The efficiency of chronic disease care in sub-Saharan Africa

doi:10.1186/s12916-016-0675-6

Editorial

. 2016 Aug 26;14(1):127.

doi: 10.1186/s12916-016-0675-6.

The efficiency of chronic disease care in sub-Saharan Africa

Pascal Geldsetzer¹, Katrina Ortblad¹, Till Bärnighausen^{2

3

4}

Affiliations

¹ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA, 02115, USA.
² Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA, 02115, USA. tbaernig@hsph.harvard.edu.
³ Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, 69120, Germany. tbaernig@hsph.harvard.edu.
⁴ Africa Health Research Institute, P.O. Box 198, Mtubatuba, 3935, South Africa. tbaernig@hsph.harvard.edu.

PMID: 27566531
PMCID: PMC5002156
DOI: 10.1186/s12916-016-0675-6

Editorial

The efficiency of chronic disease care in sub-Saharan Africa

Pascal Geldsetzer et al. BMC Med. 2016.

. 2016 Aug 26;14(1):127.

doi: 10.1186/s12916-016-0675-6.

Authors

Pascal Geldsetzer¹, Katrina Ortblad¹, Till Bärnighausen^{2

3

4}

Affiliations

¹ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA, 02115, USA.
² Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA, 02115, USA. tbaernig@hsph.harvard.edu.
³ Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, 69120, Germany. tbaernig@hsph.harvard.edu.
⁴ Africa Health Research Institute, P.O. Box 198, Mtubatuba, 3935, South Africa. tbaernig@hsph.harvard.edu.

PMID: 27566531
PMCID: PMC5002156
DOI: 10.1186/s12916-016-0675-6

Abstract

The number of people needing chronic disease care is projected to increase in sub-Saharan Africa as a result of expanding human immunodeficiency virus (HIV) treatment coverage, rising life expectancies, and lifestyle changes. Using nationally representative data of healthcare facilities, Di Giorgio et al. found that many HIV clinics in Kenya, Uganda, and Zambia appear to have considerable untapped capacity to provide care for additional patients. These findings highlight the potential for increasing the efficiency of clinical processes for chronic disease care at the facility level. Important questions for future research are how estimates of comparative technical efficiency across facilities change, when they are adjusted for quality of care and the composition of patients by care complexity. Looking ahead, substantial research investment will be needed to ensure that we do not forgo the opportunity to learn how efficiency changes, as chronic care is becoming increasingly differentiated by patient type and integrated across diseases and health systems functions.Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0653-z.

Keywords: Antiretroviral therapy; Chronic diseases; Differentiated care; Efficiency; HIV; Integrated care; Non-communicable diseases.

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Comment on

The potential to expand antiretroviral therapy by improving health facility efficiency: evidence from Kenya, Uganda, and Zambia.
Di Giorgio L, Moses MW, Fullman N, Wollum A, Conner RO, Achan J, Achoki T, Bannon KA, Burstein R, Dansereau E, DeCenso B, Delwiche K, Duber HC, Gakidou E, Gasasira A, Haakenstad A, Hanlon M, Ikilezi G, Kisia C, Levine AJ, Maboshe M, Masiye F, Masters SH, Mphuka C, Njuguna P, Odeny TA, Okiro EA, Roberts DA, Murray CJ, Flaxman AD. Di Giorgio L, et al. BMC Med. 2016 Jul 20;14(1):108. doi: 10.1186/s12916-016-0653-z. BMC Med. 2016. PMID: 27439621 Free PMC article.

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References

1. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. - PMC - PubMed
1. Bärnighausen T, Welz T, Hosegood V, Bätzing-Feigenbaum J, Tanser F, Herbst K, Hill C, Newell M-L. Hiding in the shadows of the HIV epidemic: obesity and hypertension in a rural population with very high HIV prevalence in South Africa. J Hum Hypertens. 2008;22:236–9. doi: 10.1038/sj.jhh.1002308. - DOI - PubMed
1. Hontelez JA, de Vlas SJ, Baltussen R, Newell ML, Bakker R, Tanser F, Lurie M, Bärnighausen T. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS. 2012;26(Suppl 1):S19–30. doi: 10.1097/QAD.0b013e3283558526. - DOI - PMC - PubMed
1. Wang H, Wolock TM, Carter A, Nguyen G, Kyu HH, Gakidou E, Hay SI, Mills EJ, Trickey A, Msemburi W, et al. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016;3(8):e361–87. doi: 10.1016/S2352-3018(16)30087-X. - DOI - PMC - PubMed
1. Ullrich A, Ott JJ, Vitoria M, Martin-Moreno JM, Atun R. Long-term care of AIDS and non-communicable diseases. Lancet. 2011;377(9766):639–40. doi: 10.1016/S0140-6736(11)60233-X. - DOI - PubMed

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[1] Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. - PMC - PubMed

[2] Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. - PMC - PubMed

[3] Bärnighausen T, Welz T, Hosegood V, Bätzing-Feigenbaum J, Tanser F, Herbst K, Hill C, Newell M-L. Hiding in the shadows of the HIV epidemic: obesity and hypertension in a rural population with very high HIV prevalence in South Africa. J Hum Hypertens. 2008;22:236–9. doi: 10.1038/sj.jhh.1002308. - DOI - PubMed

[4] Bärnighausen T, Welz T, Hosegood V, Bätzing-Feigenbaum J, Tanser F, Herbst K, Hill C, Newell M-L. Hiding in the shadows of the HIV epidemic: obesity and hypertension in a rural population with very high HIV prevalence in South Africa. J Hum Hypertens. 2008;22:236–9. doi: 10.1038/sj.jhh.1002308. - DOI - PubMed

[5] Hontelez JA, de Vlas SJ, Baltussen R, Newell ML, Bakker R, Tanser F, Lurie M, Bärnighausen T. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS. 2012;26(Suppl 1):S19–30. doi: 10.1097/QAD.0b013e3283558526. - DOI - PMC - PubMed

[6] Hontelez JA, de Vlas SJ, Baltussen R, Newell ML, Bakker R, Tanser F, Lurie M, Bärnighausen T. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS. 2012;26(Suppl 1):S19–30. doi: 10.1097/QAD.0b013e3283558526. - DOI - PMC - PubMed

[7] Wang H, Wolock TM, Carter A, Nguyen G, Kyu HH, Gakidou E, Hay SI, Mills EJ, Trickey A, Msemburi W, et al. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016;3(8):e361–87. doi: 10.1016/S2352-3018(16)30087-X. - DOI - PMC - PubMed

[8] Wang H, Wolock TM, Carter A, Nguyen G, Kyu HH, Gakidou E, Hay SI, Mills EJ, Trickey A, Msemburi W, et al. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016;3(8):e361–87. doi: 10.1016/S2352-3018(16)30087-X. - DOI - PMC - PubMed

[9] Ullrich A, Ott JJ, Vitoria M, Martin-Moreno JM, Atun R. Long-term care of AIDS and non-communicable diseases. Lancet. 2011;377(9766):639–40. doi: 10.1016/S0140-6736(11)60233-X. - DOI - PubMed

[10] Ullrich A, Ott JJ, Vitoria M, Martin-Moreno JM, Atun R. Long-term care of AIDS and non-communicable diseases. Lancet. 2011;377(9766):639–40. doi: 10.1016/S0140-6736(11)60233-X. - DOI - PubMed

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The efficiency of chronic disease care in sub-Saharan Africa

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The efficiency of chronic disease care in sub-Saharan Africa

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