Diabetes, Metabolic Syndrome and Obesity (Oct 2019)
Mitigating The Burden Of Diabetes In Sub-Saharan Africa Through An Integrated Diagonal Health Systems Approach
Abstract
Tim Mercer,1 Alice C Chang,2 Lydia Fischer,3 Adrian Gardner,4–6 Immaculate Kerubo,7,8 Dan N Tran,7,9 Jeremiah Laktabai,10 Sonak Pastakia7,9 1Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX 78712, USA; 2Genentech Inc., San Francisco, CA, USA; 3Department of Child Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; 4Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; 5Department of Medicine, Moi University School of Medicine, Eldoret, Kenya; 6Indiana Institute for Global Health, Indianapolis, IN 46202, USA; 7Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya; 8National Spinal Injury Referral Hospital, Nairobi, Kenya; 9Department of Pharmacy Practice, Purdue University College of Pharmacy, Purdue Kenya Partnership P.O. Box 5760, Eldoret 30100, Kenya; 10Department of Family Medicine, Moi University School of Medicine, Eldoret, KenyaCorrespondence: Sonak PastakiaDepartment of Pharmacy Practice, Purdue Kenya Partnership, Purdue University College of Pharmacy, P.O. Box 5760, Eldoret 30100, KenyaEmail [email protected]: Diabetes is a chronic non-communicable disease (NCD) presenting growing health and economic burdens in sub-Saharan Africa (SSA). Diabetes is unique due to its cross-cutting nature, impacting multiple organ systems and increasing the risk for other communicable and non-communicable diseases. Unfortunately, the quality of care for diabetes in SSA is poor, largely due to a weak disease management framework and fragmented health systems in most sub-Saharan African countries. We argue that by synergizing disease-specific vertical programs with system-specific horizontal programs through an integrated disease-system diagonal approach, we can improve access, quality, and safety of diabetes care programs while also supporting other chronic diseases. We recommend utilizing the six World Health Organization (WHO) health system building blocks – 1) leadership and governance, 2) financing, 3) health workforce, 4) health information systems, 5) supply chains, and 6) service delivery – as a framework to design a diagonal approach with a focus on health system strengthening and integration to implement and scale quality diabetes care. We discuss the successes and challenges of this approach, outline opportunities for future care programming and research, and highlight how this approach can lead to the improvement in the quality of care for diabetes and other chronic diseases across SSA.Keywords: diabetes, sub-Saharan African, integrated diagonal health systems approach, health system building blocks, health system strengthening, health system integration
