Implementation outcomes of national decentralization of integrated outpatient services for severe non-communicable diseases to district hospitals in Rwanda

Simon Pierre Niyonsenga, Paul H. Park, Gedeon Ngoga, Evariste Ntaganda, Fredrick Kateera, Neil Gupta, Edson Rwagasore, Samuel Rwunganira, Antoine Munyarugo, Cadet Mutumbira, Symaque Dusabayezu, Arielle Eagan, Chantelle Boudreaux, Christopher Noble, Marie Aimee Muhimpundu, F. Gilles Ndayisaba, Sabin Nsanzimana, Gene Bukhman, and Francois Uwinkindi

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Effective coverage of non-communicable disease (NCD) care in sub-Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first-level hospitals.

By 2017, all NCD clinics were staffed by at least one NCD-trained nurse. With the exception of warfarin and beta-blockers, national essential medicines were available at more than 70% of facilities. Clinicians adhered to clinical protocols at approximately 70% agreement with evaluators.

The government of Rwanda was able to scale a nurse-led outpatient NCD programme to all first-level hospitals with good fidelity, feasibility and penetration as to expand access to care for severe NCDs.