Accessing diabetes care in rural Uganda: Economic and social resources

ABSTRACT

Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients’ journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system.

KEYWORDS:

• Type 2 diabetes
• Uganda
• diabetes treatment
• therapy management group
• therapeutic journeys

Acknowledgements

The authors wish to thank the individuals who opened their homes and took time to participate in this study. The field assistants are acknowledged for helping with translation and the staff at Kagando Hospital for their hospitality and support to the research project.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Jannie Nielsen http://orcid.org/0000-0003-4897-8705

Silver K. Bahendeka http://orcid.org/0000-0001-8080-7872

Ib C. Bygbjerg http://orcid.org/0000-0001-9100-2754

Dan W. Meyrowitsch http://orcid.org/0000-0003-1108-8987

Additional information

Funding

This work was supported by the Novo Nordisk Fonden [Grant number 29847], Aase & Ejnar Danielsen Fond, Thorvald Madsens Fond, and Christian & Ottilia Brorsons Fond. JN’s Ph.D. fellowship is partly funded by Novo Nordisk Fonden. None of the sponsors had any influence on the study design, data collection, analysis, interpretation or writings. The remaining authors have declared no conflict of interest.