Non-communicable Diseases (NCDs)
NCD register: diabetes, hypertension, cardiovascular risk
NCD longitudinal patient monitoring system
The monitoring system can be used to capture output and result data by cohort. It was developed based on experience developing and implementing the generic HIV patient monitoring system.
This system was designed to link easily with HIV and TB care and has been used to support integrated NCD-HIV care.
The essential medicines and equipment for NCDs continues to be a challenge in the lower level facilities and within these facilities as numbers increase. To address the continued local challenges of inadequate drug supply in the districts, the Ugandan National Medical Stores has established a separate NCD drug basket to allow the Regional Referral Hospitals and Health Centre IVs to draw more NCD drugs outside of their current budget. One of the issues identified was lack of facility awareness of the number of patients with NCDs in care and their NCD medicine requirements. The patient monitoring system captures numbers of patients and retention in care (among other indicators) which supports future ordering of supplies and medicines. This is very much needed in the district health system, and health workers are ready to put in the time to have this information. Drug supply management can also be improved by using the Handbook of NCD supply management at first-level health care facilities.
IMAI NCD patient monitoring system can measure the Global HEARTS CVD/diabetes indicators
Percentage of patients registered 6-9 months previously with controlled BP at last visit in last quarter: <140/90 (short term retention)
Number and estimated % of people whose hypertension was controlled in reporting treatment facilities (denominator: survey-based estimates total with HTN) (cumulative number, retention, with control)
% registered diabetes patients with blood glucose control at last visit in last quarter
Number and estimated % of people whose diabetes was controlled in the treatment facilities reporting (retention, with control)
% people with total CVD risk ≥ 30% with a. BP control; b. Diabetes control; c. On statin
% patients registered for treatment with prior CVD (heart attacks, strokes, and peripheral vascular disease) on statin
The NCD longitudinal patient monitoring system can provide more indicators by ongoing cohort monitoring to monitor retention in care, outcomes of treatment over time- BP, FBG or HbA1c, as well as complications over time (heart attack, heart failure, stroke, kidney disease, PVD, death etc).