Background
infectious diseases, NCD, malaria, tuberculosis, HT, chronic disease
INFECTIOUS DISEASES, MALARIA, TUBERCULOSIS, DISEASES, CHRONIC DISEASE
Sub-Saharan Africa (SSA) is facing a rapidly increasing burden of non-communicable diseases (NCDs) whilst the prevalence of infectious diseases such as malaria, HIV/AIDS and tuberculosis remains substantial [To address this double challenge, the UN General Assembly issued a resolution on NCDs control and prevention in 2011 stated as “From 2013 to 2016, we conducted a large cluster randomised controlled trial to evaluate the effectiveness of an intervention package that aimed to improve NCD care at primary care facilities in Uganda and Tanzania, with a focus on HT and DM (the health systems and chronic disease project, EACDRP, ISRCTN27340385). The EACDRP trial showed that the intervention was highly effective in improving NCD service readiness at intervention facilities across different levels of primary care, with large and significant differences between intervention and control facilities in the availability of functional basic equipment and consumables and in healthcare worker knowledge. The intervention was also highly effective in improving quality of care, measured by the proportion of NCD patients who were treated according to national guidelines. For example, in Uganda, the mean performance score in intervention facilities was nearly double that in control facilities, and 95% of the intervention facilities provided NCD care according to guidelines compared to only 8% in the control arm [Efforts were also made to ensure that the newly introduced NCD services were sustained after the end of the trial. These included close involvement of the ministerial and local governance structure in study activities throughout the study and handover of important intervention resources (e.g., documents, equipment and up to 9 months of a buffer supply of NCD drugs to overcome potential shortfalls in the national drug supply system). The study also encouraged patient-led initiatives to form patient clubs. These clubs promoted peer support and monetary contributions to a communal fund to procure drugs and other supplies with a high stock out rate, e.g., metformin or glucose test strips. These supplies were issued when the freely provided supplies from the public health system were insufficient.The EACDRP trial created an excellent platform to assess the medium- to long-term sustainability of a successful health system NCD intervention within primary care settings in Uganda, the As part of the MeLoHanD study, we have previously reported the post-trial effects on service availability and readiness and the HF-based quality-of-patient care and experience [We also used the MeLoHanD study as an opportunity to assess 