Wakiso Health Clinic, Uganda

Until about a decade ago, African health services were primarily dealing with acute infections, such as tuberculosis (TB), malaria, and the consequences associated with HIV infection. Nowadays, chronic conditions such as diabetes and hypertension, which require regular and lifelong care, have an equal to or higher burden than infectious diseases in many sub-Saharan African countries.

Diabetes and hypertension lead to serious clinical complications including heart attacks, stroke and kidney disease. They are of grave concern. However, health services in Africa have historically focused on infectious diseases and are therefore ill-equipped to provide proper health services for the diagnosis and management of these NCDs –less than 5% of those affected by diabetes or hypertension are thought to be in regular care.

Universal health coverage (UHC) strives to ensure that “every person- no matter who they are or where they live- be able to get the quality health services they need without facing financial hardship”. Every year on this day (12 December), there is a global call to ensure the right to health for everyone across the world. This includes ensuring access to high-quality health services, affordable drugs and people-centred care, all while being free of catastrophic payments for the basic human right of health.

Strong evidence-based research is needed to support UHC initiatives and particularly for scaling up diabetes and hypertension services in settings with limited resources. According to the World Health Organization, at least half of the world’s population still misses out on essential health services.

Patients waiting to have their blood pressure measured in a clinic at Dar es Salaam, Tanzania

The INTE-AFRICA (Integrating and Decentralising HIV, diabetes and hypertension services in Africa) project is the first of its kind and aims to test the efficacy of integrating diabetes and hypertension services alone, or together with HIV-infection services, in two sub-Saharan African countries: Uganda and Tanzania. The severe absence of clinically skilled healthcare staff across Africa combined with stand-alone services are among the biggest factors behind the very low coverage of diabetes and hypertension services and the reason why integration could make services more efficient, resulting in better outcomes for the patients. The results from this large trial are expected to be relevant and applicable to other conditions and other sub-Saharan African countries.

In addition to contributing to the evidence on effectiveness and cost-effectiveness of a large-scale intervention such as this one, INTE-AFRICA will provide services and care for people with diabetes or hypertension who may not have known they were affected, or who were not able to access care.

As health researchers, we are part of the community that must continue to push for universal health coverage. While the INTE-AFRICA project strives to offer quality, integrated, and simplified diabetes and hypertension care across Tanzania and Uganda, the same should be done for all diseases, around the world. Only by integrating the knowledge and experiences of communities and health and research professionals alike, will we be able to ensure the right to health for everyone near and far.


This post was originally published in the Health is Global blog on occasion of Universal Health Coverage Day