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The management of diabetes at primary level in South Africa: the results of a facility-based assessment

Avenida de Zimbabwe Maputo Mozambique

W. John Kalk, MB, BCh, FRCP

Medical School University of the Witwatersrand 7 York Road Parktown Johannesburg 2193 South Africa

Max Price, MB, BCh, BA, MSc, MMed

c/o Centre for Health Policy The Spencer Lister Building SAIMR Cnr Hospital and De Korte Streets, Hillbrow Johannesburg South Africa

Leatitia Rispel, BSc, MSc, Dip

c/o Centre for Health Policy The Spencer Lister Building SAIMR Cnr Hospital and De Korte Streets, Hillbrow Johannesburg South Africa

Paed Nursing, PhD

c/o Centre for Health Policy The Spencer Lister Building SAIMR Cnr Hospital and De Korte Streets, Hillbrow Johannesburg South Africa

Jonathan Broomberg, MB, BCh, BA, MSc, PhD

c/o Centre for Health Policy The Spencer Lister Building SAIMR Cnr Hospital and De Korte Streets, Hillbrow Johannesburg South Africa

J. Cabral, MB, BCh, MSc

c/o Centre for Health Policy The Spencer Lister Building SAIMR Cnr Hospital and De Korte Streets, Hillbrow Johannesburg South Africa

Diabetes is a widespread condition in South Africa and is often managed at primary level health facilities. This study aimed to assess the quality of diabetes management using a rapid assessment approach, focusing on three indicators as proxy measurements of quality: the regularity of blood glucose level (BGL) measurement; the percentage of patients whose BGLs were within 'acceptable' limits (under 10.0 mmol/l) on at least 75% of visits; the rate at which action was taken in response to high BGLs. Five sites were included in the study, including public and private, doctor- and nurse-based facilities. A total of 128 records were examined. Only 33% of all records were found to be well-managed according to the study criteria. None of the individual facilities were found to have more than 40% of patients achieving BGLs within the study limits. Some obstacles to good glycaemic control were costs to patients, transport problems, a lack of health education and shortcomings in clini cal expertise. Policy implications and recommendations are suggested.

Key Words: Diabetes • primary health care • quality • quality assessment • developing countries • South Africa

The Journal of the Royal Society for the Promotion of Health, Vol. 118, No. 6, 338-345 (1998)
DOI: 10.1177/146642409811800612


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