“Health systems in sub-Saharan Africa, geared so far toward the control of infectious diseases are less prepared to face the emerging challenges resulting from NCDs. As a result, NCDs are often ignored, under-diagnosed with a high burden of acute and chronic complications. While health systems in these countries are being realigned to integrate aspects of NCDs care, an issue of major importance to be addressed urgently relates to the lack of adequately trained health workforce for the management of these conditions.”
Background: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon.
Methods: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were identified and adapted to the country’s circumstances. Training and follow-up tools were developed and nurses trained by experienced physicians in the management of the four conditions. Basic diagnostic and follow-up materials were provided and relevant essential drugs made available.
Results: Forty six nurses attended six training courses. By the second year of activity, three and four clinics were operational in the urban and the rural areas respectively. By then, 925 patients had been registered in the clinics. This represented a 68.5% increase from the first year. While the rural clinics relied mainly on essential drugs for their prescriptions, a prescription pattern combining generic and proprietary drugs was observed in the urban clinics.
Conclusion: In the quest for cost-effective health care for NCD in sub-Saharan Africa, rethinking health workforce and service delivery has relevance. Nurse-led clinics, algorithm driven service delivery stands as alternatives to overcome the shortage of trained physicians and other issues relating to access to care.
In addition to the published article, authors include the following documents from the Cameroon Essential Health Intervention Project (CENHIP) in the Appendices:
- New Patient form
- Diabetes Initial Assessment form
- Diabetes Follow-up form
- Diabetes Annual Evaluation form
- Hypertension Follow-up form
- Hypertension Annual Evaluation form
- Asthma Initial Assessment form
- Asthma Follow-up form
- Epilepsy Initial Assessment form
- Epilepsy Follow-up form