Content, participants and outcomes of three diabetes care programmes in three low and middle income countries

Prim Care Diabetes. 2015 Jun;9(3):196-202. doi: 10.1016/j.pcd.2014.09.001. Epub 2014 Oct 3.

Abstract

Aims: To improve access and quality of diabetes care for people in low-income countries, it is important to understand which elements of diabetes care are effective. This paper analyses three diabetes care programmes in the DR Congo, Cambodia and the Philippines.

Methods: Three programmes offering diabetes care and self-management were selected. Programme information was collected through document review and interviews. Data about participants' characteristics, health outcomes, care utilisation, expenditures, care perception and self-management were extracted from a study database. Comparative univariate analyses were performed.

Results: Kin-réseau (DR Congo) is an urban primary care network with 8000 patients. MoPoTsyo (Cambodia) is a community-based peer educator network, covering 7000 patients. FiLDCare (Philippines) is a programme in which 1000 patients receive care in a health facility and self-management support from a community health worker. Content of care of the programmes is comparable, the focus on self-management largest in MoPoTsyo. On average, Kin-réseau patients have a higher age, longer diabetes history and more overweight. MoPoTsyo includes most female, most illiterate and most lean patients. Health outcomes (HbA1C level, systolic blood pressure, diabetes foot lesions) were most favourable for MoPoTsyo patients. Diabetes-related health care expenditure was highest for FiLDCare patients.

Conclusions: This study shows it possible to maintain a diabetes programme with minimal external resources, offering care and self-management support. It also illustrates that health outcomes of persons with diabetes are determined by their bio-psycho-social characteristics and behaviour, which are each subject to the content of care and the approach to chronic illness and self-management of the programme, in turn influenced by the larger context.

Keywords: Diabetes care; Low-income countries; Self-management education; Translational research.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cambodia / epidemiology
  • Community Health Services* / economics
  • Community Health Services* / organization & administration
  • Democratic Republic of the Congo / epidemiology
  • Developing Countries / economics*
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / economics
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy*
  • Female
  • Health Care Costs
  • Health Expenditures
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility
  • Healthcare Disparities
  • Humans
  • Income*
  • Male
  • Middle Aged
  • National Health Programs* / economics
  • National Health Programs* / organization & administration
  • Patient Education as Topic
  • Philippines / epidemiology
  • Poverty / economics*
  • Primary Health Care* / economics
  • Primary Health Care* / organization & administration
  • Process Assessment, Health Care* / economics
  • Process Assessment, Health Care* / organization & administration
  • Program Development
  • Program Evaluation
  • Self Care
  • Treatment Outcome