Table 2 Organisation of care for selected chronic conditions at primary and secondary level
Category | HIV care | Diabetes and cardiovascular conditions | Mental Health (Epilepsy) | Palliative care (Cancer) |
|---|---|---|---|---|
Organization of services and level of care | Stand-alone clinics on designated days of a week; special clinics for different groups e.g. pregnant and lactating mothers, teens and young adults | Consultation visits in outpatient clinics of PHC facilities; joint diabetes and hypertension clinic in district health centre | Consultation visits in outpatient clinics of PHC facilities; Selected clinic days for mental health and palliative services in the district health centre | |
Medical supply | Antiretroviral treatment constantly available in all facilities | Most drugs in the essential medicines list are frequently out of stock; patients referred to paying or secondary level facilities | Essential cancer treatment and palliative care provided in 3 health facilities | |
Screening and diagnostic resources | Vital measurements taken as per treatment guidelines; screening for tuberculosis and cervical cancer screening (VIA) available; results of HIV viral load sometimes delay | Resources for screening and diagnostic limited in public PHC facilities; patients referred to private PHC or referral facilities | ||
Cost and affordability of services | Free HIV services in all health facilities (public and private). Includes consultation, diagnostics, and treatment | Free health care in all public health facilities. Includes consultation, diagnostics, and treatment. Out-of-pocket payment when patients referred to private facilities | ||
Health workforce | Multi-disciplinary team with designated tasks i.e. clinicians, lab technicians, data clerks, health surveillance assistants, and HIV expert-patients | Clinician on duty provides consultation services (inadequate numbers and skills-mix); health surveillance assistants support health education, triage, and documentation | ||
Health information system | Most public health facilities use electronic medical record system. Patient information recorded in health passports | Documentation is mostly paper-based records; patient information recorded in health passports | ||
Other initiatives | Differentiated care: Preventing mother to child transmission (OPTION B+ approach); HIV teen and youth clubs; HIV discordant couple programme Community support: self-formed patient support groups; home-based care through community health volunteers HIV expert patients support HIV care in clinics and patient homes | Community support: home-based care through community health volunteers NCD master card; data reporting tool for hypertension and diabetes introduced at the district health centre | Community support: home-based care through community health volunteers | |