ArticleTropical medicine & international health : TM & IH2021
Implementation outcomes of national decentralization of integrated outpatient services for severe non-communicable diseases to district hospitals in Rwanda.
Article in Tropical medicine & international health : TM & IH, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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23 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review.The Lancet. Global health · 2022Pooled it
- Feasibility and effectiveness of self-monitoring of blood glucose among insulin-dependent patients with type 2 diabetes: open randomized control trial in three rural districts in Rwanda.BMC endocrine disorders · 2022Trial
- Patient and provider experiences with PEN-Plus in rural Mozambique: cohort characteristics at baseline.Global health action · 2026Article
- Availability of essential medicines for non-communicable diseases: a scoping review of challenges and opportunities.BMJ global health · 2025Article
- Understanding the role and organization of health workers delivering non-communicable disease management in primary care in low- and middle-income countries: a scoping review.BMC primary care · 2025Article
- Factors influencing blood pressure control among patients with hypertension in Rwanda: the role of patients and caretakers.BMC public health · 2025Article
- Assessment of Blood Pressure Control Status Among Hypertensive Patients Attending Rwandan District Hospital NCD Clinics: A Retrospective Follow-Up Study.Journal of epidemiology and global health · 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
- Prospective cohort study evaluating feasibility, acceptability, and clinical impact of diabetes self-management education in a PEN-Plus program in Southeastern Liberia.PLOS global public health · 2025Article
- Nurturing hope in Rwandan healthcare settings: Exploring factors that influence hope among healthcare providers, pregnant women, and mothers with children under five years.PLOS global public health · 2025Article
- Diabetes service decentralization to primary healthcare unit in Tigray, Ethiopia: A pilot study.PloS one · 2025Article
- Decentralization Matters: Association of Adherence to Treatment and Distance for the Management of Non-Communicable Diseases in Rural Tanzania.International journal of environmental research and public health · 2024Article
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- Role and knowledge of nurses in the management of non-communicable diseases in Africa: A scoping review.PloS one · 2024Article
- Using e-modules for acquisition of complex diabetes skills in diabetes care providers in Rwanda.PLOS global public health · 2024Article
- Availability and affordability of anticancer medicines at cancer treating hospitals in Rwanda.BMC health services research · 2023Article
- Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review.Journal of global health · 2023Article
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Corrections and comments
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Authors and funding
19 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesEffective coverage of non-communicable disease (NCD) care in sub-Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first-level hospitals. This study describes the facility-level implementation outcomes of this strategy.
methodsIn 2014, the Ministry of Health trained two nurses in each of the country's 42 first-level hospitals to implement and deliver nurse-led, integrated, outpatient NCD clinics, which focused on severe NCDs. Post-intervention evaluation occurred via repeated cross-sectional surveys, informal interviews and routinely collected clinical data over two rounds of visits in 2015 and 2017. Implementation outcomes included fidelity, feasibility and penetration.
resultsBy 2017, all NCD clinics were staffed by at least one NCD-trained nurse. Among the approximately 27 000 nationally enrolled patients, hypertension was the most common diagnosis (70%), followed by type 2 diabetes (19%), chronic respiratory disease (5%), type 1 diabetes (4%) and heart failure (2%). With the exception of warfarin and beta-blockers, national essential medicines were available at more than 70% of facilities. Clinicians adhered to clinical protocols at approximately 70% agreement with evaluators.
conclusionThe government of Rwanda was able to scale a nurse-led outpatient NCD programme to all first-level hospitals with good fidelity, feasibility and penetration as to expand access to care for severe NCDs.
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