Health System Strengthening: Decentralisation of Non-Communicable Disease Care
By Dr. David Mazza, Clinical Advisor, Primary Care International
Primary Care International (PCI) is partnering with one of Mozambique’s most established healthcare leaders, Professor Ana Mocumbi, Head of Non-Communicable Disease (NCD) Research at the Mozambique Institute for Health Education and Research. The partnership will test how strengthening primary care systems and upskilling health professionals in NCD care provision can improve outcomes for patients with diabetes and at risk of heart disease and stroke.
As part of PCI’s Letshego-funded Healthcare Innovation Project team, I headed from downtown Maputo, the capital of Mozambique, with its impressive historic buildings, along streets lined with modern steel and glass blocks, to the much poorer outskirts of the city. PCI is piloting a practical NCD care project with Mavalane Hospital, which serves some 800,000 people, most of who are living in poverty. Clinicians face multiple challenges in managing the large numbers of patients with acute health problems who seek services daily from the out-patient and emergency departments.
The pressure is intensified when trying to provide care for people with chronic, ongoing conditions, NCDs such as raised blood pressure (Hypertension) and Diabetes — they are unable to provide the quality of care that they know will improve their patients’ health outcomes. Stroke, a consequence of hypertension, is common. One senior clinician narrated to me the frustration of seeing at least two people every week with diabetic foot disease who require amputation, “and yet we can prevent this condition”. Due to lack of capacity, only a minority of people with diabetes in the population are seen in the hospital diabetes clinic. The majority remain undiagnosed. Even for those patients who do attend the clinic, challenges persist. Important medication for the management of diabetes and other NCDs is often out of stock in the pharmacy. Those who can afford to, buy the medication from private pharmacies. I heard of one diabetic patient who drives to South Africa to buy the vital medication. Unfortunately, these options are not available to the majority of patients who live in poverty. This have negative effects on their health, and that of their dependents.
Dr Ana Mocumbi, in her role as Head of NCD Research at the Institute for Health Education and Research, is partnering with PCI to pilot a project to improve Diabetes and Hypertension care for the population served by Mavalane Hospital. The model moves the bulk of NCD care away from the hospital and into the primary care health centres. This will provide a more local service for patients and avoids overwhelming the already overburdened hospital departments, as well as diagnosing and treating them as early as possible in the disease before symptoms take them to hospital.
PCI’s role will be to work closely with Dr Mocumbi and her team to create guidelines for managing these conditions and relevant training materials for health professionals. PCI will also train clinicians to be NCD Trainers, who will then be a resource for sustaining the workforce going forward — often called ‘cascade training’. In addition, the project will consider the operational elements in the wider primary healthcare system which are required to deliver a successful NCD care service, including consideration of how such issues of medication supply can be addressed.
Dr Mocumbi’s ambition for the NCD care project is “to demonstrate good clinical and ethical practice as a model that can be adopted by the Ministry of Health for NCD Clinics countrywide”. PCI is delighted to be a partner in such a timely and ambitious project.