Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 1;20(1):486.
doi: 10.1186/s12913-020-05351-x.

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

Marthe Frieden  1 , Blessing Zamba  2 , Nisbert Mukumbi  3 , Patron T Mafaune  2 , Brian Makumbe  2 , Elizabeth Irungu  3 , Virginia Moneti  3 , Petros Isaakidis  4 , Daniela Garone  5 , Madhu Prasai  5
Affiliations

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

Marthe Frieden et al. BMC Health Serv Res. .

Abstract

Background: In the light of the increasing burden of non-communicable diseases (NCDs) on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context-adapted, cost-effective service delivery models are now required as a matter of urgency. We describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in rural Zimbabwe, a low-income country with unique socio-economic challenges and a dual disease burden of HIV and NCDs.

Methods: Mirroring the HIV experience, we designed a conceptual framework with 9 key enablers: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system. We selected 9 primary health care clinics (PHC) and two hospitals in Chipinge district and integrated DM and HTN either into the general out-patient department, pre-existing HIV clinics, or an integrated chronic care clinic (ICCC). We provided structured intensive mentoring for staff, using simplified protocols, and disease-specific education for patients. Free medication with differentiated periodic refills and regular monitoring with point of care (POC) glycosylated haemoglobin (HbA1c) were provided.

Results: Nurses in 7 PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM and HTN patients, and 3094 patients were registered in the programme (188 with DM only, 2473 with HTN only, 433 with both DM and HTN). Major lessons learned from our experience include: the value of POC devices in the management of diabetes; the pressure on services of the added caseload, exacerbated by the availability of free medications in supported health facilities; and the importance of leadership in the successful implementation of care in health facilities.

Conclusion: Our experience demonstrates a model for nurse-led decentralized integrated DM and HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process. We present our lessons learned with the intention of sharing experience which may be of value to other public health programme managers.

Keywords: Diabetes mellitus; Hypertension; Mentoring; Non-communicable diseases; Nurse-led; Primary-health-care.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual framework
See this image and copyright information in PMC

References

    1. Institute for Health Metrics and Evaluation . Findings from the Global Burden of Disease Study 2017. Seattle: IHME; 2018.
    1. World Health Organization. Global status report on noncommunicable diseases 2014: World Health Organization; 2014. https://www.who.int/nmh/publications/ncd-status-report-2014/en/. Accessed 15 Aug 2019.
    1. Mutowo MP, Mangwiro JC, Lorgelly P, Owen A, Renzaho AM. Hypertension in Zimbabwe: A meta-analysis to quantify its burden and policy implications. World J Meta-Analysis. 2015;3(1):54–60. doi: 10.13105/wjma.v3.i1.54. - DOI
    1. Mutowo M, Gowda U, Mangwiro JC, Lorgelly P, Owen A, Renzaho A. Prevalence of diabetes in Zimbabwe: a systematic review with meta-analysis. Int J Public Health. 2015;60(1):1–11. doi: 10.1007/s00038-014-0626-y. - DOI - PubMed
    1. Ministry of Health and Child Care (MOHCC) Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2015–16: First Report. Harare: MOHCC; 2017.