Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries
Biraj Man Karmacharya,
Neil Gupta,
Paul H Park,
Gene Bukhman,
Emily B Wroe,
Matthew M Coates,
Abebe Bekele,
Roodney Dupuy,
Darius Leopold Fénelon,
Anna D Gage,
Theodros Getachew,
Gene F Kwan,
Aimée M Lulebo,
Jones K Masiye,
Mary Theodory Mayige,
Maïmouna Ndour Mbaye,
Malay Kanti Mridha,
Wubaye Walelgne Dagnaw
Affiliations
Biraj Man Karmacharya
Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Province 3, Nepal
Neil Gupta
Center for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USA
Paul H Park
1 Center for Integration Science, Division of Global Health Equity, Brigham and Women`s Hospital, Boston, Massachusetts, USA
Gene Bukhman
Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Emily B Wroe
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Matthew M Coates
Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Abebe Bekele
Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Roodney Dupuy
Le Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
Darius Leopold Fénelon
Zanmi Lasante, Port-au-Prince, Haiti
Anna D Gage
Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Theodros Getachew
Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Gene F Kwan
Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
Aimée M Lulebo
Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
Jones K Masiye
Noncommunicable Diseases and Mental Health Clinical Services, Malawi Ministry of Health, Lilongwe, Malawi
Mary Theodory Mayige
National Institute for Medical Research, Dar es Salaam, Tanzania
Maïmouna Ndour Mbaye
Department of Internal Medicine, University Hospital Center of Dakar, Cheikh Anta Diop University, Dakar, Senegal
Malay Kanti Mridha
Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
Context and objectives Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.Design Secondary analysis of existing cross-sectional survey data.Setting We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.Outcome measures We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities.Results Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability.Conclusions Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.
