Exploring community nurses` experiences on the decentralization of non-communicable diseases` care in the Lubombo region, Eswatini
Abstract
Background and Aim: Non-Communicable Diseases (NCDs) remain a global challenge. The primary healthcare has been identified as a vital aspect of the healthcare system that will assist in addressing the burden of NCDs in low and middle-income countries. As such, the Eswatini Ministry of Health-NCD program had embarked on the decentralization of NCDs` services to primary healthcare facilities. This initiative called for nurses to deliver NCD treatment services in primary healthcare facilities. However, the experiences of community nurses about this initiative have not been explored. Therefore, this study explored and described the community nurses` experiences with decentralizing care for NCDs in the Lubombo Region of Eswatini.
Methods and Materials: A descriptive qualitative study design approach was used to explore and describe the experiences of ten purposively sampled community nurses. Data was collected through audio-recorded face-to-face interviews using a semi-structured interview guide. Data was subjected to thematic analysis using Colaizzi’s descriptive method of data analysis.
Results: Three themes emerged from the study findings; 1) Decentralising NCD care is a good move by the Government, 2) Challenges brought by the decentralization of NCD services, and 3) Nurses’ perceived support needs in managing NCDs at clinics.
Conclusion: Community nurses applauded the government`s move to decentralized NCD services even though they viewed rural clinics as not well prepared to offer NCD services due to the challenges faced. There is a need for more support for rural clinics regarding human resources, NCD diagnostic equipment and medicines, and training of nursing personnel.
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26. Aantjes CJ, Quinlan TK, Bunders JF. Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions. BMC Health Services Research. 2014 Dec;14:1-4.
27. Elias MA, Pati MK, Aivalli P, Srinath B, Munegowda C, Shroff ZC, Bigdeli M, Srinivas PN. Preparedness for delivering non-communicable disease services in primary care: access to medicines for diabetes and hypertension in a district in south India. BMJ Global Health. 2018 Jan 1;2(Suppl 3):e000519.
28. Kien VD, Van Minh H, Giang KB, Ng N, Nguyen V, Tuan LT, Eriksson M. Views by health professionals on the responsiveness of commune health stations regarding non-communicable diseases in urban Hanoi, Vietnam: A qualitative study. BMC Health Services Research. 2018 Dec;18:1-2.
29. Van Minh H, Do YK, Bautista MA, Tuan Anh T. Describing the primary care system capacity for the prevention and management of non‐communicable diseases in rural Vietnam. The International Journal of Health Planning and Management. 2014 Apr;29(2):e159-73.
30. Jackson-Morris A, Nugent R. Tailored support for national NCD policy and programme implementation: an over-looked priority. BMJ Global Health. 2020 Aug 1;5(8):e002598.
31. Laari L. Context and practice s of health advocacy role by nurses in Ghana: A qualitative study. Nursing Practice Today. 2024; 11(4):388-397.
32. Žiaková K, Kohanová D, Čáp J, Kurucová R. A thematic analysis of professionalism from the perspective of nurse managers. Nursing Practice Today. 2023; 10(4): 344-55.
2. World Health Organisation. Noncommunicable diseases: mortality and morbidity 2024. 2024. Available at: https://www.who.int/data/gho/data/themes/topics/indicator-group. Accessed September 24, 2024
3. World Health Organisation African region. Country disease outlook: Eswatini. 2023. Available at: http://www.afri.who.in>file>ESWATINI. Assessed June 14, 2023
4. Sharp A, Riches N, Mims A, Ntshalintshali S, McConalogue D, Southworth P, Pierce C, Daniels P, Kalungero M, Ndzinisa F, Elston E. Decentralising NCD management in rural southern Africa: evaluation of a pilot implementation study. BMC Public Health. 2020 Dec;20:1-8.
5. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. 2013.
6. Department of Health. Adult primary care: symptoms-based integrated approach to the adult in primary care. South African National Department of Health; 2019. Available at: https://knowledgehub.health.gov.za/system/files/elibdownloads/2020-08/APC%202019-20%20eBook.pdf
7. Niyonsenga SP, Park PH, Ngoga G, Ntaganda E, Kateera F, Gupta N, Rwagasore E, Rwunganira S, Munyarugo A, Mutumbira C, Dusabayezu S. Implementation outcomes of national decentralization of integrated outpatient services for severe non‐communicable diseases to district hospitals in Rwanda. Tropical Medicine & International Health. 2021 Aug;26(8):953-61.
8. Haque M, Islam T, Rahman NA, McKimm J, Abdullah A, Dhingra S. Strengthening primary health-care services to help prevent and control long-term (chronic) non-communicable diseases in low-and middle-income countries. Risk Management and Healthcare Policy. 2020 May 18:409-26.
9. DeCola P, Benton D, Peterson C, Matebeni D. Nurses' potential to lead in non‐communicable disease global crisis. International Nursing Review. 2012 Sep;59(3):321-30.
10. Jacobs B, Hill P, Bigdeli M, Men C. Managing non-communicable diseases at health district level in Cambodia: A systems analysis and suggestions for improvement. BMC Health Services Research. 2015 Dec;16:1-2.
11. Akinwumi AF, Esimai OA, Fajobi O, Idowu A, Esan OT, Ojo TO. Knowledge of primary healthcare workers regarding the prevention and control of non-communicable diseases in Osun State, Nigeria: A rural-urban comparison. African Journal of Primary Health Care & Family Medicine. 2021 June;13(1):1-8.
12. Shiroya V, Shawa N, Matanje B, Haloka J, Safary E, Nkhweliwa C, Mueller O, Phiri S, Neuhann F, Deckert A. Reorienting primary health care services for non-communicable diseases: a comparative preparedness assessment of two healthcare networks in Malawi and Zambia. International Journal of Environmental Research and Public Health. 2021 May 10;18(9):5044.
13. Kamvura TT, Dambi JM, Chiriseri E, Turner J, Verhey R, Chibanda D. Barriers to the provision of non-communicable disease care in Zimbabwe: a qualitative study of primary health care nurses. BMC Nursing. 2022 Mar 18;21(1):64.
14. Witter S, Zou G, Diaconu K, Senesi RG, Idriss A, Walley J, Wurie HR. Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: perceptions of policy-makers and health providers in Sierra Leone. Conflict and Health. 2020 Dec;14:1-4.
15. Doede AL, Allen TE, Ja'Lynn SG, Herbst AG, Hlungwani MC, Ramakuela NJ, Xie AX, Campbell CL. Community health workers and the management of noncommunicable diseases among rural health clinics in Limpopo Province, South Africa: a pilot study. Family & Community Health. 2017 Oct 1;40(4):338-46.
16. Maimela E, Alberts M, Bastiaens H, Fraeyman J, Meulemans H, Wens J, Van Geertruyden JP. Interventions for improving management of chronic non-communicable diseases in Dikgale, a rural area in Limpopo Province, South Africa. BMC Health Services Research. 2018 Dec;18:1-9.
17. World health organisation (2019): Know your health numbers: to mark World Health Day 2019. Available at: http://www.who.int/news-room/fact-sheet/detil/know-health-numbers-mark-world-day-2019. Accessed September 16, 2023.
18. United Nation Population Fund (UNFPA) Kingdom of Eswatini (2017). Swaziland releases population count 2017 census 2017. Available at: http://eswatini.unfpa.org. Accessed September 16, 2023.
19. Eswatini ministry of health (2017). Lubombo regional health programme: 2017 annual programme report. Monitoring and evaluation unit: strategic information department; Eswatini.
20. Creswell JW. Research designs: qualitative, quantitative and mixed methods approaches (4th Ed.). Thousand Oaks: SAGE; 2014. P.398
21. Kaae S, Traulsen JM. Qualitative methods in pharmacy practice research. Pharmacy Practice Research Methods. 2020:31-54.
22. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2015
23. Valle RS, King M. Existential-phenomenological alternatives for psychology. Oxford U Press; 1978.
24. Lincoln YS, Guba EG. Criteria for Assessing Naturalistic Inquiries as Reports.
25. Chang H, Hawley NL, Kalyesubula R, Siddharthan T, Checkley W, Knauf F, Rabin TL. Challenges to hypertension and diabetes management in rural Uganda: a qualitative study with patients, village health team members, and health care professionals. International Journal for Equity in Health. 2019 Dec;18:1-4.
26. Aantjes CJ, Quinlan TK, Bunders JF. Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions. BMC Health Services Research. 2014 Dec;14:1-4.
27. Elias MA, Pati MK, Aivalli P, Srinath B, Munegowda C, Shroff ZC, Bigdeli M, Srinivas PN. Preparedness for delivering non-communicable disease services in primary care: access to medicines for diabetes and hypertension in a district in south India. BMJ Global Health. 2018 Jan 1;2(Suppl 3):e000519.
28. Kien VD, Van Minh H, Giang KB, Ng N, Nguyen V, Tuan LT, Eriksson M. Views by health professionals on the responsiveness of commune health stations regarding non-communicable diseases in urban Hanoi, Vietnam: A qualitative study. BMC Health Services Research. 2018 Dec;18:1-2.
29. Van Minh H, Do YK, Bautista MA, Tuan Anh T. Describing the primary care system capacity for the prevention and management of non‐communicable diseases in rural Vietnam. The International Journal of Health Planning and Management. 2014 Apr;29(2):e159-73.
30. Jackson-Morris A, Nugent R. Tailored support for national NCD policy and programme implementation: an over-looked priority. BMJ Global Health. 2020 Aug 1;5(8):e002598.
31. Laari L. Context and practice s of health advocacy role by nurses in Ghana: A qualitative study. Nursing Practice Today. 2024; 11(4):388-397.
32. Žiaková K, Kohanová D, Čáp J, Kurucová R. A thematic analysis of professionalism from the perspective of nurse managers. Nursing Practice Today. 2023; 10(4): 344-55.
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| non-communicable disease; community nurses; decentralization | ||
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How to Cite
1.
Thwala P, Nhlabatsi T. Exploring community nurses` experiences on the decentralization of non-communicable diseases` care in the Lubombo region, Eswatini. NPT. 2025;:X-X.
