Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda

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; Joseph Mucumbitsi; Cyprien Gahamanyi; Cadet Mutumbira; Paul H Park; Tharcisse Mpunga; Gene Bukhman

doi:10.1136/bmjgh-2019-001449

journal article Jun 01, 2019

Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda

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 Joseph Mucumbitsi Cyprien Gahamanyi Cadet Mutumbira Paul H Park Tharcisse Mpunga Gene Bukhman

BMJ Global Health Vol. 4 No. 3 pp. e001449 · BMJ

View at Publisher Save 10.1136/bmjgh-2019-001449

Abstract

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.

Topics

No keywords indexed for this article. Browse by subject →

References

25

[1]

Ottersen T , Norheim OF , World Health Organization Consultative Group on Equity and Universal Health Coverage . Making fair choices on the path to universal health coverage. Bull World Health Organ 2014;92.doi:10.2471/BLT.14.139139 10.2471/blt.14.139139

[2]

Tracking universal health coverage. First global monitoring report. Geneva World Health Organization; 2015.

[3]

10.1016/s0140-6736(15)00278-0

[4]

Stenberg K , Hanssen O , Edejer TT-T , et al . Financing transformative health systems towards achievement of the health sustainable development goals: a model for projected resource needs in 67 low-income and middle-income countries. Lancet 2017. 10.1016/s2214-109x(17)30263-2

[5]

10.1016/s0140-6736(18)30665-2

[6]

World Health Organization . Scaling up action against noncommunicable diseases: how much will it cost? Geneva: World Health Organization, 2011. Available: http://www.who.int/iris/handle/10665/44706

[7]

10.1016/s0140-6736(03)12655-4

[8]

Soliman EZ , Mendis S , Dissanayake WP , et al . A polypill for primary prevention of cardiovascular disease: a feasibility study of the World Health Organization. Trials 2011;12.doi:10.1186/1745-6215-12-3 10.1186/1745-6215-12-3

[9]

WHO . Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva World Health Organization; 2010.

[10]

Implementation tools . Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva World Health Organization; 2013: pp. 1–210.

[11]

Bukhman G , Kidder A , eds. The Partners In Health Guide to Chronic Care Integration for Endemic Non-Communicable Diseases—Rwanda Edition. Boston, MA: Partners in Health, 2011.

[12]

10.1016/j.jchf.2013.03.006

[13]

Eberly "Nurse-driven echocardiography and management of heart failure at district hospitals in rural Rwanda" Circ Cardiovasc Qual Outcomes (2018) 10.1161/circoutcomes.118.004881

[14]

10.1136/heartjnl-2017-312644

[15]

Habineza "Treating persistent asthma in rural Rwanda: characteristics, management and 24-month outcomes" Int J Tuberc Lung Dis (2017) 10.5588/ijtld.17.0039

[16]

Tapela "Diabetes in rural Rwanda: high retention and positive outcomes after 24 months of follow-up in the setting of chronic care integration" Int J Diabetes Clin Res (2016) 10.23937/2377-3634/1410058

[17]

National Institute of Statistics of Rwanda (NISR) . Ministry of Finance and Economic Planning (MINECOFIN). Rwanda Rwanda Fourth Population and Housing Census; 2012.

[18]

10.1155/2017/4319057

[19]

Gupta "Leveraging the lessons learned from HIV/AIDS for coordinated chronic care delivery in resource-poor settings" Healthcare (2015) 10.1016/j.hjdsi.2015.09.006

[20]

10.1136/heartjnl-2016-310913

[21]

Bukhman "Endemic diabetes in the world's poorest people" Lancet Diabetes Endocrinol (2015) 10.1016/s2213-8587(15)00138-2

[22]

Harvard Medical School and Partners in Health co-host session with World Health Organization on addressing gaps for severe NCDs such as Type 1 Diabetes through “PEN-Plus” strategies at WHO AFRO in Dakar, Senegal [Internet]. Dakar, Senegal NCD Synergies; 2018. http://ncdsynergies.org/harvard-medical-school-afro-session/

[23]

10.1016/j.jacc.2018.12.028

[24]

Feachem RG , Kjellstrom T , Murray CJL , et al . The health of adults in the developing world. New York: Oxford University Pres, 1992.

[25]

IHME (Institute for Health Metrics and Evaluation) . Global burden of disease 2016 data visualizations, 2017. Available: http://viz.healthmetricsandevaluation.org/gbd-compare/ [Accessed 12 Mar 2019].

Cited By

28

Experience of living with type 1 diabetes in a low-income country: a qualitative study from Liberia

Alma J Adler, Celina Trujillo · 2021

BMJ Open

Metrics

28

Citations

25

References

Details

Published: Jun 01, 2019
Vol/Issue: 4(3)
Pages: e001449

Authors

L

Lauren Anne Eberly

Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA

C

Christian Rusangwa

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

L

Loise Ng'ang'a

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

C

Claire C Neal

Organizational Transformational Initiatives, Greenville, South Carolina, USA

J

Jean Paul Mukundiyukuri

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

E

Egide Mpanusingo

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

J

Jean Claude Mungunga

Partners In Health, Boston, Massachusetts, USA

H

Hamissy Habineza

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

T

Todd Anderson

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

G

Gedeon Ngoga

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

S

Symaque Dusabeyezu

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

G

Gene Kwan

Department of Medicine, Section of Cardiology, Boston University, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Program in Global NCDs and Social Change, Harvard Medical School, Boston, Massachusetts, USA

C

Charlotte Bavuma

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda; Department of Internal Medicine, Endocrinology Unit, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

E

Emmanual Rusingiza

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda; Department of Pediatrics, Pediatric Cardiology Unit, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

F

Francis Mutabazi

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

J

Joseph Mucumbitsi

Department of Paediatrics, King Faisal Hospital, Kigali, Rwanda

C

Cyprien Gahamanyi

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

C

Cadet Mutumbira

Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, Rwanda

P

Paul H Park

Partners In Health, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Program in Global NCDs and Social Change, Harvard Medical School, Boston, Massachusetts, USA

T

Tharcisse Mpunga

Ministry of Health, Kigali, Rwanda

G

Gene Bukhman

Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA; Partners In Health, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Program in Global NCDs and Social Change, Harvard Medical School, Boston, Massachusetts, USA

Cite This Article

Lauren Anne Eberly, Christian Rusangwa, Loise Ng'ang'a, et al. (2019). Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda. BMJ Global Health, 4(3), e001449. https://doi.org/10.1136/bmjgh-2019-001449

Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda

You May Also Like