Evaluation of care access and hypertension control in a community health worker driven non-communicable disease programme in rural Uganda: The chronic disease in the community project

The burden of non-communicable diseases continues to grow throughout the developing world. Health systems in low- and middle-income regions face significant human resource shortages, which limit the ability to meet the growing need for non-communicable disease care. Specially trained community health workers may be useful in filling that provider gap. This study aimed to evaluate consistency of access to care and quality of hypertension control in a community health worker led, decentralized non-communicable disease programme operating in rural Uganda. Days between clinical evaluations and average systolic blood pressure were described for programme patients; these markers were also compared with patients seen in a central, hospital-based clinic. In 2013, community health worker programme patients were seen every 35.6 days and significantly more often than clinic patients (50.8 days, P < 0.001). From October to December 2013, hypertensive patients in the community health worker programme had a mean systolic blood pressure of 147.8 mmHg. This was lower than the average systolic pressure of clinic patients (156.7 mmHg, P < 0.001). Programme patients' blood pressures were also more frequently measured at below goal than clinic patients (71.2 vs 59.8%, P ¼ 0.048). Decentralizing care and shifting significant clinical management responsibilities to community health workers improved consistency of access to care and did not come with a demonstrable cost in quality of hypertension control. Community health workers may have the potential to bridge the provider gap in low-income nations, providing expanded non-communicable disease care.