Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

Abstract

BackgroundChronic 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. MethodsWe 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.ResultsOne 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 centre 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. Conclusion: 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-centred, integrated approaches at its heart.

The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review

“…The availability of SABA inhalers was described in 23 countries but only six countries reported an availability of 80% or more at any of their study sites (table 2, figure 2). [24][25][26]38 The availability of SABA inhalers ranged widely, from unavailable in Bhutan to 100% in Eritrea. 25 One study reported that generic SABA inhalers were more widely available than originator brands.…”

“…41,46 The availability of SABA nebules ranged from 10•0% in Tanzania to 58•8% in Nigeria. 26,41 Antimuscarinic agents were not available in several countries including Benin, Eritrea, Bhutan, Viet Nam, and Ghana, but were available in 30•8% of facilities in Sri Lanka. 25,28,39 The only data on antimuscarinic nebules came from Nigeria and The Gambia, where availability ranged between 0•0% and 13•0%.…”

The reality of managing asthma in sub-Saharan Africa – Priorities and strategies for improving care

“…A study of health system preparedness for managing chronic lung diseases in Sudan and Tanzania identified the lack of access to PEF meters for diagnostic purposes as an important barrier to care. [35]…”

“Honestly, this problem has affected me a lot”: A qualitative exploration of the socioeconomic impacts of chronic respiratory disease among people and their communities in Sudan and Tanzania

“…Sudan and Tanzania were selected for the IMPALA's health systems research work package . Our baseline situation analysis in Dodoma region of Tanzania and Gezira state in Sudan explored the readiness of health facilities in these areas to deliver care for CRD (5). Both sites are mainly rural and semi-urban, with inhabitants engaged mostly in informal livelihoods.…”

“…In sub-Saharan Africa (SSA), the increasing burden is driven by indoor air pollution due to domestic use of biomass fuel, which is used for cooking by approximately 90% of rural households(3); tobacco smoke; and post tuberculosis lung disease (4). Despite increasing recognition, CRDs are rarely prioritised by communities, health systems, or governments in SSA and robust data with which to inform CRD interventions are lacking (5). Reliable data on the prevalence of CRDs in Sub Saharan Africa (SSA) are scarce.…”