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Table 2 Enablers, key components of each enabler, and lessons learned during programme implementation

From: Setting up a nurse-led model of care for management of hypertension and diabetes mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive study


Key components

Lessons learned

1. Decentralisation

Service set-up and empowerment of nurses to diagnose and manage DM and HTN

Nurse-led services fully operational in 7/9 PHC facilities and 1 hospital.

Spread patient visits throughout the week to manage workload.

Difficult to ensure regular access of mentoring teams to remote sites

2. Integration

Two models emerged for NCD integration: either in general OPD or with HIV services.

What works best depends on individual circumstances of each health facility

Choose the best fit rather than imposing a ‘one size fits all’ model

3. Simplification

Context-adapted SOPs

Experience-based fine-tuning of clinical treatment

Guideline development is a dynamic process requiring internal and external expertise, responding to user feedback

4. Mentoring and task sharing

Multidisciplinary MSF mentoring teams and MoH mentees

Mentoring curriculum comprising clinical and programmatic knowledge

On-the-job support by mentor.

Competence dashboard to monitor progress

Major limitations:

Long travel distance for mentors,

HR shortages limiting the availability of dedicated key staff for regular mentoring, high patient volume

Requirement for ownership and leadership in health facilities

5. Affordable medicines

Rational medication choices

Free medications subsidised by MSF

Advocacy to improve MoH medication supply to health facilities

Free medications improved access to care for patients

Reliable MSF-supported supply allowed spacing of patient appointments

‘Pull factor’ of free medications increased programme demand

6. Quality assured lab support

Use of pre-existing laboratory systems and equipment

Introduction of POC machines for glucose and creatinine measurement

External Quality Assurance system for HbA1c

Problems with transport of samples to central laboratory overcome by on-site POC machines

Trained and motivated laboratory staff required to produce quality results when conventional machines are used

7. Patient empowerment

Individual and group literacy sessions for DM and HTN

Successful implementation of DM and HTN literacy sessions

8. Dedicated Monitoring and Evaluation

Design and implementation of patient records for DM and HTN consultations

Data collection in electronic database and quarterly analysis

Development of standard indicators

Simplification of patient records improved completeness and quality of data

Dedicated M&E system improved resource quantification

9. Referral system

Development of referral criteria to higher level for complex patients

On- and off-site decision support by doctors