Diabetes is rapidly increasing in numbers, especially in low-income countries. This calls for reflection on the organisation of care. How can health care systems improve care for people with diabetes (and chronic diseases in general) and strengthen the self-management of these people? Can innovations such as mobile technology play a role? But which role exactly?
We investigated how diabetes care programmes have developed in three countries, DR Congo, Cambodia and the Philippines, how a mobile-health intervention (sending SMS messages) was implemented and what its effects were. Our analyses show that it is possible to improve diabetes care, even in a health care system with very little resources. The implementation of the mobile-health intervention turned out differently in each country, with challenges at the programme level and barriers at the side of the people receiving messages. After two years it did not lead to better health outcomes. We warn against too high expectations of mobile phone applications as a game changer to improve chronic care in low-income countries.
Self-management and care are two sides of the same coin. Both are needed and ideally reinforce each other. Interventions to improve chronic disease management should be directed to providers and to patients directly. Apart from the ‘hardware’ essentials such as medicines and diagnostics, there is a dire need to experiment with the improvement of the ‘software’.
The discussion will be moderated by Josefien van Olmen, MD, MPH, PhD, Family Physician, Specialist in Tropical Medicine and International Health
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