Readiness of health facilities for the outpatient management of non-communicable diseases in a low-resource setting: an example from a facility-based cross-sectional survey in Tanzania

Objective This study assessed the readiness of health facilities to provide outpatient management of non-communicable diseases using a nationally representative sample of health facilities from Tanzania as an example of a low-resource country. Design Facility-based cross-sectional survey. Setting This study analysed data collected from public and private-owned dispensaries/clinics, health centres and hospitals during the 2014-2015 Tanzania Service Provision Assessment survey. Primary outcome measures Three outcome variables are included in this study, namely readiness of facilities to provide outpatient management for diabetes, hypertension and chronic respiratory diseases. These were composite variables measured based on availability of indicators identified in the WHO-Service Availability and Readiness Assessment manual. These indicators were grouped into three domains, viz staff training and guidelines, basic diagnostic equipment and basic medicines. Readiness was measured by assessing the presence of required indicators in each of these domains. Results Out of 1188 health facilities assessed, 52.1%, 64.8% and 60.9% reported providing services related to diabetes, hypertension and chronic respiratory diseases, respectively. A few facilities reported having treatment guidelines (33.2%) or staff trained to provide non-communicable disease services (10.4%). The availability of basic diagnostic equipment and medicines for these diseases was significantly lower in public lower level facilities than in their private counterparts (p<0.05). Facilities located in urban settings as well as higher level (health centre and hospitals) and publicly owned facilities were significantly associated with increased service readiness index for providing outpatient management of non-communicable diseases. Conclusion A fair distribution of resources through the 'push' system of refresher training, treatment guidelines, medicines and diagnostic equipment from higher authorities or other agencies may be one way of strengthening the readiness of lower level and public facilities to cope with the increasing burden of non-communicable diseases in low-resource countries such as Tanzania.