An evaluation of the access to public health care for diabetic patients in Zimbabwe

Abstract

Zimbabwe is facing very serious economic challenges including hyperinflation, poor international relations, scarce foreign currency and a crumbling infrastructure. This situation has adversely affected all sectors of the economy, including health care. Resources for health care have significantly dwindled and the population's disposable incomes are very low. However, the burden of disease due to HIV/AIDS, TB, Malaria and Diabetes is increasing unabated. Thus, the current study seeks to determine whether public sector diabetes care services are available, affordable, acceptable and also whether access to care is equitable or not. A cross sectional design was adopted for this study. Questionnaires were administered to 179 patients who presented at public health facilities in Harare, 15 provider interviews were done, 15 health facility checklists were completed, one Provincial Medical Director completed a questionnaire and three focus group discussions (FGDs) were conducted. Purposive sampling was used for key informant interviews (PMDs) and also, in the selection of FGD participants. For provider interviews, nurses who attended to Diabetics were selected as respondents. All Diabetic patients who presented for care at selected health facilities were interviewed. The study also conveniently selected 10 facilities from high density areas, three from the medium and two from the low density areas for checklists. Study findings show that the major challenges lie with availability and affordability of care. In summary, there is a shortage of resources such as staff, drugs, equipment and supplies. Patients also face high direct and indirect costs of care due to high drug, food and transport costs. Membership of medical aid seems to be restricted to the richest patients. Moreover, poorest the patients do not belong to any support groups. However, the interaction between patients and their providers is reported to be good. There is a high level of trust between patients and their providers and in addition, patients affirm that providers respect the principle of confidentiality.