Abstract:
: Diabetes is a chronic non-communicable disease (NCD) presenting growing
health and economic burdens in sub-Saharan Africa (SSA). Diabetes is unique due to its
cross-cutting nature, impacting multiple organ systems and increasing the risk for other
communicable and non-communicable diseases. Unfortunately, the quality of care for dia betes in SSA is poor, largely due to a weak disease management framework and fragmented
health systems in most sub-Saharan African countries. We argue that by synergizing disease specific vertical programs with system-specific horizontal programs through an integrated
disease-system diagonal approach, we can improve access, quality, and safety of diabetes
care programs while also supporting other chronic diseases. We recommend utilizing the six
World Health Organization (WHO) health system building blocks – 1) leadership and
governance, 2) financing, 3) health workforce, 4) health information systems, 5) supply
chains, and 6) service delivery – as a framework to design a diagonal approach with a focus
on health system strengthening and integration to implement and scale quality diabetes care.
We discuss the successes and challenges of this approach, outline opportunities for future
care programming and research, and highlight how this approach can lead to the improve ment in the quality of care for diabetes and other chronic diseases across SSA.
