Scaling up Integrated Diabetes Care and Management in Lesotho

Objectives

To roll out the first phase of a national non-communicable disease (NCD) programme in Lesotho through expansion of model for integrated NCD care, with a focus on diabetes and hypertension, and piloting of full-scale integration of NCD and HIV and tuberculosis (HIV/TB) care.

Approach

Building on a World Diabetes Foundation‑supported pilot (WDF20‑1778) that tested integrated diabetes and hypertension prevention, screening and treatment at community and primary care levels in two rural districts, this project expands that model into a first‑phase national NCD programme in four districts. It will reach roughly 40% of Lesotho’s population, with emphasis on underserved rural areas, by strengthening services at health centre and district levels and by deepening community engagement.

Project activities
The project uses a phased district model to make services practical, coordinated and scalable:

1. Integrated chronic care (two districts)
• Development of two implementation manuals: an integrated chronic care manual to guide care across 20 health centres and 3 hospitals, and a patient referral manual to establish clear referral pathways between facilities.
• Delivery of a five‑day training for 120 health care providers across 23 facilities.
• Establishment chronic care clinics at those 23 facilities to provide regular, coordinated management of NCDs alongside HIV and TB services.
2. Enhanced NCD care (one district)
• Deploy improved tools for clinical management and data: a cardiovascular disease (CVD) registry, an integrated screening tool and NCD patient treatment cards to strengthen patient records and follow‑up.
• Provide a five‑day advanced NCD training for 100 nurses from 25 health centres.
3. Basic NCD care strengthening (one district)
• Support to the District Health Management Team (DHMT) to assess gaps across 18 facilities, develop strategic action plans and set up routine quality monitoring.
• Delivery of a three‑day basic NCD care training for 60 nurses.
4. Shared interventions across all four districts
• Training of more than 300 health care providers in NCD care and equip DHMTs to monitor NCDs and integrated service delivery across 66 health facilities.
• Strengthening of facility capacity for routine screening to enable earlier diagnosis and timely treatment.
• Establishment of a Community Advisory Committees to ensure community perspectives shape services and to strengthen local ownership.

Expected results

• 120 healthcare professionals trained on NCD and HIV/TB integrated chronic care delivery from 23 health facilities in 2 districts; 100 nurses from 25 health clinics trained on advanced clinical NCD care in 1 district; and 60 nurses trained on basic NCD care in 18 health facilities in the remaining district.
• 66 health facilities strengthened: 18 facilities (1 hospital, 17 health clinics) strengthened to provide basic NCD care; 25 health clinics strengthened to provide advanced NCD care; 23 facilities (3 hospitals, 20 health clinics) strengthened to provide full package of integrated chronic care.
• 65 District Health Management Team (DHMT) members trained to monitor gaps in access to quality care, interpret district health data, and make evidence-based decisions.
• 2,175 persons diagnosed with diabetes; 600 patients trained on diabetes self-management.
• 18,000 persons reached through awareness campaigns.
• Development of 2 key manuals: the integrated chronic disease management manual, and the referral implementation booklet.