Assessment of health system challenges and opportunities for possible integration of diabetes mellitus and tuberculosis services in South-Eastern Amhara Region, Ethiopia: a qualitative study
The double burden of tuberculosis (TB) and diabetes mellitus (DM) is a significant public health problem in low and middle income countries. However, despite the known synergy between the two disease conditions, services for TB and DM have separately been provided. The objective of this study was to...
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| description | The double burden of tuberculosis (TB) and diabetes mellitus (DM) is a significant public health problem in low and middle income countries. However, despite the known synergy between the two disease conditions, services for TB and DM have separately been provided. The objective of this study was to explore health system challenges and opportunities for possible integration of DM and TB services.
This was a descriptive qualitative study which was conducted in South-Eastern Amhara Region, Ethiopia. Study participants included health workers (HWs), program managers and other stakeholders involved in TB and DM prevention and control activities. Purposive sampling was applied to select respondents. In order to capture diversity of opinions among participants, maximum variation sampling strategy was applied in the recruitment of study subjects. Data were collected by conducting four focus group discussions and 12 in-depth interviews. Collected data were transcribed verbatim and were thematically analyzed using NVivo 10 software program.
A total of 44 (12 in-depth interviews and 32 focus group discussion) participants were included in the study. The study participants identified a number of health system challenges and opportunities affecting the integration of TB-DM services. The main themes identified were: 1. Unavailability of system for continuity of DM care. 2. Inadequate knowledge and skills of health workers. 3. Frequent stockouts of DM supplies. 4. Patient's inability to pay for DM services. 5. Poor DM data management. 6. Less attention given to DM care. 7. Presence of a well-established TB control program up to the community level. 8. High level of interest and readiness among HWs, program managers and leaders at different levels of the health care delivery system.
The study provided insights into potential health systems challenges and opportunities that need to be considered in the integration of TB-DM services. Piloting TB and DM integrated services in selected HFs of the study area is needed to assess feasibility for possible full scale integration of services for the two comorbid conditions. |
| doi_str_mv | 10.1186/s12913-016-1378-6 |
| format | Article |
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This was a descriptive qualitative study which was conducted in South-Eastern Amhara Region, Ethiopia. Study participants included health workers (HWs), program managers and other stakeholders involved in TB and DM prevention and control activities. Purposive sampling was applied to select respondents. In order to capture diversity of opinions among participants, maximum variation sampling strategy was applied in the recruitment of study subjects. Data were collected by conducting four focus group discussions and 12 in-depth interviews. Collected data were transcribed verbatim and were thematically analyzed using NVivo 10 software program.
A total of 44 (12 in-depth interviews and 32 focus group discussion) participants were included in the study. The study participants identified a number of health system challenges and opportunities affecting the integration of TB-DM services. The main themes identified were: 1. Unavailability of system for continuity of DM care. 2. Inadequate knowledge and skills of health workers. 3. Frequent stockouts of DM supplies. 4. Patient's inability to pay for DM services. 5. Poor DM data management. 6. Less attention given to DM care. 7. Presence of a well-established TB control program up to the community level. 8. High level of interest and readiness among HWs, program managers and leaders at different levels of the health care delivery system.
The study provided insights into potential health systems challenges and opportunities that need to be considered in the integration of TB-DM services. Piloting TB and DM integrated services in selected HFs of the study area is needed to assess feasibility for possible full scale integration of services for the two comorbid conditions.</description><identifier>ISSN: 1472-6963</identifier><identifier>EISSN: 1472-6963</identifier><identifier>DOI: 10.1186/s12913-016-1378-6</identifier><identifier>PMID: 27095028</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject><![CDATA[Adult ; Care and treatment ; Collaboration ; Comorbidity ; Continuity of Patient Care ; Cost of Illness ; Data collection ; Delivery of Health Care, Integrated - economics ; Delivery of Health Care, Integrated - organization & administration ; Diabetes ; Diabetes Mellitus - economics ; Diabetes Mellitus - prevention & control ; Disease ; Ethics ; Ethiopia ; Fees, Medical ; Focus Groups ; Health aspects ; Health care delivery ; Health Policy ; Health services ; Health Services - economics ; Health Services - supply & distribution ; Humans ; Investigations ; Qualitative Research ; Rural Health - economics ; Rural Health - statistics & numerical data ; Salaries and Fringe Benefits ; Services ; Surveys and Questionnaires ; Tuberculosis ; Tuberculosis - economics ; Tuberculosis - prevention & control ; Urban Health - economics ; Urban Health - statistics & numerical data]]></subject><ispartof>BMC health services research, 2016-04, Vol.16 (135), p.135-135, Article 135</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>Workneh et al. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-bd0e0ffbf8ff818000f0d2bdbd32e9ea438c1895f76f4ce40304452aef9001bb3</citedby><cites>FETCH-LOGICAL-c518t-bd0e0ffbf8ff818000f0d2bdbd32e9ea438c1895f76f4ce40304452aef9001bb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837556/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837556/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,26544,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27095028$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Workneh, Mahteme Haile</creatorcontrib><creatorcontrib>Bjune, Gunnar Aksel</creatorcontrib><creatorcontrib>Yimer, Solomon Abebe</creatorcontrib><title>Assessment of health system challenges and opportunities for possible integration of diabetes mellitus and tuberculosis services in South-Eastern Amhara Region, Ethiopia: a qualitative study</title><title>BMC health services research</title><addtitle>BMC Health Serv Res</addtitle><description>The double burden of tuberculosis (TB) and diabetes mellitus (DM) is a significant public health problem in low and middle income countries. However, despite the known synergy between the two disease conditions, services for TB and DM have separately been provided. The objective of this study was to explore health system challenges and opportunities for possible integration of DM and TB services.
This was a descriptive qualitative study which was conducted in South-Eastern Amhara Region, Ethiopia. Study participants included health workers (HWs), program managers and other stakeholders involved in TB and DM prevention and control activities. Purposive sampling was applied to select respondents. In order to capture diversity of opinions among participants, maximum variation sampling strategy was applied in the recruitment of study subjects. Data were collected by conducting four focus group discussions and 12 in-depth interviews. Collected data were transcribed verbatim and were thematically analyzed using NVivo 10 software program.
A total of 44 (12 in-depth interviews and 32 focus group discussion) participants were included in the study. The study participants identified a number of health system challenges and opportunities affecting the integration of TB-DM services. The main themes identified were: 1. Unavailability of system for continuity of DM care. 2. Inadequate knowledge and skills of health workers. 3. Frequent stockouts of DM supplies. 4. Patient's inability to pay for DM services. 5. Poor DM data management. 6. Less attention given to DM care. 7. Presence of a well-established TB control program up to the community level. 8. High level of interest and readiness among HWs, program managers and leaders at different levels of the health care delivery system.
The study provided insights into potential health systems challenges and opportunities that need to be considered in the integration of TB-DM services. Piloting TB and DM integrated services in selected HFs of the study area is needed to assess feasibility for possible full scale integration of services for the two comorbid conditions.</description><subject>Adult</subject><subject>Care and treatment</subject><subject>Collaboration</subject><subject>Comorbidity</subject><subject>Continuity of Patient Care</subject><subject>Cost of Illness</subject><subject>Data collection</subject><subject>Delivery of Health Care, Integrated - economics</subject><subject>Delivery of Health Care, Integrated - organization & administration</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - economics</subject><subject>Diabetes Mellitus - prevention & control</subject><subject>Disease</subject><subject>Ethics</subject><subject>Ethiopia</subject><subject>Fees, Medical</subject><subject>Focus Groups</subject><subject>Health aspects</subject><subject>Health care delivery</subject><subject>Health Policy</subject><subject>Health services</subject><subject>Health Services - 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Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC health services research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Workneh, Mahteme Haile</au><au>Bjune, Gunnar Aksel</au><au>Yimer, Solomon Abebe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of health system challenges and opportunities for possible integration of diabetes mellitus and tuberculosis services in South-Eastern Amhara Region, Ethiopia: a qualitative study</atitle><jtitle>BMC health services research</jtitle><addtitle>BMC Health Serv Res</addtitle><date>2016-04-19</date><risdate>2016</risdate><volume>16</volume><issue>135</issue><spage>135</spage><epage>135</epage><pages>135-135</pages><artnum>135</artnum><issn>1472-6963</issn><eissn>1472-6963</eissn><abstract>The double burden of tuberculosis (TB) and diabetes mellitus (DM) is a significant public health problem in low and middle income countries. However, despite the known synergy between the two disease conditions, services for TB and DM have separately been provided. The objective of this study was to explore health system challenges and opportunities for possible integration of DM and TB services.
This was a descriptive qualitative study which was conducted in South-Eastern Amhara Region, Ethiopia. Study participants included health workers (HWs), program managers and other stakeholders involved in TB and DM prevention and control activities. Purposive sampling was applied to select respondents. In order to capture diversity of opinions among participants, maximum variation sampling strategy was applied in the recruitment of study subjects. Data were collected by conducting four focus group discussions and 12 in-depth interviews. Collected data were transcribed verbatim and were thematically analyzed using NVivo 10 software program.
A total of 44 (12 in-depth interviews and 32 focus group discussion) participants were included in the study. The study participants identified a number of health system challenges and opportunities affecting the integration of TB-DM services. The main themes identified were: 1. Unavailability of system for continuity of DM care. 2. Inadequate knowledge and skills of health workers. 3. Frequent stockouts of DM supplies. 4. Patient's inability to pay for DM services. 5. Poor DM data management. 6. Less attention given to DM care. 7. Presence of a well-established TB control program up to the community level. 8. High level of interest and readiness among HWs, program managers and leaders at different levels of the health care delivery system.
The study provided insights into potential health systems challenges and opportunities that need to be considered in the integration of TB-DM services. Piloting TB and DM integrated services in selected HFs of the study area is needed to assess feasibility for possible full scale integration of services for the two comorbid conditions.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27095028</pmid><doi>10.1186/s12913-016-1378-6</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Care and treatment Collaboration Comorbidity Continuity of Patient Care Cost of Illness Data collection Delivery of Health Care, Integrated - economics Delivery of Health Care, Integrated - organization & administration Diabetes Diabetes Mellitus - economics Diabetes Mellitus - prevention & control Disease Ethics Ethiopia Fees, Medical Focus Groups Health aspects Health care delivery Health Policy Health services Health Services - economics Health Services - supply & distribution Humans Investigations Qualitative Research Rural Health - economics Rural Health - statistics & numerical data Salaries and Fringe Benefits Services Surveys and Questionnaires Tuberculosis Tuberculosis - economics Tuberculosis - prevention & control Urban Health - economics Urban Health - statistics & numerical data |
| title | Assessment of health system challenges and opportunities for possible integration of diabetes mellitus and tuberculosis services in South-Eastern Amhara Region, Ethiopia: a qualitative study |
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