Decentralising NCD care in Mozambique

It’s exciting to see the next steps taking place within our ambitious project of decentralisation of non-communicable disease (NCD) care in Mozambique. This pilot project is a result of a new partnership between PCI and Professor Ana Mocumbi’s research team at the Instituto Nacional de Saúde (INS)- the National Public Health Institute, facilitated by the Mozambique Institute for Health Education and Research (MIHER). Myself and clinical team colleague Dr David Mazza have been supporting the development of tailored guidelines for peer-to-peer cascade training to enable this decentralisation of care.

Work on the guidelines began with introductions to all local stakeholders, including representatives from the Ministry of Health, the World Health Organisation NCD department, and senior clinical staff from the community and hospitals across Maputo. The project is funded by Letshego Holdings Ltd as part of our broader Healthcare Innovations Programme, and we were delighted to have them present to support the discussions too. This collaborative group explored the current challenges in providing NCD care in this setting, where resources are often thin on the ground and there is a high prevalence of NCDs. It was heartening to see how committed the stakeholders were to the success of the project and discussions evolved on how these challenges could be overcome throughout the project.

One of the GP participants said “This is an important programme. We need this. We are ready to change and now we can see how.”

The following four days were spent with a dynamic group of 21 doctors, nurses and other healthcare workers, supported by the INS research team, in order to agree on standardised NCD clinical guides and training materials to be developed by PCI for a ‘training of trainers’ programme to be delivered later in the year. These are based on PCI’s tried and tested existing guides and were adapted as necessary and translated into Portuguese during our week together. The workshop illustrated PCI’s main strengths in providing training: that it is relevant to clinicians on the ground; adapted to their local working environment; and supported by an evidence-based approach. The team members were particularly keen to include clinical skills teaching as well as knowledge-based sessions. As PCI we were also able to support decisions surrounding implementation of the project and offered our experience in the planning of monitoring and evaluation tools.

We are very much looking forward to the next phase of the project, starting this month with the opening of the first formal NCD clinic in Mavelane Hospital. Then PCI will provide the adapted ‘training of trainers’ programme in April, which will support healthcare staff to cascade their knowledge and decentralise NCD care from the hospital to the surrounding eight health centres, which together provide care to approximately 800,000 of Maputo’s poorest and most vulnerable populations. The enthusiasm, expertise and dedication of the team led by Professor Mocumbi, and facilitiated by Dr Edna Juga and pharmacist Neusa Bay, was evident throughout and there is no doubt that this pilot project will provide a vital contribution in guiding the Ministry of Health with a model for the roll-out of NCD care nationally.