TY - JOUR
T1 - Management of chronic lung diseases in Sudan and Tanzania
T2 - how ready are the country health systems?
AU - The IMPALA Consortium
AU - Egere, Uzochukwu
AU - Shayo, Elizabeth
AU - Ntinginya, Nyanda
AU - Osman, Rashid
AU - Noory, Bandar
AU - Mpagama, Stella
AU - Hussein, El Hafiz
AU - Tolhurst, Rachel
AU - Obasi, Angela
AU - Mortimer, Kevin
AU - Sony, Asma El
AU - Taegtmeyer, Miriam
AU - Addo-Yobo, Emmanuel
AU - Allwood, Brian
AU - Banda, Hastings
AU - Bates, Imelda
AU - Binegdie, Amsalu
AU - Falade, Adegoke
AU - Khan, Jahangir
AU - Lesosky, Maia
AU - Mbatchou, Bertrand
AU - Meme, Hellen
AU - Mutayoba, Beatrice
AU - Niessen, Louis
AU - Rylance, Jamie
AU - Worodria, William
AU - Zar, Heather
AU - Zulu, Eliya
AU - Zurba, Lindsay
AU - Squire, S. Bertel
N1 - Funding Information:
This work was a collaborative work by the International Multidisciplinary Program to Address Lung Health and Tuberculosis in Africa (IMPALA) Consortium. We thank the IMPALA management team for their support and leadership, and for reviewing the manuscript. We thank the IMPALA program manager, Martina Savio and administrator, Elly Wallis, for ongoing managerial and logistical support for this work. We are grateful to research assistants and colleagues from the National Institute for Medical Research (NIMR) Tanzania, National Leprosy and Tuberculosis Program (NLTP) Tanzania, Kibong’oto Infectious Disease Hospital, Tanzania and the Epidemiological Laboratory (EPILAB), Khartoum Tanzania for their invaluable role in the organization and conduct of the study. Our gratitude also goes to the Ministry of Health, Community development, Gender, Elderly and Children (MoHCDEC), Tanzania; Dodoma Regional and Chamwino District government authorities, and the Gezira State ministry of Health, Al Gezira, Sudan for their support. We thank all national, regional/state and district/locality informants who participated in the interviews, and heads and staff of health facilities where readiness assessment and record reviews were conducted, for their cooperation and time. Finally, we are grateful to the patients, their families and communities who participated in this study. On behalf of IMPALA Consortium collaborators Emmanuel Addo-Yobo, Brian Allwood, Hastings Banda, Imelda Bates, Amsalu Binegdie, Adegoke Falade, Jahangir Khan, Maia Lesosky, Bertrand Mbatchou, Hellen Meme, Beatrice Mutayoba, Louis Niessen, Jamie Rylance, William Worodria, Heather Zar, Eliya Zulu, Lindsay Zurba and S Bertel Squire.
Funding Information:
This research was funded by the National Institute for Health Research (NIHR) (IMPALA, grant reference 16/136/35) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Chronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. Methods: We conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains. Results: One health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care. Conclusions: Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart.
AB - Background: Chronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. Methods: We conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains. Results: One health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care. Conclusions: Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart.
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U2 - 10.1186/s12913-021-06759-9
DO - 10.1186/s12913-021-06759-9
M3 - Article
C2 - 34303370
AN - SCOPUS:85111652947
VL - 21
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 734
ER -