Decentralization Matters: Association of Adherence to Treatment and Distance for the Management of Non-Communicable Diseases in Rural Tanzania

Paolo Belardi (), Noemi Bazzanini, Francesca Cera, Katunzi Mutalemwa, Francesca Tognon, Emmanuel Ndile, Alessandro Mele, Rehema Itambu, Rhoda Naftali, Bernard Kakala, Veronica Kayombo, Benjamin Mfaume, Bruno Ndunguru, Samwel Marwa and Mario Saugo
Additional contact information
Paolo Belardi: Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania
Noemi Bazzanini: Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania
Francesca Cera: Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania
Katunzi Mutalemwa: Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania
Francesca Tognon: Doctors with Africa CUAMM, 35121 Padua, Italy
Emmanuel Ndile: Muhimbili National Hospital, Dar-es-Salaam P.O. Box 65000, Tanzania
Alessandro Mele: Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania
Rehema Itambu: Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania
Rhoda Naftali: Tosamaganga Regional Referral Hospital, Iringa P.O. Box 11, Tanzania
Bernard Kakala: Tosamaganga Regional Referral Hospital, Iringa P.O. Box 11, Tanzania
Veronica Kayombo: Tosamaganga Regional Referral Hospital, Iringa P.O. Box 11, Tanzania
Benjamin Mfaume: Tosamaganga Regional Referral Hospital, Iringa P.O. Box 11, Tanzania
Bruno Ndunguru: Iringa District Council, Iringa P.O. Box 108, Tanzania
Samwel Marwa: Iringa District Council, Iringa P.O. Box 108, Tanzania
Mario Saugo: Doctors with Africa CUAMM, 35121 Padua, Italy

IJERPH, 2024, vol. 21, issue 11, 1-14

Abstract: Since March 2019, a non-communicable diseases program has been established at hospital level, with enrollment and clinical reassessment every 6 months. Since July 2023, monthly enrollment and visits have also been conducted at health center level. This study aimed at assessing the adherence to scheduled follow-up visits following the decentralization of the integrated NCDs program from Hospital to Health Center level and investigate factors influencing follow-up adherence. The study was performed in a rural district in Iringa Region, Tanzania. Adherence was measured at both levels. Multivariate regression analysis was conducted to describe socio-demographic and clinical factors influencing attendance at the 6-month hospital-level visit. Among 2198 patients enrolled at the hospital level, weighted adherence over 42 months was 40.8% (95% CI 39.0–42.6%) at the 6-month visit. Multivariate analysis revealed that as the distance from the hospital increased, the probability of attendance decreased (OR 0.17; 95% CI: 0.08–0.39). Among 571 patients enrolled at the residence level, adherence over the first 10 months of program implementation was 91.6% (90.4–92.8%). The findings showed that distance was by far the most important barrier to follow-up adherence and suggested that decentralizing the program from the hospital to peripheral health centers may ensure high follow-up rates.

Keywords: non-communicable disease; NCD; Tanzania; diabetes; hypertension; decentralization; health service development (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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