Our trip to UNHCR refugee camps in Uganda was an opportunity to see how far our ‘NCD champions’ had come since our initial training visit and it did not disappoint.
Nine months after receiving training on delivering NCD care at primary care level, the Ugandan UNHCR NCD champions were able, through a health systems approach, to develop NCD services from scratch across all UNHCR health facilities in Uganda. These facilities serve over one million refugees. They did this in a variety of ways e.g.; cascaded training to other clinicians; set up dedicated clinics supported by a health information system; and ensured NCD patients were monitored and followed up appropriately.
Particularly heartening is how they adapted their NCD skills to their diverse contexts and demonstrated inspiring levels of innovation and commitment to the sustainability of the service. The champions in the more established refugee populations of the South Western region of Uganda discovered that starting specific NCD clinics led to unprecedented demand which was both satisfying and challenging; requiring them to trial different solutions to ensure the needs of the communities were met. The success of NCD care provision has been such that it is now enjoyed by Ugandan nationals as well as nationals from neighbouring countries!
The West Nile champions on the other hand, serving a more mobile and unstable population for whom NCD services may not be a priority, were able to strengthen their facility based NCD care to provide a robust package of dedicated NCD clinic days and staff, specially designed NCD registers and NCD patient held notes that ensured the relevant information remained with the patient wherever they accessed care.
There were some limitations to providing stable and reliable NCD care, chief amongst which was the inconsistency in the availability of NCD medication and consumables. However, defining how care is delivered and thus the ability to evaluate process and progress has meant that our champions have data that can more reliably inform medication and consumable requisition.
Action-planning with the highly motivated NCD champions brought our visit to an end. Their sights are now firmly set on a future of service expansion where NCD care moves out of the facilities into the communities and where the supply chain for NCD drugs and consumables becomes more certain.
As I left Uganda, I was struck by the focus and dedication of the champions to implement, innovate and expand NCD care for their refugee communities. Amidst the unique demands of caring for refugee populations and the ever-present threat of infectious disease outbreaks, they have shown a determination to establish NCD care that is truly impressive, and it has been a real privilege to have been part of the process.