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Table 2 Organisation of care for selected chronic conditions at primary and secondary level

From: Context matters: a qualitative study of the practicalities and dilemmas of delivering integrated chronic care within primary and secondary care settings in a rural Malawian district

Category HIV care Diabetes and cardiovascular conditions Mental Health (Epilepsy) Palliative care (Cancer)
Organization of services and level of care Stand-alone clinics on designated days of a week; special clinics for different groups e.g. pregnant and lactating mothers, teens and young adults Consultation visits in outpatient clinics of PHC facilities; joint diabetes and hypertension clinic in district health centre Consultation visits in outpatient clinics of PHC facilities; Selected clinic days for mental health and palliative services in the district health centre
Medical supply Antiretroviral treatment constantly available in all facilities Most drugs in the essential medicines list are frequently out of stock; patients referred to paying or secondary level facilities Essential cancer treatment and palliative care provided in 3 health facilities
Screening and diagnostic resources Vital measurements taken as per treatment guidelines; screening for tuberculosis and cervical cancer screening (VIA) available; results of HIV viral load sometimes delay Resources for screening and diagnostic limited in public PHC facilities; patients referred to private PHC or referral facilities
Cost and affordability of services Free HIV services in all health facilities (public and private). Includes consultation, diagnostics, and treatment Free health care in all public health facilities. Includes consultation, diagnostics, and treatment. Out-of-pocket payment when patients referred to private facilities
Health workforce Multi-disciplinary team with designated tasks i.e. clinicians, lab technicians, data clerks, health surveillance assistants, and HIV expert-patients Clinician on duty provides consultation services (inadequate numbers and skills-mix); health surveillance assistants support health education, triage, and documentation
Health information system Most public health facilities use electronic medical record system. Patient information recorded in health passports Documentation is mostly paper-based records; patient information recorded in health passports
Other initiatives Differentiated care: Preventing mother to child transmission (OPTION B+ approach); HIV teen and youth clubs; HIV discordant couple programme
Community support: self-formed patient support groups; home-based care through community health volunteers
HIV expert patients support HIV care in clinics and patient homes
Community support: home-based care through community health volunteers
NCD master card; data reporting tool for hypertension and diabetes introduced at the district health centre
Community support: home-based care through community health volunteers
  1. Acronym: HIV human immunodeficiency virus; NCD non-communicable diseases; PHC primary health care; VIA visual inspection with acetic acid
  2. Notes: OPTION B+ is a prevention of vertical transmission approach to HIV positive expectant mothers and treatment initiated immediately, and continued for life