseases).

For the patient, hospital visits mean transport fares (and most of our patients travel great distances to a health facility), missed time away from occupations (ranging from office work to digging in their gardens) and in some cases health care related out-of-pocket expenditures. For the health system, multiple patient visits could translate into increased administrative costs, greater work loads for staff, especially front line staff, and disintegrated patient records/information.

Non Communicable Diseases – the global and local context

Non Communicable Diseases (NCDS) have been defined by the World Health Organization as chronic diseases that are not passed from person to person. Besides diabetes, cardiovascular (hypertension, stroke), and chronic kidney diseases, other NCDs include: cancer, chronic lung diseases, mental illnesses such as depression, neurological disorders such as epilepsy, and blood disorders such as sickle cell disease.

Sixty percent of deaths around the world are due to NCDs and majority of these (80%) are happening in low- and middle-income countries. In Sub-Saharan Africa, NCDs are rising faster especially in young people and 50% of NCD deaths occur during reproductive years. The effects of this to an individual include lost family income due to disability or death, high health care costs leading to poverty and for the national economy this means reduced quantity and quality of labor, hence decreased economic development.

Does the health care system have a response to this?

There is fragmentation of clinical services for major NCDs like diabetes, hypertension and renal disease in most of the health facilities in Uganda; each of the NCD clinics often work independently. These sub-specialties use the same physical space, the same nurses, medical officers, and clinical officers but different medical records. This fragmented care, especially for patients with co-morbidity leads to incomplete patient records, misuse of medication, time wastage, and erratic follow-up.

Uganda, a country of over 30 million people, is now facing a double burden of disease. The infectious diseases remain a challenge to the health sector and now the burden of NCDs is rising. For long, the approach of the health system towards addressing these had been the much criticized vertical or disease oriented programs. There is now need for not only a horizontal or system wide approach but also an integrated comprehensive method to tackle complex, inter-related chronic diseases.

This approach could be modeled around a system where a patient with co-morbidity visits the hospital at least once a month, his or her NCD related clinical, has diagnostic tests done all at once (blood pressure, blood sugar measurement, urine analysis, among others) and is seen by one clinician unless it’s a complicated cases requiring a specialist. Then his/her medical records are all captured in one file and they would receive comprehensive NCD-related health education. This will go a long way in improving the quality of care, patient hospital experiences and reduced hospital visits. Further still, it will also reduce workloads for health workers, free up more time for workers to complete other tasks, cut down administrative costs and improve medical records for patients

The role UINCD in NCD prevention and clinical care

I am privileged to work as an Informatics Officer with Uganda Initiative for Integrated Management of Non Communicable Diseases (UINCD) as a Global Health Corps Fellow 2014/15. For the one-year fellowship period, I will work towards building capacity for UINCD ‘s database for NCD related information and capturing patient medical record into an electronic medical records system.

UINCD seeks to contribute to addressing NCDs by building capacity in the realms of prevention, clinical care, health worker training, and research to enable the provision of effective and integrated management of NCDs. UINCD is working to shift the paradigm in Uganda by developing and piloting new models of integrated delivery platforms for NCDs. This initiative is a research collaboration of Yale University, Makerere University College of Health Sciences, Mulago National Referral and Teaching Hospital and the Ministry of Health.

 

 

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