Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda
Background Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised c...
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BMJ Publishing Group
2019-06-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/3/e001449.full |
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| author | Joseph Mucumbitsi Lauren Anne Eberly Christian Rusangwa Loise Ng'ang'a Claire C Neal Jean Paul Mukundiyukuri Egide Mpanusingo Jean Claude Mungunga Hamissy Habineza Todd Anderson Gedeon Ngoga Symaque Dusabeyezu Gene Kwan Charlotte Bavuma Emmanual Rusingiza Francis Mutabazi Cyprien Gahamanyi Cadet Mutumbira Paul H Park Tharcisse Mpunga Gene Bukhman |
| author_facet | Joseph Mucumbitsi Lauren Anne Eberly Christian Rusangwa Loise Ng'ang'a Claire C Neal Jean Paul Mukundiyukuri Egide Mpanusingo Jean Claude Mungunga Hamissy Habineza Todd Anderson Gedeon Ngoga Symaque Dusabeyezu Gene Kwan Charlotte Bavuma Emmanual Rusingiza Francis Mutabazi Cyprien Gahamanyi Cadet Mutumbira Paul H Park Tharcisse Mpunga Gene Bukhman |
| author_sort | Joseph Mucumbitsi |
| collection | DOAJ |
| description | Background Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease.Methods A retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined.Results A total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing.Conclusions This is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems. |
| format | Article |
| id | doaj-art-ef1f48e480704506ad5d885537a0ed4c |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-ef1f48e480704506ad5d885537a0ed4c2024-12-15T10:55:07ZengBMJ Publishing GroupBMJ Global Health2059-79082019-06-014310.1136/bmjgh-2019-001449Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural RwandaJoseph Mucumbitsi0Lauren Anne Eberly1Christian Rusangwa2Loise Ng'ang'a3Claire C Neal4Jean Paul Mukundiyukuri5Egide Mpanusingo6Jean Claude Mungunga7Hamissy Habineza8Todd Anderson9Gedeon Ngoga10Symaque Dusabeyezu11Gene Kwan12Charlotte Bavuma13Emmanual Rusingiza14Francis Mutabazi15Cyprien Gahamanyi16Cadet Mutumbira17Paul H Park18Tharcisse Mpunga19Gene Bukhman20College of Medicine and Health Sciences, University of Rwanda, Kigali, RwandaDepartment of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USAPartners In Health, Kigali, RwandaInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaOrganizational Transformational Initiatives, Greenville, South Carolina, USAInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaPartners In Health, Boston, Massachusetts, USAInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaDepartment of Cardiac Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, CanadaNon-Communicable Diseases Division, Rwanda Biomedical Center, Kigali, RwandaPartners In Health/Inshuti Mu Buzima, Rwinkwavu, RwandaDepartment of Medicine, Section of Cardiology, Boston University, Boston, Massachusetts, USAInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaInshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda1 Center for Integration Science, Division of Global Health Equity, Brigham and Women`s Hospital, Boston, Massachusetts, USAMinistry of Health, Kigali, RwandaPartners In Health, Boston, Massachusetts, USABackground Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease.Methods A retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined.Results A total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing.Conclusions This is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems.https://gh.bmj.com/content/4/3/e001449.full |
| spellingShingle | Joseph Mucumbitsi Lauren Anne Eberly Christian Rusangwa Loise Ng'ang'a Claire C Neal Jean Paul Mukundiyukuri Egide Mpanusingo Jean Claude Mungunga Hamissy Habineza Todd Anderson Gedeon Ngoga Symaque Dusabeyezu Gene Kwan Charlotte Bavuma Emmanual Rusingiza Francis Mutabazi Cyprien Gahamanyi Cadet Mutumbira Paul H Park Tharcisse Mpunga Gene Bukhman Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda BMJ Global Health |
| title | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
| title_full | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
| title_fullStr | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
| title_full_unstemmed | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
| title_short | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
| title_sort | cost of integrated chronic care for severe non communicable diseases at district hospitals in rural rwanda |
| url | https://gh.bmj.com/content/4/3/e001449.full |
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