Table 3.
Respondents (health personnel) perspectives of NCD services.
| Themes | Verbatim Quotes from Qualitative Interviews | Respondent |
|---|---|---|
| NCD-related medicine supply and value chain | “The essential NCD drugs purchased are decided by the district health office and often times facility-specific needs are ignored.” “The paper-based stock management for drugs and medical supply is cumbersome” |
-T5R1 Pharmacy-in-Charge #1 (Lilongwe) |
| “Our procurement system is too slow. It can take more than a week in case of emergencies. Anti-asthmatic drugs run out fast during the cold season but are not stocked in time. We also have a “push system” where some drugs from other facilities may be brought shortly before expiring and don’t move fast enough hence, they expire on shelves.” | -T5R2 District Health Office (Lilongwe) |
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| “Our supply of NCD drugs from the government is erratic and barely meets the demand. We experience frequent stockouts of antihypertensives and oral hypoglycemics. We also have no insulin.” | -T5R3 Health Worker #1 (Lusaka) |
|
| Human resource availability vs. service utilization | “It is now 10.30 am already and my colleague who is supposed to be at the General outpatient clinic has not yet shown up. I am therefore the only clinician on duty today and I have to step in as the numbers in general OPD are obviously very many. That means NCD clients at the clinic will most likely not be attended to today or they will have to wait very long.” | -T5R4 NCD Focal Person #1 (Lilongwe) |
| Patient flow management | “When a patient arrives, they give client cards to community health workers who pull out their files and direct them to the vital waiting area. During first consultation, the patient will be screened, diagnosed, given counselling and treatment and referred if need be. Unfortunately, non-ART NCD clients are not captured in the electronic records system so it is a bit more difficult to monitor and follow-up compared to ART clients.” | -T5R5 NCD Focal Person #2 (Lusaka) |
| Human resource training versus involvement | “NCDs for us here even though we know it’s a problem, it is currently a one-man clinic by one medical assistant. Even within the facility, other staff are not involved. When NCD drugs go out of stock, if the pharmacy technician is not pushed, they will not put it as a priority. The big issue here is knowledge and we need to include all staff, including support staff in training.” | -T5R6 Facility-in-Charge #1 (Lilongwe) |
| Health worker attitudes and perspectives on operationalizing NCD integration | “Integration should be responsive to all the needs of the patient at the point of care without causing too much burden to the health worker. With more support and training, the services will keep improving.” | -T5R7 Facility-in-Charge #2 (Lusaka) |
| “For me integration means a one stop shop where when a client comes to the facility for any service at any department or clinic, they are still able to receive any specific service needed at that point, including NCDs. I do not see why all clinics would not be able to screen for hypertension and diabetes for example.” | -T5R8 Facility-in-Charge #3 (Lilongwe urban) |
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| “Currently as a facility we are supposed to be providing the NCD services for hypertension, diabetes and Asthma but we have no guideline. We have to develop our own, but as clinicians, we are motivated to provide the services, we just lack resources here. ” | -T5R9 Facility-in-Charge #4 (Lilongwe rural) |