Primary Health Care System Readiness for Diabetes Mellitus and Tuberculosis Service Integration in South Africa

Abstract

Background: In recognition of the convergence of high levels of Tuberculosis (TB) and increasing Diabetes Mellitus (DM) in South Africa, the country has prioritized integrated clinical service management for acute diseases and chronic conditions at the primary health care level. The shift toward collaborative activities requires changes in all areas of the health system. Objective: To assess the readiness of the primary health care system to provide integrated tuberculosis and diabetes services, this case study assessed leadership/governance, the health workforce, health information systems, access to medicines, and service delivery. Methods: The mixed-method study included interviews with health facility managers, facility checklist of TB and DM supplies and commodities, review of health records, a patient survey, and focus group discussions with health managers in three districts in KwaZulu Natal Province, Eastern Cape Province, and Free State Province. Results: Performance in bi-directional screening and co-management of TB and DM was weak: TB patients sometimes received DM screening, and the results were sometimes reported. Whether DM patients were routinely being screened for TB was unclear due to the lack of systematic reporting on DM patients. Two potential factors undermining service delivery were the overburdened health workforce and the poor health information system, particularly for DM data recording and reporting. The availability of supplies and commodities for integrated service delivery was good. Conclusion: South Africa has exhibited a strong policy-level commitment to the integrated management of chronic and acute diseases at all levels. The challenge is on operationalizing the guidelines at the primary health care level. Investments need to focus particularly on strengthening the capacity of the health workforce at the primary health care level and establishing an integrated strategy for data collection and analysis.