Table 2.

Enablers, key components of each enabler, and lessons learned during programme implementation

Enabler	Key components	Lessons learned
1. Decentralisation	Service set-up and empowerment of nurses to diagnose and manage DM and HTN	Nurse-led services fully operational in 7/9 PHC facilities and 1 hospital. Spread patient visits throughout the week to manage workload. Difficult to ensure regular access of mentoring teams to remote sites
2. Integration	Two models emerged for NCD integration: either in general OPD or with HIV services.	What works best depends on individual circumstances of each health facility Choose the best fit rather than imposing a ‘one size fits all’ model
3. Simplification	Context-adapted SOPs Experience-based fine-tuning of clinical treatment	Guideline development is a dynamic process requiring internal and external expertise, responding to user feedback
4. Mentoring and task sharing	Multidisciplinary MSF mentoring teams and MoH mentees Mentoring curriculum comprising clinical and programmatic knowledge On-the-job support by mentor. Competence dashboard to monitor progress	Major limitations: Long travel distance for mentors, HR shortages limiting the availability of dedicated key staff for regular mentoring, high patient volume Requirement for ownership and leadership in health facilities
5. Affordable medicines	Rational medication choices Free medications subsidised by MSF Advocacy to improve MoH medication supply to health facilities	Free medications improved access to care for patients Reliable MSF-supported supply allowed spacing of patient appointments ‘Pull factor’ of free medications increased programme demand
6. Quality assured lab support	Use of pre-existing laboratory systems and equipment Introduction of POC machines for glucose and creatinine measurement External Quality Assurance system for HbA1c	Problems with transport of samples to central laboratory overcome by on-site POC machines Trained and motivated laboratory staff required to produce quality results when conventional machines are used
7. Patient empowerment	Individual and group literacy sessions for DM and HTN	Successful implementation of DM and HTN literacy sessions
8. Dedicated Monitoring and Evaluation	Design and implementation of patient records for DM and HTN consultations Data collection in electronic database and quarterly analysis Development of standard indicators	Simplification of patient records improved completeness and quality of data Dedicated M&E system improved resource quantification
9. Referral system	Development of referral criteria to higher level for complex patients	On- and off-site decision support by doctors