Table 4.
Clinic context, mechanisms and outcome configuration for intervention clinics
| Clinic name | Context | Mechanisms | Outcomes | |||||||||
| Clinic infrastructure | BP machines | Other materials (files, drugs, packs for drugs) | Clinic management | Visit per nurse per month (% change) | Existing manager, staff and patient relationship | LHW intervention | Chronic care processes | Patients adhering to appointments | Chronic care pathway | Other aspects of chronic care | Patient attending on booked date | |
| Hillard | Modern spacious building | Broke down a few times | Erratic supply | Strong clinic manager in control of the clinic | 528 to 429 (−19%) |
Good relationship among staff and with patients | Skilled LHWs. 36% workload increase per month. Good teamwork, supported by staff. |
Strong manager led to good relations for staff. Better equipment. Low patient load motivated staff to be dedicated. | Space facilitated quality counselling and confidential space. Skilled LHWs, dedicated queue led to lesser clinic time. |
Functional: chronic care pathway Erratic: chronic consultation room Did not happen: designated vital signs station |
Functional: filing, appointments, prepacking medication, phone call reminders | HTN: 76% (n=4482) Other chronic: 66% |
| Timber | Modern building but with limited space | Frequently broke down | Erratic supply | Strong clinic manager but not liked by nurses | 433 to 202 (−53%) |
Poor relations among staff and with patients | Skilled LHW. 7% workload decrease per month. Good teamwork, supported by staff. | Nurses frustrated with breakdown of equipment and limited space. This led to lack of commitment and poor relations. | Skilled LHWs ensured patients attend appointment, yet affected by lack of space and nurses were frustrated. |
Functional: chronic consultation room Erratic: designated vital signs station Did not happen: chronic care pathway |
Functional: filing, appointments, phone call reminders Erratic: Prepacking medication |
HTN: 72% (n=2035) Other chronic: 56% |
| Troy | Modern building but with limited space | Frequently broke down | Good supply of materials | Weak clinic manager | 252–347 (+38%) |
Poor relations among staff and with patients | Skilled LHW. 48% workload increase per month. Good teamwork, supported by very few staff. | Weak manager, limited space and BP machines that broke down led to poor relations and staff not willing to work. | Skilled LHW that ensured patients attend appointment, yet patients did not like staff attitude and long waiting. |
Erratic: chronic consultation room, chronic care pathway Did not happen: designated vital signs station |
Functional: filing, appointments, phone call reminders Erratic: prepacking medication |
HTN: 70% (n=8960) Other chronic: 63% |
| Orange | Dilapidated building with limited space | Frequently broke down | Erratic supply | Weak clinic manager | 276–413 (+50%) |
Poor relations among staff and with patients | Unskilled LHW. 79% workload increase per month. Poor teamwork, supported by very few staff. |
Weak manager, poor infrastructure, limited space and BP machines that broke down led to poor relations and staff not willing to work. | Poor queuing, infrastructure, unskilled and uncoordinated LHWs led to long queues and patients unsatisfied with care services. |
Functional: chronic consultation room Erratic: chronic care pathway Did not happen: designated vital signs station |
Functional: phone call reminders, filing, appointments but with some mistakes. Did not happen: prepacking of medication |
HTN: 67% (n=3123) Other chronic: 56% |
HTN: patients with hypertension; other chronic: patients without hypertension.
BP, blood pressure; LHW, lay health worker.