Guidance on Provision of NCD and Mental Health Services in the Context of COVID-19 Outbreak in Tanzania

Objectives

The guidance provides a national framework for Tanzania to sustain safe, equitable and integrated non-communicable disease, mental health, rehabilitation and palliative-care services during the COVID-19 pandemic, while reducing severe illness and deaths among people with chronic conditions.[1][2][3]It combines prevention of severe acute respiratory syndrome coronavirus 2 transmission with continuity of essential care and support for Universal Health Coverage without increasing patients’ financial burden.[3]

• Reduce non-communicable disease and mental health risks, prevent COVID-19 infection, identify complications early, and lower morbidity and mortality among people with comorbid conditions.[2][3]
• Maintain health promotion, prevention, treatment, rehabilitation, palliative care and psychosocial support at facility, community and household levels throughout the outbreak and recovery period.[2][3][4][5]
• Prioritise people at heightened risk of severe COVID-19, including older people and people with hypertension, cardiovascular disease, diabetes, cancer, renal disease, chronic respiratory disease, obesity, immunosuppression and other major chronic conditions.[6][7][8]
• Address modifiable risk factors through tobacco cessation, avoidance of hazardous alcohol use, healthy diets, physical activity, breastfeeding support and weight management.[9][10][11][12]
• Protect patients, health workers, caregivers and communities through infection prevention and control, triage, testing, isolation, contact tracing, physical distancing and access to personal protective equipment.[6][13][14]
• Support mental wellbeing, prevent stigma and discrimination, and provide psychosocial assistance for the general population, affected individuals, families, children, people in isolation or quarantine, and health workers.[15][16][17]

Implementation

Implementation is centred on integrating COVID-19 prevention, case management and infection prevention and control into established chronic-care services, with differentiated delivery to reduce unnecessary exposure while preserving clinically necessary treatment.[18][13][19]Coordination is led through the National Non-Communicable Disease Prevention and Control Programme and its National NCD-COVID-19 Taskforce, linked to national case-management and infection-prevention teams and regional and local structures.[2][6][13]

• Coordinate the Ministry of Health, Community Development, Gender, Elderly and Children, the President’s Office, Regional Administration and Local Government, the Tanzania Noncommunicable Diseases Alliance, the World Health Organization, professional associations, referral institutions, universities, regional health management teams and other partners.[20][21][3]
• Train chronic-care staff in COVID-19 case management and infection prevention and control, provide refresher training on non-communicable diseases and mental health comorbidities, and protect vulnerable staff through screening, reassignment where appropriate, psychosocial support and occupational-health measures.[6][13][22][17]
• Reorganise facilities through entry checkpoints, screening, triage, isolation areas, ventilation, distancing, visitor restrictions, zoning of clean and contaminated areas, hygiene supplies, environmental cleaning and safe medical-waste disposal.[13][19][22]
• Use remote and decentralised delivery, including telephone helplines, teleconsultations, social media communication, prescription refills collected by relatives or peer supporters, longer refill intervals, home visits where appropriate, and remote rehabilitation or mental health support.[19][23][16][5]
• Maintain condition-specific care through diabetes education and glucose and ketone monitoring; continuity of cardiovascular, respiratory, renal, cancer, sickle cell, adrenal-insufficiency and medication-assisted treatment services; and individualised decisions on hospitalisation, procedures and treatment intensity.[24][25][26][27][28][29]
• Provide dedicated arrangements for dialysis and oncology patients, including pre-attendance symptom checks, separation or isolation of suspected and confirmed cases, protective equipment, scheduled treatment and adapted regimens that minimise avoidable visits without compromising urgent care.[7][30][25][31]
• Deliver rehabilitation across acute, sub-acute and long-term phases through hospitals, stepdown facilities, outpatient care, home-based services, mobile services and telehealth, addressing respiratory, mobility, cognitive, swallowing, communication and psychosocial needs.[5]
• Deliver palliative care through hospitals, hospices, community services, home visits, day care and remote consultation, using referral pathways and District Medical Officer notification for suspected cases.[29][4][14]
• Report emerging findings through case-management leadership or the NCD taskforce, use scientific and professional guidance to update practice, and revise the guidance as evidence on COVID-19 pathogenesis, presentation and comorbidities develops.[20][18]
• Use available reporting channels through non-communicable disease coordinators and local authorities, while recognising that the supplied material does not define a comprehensive programme indicator set, reporting timetable, evaluation methodology or formal accountability framework.[10][5]
• Mobilise resources for training, protective equipment, hygiene and cleaning supplies, testing, telehealth, transport for home-care teams, essential medicines and community-based palliative-care support; no overall budget, quantified allocation or costing methodology is specified.[13][29][4][5]

Monitoring & Evaluation

Monitoring is principally clinical and operational, with guidance requiring case detection, triage, staff and patient screening, symptom assessment, referral, surveillance, reporting of emerging findings, and periodic revision as evidence develops. A unified document-level indicator framework, reporting timetable, evaluation methodology and audit system are not specified.[18][10][22][5]

• Monitor evolving scientific research, World Health Organization recommendations, clinical presentation and comorbidities, and revise guidance when validated evidence or new findings warrant change.[20][3][18]
• Report new findings through the case-management lead or non-communicable disease taskforce, and communicate validated findings officially before reviewing or updating guidance.[18]
• Follow local reporting procedures through non-communicable disease coordinators and local authorities before submitting reports to the next administrative level.[10]
• Coordinate surveillance and research through a dedicated research and surveillance subcommittee.[10]
• Screen health workers daily before facility entry using temperature measurement and exposure or respiratory-history checks; evaluate and test staff with fever, require symptom reporting and self-isolation, and screen staff before return to work.[22]
• Assign section managers and the facility COVID-19 surveillance officer to investigate clusters involving three or more staff with fever or respiratory-illness leave.[22]
• Screen dialysis patients before attendance, preferably by telephone on the preceding day, and again at the unit through symptom checks, temperature measurement and oxygen-saturation assessment.[7]
• Evaluate suspected COVID-19 among dialysis patients through clinical assessment, recommended laboratory and chest-imaging investigations, and hospital testing protocols.[30]
• Undertake enhanced surveillance and follow-up for higher-risk oncology patients, including older people and those with lung tumours or comorbidities; use COVID-19 status to determine isolation and treatment scheduling.[25][31]
• Monitor people with diabetes through more frequent blood-glucose and ketone checks during illness, using the stated fasting plasma-glucose reference range of 4 to 6 mmol/L and post-prandial range of 6 to 10 mmol/L.[26]
• Check glucose on admission and every two to four hours, or use continuous glucose monitoring where available, and assess ketones and renal function for admitted people with diabetes.[27][32]
• Assess COVID-19 severity using respiratory symptoms, respiratory rate, oxygen saturation, radiographic findings, respiratory failure, septic shock and multiple organ failure; evaluate deterioration for thromboembolic disease where pulmonary, cardiac or neurological function worsens rapidly.[33][34]
• Monitor shock through dynamic fluid-responsiveness measures, skin temperature, capillary refill time, lactate, cardiac function and perfusion; record when echocardiography has been curtailed because of COVID-19 circumstances.[35][36]
• Record and report mental health and psychosocial services provided and areas for improvement, assess distress among healthcare workers, and refer work-related mental health disorders or substance-use problems for care.[16][17]
• Use remote or on-site assessment, notification through the District Medical Officer, contact tracing and referral pathways to identify and manage possible COVID-19 cases among palliative-care clients.[29][4][14]
• Assess rehabilitation outcomes and generate practice evidence to inform future changes in rehabilitation techniques.[5]

Beyond these clinical, service-level and coordination arrangements, the material does not specify formal programme indicators, targets, routine reporting frequencies, national surveillance information systems, independent evaluation arrangements or comprehensive accountability mechanisms.[13][30][28][37]

Costing & Financing

Costing and financing information is limited. The material identifies substantial operational resource needs and acknowledges technical and financial assistance in revising the guidance, but does not provide an overall budget, quantified allocation, costing methodology, funding gap, financing formula or economic assumptions.[20][21][29][4]

• Mobilise technical and financial assistance from government departments, the President’s Office, Regional Administration and Local Government, the Tanzania Noncommunicable Diseases Alliance, the World Health Organization in Tanzania and other stakeholders involved in revising the guidance.[20][21]
• Maintain essential services without increasing patients’ financial burden, although no financing mechanism or funding amount is defined.[3]
• Resource staff training, clinic reorganisation, personal protective equipment, testing access, hand-hygiene supplies, cleaning and disinfection materials, communication materials, screening arrangements and service adaptations.[6][13][10]
• Provide practical inputs for diabetes care, including medicines, prescription refills, glucose and ketone testing supplies, continuous glucose-monitoring equipment and insulin-pump supplies, without monetary valuation.[26][38]
• Support home supplies of steroid medicines and injections for adrenal insufficiency, and enable patient-led glucose monitoring where feasible to reduce staff exposure and use of personal protective equipment.[27][32]
• Invest in education, personal protective equipment, essential medical supplies and locally available preventive and treatment resources for community and home-based palliative care.[29]
• Allocate resources for home-care-team transport to communities, referrals from community to hospital level, free care for confirmed cases, preventive supplies and support.[4]
• Provide vitamin C and zinc supplements free of charge to patients in the specified high-risk palliative-care category.[14]
• Resource rehabilitation protective equipment, training, education materials, telehealth and workforce capacity, although no costs or financing sources are stated.[5]

No monetary values, local-currency amounts, external funding commitments, funding-gap estimates, cost-effectiveness analyses or economic assumptions are supplied for the identified resource requirements.[24][8][16][5]