Nearly half of all sub-Saharan African countries lack operational Diabetes Mellitus policies. This represents an opportunity to build reliable evidence to underpin such policies when they are eventually developed. Representing the interests of those with the experience of living with the condition in national diabetes policies is important, particularly the interests regarding medicine access, a key pillar in diabetes management. One way to achieve this representation is to publish patient perceptions. Patient perspectives are especially valuable in the context of diabetes in Sub-Saharan Africa, where much of the empirical work has focused on clinical and epidemiological questions. We therefore captured the challenges and suggestions around medicine access articulated by a population of diabetes patients and their caregivers. This was a qualitative interpretivist study based on data from focus group discussions with adult diabetes patients and their caregivers. Eight FGDs of 4–13 participants each whose duration averaged 13.35 minutes were conducted. Participants were recruited from diabetes outpatient clinics at two health facilities in Harare. One site was Parirenyatwa Hospital, the largest public referral and teaching hospital in Zimbabwe. The other was a private for-profit facility. Ethics approval was granted by the Joint Research Ethics Committee for University of Zimbabwe College of Health Sciences and the Parirenyatwa Group of Hospitals (Ref: JREC 295/18). Diabetes patients and their caregivers are interested in affordable access to medicines of acceptable form and quality with minimum effort. Yet, they often find themselves privileging one dimension of access over another e.g. prioritising affordability over acceptability. Based on participants’ articulations, a sound diabetes policy should: 1. provide for financial and consumer protections, 2. regulate healthcare business practices and medicine prices, 3. provide for a responsive health workforce attentive to patient problems, 4. accord the same importance to diabetes that is accorded to communicable diseases, 5. decentralize diabetes management to lower levels of care, 6. limit wastage, corruption, bad macro-financial governance and a lack of transparency about how funding for health is used, and 7. provide support to strengthen patients’ and caregivers’ psychosocial networks. A diabetes policy acceptable to patients is one infused with principles of good governance, fairness, inclusiveness and humanity; characterised by: financial protection and price regulation, consumer protection, equity in the attention accorded to different diseases, decentralized service delivery, inclusion of patient voice in political decision-making, a responsive compassionate health workforce, psychosocial support for patients and their caregivers and allocative efficiency and transparency in public expenditure.

No abstract

No abstract

UNSTRUCTURED ABSTRACT Hypertension and diabetes are amongst the most common non-communicable diseases in Zimbabwe. These two conditions are largely prevented and controlled by modification of lifestyles such as healthy eating habits, physical activity as well as avoiding harmful use of tobacco and alcohol. We have designed a study to evaluate the effects of a community health worker-led health literacy intervention for lifestyle modification among diabetes and hypertension patients in Harare, Zimbabwe and this paper describes the research design and rationale. This six month long cluster-randomized controlled trial will be conducted in 14 primary health care clinics in the City of Harare. A total of 680 adult hypertension and diabetes patients will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification (developed by the principal researcher), which will be delivered by trained community health worker, whilst those in the control arm will receive the usual care. Baseline and follow-up surveys will be conducted in a standardized manner in all the facilities. The primary study outcome will be levels of adherence to recommended lifestyle modification. Other outcomes will include changes in diabetes and hypertension control and adherence to medication, changes in glycosylated haemoglobin (HbA1c) measurements. Data management and analysis will be done using Epi-info software The use of community health workers to address the inadequate health care workers in management of hypertension, diabetes and other chronic conditions has been widely recommended for resource limited settings (Mishra et al., 2015; Joshi and Peiris, 2019). However, there is an information dearth regarding the effectiveness of community health worker interventions for management and control of hypertension in Ziombabwe. Our study offers an opportunity to show the effectiveness of community health workers (CHWs) in addressing the gaps in management of hypertension and diabetes. The findings from our study will provide the much-needed evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource constrained areas.

Background Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. Objective This study aims to evaluate the effects of a community health worker (CHW)–led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. Methods This is a 6-month–long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. Results Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants’ recruitment, and the final data collection will be completed by January 31, 2024. Conclusions There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. International Registered Report Identifier (IRRID) PRR1-10.2196/47512