We spoke with Noel Kasomekera, Non-Communicable Disease Technical Assistant in Malawi’s Ministry of Health. The Ministry, with support from Partners in Health (PIH), provides comprehensive, integrated healthcare and social support in rural Neno District and beyond.
Noel, please can you explain how the integrated chronic care model implemented by PIH works?
In Neno District, we work through a one-stop-shop model. The overall objective is to leverage the HIV service platform to improve non-communicable disease (NCD) screening, treatment, care and follow up.
In the 14 facilities in the district, services for several chronic diseases – most commonly HIV, hypertension and diabetes – are provided in one chronic disease clinic. Screening and referral of clients encompasses HIV, tuberculosis, hypertension, diabetes, family planning and nutrition. In addition, we support routine bi-weekly scheduled clinical visits to all 14 health facilities.
Can you describe the DSD building blocks of this model?
The “what” or the service package includes health education, screening and linkage, diagnostics, treatment, psychosocial counselling and palliative care. For “where”, services for clients established on ART with controlled NCDs and/or non-controlled hypertension are facility-based, and clients with controlled NCDs receive services in the community. The “when” for facility-based services is on weekdays and weekends. The “who” are physicians, nurses, medical assistants, psychosocial counsellors, clinical officers and data clerks providing services. In community locations or client homes, services are provided by community health workers.
What do clients think of this integrated model?
Clients often highlight the advantages of having one appointment for all conditions. This approach can also help reduce stigma. As one client explained: “When we are accessing care at this clinic, we do not hear any rumours outside that disgrace us … we just come here and receive our drugs [and] then off we go, we don’t hear any hearsay.”
What are other key takeaways and lessons learnt from implementing this model?
We conducted a prospective cohort study, which showed that integrating screening and treatment for chronic health conditions into Malawi’s HIV service delivery platform was financially feasible and associated with several positive clinical outcomes. Annualized total cost per client was reduced from USD 317 to USD 260 per capita. Over a 12-month period, client retention in the model was 80%, with 81% of clients living with HIV achieving viral suppression during the first year. The rate of controlled hypertension increased from 18% to 57% in their first year of treatment, and measures of controlled blood pressure, asthma severity and seizure frequency improved.
