Skip to main content

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

EnablerKey componentsLessons learned
1. DecentralisationService set-up and empowerment of nurses to diagnose and manage DM and HTNNurse-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. IntegrationTwo 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. SimplificationContext-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 sharingMultidisciplinary 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 medicinesRational 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 supportUse 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 empowermentIndividual and group literacy sessions for DM and HTNSuccessful implementation of DM and HTN literacy sessions
8. Dedicated Monitoring and EvaluationDesign 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 systemDevelopment of referral criteria to higher level for complex patientsOn- and off-site decision support by doctors