Integration of non-communicable chronic diseases (NCDs) and HIV/AIDS and mental health care through the involvement of chronically ill patients using empowerment evaluation

摘要

Background: The emphasis in health care in South Africa is gradually shifting to acknowledge the different roles patients have regarding their own care. There is, however, very little evidence of this practice and of related practical outcomes. Methods: In the North West province, empowerment evaluation was used as the vehicle for patient engagement in integrating and improving services for chronically ill patients, namely those with non-communicable diseases (NCDs), HIV and mental illnesses at primary health care (PHC) clinics. This research was designed as an additional intervention in an ongoing quality improvement (QI) cycle, which had started in 2007. Empowerment evaluation shares many participatory action research qualities with an emphasis on collaboration, emancipation and the creation of new knowledge but with the additional aspect of evaluating and monitoring the processes that have been co-developed. Results: After 62 visits to 9 facilities over a year and after capturing 332 patient and health worker opinions and ideas, many interventions were implemented leading to improved flow at clinics, a heightened awareness of good services, interesting performance-measuring tools and patient/staff teams that acknowledged their symbiotic strength. Objective measurements comparing clinics that had been exposed to the Integrated Chronic Disease Model (ICDM, which is explained in the article) and those with the collaborative patient/staff groups showed no significant difference in clinical outcomes or waiting times. However, waiting time had improved across one sub-district. This may be because the ICDM clinics have been functioning for four years and the research clinics for only one year. There have also been many external influences on the project, such as a number of new doctors appointed at clinics, under the National Health Insurance pilot project, a high turnover of staff, a new chronic drug policy, stable patients being able to access their medication at external ‘pick-up points’ and others. Conclusions: It was found that the potential of patients and patient–staff collaboration are being under-utilised in a resource-strained sector where the harnessing of this potential might contribute positively towards QI in health.