“Nurses, using simplified protocols and basic echocardiography, provided timely and accurate diagnoses, initiated appropriate medications, and expedited referral of surgery patients, leading to quality health failure care for the rural poor.”
Heart failure causes significant morbidity and mortality in sub-Saharan Africa. An estimated 2 to 3 million people have heart failure in this region, with a persistent burden of rheumatic disease and nonischemic cardiomyopathies. The majority (62%) of the population in sub-Saharan Africa is rural, and >85% of the poor in sub-Saharan Africa live in rural areas. Capacity to diagnose and manage heart failure at first-level hospitals serving this population is extremely limited. As a result, strategies to simplify, decentralize, and integrate heart failure care are essential so that the poorest patients are appropriately diagnosed with this life-threatening and disabling condition, and given access to medical therapies or cardiac surgery when appropriate.
To address gaps in care for the rural poor, the Rwandan Ministry of Health, supported by Inshuti Mu Buzima (Partners In Health—Rwanda), started to train nurses to provide care for a group of severe chronic noncommunicable diseases (NCDs), including heart failure, initially at 3 rural district hospitals, beginning in 2006. Nurses were trained in simplified diagnostic protocols incorporating basic echocardiography to place patients into broad categories of heart failure most prevalent in the area. Treatment was administered based on category-specific pathways and delivered in the context of an integrated NCD clinic.
This represents the first reported strategy to successfully decentralize and integrate heart failure diagnosis and management at first-level hospitals in highly constrained health systems.