Service readiness for the management of non-communicable diseases in publicly financed facilities in Malawi: findings from the 2019 Harmonised Health Facility Assessment census survey.

Autor:	Ahmed S; Department of Global Health, University of Washington, Seattle, Washington, USA., Cao Y; Department of Geography, The University of Hong Kong, Hong Kong, China., Wang Z; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Coates MM; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Twea P; Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway.; Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi., Ma M; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Chiwanda Banda J; Curative and Medical Rehabilitation Services, Ministry of Health, lilongwe, Malawi.; Department of Community and Environmental Health, Kamuzu University of Health Sciences, Blantyre, Malawi., Wroe E; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Bai L; Department of Public Administration, Nanjing University of Traditional Chinese Medicine, Nanjing, China., Watkins DA; Department of Global Health, University of Washington, Seattle, Washington, USA.; Department of Medicine, University of Washington, Seattle, Washington, USA., Su Y; Department of Global Health, University of Washington, Seattle, Washington, USA yfsu@uw.edu.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Jan 04; Vol. 14 (1), pp. e072511. Date of Electronic Publication: 2024 Jan 04.
DOI:	10.1136/bmjopen-2023-072511
Abstrakt:	Introduction: Non-communicable diseases (NCDs) are rising in low-income and middle-income countries, including Malawi. To inform policy-makers and planners on the preparedness of the Malawian healthcare system to respond to NCDs, we estimated NCD service readiness in publicly financed healthcare facilities in Malawi. Methods: We analysed data from 564 facilities surveyed in the 2019 Harmonised Health Facility Assessment, including 512 primary healthcare (PHC) and 52 secondary and tertiary care (STC) facilities. To characterise service readiness, applying the law of minimum, we estimated the percentage of facilities with functional equipment and unexpired medicines required to provide NCD services. Further, we estimated permanently unavailable items to identify service readiness bottlenecks. Results: Fewer than 40% of PHC facilities were ready to deliver services for each of the 14 NCDs analysed. Insulin and beclomethasone inhalers had the lowest stock levels at PHC facilities (6% and 8%, respectively). Only 17% of rural and community hospitals (RCHs) have liver and kidney diagnostics. STC facilities had varying service readiness, ranging from 27% for managing acute diabetes complications to 94% for chronic type 2 diabetes management. Only 38% of STC facilities were ready to manage chronic heart failure. Oral pain medicines were widely available at all levels of health facilities; however, only 22% of RCHs and 29% of STCs had injectable morphine or pethidine. Beclomethasone was never available at 74% of PHC and 29% of STC facilities. Conclusion: Publicly financed facilities in Malawi are generally unprepared to provide NCD services, especially at the PHC level. Targeted investments in PHC can substantially improve service readiness for chronic NCD conditions in local communities and enable STC to respond to acute NCD complications and more complex NCD cases. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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