MSF supports Govt to launch chronic care clinic in Chipinge

PAUROSI Chimusoro (65) from Chipinge is not only living with HIV, but also suffers from diabetes and hypertension.

He started taking antiretrovirals in 2008 before he was diagnosed of hypertension in 2016 and diabetes in 2017.

Every day he takes 11 tablets to treat his various conditions. Taking this amount of pills makes him continually sleepy and he often feels like he is overdosing himself.

Paurosi wishes he could take his drugs together, in a fixed combination so that he would only need to take two or even one tablet a day, just as he does with his HIV medication. The treatment for HIV has long been simplified by combining three antiretrovirals in one daily pill, easing patients’ lives in many ways.

“I wish I could take at least two tablets or even one tablet, just like we do for HIV,” says Paurosi. “Every time I take 11 tablets, I feel like I am overdosing.”

Paurosi is one of many people in Zimbabwe who live with more than one health condition. Like him, many struggle to take different types of medication for various conditions, not to mention the time and travel costs that result from visiting the nearest clinic to collect medication on different days.

In 2016, the international medical humanitarian organisation, Medecins Sans Frontieres or Doctors without Borders (MSF) piloted a project with the Ministry of Health and Child Care (MoHCC) to provide treatment, care and support to patients with non-communicable diseases (NCDs) with a specific focus on hypertension and diabetes in nine clinics and two district hospitals in Chipinge using a mentoring approach.

A team of MSF doctors and nurses visited the supported health facilities every two weeks to provide mentoring services to MoHCC staff on the management of NCDs and other medical conditions like HIV and TB.

During their routine visits, the MSF medical team in collaboration with MoHCC, noted that there were a number of patients affected by many conditions and in need of comprehensive treatment for all conditions. People living with HIV are more susceptible to infections and are more likely to be affected by diseases such as tuberculosis, hypertention and diabetes.

“While providing treatment to HIV and tuberculosis (TB) patients at the Opportunistic Infections (OI) clinic, MoHCC and MSF continued to see many patients with hypertention and diabetes,”said the MSF deputy field coordinator for the Chipinge NCD project, Mr Elton Mbofana.

“Patients who are HIV negative were being seen at the out-patients department (OPD) by the same medical team. The massive influx of patients on a limited number of days led to overcrowding of the OPD, to the extent that the emergency department was overwhelmed by patients in need of chronic care,” said MrMbofana.

To overcome the hurdle, MoHCC with support from MSF decided to construct the Chronic Care Clinic (CCC) at St Peter’s Hospital in Checheche to provide comprehensive treatment to patients with many conditions thereby integrating services, saving costs and time. The Chronic Care Clinic consists of two consultation rooms, a pharmacy, dispensary, the Opportunistic Infections Clinic and its waiting area.

The Chronic Care Clinic was launched last Friday, at St Peters Hospital in Checheche to integrate HIV and NCD services, thus decongesting the outpatient department.

“Patients living with both HIV and NCDs will now receive comprehensive treatment in one place at the same time, by the same staff, thus saving time and money,” said Mr Mbofana.

The model of care used was tailored to suit the rural context. Nurse-led diagnosis and management approach was used at the primary and secondary health levels. The clinic will provide services through nurses but will refer complicated cases to doctors.

Setting up nurse-led NCD services at the Chronic Care Clinic at St Peter’s Mission Hospital means task-shifting of diagnosis and management of hypertension and or diabetes to nurses and task sharing with doctors for complicated cases.

“Task shifting and introducing nurse-led NCD services is possible and necessary in resource constrained settings. We hope MoHCC and other service providers will adopt the model,” said MSF Dr Nisbert Mukumbi.

This pilot has demonstrated that with adequate investment, including ensuring the availability of affordable medication, it is possible for diseases like hypertention and diabetes to be managed in primary health facilities — and this will save lives, added DrMukumbi.

According to the World Health Organisation, diabetes and hypertension are among the leading causes of deaths globally. In Zimbabwe, NCDs are estimated to account for 31 percent of total deaths (WHO).

Although the disease burden from NCDs is rapidly increasing, little is known on how to provide access to NCD care in rural settings and in environments where resources such as medicines or diagnostic services are not always available. While other diseases such as HIV/AIDS, Tuberculosis and other communicable diseases have received much attention, little has been done about NCDs, which have become silent killers.

There is a need to continue to adapt different models of service that can target different vulnerable groups, just like what was done with success in the field of HIV where so-called community art refill groups (CARGS) have proved to be sustainable. There is need for patient education, patient empowerment or patient self-management and what we in the end call expert patients, said doctor Mukumbi.

MSF is an international medical humanitarian organization that provides medical assistance to communities in need. MSF has been working in close collaboration and partnership with the Zimbabwean Ministry of Health and Child Care (MoHCC) since 2000.

Over the years, MSF has supported the implementation of medical programs, supporting the piloting and scale-up of innovative solutions towards increasing access to quality medical care and by providing medical care during emergencies.