Non-communicable Diseases (NCDs)

NCD Acute and Chronic Care

Uganda has a long history of leadership and excellence in providing disease care using a public health approach, employing decentralized service delivery down to the primary health care level. Specifically, in 2003 and 2004, Masaka was the regional leader in the rapid scale-up of ART for HIV/AIDS, using simplified and adapted operational tools and training originating from the IMAI Team in the Department of HIV at WHO-HQ and WHO AFRO.   

After Ugandan adaptation of the NCD guideline modules and training materials in 2017, training of clinical teams in the greater Masaka region began as a logistical trial to establish NCD clinics at Health Center III and IV level.  As in the Quick Check+, this is clinical team training- training of primary health care clinicians (doctors, nurses, clinical officers) and auxiliaries are done in parallel then brought together for clinical team sessions. There is a clear sequence of care and roles.

Staff were also trained, and the patient monitoring system incorporated into the existing Masaka Regional Referral Hospital (MRRH) twice weekly clinics. It was observed that the very large numbers of NCD patients overwhelming the MRRH clinics can be relieved by quality NCD case management at the lower health facilities and by introducing NCD care into HIV care/ART clinics such as Uganda Cares. The success of this depends on making essential NCD medicines available consistently at these health centres and clinics. The logistical trial continued through 2019, as a collaboration between the Ministry of Health, Walimu and the IMAI Alliance (funded by Novartis Social Business.) The Uganda-adapted IMAI NCD tools were iteratively improved and further reviewed by Ugandan MOH experts, then adopted as the national curricula for NCD training at primary care level.

By December 2019, over 1880 patients had been enrolled in NCD care with a patient card filled out and transfer of a subset of data to the NCD longitudinal register.  In addition to Masaka, the Ugandan IMAI NCD tools have been used in Nakaseke and by MRC and UPMB in other districts. Adequate numbers of trained staff and regular access to essential NCD medicines, equipment and laboratory remain the main obstacles to expansion. The Uganda MOH is keen to expand this program to other districts in Uganda.