Original Research

Sustainability of the integrated chronic disease management model at primary care clinics in South Africa

Ozayr H. Mahomed, Shaidah Asmall, Anna Voce
African Journal of Primary Health Care & Family Medicine | Vol 8, No 1 | a1248 | DOI: https://doi.org/10.4102/phcfm.v8i1.1248 | © 2016 Ozayr H. Mahomed, Shaidah Asmall, Anna Voce | This work is licensed under CC Attribution 4.0
Submitted: 09 July 2016 | Published: 17 November 2016

About the author(s)

Ozayr H. Mahomed, Public Health Medicine, University of KwaZulu-Natal, South Africa
Shaidah Asmall, National Department of Health, South Africa
Anna Voce, Public Health Medicine, University of KwaZulu-Natal, 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.
Aim: The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation.
Setting: 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.
Conclusion: 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.


Integrated chronic diseases


Total abstract views: 6149
Total article views: 5691


Crossref Citations

1. Effectiveness of an Integrated Approach to HIV and Hypertension Care in Rural South Africa: Controlled Interrupted Time-Series Analysis
Soter Ameh, Kerstin Klipstein-Grobusch, Eustasius Musenge, Kathleen Kahn, Stephen Tollman, Francesc Xavier Gómez-Olivé
JAIDS Journal of Acquired Immune Deficiency Syndromes  vol: 75  issue: 4  first page: 472  year: 2017  
doi: 10.1097/QAI.0000000000001437