Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA.
WHO Regional Office for Africa, Cité de Djoué, Brazzaville, Republic of Congo.
Health Policy Plan. 2022 Apr 12;37(4):452-460. doi: 10.1093/heapol/czab142.
Severe chronic non-communicable diseases (NCDs) pose important challenges for health systems across Africa. This study explores the current availability of and demand for decentralization of services for four high-priority conditions: insulin-dependent diabetes, heart failure, sickle cell disease, and chronic pain. Ministry of Health NCD Programme Managers from across Africa (N = 47) were invited to participate in an online survey. Respondents were asked to report the status of clinical care across the health system. A care package including diagnostics and treatment was described for each condition. Respondents were asked whether the described services are currently available at primary, secondary and tertiary levels, and whether making the service generally available at that level is expected to be a priority in the coming 5 years. Thirty-seven (79%) countries responded. Countries reported widespread gaps in service availability at all levels. We found that just under half (49%) of respondents report that services for insulin-dependent diabetes are generally available at the secondary level (district hospital); 32% report the same for heart failure, 27% for chronic pain and 14% for sickle cell disease. Reported gaps are smaller at tertiary level (referral hospital) and larger at primary care level (health centres). Respondents report ambitious plans to introduce and decentralize these services in the coming 5 years. Respondents from 32 countries (86%) hope to make all services available at tertiary hospitals, and 21 countries (57%) expect to make all services available at secondary facilities. These priorities align with the Package of Essential NCD Interventions-Plus. Efforts will require strengthened infrastructure and supply chains, capacity building for staff and new monitoring and evaluation systems for efficient implementation. Many countries will need targeted financial assistance in order to realize these goals. Nearly all (36/37) respondents request technical assistance to organize services for severe chronic NCDs.
严重的慢性非传染性疾病（NCD）对非洲各地的卫生系统构成了重大挑战。本研究探讨了四种高优先级疾病（胰岛素依赖型糖尿病、心力衰竭、镰状细胞病和慢性疼痛）的服务去中心化的当前可用性和需求。邀请了来自非洲各地的卫生部 NCD 项目管理人员（N=47）参加在线调查。受访者被要求报告整个卫生系统的临床护理状况。为每种疾病描述了一个包括诊断和治疗的护理包。受访者被问及所描述的服务目前是否可在初级、二级和三级卫生机构获得，以及在未来 5 年内将该服务普遍提供给该级别是否是优先事项。37 个（79%）国家作出回应。各国报告说，各级服务的可用性都存在广泛差距。我们发现，近一半（49%）的受访者报告说，二级（区医院）可普遍获得胰岛素依赖型糖尿病的服务；32%报告心力衰竭情况相同，27%报告慢性疼痛，14%报告镰状细胞病。在三级（转诊医院）的报告差距较小，在初级保健一级（卫生中心）的报告差距较大。受访者报告说，在未来 5 年内，他们雄心勃勃地计划引入和去中心化这些服务。32 个国家（86%）的受访者希望在三级医院提供所有服务，21 个国家（57%）希望在二级设施提供所有服务。这些优先事项与《基本非传染性疾病干预套餐加》一致。为了实现这些目标，需要加强基础设施和供应链，为员工提供能力建设，并建立新的监测和评估系统以实现有效实施。许多国家需要有针对性的财政援助才能实现这些目标。几乎所有（36/37）的受访者都要求提供技术援助，以组织严重慢性 NCD 的服务。
