{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:01:31Z","timestamp":1790910091619,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T00:00:00Z","timestamp":1621123200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Effective coverage of non\u2010communicable disease (NCD) care in sub\u2010Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first\u2010level hospitals. This study describes the facility\u2010level implementation outcomes of this strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In 2014, the Ministry of Health trained two nurses in each of the country\u2019s 42 first\u2010level hospitals to implement and deliver nurse\u2010led, integrated, outpatient NCD clinics, which focused on severe NCDs. Post\u2010intervention evaluation occurred via repeated cross\u2010sectional surveys, informal interviews and routinely collected clinical data over two rounds of visits in 2015 and 2017. Implementation outcomes included fidelity, feasibility and penetration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>By 2017, all NCD clinics were staffed by at least one NCD\u2010trained nurse. Among the approximately 27\u00a0000 nationally enrolled patients, hypertension was the most common diagnosis (70%), followed by type 2 diabetes (19%), chronic respiratory disease (5%), type 1 diabetes (4%) and heart failure (2%). With the exception of warfarin and beta\u2010blockers, national essential medicines were available at more than 70% of facilities. Clinicians adhered to clinical protocols at approximately 70% agreement with evaluators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The government of Rwanda was able to scale a nurse\u2010led outpatient NCD programme to all first\u2010level hospitals with good fidelity, feasibility and penetration as to expand access to care for severe NCDs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13593","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T22:23:41Z","timestamp":1619216621000},"page":"953-961","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Implementation outcomes of national decentralization of integrated outpatient services for severe non\u2010communicable diseases to district hospitals in Rwanda"],"prefix":"10.1111","volume":"26","author":[{"given":"Simon Pierre","family":"Niyonsenga","sequence":"first","affiliation":[{"name":"Rwanda Biomedical Center Rwanda Ministry of Health  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul H.","family":"Park","sequence":"additional","affiliation":[{"name":"Partners In Health  Boston MA USA"},{"name":"Division of Global Health Equity Brigham and Women\u2019s Hospital  Boston MA USA"},{"name":"Department of Global Health and Social Medicine Program in Global Noncommunicable Diseases and Social Change Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gedeon","family":"Ngoga","sequence":"additional","affiliation":[{"name":"Partners In Health  Boston MA USA"},{"name":"Inshuti Mu Buzima  Rwinkwavu Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evariste","family":"Ntaganda","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Rwanda Ministry of Health  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrick","family":"Kateera","sequence":"additional","affiliation":[{"name":"Inshuti Mu Buzima  Rwinkwavu Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Gupta","sequence":"additional","affiliation":[{"name":"Partners In Health  Boston MA USA"},{"name":"Division of Global Health Equity Brigham and Women\u2019s Hospital  Boston MA USA"},{"name":"Department of Global Health and Social Medicine Program in Global Noncommunicable Diseases and Social Change Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edson","family":"Rwagasore","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Rwanda Ministry of Health  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Rwunganira","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Rwanda Ministry of Health  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Munyarugo","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Rwanda Ministry of Health  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cadet","family":"Mutumbira","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Rwanda Ministry of Health  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Symaque","family":"Dusabayezu","sequence":"additional","affiliation":[{"name":"Inshuti Mu Buzima  Rwinkwavu Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arielle","family":"Eagan","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine Program in Global Noncommunicable Diseases and Social Change Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantelle","family":"Boudreaux","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine Program in Global Noncommunicable Diseases and Social Change Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Noble","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine Program in Global Noncommunicable Diseases and Social Change Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Aimee","family":"Muhimpundu","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Rwanda Ministry of Health  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. 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