Perceptions on diabetes care provision among health providers in rural Tanzania: a qualitative study

Abstract

Diabetes prevalence in Tanzania was estimated at 9.1% in 2012 among adults aged 24–65 years — higher than the HIV prevalence in the general population at that time. Health systems in lower- and middle-income countries are not designed for chronic health care, yet the rising burden of non-communicable diseases such as diabetes demands chronic care services. To inform policies on diabetes care, we conducted a study on the health services in place to diagnose, treat and care for diabetes patients in rural Tanzania. The study was an exploratory and descriptive study involving qualitative methods (in-depth interviews, observations and document reviews) and was conducted in a rural district in Tanzania. Fifteen health providers in four health facilities at different levels of the health care system were interviewed. The health care organization elements of the Innovative Care for Chronic Conditions (ICCC) framework were used to guide assessment of the diabetes services in the district. We found that diabetes care in this district was centralized at the referral and district facilities, with unreliable supply of necessary commodities for diabetes care and health providers who had some knowledge of what was expected of them but felt ill-prepared for diabetes care. Facility and district level guidance was lacking and the continuity of care was broken within and between facilities. The HMIS could not produce reliable data on diabetes. Support for self-management to patients and their families was weak at all levels. In conclusion, the rural district we studied did not provide diabetes care close to the patients. Guidance on diabetes service provision and human resource management need strengthening and policies related to task-shifting need adjustment to improve quality of service provision for diabetes patients in rural settings.

Healthcare Providers' Perception of Healthcare System Factors Associated with Poor Glycemic Control among Type 2 Diabetes Patients in Fiji

“…This is similar to the findings of the qualitative study on the perceptions of diabetes care provision among healthcare providers in rural Tanzania by Mwangome at al. [31]. They found that lack of equipment, supplies, and medication for diabetes diagnosis, treatment, and monitoring served as barrier to effective diabetes management and care.…”

How have researchers defined and used the concept of ‘continuity of care’ for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework

“…public community health centres model, ‘gate-keeper’ CHC model or hospital-owned CHC model) was most effective in enhancing access to and quality of care for patients with chronic diseases (i.e. with hypertension or diabetes)Tang, 2015 [66]Study designHypertensionChinaStudy design of a clustered randomised controlled trial to build and evaluate an integrated healthcare system for chronic patientsWei, 2015 [72]Multistage stratified random surveyChronic diseasesChinaChanges in perspectives of patients on quality of primary care following the introduction of health system reformsMwangome, 2016 [75]Qualitative in-depth interviewHIV/diabetes mellitusTanzaniaPerceptions, experiences and practice of care for HIV and diabetes from the perspective of patients and family caregiversYe, 2016 [70]Cohort studyHypertensionChinaEffect of continuity of care on health-related quality of life in adult patients with hypertensionMwangome, 2017 [74]Qualitative studyDiabetes mellitusTanzaniaPerception of health providers on diabetes care provisionZhang, 2017 [69]Clustered randomised controlled trialHypertensionChinaEffects of integrated chronic care models on hypertension outcomes and spendingGroup 5: Measuring continuity of care with validated questionnairesWei, 2008b [76]Cross-sectional surveyDiabetes mellitusChinaContinuity of care in a community diabetes programmeVargas, 2017 [77]Cross-sectional surveyChronic diseasesColumbia and BrazilPatient perceptions of continuity of healthcare and associated factors CHC community health center, FGDs focus group discussions, LICs low-income countries, LMICs low- and middle-income countries, NCDs non-communicable diseases, SSIs semi-structured interviews a Location could be: a country or a region or a setting…”

“…Three other interventions were implemented at the primary healthcare level in China using two models, namely Starfield’s model of primary care and the Primary Care Assessment Tool; both have components of CoC [71–73]. Finally, two qualitative studies investigated CoC in the Tanzanian Health System at the patient and provider levels, based on WHO’s ICCC Framework [74, 75].…”

Pathways to diabetic care at hospitals in rural Eastern Uganda: a cross sectional study

“…There is usually lack of expertise to manage diabetes at primary health care levels [30]. For example, research in neighbouring Tanzania shows many of their lower facilities lack diagnostic equipment, may not be having guidelines and lack anti-diabetic medicines [31, 32]. Switching between multiple providers also attests to limited capacity for the continuity of care for diabetes, a weakness reported for the management of chronic illnesses in sub-Saharan Africa [7].…”