Local models for chronic care and self-management support in Southern Malawi

  • Angwenyi, Vibian (PhD Student)
  • Criel, Bart (Promotor)
  • Bunders, Joske (Promotor)
  • Aantjes, Carolien (Copromotor)

Project Details


Health systems in Africa are grappling with considerable challenges including poor health infrastructure, erratic supply chain, inadequate human resources and lack of pro-poor health financing policies. The double burden of infectious diseases (HIV and tuberculosis) and rise in non-communicable diseases (hypertension, diabetes and cardiovascular disease) and related mortality, is forcing policy makers to re-orient their health systems to meet the changing health care needs, and develop interventions and services to address this new burden. Most African settings lack clear guidelines and policies to guide prevention and management of chronic conditions. In addition, investments towards chronic diseases have mainly been on secondary and tertiary health care levels, with little/no investments at primary health care (PHC) level where most prevention and health promotion efforts are much needed. While there have been growing calls for integrated services at PHC level, African governments have little to draw on in terms of published evidence base, which contextualises and gives guidance to the concept of integration in resource-constrained settings. One approach is to draw from the advancement of HIV/AIDS care programmes in Africa to inform the development of health services for patients with other chronic conditions. Reasons supporting this argument include the transition of HIV care from palliative care to chronic care, which occurred in conjunction with the decentralisation of anti-retroviral treatment (ART) services to primary health care level. In addition, the manifestation of chronic non-communicable diseases (NCDs) and HIV requires similar health care services, hence it is argued there is little justification for them to run parallel to each other in vertical programmes, especially where health systems resources are constrained. Furthermore, there is emerging evidence showing correlation between HIV treatment and early onset of NCDs. Until recently, a few African countries have documented their experiences of integrating HIV community and home-based care programme activities into PHC, and their potential to extend health care services to other chronic conditions. Due to the long term nature of chronic conditions, patients require continuous support and provision of care beyond clinical settings. Hence family members, peers and community partners play a central role in supporting patients with chronic conditions self-manage their disease. The overall aim of the PhD study is to explore chronic care interventions at the community and primary health care level, and effectiveness of self-management interventions led by patients, family caregivers and community partners in community home-based care programmes in Malawi and South Africa.
The specific objectives are:
1. To study the experimentation and learning with chronic care interventions at primary health care and community level. These interventions cover preventive, treatment, care and self-management aspects.
2. To describe local chronic care models and the interconnections between health care teams, community partners, patients and families.
3. To assess the perceived effectiveness of self-management interventions in community-based programmes, on patients health outcomes.
The PhD study adopts a mixed methods design, consisting of both qualitative and quantitative data collection techniques. The qualitative element of the design is an in-depth case study of CHBC programmes in Phalombe District (Malawi). Overall, data collection includes observations in CHBCs/service delivery points, community mapping, interviews (n>60) and focus group discussions (n>4) with respondents purposively selected at different levels. For instance at primary health care level, engage CHBC programme staff, health workers, lay community volunteers/caregivers and CHBC beneficiary households. At district and regional level interview government officials in health, social welfare and community development departments, as well as donor/development partners representatives. The second research component is a quasi-experimental study (single-group multiplemeasures design) nested in the CHBC sites in Phalombe District in Malawi. The aim is to assess the perceived effectiveness of self-management support interventions in CHBC programmes that are either delivered in groups or at individual level. Our proposed study group are patients with chronic conditions (HIV, Tuberculosis, Diabetes, Hypertension), and are exposed to CHBC programme activities. Recruitment to this study was on a continuous basis, and ultimately recruited 140 study participants who are followed up after months 3, 6 and 12. The outcomes of interest are health status, self-management behaviour and selfefficacy/ emotional wellbeing, which will be evaluated using an adapted version of the Stanford chronic disease self-management programme measurement scales. Findings from this study will contribute to further knowledge on the innovations and conceptualisation of chronic care models at community level, and the role of community providers, patients and immediate family members in supporting self-management for patients with chronic conditions. Generate evidence on initiatives aimed at strengthening integration and decentralisation of chronic care services at primary health care level. The evidence generated could potentially inform the design of affordable, accessible, costeffective chronic care interventions in Africa.
Effective start/end date12/01/172/06/20

IWETO expertise domain

  • B680-public-health