title: Patient-centred innovation to ensure access to diabetes care in Cambodia: the case of MoPoTsyo.
abstract: BACKGROUND
  The increasing prevalence of chronic diseases puts a high burden on the health care systems of Low and Middle Income Countries which are often not adapted to provide the care needed. Peer support programmes are promoted to address health system constraints. This case study analyses a peer educator diabetes programme in Cambodia, MoPoTsyo, from a health system's perspective. Which strategies were used and how did these strategies change? How is the programme perceived?
  
  
  METHODS
  Data were collected through semi-structured interviews with patients, MoPoTsyo staff and peer educators, contracted pharmacy staff and health workers, health care workers and non-contracted pharmacists and managers and policy makers at district, provincial and national level. Four areas were purposively selected to do the interviews. An inductive content analysis was done independently by two researchers.
  
  
  RESULTS
  MoPoTsyo developed into three stages: a focus on diabetes self-management; a widening scope to ensure affordable medicines and access to other health care services; and aiming for sustainability through more integration with the Cambodian public system and further upscaling. All respondents acknowledged the peer educators' role and competence in patient education, but their ideas about additional tasks and their place in the system differed. Indirectly involved stakeholders and district managers emphasized the particular roles and responsibilities of all actors in the system and the particular role of the peer educator in the community. MoPoTsyo's diagnostics and laboratory services were perceived as useful, especially by patients and project staff. Respondents were positive about the revolving drug fund, but expressed concerns about its integration into the government system. The degree of collaboration between health care staff and peer educators varied.
  
  
  CONCLUSIONS
  MoPoTsyo responds to the needs of people with diabetes in Cambodia. Key success factors were: consistent focus on and involvement of the target group, backed up by a strong organisation; simultaneous reduction of other barriers to care; and the ongoing maintenance of relations at all levels within the health system. Despite resistance, MoPoTsyo has established a more balanced relationship between patients and health service providers, empowering patients to self-manage and access services that meet their needs.
authors.affiliation: Department of Public Health Antwerp, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium ; Department of General Practice & Elderly Medicine, EMGO, Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 Amsterdam, The Netherlands.
authors.forename: Josefien
authors.initials: J
authors.lastname: van Olmen
authors.affiliation: University Hospital, University Hospital Brussels, Laarbeeklaan 101, Brussels, Belgium.
authors.forename: Natalie
authors.initials: N
authors.lastname: Eggermont
authors.affiliation: MoPoTsyo, #9E, Street 3C, Phum Trea 1, Stung Meanchey, 12352 Phnom Penh Cambodia.
authors.forename: Maurits
authors.initials: M
authors.lastname: van Pelt
authors.affiliation: MoPoTsyo, #9E, Street 3C, Phum Trea 1, Stung Meanchey, 12352 Phnom Penh Cambodia.
authors.forename: Heang
authors.initials: H
authors.lastname: Hen
authors.affiliation: Department of Public Health Antwerp, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.
authors.forename: Jeroen
authors.initials: J
authors.lastname: de Man
authors.affiliation: Department of General Practice & Elderly Medicine, EMGO, Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 Amsterdam, The Netherlands ; NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht, 3513 CR The Netherlands.
authors.forename: François
authors.initials: F
authors.lastname: Schellevis
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Peters
authors.affiliation: World Health Organisation, Alliance for Health Policy and Systems Research, 20 avenue Appia, 1211 Geneva, Switzerland.
authors.forename: Maryam
authors.initials: M
authors.lastname: Bigdeli
keywords: Chronic care; Chronic conditions; Chronic diseases; Diabetes care; Health system analysis; Health systems research; Patient-centred; Peer educator; Self management; Stakeholder analysis