Sustainability of the integrated chronic disease management model at primary care clinics in South Africa.
BACKGROUND
An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes.


OBJECTIVE
The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation.


METHODS
The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa.


METHODS
The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability.


RESULTS
Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70-79.89) followed by West Rand Health District (70.25 (95% CI: 63.96-76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17-77.83)). Four facilities (11%) had an overall sustainability score of less than 55.


CONCLUSIONS
The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model.
Public Health Medicine, University of KwaZulu-Natal. mahomedo@ukzn.ac.za.
Ozayr H
OH
Mahomed
Shaidah
S
Asmall
Anna
A
Voce
D002908:Chronic Disease / Q000628:therapy*; D003695:Delivery of Health Care; D019468:Disease Management; D004526:Efficiency; D006268:Health Facilities; D006801:Humans; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D013019:South Africa