ArticleBMJ global health2019
Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda.
Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review.BMC public health · 2022Pooled it
- Patient and provider experiences with PEN-Plus in rural Mozambique: cohort characteristics at baseline.Global health action · 2026Article
- Exploring the Socio-Economic Toll of Non-Communicable Diseases in Low-Resource Settings: Novel Evidence From Mozambique.The International journal of health planning and management · 2026Article
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- Cost-Effectiveness Analysis of Surgical Strategies Versus Medical Management for Rheumatic Heart Disease in Rwanda.Journal of the American Heart Association · 2025Article
- Facility readiness for decentralized Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) care in nine lower-income countries.PLOS global public health · 2025Article
- Outcomes of an integrated knowledge translation approach in five African countries: a mixed-methods comparative case study.Health research policy and systems · 2024Article
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- Using Point-of-Care Ultrasound in Heart Failure Diagnosis and Management in Rural and Resource-Limited Settings.CASE (Philadelphia, Pa.) · 2022Article
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- Addressing severe chronic NCDs across Africa: measuring demand for the Package of Essential Non-communicable Disease Interventions-Plus (PEN-Plus).Health policy and planning · 2022Article
- Modelling study of the ability to diagnose acute rheumatic fever at different levels of the Ugandan healthcare system.BMJ open · 2022Article
- [Integrated Care Protocols, a strategy for chronic diseases].Revista medica del Instituto Mexicano del Seguro Social · 2022Article
- Comparison of community and clinic-based blood pressure measurements: A cross-sectional study from Haiti.PLOS global public health · 2022Article
- Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus Strategies.Annals of global health · 2022Article
- Experience of living with type 1 diabetes in a low-income country: a qualitative study from Liberia.BMJ open · 2021Article
- Implementation outcomes of national decentralization of integrated outpatient services for severe non-communicable diseases to district hospitals in Rwanda.Tropical medicine & international health : TM & IH · 2021Article
- An investment case for the prevention and management of rheumatic heart disease in the African Union 2021-30: a modelling study.The Lancet. Global health · 2021Article
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Authors and funding
21 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntegrated 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.
methodsA 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.
resultsA 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.
conclusionsThis 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.
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