Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda

Lauren Anne Eberly, Christian Rusangwa, Loise Ng’ang’a, Claire C Neal, Jean Paul Mukundiyukuri, Egide Mpanusingo, Jean Claude Mungunga, Hamissy Habineza, Todd Anderson, Gedeon Ngoga, Symaque Dusabeyezu, Gene Kwan, Charlotte Bavuma, Emmanual Rusingiza, Francis Mutabazi, Joseph Mucumbitsi, Cyprien Gahamanyi, Cadet Mutumbira, Paul H Park, Tharcisse Mpunga, Gene Bukhman

Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease.