Care for chronic diseases in low income countries. The health system perspective and self-management of diabetes

Chronic diseases such as diabetes are rapidly increasing in numbers, also in low-income countries. This calls for reflection on the organization of care. This thesis focuses on how health care systems in low-income countries can improve care for people with chronic diseases and strengthen the self-management of these people, through the use of new features such as mobile technology. We investigate how diabetes care programmes have developed in three countries, DR Congo, Cambodia and the Philippines, how a mobile-health intervention (sending SMS messages) was implemented and what its effects were.
Our analysis shows that it is possible to improve diabetes care, even in a health care system with very little resources. The implementation of the mobile-health intervention turned out differently in each country, with challenges at the progamme level and barriers at the side of the people receiving messages. After two years it did not lead to better health outcomes.
We warn against too high expectations of mobile phone applications as a game changer to improve chronic care in low-income countries. A thorough analysis of its added value and integration into existing care should proceed any decision to add such an intervention. Our lessons are also relevant for other chronic diseases. Self-management and care are two sides of the same coin. Tackling chronic diseases in low-income countries should focus on interventions in the health care providers and patients and their families.