1. Hypertension 2. Diabetes mellitus (type II) Circulatory System 1. Hypertension 2. Diabetes mellitus (type II)
Conditions
Interventions
Sub-study 1:
In each country (Uganda and Tanzania), 40 primary health care facilities will be assessed, stratified by kind of facility ('health centres' and 'dispensaries 'in Tanzania
'health centres III' and 'health centres II' in Uganda). The head of the facility and the health worker in charge of the outpatient department (OPD) will be interviewed. OPDs, pharmacies and laborator
the results will feed into a facility specific summary score, again to reflect the degree of service readiness of the facility.
Sub-study 2:
At each primary health car
Sponsors
London School of Hygiene and Tropical Medicine
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Health facilities: 1. Located in one municipality and two rural districts each in SW Uganda and NW Tanzania Health workers 1. Those in charge of outpatient services 2. All HWs who provide care for patients with hypertension (HT) and/or diabetes mellitus (DM) 3. Working at the above intervention and comparison HFs Patients at HFs: 1. Aged 18 or over 2. Diagnosis of hypertension or diabetes mellitus 3. Access services at intervention or comparison health facilities Patients, community based: 1. Aged 18 or over 2. Diagnosis of hypertension or diabetes mellitus 3. Reside in the catchment areas of intervention or comparison health facilities 4. Diagnosed during a previous cross-sectional survey conducted prior to the intervention project Community members: 1. Aged 18 or over 2. Reside in communities adjacent to intervention and comparison facilities
Exclusion criteria
Exclusion criteria: Health workers: Thosenot involved in providing OPD care for HT/DM Patients: 1. Aged <18 years 2. Not affected by HT/DM General population 1. Aged <18 years 2. Not a resident in a community adjacent to an intervention or comparison health facility
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Quality of services provided for selected NCDs (hypertension and diabetes mellitus) at 40 public health facilities each in Uganda and Tanzania, measured through a composite evaluation score. The primary outcome is measured in sub-studies 1, 2 and 3. Sub-study 1: Service readiness at primary care facilities for the diagnosis and case management of hypertension and diabetes will be assessed using physical inspection of essential equipment and consumables; health workers’ knowledge on selected chronic diseases will be assessed using a validated knowledge test; Sub-study 2: Quality of NCD case management currently received by individual patients will be assessed through patient interviews, evaluation of medical records, physical examination, blood pressure measurement and blood tests for diabetes. Sub-study 3: Health status and treatment seeking behaviour of NCD patients residing in the catchment areas of participating health facilities will be assessed as in sub-study 2, i.e. through patient interviews, evaluation of medical records, physical examination, blood pressure measurement and blood tests for diabetes. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Costs and cost-effectiveness of NCD care services will be documented from the provider perspective by collating costs for equipment, consumables, utilities and health worker time. Cost-effectiveness will be estimated by relating costs to the numbers of NCD cases managed according to guidelines, and comparing these data between participating health facilities (sub-study 4 only). 2. Potential secondary effects of NCD services on other services provided at the same facilities(e.g. mother-and child care), will be assessed through in-depth interviews of health workers working at the participating health facilities (sub-study 5 only) 3. Community perceptions and health seeking beliefs for the prevention and care of NCDs will be assessed through focus-group discussions and in-depth interviews conducted with members from the general adult population residing in the catchment of participating health facilities (sub-study 6 only) | — |
Countries
Tanzania, Uganda
Outcome results
None listed