Background
Methods
Development of the needs assessment tool
Technologies: | Tools: |
---|---|
Thermometer Stethoscope Blood pressure measurement device Measurement tape Weighing machine Peak flow meter Spacers for inhalers Glucometer Blood glucose test strips Urine protein test strips Urine ketones test strips | WHO/ISH risk prediction charts Evidence based clinical protocols Flow charts with referral criteria Patient clinical record Medical information register Audit tools |
Add when resources permit | |
Nebulizer Pulse oximeter Blood cholesterol assay Lipid profile Serum creatinine assay Troponin test strips Urine microalbuminuria test strips Tuning fork Electrocardiograph (if training to read and interpret electrocardiograms is available) Defibrillator |
NCD Medicines | |
---|---|
Thiazide diuretic Calcium channel blocker (amlodipine) Beta-blocker (atenolol) Angiotensin inhibitor (enalapril) Statin (simvastatin) Insulin Metformin Glibenclamide Isosorbide dinitrate Glyceryl trinitrate Furosemide Spironolactone Salbutamol Prednisolone Beclometasone Aspirin Paracetamol | Ibuprofen Codeine Morphine Penicillin Erythromycin Amoxcillin Hydrocortisone Epinephrine Heparin Diazepam Magnesium sulphate Promethazine Senna Dextrose infusion Glucose injectable solution Sodium chloride infusion Oxygen |
Sampling
Data collection
Analysis
Dissemination
Results
Description of sample
Type of Facility | Total Surveyed | Geographic category | |
---|---|---|---|
Urban n/Total respondents (%) | Rural n/Total respondents (%) | ||
Regional Referral Hospital (RRH) | 13 | 8/9 (88.9) | 1/9 (11.1) |
General Hospital (GH) | 26 | 6/21 (28.6) | 15/21 (71.4) |
Health Center IV (HCIV) | 14 | 3/12 (25) | 9/12 (75) |
Health personnel
Personnel Type | Regional Referral Hospitals (N = 13) | General Hospitals (N = 26) | Health Center IVs (N = 14) | |||
---|---|---|---|---|---|---|
No. reporting at least 1 staff member of this cadre n (%) | Mean no. of members (±SD) | No. reporting at least 1 staff member of this cadre n (%) | Mean no. of members (±SD) | No. reporting at least 1 staff member of this cadre n (%) | Mean no. of members (±SD) | |
General Practitioners | ||||||
Family physician | 3 (23.1) | 1.7 (± 1.2) | 3 (11.5) | 1.0 (± 0.0) | 0 (0.0) | – |
Medical officer | 10 (76.9) | 5.3 (± 4.3) | 23 (88.4) | 3.4 (±1.9) | 11 (78.6) | 1.2 (±0.7) |
Clinical officer | 13 (100.0) | 10.6 (± 3.9) | 23 (88.4) | 6.0 (±3.1) | 11 (78.6) | 1.2 (±1.3) |
Specialist Physicians | ||||||
Cardiologist | 1 (7.7) | 1.0 (± 0.0) | 1 (3.8) | 5.0 (± 0.0) | 3 (21.4) | 1.7 (±0.6) |
Endocrinologist/diabetologist | 1 (7.7) | 1.0 (± 0.0) | 1 (3.8) | 2.0 (± 0.0) | 0 (0.0) | – |
Neurologist | 0 (0.0) | – | 1 (3.8) | 1.0 (± 0.0) | 0 (0.0) | – |
Oncologist | 0 (0.0) | – | 0 (0.0) | – | 0 (0.0) | – |
Pathologist | 1 (7.7) | 1.0 (± 0.0) | 0 (0.0) | – | 0 (0.0) | – |
Psychiatrist | 1 (7.7) | 1.0 (± 0.0) | 2 (7.7) | 1.0 (± 0.0) | 3 (21.4) | 1.0 (± 0.0) |
Pulmonologist | 0 (0.0) | – | 0 (0.0) | – | 0 (0.0) | – |
Radiologist | 6 (46.2) | 1.8 (± 1.3) | 0 (0.0) | – | 0 (0.0) | – |
Nurse | ||||||
Nurse - general | 10 (76.9) | 47.8 (± 22.2) | 22 (84.6) | 33.2 (±15.8) | 13 (92.9) | 5.4 (±1.7) |
Nurse - diabetic | 4 (30.8) | 3.0 (± 1.0) | 7 (26.9) | 1.4 (±0.8) | 2 (14.3) | 2.5 (±2.1) |
Nurse - psychiatric | 9 (69.2) | 3.9 (± 3.3) | 20 (76.9) | 1.6 (±0.9) | 8 (57.1) | 1.8 (±0.5) |
Other | ||||||
Community health worker | 7 (53.8) | 2.6 (± 0.9) | 7 (26.9) | 5.3 (±6.6) | 2 (14.3) | 1.9 (± 2.1) |
NCD Counselor | 0 (0.0) | – | 1 (3.8) | 2.0 (± 0.0) | 0 (0.0) | – |
Foot care specialist | 1 (7.7) | 1.0 (± 0.0) | 0 (0.0) | – | 0 (0.0) | – |
Social worker | 6 (46.2) | 1.6 (± 0.9) | 11 (42.3) | 1.1 (±0.3) | 0 (0.0) | – |
Diabetes educator | 1 (7.7) | 1.0 (± 0.0) | 1 (3.8) | 6.0 (± 0.0) | 0 (0.0) | – |
Nutritionist | 8 (61.5) | 1.3 (± 0.5) | 8 (30.8) | 1.1 (± 0.35) | 0 (0.0) | – |
Essential services and technologies
Equipment | No. of facilities (by type) that have at least one of equipment | ||
---|---|---|---|
RRH (N = 13) n (%) | GH (N = 26) n (%) | HCIV (N = 14) n (%) | |
Thermometer | 7 (53.8) | 14 (53.9) | 8 (57.1) |
Stethoscope | 8 (61.5) | 16 (61.5) | 7 (50.0) |
Blood pressure machine: Mercury sphygmomanometer | 6 (46.2) | 9 (34.6) | 6 (42.9) |
Blood pressure machine: Aneroid | 6 (46.2) | 7 (26.9) | 6 (42.9) |
Blood pressure machine: Automated | 5 (38.5) | 13 (50.0) | 5 (35.7) |
BP cuffs: Standard (25 cm × 12 cm) | 4 (30.8) | 9 (34.6) | 8 (57.1) |
BP cuffs: Alternate (36 cm × 12 cm) | 0 (0.0) | 1 (3.8) | 1 (7.1) |
BP cuffs: Pediatric | 1 (7.7) | 3 (11.5) | 3 (21.4) |
Measuring tapes | 7 (53.8) | 13 (50.0) | 7 (50.0) |
Weighing scales: Bathroom type | 7 (53.8) | 15 (57.7) | 8 (57.1) |
Weighing scales: Hospital type | 4 (30.8) | 11 (42.3) | 4 (28.6) |
Glucometer | 8 (61.5) | 19 (73.1) | 6 (42.9) |
Urine testing strips | 3 (23.1) | 2 (7.7) | 2 (14.3) |
Monofilament | 1 (7.7) | 1 (3.8) | 0 (0.0) |
Spirometer | 1 (7.7) | 0 (0.0) | 0 (0.0) |
Spacers for inhalers | 3 (23.1) | 1 (3.8) | 1 (7.1) |
Nebulizer | 4 (30.8) | 2 (7.7) | 2 (14.3) |
All of the above | 0 (0.0) | 0 (0.0) | 0 (0.0) |
None of the above | 1 (7.7) | 2 (7.7) | 2 (14.3) |
Advanced technologies
Equipment | Regional Referral Hospitals (N = 13) | General Hospitals (N = 26) | Health Center IVs (N = 14) | |||
---|---|---|---|---|---|---|
Available n (%) | Functional n (%) | Available n (%) | Functional n (%) | Available n (%) | Functional n (%) | |
Ultrasound Scan | 11 (84.6) | 6 (54.6) | 22 (84.6) | 17 (77.3) | 7 (50.0) | 3 (42.9) |
ECG Machine | 3 (23.1) | 1 (33.3) | 4 (15.4) | 2 (50.0) | 1 (7.2) | 0 (0.0) |
X-Ray | 10 (76.9) | 6 (60.0) | 21 (80.8) | 11 (52.4) | 2 (14.3) | 0 (0.0) |
CT-Scan | 2 (15.4) | 1 (50.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Doppler | 5 (38.5) | 3 (60.0) | 1 (3.8) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Reliable power supply | 7 (53.8) | 4 (57.1) | 16 (61.5) | 13 (81.3) | 4 (28.6) | 2 (50.0) |
Alternative source of power | 9 (69.2) | 7 (77.8) | 19 (73.1) | 17 (89.5) | 9 (64.3) | 4 (44.4) |
All of the above | 1 (7.7) | 1 (7.7) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
None of the above | 2 (15.4) | 4 (30.8) | 2 (7.7) | 5 (19.2) | 3 (21.4) | 8 (57.1) |
Laboratory services
On-site laboratory | Number of facilities with laboratory equipment or test | ||
---|---|---|---|
RRH (N = 13) n (%) | GH (N = 26) n (%) | HCIV (N = 14) n (%) | |
13 (100%) | 26 (100%) | 12 (86%) | |
General tests | |||
Hemoglobin | 12 (92.3) | 23 (88.5) | 11 (78.6) |
Complete blood count and differential | 11 (84.6) | 19 (73.1) | 5 (35.7) |
Electrolytes | 9 (69.2) | 10 (38.5) | 0 (0.0) |
Renal function | 9 (69.2) | 13 (50.0) | 1 (7.1) |
Liver function | 9 (69.2) | 11 (42.3) | 0 (0.0) |
Lipid profile | 6 (46.2) | 8 (30.8) | 1 (7.1) |
Urinalysis | 11 (84.6) | 25 (96.2) | 13 (92.9) |
All of the above | 6 (46.2) | 6 (23.1) | 0 (0.0) |
None of the above | 1 (7.7) | 0 (0.0) | 0 (0.0) |
Diabetes tests | |||
Random blood glucose | 12 (92.3) | 23 (88.5) | 14 (100.0) |
Hemoglobin A1c | 0 (0.0) | 5 (19.2) | 0 (0.0) |
Urine microalbumin | 4 (30.8) | 3 (11.5) | 0 (0.0) |
All of the above | 0 (0.0) | 1 (3.8) | 0 (0.0) |
None of the above | 1 (7.7) | 2 (7.7) | 0 (0.0) |
Cancer tests | |||
Cytology | 2 (15.4) | 3 (11.5) | 0 (0.0) |
Fecal occult blood | 3 (23.1) | 4 (15.4) | 0 (0.0) |
Prostate-Specific Antigen | 1 (7.7) | 2 (7.7) | 1 (7.1) |
All of the above | 0 (0.0) | 0 (0.0) | 0 (0.0) |
None of the above | 8 (61.5) | 19 (73.1) | 13 (92.9) |
Sickle cell disease tests | |||
Hemoglobin electrophoresis | 0 (0.0) | 4 (15.4) | 0 (0.0) |
Sickling test | 11 (84.6) | 21 (80.8) | 7 (50.0) |
All of the above | 0 (0.0) | 2 (7.7) | 0 (0.0) |
None of the above | 2 (15.4) | 4 (15.4) | 7 (50.0) |
Essential medicines for NCDs
Pharmaceutical Classes | RRH (N = 13) | GH (N = 26) | HCIV (N = 14) | |||||||
---|---|---|---|---|---|---|---|---|---|---|
No. that have drug available | Stockout in last quarter | Stockout in last year | No. that have drug available | Stockout in last quarter | Stockout in last year | No. that have drug available | Stockout in last quarter | Stockout in last year | ||
n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | ||
Hypertension | ||||||||||
Thiazide diuretic | 12 (92.3) | 1 (7.7) | 2 (15.4) | 23 (88.5) | 3 (11.5) | 2 (7.7) | 9 (64.3) | 3 (21.4) | 2 (14.3) | |
Calcium channel blocker | 12 (92.3) | 1 (7.7) | 1 (7.7) | 22 (84.6) | 2 (7.7) | 3 (11.5) | 14 (100.0) | 4 (28.6) | 5 (35.7) | |
Beta-blocker | 7 (53.8) | 3 (23.1) | 3 (23.1) | 14 (53.8) | 9 (34.6) | 7 (26.9) | 13 (92.9) | 3 (21.4) | 3 (21.4) | |
ACE inhibitor | 10 (76.9) | 2 (15.4) | 2 (15.4) | 20 (76.9) | 5 (19.2) | 6 (23.1) | 6 (42.9) | 2 (14.3) | 2 (14.3) | |
Others (e.g. Methyldopa, hydralazine, magnesium sulphate) | 10 (76.9) | 2 (15.4) | 2 (15.4) | 20 (76.9) | 2 (7.7) | 5 (19.2) | 9 (64.3) | 3 (21.4) | 2 (14.3) | |
Diabetes | ||||||||||
Biguanides | 12 (92.3) | 0 (0.0) | 0 (0.0) | 23 (88.5) | 4 (15.4) | 2 (7.7) | 14 (100.0) | 4 (28.6) | 5 (35.7) | |
Sulfonylureas | 11 (84.6) | 2 (15.4) | 2 (15.4) | 21 (80.8) | 6 (23.1) | 2 (7.7) | 11 (78.6) | 3 (21.4) | 4 (28.6) | |
Thiazolidinediones | 1 (7.7) | 2 (15.4) | 2 (15.4) | 2 (7.7) | 5 (19.2) | 4 (15.4) | 1 (7.1) | 1 (7.1) | 1 (7.1) | |
Dipeptidyl peptidase-4 inhibitors | 1 (7.7) | 1 (7.7) | 1 (3.8) | 5 (19.2) | 4 (15.4) | 1 (7.1) | 1 (7.1) | 0 (0.0) | ||
Alpha-glucosidase inhibitors | 1 (7.7) | 1 (7.7) | 2 (7.7) | 5 (19.2) | 5 (19.2) | 0 (0.0) | 0 (0.0) | 1 (7.1) | ||
Insulin type | Ultra short-acting | 8 (61.5) | 1 (7.7) | 0 (0.0) | 9 (34.6) | 3 (11.5) | 6 (23.1) | 3 (21.4) | 0 (0.0) | 0 (0.0) |
Short-acting | 9 (69.2) | 3 (23.1) | 3 (23.1) | 14 (53.8) | 2 (7.7) | 6 (23.1) | 5 (35.7) | 1 (7.1) | 1 (7.1) | |
Intermediate | 10 (76.9) | 3 (23.1) | 5 (38.5) | 12 (46.2) | 4 (15.4) | 6 (23.1) | 3 (21.4) | 0 (0.0) | 0 (0.0) | |
Long-acting | 11 (84.6) | 3 (23.1) | 4 (30.8) | 14 (53.8) | 3 (11.5) | 5 (19.2) | 3 (21.4) | 1 (7.1) | 1 (7.1) |
Specialty NCD clinics
Clinics/Wards | RRH (N = 13) n (%) | GH (N = 26) n (%) | HCIV (N = 14) n (%) |
---|---|---|---|
Diabetes | 11 (84.6) | 14 (53.8) | 3 (21.4) |
Hypertension | 7 (53.9) | 5 (19.2) | 1 (7.1) |
Cancer | 2 (15.4) | 1 (3.8) | 0 (0.0) |
Cardiology | 2 (15.4) | 1 (3.8) | 0 (0.0) |
COPD | 1 (7.7) | 0 (0.0) | 0 (0.0) |
Renal | 2 (15.4) | 0 (0.0) | 0 (0.0) |
Sickle Cell | 4 (30.8) | 2 (7.7) | 0 (0.0) |
All of the above | 0 (0.0) | 0 (0.0) | 0 (0.0) |
None of the above | 1 (7.7) | 11 (42.3) | 11 (78.6) |
Patient support and education
Education or support service | RRH (N = 13) n (%) | GH (N = 26) n (%) | HCIV (N = 14) n (%) |
---|---|---|---|
Individual NCD education | 9 (69.2) | 17 (65.4) | 5 (35.7) |
Group NCD education | 12 (92.3) | 18 (69.2) | 4 (28.6) |
Foot care for diabetic patients | 8 (61.5) | 15 (57.7) | 2 (14.3) |
Nutrition advice for all patients | 12 (92.3) | 23 (88.5) | 11 (78.6) |
NCD Information, Education and Communication (IEC) materials | 4 (30.8) | 2 (7.7) | 2 (14.3) |
Self-management NCD support | 10 (77.0) | 13 (50.0) | 2 (14.3) |
Peer/social group NCD support | 10 (77.0) | 10 (38.5) | 3 (21.4) |
All of the above | 2 (15.4) | 2 (7.7) | 0 (0.0) |
None of the above | 1 (7.7) | 1 (3.8) | 1 (7.1) |
Quality assurance
Registries and Guidelines | RRHs N = 13 n (%) | GHs N = 26 n (%) | HCIVs N = 14 n (%) |
---|---|---|---|
NCD registry for new cases | 6 (46.2) | 6 (23.1) | 1 (7.1) |
Diabetes management | 4 (30.8) | 4 (15.4) | 1 (7.1) |
Hypertension management | 3 (23.1) | 3 (11.5) | 1 (7.1) |
Hyperlipidemia management | 0 (0.0) | 2 (7.7) | 0 (0.0) |
Tobacco screening & treatment | 0 (0.0) | 2 (7.7) | 0 (0.0) |
Alcohol screening & treatment | 0 (0.0) | 1 (3.9) | 1 (7.1) |
Cancer (cervical, breast, prostate) screening & treatment | 3 (23.1) | 2 (7.7) | 2 (14.3) |
Mental health screening & treatment | 2 (15.4) | 3 (11.5) | 2 (14.3) |
Asthma management | 2 (15.4) | 2 (7.7) | 1 (7.1) |
Sickle cell screening & management | 2 (15.4) | 3 (11.5) | 0 (0.0) |
Palliative care | 2 (15.4) | 6 (23.1) | 1 (7.1) |
All of the above | 0 (0.0) | 0 (0.0) | 0 (0.0) |
None of the above | 4 (30.8) | 13 (50.0) | 10 (71.4) |