Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?
Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?
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DOI：
10.1186/s12913-021-06759-9
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发表时间：
2021-07-24
影响因子：
2.8
通讯作者：
IMPALA Consortium
中科院分区：
文献类型：
--
作者：
Egere U;Shayo E;Ntinginya N;Osman R;Noory B;Mpagama S;Hussein E;Tolhurst R;Obasi A;Mortimer K;Sony AE;Taegtmeyer M;IMPALA Consortium
慢性肺病（CLD）每年在全球造成400万人死亡，在低收入和中等收入国家日益重要，目前全球大部分CLD死亡率都发生在这些国家。由于资源匮乏的现有卫生系统，特别是撒哈拉以南非洲地区，一般不以提供高质量的慢性病护理为导向，重新构想的第一步是认真考虑现有系统所有方面的服务提供准备情况。我们在坦桑尼亚和苏丹两个不同的SSA卫生系统背景下，在18个有目的地选择的卫生设施中进行了CLD服务准备的混合方法评估。我们使用了世界卫生组织（WHO）的服务可用性和就绪性评估清单，对关键卫生系统利益相关者进行定性访谈，对卫生设施登记册进行审查，并评估了临床医生使用患者插图管理CLD的能力。地方发展中心服务准备情况的评分是根据世卫组织服务提供情况清单中三个领域的特定服务追踪项目的提供情况进行的：工作人员培训和指导方针、诊断和设备以及基本药物。使用相同的领域对定性数据进行分析。坦桑尼亚的一家卫生机构和苏丹的五家卫生机构在CLD护理方面的CLD准备得分≥ 50%。在坦桑尼亚，得分从药房的14.9%到卫生中心的53.3%不等，在苏丹从36.4%到86.4%不等。这两个国家最少可用的示踪物项是训练有素的人力资源和指南以及峰值流量计。只有两个机构有COPD指南。患者小插曲分析显示，临床医生管理CLD的能力存在显著差距。关键的受访者确定低优先级的关键障碍CLD护理。在坦桑尼亚和苏丹，慢性病护理服务的可获得性和准备程度方面的差距威胁着在这些环境中实现全民健康覆盖。卫生系统研究人员在与卫生系统各级利益攸关方讨论时进行的详细评估可以确定关键障碍，以重新构想以人为本的CLD服务提供，以综合方法为核心。在线版本包含补充材料，可通过10.1186/s12913-021-06759-9获得。
Chronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. We conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains. One health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care. Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart. The online version contains supplementary material available at 10.1186/s12913-021-06759-9.
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影响因子：
2.5
作者：
Banda HT;Mortimer K;Bello GA;Mbera GB;Namakhoma I;Thomson R;Nyirenda MJ;Faragher B;Madan J;Malmborg R;Stenberg B;Mpunga J;Mwagomba B;Gama E;Piddock K;Squire SB
通讯作者：
Squire SB
影响因子：
2.9
作者：
Bintabara D;Ngajilo D
通讯作者：
Ngajilo D
影响因子：
1.4
作者：
El Sony, A. I.;Chiang, C-Y.;Enarson, D. A.
通讯作者：
Enarson, D. A.
影响因子：
34.3
作者：
Peck, Robert;Mghamba, Janneth;Vanobberghen, Fiona;Kavishe, Bazil;Rugarabamu, Vivian;Smeeth, Liam;Hayes, Richard;Grosskurth, Heiner;Kapiga, Saidi
通讯作者：
Kapiga, Saidi
影响因子：
4
作者：
Gale NK;Heath G;Cameron E;Rashid S;Redwood S
通讯作者：
Redwood S